TRANSACTIONS OF THE World's Homeopathic Convention, HELD AT PHILADELPHIA, UNDER THE AUSPICES OF THE American Institute of Homeopathy, AT ITS TWENTY-NINTH SESSION, June 26th, 27th, 28th, 29th, 30th, July 1st, 1876. VOL. I. MINUTES, ESSAYS, DISCUSSIONS. PHILADELPHIA: SHERMAN & CO., PRINTERS. 188 1. PREFACE. The Proceedings of the First World's Homoeopathic Conven- tion, held in Philadelphia, 1876, together with the business trans- acted by the American Institute of Homoeopathy, at its Twenty- ninth Session, held at the same time, are herewith presented. By a resolution at its session in 1874, the Institute met as the World's Homoeopathic Convention, in Philadelphia, in 1876; the officers of the Institute (viz., President, Vice-President, Sec- retary, Treasurer, and Board of Censors) elected in 1875 were the officers of the World's Convention-it being understood that the Convention should at its pleasure elect to temporary honorary offices such distinguished home or foreign physicians present as they desired to honor; the bureaus and committees appointed or elected in 1875 were not to report until 1877 ; but instead of the reports of bureaus and committees the World's Convention re- ceived and discussed historical and statistical reports and scien- tific papers from our own and foreign countries. Brief executive sessions of the American Institute of Homoeopathy were held daily, for the election of officers for the year 1877, for receiving and acting upon the reports of the Publication Committee, the Treasurer, and the Board of Censors, for the admission of new members, and other necessary business. The editor began his work upon this, the third volume issued by him for the Institute in a period of eleven months, with a wholesome dread of the prospective tedious detail of revising all the material herein contained. To his pleasure, however, he discovered that the greater bulk of the MSS. had been deftly arranged by the masterly hands of his predecessors, Drs. C. Dunham and R. J. McClatchey, though chiefly by the latter; as is well known, their work was interrupted only in conse- VI PREFACE. quence of the death of Dr. Dunham and the complete breaking down of the health of Dr. McClatchey. The "copy" was thus sent to press at an early date, and this volume would have been issued fully a month or six weeks earlier, but for the many de- lays of the printers. The editor's thanks are due Dr. Charles M. Thomas, for correcting the papersand discussions in the Surgical Department, and to Dr. R. J. McClatchey for able assistance in revising the Discussions, and for advice in the make-up of the book. For greater convenience of ready reference, the editor presents a " Table of Contents " in the forepart of the volume, in addi- tion to a carefully prepared Index at the end. In the latter is a clinical summary of the action of each remedy, as far as men- tioned in the book. Joseph C. Guernsey, M.D., Editor. Philadelphia, May, 1881. CONTENTS. PAGE Officers, Committees, etc., of the Institute and World's Convention, for 1876, . xiii Proceedings of the Twenty-ninth Session 9 Adoption of the Order of Business, 9 Report of the Committee of Publication, 9 Arrangements of the World's Homoeopathic Convention, 10 Appointment-of Committee on Correspondence, 11 Report of the Treasurer, 12, 20 Appointment and Report of Auditing Committee, 12 Election of Officers for 1877 13 Places Proposed for Next Meeting, 1877, 13 Election of Honorary Members, 13 Choice of Place of Meeting for Ensuing Year 14 Final Report from Board of Censors; by F. R. McManus, M.D., 14 Appointment of C. Wesselhoeft, M.D., as Chairman of Bureau of Materia Medica, . 14 Discussion on erasing the Name of G. E. Shipman, M.D., from the List of Senior Members, and Reference of the Matter to a Committee, 15 Report of the Bureau on Organization, Registration, and Statistics, . . . .15 Nomination of Honorary and Corresponding Members, 15 Congratulatory Resolution to C. Dunham, M:D 15 Report from the University of Michigan; by J. C. Morgan, M.D., 16 Experience of Dr. Campbell, of St. Louis, at the Centennial, 17 Reference of Condemnatory Resolution to Committee, 18 Votes of Thanks, . . .18 Complete Report of Board of Censors, . 19 American Institute of Homceopathy. World's Homoeopathic Convention. List of Names of those Attending the World's Convention, 23 Adoption of the Order of Business, 37 Address of the President, Carroll Dunham, M.D., , . .• 37 Secretary Instructed to print 5000 extra copies of the President's Address, . . 50 Introduction of Dr. Clotar Muller, Germany, 51 Dr. Richard Hughes, England, 51 Dr. Albert Haupt, Germany, . . .52 Dr. John W. Hayward, England, 52 Dr. Arthur Clifton, England, 53 Dr. Thomas Skinner, England, 54 Resolution of Thanks to Madame Hahnemann, 54 Invitation from the Academy of Natural Sciences, 54 Contents of the Department of Materia Medica, 56 The Foundations and Boundaries of Modern Therapeutics. William Sharp, M.D.,. 57 Memoir on Arnica. A. Imbert Gourbeyre, M.D., 81 Apis Mellifica. H. Goullon, Jr., M.D., 131 VIII CONTENTS. PAGE Mezereum; Portion of a Physiological Study. Adolph Gerstel, M.D 155 Hydrocyanic acid: its Value in Epilepsy. Richard Hughes, M.D 177 Some Therapeutic Effects of Curare. Paul Pitet, M.D., 187 Necessity of the Study of the Characteristic Symptoms in Homoeopathic Therapeu- tics. Dr. Don Tomas Pellicer y Frutos, 199 A Few Thoughts on the Study and Practice of Homoeopathy. David Wilson, M.D., 206 Potencies and Doses in Tropical Climates. Jost T. Navarro, M.D., . . . .220 Survey of Medical Science. Conrad Wesselhceft, M.D., 226 Discussion on Materia Medica: Discussion of J. P. Dake, M.D. Materia Medica as a Science 254 Richard Hughes, M.D., on Hydrocyanic Acid, 273, 302 Conrad Wesselhceft, M.D., on the Theory and the Modus Operand! of the Homoeopathic remedy, 275 Adolph Lippe, M.D., on the Foundations and Boundaries of Modern Therapeutics (Dr. Sharp's paper), 279 William Owens, M.D., on the Foundations and Boundaries of Modern Therapeutics, 282 Timothy F. Allen, M.D., on Physiological Materia Medica, . . .285 S. M. Cate, M.D., on Hydrocyanic acid: its Value in Epilepsy, . . 298 Remarks of G. R. Naylor, M.D. 292 Discussion of E. A. Farrington, M.D., on Dr. Sharp's Paper, and Hydroc. acid, . 294 H. H. Baxter, M.D., on Arnica 296 C. B. Knerr, M.D., on Arnica, 299 Department of Clinical Medicine. Genesis and Etiology of Acute and Chronic Diseases, and Deductions for their Treat- ment. Dr. Marquis de Nunez, Madrid, Spain, 307 Miliary Pneumonia; Clinical Studies of Tarantula. Hahnemannian Society of Madrid, Spain 323 Latent Pneumonia in the Aged: Digitalis. P. Jousset, M.D 337 Primary Congestion of the Lungs. J. Meyhoffer, M.D., . . 341 Cirrhosis of the Liver. L. Salzer, M.D. .'.... 369 Intermittent Fever. A. Charge, M.D., 383 Intermittent Fever in Italy. Cav. Francesco Panelli, M.D., 431 The Roman Fever. ' G. Pompili, M.D., 439 Eruptive Fevers. P. P. Wells, M.D., 447 Variola, 449 Scarlet Fever, 457 Measles, 471 Certain Diseases of Children. B. F. Joslin, M'.D. Diphtheria, 479 Gangrene of the Mouth,. . . 482 Croup, 485 Bibliography of Croup, . . . 502 Diphtheria. Adolph Lippe, M.D 515 Angina Pectoris: A Symptom. E. B. De Gersdorff, M.D., .523 Modifying Influence of Epidemics on Therapeutics. Parti. A. W. Woodward, M.D., 531 Part II. T. C. Duncan, M.D., . 537 Discussion on Clinical Medicine: Henry Detwiller, M.D., Elected Honorary Vice-President of the Convention, . 549 Discussion of A. W. Woodward, M.D., on The Modifying Influence of Epidemics, . 549 P. P. Wells, M.D., on Diphtheria,. . . 551 Henry D. Paine, M.D., on Croup and Diphtheria 554 C. Pearson, M.D., on Croup, Pneumonia, Intermittent Fever.. . . 557 J. J. Mitchell, M.D., on Germ Theory of Diphtheria, .... 559 G. H. Wilson, M.D., on Petroleum in Diphtheria, 568 T. L. Brown, M.D., on Disinfectants, 568 CONTENTS, IX PAGE Discussion of T. C. Duncan, M.D., on Croup, 570 Albert Haupt, M.D., on Diphtheria, 571 E. B. De Gersdorff, M.D., on Diphtheria, 574 D. H. Beckwith, M.D., on Intermittent Fever, 576 L. E. Ober, M.D., on Intermittent Fever, 578 J. C. Morgan, M.D., on Intermittent Fever 581 J. W. Hayward, M.D., on Pneumonia, 582 E. W. Jones, M.D., on Pneumonia of the Aged, 585 S. Lilienthal, M.D., on Pneumonia, 588 Clotar Muller, M.D., on Angina Pectoris, 589 T. Dwight Stow, M.D., on Congestion of the Lungs and CEdema of the Lungs, 592 N. R. Morse, M.D., on Diphtheria, 593 Department of Surgery. George S, Norton, M.D. Inflammation of the Conjunctiva, 597 Conjunctivitis Catarrhalis 597 Purulenta, 603 Trachomatosa, 609 Ophthalmia Phlyctenularis, 612 Ophthalmic Therapeutics. W. H. Woodyatt, M.D., 623 Acute Diseases of the Ear: Their Homoeopathic Treatment. T. P. Wilson, M.D., . 635 Homoeopathic Therapeutics of Aural Surgery. Henry C. Houghton, M.D., . . 645 William Tod Helmuth, M.D. The Influence of Homoeopathy upon Surgery,. . 663 Ovarian Tumors, 673 Aneurism, 678 Anus, Diseases of, 679 Bone, Disease of, 679 Cancer, 684 Calculus, 690 Dropsy, 691 Gangrene, 691 Haematocele, 693 Haemorrhage 693 Haemorrhoids, 694 Hernia 695 Hip Disease, 696 Hydrocele 696 Joint, Diseases of, 697 Polypus 697 Pyelitis, 698 Ranula 698 Tumors, Ovarian, 699 Ulcers, 700 Urethra, Diseases of, 702 Warts, Whitlow Wounds 703 Uro-lithiasis in Russia. C. Bojanus, M.D., 705 Albert G. Beebe, M.D. Therapeutics of Benign Tumors 759 , Sebaceous Cysts, 762 Synovial Cysts, Bursae, Ganglion, 762 Ovarian Tumors 763 Lipoma Fibrous Tumors, 764 Uterine Fibroids Polypoid Growths, 765 Adenoid Tumors, 767 X CONTENTS. PAGE Homoeopathic Therapeutics in Gunshot Wounds, and the Sequelae of Operations. (See Index.) E. C. Franklin, M.D 771 Homoeopathic Treatment of Syphilis. J. H. McClelland, M.D. 803 The Medical Treatment of Varicose Veins and Haemorrhoids. John C. Minor, M.D., 813 Gunshot Wound. Case of Ball in the Skull. W. H. Jenney, M.D., .... 826 Partial Report from Committee on Correspondence. Communications from Ma- dame Hahnemann, Dr. J. Kafka, SociEtE Hahnemannienne Federative de Paris, Dr. Rocco Rubini, 831-839 Discussion on Surgery: Discussion of S. R. Beckwith, M.D., on Syphilis, 840,854 L. H. Willard, M.D., on Syphilis, 842 A. C. Clifton, M.D., on Syphilis, 844 H. F. Biggar, M.D., on Syphilis, 847 William Tod Helmuth, M.D., on Syphilis, . . • . . . 848, 850,854 A. Varona, M.D., on Syphilis, 849 J. W. Hayward, M.D., on Syphilis, 849 Richard Hughes, M.D., on Syphilis, 850 E. A. Farrington, M.D., on Syphilis, 851 Malcolm Macfarlan, M.D., on Syphilis, 852 J.H. McClelland, M.D., on Syphilis 855 William Tod Helmuth, M.D., on Tumors, 856 I. T. Talbot, M.D., on Tumors 859 J. H. McClelland, M.D., on Tumors, 860 Bushrod W. James, M.D., on Tumors 861 S. S. Lungren, M.D., on Tumors, 864 S. C. Knickerbocker, M.D., on Tumors, 864 A. Varona, M.D., on Tumors, 865 T. W. Donovan, M.D., on Tumors, 865 James B. Bell, M.D., on The Influence of Homoeopathy upon Surgery, 866 T. P. Wilson, M.D., on Conjunctivitis 868 W. A, Phillips, M.D., on Chronic Diseases of the Middle Ear, . . 870 J. A. Campbell, M.D., on Diseases of the Ear, 872 Department of Obstetrics and Gynaecology. Hysteria. Db. Davidson, 877 Metrorrhagic Chlorosis. Abel Claude, M.D., 947 The Neurotic Element in the Local diseases of Women. B. H. Cheney, M.D., . . 957 Membranous Dysmenorrhoea from Repelled Eruptions. R. Ludlam, M.D., . . 969 Homoeopathic Treatment of Diseases Incident to Pregnancy. H. N. Guernsey, M.D., 979 J. C. Sanders, M.D. Therapeutic Treatment of Certain Diseases of the Digestive Centre incident to Pregnancy, 988 Therapeutics of Ptyalism, 988 Stomatitis, ' 990 Malarial Cachexia, 996 Strumous Cachexia, 998 Scorbutic Cachexia 1000 Mercurial Cachexia, 1000 Syphilitic Cachexia, 1001 Nausea and Vomiting, 1002 Puerperal Fever. J. H. Woodbury, M.D., 1009 Remedies in 1030-1032 The Homoeopathic Treatment of Puerperal Fever. O. P. Baer, M.D.,.... 1033 Silver Wire Sutures in the Caesarian Section. S. S. Lungren, M.D., .... 1043 Discussion on Obstetrics and Gynaecology: Discussion of S. P. Burdick, M.D., on Puerperal Fever, 1051 CONTENTS. XI PAGE Lady physicians invited to meet at the house of Dr. Harriet J. Sartain, . . 1053 Discussion of R. Ludlam, M.D., on Puerperal Fever, 1053,1068 J. H. Gallinger, M.D., on Diseases incident to Pregnancy, . . . 1055 Reply of H. N. Guernsey, M.D., to Dr. Gallinger, . 1060 Discussion of II. N. Guernsey, M.D., on Hysteria, 1061 O. B. Gause, M.D., on Hysteria and Membranous Dysmenorrhcea, . 1061 Richard Hughes M.D., on Metrorrhagie Chlorosis, .... 1063 T. S. Kinne, M.D., on Membranous Dysmenorrhcea, .... 1064 F. H. Krebs, M.D., on Membranous Dysmenorrhcea, .... 1066 Remarks on the Early Days of the American Institute., F. R. McManus, M.D., . 1067 Final Report of the Committee on Correspondence, 1069 Communication from the Colombian Homoeopathic Assembly, 1069 Resolutions relative to holding the Second World's Homoeopathic Convention, . . 1071 Remarks and Motion of Lewis Sherman, M.D., Relative to an International Ho- moeopathic Pharmacopoeia, . . 1071 Remarks of Richard Hughes, M.D., on an International Homoeopathic Pharmaco- poeia, 1073 Remarks of Carroll Dunham, M.D., on an International Homoeopathic Pharma- copoeia, 1073 Paper by Dr. Jenney, on Gunshot Wounds, 1074 Dr. S. S. Lungren, on Silver Wire Sutures in Csesarian Section,. . . 1074 Referring of Papers, by Drs. Jenney and Lungren, to Committee on Publication, 1074 Remarks of Dr. Hayward, on Homoeopathic Publications in England, . . . 1074 Congratulatory Resolutions to Dr. C. Dunham, 1075 Closing Remarks of Dr. C. Dunham 1076 APPENDIX: Historical Sketch of Materia Medica. C. Hering, M.D., . . . 1077 Sixth and Final Session of the World's Convention. AMERICAN INSTITUTE OF HOMCEOPATHY OFFICERS FOR 1876. President. CARROLL DUNHAM, M.D Irvington on Hudson, N. Y Vice-President. E. C. FRANKLIN, M.D.,- St. Louis, Mo. General Secretary. R. J. McCLATCHEY, M.D Philadelphia, Pa. Provisional Secretary. T. C. DUNCAN, M.D. Chicago, III. Treasurer. E. M. KELLOGG, M.D. New York. Censors. F. R. McMANUS, M.D., Baltimore, Md. N. R. MORSE, M.D., Salem, Mass. A. E. SMALL, M.D Chicago, III. A. R. THOMAS, M.D PHILADELPHIA, Pa. T. F. POMEROY, M.D., JERSEY CITY, N. J. Auditing Committee. CHARLES A. STEVENS, M.D Scranton, Pa. G. W. BARNES, M.D., San Diego, Cal. JAMES B. BELL, M.D Augusta, Me. Committee on Foreign Correspondence. I. T. TALBOT, M.D Massachusetts. CLOTAR MULLER, M.D., Germany. RICHARD HUGHES, M.D England. A. C. COWPERTHWAIT, M.D. Nebraska. Executive and Publication Committee. CARROLL DUNHAM, M.D. Irvington on Hudson, N. Y. E. C. FRANKLIN, M.D. St. Louis, Mo. R. J. McCLATCHEY, M.D Philadelphia, Pa. T. C. DUNCAN, M.D., Chicago, III. E. M. KELLOGG, M.D., New York. Committee on the World's Homoeopathic Convention. WILLIAM E. PAYNE, M.D Maine. J. H. GALLINGER, M.D., New Hampshire. G. N. BRIGHAM, M.D VERMONT. I. T. TALBOT, M.D., MASSACHUSETTS. J. C. BUDLONG, M.D., Rhode Island. G. H. WILSON, M.D. Connecticut. CARROLL DUNHAM, M.D NEW York. J. J. YOULIN, M.D. New Jersey. J. C. BURGHER, M.D., Pennsylvania. A. NEGENDANK, M.D., Delaware. F. R. McMANUS, M.D., Maryland. T. S. VERDI, M.D District of Columbia. J. V. HOBSON, M.D., Virginia. W. E. FREEMAN, M.D North Carolina. XIV LIST OF OFFICERS. F. H. ORMES, M.D., Georgia. W. H. HOLCOMBE, M.D., Louisiana. A. WALKER, M.D., . Arkansas. J. P. DAKE, M.D., Tennessee. W. H. HUNT, M.D KENTUCKY. E. C. FRANKLIN, M.D., Missouri. 8. R. BECKWITH, M.D., Ohio. O. P. BAER, M.D., Indiana. R. LUDLAM, M.D., Illinois. F. WOODRUFF, M.D. Michigan. L. E. OBER, M.D., WISCONSIN. G. N. SEIDLITZ, M.D Iowa. J. F. ALLEY, M.D., MINNESOTA. O. S. WOOD, M.D Nebraska. S. K. HUSON, M.D. Kansas. G. W. BARNES, M.D., California. E. A. WILD, M.D., Nevada. Executive Committee of the World's Homoeopathic Convention {consisting of Phila- delphia Physicians only). H. N. GUERNSEY, M.D., J. C. GUERNSEY, M.D., R. J. McCLATCHEY, M.D., A. R. THOMAS, M.D., P. DUDLEY, M.D., C. HERING, M.D., THOMAS MOORE, M.D., BUSHROD W. JAMES, M.D. On Reception of Foreign Delegates. D. S. SMITH, M.D., CHICAGO, ILL. D. H. BECKWITH, M.D Cleveland, O. C. NEIDHARD,M.D., Philadelphia. T. S. VERDI, M.D., Washington, D. C. AD. FELLGER. M.D., Philadelphia. J. ANTONIO TERRY, M.D. New York. J. G. HOUARD. M.D Philadelphia. P. G. VALENTINE, M.D St. Louis, Mo. C. WESSELHOEFT, M.D Boston, Mass. Necrologist. HENRY D. PAINE, M.D., . New York. OFFICERS FOR 1877. President. E. C. FRANKLIN, M.D St. Louis, Mo. Vice- President. T. P. WILSON, M.D., Cincinnati, O. General Secretary, R. J. McCLATCHEY, M.D., Philadelphia. Provisional Secretary. JOSEPH C. GUERNSEY, M.D., Philadelphia. Treasurer. EDWIN M. KELLOGG, M.D., New York. Bureaus for 1877.* * These Bureaus were appointed by the Institute in 1875, to report at the meeting of 1877. (See Transactions, 1877.) AMERICAN INSTITUTE OF HOMOEOPATHY, HELD IN PHILADELPHIA, 1876. PROCEEDINGS OF THE TWENTY-NINTH SESSION OF THE AMERICAN INSTITUTE OF HOM CEO PA THY, Held at Philadelphia, June 26, 27, 28, 29, 30, July 1, 1876. FIRST DAY. The Institute was called to order at 2 o'clock p.m. by the President, Carroll Dunham, M.D., of Irvington-on-Hudson, N. Y., who said : " The American Institute of Homoeopathy now commences its Twenty-ninth Session and Thirty-second Anniversary. You have in your hands the order of business prepared by the Exec- utive Committee. Is it your pleasure that this shall be the order of business of the Institute?" The order of business prepared by the Executive Committee was then unanimously adopted. The President: The first business in order, according to this programme, is the report of the Committee of Publication and the General Secretary. The General Secretary then presented the report of the Committee of Publication as follows: To the American Institute of Homoeopathy: The Committee of Publica- tion respectfully report as follows : Since the last session of the Institute the volume of Transactions of the Twenty-eighth Session has been printed, and is now ready for distribution to those entitled to receive it. In the publication of this volume your committee have endeavored to fol- low the rule laid down by the Institute regarding the publication of papers, viz., to publish only such papers of a bureau as treat of the subject selected for presentation and discussion by that bureau. This rule has been adhered to, except in a single instance, where your committee, by vote, were author- ized to use their discretion regarding the publication of a certain paper. 10 AMERICAN INSTITUTE OF HOMOEOPATHY. The condition of the finances of the Institute not warranting the publica- tion of a large volume, your committee endeavored to keep down the bulk of the present issue by leaving out all discussions, and by abridging the re- port of the Proceedings to the shape of minutes ; and yet, notwithstand- ing this, the volume comprises 6'26 pages of closely printed matter. The delay in issuing the volume was due to circumstances over which your committee had no control. Carroll Dunham, M.D., President, R. J. McClatchey, M.D., General Secretary, E. M. Kellogg, M.D., Treasurer. The report was accepted and adopted. The Treasurer not being prepared to report, the presenta- tion of his statement was by special vote made the first business in order on Tuesday morning. The President : The next business will be the presentation of a report from the Committee of Arrangements of the World's Homoeopathic Convention, the announcement of a Reception Committee, and a statement from the Bureau of Organization, Registration, and Statistics, relative to the mode of registry, etc. The President then presented the following: REPORT OF THE COMMITTEE OF ARRANGEMENTS OF THE WORLD'S HOMOEOPATHIC CONVENTION. To the American Institute of Homoeopathy : In view of the World's Ho- moeopathic Convention to be held this year under its auspices and control, the American Institute of Homoeopathy, at its last session, resolved that its proceedings this year should be restricted to such matters of business as its constitution and by-laws make imperative, and that reports of bureaus and committees on scientific subjects, appointed in 1875, should be received at the meeting of 1877. Accordingly the transactions of the Institute at this ses- sion will be confined to the receipt and disposal of reports of officers and busi- ness committees, election of new members and of officers for the ensuing year, determining the place of our next meeting, and acion on the report of the Committee of Arrangements of " The World's Homoeopathic Con- vention." In accordance with the resolution of the Institute at its last ses- sion the officers and business committees of the Institute will be those of the Convention. The Committee of Arrangements of the World's Homoeopathic Conven- tion report to the Institute that they have fulfilled, as far as was practicable, the duties laid upon them by the Institute in its action in 1874 and 1875. Their correspondence with officers of societies and with representative men in our own and other countries has been diligent, and they are able to submit to the Convention, as the result of their efforts, and of the cordial co-operation of the members of our school throughout the world, essays as well as historical and statistical reports of exceeding value from every country of Europe, from Asia, Africa, Australia, and South America, and the West Indies. Most of the essays have been printed and placed in the hands of debaters appointed by the chairman from various sections of our country, and such foreign countries as are represented here. Some papers, which came into the chairman's hands too late to be printed, or which, for other reasons, he was not able to print before the meeting, will be presented in manuscript by the chairman, or by some debater acting for him. PROCEEDINGS OF TWENTY-NINTH SESSION. 11 In obedience to the order of the Institute the chairman, soon after the last session, estimated the amount of money necessary to be raised in addition to the dues and assessment of members, in order to meet the expenses of pub- lication, and apportioned the amount among the States in proportion to membership. The report of the Treasurer shows how far this apportionment has been met. In general it may be said that the responses have been satis- factory. The action of the Publication Committee, however, must, in some measure, depend on the action of members in the respective States on the question of finance. In accordance with the recommendations of the committee, the chairman appointed some weeks ago a Reception Committee, whose special duty it should be to administer to the comfort and enjoyment of our foreign guests. This committee consists of; D. S Smith, M.D., Chicago; D. H Beckwith, M.D., Cleveland; C. Neidhard, MD., Philadelphia; T. S. Verdi, M.D., Washington; Ad. Fellger, M.D., Philadelphia; J. Antonio Terry, M D , New York; J. G. Houard, M.D., Philadelphia; P. G. Valentine, M.D., St. Louis; C. Wesselhoeft, M.D., Boston. The business of registering the attendance on the convention will be at- tended toby the Bureau of Organization, Registration, and Statistics of the Institute, which has adopted a suitable method. . The members of the In- stitute are earnestly requested to comply with the requests of this bureau and second its efforts to insure a complete and accurate daily registration In concluding his report the chairman of the committee begs leave to say that his exceedingly arduous labors of the last year have been made pleasant by the cordial spirit in which his applications have been met, and all his efforts for the success of the Convention seconded by our colleagues of foreign countries as well as at home. He desires especially to acknowledge and express his gratitude for the assistance generously given him in the work of translating and editing by Drs. Hoffendahl and Wesselhoeft, of Boston ; Berghaus, Lilienthal, Kellogg, Guernsey, and Terry, of New York; Fan- ning, of Tarrytown, and Knerr and Houard, of Philadelphia. For the most friendly and efficient aid in every department of his work, his especial thanks are due to his friend, Dr. Henry M. Smith, of New York. The committee, in conclusion, present and recommend the adoption of the order of business embodied in the printed programme as the Order of Busi- ness of the Institute and Convention. For the committee, Carroll Dunham, M.D., President. On motion, the report was accepted and adopted, and on further motion the suggestion that the printed order of business for the Institute and the Convention be adopted for the gov- ernment of both bodies was unanimously adopted. The Institute then adjourned to meet on Tuesday morning. SECOND DAY. The Institute was called to order at 9 o'clock a.m., by the President, who appointed the following COMMITTEE ON CORRESPONDENCE. I. T. Talbot, M.D., Massachusetts, Clotar Muller, M.D., Germany, Richard Hughes, M.D., England, A. C. Cowberthwaite, M.D., Nebraska. 12 AMERICAN INSTITUTE OF HOMCEOPATHY. F. R. McManus, M.D., Chairman of the Board of Censors, was granted permission to make a partial report from the board, in advance of the presentation of the Treasurer's Report. E. M. Kellogg, M.D., of New York, Treasurer, then pre- sented his annual report,* which was accepted, and referred to the following Auditing Committee, appointed by the chair: AUDITING COMMITTEE. Charles A. Stevens, M.D., Scranton, Pa., G. W. Barnes, MD., San Diego, Cal., James G. Bell, M.D., Augusta, Me. In due time this committee reported that they had examined the Treasurer's accounts and vouchers, and had found them cor- rect. On motion, the report was received and accepted. The President : The Institute now stands adjourned. THIRD DAY. The Institute was called to order at 9 o'clock A.M., by the President. In the absence of the Chairman of the Board of Censors, Dr. N. R. Morse, of Salem, Massachusetts, a member of the board, presented the names of several applicants for membership, that the members might have opportunity to object, if they knew of any cause why these applicants should not be admitted. The Institute then adjourned until Thursday morning, at 9 o'clock. FOURTH DAY. The Institute was called to order by the President. Dr. F. R. McManus, Chairman of the Board of Censors, read the credentials of fifty-seven applicants for membership, who had been passed by the board. There being no objection offered to any of the names read, these applicants were, on motion of L. E. Ober, M.D., of La Crosse, Wisconsin, admitted to membership. The Institute adjourned until Friday morning, at 8.30 o'clock. FIFTH DAY. The Institute was called to order at 8.30 o'clock a.m., by the President, Dr. Carroll Dunham. Dr. E. C. Franklin, Vice-President, then took the chair. * See page 23. PROCEEDINGS OF TWENTY-NINTH SESSION. 13 Dr. F. R. McManus then made a partial report from the Board of Censors, recommending certain applicants for membership, who were thereupon elected members. The Institute then proceeded to the election of officers for the ensuing year, with the following result: President. E. C. Franklin, M.D., St. Louis, Mo. Vice-President. T. P. Wilson, M.D., ..... Cincinnati, 0. General Secretary. Robert J. McClatchey, M.D., . . . Philadelphia, Provisional Secretary. Joseph C. Guernsey, M.D., . . . Philadelphia. Treasurer. Edwin M. Kei logo, M.D., .... New York. Censors. F. R. McManus, M.D., Baltimore, Md. J. C. Burgher, M.D., Pittsburg, Pa. Nathan R. Morse, M.D., .... Salem, Mass. R. B. Rush, M.D., Salem, O. Geo. A. Hall, M.D., Chicago, Ill. ELECTION OF OFFICERS. I. T. Talbot. M.D., of Boston, moved, and it was carried, that a committee of five be appointed to consider and report to the Institute upon the time and place for the next meeting; whereupon the chair appointed Drs. I. T. Talbot, of Boston, Philo G. Valentine, of St. Louis, Wm. H. Jenny, of Kansas City, Mo., D. S. Smith, of Chicago, and W. L. Breyfogle, of Louisville, Ky., said committee. The Secretary read a communication from the Michigan Homoeopathic Medical Society, inviting and urging the Institute to meet next year at Detroit, Mich. T. P. Wilson, M.D., of Cincinnati, presented for considera- tion, and urged the adoption of, Chautauqua Lake, N. Y., as the place for the next assembling of the Institute; Dr. Youlin men- tioned Long Branch, and Dr. T. C. Duncan, of Chicago, urged the claim of Indianapolis. St. Paul, Minn., and Spring Lake Beach, N. J., were also mentioned as suitable places for the meet- ing. These were all referred to the committee. ELECTION OF HONORARY MEMBERS. The Secretary : I call the attention of the Institute to the fact that at the last session of the Institute, held at Put-in-Bay, 14 AMERICAN INSTITUTE OF HOMOEOPATHY. Dr. Carroll Dunham presented the names of certain distinguished European homoeopathists for election to honorary membership at this meeting. You will find these names recorded on page 70 of the Transactions of the Twenty-eighth Session, us follows : Drs. Adolphus Gerstel, Vienna, Austria; von Grauvogl, Nuremberg, Germany ; J. P. Jousset, Paris, France ; Clotar Miil- ler, Leipzig, Germany; R. E. Dudgeon, London, England. On motion, the gentlemen were declared unanimously elected, and the Secretary was instructed to forward their diplomas of membership. The Committee on a Place of Meeting for the ensuing year re- ported that they had been unable to decide and left the choice to the Institute. Chautauqua Lake was then chosen as the place, and, on motion, the time was left to thfe Executive Committee. Dr. F. R. McManus then made a further report from the Board of Censors. The Institute then adjourned to meet on Saturday after the adjournment of the World's Convention. SIXTH DAY. The Institute was called to order by the President, Dr. Car- roll Dunham, upon the adjournment of the World's Convention. The Chair : The American Institute will now hold its closing session for this year. The first business in order is the final report of the Board of Censors. F. R. McManus, M.D., then read the report, which was ac- cepted, and on motion, the applicants were duly declared elected. Dr. McManus then said : " I desire to call attention to the fact that many of the applicants for admission to this Institute, have graduated in 1874, 1875, and some of them even in this year, 1876. I suggest that a resolution be offered to this Insti- tute, fixing the time which will render applicants eligible to election only after three or five years of practice, so that they can give to the members of the profession an opportunity to judge of their status as well as of their morals; this will render them better candidates for membership to this great Institute." The Secretary, then announced that Dr. T. F. Allen wished to be relieved from the chairmanship of the Bureau of Materia Medica for the coming year, as it would be utterly im- possible for him to fulfil the duties of that position. Those who'knew how fully his time was occupied would understand this. Dr. Conrad Wesselhoeft was then appointed chairman. A discussion then ensued, participated in by Drs. J. P. Dake, R. J. McClatchey, L. E. Ober, I. T. Talbot, and David Thayer, PROCEEDINGS OF TWENTY-NINTH SESSION. 15 relative to expunging from the minutes of the preceding year, the motion to place the name of Dr. George E. Shipman* upon the list of senior members ; the by-laws require a membership of 25 years before admission to that list, whereas Dr. Shipman had been a member for only nineteen years. After a lengthy .debate the matter was referred to a committee composed of Drs. J. P. Dake, I. T. Talbot, H. D. Paine, with instructions to report thereon at the meeting next year. The Chair : The report of the Bureau of Organization, Reg- istration, and Statistics is in order. Henry M. Smith, M.D.: The plan pursued in registering the visitors to the World's Convention was as follows: Printed blanks were distributed to each one upon which he could write his name and home address, his address in Philadelphia, the society from which he was a delegate, and his attendance each day. The whole report of this bureau will be made up and presented to the Committee on Publication.! On motion, the report was accepted. I. T. Talbot, M.D.: I nominate as honorary member of the American Institute of Homoeopathy, Drs. Richard Hughes, Brighton, England; J. J. Drysdale, Liverpool, England; Mar- quis de NUnez, Madrid, Spain. I also nominate for corresponding members, to be voted upon at once, as provided for, at this session, the following: Drs. Albert Haupt, Chemnitz, Saxony; W. H. Hayward, Liverpool, England; Arthur C. Clifton, Northampton, Eng- land; Thomas Skinner, Liverpool, England. There being no objection, these gentlemen were then declared elected as corresponding members of the Institute; the names for honorary membership were laid over for another year. Henry D. Paine, M.D.: Mr. President: The resolution I am about to offer may at first sight seem superfluous in view of the one offered a short time ago while the World's Convention was in session. But as this is a different body from that, it seems fitting that there should be spread upon the records of the American Institute, to appear in its publications, as separate and apart from the Convention, a resolution of similar import to that referred to. Resolved, That the American Institute of Homoeopathy hereby expresses its deep sense of obligation to its president, Dr. Carroll Dunham, for his earnest zeal and arduous labors in the organization and conducting to a suc- cessful issue, the first World's Homoeopathic Convention ; and, that we also tender him our hearty thanks on behalf of the members of the Institute. * See Transactions, 1875, page 65. f See page 27 et seq. 16 AMERICAN INSTITUTE OF IIOMCEOPATHY. The resolution was unanimously carried. C. Dunham, M.D.: I can only say again that the success of this meeting is due to the members of the Institute, who have been very much attached to the objects to be gained thereby, as well as to the members of the World's Convention, who were determined that things should go on harmoniously. I thank you for this expression of your kindness and good-will. The report from the University of Michigan was then called for, which was responded to by Prof. John C. Morgan, M.D. : Ladies and Gentlemen: I have no doubt that your interest in the University of Michigan grows out largely from*the fact that it is an evidence of the sub- stantial progress of homoeopathy. (Dr. Morgan then gave a brief review of the twenty years of litigation* before a chair of homoeopathy was established in this University.) We, Dr. S. A. Jones and myself, met our class in pursuance of our appoint- ment as professors in the University, last September; we had twenty-four students to begin with. Some of these were ad- vanced students, who thought to graduate in the spring; but finding the field of study in homoeopathy larger than they antici- pated, they determined to pursue a three years' course and to return next 'winter. This praiseworthy decision, however, on the part of the advanced students, one of whom was a bachelor of science, has been taken hold of by the old-school regents, as a sign that they feared the examinations of the allopathic pro- fessors, and this precise opinion was published in the Louisville Medical News. It is sufficient, however, for me to assure you that if these students had come forward for examination, they would have passed equal to some of the very best of their own side. It was at first proposed to give the whole examination into our hands ; but this we thought was not politic, as it might be attributed to an unwillingness on the part of the students to appear before the allopathic professors. J. P. Dake, M.D.: Are the questions and answers in writing? Prof. Morgan: Dr. Jones and myself have agreed that that will be the only fair course, as a written examination is at any time subject to inspection. The examination of students prior to their matriculation is a practice adopted in the old medical department, and heartily concurred in by us. This merely includes, at present, the branches of a thorough English education, such as no physician should pretend to practice, or even begin to study, without. * See World's Homoeopathic Convention, Vol. II, History, page 814, " The University of Michigan ; " also, Legislation, page 1004. PROCEEDINGS of twenty-ninth session. 17 Upon our arrival at Ann Arbor we were met oil all sides with the utmost courtesy-even by the allopaths. Dr. Charles Rynd, a leading allopathic physician, a Regent of the Univer- sity, and Chairman of its Committee on Medical Department, freely asserted that we were there of right. The allopathic fac- ulty were as polite as we could have expected. Two of the latter, Drs. Ford and Dunster, called upon us at our residence. What we now want is an appropriation from the legislature, that will enlarge our facilities and give us a hospital ward. The legislature will treat us with great liberality if the homoeopathic profession send us a sufficient number of students to show that the University is sustained by public interest. I hold in my hand the calendar for 1875-76, in which are found the departments of medicine and surgery, of law, and of the Homoeopathic Medical College, all embraced in one publi- cation, under State authority. In the last pages of this is printed a list of all the officers and professors, including those of the homoeopathic department. We thus, as you see, have a strong foothold in Michigan, and now our success or failure rests with the profession. I conjure you, for the national interest, not to forget the homoeopathic de- partment in the University of Michigan. T. P. Wilson, M.D.: I would like to say that Dr. Camp- bell, of St. Louis, has had some recent experience with the Med- ical Department of the Centennial Exposition, which I deem of sufficient importance to warrant its rehearsal on this floor. I move, therefore, that Dr. Campbell relate his experience. Dr. Campbell then stated that on the Saturday previous, during a visit to the Centennial grounds, he attempted to enter the building labelled "The Centennial Medical Depart- ment," but was met by the question : "Are you an old-school physician ?" On returning a negative reply he was asked : " Are you a homoeopath ?" On replying in the affirmative, he was told that, according to the regulations, he could not be permitted to enter. Dr. Hill, who was with him, was treated in like man- ner. Dr. Campbell went on to say that this treatment differed widely from all his .former experience. He had visited every hospital almost in England, Scotland, Ireland, Germany, and throughout Europe generally, and had always been received with the utmost courtesy by the great men who had them in charge. He had asked if this medical department was a private concern, and had been told that it was not, that it was sanctioned by the Centennial Commissioners, and was in charge of the most prominent physicians in Philadelphia. He did not desire his 18 AMERICAN INSTITUTE OF HOMCEOPATHY. experience- to be treated as a personal matter by the Institute, but as it was so at variance with the openhanded hospitality which Philadelphia had seemed to offer to every stranger who had entered the city that he thought this special point of discrimi- nation in favor of the different schools of medicine required that some action be taken by the Institute. T. P. Wilson, M.D., then offered the following: Whereas, The Medical Department of the Centennial Exposition has seen fit, through its attendants, to refuse admission to two or more of the members of this body on the ground of their being homoeopathic physicians ; therefore, Resolved, That the American Institute of Homoeopathy is called upon to declare the action of the Medical Department of the Centennial Exposition unworthy the spirit of the age, and a gratuitous insult to the large body of medical men whom we represent, and is calculated only to bring a blush of shame to the face of every honorable-minded man and woman in this nation. This being seconded by several members, a lengthy discus- sion upon its adoption ensued, participated in by Drs. N. R. Morse, L. E. Ober, D. H. Beckwith (who stated that they had visited the department in question and had been shown through it without any questions being asked as to their school of practice), T. P. Wilson, J. P. Dake, David Thayer, Bushrod W. James, R. J. McClatchey, and John C. Morgan. The resolution was finally adopted, and, on motion, referred to the following com- mittee of Philadelphia physicians: Drs. Bushrod W. James, P. Dudley, R. J. McClatchey. The Secretary : I desire to announce that Dr. Allen, of the National Surgical Institute, at the northeast corner of Broad and Arch streets, invites this body to visit his institution at any time they may see fit to do so; also, that copies of the President's address are now ready for delivery and subscriptions will be re- ceived by E. M. Kellogg, M.D. Bushrod W. James, M.D., moved that a vote of thanks from the Institute be extended to the officers of the Cape May Railroad for a free invitation to visit that place. Carried. On motion of I. T. Talbot, M.D., the thanks of the Institute were extended to the Trustees of the First Reformed Presbyte- rian Church for their extreme kindness in allowing the use of their church for the sessions of the World's Homoeopathic Con- vention and the meeting of the Institute. Carried. Also, a vote of thanks was tendered the press for their very full reports of the sessions, also for their diligence and accuracy. On motion, the Institute then adjourned. PROCEEDINGS OF TWENTY-NINTH SESSION. 19 COMPLETE REPORT OF THE BOARD OF CENSORS. An vms, Reuben A., M.D., Rochester, N. Y., . . . Hah. Med. Coll. Philadelphia, 1868. Andrews, Purnell W., M.D., Camden, N. J., . . Hom. Med. Coll., Penna., 1867. Baldwin, Harry D., M.D., Montrose, Pa., . . . N. Y. Hom. Med. Coll., 1875. Banks, James 0. H., M.D., Philadelphia, .... Hah. Med. Coll. Philadelphia., 1873. Beebe, Harry E., M.D., Sidney, O., Cleveland Hom. Hosp. Coll., 1873. Bennett, Robert A., M.D., Dover, N. J., .... N. Y. Hom. Med. Coll., 1874. Bigler, Wm. H., M.D., Philadelphia Hah. Med. Coll. Philadelphia, 1871. Bronson, Benjamin F., M.D., Bridgeport, Conn., . Hah. Med. Coll. Philadelphia, 1873. Brown, Asa W., M.D., Providence, R. I., . . . . Cleveland Hom. Coll., 1853. Bruns, Frederick, M.D., Boston, Mass Hah. Med. Coll. Philadelphia, 1876. Campbell, James A., M.D., St. Louis, Mo.,. . . . Hom. Med. Coll., Missouri, 1869. Cate, William M., M.D., Salem, Mass., Chas®, Herbert A., M.D., Cambridge, Mass., . . Boston University, 1876. Conant, Thomas, M.D., Gloucester, Mass.,. . . . Harvard Med. Coll., 1868. Cooper, Clark J., M.D., Camden, N. J., .... Hah. Med. Coll. Philadelphia, 1868. Couch, Louis B., M.D., Nyack, N. Y., N. Y. Hom. Med. Coll., 1874. Crocket, Frederick E., M.D., West Newton, Mass., Phila. Univ. Med. & Surg., 1867. Crosby, Obed H., M.D., Atlantic City, N. J., . . . N. Y. Hom. Med. Coll., 1874. Curtis, John M., M.D., Wilmington, Del.,.... Hah. Med. Coll. Philadelphia, 1869. Dixon, George M., M.D., Fond du Lac, Wis., . . N. Y. Hom. Med. Coll., 1871. Eckel, John N., M.D., San Francisco, Cal., . . /st- Louis Coll, of Hom. Phys, and ( ou.rg\, io/u. Elliott, Levi W., M.D., Stockton, Cal., Hah. Med. Coll. Chicago, 1875. Enloe, Thos. E., M.D., Nashville, Tenn., .... Nashville University, 1874. Fellger, Adolphus, M.D., Philadelphia Hah. Med. Coll. Philadelphia, 1869. Gordon, Peter A., M.D., Flemingsburg, Ky., . . N. Y. Hom. Med. Coll., 1868. Griffin, John F., M.D., Stamford, Conn N. Y. Hom. Med. Coll., 1873. Guernsey, Wm. J., M.D., Frankford, Pa., .... Hah. Med. Coll. Philadelphia, 1875. Harpel, Edward N., M.D., Shenandoah, Pa., . . Eclectic Med. Coll., Penna., 1869. Hindman, David R., M.D., Marion, Iowa Hom. Med. Coll. Penna., 1857. Hoag, Sanford, M.D., Canton, N. Y., Cleveland Hom. Hosp. Coll., 1871. Hobart, Henry M., M.D., Chicago, Ill., .... Hah. Med. Coll. Chicago, 1876. Hoppins, Henry S..M.D., Geneseo, Ill., .... Hom. Med. Coll., Mo., 1873. Jackson, Edward R., M.D., Dubuque, Iowa, . . Cincinnati Coll, of Med. & Surg., 1874. Johnson, George H. T., M.D., Atchison, Kan.,. . Hom. Med. Coll., Mo., 1869. Johnson, Maria N., M.D., Philadelphia Hah. Med. Coll. Chicago, 1872. Kanouse, Abijah, M.D., Columbus, Wis., . . . . Hah. Med. Coll. Chicago, 1873. Kinne, Porter 8., M.D., Paterson, N. J., . . . . N. Y. Hom. Med. Coll., 1872. Lounsberry, Osmer W., M.D., Cincinnati, O., . . Pulte Med. Coll., 1874. Mann, Thomas H., M.D., Woonsocket, R. I.,. . . Albany Med. Coll., 1870. Martin, Samuel J., M.D., Racine, Wis., .... Eclectic Med. Coll., Penna., 1863. Mercer, William M., M.D., Galveston, Texas, . . University of La., 1859. Mohr, Chas., M.D., Philadelphia, Hah. Med. Coll. Philadelphia, 1875. Monmonier, Julius L., M.D., Brooklyn, N. Y., . . N. Y. Hom. Med. Coll., 1871. Moore, J. Murray, M.D., Liverpool, England,. . Morse, George, M.D., Gloucester, Mass., .... Boston University, 1875. Nichols, Ammi 8., M.D., Faribault, Minn Hahn. Med. Coll. Philadelphia, 1876. Nichols, George, M.D., Brooklyn, N. Y., .... Hom. Med. Coll., Penna., 1861. Ostrom, Homer J., M.D., New York City, . . . . N. Y. Hom. Med. Coll., 1873. Pope, Gustavus, M.D., Washington, D. C.,.... Albany Med. Coll., 1851. Pratt, John W., M.D., Downingtown, Pa Hah. Med. Coll. Philadelphia, 1873. Price, Emmor H., M.D., Chattanooga, Tenn., . . Pulte Med. Coll., 1873. Quint, Silas H., M.D., Camden, N. J., Hah. Med. Coll. Philadelphia, 1873. Richardson, Wm. C., M.D., St. Louis, Mo., . . . Hom. Med. Coll., Mo., 1868. Seward, John L., M.D., Orange, N. J., Hah. Med. Coll. Philadelphia, 1873. Slough, Frank J., M.D., Allentown, Pa., .... Hom. Med. Coll., Penna., 1862. Smith, John Miller, M.D., Lafayette, Ind., . . . Hah. Med. Coll. Chicago, 1869. Smith, Linneus A., M.D., Philadelphia, .... Hah. Med. Coll. Philadelphia, 1876. Smith, Luther W., M.D., Canton, O., Cleveland Hom. Hosp., Coll., 1876. Sumner, Albert, E., M.D., Brooklyn, N. Y., . . . N. Y. Univ. Med. Coll., 1861. Vail, John D„ M.D., Montrose, Pa. { ^^1855^ C°U'' Pittsfield' De Varona, Adolph, M.D., Brooklyn, N. Y.,. . . Hom. Med. Coll., Penna., 1859. Van Deusen, Josephine, M.D., Philadelphia, . . Woman's Coll, of Penna., 1873. Van Vleck, Peter H., M.D., Sturgis, Mich Hom. Med. Coll., Mo., 1865. Vincent, John A., M.D., Springfield, Ills.,.... Eclectic Inst., 1858. Wellman, Washington I., M.D., New York City,. N. Y. University, 1856. Wheeler, Byron H., M.D., Denver, Col., . . . . Hah. Med. Coll., Chicago, 1867. Wildes, Thomas, M.D., New York City, N. Y. Hom. Med. Coll., 1876. Williams, Adaline, M.D., St. Charles, Minn., . . ■[ Co11' & HosP- for Women, ' ' I I860. Williams, Nancy T., M.D., Gardiner, Me J & HosP' p)r Women, ' ' ' ' ( 1866. Williamson, Alonzo P., M.D., Middletown, N.Y.,. Hah. Med. Coll. Philadelphia, 1876. Wilson, Joseph H., M.D., Bellefontaine, O., . . . Cleveland Hom. Hosp. Coll., 1871. Total 71. 20 AMERICAN INSTITUTE OF HOMOEOPATHY. TREASURER'S REPORT. Dr. E. M. Kellogg, M.D., Treasurer, in Account with the American Institute of Homceopathy. Cr. 1875-76. 1875. By stenographer's bill, ..... $329 90 1876. " disbursements of Treasurer : For postage, . . . . . 112 10 " expressage, . . . . . 20 10 " printing, ..... 27 25 " certificates, . . . . . 18 15 " stationery, etc., .... 27 10 1876.* By disbursements of Secretary : For printing and binding Transactions, postage, clerical aid, stationery, etc., 3497 00 4030 70 1876. By expenses of World's Convention, . . 1013 41 Total disbursements, ..... 5044 11 Balance on hand, ...... 2510 89 $7555 00 The Auditing Committee report that they have examined the accounts and vouchers of the Treasurer for the past year and find them correct. Signed, C. A. Stevens, M.D. G. W. Barnes, M.D. J. B. Bell, M?D. 1875. To balance, ....... $101 51 : 1876. " dues, etc., ....... 4563 00 " " assessments, ...... 1015 001 " " sale of volumes, ...... 150 49 " " voluntary contributions to World's Conven- tion Fund, ...... 1725 00 $7555 00 * See report of Treasurer, vol. 1875, p. 31. THE WORLD'S HOMCEOPATHIC CONVENTION, HELD IN PHILADELPHIA, 1876. WORLD'S HOMEOPATHIC CONVENTION. The Bureau of Registration, to whom was assigned the duty of preparing a correct list of those present at the World's Homoeopathic Convention, respectfully report the names of those registered, numbering 788. The attendance on Monday (the first day), was 229 ; on Tues- day, 415; on Wednesday, 449; on Thursday, 423 ; On Friday, 417; on Saturday, 171. An average of 351. The names are reported as furnished to the bureau. Others than members of the profession are included in the list, while some not registered as such are not published as physicians. As will be seen many omitted to give their address. Abell, D. T., M.D., Sedalia, Mo., delegate Missouri Homoeo- pathic Institute; Ackland, James, Ontario; Adams, E. T., M.D., Savannah, Ga.; Adams, George H., M.D., Webster, Mass.; Adams, George S., M.D., Schuylkill Falls, Pa.; Adams, Reuben A., M.D., Rochester, N. Y.; Adams, J. A. Dunning, Corry, Pa.; Adams, Myron H., M.D., Palmyra, N. Y.; Allen, Rich- ard C., M.D., Philadelphia, Pa.; Allen, Timothy F., M.D., New York City; Andrews, William J., M.D., Newark, N. J.; Andrews, P. W., Camden, N. J.; Arthur, A. A., M.D., Ver- gennes, Vt.; Ashton, A. H., M.D., Philadelphia, Pa.; Ast, William B., New York. Babcock, Lucy Almy, M.D., Westerly, R. I.; Babendrier, Lewis, Jr., Westerly, R. I.; Bacmeister, Theodore, M.D., Tou- lon, Ill.; Bacon, Charles A., M.D., New York; Baer, Oli- ver P., M.D., Richmond, Ind.; Baldwin, Aaron, M.D., Washington, D. C.; Baldwin, Mrs. Dr. Aaron, Wash- ington, D. C.; Baker, Charles H., M.D., Philadelphia, Pa.; Baker, Mrs., Philadelphia, Pa.; Baker, Mary G., M.D., Wor- cester, Mass.; Baker, Peter, M.D., Kansas City, Kansas, dele- gate Kansas City Hom. Aled. Association ; Baldwin, Harry D., M.D., Montrose, Susquehanna Co., Pa.; Baner, William J., M.D., New York; Bangs, L. G.; Banks, James O. H., M.D., 24 TRANSACTIONS OF THE Philadelphia, Pa.; Barnes, George William, M.D., San Diego, Cal.; Barr, D. F.; Bartlett, Henry H., M.D., Ashtabula, Ohio ; Bartlett, Mrs. Dr., Ashtabula, Ohio; Barr, Frank H., M.D., Cleveland, Ohio; Bauer, Mrs. H. S., Philadelphia, Pa.; Baxter, H. H., M.D., Cleveland, Ohio, delegate Hom. Hospital College, Cleveland, Ohio; Baylies, B. L. B., M.D., Astoria, N. Y.; Baylies, Julia M., Astoria, N. Y.; Bearby, Jennie, Philadelphia, Pa.; Bechtell, J. W., Jr., M.D., Harrisburg, Pa.; Beckwith, E. C., M.D., Columbus, Ohio; Beckwith, D. H., M.D., Cleveland, Ohio; Beckwith, Mrs. D. H., Cleveland, Ohio; Beckwith, Seth R., M.D., Cincinnati, Ohio; Beebe, E. W., Evansville, Wis.; Beebe, Mrs. E. W., Evansville, Wis.; Beebe, Henry E., M.D., Sidney, Ohio ; Beebe, Mrs. F. A., Evansville, Wis.; Betancourt, A. L., M.D., Phila- delphia, Pa.; Belt, Miss, Philadelphia, Pa.; Belt Mrs. Phila- delphia, Pa.; Bell, James B., M.D., Augusta, Me.; Bemis, Ar- thur, AV est Chester, Pa.; Bemis, Mrs., WestChester, Pa.; Ben- nett, Isabel M., M.D., Rochester, N. Y.; Berghaus, Alexander, M.D., New York, N. Y.; Berlet, James F., Hoppenville, Pa.; Bertron, S. R., Port Gibson, Miss.; Best, Miss M. E., Seneca Falls, N. AC ; Bete, Miss K. D., Philadelphia, Pa.; Bettis, J. T., Livonia, N. Y.; Betts, B. Frank, M.D., Philadelphia, Pa.; Biggar, Hamilton Fisk, M.D., Cleveland, Ohio; Bigler, Wil- liam Howard, M.D., Philadelphia, Pa.; Birch, John P., M.D., Philadelphia, Pa.; Bird, O. B., Philadelphia, Pa.; Bishop, D. F., M.D., Lockport, N. Y. ; Bishop, Herbert M., M.D., Norwich, Conn.; Boericke, F. E., M.D., Philadelphia, Pa.; Boland, R. W., Philadelphia, Pa.; Boucher, F. H., Phila- delphia, Pa.; Bosley, Annie, Clarksburg, W. Va.; Bosley, S. Clement, M.D., Clarksburg, W. Va.; Bowie, Alonzo P., M.D., Uniontown, Pa.; Bowman, Benjamin, M.D., Chambersburg, Pa.; Boyce, C. William, M.D., Auburn, N. Y.; Boyer, Charles, Altoona, Pa.; Boyer, Francis W., M.D., Pottsville, Pa.; Brack- ett, S. R., Lowell, Mass.; Bradford, Herbert C., M.D., Lewis- ton, Me.; Bradford, Thomas L., M.D., Skowhegan, Me.; Brad- ley, B. H., M.D., Bryn Mawr, Pa.; Bradner, Frederick H., M.D., Middletown, N. Y.; Brainerd, Miss Maria M., Wor- cester, Mass.; Breyfogle, William L., M.D., Louisville, Ky.; Breyfogle, Mrs. W. L., Louisville, Ky.; Briry, Molton S., M.D., Bath, Me.; Bronson, Benjamin Franklin, M.D., Bridgeport, Conn.; Bronson, Charles H., M.D , Brooklyn, N. Y.; Brown, Charles G., Jacksonville, Ill. ; Brown, Charles H., Preston, Conn.; Brown, George W., Jewell City, Conn.; Brown, H. E., M.D., Corning, N. Y.; Brown, Mrs. H. E., world's homoeopathic convention. 25 M.D., Corning, N. Y.; Brown, Miss Mary E., Binghamton, N. Y.; Brown, Titus L., M.D., Binghamton, N. Y.; Brown, L. AV., M.D., Vineland, N. J.; Brown, L. R., M.D., Elizabeth, N. J.; Brough, John, Philadelphia, Pa.; Bruce, W. T., M.D., Philadelphia, Pa.; Bruns, Frederick, M.D., Athol, Mass..; Babendrein, L., Jr., Philadelphia, Pa.; Budlong, John C., M.D., Centredale, R. I., delegate R. I. Hom. Society ; Buck, J. D., M.D., Cincinnati, Ohio; Bunting, Jacob S., Philadelphia, Pa.; Burdick, Alice H., M.D., New York ; Burdick, Stephen P., M.D., New York; Burgher, John C., M.D., Pittsburg, Pa.; Burr, Charles P., Davenport, Iowa. Calvert, William J., M.D., Jackson, Mich.,delegate Hom. Med. Soc. of the State of Michigan, and Jackson Co. Hom. Med Soc.; Calvert, Mary J., Jackson, Mich.; Calvert, Miss Aggie J., Jack- son, Mich.; Campbell James A., M.D., St. Louis, Mo., delegate West. Academy of Hom., and Good Samaritan Hosp, of St. Louis; Campbell, Merrett B., M.D., Joliet, Ill., delegate Kankakee and Desplains Valley Med. Association; Campbell, H. J., M.D.; Canfield, Mrs. CorrestaT., M.D., Titusville, Pa.; Capen, Thomas A., M.D., Fall River, Mass.; Carleton, Edmund, Jr., M.D., New York; Carmony, C. J., Harrisburg, Pa.; Carpenter, Charles H., M.D., Troy, N. Y. ; Carpenter, C. E., Troy, N. Y.; Carpenter, Charles V.; Cate, Shadrach M., M.D., Salem, Mass.; Cator, H. Hull, M.D., Camden, N. J. ; Chamberlain, Mrs. L. B., Worces- ter, Mass.; Chamberlain, William B., M.D., Worcester, Mass.; Chantier, I. B., M.D., Sewickley, Pa.; Chase, Morris J., M.D., Galesburg, Ill., delegate AV estern Academy of Homoeopathy; Cheney, Benjamin H., M.D., New Haven, Conn.; Chew, Edmund, M.D., Phila., Pa.; Child, Nelson L., M.D., Ogdensburg, N. Y.; Childs, Orrin D., M.D., Akron, Ohio; Childs, Mrs. Dr., Akron, Ohio; Clap]), Herbert C., M.D., Boston, Mass., delegate Hom- oeopathic Medical Society; Clark, George H., M.D., Phila., Pa.; Clark, John L.,M.D.,Fall River,Mass.; Clark,Mrs. John L., Fall River, Mass.; Clark, J. Nelson, M.D.,Harrisburg,Pa.; Clarke, Henry B., M.D., New Bedford, Mass.; Clifton, Arthur C., Northampton, England, delegate Midland Homoeopathic Society; Colgrove, Charles H., Willimantic, Conn.; Conant, Clarence M., M.D., Middletown, N. Y.; Conant, Thpmas, Gloucester, Mass.; Connor, Mrs. Delania T., M.D., New Haven, Conn.; Contant, G. F., M.D., La Salle, Ill., delegate Ill. Valley Homoeopathic So- ciety; Conway, Belle, West Philadelphia, Pa.; Cook, E. G., M.D., Buffalo, N. Y.; Cook, Mrs. J. A.; Coon,Henry C., M.D., Alfred Centre, N. Y.; Cooper, J. F., M.D., Alleghany, Pa., 26 TRANSACTIONS OF THE delegate Hom. Med. Society of Alleghany Co., Pa.; Cooper, J. T., Pa.; Cooper, Clark J., Camden, N. J.; Coit, George, Co- lumbus, Ohio; Cote, Marcellin, M.D., Pittsburg, Pa., dele- gate Hom. Med. Society of the State of Pennsylvania; Covert, Rynear B., M.D., Seneca Falls, N. Y.; Covert, Mrs. R. B., Seneca Falls, N. Y.; Covert, Nelson B., M.D., Geneva, N. Y.; Cowl, Walter Y., New York; Cowperthwaite, Allen C., M.D., Nebraska City, Nebraska, delegate Nebraska State Hom. Med. Society ; Cragin, Francis M., M.D., Norwood, Mass.; Crane, J. D., M.D., Fallston, Md.; Crane, Mrs. J. B., Falston, Md.; Crater, Henry, M.D., Somerville, N. J.; Cross, Hiram B., M.D., Jamaica Plain, Mass.; Cross, Mrs. Hiram B., Jamaica Plain, Mass.; Cunningham, J. M., Las Vegas, New Mexico; Curtis, John M., Wilmington, Del., delegate Delaware State Homoeopathic Medical Society ; Cushing, Alvin M., M.D., Lynn, Mass., delegate Mass. Homoeopathic Medical Society; Cushing, Elizabeth P., Lynn, Mass. Dake, Benjamin F., M.D., Pittsburg, Pa.; Dake, Mrs. Benja- min F., Pittsburgh, Pa.; Dake, Charles A., M.D., Rochester, N. Y.; Dake, Jabez P., M.D., Nashville, Tenn., delegate Plomoeo- pathic Society of Tennessee ; Dake, Lucia A., Rochester, N. Y.; Dake, Mrs. Louisa D., N. Y.; Dake, L. E., Rochester, N. Y. ; Dale, James H., Media, Pa.; Davis, F. L., M.D.; Day- foot, Herbert M., M.D., Mount Morris, N.Y.; Deminger, J. C., Philadelphia, Pa.; Dennis, L., M.D., Newark, N. J.; Det- willer, Henry,M.D.,Easton,Pa.; Demarest, James H.; Desehere, Martin, M.D., New York; Dixson, George M., M.D., Fon-du- lac, Wis., delegate Hora. Med. Society of the State of Wiscon- sin ; Dixon, Mrs. Elm.; Dodge, Moses, M.D., Portland, Me.; Dojlge, W. Lovell, M.D., Philadelphia, Pa. ; Donovan, Francis C., M.D., New York; Donovan, Thomas W., M.D., Tompkins- ville, Staten Island, N. Y.; Dougherty, William, Philadelphia, Pa.; Dowling, John W., M.D., New York ; Dudley, Pember- ton, M.D., Philadelphia, Pa.; Duff, Peter S., M.D., Great Belt P.O., Pa.; Duncan, T. Cation, M.D., Chicago, Ill., delegate Ill. Hom. Med. Assoc., Foundling's tlome, U. S. Med. Investi- gator; Dunham, Carroll, M.D., Irvington-on-Hudson, N. Y.; Dunham, Mrs. Carroll, Irvington-on-Hudson, N. Y.; Dunham, Carroll, Jr., Irvington-on-Hudson, N. Y.; Dunham, Edward K., Irvington-on-Hudson, N. Y.; Dunham, Theodore, Irving- ton-on-Hudson, N. Y.; Dunham, Miss Beatrice, Irvington-on- Hudson, N. Y.; Dunning, Thomas S., M.D., Philadelphia, Pa.; Dwindle, H. S., New York. Eaton, Plosea B., M.D., Rockport, Me., delegate Maine Ho- world's homoeopathic convention. 27 moeopathic Medical Society; Eaton, AI. AV., Peoria, Ill., dele- gate Ill. Hom. Med. Association; Egee, J. B. S., AI.D., Phila- delphia, Pa.; Eggert, William, M.D., Indianapolis, Ind., delegate Indiana State Society ; Eisenbrey, Edward II., Glo- versville, N. Y.; Ellis, Mary W., Phoenixville, Pa.; Ely, Sarah, Philadelphia, Pa.; Ensign, Jenny, M.D., New York; Ernst, Susanna, Philadelphia, Pa.; Evans, AV. H., Frostburg, Aid.; Everett, Alary H., M.D., New York. Eager, Charles B., M.D., Harrisburg, Pa.; Fanning, Thomas C., M.D., Tarrytown, N. Y.; delegate Westchester Co., N. Y., Society ; Farnsworth, Charles H., AI.D., East Cambridge, Mass., delegate Mass. Homoeopathic Aledical Society; Farrington, Ernest A.,M.D., Philadelphia, Pa.; Fearon, Fras., AVest Philadelphia, Pa.; Fegely, AI. B., Philadelphia, Pa.; Feld,J., AI.D., Kansas City, Mo., delegate Kansas State and Missouri Valley Homoeo- pathic Society; Fellger, Adolphus, AI.D., Philadelphia, Pa.; Floyd. Henry, Philadelphia, Pa.; Finley, Robert S., Xenia, Ohio; Finnelly, S. P., M.D., Altoona, Pa.; Fisk, AV. ALL., AI.D., Brooklyn, N. Y.; Fitts, AVilliam B., New York ; Flagg, Levi W., AI.D., Yonkers, N. Y., delegate Hom. Med. Soc. of the State of N. Y. and of Westchester Co. Soc.; Flowers, Joab R., M.D., Columbus, Ohio; Folsom, E. E.; Foote, C. C., Philadelphia, Pa.; Foote, George F., ALD., Stamford, Conn.; Franklin, Edward C., AI.D., St. Louis, Alo., delegate Horn. Aled. Coll, of Alo., AVest Acad, of Hom., and Good Samaritan Hosp.; Frantz, F. F., AI.D., Lancaster, Pa.; Freeman, AVarren, AI.D., New York; Freeman, AVilliam E., AI.D., Wilmington, N. C.; French, E. J., Philadelphia, Pa.; Frepch, Harriet S., AI.D., Philadelphia, Pa.; Friedlander, E. H., New York ; Fried- man, S., Jr., New York; Friese, Alichael, AI.D., Harrisburg, Pa.; Friese, Airs. Alichael, Harrisburg, Pa.; Frye, Aloses M., M.D., Auburn, N. Y.; Frye, Aliss AI., Auburn, N. Y.; Fuller, Clara A., AI.D., Fredonia, N. Y. Gale, Stephen AI., AI.D., Newburyport, Alass.; Gallinger, Jacob H., AI.D., Concord, N. H.; Gallupe, AVilliam, AI.D., Ban- gor, Me., delegate Alaine Hom. Aled. Society; Gallupe, Aliss Lucy E.; Gambell, AV. P., AI.D., Boston, Mass. ; Gambell, Airs. Dr., Boston, Alass.; Gardiner, Daniel R.,Woodbury, N. J.; Gardiner, Richard A., AI.D., Philadelphia, Pa.; Gause, Owen B., AI.D., Philadelphia, Pa.; Gawin, J. Paul, AI.D., Alton, Ill.; Gerhard, Joseph AI., Philadelphia, Pa.; de Gersdorff, E. B., AI.D., Boston, Alass., delegate Hom. Aled. Dispensary, Boston ; Gessler, Charles W., Philadelphia, Pa.; Gibson, An- drew J., Alarion, Iowa; Gibson, C. H., AI.D., Allen, Cumber- 28 TRANSACTIONS OF THE land Co., Pa.; Gibson, J. W., Marion, Iowa; Gill, Sarah Ann, Philadelphia, Pa.; Gilbert, Charles B., M.D., Washington, D. C.; Glover, W. A., Camden, N. J.; Goodno, William C., Phila- delphia, Pa.; Goodno, Carrie, Hoboken, N. J.; Gorham, George E., Athens, Pa. ; Goodsell, Alma, Mt. Clemens, Mich.; Good- sell, Samuel, M.D., Mt.Clemens, Mich.; Gordon, George A., M.D., Sandusky, Ohio; Gordon,P. A., Flemingsburg, Ky.; Gorth,Dr.; Gottschalk, Wm. Von, M.D., Providence, R. I., delegate Provi- dence Hom. Dispensary ; Gottschalk, Mrs. Wm., Providence, R. I.; Gramm,GustavusE.,M.D.,Philadelphia,Pa.; Gray, John F., M.D.,New York; Green,Nellie,Marietta, Ohio; Greenleaf, John T., M.D., Owego, N. Y. ; Gregory, Edward P., M.D., Milford, Conn.; Griffen, John F., M.D., Stamford, Conn.; Griffith, Horace G., Manayunk, Pa.; Griffith, W. M., M.D., Philadel- phia, Pa.; Griffiths, Anna E., M.D., Camden, N. J.; Groot, S. I., M.D., Washington, D. C., delegate Washington Hom. Med. Society; Grumbeir,William,M.D., Annville,Lebanon Co., Pa.; Guernsey, Henry N., M.D., Philadelphia, Pa.; Guernsey, Mrs. H. N., Philadelphia, Pa.; Guernsey, Miss Lillie W., Philadelphia, Pa.; Guernsey, Joseph C., M.D., Philadelphia, Pa.; Guernsey, William F., M.D., Philadelphia, Pa. ; Guernsey, William Jefferson, M.D., Philadelphia, Pa. ; Gully, John B., M.D., Geneva, Ill.; Gumbert, B. B., M.D., Philadelphia, Pa.; Guy, Samuel S., M.D., Brooklyn, N.Y.; Gwynn, William M., M.D., Throopsville, N. Y., delegate Hom. Med. Soc., N. Y. Haeseler, Charles H., M.D., Philadelphia, Pa.; Hall, John, M.D., Toronto, Ont.; Hall, W. E., Philadelphia, Pa.; Hall, H. B., M.D., Riverton, N. J.; Hammond, Milton, M.D., Baltimore, Md.; Hammond, Mrs. Dr., Baltimore, Md. ; Hand, George F., Binghamton, N. Y.; Harding, Evan B., M.D., Northampton, Mass.; Harpel, Edward Newton, M.D., Shenandoah, Pa.; Har- pel, F. E., M.D., Danville, Montrose Co., Pa. ; Hasbrouck, Ev- erett, M.D., Brooklyn, N. Y.; Hastings, Charles, M.D., De- troit, Mich., Delegate Detroit Institute of Homoeopathy ; Hast- ings, Mrs. C., Detroit, Mich. ; Haupt, W. Albert, M.D., Chem- nitz, Saxony, Delegate Sachsische Homoeopathic Land-Verein ; Hawly, Annie M., Pughtown, Pa.; Hayward, Milton P., M.D., Oberlin, Ohio ; Hayward, John W., M.D., Liverpool, England, delegate Liverpool Homoeopathic and Chirurgical Society ; Hay- ward Joseph W., M.D., Taunton, Mass.; Hecker, R., Philadel- phia, Pa.; Heckman, Lawrence M., M.D., West Chester, Pa. ; Hedges, William L., M.D., Warrensburg, Mo., delegate Mis- souri Homoeopathic Institute ; Heinemann, J. D., M.D., Buffalo, N.Y.; Helmuth, William Tod, M.D.,New York; Helmuth,Mrs. world's homoeopathic convention. 29 W. T., New York ; Helmuth, Miss, New York ; Helmuth, Miss F. I. ; Helmuth, Willie, New York ; Henderson, Sarah A.,M.D., Kelley's Island, Ohio; Hering Constantine, M.D., Philadel- phia, Pa.; Hering, Mrs. Dr. C., Philadelphia, Pa.; Hibbard, N. R., Upper Darby, Pa.; Higbee, Albert E., M.D., St. Paul, Minn.; Hill, Robert L., M.D., Dubuque, Iowa; Hills, Alfred K., M.D., New York ; Hills, Mrs. A. K., New York ; Hind- man, David R., M.D., Marion, Lynn Co., Iowa, delegate Lynn County Homoeopathic Medical Society; Hinton, R. K., M.D., Philadelphia, Pa.; Hoag, Sanford, M.D., Canton, N. Y. ; Ho- bart, Henry M., M.D., Chicago, Ill.; Hofman, Ernst F., New York ; Hofmann, H. H., M.D., Pittsburg, Pa.; Hooker, Ed- ward B., Hartford, Conn.; Hoopes, Levi, M.D., Pottstown, Pa.; Hoppins, Henry I., Geneseo, Ill. ; Hotchkiss, Jesse T., M.D., Cornwall, N.Y.; Hotchkiss, Mrs. J. T., Cornwall, N. Y.; Hou- ard, J. E., Philadelphia, Pa. ; Houard, John G., M.D., Phila- delphia, Pa.; Houard, Mrs. Dr. J. G., Philadelphia, Pa.; Hough- ton, Henry C., M.D., New York ; Howard, E. M., Camden, N. J.; Huebener, O. T., M.D., Litiz, Pa.; Hughes, L. B., Phila- delphia, Pa.; Hughes, Richard, M.D., Brighton, England, dele- gate British Homoeopathic Society; Hungerbuehler, Marie, Phil- adelphia, Pa.; Hunt, Fleury F., M.D., Camden, N. J., dele- gate New Jersey State Homoeopathic Medical Society ; Hunt, William H., M.D., Covington, Ky. ; Hunter, Horatio M., Low- ell, Mass.; Hurd, George F., M.D., Rochester, N. Y.; Hurd, Mrs. George F., Rochester, N.Y. ; Hutchins, Horace S., M.D., Batavia, N. Y.; Hutchins, Mrs. H. S., Batavia, N. Y. Ingalls, Frederick W., M.D., Kingston, N. Y. Jaffery, G. C., M.D., Brooklyn, N. Y.; James, Bushrod W., M.D., Philadelphia, Pa.; James, John E., M.D., Philadelphia, Pa. ; James, Walter M., M.D., Philadelphia, Pa.; Jeanes, Jacob, M.D., Philadelphia, Pa. ; Jefferds, George P., M.D., Bangor, Me. ; Jefferis, William M., Delaware College, Del.; Janney, W. H., M.D., Kansas, Mo. ; Johnston, J. G., Irvington, N. J.; Johnson, George H. T., Atchison, Kansas ; Johnson, Isaac D., M.D., Kennett Square, Pa.; Johnson, Maria M., M.D., Phila- delphia, Pa.; Johnson T. M.,Camden, N. J.; Jones, Edward, Liv- erpool, England ; Jones, E. Darwin, M.D., Albany, N. Y.; Jones, Elijah U., M.D., Taunton, Mass.; Jones, Henry C., M.D., Mount Vernon, N. Y.; Jones, William J., Philadelphia, Pa.; Jones, Joseph E., M.D., West Chester, Pa.; Jones, Stephen D., M.D., Indianapolis, Ind.; Joslin, Benjamin F., M.D., New York ; Joslin, Mrs. B. F., New York. Kanouse, Abijah W., M.D., Columbus, Wis.; Karsner, 30 TRANSACTIONS OF THE Charles, M.D., Philadelphia, Pa.; Keep, Lester, M.D., Brook- lyn, N. Y.; Kellogg, Edwin M., M.D., New York; Kellogg, George, New York ; Kelley, J. R , Philadelphia, Pa. ; Kenyon, Lorenzo M., M.D., Buffalo, New York ; Kenyon, Mrs. L. M., Buffalo, N. Y.; Keim, William H., M.D., Philadelphia, Pa.; Kern, William PI., M.D., McKeesport, Pa.; Kimball, Daniel S., M.D., Sackett's Harbor, N. Y.; King, Mrs. G. O., Fredonia, N. Y.; Kinney, Theodore Y., M.D., Paterson, N. J.; Kirby, Edmund W., Philadelphia, Pa. ; Kirkpatrick, Alexan- der, Burlington, N. J.; Kitchen, James, M.D., Philadelphia, Pa. ; Kneass, Nicholas W., M.D., Baltimore,Md. ; Knerr, Calvin B., M.D., Philadelphia, Pa. ; Knickerbocker, Simeon C., M.D., Watertown, N. Y.; Kniffen, J. B., Philadelphia, Pa.; Koch, August W., M.D., Philadelphia, Pa.; Korndoerfer, Augustus, M.D., Philadelphia, Pa.; Korth, Francisco Lucia D', M.D., Montevideo, Brazil; Krause, William, Philadelphia, Pa.; Ku- hole, Charles F., Philadelphia, Pa. Landis, E. Y., Philadelphia, Pa.; Landon, Elizabeth T., M.D., Fredonia, N. Y.; Landon, Reuben B., M.D., Fredonia, N. Y.; Lang, Eliza H.; Lawton, Charles H., Wilmington, Del.; Leach, Harriet E., Philadelphia, Pa.; Leach, Leonard, Phila- delphia, Pa. ; Lee, George Andrew, Philadelphia, Pa.; Lee, Wellington, Philadelphia, Pa.; Leonard, William Huntingdon, M.D., Minneapolis, Minn.; Lewis, John A., Brooklyn, N.Y.; Lewis, Mrs. Dr. H. M., Brooklyn, N. Y.; Lewis, Joseph C., M.D., Philadelphia, Pa.; Lewis, Richard, M.D., Philadelphia, Pa.; Liebold, Carl Theodore, M.D., New York ; Lilienthal Samuel, M.D., New York ; Lindsley, David R., Andover, Mass.; Lippe, Adolph, M.D., Philadelphia, Pa.; Lippincott, Aquilla, Salem, N. J.; Logee, H. M., M.D., Oxford, Ohio; Logee, Mrs. H. M., Oxford, Ohio; Loring, Charles P., M.D., Providence, R. I., delegate Rhode Island Homoeopathic Society; Loring, Mrs. C. P., Providence, R. I.; Longee, William H., M.D., Lawrence, Mass.; Longacre, Andrew, Philadelphia, Pa.; Longshore, Re- becca H., M.D., Columbus, Platte Co., Nebraska; Longshore, Samuel C., Columbus, Platte Co., Nebraska ; Lucy, J. A., M.D., Oscaloosa, Iowa, delegate Society of Homoeopathic Physicians of Iowa; Ludlam, Edward M. P., M.D., Chicago, Ill., delegate Chicago Academy of Homoeopathic Physicians and Surgeons; Ludlam, Reuben, M.D., Chicago, Ill., delegate Illinois Hom. Medical Association; Ludlam, Mrs R., Chicago, Ill.; Lukens, Isaiah, M.D., Newport, Del.; Lungren, Samuel S., M.D., Toledo, Ohio ; Lungren, Mrs. S., Toledo, Ohio. McDonald, David, Pittsburg, Pa.; MacFarlan, Malcolm, world's homoeopathic convention. 31 M.D., Philadelphia, Pa.; Malin, John, M.D., German- town, Philadelphia, Pa.; Mandeville, F. B., M.D., New- ark, N. J.; Mann, Maria R., Philadelphia, Pa.; Mans- field, Job, Germantown, Pa.; Manson, C. Franklin, M.D., Philadelphia, Pa.; Marshall, Anna M., Philadelphia, Pa.; Massey, L. C.; Marter, George W., Philadelphia, Pa.; Martin, Frank ; Martin, Henry Noah, M.D., Philadelphia, Pa. ; Martin, Samuel J., M.D., Racine, Wis., delegate Hom. Med. Society of the State of Wisconsin; Matthews, Fannie C., New York; Matthes G. Felix, M.D., New Bedford, Mass.; Maxwell, Sam- uel, M.D., Philadelphia, Pa.; Maxwell, Mrs. William H.; Mea- sey, Miss Lizzie; McAfiee, E.M.,M.D., Mount Carroll, HI., dele- gate Ill. Hom. Med. Association ; McClatchey, Robert J., M.D., Philadelphia, Pa.; McClelland James H., M.D., Pittsburg, Pa., delegate Mat. Med. Club of Allegheny Co., Pa. ; McDer- mott, George C., M.D., Williamsport, Pa.; McEntee, Sarah, M.D., Kingston, N. Y. ; McGeorge, Wallace, M.D., Woodbury, N. J., delegate New Jersey State Hom, Med. Society ; McKee- han, C. W., Philadelphia, Pa.; McManus, Felix R., M.D., Bal- timore, Md.; McMullin, Mrs.; McRenolds, A. ; Meade, Samuel IL, Philadelphia, Pa.; Mercer, Robert P., M.D., Chester Pa.; Milderberger, Mrs. John, New York ; Middleton, Caleb S., M.D., Philadelphia, Pa.; Middleton, Melburne F., Camden, N. J.; Millard, Ezra H., Massachusetts; Millard, Louisa S., M.D., Great Barrington, Mass.; Miller, Christopher C., M.D., Detroit, Mich. ; Miller, Carlos J., M.D., Mt. Kisco, N. Y. ; Miller, C. T., M.D., Brenhoen, Texas ; Miller, R. P.; Milno, Mrs. M. A.; Minton, Henry, M.D., Brooklyn, N. Y.; Mitchell, Edgar Ormsby, Newburgh, N. Y.; Mitchell, J. A., Philadelphia, Pa. ; Mitchell, John J., M.D., Newburgh, N. Y.; Mitchell, John W., M.D., Brooklyn, N. Y.; Moffat, Reuben C., M.D., Brooklyn, N. Y.; Moffat, Mrs. R. C., Brooklyn, N. Y. ; Mohs, Charles, Jr., M.D., Philadelphia, Pa. ; Morrow, D. B., M.D., Cincinnati, Ohio ; Moore, Thomas, M.D., Germantown, Pa.; Morgan, Cy- rus R., M.D., Philadelphia, Pa. ; Morgan, John C., M.D., Philadelphia, Pa.; Monell, A. H., Harper's Ferry, W. Va.; Morrill, Mrs. Dr. H. E., Brooklyn, N. Y.; Morse, Lucius D., M.D., Memphis, Tenn., delegate State Hom. Society of Tennes- see ; Morse, Nathan R., M.D., Salem, Mass., delegate Essex Co. Massachusetts Hom. Aled. Society; Morse, Mrs. Nathan R., Salem, Mass.; Mosman, Nathan A., M.D., Norwalk, Conn. ; Miiller, Clotar, M.D., Leipzig, Saxony, delegate Hom. Central- Verein Deutschlands. Naylor, G. R., M.D., Calcutta, India; Neely, T. B., Phila- 32 TRANSACTION'S OF THE delphia, Pa.; Neidhard, Charles, M.D., Philadelphia, Pa. ; Neufeldo, F. L., Lancaster, Pa.; Neville, William H. H., M.D., Philadelphia, Pa.; Nichols, Ammi Sibley, M.D., Faribault, Minn.; Nichols, Frank, M.D., Hoboken, N.J. ; Nichols, George, M.D., Brooklyn, N. Y.; Nouxeira, Ataliba G., Brazil ; Nogue- ria D. P., M.D., Laspaulo, Brazil; Norton, Claude R., M.D., Madison, Wis.; Norton, George S., M.D., New York; Norton, Lucien H., M.D., Bridgeport, Conn. Ober, Levi E., M.D., Lacrosse, Wis., delegate Hom. Med. So- ciety of the State of Wisconsin; Ockford, George M., M.D., Hack- ensack, N. J.; Ormes, Cornelius, M.D., Jamestown, N. Y.; Owens, Mary, Cincinnati, O.; Owens, Mrs. S. E., Cincinnati, 0. ; Owens, William, M.D., Cincinnati, Ohio, delegate Pulte Med. College, Cincinnati; Owen, Reuben, M.D., Coatesville, Pa. Paine, Henry D., M.D., New York ; Palmer, L. J., Phila- delphia, Pa.; Pancoast, Seth, M.D., Philadelphia, Pa.; Parcell, George H., M.D., Weedsport, N. Y.; Parsons, Kate, M.D., Cleveland, Ohio; Parsons, Scott B., M.D., St. Louis, Mo., delegate Western Academy of Medicine and Missouri State Homoeopathic Society ; Paschall, Mrs. M. L., Philadelphia, Pa.; Patchen, T. J., M.D., Fond-du-Lac, Wis. ; Payne, William E., M.D., Bath, Me. ; Peacock, William, Philadelphia, Pa.; Pear- sall, S. J., M.D., Saratoga Springs, N. Y.; Pearson, Clement, M.D., Washington, D. C.; Pearsons, W. B. C., Holyoke, Mass. ; Peer, George W., M D., Rochester, N. Y.; Pennoyer, Nelson A.,M.D., Kenosha, Wis.; Perkins, C. W , Chester, Pa.; Peterson, Alfred C., Philadelphia, Pa.; Pettingill, Eliza F., M.D., Philadelphia, Pa.; Pettingill, Sarah B., M.D., Philadelphia, Pa.; Perry, H. E., Philadelphia, Pa.; Pfeiffer, George S. F., M.D., Camden, N. J. ; Phillips, Albert William, M.D., Birmingham, Conn.; Phillips, W. A., M.D., Cleveland, Ohio; Phillips, Edward H., M.D., West New Brighton, Staten Island, N. Y.; Phillips, R. Oliver, Newburgh, N. Y.; Pigford, J. E., Wallace, N. C.; Pinkham, R. C., Berlin Heights, Ohio; Piper, Albert F., M.D., Thomas- ton, Me.; Piper, Mrs., Thomaston, Me. ; Pool, Augustus, M.D., Oswego, N. Y.; Pope, Gustavus AV., M.D., Washington, D. C.; Pratt, D. T., Philadelphia,Pa.; Pratt, E. H., M.D., Wheaton, Ill., delegate Illinois Homoeopathic Medical Association; Pratt, J. AV., M.D., Downingtown, Pa.; Preston, Coates, M.D., Chester, Pa.; Preston, Mahlon, M.D., Norristown, Pa. ; Price, Eldridge C., M.D., Baltimore, Md.; Price, Elias C., M.D., Baltimore, Md., delegate Baltimore Homoeopathic Dispensary ; Price, AVilliam H., Cleveland, Ohio; Prindle, Clarence W., M.D., Grand Rapids, Mich. Quint, Silas Hurd, M.D., Camden, N. J. world's homoeopathic convention. 33 Radde, William, New York ; Ramsey, Alexander, Jr.; Ran- kin, C. P., Pittsburg, Pa.; Rankin, John S., AI.D., Pittsburg, Pa.; Randel, William H., M.D., Albany, N.Y.; Rane, Charles G., AI.D., Philadelphia, Pa.; Read, H. B., Stockbridge, Mass.; Reading, Edward, AI.D., Hatboro, Pa.; Reading, John R., M.D., Somerton, Pa.; Read, Mrs. H. B., Stockbridge, Mass.; Reed, J. B., Philadelphia, Pa.; Reed, N. H.; Rees, H. J., Philadelphia, Pa.; Rembaugh, Alonzo C., M.D., Philadelphia, Pa. ; Reimer, Louis, Philadelphia, Pa.; Reinhold, Hahnemann E., M.D., Williamsport, Pa.; Rice, II. W., M.D., Aurora, Ill.; Richards, Charles H., Syracuse, N. Y.; Richards, George AV., M.D., Orange, N. J.; Richardson, Edward T., M.D., Brooklyn, N. Y.; Richardson, William C., M.D., St. Louis, Mo., dele- gate Missouri School of Midwifery ; Rittenhouse, S. R., M.D., Reading, Pa.; Roberts, C. H., M.D., Jackson, Mo. ; Robertson, E. AV., M.D., Cleveland, Ohio; Robertson, George A., M.D., Chelsea, Mich.; Robinson, G. P., Eastport, N. Y.; Robinson, M. R., Salem, Ohio; Robinson, S. A., M.D., Laporte, Ind.; Rogers, H. S., Philadelphia, Pa.; Rogers, Sarah T., M.D., Philadelphia,' Pa.; Rossiter, E. B., AI.D., Spring City, Pa.; Rush, Bessie C., Salem, Ohio; Rush,R. B., AI.D., Salem, Ohio; Rush, Mrs. AI., Salem, Ohio. Sargent, Rufus, AI.D., Philadelphia, Pa. ; Sartain, Harriet J., M.D., Philadelphia, Pa.; Sanford, Mrs. Charles, Paterson, N. J.; Sawyer, 0. F., Philadelphia, Pa.; Seales, Edward P., M.D., Newton, Mass., delegate Middlesex South. Hom. Med. So- ciety, Mass.; Scales, Thomas S., M.D., Woburn, Mass.; Scaff, Jeremiah G., Fallston, Md. ; Scheurer, E. M., M.D., Clearfield, Pa.; Schmid, AV., M.D., Philadelphia, Pa.; Schmucker, Elhanan Z., M.D., Reading, Pa.; Scott, A rami nta V., Phila- delphia, Pa.; Scott, Mary C.; Scott, Samuel C., Philadelphia, Pa.; Scott, John P., Philadelphia, Pa.; Scott, Sarah E.; Seid- litz, Geo. Newman, M.D., Keokuk, Iowa, delegate Society of Hom. Phys, of Iowa ; Seymour, Abby J., M.D., Buffalo, N.Y. ; Shackford, Rufus, AI.D., Portland, Me. ; Shaffer, George AV., Manchester, Md.; Shallcross, AVilliam H., Philadelphia, Pa.; Sharkey, William P., M.D., Philadelphia, Pa.; Sharp, Jacob G., M.D., Philadelphia, Pa. ; Shaw, Samuel, New Bedford, Mass.; Shay, Miss Jennie K., AVashington, D. C.; Shearer, Thomas, M.D., Baltimore, Md.; Sheldon, E. L., Chicago, HI. ; Sherman, Lewis, M.D., Milwaukee, Wis., delegate Hom. Aled. Society of the State of Wisconsin; Shivers, B. H., AI.D., Haddonfield, N. J.; Sibley, F. R., Warren, Alass.; Silliman, Dwight, Hudson, Wis. ; Skinner, Thomas, AI.D., Liverpool, England ; Slocum, 34 TRANSACTIONS OF THE C. C.,M.D., Middlebury, Mass.; Slough, Frank J., M.D., Allen- town, Pa.; Slough, William C. J., M.D., Fogelsville, Pa.; Small, Alvan E., M.D., Chicago, Ill., delegate Ill. Hom. Med. Association ; Small, Mrs. A. E., Chicago, Ill.; Small, Mrs. M. M., Chicago, Ill.; Smedley, Robert C., M.D., West Chester, Pa.; Smith, A. M., Nebraska City, Neb. ; Smith, C. Carleton, M.D., Philadelphia, Pa.; Smith, Mrs. C. F., Milwaukee, Wis.; Smith, George W. M.D., Philadelphia, Pa.; Smith, I). S., M.D., Chicago, Ill., delegate UI. Hom. Med. As- sociation; Smith, Henry M., M.D., New York; Smith, John Miller, Lafayette, Ind.; Smith, John T. S., M.D., New York ; Smith, Lilian, Milwaukee, Wis.; Smith, Linnaeus A., M.D., Philadelphia, Pa.; Smith, Luther AV., Canton, Ohio; Smith, R. C., Philadelphia, Pa.; Smith, T. Hart, M.D., Philadelphia, Pa.; Smith,Thomas Franklin, M.D.,New York; Smith, William H., M.D., Philadelphia, Pa.; Sonnenschmidt, C. W., M.D., AVashington, D. C.; South, E. AV., Plainfield, N. J.; Sover- eign, Baxter, M.D., Yorkshire, N. Y.; Sparhawk, George E. E., M.D., Gaysville, Vt.; Spooner, E.H., M.D., Reading, Pa.; Stam- bach, II. L., Philadelphia, Pa.; Stanhope, CharlesD., Milwaukee, AVis., delegate Hom. Med. Society of the State of Wisconsin ; Starr, Samuel, Chester, Pa.; Stebbins, S., Unionville, Pa.; Sterling, C. F.; Stevenson, Charles L., M.D., Philadelphia, Pa.; Stevens, Charles A., M.D., Scranton, Pa.; Stewart,II. Knox, M.D., Philadelphia, Pa.; Stiles, Henry R., M.D., Middletown, N. Y., Stockwell, A. AV., Boston, Mass.; Stone, Carrie J., Binghamton, N. Y.; Stone, Henry E., M.D., Fair Haven, Conn.; Stone, Martha M., Cleveland, Ohio; Stow, T. Dwight, M.D., Fall River, Mass. ; Streets, Jacob G., M.D., Bridgeton, N. J.; Sum- ner, A. E., M.D., Brooklyn, N. Y.; Sumner, Charles, M.D., Rochester, N. Y.; Swan, Samuel, M.D., New York ; Swan, Mrs. Samuel, New York ; Swazey, George AV., M. D., Springfield, Mass.; Swazey, Greta L., Springfield, Mass.; Swazey, Helen C., Springfield, Mass.; Swift, Theodore E., Elmira, N. Y.; Tafel, A. J., Philadelphia, Pa.; Talbot, I. Tisdale, M.D., Bos- ton, Mass., delegate Boston University School of Med.; Talcott, Selden H., M.D., Hom. Hospital, Ward's Island, New York; Taylor, H. AV., Crawfordville, Ind.; Thatcher, Mrs. R. D., Keene, N. H.; Thayer, David, M.D., Boston, Mass.; Thayer, Mrs.; Thomas, Amos R., M.D., Philadelphia, Pa.; Thomas, Charles M., M.D., Philadelphia, Pa.; Thompson, Samuel, Phila- delphia, Pa.; Thomas, Miss Gertrude, Catasauqua, Pa.; Thomp- son, John H., M.D., New York ; Thompson, Mrs. J. H., New York; Thompson, Virgil, M.D., New York ; Throop, Aug. P., world's homoeopathic convention. 35 M.D., New York; Tillotson, Mary E., Vineland, N. J.; Tom- linson, William IT., M.D., Philadelphia, Pa.; Townsend, Mrs. C., Oswego, N. Y.; Townsend, E. W., M.D., Greensburg, Pa.; Townsend, Mrs. E. W., Greensburg, Pa.; Trego, Edwin H., M.D., Philadelphia, Pa.; Trites, David T., M.D., Manayunk, Pa.; Trites, William Budd, M.D., Manayunk, Pa.; Tullaway, E., Philadelphia, Pa. ; Tupper, H. M., Raleigh, N. C. Umstead, David B., Philadelphia, Pa. Vail John D., M.D., Montrose, Pa.; Valentine, Philo G., M.D., St. Louis, Mo., delegate Missouri Hom. Institute and St. Louis Academy of Hom.; Vanartsdalen, Christopher, Shoe- makertown, Pa.; Vanderveer, George W., M.D., Medford, N. J.; Vandeusen, H. P.; Vandeusen, Josephine, M.D., Philadel- phia, Pa.; Van Evera, Juliet Tiffany, New York ; Van Vleck, Peter H., Sturgis, Mich.; Varona, Adolpho, M.D., Brooklyn, N. Y.; Verdi, Tullio S., M.D., Washington, D. C.; Vinal, L. G., Philadelphia, Pa.; Vincent, Frank L., M.D., Troy, N. Y.; Vincent, John A., M.D., Springfield, Ill., delegate Illinois Hora. Med. Association; Vincent, J. B. ; von Tagen, Charles H., M.D., Cleveland. Ohio; Voorhies, E., Kirksville, Mo. Walker, C. IL, M.D., Boston, Mass., delegate Consumptives' Horae, Boston ; Walker, Mahlon, MD., Germantown, Phila- delphia, Pa.; Wallace, Adrian E., Oneida, N. Y.; Walter, C. E., Marietta, Ohio; Walter, Mrs. C. E., Marietta, Ohio; Wal- ter, Ziba D., M.D., Marietta, Ohio; Ward, John A., M.D., New York; Ward, Walter, M.D., Mt. Holly, N. J.,delegate West New Jersey Hom. Med. Society ; Warner, Nellie M., Irvington- on-Hudson, N. Y. ; Warren, Dwight, Winsted, Conn. ; War- ren, H. Anna, M.D., Emporia, Kansas, delegate Kansas and Missouri Valley Hom. Med. Society; Warren, John K., M.D., Palmer, Mass.; Warren, R. N., Wooster, Ohio; Waters, H. L., Philadelphia, Pa.; Watt, J. S., Philadelphia, Pa.; Waugh, Theodore R., St. Albans, Vt.; Weeks, R. D., M.D., Philadel- phia, Pa.; Wells, Lucien B., M.D., Utica, N. Y., delegate Hom. Med. Society of the County of Oneida, N. Y.; Wells, P. P., M.D., Brooklyn, N.Y.; Wenz, C. H., Newark, N. J.; Wesselhoeft, Conrad, M.D., Boston, Mass.; Wesselhceft, Wil- liam P., M.D., Boston, Mass.; Weston, Mrs. Lizzie, Philadelphia, Pa.; Westover, Henry W., St. Joseph, Mo.; Wetmore, John McE., M.D., New York; Wheeler, Byron A., Denver, Color- ado; Wheelwright, Mrs.; White, J. Ralsey, M.D., New York; White, W. H., M.D., New York; Whittier, Daniel B., M.D., Fitchburg, Mass; Whittier, Mary C., Fitchburg, Mass.; Wil- der, John K., Toledo, Ohio; Wilder, Mrs. J. K., Toledo, O.; 36 TRANSACTIONS OF WORLD'S HOMCEOPATIIIC CONVENTION. Wiley, Fannie M., Providence, R. I.; Wilkinson, M. E., Phil- adelphia, Pa.; Willard, L. H., M.D., Allegheny, Pa., Williams, A., M.D., Phoenixville, Pa.; Williams, Adaline, M.D., St. Charles, Minn.; Williams, Nancy T., M.D., Gardiner, Me.; Williams, Thomas C., M.D., Philadelphia, Pa.; Williamson, Alonzo P., M.D., Ward's Island, New York; Williamson, Matthew S., M.D., Philadelphia, Pa.; Wilson, G. H., M.D., West Meriden, Conn.; Wilson, J. H., M.D., Bellefontaine, Ohio; Wilson, T. P., M.D., Cincinnati, Ohio; Wilson, Mrs. T. P., Cincinnati, Ohio ; Winans, Jonathan Edwards, M.D., Lyon's Farms, N. J.; Winslow, W. H., M.D. ; Wood, James Bayard, M.D., West Chester, Pa.; Woodbury, John H., M.D., Boston, Mass., delegate Mass. Hom. Hospital ; Woodruff, Francis, M.D., Detroit, Mich., delegate Hom. Med. Society of the State of Michigan ; Woodruff, George M., Detroit, Mich.; Woodward, A. M., M.D., New York ; Woodward, Mrs. A. M., New York ; Woodward, Alfred W., M.D., Chicago, Ill.; Wood- worth, N. F., Philadelphia, Pa.; Woodyatt, W. H., M.D., Chicago, Ill., delegate Ill. Hom. Med. Association ; Worley, P. H., M.D., Davenport, Ohio; Worthington, A. F., M.D., Cin- cinnati, Ohio ; Wright, A. R., M.D., Buffalo, N. Y.; Wright, H. Amelia, M.D., New York; Wright, John R., Newark, N. J., Wylie, Theop. A,,Bloomington, Ind. Yeomans, Caroline J., M.D., New York ; Yeomans, Clara, M.D., Clinton, Iowa ; Youlin, John J., M.D., Jersey City, N. J., delegate New Jersey State Hom. Med. Society ; Youlin, Mrs. J. J., Jersey City, N. J.; Young, J. N., Philadelphia, Pa. Zerns, William M., M.D., Philadelphia, Pa. Respectfully submitted, Henry M. Smith, M.D., Chairman of Bureau. THE WORLD'S HOMEOPATHIC CONVENTION. FIRST SESSION. Monday, June 26, 1876. The First Session of the World's Homoeopathic Convention was called to order immediately after the adjournment of the American Institute of Homoeopathy, June 26th, 1876, by the President, Dr. Carroll Dunham. Dr. Dunham: The World's Convention of 1876 is now in session. On motion, the printed order of business, as arranged by the Executive Committee, was then adopted. Dr. Dunham then delivered the following address: Ladies and Gentlemen: The proposition to hold a World's Homoeopathic Convention was first made by the American In- stitute of Homoeopathy, in a circular letter issued by its Com- mittee of Foreign Correspondence in 1867. The plan of the present Convention was conceived soon after the project of a formal celebration of our National Centennial took definite shape. Many years must elapse, it is true, before the centennial of homoeopathy, which, in America, has but just celebrated her fiftieth anniversary. Yet certain analogies between the early history of homoeopathy, and the event which our countrymen celebrate in Philadelphia this summer, justify the time and place of our assemblage. The innovation upon accepted theories of society and govern- ment involved in the Declaration of Independence by our fore- fathers was not more radical than that which was involved in the reform introduced in medical science by Hahnemann. Notions of prerogative by virtue of birth or of caste; notions of governors as a race distinct from the governed ; vested rights transmitted in corporations from medireval times; in these things 38 TRANSACTIONS OF THE was grounded the opposition to the political reform of our fathers. Things identical or analogous hindered, and still hinder, the advancement of homoeopathy, as the historical and statistical reports presented to this Convention abundantly show. Reforms are not favored nor furthered by governments and venerable corporations. These institutions are, from the nature of things, conservative and repressive. Reforms of a practical nature are received first by the people; adopted and cherished by the people; and, if governmental ac- ceptance be necessary, forced on the government by the people. The history of homoeopathy shows that in countries in which the government is absolute, in which education and the exercise of the liberal professions and the arts connected therewith are under the control of self-perpetuating boards or corporations, there our colleagues have found it difficult to obtain freedom to practice, and wellnigh impossible to gain liberty to teach. In proportion as the government, whether of the realm or of corporations, being in a degree representative, stands nearer to the people to whom the reform is a matter of vital interest, do our colleagues enjoy comparative freedom to practice and to teach. In our own land, where the liberty of the individual is limited only by the liberty of his neighbors, where order is maintained by a government "of the people, for the people, by the people," we practice and teach without hindrance ; and the advancement of homoeopathy has been rapid and solid beyond precedent, be- cause the people have so willed it. The coincidence, then, of this Convention and the centennial of our nation has a significance. It is full of instruction and warning to us, if we would retain what we possess. It was not to be expected that many of our foreign colleagues should make the long journey necessary to be present with us on this occasion. Some have come, however; and we welcome most heartily our distinguished confreres, already known to us by their works and their fame, who represent the homoeopathists of Europe and South America- But although comparatively few could be with us in person, our colleagues in every land have responded heartily to our in- vitation by reports and scientific papers, which, together with those contributed by our fellow-citizens, will furnish the topics of our discussions. Moreover, by official and personal letters, they have manifested their good-will and sympathy in the inception and work of the world's homoeopathic convention. 39 Convention. Such letters as are addressed to the Convention are herewith submitted ; and since some of them contain suggestions for action on the part of the Convention, I request that they be referred to the Committee on Correspondence, with instructions to report with recommendations. Among these communications is one from the venerable widow of the illustrious founder of our school, who now, at an advanced age, impoverished by the calamities of war, extends her greet- ings to the homoeopathists of the world here represented. In token of her sympathy, she sends to the Convention, with an ul- terior destination in the discretion of the President, this bronzed bust of Hahnemann, cast from the marble bust by David D'Anger, and which she affirms to be a perfect likeness of that illustrious man. Our colleague, Dr. Rubini, of Naples, in a letter to the Con- vention, calls attention to his peculiar views of the treatment of epidemic cholera, which he supports by remarkably favorable statistics. As a mark of respect for the Convention, he has sent to the President autograph letters of Hahnemann. Our colleagues of the United States of Colombia, in South America, inspirited by the energy and prosperity of the Ameri- can Institute of Homoeopathy, have not only revived their National Institute, which, in consequence of political disturb- ances, had slept for several years, but they have organized in Bogota a homoeopathic school, which they have done us the honor to designate as a "branch of the American Institute of Homoeopathy." These institutions request us to enter into inti- mate scientific relations "with them in matters connected with the cultivation of our Materia Medica; and they make suggestions to this Convention, which appear in the letters here submitted. Several other societies and individuals send communications, which, if you please, will be reported in detail by the committee. The historical and statistical reports presented to the Conven- tion, and which though of exceeding interest are altogether too long to be read during our sessions, comprise the history and statistics of our school in every country of Europe; in India, in South America, where, in Brazil, a national institute was estab- lished one year before our own; in North and South Africa; in Australia, and in New Zealand. We may say, with almost ab- solute accuracy, that in none of these countries save Germany was there fifty-five years ago a single homoeopathic physician. Now, it is safe to say, that Germany, France, England, and Italy have each about 300, Spain and her colonies between 500 and 600, Brazil about 200, Russia about 150; and in each of 40 TRANSACTIONS OF THE these countries, we are told, the demand for homoeopathic prac- titioners is so great that, if instruction were free to our colleagues, and no hindrances were placed in the way of students of homoeo- pathic medicine, the increase in our numbers would be very rapid. Dispensaries and hospitals exist and are increasing in numbers and patronage. Measures are being set on foot for the education of young physicians in the principles and practice of homoeopathy, and the confidence of the public is won by our practical success. In our own country, the reports of the several States give an aggregate number of over 5000 homoeopathic physicians. We have many dispensaries and hospitals supported by private charity; nine colleges, exclusively homoeopathic, enjoying equal privileges with any other medical colleges in the country ; and two State universities and several State hospitals, in which, de- spite the opposition of our brothers of the old school, the people who support these institutions have decreed us places in the fac- ulty and on the staff. This rapid growth of homoeopathy in America, unparalleled in any other country, was made possible by the freedom to prac- tice and to teach secured by our institutions. It became a fact, however, through the wise and unselfish action of the pioneers of homoeopathy in America. Scarcely had a handful of these earnest students become acclimated in the country of their adop- tion, when they opened, in 1834,* at Allentown, Pennsylvania, under a charter from the State, " The North American Academy of the Homoeopathic Healing Art." Under the auspices of this institution the fifth edition of Hahnemann's Organon and Jahr's Manual were translated and published; a medical journal was established; students were made conversant with the science and practice of homoeopathy, and by the zeal of their teachers were heartily engaged in that work which is indispensable to a thorough knowledge of Materia Medica,-the proving of drugs. Here were proved Lachesis, Crotalus, Mephitis, Calcarea phosphorica, Cinnabaris, Sanguinaria, Bromine, Kalmia, Phyto- lacca, and Gelsemium. From this academy students, well grounded in knowledge and infected with the enthusiasm of their teachers, went forth to introduce or extend the knowledge of the new science and to labor for its development throughout Penn- sylvania, in Ohio and the West, in Rhode Island and Massa- chusetts. To the establishment and wise conduct of this academy, short- * See World's Homoeopathic Convention, History, vol. ii, p 773. world's homoeopathic convention. 41 lived as it was, may be referred, it seems to me, the grand im- pulse towards the extension of homoeopathy and the develop- ment and expansion of the Materia Medica which have distin- guished American homoeopathy. The leaders in this enterprise were Dr. William Wesselhoeft, whose name is honorably represented in our ranks to-day, and Dr. Constantine Hering, who, constant in his devotion to the advancement of the healing art, untiring in his labors to de- velop our Materia Medica, generous as the sun to all who seek for light and knowledge, is still with us, our honored leader. Most schools of medicine have perished with their founders, or a little before them. Thirty-three years have passed since the founder of our school entered into his well-earned rest. Our growth in numbers and influence has been steady, and never so rapid as within the last decade. The time at my disposal would not permit an analysis of the system which presents so remarkable a history. I desire, how- ever, to devote a few moments to some of the relations of ho- moeopathy to the medical science of Hahnemann's day and to the medical science of our own day. Homoeopathy, in its complete form, was introduced to the public in 1810, by the publication of the Organon of the Ra- tional Art of Healing, a work which, it seems to me, has hardly been fully understood or appreciated even by the majority of Hahnemann's enthusiastic admirers, a work which-far from con- signing to the shelves as a classic, venerated but seldom read, and not looked on as authority in practical matters-I should place, for frequent perusal and as a trusted guide, in the hands, not per- haps of the student, but of the educated earnest practitioner. Condensed in style to the exclusion of every superfluous word, this work is not a system of medical science, but, as its title sig- nifies, a treatise on the practical art of healing, with only so much of theoretical discussion as seemed necessary to make the meaning clear, with only so much allusion to other departments of medical science as seemed necessary to show their insufficiency for the needs of the practical physician, or to show the errors of philosophy and method through which they failed to accomplish the true end and object of all medical science,-a speedy, safe, and pleasant mode of cure. Should we heed some self-appointed champions of Hahne- mann, we might suppose that this illustrious physician denounced all medical science save that which he especially taught, and discouraged its acquisition by his followers. Were this indeed so, the reproach of our adversaries might 42 TRANSACTIONS OF THE have some foundation ; that homoeopathy is a system which a layman might practice as well as a doctor. Again, if we listen to these brethren who seem to arrogate a special knowledge of Hahnemann and of homoeopathy, we might suppose that Hahne- mann proclaimed his Organon and latter works to be the alpha and omega of medical science, rendering all other medical knowl- edge superfluous. Very far is either of these propositions from the truth. Hahnemann as a physician was distinguished by profound learning and the broadest medical culture of his times. His writings are full of this learning. His extensive reading in every language in which medical men had written, enabled him to make those citations which, in the Organon, so irrefutably prove his positions, and in the Materia Medina enrich his patho- geneses. The spirit of the medical science of his day permeates his Organon. It is not too much to say, that without this great fund of medical knowledge he could not have given us the mag- nificent argument of the Organon, nor the practical instrument of the Materia Medina. Now, seeing from the commanding eminence which he occupied, as a master in medicine, how bar- ren of practical good was the medical science of the day, he was not so illogical and unjust as to denounce that which gave him this broad vision,and the benevolent hope that came with it. He did perceive that all the efforts of scientific men had failed to realize what is, after all, the great practical end of all effort in this direction, viz., a true science and successful art of thera- peutics. And he perceived and clearly showed that this failure resulted from an erroneous method of seeking for facts and rea- soning from them; in a word from misdirected observation and a mistaken philosophy. He proceeded accordingly to use the facts of which his acquaintance with medical science had pos- sessed him, to demonstrate the new science of therapeutics which he unfolded, and to make new observations in accordance with what he deemed a correct philosophy. But he never declared the ladder superfluous by which he had climbed, nor denounced the bridge which had carried him safely over his perplexities ! The Organon is strictly what its name signifies-an instrument of the rational art of healing-an expo- sition of therapeutics or that branch of medical science which concerns itself with healing disease by means of drugs, and its author assumed that those who would use it would be men al- ready versed in medical science. In four of the terse and weighty sentences which characterize this book,* Hahnemann takes it for granted, "as a matter of course/' that "every sen- * Paragraph 5 and the note. world's homceopathic convention. 43 sible physician," before applying the art of healing which he is unfolding, will first make certain investigations and take cer- tain steps, which investigations and steps really comprehend what we now comprise under the heads of etiology, semeiology, diagnosis, and hygienic management. -I need not say to this learned body that he who can investigate these points satisfac- torily, and take these measures judiciously, must be well versed in medical science. With this single assumption that his fol- lower would, as he needs must, be familiar with general medical science, Hahnemann dismissed all considerations of anything save therapeutics ; and he proceeded to show the errors of this department of medicine as it then existed. He showed that the indications for treatment were based on hypothetical assumptions of the essential nature of the disease-a matter which is of ne- cessity unknown, it being but a modification of the eternal mys- tery, Life. He showed that the uses of drugs were deduced from hypotheses concerning their intimate action ; and this not on a constant but a variable object, viz., the diseased organism. It was this unstable foundation of hypothesis in therapeutics which Hahnemann denounced, and for which he was the first to sub- stitute the " positive philosophy " based on pure experiment and exact observation, which is now universally accepted in the physi- cal sciences, the therapeutics of the old school alone excepted. In the exposition of his new philosophy Hahnemann provided for an investigation of the patient of which hypothesis should form no part of the foundation, by affirming that, for the practi- cal needs of the healer of the sick, the aggregate of the symp- toms constitutes the " principal and only condition to be recog- nized and removed by his art." The semeiologist may speculate, if he will, on the ulterior cause or the essential nature of some or all of the symptoms, but for the practical prescriber the symp- toms themselves in their totality furnish the only precise and safe indication for treatment by drugs. He was the first to establish pharmacodynamics as an independent physical science, based on observation of the effects of drugs on a constant object, the healthy human organism. I use the term pharmacodynam- ics instead of Materia Mediea, because this science-the subject of which is the relation of the healthy living organism to what- ever substance is capable of modifying it, the extension of which is limited only by the variety of substances capable of modifying the organism,-investigates the properties of all substances that have the power to change function or tissue, independently of any use which has been or may be made of them in the medical art. It properly, therefore, embraces, to use Professor Allen's 44 TRANSACTIONS OF THE happy phrase, " every noxious substance;" the word "noxious" meaning-not "nasty," as some appear to think, but-"capable of harming or injuring-that is, of modifying-healthy function or tissue." He demonstrated the law of relation between the symptoms of the sick 'and those produced by drugs on the healthy, by virtue of which law the right remedy might bo se- lected for each case, provided the science of pharmacodyamics have given us a knowledge of the required drug. He proved that the power of drugs to cure disease is not in direct propor- tion to the quantity of the drug employed, and further that a certain mode of subdivision of the particles of the drug greatly enhances the power of the preparation to modify morbid func- tions and tissues. These are the essential features of the reform in medicine, which in 1810 was represented by Hahnemann. In 1876, this representative body, speaking for thousands of practitioners, and millions of grateful adherents in every quarter of the globe, at- tests its soundness and vitality. During this period, our brethren of the old school have been most diligent in the pursuit of medical science, and we may profitably ask, what relations the departments to which they have especially devoted themselves now hold to the science which alone distinguishes us from them,-Therapeutics? This ques- tion will be discussed, in various relations, during the sessions of this Convention. I crave permission to say, for myself, a few words on one of them. Pathology, which hardly existed as a positive science in Hahnemann's day, has been diligently elaborated by ingenious and exact experimentation, until to-day it holds no mean rank among the positive sciences of observation. Must we denounce it as Hahnemann did the pathology of his day? Can we not use it? It has been held to be the criterion of a true natural science, that new discoveries, new sciences, ex- tend and enrich it; unite withit in amplifying the horizon of human knowledge and power; but never contradict or supersede it, nor are ever indifferent to it. This is an expression of the unity of true science. If, then, our science of therapeutics be not capable of adapting itself to, of dovetailing with, or making subservient to its uses any exact related physical science, is not that fact the condemnation of our therapeutics? Pathology is the science of functions as modified by disease, and pathological anatomy the science of tissues as modified by disease. Using the word symptom in its largest sense, as a modification of function, or tissue, or both, pathology is, therefore, the science of symptoms. It concerns itself with the relations of symptoms to each other world's homoeopathic convention-. 45 as individuals or classes, with the rank of different symptoms in order of time and causation, with their origin and evolution, and their relation to tissues, organs, or apparatus. To give a few examples, it deals with the relations of the symptoms of the heart and kidney respectively; of those of glycosuria and func- tional liver disturbance, or cerebral disorder, or gastric derange- ment, or dietetic error. This science of symptoms enables us to detect the dependence of symptoms upon material removable causes, such as the symptoms of syncope on a wounded blood- vessel, of intoxication on poisonous ingesta, of various disorders on injudicious modes of life, and leads us to those measures which Hahnemann supposes every ''sensible physician" will resort to before he has recourse to therapeutics proper. Finally, it enables us to detect " morbid chronic miasms," as Hahnemann calls them, as the hidden "causes of chronic disease." These are a few examples from a host that might be cited. Now, pathology, enabling us thus to trace the relations of symptoms to each other, enables us, in the first place, to follow Hahnemann's advice more extensively than was practicable in his own day, and "discover the primary cause of a chronic dis- ease," or "discern the exciting or maintaining cause of the dis- ease and take measures for its removal," as Hahnemann directed us; and, by the aid of pathology, many cases are now relegated to the domain of hygiene, which were formerly regarded as proper subjects for drug treatment. In the second place, pathology, concerning itself with the origin and relations of modifications of functions, that is, with symptoms, enables us to procure from observation of the patient a much more complete picture of the totality of the symptoms than would be possible without its aid; just as a systematic and intelligent survey of a museum gives us a more complete knowl- edge of its contents than any routine examination of it would do. Where, for example, the routine observer, getting the symptoms resulting from a diseased kidney, might from the absence of striking symptoms fail to interrogate those of the heart, or vice versa, and thus fail to get the complete totality of the symptoms, the pathologist is led, by his knowledge of the close relations of these organs in disease, to investigate more closely, with results which greatly assist his selection of the remedy. Or, the routine observer might fail to get, in a pleurisy, more symptoms than those of a pleurodynia; but the pathologist who knows the sem- blances and differences in the symptomatology of these affections, will so direct his inquiries as to bring out a totality of symptoms which should not only leave no doubt as to diagnosis, but should 46 TRANSACTIONS OF THE also point more clearly to the remedy than the others. So it appears that modern pathology, which has been assumed to stand in direct opposition to the doctrine that for the prescriber the totality of the symptoms represents the disease he is to remove, is really the prescriber's most efficient and indispensable instru- ment and aid in getting at that very totality of symptoms which he is to remove by a corresponding drug. Used in this way, as an aid in the methodical investigation of the symptoms, both of disease and of remedies, pathology, imperfect as it is, is of ines- timable value to the homoeopathist. And, taking this view of the subject, I do not hesitate to say that the strict Habneman- nian, if, with complete medical culture, he investigate and treat his case in the spirit of Hahnemann's doctrine, is the best and profoundest pathologist. But if, diverting pathology from this, its legitimate function, the homoeopathist construct by its aid a theory of the essential nature of the disease, and a theory of the essential nature of drug- effects, as that the one or the other depend on a plus or minus of some blood constituent, or on such or such a cell change, or on such or such a structural lesion, and if he draws his indications for treatment from such a theory, he introduces into his thera- peutics the same element of hypothesis against which Hahnemann protested, and in so doing he diverges from homoeopathy towards the blind uncertainty of the older therapeutics. Moreover, how- ever well grounded his hypothesis may be-when he prescribes on the basis of a pathological induction, or when he elects to regard one pathological modification of function or tissue as com- prising the sum and substance of each and every case in which it is recognized, he necessarily prescribes for a class, and is unable to observe that strict individualization which is essential to a sound homoeopathic prescription. This must always be the ease. It is especially true in the present imperfect state of pathology, which has no way of accounting for the finer subjective symp- toms that are so valuable to the individualizes* To say more on this point would be to trespass on your pa- tience and on the ground of to-morrow's discussion. When Hahnemann promulgated his reform it was received * Since this Address was delivered, my attention has been called to an essay by Ad. Lippe, M.D , entitled "The Relation of Homoeopathy to Pa- thology and Physiology." It was presented to the " Pacific Homoeopathic Medical Society of California," at its annual session, May 10th, 1870, and printed in the Transactions of that Society for 1874-76, in July, 1876.-I refer the reader also to my Essays, " Homoeopathy, the Science of Therapeu- tics," Am. Hom. Review, 111, 1863 ; and " The Relations of Pathology and Homoeopathic Therapeutics," Am. Hom. Review, IV, 1864.-C. D. world's homoeopathic convention. 47 with universal derision by the profession. What is the present attitude of our opponents towards its fundamental propositions? First. That, for the practical physician, the aggregate of the symptoms constitutes the disease. Aitken says: " It is now a received pathological doctrine that disease does not consist in any single state or special existence, but is the natural expression of « combination of phenomena arising out of impaired function or altered tissue." (1.6.) This is equivalent to Hahnemann's proposition. Second. That the only valid source of positive knowledge of the action of drugs is to be found in observations on the healthy organism is now widely conceded, and the physiological labora- tories of the old school issue every year elaborate drug provings which, though defective in points that we deem essential, are, I think, of great value to us. Third. Touching the law of cure, Similia similibus curantur, to show the absurdity of which so much logic and wit have been expended by our opponents, the latest utterance of the old school is the following by Dr. L. Brunton, the well-known English physiologist: 11 The opposite action of large and small doses seems to be the basis of truth on which the doctrine of homoeopathy has been founded. The irrational practice of giving infinitesi- mal doses, has, of course, nothing to 'do with the principle of homoeopathy, Similia similibus curantur. The only requisite is that mentioned by Hippocrates when he recommended Mandrake in mania, viz., that the dose be smaller than would be sufficient to produce in a healthy man symptoms similar to those of the disease. . . . But it is not proved that all drugs have an oppo- site action in large or small doses, and homoeopathy, therefore, cannot be accepted as a universal rule of practice." A great con- cession, truly ! It appears then that our opponents have come pretty nearly to our ground, except on the fourth point, that of the infinitesimal dose. Touching this point their denunciation of us has lost none of its bitterness. They claim to have demonstrated again and again that there is nothing in our potentized preparations. The reasoning of Thomson touching the size of molecules fur- nishes them with a welcome argument against the possibility of any drug potency existing in even our medium attenuations. And these arguments have strongly influenced many of our own school whose personal experience and observation had not com- pelled opposite convictions. But let me say that proofs of a negative in any matter which can be determined only by experi- ment, are very fallacious, and a dangerous dependence. I do not despair of seeing before many years, from some old-school 48 TRANSACTIONS OF THE authority or some non-medical investigator, a demonstration of the medicinal powers of homoeopathic potencies ; and I warn such of my colleagues as have been influenced by the arguments of our opponents, against the chagrin they will feel when they shall be outflanked on this point; when to unbelieving homceopathists shall be presented, by experimenting allopaths, a demonstration of the drug-power inherent in homoeopathic attenuations. An incident touching on the history of our Materia Medica is very suggestive in this connection. When the Nestor of Homoeopathy,* whose jubilee we celebrated here last March, and whom God spares to gladden our hearts to-day by his presence, undertook those studies of serpent-venom which have brought such honor to his name, anol such benefit to suffering humanity, he added to the effects observed from swallowing minute quantities of the venom, the effects produced by large quantities introduced into the system by a snake-bite, regarding the latter as complemen- tary to the former, and both as portions of a graduated scale of homologous effects. But many of our own school could not admit an analogy between the effects of small internal doses and of the bite. The chemists proved that saliva, or gastric juice, or alcohol render venom innocuous. Finally, it was ''proved to demonstration," in this city and India, that serpent-venom in- troduced into the stomaelf could not act. This demonstration of a negative was accepted by many of our own school, by whom the serpent-venoms were accordingly discarded as inert. Soon, however, Hermann, the physiologist, giving Curare to a rabbit whose renal arteries were tied, found death occur, and from as small a dose introduced into the stomach as would have proved fatal if introduced beneath the skin. This suggested the idea that the apparent inertness of venom in the stomach results from its slow absorption and rapid elimination, which prevent its reaching the centres on which it acts. And lately Fayrer and Brunton, studying serpent-venom under the auspices of the British government, have satisfied themselves, and unequivocally affirm that venom introduced into the stomach affects the system more slowly and gently, and therefore with a greater variety of symptoms, but in essentially the same way, and with a tendency to the same results as when introduced into the blood by a bite. Thus is the negative demonstration overthrown, and the correct- ness of our veteran colleague's induction most happily estab- lished. But in what a position do these facts leave those of our school, who, disregarding the provings of trustworthy members of their own school, disregarding and not willing to verify the * Dr. Constantine Hering. world's homoeopathic convention. 49 a posteriori evidence of cures in great numbers, cast out from their Materia Medica, Lachesis, Crotalus, and Naja, on the nega- tive demonstration of an old-school physiologist! In the same position many will stand, I think, when ingenious experiment or molecular energy shall lead a Tyndall or a Crookes to a de- monstration of the power of potentized medicaments. Such is the position of advanced thinkers of the dominant school, touching the cardinal points of the doctrine held by those who are known as homoeopaths, a name which, inasmuch as it still expresses radical differences in scientific belief, and a vital difference to the patient, in the modes of practice which it in- volves, I, for one, am not disposed to relinquish. When there shall cease to be fundamental differences in faith and practice among medical men, there will be no further occasion for dis- tinctive appellations. Ladies and gentlemen! From the. tiny spark kindled in Hahnemann's little house at Leipzig, homoeopathy has become this great beacon, illuminating every quarter of the earth ; from the solitary promulgator of the reform in Germany, her advo- cates have become the host here represented, and this by virtue of the fact that every physician who investigated and was con- vinced, exercised his inborn right to liberty of judgment. From her tiny beginnings in 1810, homoeopathy has come to have to- day her thousands of practitioners and her millions of adherents, not so much by virtue of the special cogency of the reasoning by which her claims were supported, as through the visible and per- ceptible effects of her practice upon the sick. This practical ar- gument has a just weight with the people, and in proportion to liberty of thought and action among the people and practitioners has been the rapidity of her growth. In this propaganda each practitioner was most efficient in the diligent, faithful, solitary performance of his round of duty. In caring for his business and his own interests, he was most effectually spreading a knowl- edge of the doctrines he professed. The present epoch calls us to other labors. The duty of ser- vice in public hospitals and charities, from which we have hitherto been exempt, is now falling on us by reason of our num- bers. The responsibility of medical instruction has always rested on physicians as experts. In other countries where the restric- tions of governmental boards and the privileges of corporations so sadly hinder freedom of action on the part of our colleagues, and of opinion on the part of students who would investigate our method, and join us if they had opportunity and dared, it would seem incumbent on our confreres to avail themselves of some way, however provisional and incomplete, to diffuse among the 50 TRANSACTIONS OF THE profession and instil into the young a knowledge of the truth we cherish. And it is a satisfaction to believe that the fact of this Convention has proved, if not an incentive, yet a great encour- agement to such effort in more than one European country. In our own land, where we have long had schools of our own estab- lished by our colleagues and their clients, the people are begin- ning to call on us for instructors in the universities which they have founded. We must be prepared to meet these calls and to fulfil all these duties. They require certain qualities in addition to those which suffice for the isolated practitioner ; capacity to work with others; patience to bear and forbear ; perseverance to labor persistently for what we believe to be right, and submit patiently until the right can be realized ; magnanimity to prefer the good of the whole to the triumph of our own ; in a word, we need to substi- tute esprit de corps for esprit de soi-meme. Surely Milton was right when he said : "A little generous prudence, a little for- bearance of one another, and some grain of charity, might win all our diligences to join and unite in one general and brotherly search after truth." Nor should this cultivation of a faculty for associated labor be confined by the boundaries of any single nation. The "world is our field ;" and this Convention shows that we may profitably and effectively unite our efforts with those of our most distant colleagues, for the development and advancement of the science of therapeutics. The remaining sessions of this Convention will be devoted to scientific discussion, free, I sincerely hope, from uncharitable re- flections on those of our profession who do not believe as we do. The subjects of discussion include some on which we differ widely, and some of us feel deeply. May I bespeak the largest tolerance for differences of opinion, and the completest freedom of expression. Thus only shall any of us get at Truth. For I firmly hold with Milton, that " Though all the winds of doctrine were let loose to play upon the earth, so Truth be in the field, we do injuriously to mis- doubt our strength. Let her and Falsehood grapple; who ever knew Truth put to the worst in a free and open encounter?" On motion of Dr. J. H. McClelland, the Secretary was in- structed to issue an edition of 5000 copies of the President's address, to be furnished to the members at the cost of publication. On motion, the correspondence was referred to the special com- mittee on correspondence. Dr. C. Dunham : I desire to call your attention to the meas- world's homoeopathic convention. 51 ures that have been taken by the Bureau of Organization to se- cure a full registration of those who are in attendance upon the sessions of the Convention to-day and on successive days, until our final adjournment. I beg you will comply with the request of the Bureau of Organization and give us every facility for making a complete registration; and, gentlemen, the Bureau of Organization, Registration, and Statistics, in making their first report, inform me of the presence of some of our foreign co- laborers. One of them, Dr. Clotar Muller, is a delegate from the oldest national homoeopathic society in the world, "The Central Homoeopathic Union of Germany." On motion, the Convention received Dr. Clotar Muller by rising. Dr. Muller then spoke as follows: Ladies and Gentlemen: I am conscious that this honor is not extended so much to myself as to the memory of my fatherland, which has the honor to be, thank God, "the fatherland of Hah- nemann." Praise also is due the name of my grandfather. In the name of my German colleagues I tender you my sin- cere thanks, and I assure you I shall very gladly carry.your re- gards and friendly welcome to my native country. Dr. Dunham : We also have present with us a delegate from the British Homoeopathic Society, who is known to all of us by his works. I refer to Dr. Richard Hughes, of Brighton, England. Dr. R. Hughes: It is with great pleasure that I appear before you to-day. Ever since I knew anything about homoeop- athy, about its history and its propagation, my deepest interest has been centred in American homoeopathy. I have seen it springing up here, and spreading forth its boughs to the sea and its branches to the river in this free soil and liberal air, and I have hoped much for it. The peculiar views entertained in the old country, and the influence of prejudice, is very great; and though that has its advantages in preventing new ideas from spreading too rapidly, testing new thoughts by the severest or- deal, yet it has the disadvantage, that if the new idea be true, yet be in weakness, it will be held down for a long time. In a new country there is the danger that new ideas which are not true will extend too rapidly and overspread the ground be- fore any one is aware of it; but, on the other hand, real truth has an advantage which it could not otherwise have, and in this New World homoeopathy has gained a home in which there is plenty of room to spread its truths. This must exercise great importance in determining the future of homoeopathy. You have here the material and the men best fitted to decide this question. In England we are doing our part, but we are such 52 TRANSACTIONS OF THE a little handful! You have as many physicians in the cities of New York and Brooklyn as we have in the whole of Great Britain. Homoeopathy spreads far more rapidly among the laity than among the profession in England, and all our time is occu- pied in attending to our professional calls; and while there is no lack of demand for that professional service here in America, your numbers are so great that you must have comparatively more leisure, as you have room for specialists. You also have room for students, investigators, observers, and teachers, and the very fact that you have students to teach is a great boon to you. To have students makes the teacher endeavor to teach better, and it makes him more faithful to his chosen vork. You have done great service for homoeopathy in the past, you will do greater service in the future. One word about this Convention. When I first heard it suggested four years ago I felt at once that it would be a glorious era in the history of homoeopathy, that it would certainly be a great occasion and a great success, and I made up my mind at any hazard to attend it. The British Homoeopathic Society, of which I am a member, was founded about thirty years ago, and has held its meetings regularly ever since. It includes not quite a hundred practi- tioners in England, chiefly those of London and its neighbor- hood, who are the representative men in England. It is the old- est medical society in Great Britain-I suppose comes very near being the oldest in Europe; and it now sends through us its very hearty greeting to you, with its very best wishes for the success of this Convention and the wellbeing of homoeopathy in America. Dr. C. Dunham: We also have present with us another rep- resentative of an old homoeopathic society of Germany, Dr. Al- bert Haupt, Vice-President of " The Homoeopathic Society," whom you all know by reputation. Dr. A. Haupt: I thank you very much for your kindness and respect, and accept it, not so much for myself, as for the society which I represent. It results from the union of the Saxon homoeopathic societies, which number twenty-four; the society to which I belong has a membership of 150, and the whole union a membership of 1150. I shall be very glad to tender them the kind regards of your society on my return home. Dr. Dunham: We have also with us a delegate from the Liverpool Homoeopathic Society, Dr. John W. Hayward. Dr. J. W. Hayward : I feel the honorable position in which I am placed in being called to appear before this Convention to represent the Homoeopathic Society of Liverpool, and to present the respects and good wishes of Liverpool, and of the large manufacturing and commercial cities of England. world's homoeopathic convention. 53 We have societies, not only in London, bnt in Birmingham, Manchester, Liverpool, and other large places, and, had it been possible, we should have had representatives from all of those societies. However, I take very great pleasure in presenting their best wishes to this Convention. I need not again go over the ground touched upon by my friend, Dr. Hughes, but will only say that we universally indorse his expressions, and I take this opportunity of expressing the thanks of the Englishmen who have come over the water for the cordiality of their reception. We shall return, I am quite sure, to " Old England " with the very best feelings for the profession in this country, with won- derfully elevated opinions regarding our brethren on this side of the ocean, with improved knowledge and with a high apprecia- tion of the progress of homoeopathy in America. Dr. C. Dunham : We also have with us an honored col- league, Dr. Clifton, who represents a large constituency, repre- sented neither by Dr. Hughes nor by Dr. Hayward. Dr. A. Clifton : Unfortunately for myself I am not here as the representative of any society, and when I was required at the door to write what I represented on a card which was there handed to me I wrote, Vox Populi! (Applause.) I came here as an independent member, and I feel somewhat like the hero in Gulliver's Travels, when he got to a large city peo- pled by giants; I feel as overpowered in coming to the United States as though I were only a pigmy. We have so far been treated as princes, and we feel that we shall so continue to be treated. We have inspected with much pleasure the institutions of New York city, and have come here to visit those of Phila- delphia, and to attend these meetings, after which we propose visiting some other parts of your great country. It is about twenty-six years since I first became acquainted with our worthy President, Dr. Carroll Dunham, having met him at the first Homoeopathic Congress held in Great Britain. This meeting was held in London, and at that time he told me that your medical millennium was coming, and that in ten or fif- teen years we should all be homoeopaths ; now while I have been highly gratified at the progress of homoeopathy I feel a spirit of sadness that I am unable quite to subdue, for I know that we have done so little in England in comparison with yourselves. At the same time, as Dr. Hughes has remarked, there are cir- cumstances in the old country with which you have not had to contend here. I take great pleasure in meeting now with you, and am sure I bring with me the well wishes of the people of Eng- land. I hope on returning to my home that the truths which I 54 TRANSACTIONS OF WORLD'S HOMOEOPATHIC CONVENTION. shall learn here may spring up as a living well of the water of knowledge within me, and redound to the welfare of mankind. Dr. C. Dunham : I now take pleasure in introducing Dr. Thomas Skinner, of Liverpool. Dr. T. Skinner: Ladies and Gentlemen: I am but a raw re- cruit in your line, and I feel very much like remaining silent; I would much prefer to come as the recipient of the accumulated wisdom of the past. There are hundreds here who have studied homoeopathy for a lifetime, while I have only studied its truths for a very short time. That I have made a kindly impression among you gives me the greatest pleasure, but it is beyond comprehen- sion that I should come from my native country to be over- whelmed with so much kindness. It is wonderful to note the marvellous changes and spread of homoeopathy in this country compared with its extension in either Germany or England, or anywhere else in fact, and it is a great comfort to myself and to all who have come to this country. We have already gained a great amount of valuable information from old and young, and this affords me the greatest delight; and if there were nothing else but to come here this day and listen to the just-delivered magnificent and admirable address of our President, it alone is quite a sufficient reward for our long journey. The position, the marvellously beautiful position in which he has placed pathology, is to my mind paramount to that given it by Dr. Hughes. He has developed the thought in a most re- markable way. I would not say one word against the Presi- dent's address. I desire oidy to compliment it. His handling of the subject is liberal, and I know that the sentiments he has expressed so eloquently have found a response in every heart. Dr. C. Dunham: The business of to-morrow will be the re- ception of papers relating to Materia Medicaand Therapeutics, as designated on the printed programme, together with the discussion of questions embraced in them and to which they may gave rise. The following resolution was offered and unanimously adopted: Resolved, That the most cordial thanks of the World's Homoeopathic Con- vention be conveyed by telegram by our President to Madame Hahnemann for her great generosity in placing before us to-day the bust of her illustrious husband, the founder of homoeopathy, as well as for the interest and sym- pathy she has shown in other ways. A communication from the President of the Academy of Natural Sciences was then read, inviting the ladies and gentle- men attending the Convention to visit that institution, which in- vitation was accepted, and a vote of thanks returned therefor. The Convention then adjourned for the day. DEPARTMENT OF MATERIA MEDICA. CONTENTS. The Foundations and Boundaries of Modern Therapeutics, William Sharp, M.D., F. R. 8., Rugby, England. Memoir on Arnica A. Imbert Gourbeyre, M.D.,Nice, France. Apis Mellifica H. Goullon, Jr., M.D., Weimar, Germany. Mezereum, Adolph Gerstel, M.D., Vienna, Austria. Hydrocyanic Acid, Richard Hughes, M.D., Brighton, Engl'd. Curare, Therapeutic effects Of, . . .. Paul Pitet, M.D., Paris, France. Necessity of the Study of Characteristic Symptoms, Don Thomas Pellicer y Frutos, M.D., Madrid, Spain. On the Study and Practice of Homoeopathy, David Wilson, M.D., London, England. Potencies and Doses in Tropical Climates, Jose J. Navarro, M.D., Santiago, Cuba. Survey of Medical Science, .... Conrad Wesselhosft, M.D., Boston, Mass. Discussion. THE FOUNDATIONS AND BOUNDARIES OF MODERN THERAPEUTICS. " Do something-do it soon-with all thy might; An angel's wing would droop if long at rest."-Carlos Wilcox. William Sharp, M. D., F. R. S. ANALYSIS. Introduction. Experiments with medicines on the sick-the universal practice before Hahnemann. Experiments with medicines on the healthy-Hahnemann. Foundations of modern therapeutics : 1. The local action of medicines ; 2. The contrary action of larger and smaller doses. Boundaries of these foundations: 1. They are limited to drugs ; 2. The action must be on the organ or part affected; 3. The medicine must be one which 'produces in health, in the larger doses, a similar disease in the organ ; 4. The dose must be the smaller, which produces a contrary action ; 5. The medicine must be so given as to cause, not topical, but local action; 6. The results are limited by the power of each medicine, and by the measure of life or vital power. Part I.-Retrospective. 57 58 world's homceopathic convention. Part II. Prospective. 1. To attend to the balance. Every dose to have its separate provings. The reports to be kept distinct; 2. To gain from these provings more accurate knowledge of the seat of the action, or the organs acted upon ; 3. To obtain distinct limits to the two ranges of doses of each drug which act in opposite directions ; 4. To investigate the question of infinitesimal doses ; 5. To study the Materia Medica of places and climates; 6. To discover the limits beyond which each medicine can not go in healing powers; 7. To diminish, if possible, the number of diseases which are at present incurable, by the discovery of new remedies. Conclusion. THE FOUNDATIONS AND BOUNDARIES OF MODERN THERAPEUTICS. " In order to see how a design is to be carried on, we must first know what the design is."-Jonathan Edwards. My Cosmopolitan Brethren-How shall address I you so as to interest alike every nation which you represent ? So as to be not more an European than an Asiatic or an American ? I think it is possible to do so. Patriotism is a national virtue. Science is cosmopolitan. Medicine is cosmopolitan. Alas! there is neither latitude nor longitude free from the maladies which flesh is heir to. All countries inhabited by man are afflicted with disease and death, and, therefore, all countries need the benevolent help which it may be in the power of medicine to give. Let me then speak to the heart, as well as to the understanding of every one who hears me to-day, as if I were his countryman, his neighbour, his friend, his brother. Next to the distinctions of nationality are the divisions in the medical profession. These are wider and deeper than those which separate nations. Is it possible so to speak as to win the attention of all medical ears ? Of those which are proud of their orthodoxy, as well as of those which are ostenta- MODERN THERAPEUTICS. 59 tious of their heresies ? I would fain hope that it is. The profession of medicine is an honorable, a beneficent calling; and there are in it many hearts which beat high with benevo- lent purposes. Let such hearts, on whatever side they may be ranged, listen to what I have to say-it is too weighty to be sectarian ; it is too true to belong to a party. The distressing imperfection of therapeutics is confessed by all those who are most competent to judge of it; so that the commending a reformation of it does not place me in antag- onism with any of the divisions in my profession. On the contrary, it gives me a claim upon the thoughtful attention of all. There are also divisions among the homoeopathists whom I am called upon specially to address. These divisions prove that Hahnemann left his work unfinished.-He would have been superhuman had he completed it. Hahnemann opened a new mine, but axes and hammers must resound in it many a day, before all its treasures are brought to light. And further, the materials need to be put into the furnace, that they may be cleared of impurities, and be forced into forms fit for use. Hahnemann began to dig in the field of experiments in health ; but this field must be dug over again many times, before a full harvest of fruits can be gathered from it. Temporary divisions on a subject of such novelty, extent, and complexity are inevitable; the only division which should be recognised as permanent among you, is the division of labour. Let it be your endeavour to keep in harmony with each other, and to march on together, step by step, in the investigation and maintenance of medical truth, and it may be confidently expected that all other divisions will gradually disappear. It may be hoped that the Convention we are participating in to day, may make some rough places smooth, and some crooked things straight. Notwithstanding that a large number of books and tracts have been written and extensively circulated, containing expla- 60 world's HOMCEOPATine CONVENTION. nations more or less accurate, of the modern system of med- icine, there is still much confusion of mind upon the subject, both within and without the medical profession. It cannot but follow that those who are carrying on the design of this reformation must be misunderstood and misappreciated, until the design itself is better known. And again, those who remain of the first generation of homoeopathists must not be angry, if they see a second gener- ation endeavouring to carry on the building of the temple of medicine not exactly after the first model. They must leave this generation to follow its own devices; and we must leave the generations which come after us to do the same. It is a great thing for each of us, if we can hope that we have faith- fully served our own generation. The responsibility of serving theirs will devolve upon those who follow us. Both these considerations constrain me to attempt to place the design of modern therapeutics, as it is at present apprehended, in the simplest and clearest point of view which is possible. Paet I. Retrospective. Experiments 'with medicines on the sick. Throughout all historic times, medicines-substances which are not food-have been given to the sick as remedies for their ailments. Until less than a century ago, the properties of these med- icines, or their powers of doing good, have been learned only by giving them to the sick. The bodies of the patients them- selves have been the laboratory within which experiments have been tried with every thing which could be thought to have medicinal virtues. It was natural that this should be the method first adopted. It is wonderful that it should have continued to be the only method-seeing that its success was so doubtful-for thirty centuries or more. That experiments upon the sick have been thus persevered in through nearly all past time, is so well known, that it may seem superfluous to bring forward any testimony in proof of it. But inasmuch as the concrete is always more impressive MODERN THERAPEUTICS. 61 than the abstract, and example more forcible than precept, it may be well to detain you a few moments with one witness. Shortly before Hahnemann's time, that is in 1753, Dr. George Young, of Edinburgh, published a clever and thought- ful book, containing his experiments with Opium. The lirst section is " of the methods that have been used to investigate the virtues of Opium." It concludes w'ith this paragraph: " From what has been said we may conclude . . . that the only way of knowing wdiat a medicine will do, in a jaundice for example, is by giving it to one that has that disease; even this method will be attended with many and often insup- erable difficulties: yet it is not only the best, but almost the only means of discovering the vires medicamentorum. I shall therefore pursue this method in my present enquiry into the virtues and use of Opium, by shewing in what cases and cir- cumstances I have found it to do good or harm." These experiments with Opium, in various doses, were made in about forty very different kinds of disease, and upon several cases of each disease. The general result may be anticipated ; the cases in which it did harm much exceed in number those in which it did good. It is interesting to enquire if any cause can be assigned for this surprising perpetuity of experiments on the sick. To me there is an obvious and sufficient cause in another fact which has run parallel with it. This is the unbroken succession of explanatory hypotheses which has accompanied all these experi- ments on the sick. One of the brightest endowments of the human mind is the imagination, or the faculty of setting up images in the mind. One of the most conspicuous faults of our fallen nature is its proneness to fall down and worship the images which our imagination has set up. The hypotheses or theories which have in this manner been imagined, or set up as images, to explain the action of med- icines, and which succeeding generations of physicians have made idols of, have been so powerful in their influence, that they have prevented the eyes of the mind looking round to observe whether the method of experimenting upon the sick is the only possible method or not. 62 woeld's homceopathic convention. It is true that these images have successively sunk in the quick-sands of time, or have been destroyed by the iconoclasts of succeeding generations ; but this has always been followed by the setting up of new idols, so that the blinding influence has been continued, and no one has laboured with success in any other manner, to learn the healing properties of medicines. That the action of a drug cannot be learned with accuracy on a sick person, ought to have been evident from the fact that such an experiment is a complex one. The effects of the cause of the malady are necessarily mixed with the effects of the drug, and so mixed that it is generally impossible to separate them. Dr. Young becomes alive to this difficulty before his experiments are finished. " How many ways," he says, " we may mistake the effects of the disease, or some other causes not a ie ided to, for the effects of Opium, and, vice versa, it will be easy to conceive." The fault is similar to that of the practice, which has also been universal, of com- bining several drugs together in the same prescription; Experiments with medicines on the healthy. Samuel Hahnemann has the distinguished honour of being o o the first to undertake in earnest the new method of experi- ments on the healthy. He did this laboriously; he did it perseveringly. Whatever changes in the practice of medicine may be brought about in future ages, Hahnemann can never be deprived of the honour of being the first to experiment extensively with medicines in health. With whatever indis- cretions he may be charged in his manner of handling the experiments, in the performance of them he was setting an example worthy the imitation of every member of his pro- fession. Whatever mistakes he may have fallen into in the doing of the work, in this new path he was the true pioneer, and as such he deserves the gratitude of mankind. A rich harvest was not slow to offer itself to the reaper, as the reward of his unwearied toil in this new field. Among the precious fruits which Hahnemann gathered were these :- 1. The giving of only one medicine at a time. MODERN THERAPEUTICS. 63 2. The rule for choosing the remedy, quaintly expressed in the words " Similia Similibus Curantur^ 3. The use of much smaller doses than had before been given. The first of these rules is perfect; it needs neither explana- tion nor comment. It is manifest that any connection which may exist between the effects of a drug on a healthy person, and its effects on a sick person, cannot otherwise be discovered than by giving it alone in both cases. The second is very obviously much less clear and perfect. It is a glimpse of a grand natural law, but a thoughtful man cannot avoid being conscious that this law is only partially and indistinctly seen. Hahnemann was careful to observe the symptoms produced by medicines when taken in health. He saw that they resembled those of natural disease; and by experiment he found that they acted curatively, when given as remedies for symptoms in disease which were like those which they produced in health. lienee the adoption of the expression "Similia Similibus Curantur^ The third rule, that of giving smaller doses than before, he was gradually led to adopt by finding that the ordinary doses, given according to the second rule, often aggravated the ail- ment instead of curing it. Later in his career, from the un- happy circumstances in which he was placed, he began to use what are called infinitesimal doses; a practice which has imported enormous difficulties into the whole subject, and which has been an almost insurmountable barrier against the progress of his system. From Hahnemann's experiments with drugs in health, and from his schema or arrangement of the symptoms of each drug under headings which include all parts or organs of the body, two inferences necessarily follow : First. That he believed that every drug through its "dynamic power on the vital force" * has a general action upon all parts of the body. He has enumerated under every heading symp- toms produced by each drug. * Organon of Medicine, § 16. 64 world's HOMCEOPATHIC CONVENTION. Secondly. That all symptoms which a drug produces, or may be thought to produce in the provings of it in health, 'whatever may have been the dose, are the similia of symptoms for which the drug may be given as a medicine. I think there can be no question that these were Hahne- mann's views. He was, moreover, a great iconoclast. He broke in pieces all the images which were standing in his time. This was a good work, but, alas ! there soon stood up in their places images of his own. He worshipped these images himself, and, like Nebuchadnezzar, he was for putting into a fiery furnace all who would not fall down before them. This fondness for a theory of his own was another great im- pediment to the general reception of his real discoveries. This estimate of Hahnemann's work will not satisfy his enthusiastic admirers, any more than his vehement depred- ators ; but it has been a matter of anxious care to me to give a statement of it which will commend itself to such impartial persons as are sufficiently acquainted with the facts. We are too near his time to be able to anticipate the judgment of history. I remember the invention of the kaleidoscope by Sir David Brewster. It immediately attracted attention and excited admiration. It is now rarely mentioned except as a toy for children ; but I hope its principle is not forgotten. By plac- ing two plane mirrors in a tube, at an angle of 60°, a few small pieces of colored glass in a box at one end of the tube, and the eye at the other end of the tube, geometrical figures of great brilliancy and beauty are seen. By slowly turning the box round an endless succession of such figures become visible; the same figure never being seen again. By open- ing the box the few small pieces of broken glass are seen, instead of the unceasing diversity of figures produced by them. Hahnemann's schema, by which he exhibits the symptoms produced by drugs taken in health, arranged under definite headings, is his kaleidoscope. This is a kind of symmetrical THE FOUNDATIONS OF MODERN THERAPEUTICS. MODERN THERAPEUTICS. 65 arrangement under these definite headings, every new proving produces a new figure, and this in an endless succession. There is great apparent regularity and beauty in each picture, but as the number of them increases indefinitely, and the same figure never can be reproduced, their utility becomes less and less, until it is quite lost in the resulting confusion. Hence it becomes necessary to look inside the box-to examine the pathological changes which have been the cause of all this variety of appearances. These are comparatively few in num- ber ; they have a fixed seat and a definite character ; and they are frequently reproduced. If we look back upon the early Materia Medica of Hahne- mann, and then look upon its present condition, we cannot but be struck with the disorder and ruin into which it is fall- ing. The arrangement of all the symptoms of a proving, under the uniform topographical headings which Hahnemann adopted, presented at first something like scientific precision. The symptoms manifested by the action of a drug upon the brain, the eye, the nose, the mouth, the throat, etc., could be understood and remembered; and they could be com- pared without difficulty with those occasioned by another drug upon the same organs. But how different has this be- come now I The accumulation of symptoms under each head of only a dozen medicines-and there are now hundreds of drugs which have been extensively proved-is such that a clear understanding of them, and a good remembrance of them, are alike impossible. Moreover, there is not only confusion from the multitude of symptoms ; there is still greater confusion from their intricacy and contradiction. It is clear, therefore, that it is in vain to pursue this path further ; another must be sought and found before a scientific foundation for therapeutics can be laid. The seat where the symptoms are manufactured, and the changes which have been made in its condition, must, as far as is possible, be un- derstood. In comparison with the symptoms the organs in which they originate are few ; the altered condition of these organs is also comparatively simple and stable. In this man- 66 world's HOMOEOPATHIC CONVENTION. ner a collection of facts which happen uniformly and invaria- bly under the same circumstances, and which may be a suffi- cient proof of a general fact or law, may be hopefully looked for. The pieces of glass inside the kaleidoscope must be ex- amined. If the treatment of diseases by medicines is ever to become a branch of physical science, it must be based upon facts like these. The only solid foundation therapeutics can have is that of facts which happen with uniformity and invariable- ness under the same circumstances. If this can be done Sydenham's hope would be realized, and the method of treat- ing the bodily ailments of man would become " fixed, definite and consummate." Doubtless this is a difficult task, but we are not to be deterred by difficulties. In all our future endeavors we are never to forget this, that it is only what is fixed and definite which can be reduced to science. Therefore, before therapeutics can be looked upon with satisfaction as a science, something much more defined than the mere similarity of symptoms must be discovered for its foundation. In former essays this foundation has been represented as consisting of two general facts : 1. The local action of each medicine ; that is, its action upon some parts or organs of the body in preference to other parts. To this fact the name of Organopathy has been given ; and 2. The contrary action of different ranges of doses of each drug. To this fact the name of Antipraxy has been given. Resting upon these facts as a foundation, the remedy in each case is a drug which in health acts where the seat of the disease is; which in larger doses produces in health effects similar to those of the disease ; and which in the smaller doses produces effects of the opposite kind. It would betray a want of respect for this assembly were the proofs of the truth of these two general facts to be repro- duced from former essays, where they have been given in de- MODERX THERAPEUTICS. 67 tail, and it would be impertinent to occupy its time with a description of many cases. But it may again be remarked that example is more influential than precept; so that, per- haps, it may be permitted me to give a single illustration, as briefly as is consistent with the object for which it is described. Miss II., aged 18 ; tall and stout; but pale to alabaster whiteness, and leucophlegmatic in temperament; amiable, fond of long walks and of dancing; with habitual cheerfulness. She has been suffering for some months from a persistent cough, which nothing has relieved ; with shortness of Ireath on slight exertion, such as going up-stairs, or walking on rising ground; palpitation of the heart, particularly in bed ; very considerable dropsical swelling of the left leg, ankle and foot. (The right leg is, I think, generally the first to swell in affec- tions of the liver.) Such was her condition on my first visit on December 11th, 1875. To the patient and her friends the cough, which seemed incurable, with the dyspnoea, were the alarming parts of the illness, as indicating to them disease of the lungs. To these two symptoms were added, it will be noticed, two more, palpitation and a leg without shape from anasarca. These were the four prominent symptoms-cough, dyspnoea, palpitation and dropsy-in a young person debili- tated by growing too fast, and by often exerting herself be- yond her strength. The stethoscope indicated little pulmon- ary disease, but there was a distinct bellows sound in the heart's movements, which were tumultuous, rapid and feeble. On carefully thinking over this case, it appeared to me that the origin of the disturbances, which looked formidable enough, was in the heart-this organ might, indeed, have been affected by sympathy with disease in the lungs or elsewhere -but I did not think so ; to me it was a case of diseased and weakened heart; the other ailments being results of this. A drop of the first centesimal dilution of the tincture of Digitalis three times a day was prescribed, with rest. This was taken for twelve days, from December 12th to 24th, with daily in- creasing benefit. Nothing else was given or advised. On December 28th all signs of illness had disappeared. The CASE. 68 world's homceopathic convention. cough, the dyspnoea, the palpitation, the unnatural sounds of the heart, and the dropsical swelling were gone ; and she de- clared herself to be feeling as w'ell as she could wish to do. What remedy the " totality of the symptoms" would have suggested to some of you I do not know ; but I think we are not acquainted with any other medicine which could have cured this case so rapidly and so perfectly as the Digitalis did. This case explains, better than any words of mine, how the general facts called Organopathy and Antipraxy-the local action of drugs, and the contrary action of larger and smaller doses-may be applied in the actual practice of medicine. It is quite certain that Digitalis has a direct action upon the heart. Taken in health for a time, in certain larger doses, it wrould bring about a condition of illness like that of this patient; and taken in health in certain smaller doses, it would do harm in an opposite direction. There can be no reasonable doubt of the truth of all this. On these two general facts-the local action of all drugs, and the contrary action of the larger and the smaller doses, as on firm and durable foundations, the temple of modern therapeu- tics may be securely built : We may, therefore, now proceed to consider THE BOUNDARIES OF THESE FOUNDATIONS. 1. They are limited to drugs. This question was investigated with care twenty-two years ago; nothing has appeared since, to shake the judgment which wras arrived at at that time; but much to confirm it.* To extend the foundations beyond this boundary is to place them in the condition of a navigable river overflowing its banks; by which its own usefulness is diminished, and the surrounding country is damaged. Assuredly, the phenomena of light, heat, electricity and magnetism are peculiar to themselves, and are governed by laws of their own ; and not by those which regulate the pro- ceedings of such material substances as drugs. o o * Essays on Medicine, 10th Edition. Essay VI. MODERN THERAPEUTICS. 69 The temptation, no doubt, is great to seek corroborative evidence of the action of medicines from a few experiments with these immaterial agencies, especially with galvanism ; but this is spurious help, and it is wiser to reject it. Experiments of an opposite kind may readily be appealed to by opponents, who will not be slow to avail themselves of so fair an advan- tage. Let it be remembered that electricity is not a drug that the effects which it can produce on the living body of man are very complicated, and very little understood; and, therefore, that it is best not to entangle ourselves with the additional difficulties which any reference to such effects must necessarily bring upon us. This opportunity may be taken to repeat the protest against experiments on the lower animals. To me it is obvious that such experiments are cruel and unnecessary ; and the help sought to be obtained from them is misleading and hurtful. The exceptions to this remark are very few. Moreover, let it be said once more that even experiments on the sick are not experiments by which we can discover the laws which govern the action of drugs. These must first be established by experiments on the healthy. 2. The action must be on the organ or part affected. This is one of the foundations. It is also one of its limits. It is manifest that whatever does not rest upon this foundation is outside the boundaries of it. In its practical application to the treatment of the sick, it implies that every part of the body which remains healthy or nearly so, is to be unmolested ; and that such remedies as have an action where the principal morbid conditions exist are the only ones which ought to be made use of. This direct method of treatment is an advantage to the patient beyond all price. To act remedially upon the diseased parts is to cure them in the proper sense of the word. Revul- sion and counter-irritation, that is, hoping to do good to one part of the body by making another part ill is, without doubt, a crooked and lame method of healing. 70 world's homceopathic convention. 3. The medicine given must be one which produces, in health, in the larger doses, a similar disease in the organ. This is the best form of Hahnemann's Homoeopathy. It em- braces all that is most worthy of being retained, in his rule of Similia Similibus Curantur. When the last mentioned boun- dary can be observed, and when the organ chiefly affected is ascertained, then inside this boundary all is tolerably clear and intelligible. Outside it every thing must be vague, indefinite, and unscientific. It will be long before our actual treatment of the sick can be distinctly confined within this limit; but this is the goal which should be aimed at, and the more entirely our practice is so confined, the more satisfactory and the more successful it will be. This, again, is looking at the pieces of glass inside the kaleidoscope. 4. The dose given must be the smaller, which produces a contrary action. That a certain range of smaller doses acts in health in a direction opposite to that of the action of larger doses, is a fact only recently brought to light; and it is one which is not yet generally acknowledged. Its discovery opens a new era in modern therapeutics. It is a perfect explanation of the utility of the boundary last spoken of, and of the surprising success of homoeopathic treatment. It answers the ques- tion why ? And it does this without any hypothesis or theory. It also answers the question, why Hahnemann was led to the use of the smaller doses, by observing the aggrava- tions caused by the larger ones, when these were given accord- ing to his principle. I am not yet acquainted with any facts which help to explain this contrary action. But neither do I know any which throw the least light upon the reason why drugs act as they do, in any doses larger or smaller ; or why they act at all upon the living human frame. Until such facts are discovered, let these questions remain unanswered. Do not set up an imag- inary explanation. Do not act the part of spiders, and spin cobwebs, which deserve only to be swept away. MODERN THERAPEUTICS. 71 5. The medicine must be so given as to produce not topical, but local action. The distinction between the topical and the local action of drugs is explained, I hope clearly and satisfactorily, in " Essay XXVIII:"* " It is well known that the topical application of some med- icines is followed by effects upon the part which it touches, which are very distinct from the effects produced by it on other parts, to which it seems to have been carried by the circulation of the blood, and which are meant by itsZtmZ action. The effects of a blister made of cantharides upon the skin which it touches, are very different from the effects produced upon the bladder, by the absorption of some of the particles of cantharides. The action on the skin caused by contact is the topical action; the action on the bladder, following absorption, is the local action." The topical action of drugs is not included in the laws which are the subjects of this Essay; it is not included in Homoeop- athy. But a practical remark may be permitted here respect- ing topical applications: They are of two kinds, or are made use of with two inten- tions : One is counter-irritation ; for this purpose blisters, Cro- ton liniments, Tartar emetic ointment, moxas, etc., are applied. These, as causing pain, are to be rejected. The other is for the purpose of soothing or allaying pain ; as fomentations with warm water, either simple, or with decoction of poppy heads, Chamomile, etc., ; liniments of Opium, Belladonna, etc.; also applications of Arnica or Bellis for bruises, Rhus for sprains. These are to be retained. 6. The results are limited by the power of each medicine, and by the measure of life or vital power. The two parts of this sentence are not identical or synon- ymous. Together they indicate a subject which has been little laboured or examined. And yet the cases in which it calls for attention are of frequent occurence. Those in which disease is killing the patient, because we know of no remedy which * Monthly Homoeopathic Review, January, 1876, Vol. XX., page 13. 72 world's iiomceopatiiic convention. has power to cure it, are, alas! very common; and those in which life is ebbing away, because the remedies which could have cured the disease have not been timely used, are also not rarely met with. I have lately been attending a case of each kind. In one, the disease was of three years standing when first seen. The medicine given was followed by such good effects as surprised both the patient and his wife; but it was the last fortnight of his life, and he died in spite of the relief, from vital exhaustion, without pain or struggle. In the other there was life enough, but no remedies were known equal to the occasion. On my last visit I told the nurse (a well trained and excellent one) not to give any more medicine, but to do every thing else in her power. She did not speak, but her look was one of astonishment. The patient died in two days. The near approach of death is an occasion too solemn for the officiousness of giving doses of drugs, large or small, w'hich can do no good. Part II. Prospective. The subject we now approach is the work of the future. Let us cheerfully remember the work which has been done, but let us also look hopefully forward and endeavor to obtain a clear view of the work which remains to be done ; and this with the intention, on the part of each of us, to address our- selves willingly to the immediate'and diligent performance of it. But some will object at once that the confusion and irregu- larity of the disorders of human life and health, practically forbid the attainment of any certain or precise knowledge respecting them; and prevent the adoption of any fixed rules for the treatment of them. To such persons it seems useless to engage in arduous labors which they think are sure to end in disappointment. Something must be said in answer to this objection, or what follows will not receive the attention which it deserves. Now there is both a presumption and an experience which suggest a reply. For, God the Creator and Governor of the universe is a MODERN THERAPEUTICS. 73 God of law and order. It may be presumed, therefore, that the disorderly conduct of His creatures, and the confusion of things on earth, are on the surface only ; and that, underlying all this, there is a divine method designed by infinite wisdom, and carried on by Almighty power. It may be presumed fur- ther that this divine government extends even to the derange- ments of human health, and to the means which may be used to remedy them. On these presumptions we may hopefully engage in an attempt to discover some of those laws by which medicines, as a department of remedial measures, are governed. In addition to this presumptive argument we have now one from experience. The first part of this Essay has, I think, distinctly shown that laws governing the action of medicines do exist, and that it is in our power to discover them. We will, therefore, without further hesitation, seriously and zeal- ously pursue our research. Let me repeat that only what is fixed and definite can be made use of, in the discovery of these laws ; and that greater accuracy and invariableness in the record of the effects pro- duced by experiments in health are required. The first requi- site for this is the careful proving of doses; and the fixing, as correctly as is possible, each symptom or effect following a given dose of a medicine, on the organ or part of the body to which it belongs. These points, with others of importance, deserve to be separately considered. 1. To attend to the balance. Every dose to have its separate provings. The reports to be kept distinct. It may be said with clamor that the balance has been used from the beginning ; for in all provings, the drug has been taken in a certain dose or weight. This is granted, but it will also be granted on the other side that, hitherto, no sufficient separation of the provings of different doses of the same drug has been made, nor sufficient pains taken to distinguish from each other the effects of different doses, or to establish a com- parison between them. This work of weighing, and keeping separate the experi- 74 world's homoeopathic convention. ments made with each weight, remains to be done ; and it must be voted by this assembly as urgent. Think of othei branches of physical science, and of the manner in which they have attained their present standing. Mechanical attraction operates upon matter of any kind at any distance. Astronomy became a science only when men began to 'measure these distances. Chemical attraction operates upon matter of different kinds, only at insensible distances and only upon quantities fixed by weight. Chemistry became a science only when men began to weigh these quantities. In like manner drug action takes place according to the dif- ferent kinds of drugs, and according to the different quan- tities or weights of each. Therapeutics - the giving of medicines to the sick-will become a science only when physicians begin to note with correctness, not only the drug, but the quantity or weight given in each dose. This must be done first in experiments on the healthy. 2. To gain from these provings more accurate knowledge of the seat of the action, or the organs acted upon. Nothing would demonstrate more clearly the truth of organopathy, nor render its application in practice more suc- cessful than the careful proving of doses. It has been shown in former essays that, with regard to some drugs, different doses have power to act upon different organs of the body; and Tartar emetic and Oxalic acid were given as examples. It is extremely important to ascertain what number of drugs have a similar power. For any thing that is at present known to the contrary, this may be true of all drugs; and even a law with respect to it may be discovered. This would be another step in advance, but let me again repeat that precision and invariableness in the facts observed are necessary for the establishment of a law; and that the element of weight is essential in proving the effects of medicines in health. For example : A certain dose of Belladonna will act upon the heart, and upon no other organ. A larger dose will act upon the brain in addition to the heart. MODERN THERAPEUTICS. 75 Perhaps a larger one will act upon the throat in addition to the heart and the head. Perhaps a still larger one will add to these an action on the skin. If this should be so, then the contrary or antipraxic dose will also vary according to the organ to be acted upon. These are questions and considerations which nothing can an- swer, or throw light upon, but very careful provings of doses in health. It is worse than useless to offer conjectures, or to imagine hypotheses about them, except as suggestions for new experiments; as explanations, such imaginings are a form of idolatry-the setting up of images, and the falling down and worshipping them. Facts are external to us; the offspring of God's providence. These we use, but regard with cold- ness. Theories are generated within us; the offspring of our own minds. These we love and cherish as part of ourselves. 3. To obtain distinct limits to the two ranges of doses of each drug, which act in opposite directions. It needs to be more strongly impressed upon the minds of many medical men than it has yet been, that the contrary ac- tion of the smaller doses of a drug, is their contrary action in health; and that this action, as well as that of the larger doses, is a mischief-making action. Though in a much slighter degree, it is an action disturbing to health, it produces dis- order. That it proves curative in disease is simply a practical application of the fact; it is not the fact itself. It is shown in the Essay on the action of small doses,* that the dividing line which separates the two ranges, of doses of Aconite, in its action upon myself, is somewhere between the fifth and the tenth part of a drop of the pure tincture. That which has been done for Aconite is required to be done for all drugs. There will be a difference in the results of the ex- periments made upon different individuals; but it will be pos- sible, from several separate provings, to draw an average suffi- ciently near the truth to be of the greatest practical value. It is not to be expected that a dose will be found which can * Assays on Medicine. Tenth edition. Essay XXII 76 world's homceopathic convention. do nothing, which acts in no direction. A mathematician may ask for this, but the discovery, if it could be made, would be of no use to the physician. A wedge has a stable equili- brium when standing on its base, and a mathematician will tell you that it has an unstable equilibrium on which it can stand on its thin edge ; but a carpenter will smile at the mathe- matician when he hears him say this ; because he knows quite well that to make it stand upon its thin edge, so that it shall not fall to one side or the other, is as practically impossible as it is practically useless. 4. To investigate the question of infinitesimal doses. It may surprise some of you when you are told that I have not yet arrived at the examination of this question. It is true that it presented itself to me in a very practical shape twenty- six years ago; but it soon became evident that there were other important and difficult questions which must first be answered distinctly before I should be competent to enter upon the investigation of this. Were there another quarter of a century for work before me, the hope might be entertained of undertaking it, but as that cannot be, it must be cheerfully handed down to another generation. It is a question so distinct, and so separate from all previous questions, that the answers to them which have been obtained, however plain and positive, throw no light upon it, nor do they afford any material help towards its solution. It is a question so delicate that it can be undertaken only by those who can imitate the minute care and singular skill with which Sir Isaac Newton, Dr. Young, Sir John Herschel, and Mr. Crookes have pursued their researches on light. It is a question so difficult, and so much more complex than the study of light, that if any one shall have the privilege of working out its resolution by the clear exhibition of facts, he will be placed upon the highest pedestal of science, and, doubtless, also upon no mean one of philanthropy. I venture to think that the work done in these Essays has rendered the infinitesimal dose more accessible; but it is evident from the nature of the subjects which are now MODERN THERAPEUTICS. 77 occupying our attention, under the form of work which still remains to be done, that great obstacles have yet to be removed before it is likely that this perplexing question can be success- fully answered. 5. To study the Materia Medica of places and climates. This is a chapter to be added in modern times to the ancient treatise of Hippocrates on "Airs, Watersand Places." I heartily join Dr. Adams in his praise of this book, of which he says: " Let us be thankful that the destroying hand of time has spared us so valuable a relic of antiquity; and instead of undervaluing our ancient instructor, because he shows himself ignorant of many truths which we are now familiar with, let us be grateful to him for the amount of information which he has supplied us, and for setting us an example which it must be both safe and profitable for us to follow." All who study this Treatise on " Airs, Waters and Places," will readily understand what the additional chapter on the Ma- teria Medica of places, and climates, should contain. I have long been certain that the plants, if not also the minerals, but probably both, which belong to the place of residence of the inhabitants of each country, are peculiarly fitted to be employed as remedies for the diseases to which these inhabitants are subject; and especially for such maladies as are common or prevalent in the locality. This is a subject which ought to excite the interest and stir up the industry of the medical men of every place. It should be a disgrace to them to remain in ignorance not only of the peculiarities of the air, water, and aspect or climate of the situation in which they have undertaken to attend the sick, but also of the several medicinal plants which grow around their path, and of the minerals upon which they tread. Suiter me, then, to press this subject with affectionate earnestness upon your attention ; and give me reason to hope that every one of you will go from this noble Convention determined to look around you at home ; to collect the plants, and particularly those which are most common, and to make provings of them again and again, and separate provings of 78 world's homceopathic convention. different doses, until you can use some of them for the com- monest sufferings of your own patients. 6. To discover the limits beyond which each medicine can- not go, in healing power. This is a subject which I do not remember to have seen noticed by any one. Its investigation would be of great practical value. It is much to be desired that patients should not be advised to continue taking any medicine after it has exhausted its power of doing good. " If men will intend to observe," says Lord Bacon, " they shall find much worthy to observe." Certainly it is not diffi- cult to notice wdien improvement ceases to follow the taking of a medicine. Its limit of power has been arrived at in that particular case; and if this should be observed in several similar cases, it is not doing the remedy an injustice to con- clude that its limit of power has been reached for the disease also. » The practical benefit of such observations as these would be very great. We should not then waste precious time, and incur renewed disappointments, by giving that medicine again in other similar cases; but we should go in search of some other remedy of greater power in that disease. Very possibly the next case of the kind, which comes under our care, may be treated much more successfully by a different remedy. There is a contrary error to this-that of changing the rem- edy frequently, and often without knowing why. But this is an error fallen into rather by amateur practitioners than by physicians. It is a childish and ignorant mode of proceeding which ought to be entirely avoided by educated and observing medical men. 7. To diminish, if possible, the number of diseases which are at present incurable, by the discovery of new remedies. Dr. Matthew Baillie, in one of his lectures, said this: " When I was a young practitioner I thought I had twenty remedies for every disease; now that I am an old one, I meet with twenty diseases for which I have no remedy at all." MODERN THERAPEUTICS. 79 This is very much the experience of every thoughtful physi- cian. It will certainly be ours, if we attend to the precept last given and take pains to notice the limits of each medicine in its power to do good. Under such circumstances it is imperative that we set about, with serious zeal and energy, the search after additional means of cure. At the beginning of this address the division of labour was referred to. It has its difficulties and its defects, but it is a necessity in medicine. A wide general knowledge of medicine and its collateral branches of science should be aimed at first, by every one intending to practice as a physi- cian ; after this, if the science of medicine is to be advanced, each practitioner should select for himself some limited de- partment, some single topic, on which to devote his leisure moments and his best abilities; in the hope of rendering it better known and better understood, if not to his cotempo- raries, at any rate, to his successoi s. The study of the Materia Medica should be divided between two great schools; one should undertake to render specific and accurate our knowledge of old remedies; the other should labor to give us equally specific and accurate knowledge of new ones. CONCLUSION. Gentlemen-Time admonishes me to conclude, and in few words. You are to be congratulated on the vast Held of medi- cal research which lies open before you. You will labour in it with industry and self-denial. I pray God to bless your en- deavors. For myself, the sentiment which animates me will be best expressed in the words of a medical ancestor : " I shall esteem it my greatest happiness, should it appear that in this enquiry I have done anything which may tend to promote an Art, in the advancement of which, the good of mankind is so nearly concerned." * Farewell. Rugby, March 10, 1876. * A Critical Enquiry into the Present State of Surgery, by Samuel Sharp, F. R. S., and Sui'geon to Guy's Hospital. 1751. MEMOIR ON ARNICA* A. Imbert Gourbetre. M. D., Nice, France. Introduction.-" It would without doubt be a very useful labor," said Stoll, " to make exact investigations of the active properties of Arnica." Hahnemann, in the first edition of Materia Medica Pura (1811), said that the effects of this plant upon the human body were far from being fully known. This drug is like many others; much talked of, daily used, yet little known. Some of its properties are even questioned. But is there a single drug that we thoroughly know ? The field of pharmacodynamics is immense ; the harvest is plenty but the laborers are few. I wish to-day to strike the mattock into the soil of Arnica, apropos of a case of poisoning of which I was a witness. I have another reason. There fell into my hands the article "Arnica" in the Dictionnaire Encyclcpedique des Sciences Medicates, from the pen of Dr. Fonssagriv.es. This distin- guished Professor of the Faculty of Montpellier, takes the the position of adversary to Homoeopathy. In his little way, he tries to be witty and speaks in a very unsuitable manner of the adepts of Homoeopathy. This touches me ; I must reply. Case 1.-The first of July 1874, I was called to Madame C., landlady at the Springs of Royat. This lady, multiparous, again eight months pregnant, had taken soup at 7 p. m. As she felt her stomach tired she wished to take a small glass of cu- *Addressed to the World's Homoeopathic Convention at Philadelphia. 81 82 world's IIOMCEOPATHIC CONVENTION. ragao, but mistook the bottle and took instead about two table spoonfuls of tincture of Arnica. Immediately after drinking it, she felt a burning in the throat, which persisted; five minutes afterwards violent pain at the pit of the stomach, lasting a quarter of an hour; at the same time warmth and sweat which obliged her to change her chemise. There is also some nausea. At the end of half an hour, a small stool with colic. After this painful cramp of the stomach, an almost irresistible desire to sleep follows. I arrived forty minutes after the accident. I found the patient in bed, face red, pulse frequent, skin hot, panting, complaining of nothing but sleepiness. I gave Ipecacuanha in solution, a teaspoonful every ten minutes. The burning in the throat continued only during the first quarter of an hour. From 8 to 10 p. m. the patient was seized with three other cramps in the stomach, but less severe and of shorter duration. Then she slept all night, and rose the next morning lively, complaining of nothing but sleepiness which passed off during the day. There was no other symptom, not even any notable diuresis. It might be feared that Arnica, being an emmenagogue and consequently abortive, would bring on premature labor, but it did not. This simple case drew my attention to poisonings by Ar- nica ; they are very rare. All toxicologists are silent on this point, except the Hollander, van Tasselt, who cites some au- thors, but gives nothing very new. The object of this memoir is to collect facts of poisoning by Arnica, and to contribute to its physiological and therapeutical history. While doing so, I shall answer in detail the article of Professor Fonssasrives. Action of Arnica upon the Intestinal Canal.-Some observations corresponding with the preceding ; and showing especially the action of Arnica upon the intestinal tract. Case 2.-In the month of October, 1867, a packer in the Custom House named Dumeny, aged 69 years, fell five or six metres. At first he only felt bruised all over, got up without help, and took, the same day, a dose of a decoction of thirty grammes of Arnica flowers in two glasses of water. After some minutes he had such serious symptoms that he thought MEMOIR OF ARNICA. 83 he was attacked by cholera, which was then raging at Boulogne. Violent twitchings, extreme anxiety, a feeling of constriction at the level of the attachments of the diaphragm, paleness, cold sweat, pulse small and frequent, convulsive movements in the limbs, alternating with trembling of the whole body, were the effects of this poisoning. Opium inter- nally and Belladonna rubbed upon the vertebral column gradu- ally quieted these symptoms ; but the patient could not be considered out of danger until after three consecutive days of treatment (Cazin). Case 3.-August 6, 1864, a middle aged man was brought to the hospital, who, the evening before, had swallowed about an ounce of Arnica tincture. For a short time the patient felt nothing except a burning in the throat. He had slept during the night, but the next morning, eight hours after swallowing tne tincture, a violent pain was felt at the pit of the stomach, increasing on pressure, with nausea and great weakness. Ten hours after, the patient was carried to the hospital in a state of collapse. His eyes were sunken and glassy, the pupils di- lated, insensible to light; the pulse feeble, irregular, 100 pul- sations ; the skin cold and dry; one hundred drops of the tincture of Opium were given him with some brandy ; there was a slight amelioration, which increased with the second dose; warm covers and bottles of warm water. The next day the patient quitted the hospital completely cured [Bertin., The Lancet, Nov., 1864]. Case -Madame M., 33 years, took, February 22, at 10 a. m., in order to bring on delayed menses, two cups of the infusion of Arnica, which she had made with a handful of flowers. Half an hour after, violent vomiting took place, with much congestion of the head, headache, vertigo ; and, in the afternoon, frequent diarrhoea with sharp colics; great pain at the pit of the stomach, which often made her cry out. The number of stools was so considerable that the patient could not determine how many. Between 6 and 7 p. m. she was seized with a fainting fit, so severe, that the friends sent for me in great haste. I could not see her till 8:30. I found her in a state of com- 84 world's HOMtEOPATIIIC CONVENTION. plete collapse, yet the attendants said she was already a little better. Before my arrival the face was much more drawn ; the skin cool, without sweat; pulse thready, 54. She contin- ually complained of violent pain in the stomach, which was not relieved by the application of warm cloths. I ordered a potion with a gramme of tincture of Opium, a teaspoonful every two hours; hot cloths continued. The 23d, in the morning, I found the patient still prostrate, but without pain and more revived. The skin was still re- markably cool; pulse small, 60; no stools. Tincture of Opium continued t. i. d.; quiet, and strict diet. 6:30 a. m., 24th, I was called. The patient was again seized with violent pains in the stomach; the blood she said was carried through the lungs so that thrice in succession she feared she should have a haemorrhage. The menses had ap- peared, merely a few drops ; the pulse small and slow; a liquid stool. As the Opium had been successful the first day, I ordered the same potion to relieve the pain and to quiet the blood. To relieve the pulmonary congestion, warm foot baths and sinapisms at the pit of the stomach. The pulmonary con- gestion did not re-appear, the menses did not increase, and in the evening the pains in the stomach became still more violent. I was sent for about 6 o'clock. The pulse continued very small, scarcely sensible, 60. I prescribed a centigramme of Morphine every half hour until the pain ceased. Cataplasms on the stomach. The pains ceased after the second dose, but re-appeared in the night about one o'clock, and disappeared after another dose of Morphine. The 25th, at 9 a. m., I found the patient much exhausted, but without pain, complaining only of heaviness in the head. Pulse a little more full, 80 ; rest in her bed and Morphine p. r. n. She took only one dose in the evening, after which the pains disappeared ; recovery after a few days ^Albert Schumann. Schmidt's Jahrbuch, 1868]. Case 5.-According to the journal of the Academy of Turin, a woman who was still young, having taken two cups of an infusion prepared with a pinch of Arnica flowers, and a litre of water, presented the following symptoms, half an MEMOIR ON ARNICA. 85 hour after: violent vomiting, intense headache, choleraic diarrhoea, epigastric pains and colics, general weakness, shiver- ing of the extremities, pulse very slow and very small. The cure was not complete until after twelve days of treatment with opiates. [Ferrand* Journal de Chimie Medicate* Sep- tember, 1869.] Case 6.-A man, 30 years old, thinking he was taking the elixir of angelica, swallowed 15 grammes of the tincture of Arnica. About 20 minutes after, he had a violent headache, vertigo, nausea, and vomiting ; these lasted an hour, followed by drowsiness and deep sleep. Cure did not take place until the seventh day (Ferrand, ibid). Case -Madame K., aged 20 years, drank, during the evening of February 24, 1870, an infusion of Arnica in which there was perhaps a table-spoonful of flowers, for delayed menstruation. She was taken in the night with violent vomit- ing abundant watery diarrhoea with constant desire to go to stool and excessive pain in the stomach. Continual vomiting of small quantities of a yellowish tasteless liquid, with very sharp pains. She had just gone to stool; in fact she had not quitted the vase de nuit the whole night. The extremities and the face were cold ; temperature of the skin normal, pulse full, slower. Epigastrium painful spontaneously and on pres- sure ; the rest of the abdomen not painful. Eight centigram- mes of Opium and of Ipecacuanha divided into ten powders, to take every one or two hours ; subcutaneous injection of Morphine; ice internally, application of cold compresses. Under the influence of this treatment, a cessation of vomitinof and of diarrhoea. The epigastrium is still painful on pres- sure. 26th a. m. The pains have returned during the night and are much more intense. Injection of Chlorhydrate of Mor- phia ; cataplasm. Slight amelioration. In the evening seven milligrammes of Morphine in powder. The warm cataplasms augment the pain ; the patient wishes to return to the cold applications. The pain is considerably aggravated till toward midnight when I was called. Injection of Chlorhydrate of Morphia two centigrammes. 86 world's iiomceopatiiic convention. 27th, a. m. Short sleep during the night but less pain; p. m., return of pain, eight milligrammes of morphine injected. Enema of tepid water ; night tolerable. 28th, a. m. Same condition ; p. m., pains renewed. Castor oil, injection of morphine. March 1. Menstruation abundant; moderate pain ; epigas- trium still very sensitive. Anorexia. March 4. The patient is convalescent [Medinz. Schmidt's Jahrbuch, 1870, Bd. 146]. Case 8.-The inconsiderate use of Arnica may sometimes cause very serious symptoms, such as M. Alibert recently saw at the Hospital St. Louis, in the case of a man who had been gorged with a decoction of Arnica flowers after a fall; he had obstinate vomiting, vertigo, convulsions, and these alarming symptoms could not be quieted for several days. [Biett, Dictumnaire des Sciences Medicales, 1812.]* The preceding observations give us the representation of symptoms common to a number of emeto-cathartic substances such as Veratrum, Ipecacuanha, Arsenic, Tartar, emet., etc. There is above all a group of choleraic symptoms. Here Arnica has acted chiefly on the whole course of the intestinal canal. It has still other fields of action. Action of Arnica upon the Nervous System-Tetanic Properties.-In the preceding observations we have seen remarkable nervous symptoms, such as trembling and convul- sions, mixed with the enteric symptoms ; we now give a group of symptoms belonging to the nervous system and suggesting tetanus. Case 9.-A chasseur took six glasses of an infusion made with an ounce of Arnica and a spoonful of honey to arrest the course of a tertian fever. He swallowed a glass every two hours until the time of the paroxysm. A few minutes after * In the Berliner Centralblatt f. die medic. Wissenchaften^ Nov. 1874, a case of fatal poisoning by the tincture of Arnica is given. A workman in good health swallowed, at one draught. 60 to 80 cubic centimetres of the tincture. He was immediately seized with a violent burning in the stomach, followed by colics ; he died 38 hours after, without having presented any other remarkable symptoms. At the autopsy there were marked traces of gastro-enteritis. This case is reported by Dr. Wilms. MEMOIR ON ARNICA. 87 taking the first glass, he felt a great working in his stomach ; soon it seemed to him that something rose up and pressed against his chest. Respiration was difficult; heaviness in the head followed, with dizziness, jumping in the limbs. He could not get up; he fell and was unable to stand. This lasted half an hour; each glass renewed it, but the patient 'remarked that each time it w'as less intense, the organs seemed very quickly to habituate themselves to the action of this substance. The same remedy, taken the next day but one, operated, so the patient said, more gently than the first time [Barbier, Traue de ^Latiere ^dedicate, 1837]. A thesis upon Arnica was two years ago presented to the Medical Faculty of Paris.* Although my name did not appear in it, I contributed a little to this dissertation by indicating the subject, the sources of information, the materials and the exper- iments. M. Guillemot, of Clermont-Ferrand, to-day army physician, is its author; I quote from his thesis two experi- ments which have real value. Case 10.-September 30, 1873, M. Gautier-Lacroze, student of pharmacy, took, at 4 p. m., eighteen grammes of alcoholic Arnica tincture. Five minutes after 4, his pulse fell from 70 to G4 ;' at first irregular, it soon became thready and evaded the finger. The patient experienced an unendurable precordial anguish; it seemed to him that his heart stopped and was go- ing to cease to beat; in fact, on applying the hand to the pre- cordial region, one perceived the feebleness and intermission of the cardiac contractions. His face grew pale and almost immediately a great muscular weakness followed ; his knees failed him and he felt a desire to sit down, which he could re- sist only by a strong effort of the will. There wrere fibrillar contractions of isolated muscular fascicles, especially manifest in the region of the jaws, and a sort of constriction of the temples. We follow with the finger the spinous processes of all the dorsal vertebrae. The pressure does not give rise to any phenomenon, but as the finger descends and presses on the dorsal vertebrae a lively and sudden sensation of illness is felt * Guillemot Etude sur les Prop. Physiol, et Therap. de I Arnica. Paris, 1874. 88 world's homoeopathic convention. and some involuntary jerks in the muscles of the nape of the neck and of the hack ; the head is thrown backwards, the trunk is upright. At the level of the last dorsal vertebra, the sensation of illness provoked by the pressure is so great that the patient shrinks from our observation. This rather strange localization of the pain, on a level with the last dorsal vertebra, seems to us remarkable; we will attentively study the phe- nomena which accompany it. Pressure developes pain in the waist at this point only, these pains radiate to the epigastrium ; the patient complains of suffocation, and of a sensation like a weight on the chest. These rather alarming symptoms made our friend begin to repent his temerity and aroused in us a lively anxiety, but they did not last more than twenty minutes. At 4:30 there was only a great weakness, depres- sion, paleness, a sensation of emptiness in the head, a slight trembling of the hands, some nausea, then great sleepiness. This condition lasted till evening ; at 10 p. m., the pulse was still feeble and irregular, temperature 36T8o° C.; the night was pretty good. The illness terminated the next day by some loose stools with tenesmus (Guillemot). This strange localization of symptoms of Arnica upon the spinal marrow, which struck M. Guillemot, was long ago noticed in the Ilahnemannian pathogenesy. The painful sen- sation remarked at the last dorsal vertebra perfectly coincides with the following symptoms: "375. Pain in the sacrum, as after a severe blow or fall (Hornburg). 376. Pain in the sacrum as if bruised by a blow {Id). 377. Pain in the sacrum as if something were torn in it. 378. Pain in the sacrum ; he felt lancing pains on coughing; labored respiration on walking." Hahnemann, moreover, points out many spinal symptoms, such as pains, itching, formication, from number 365 to 395. He is amply confirmed by the experiment of M. Guillemot. He was previously confirmed by Jorg in 1825. This German professor undertook to controvert Hahnemann upon different remedies. His experiments, made covertly with his pupils, ended, on the whole, in rendering homage to the founder of Homoeopathy; I will say the same of my experiments on Arsenic. There is the greatest coincidence between Dr. Jorg's MEMOIR ( N ARNICA. 89 experiments on Arnica* and the Hahnemannian pathogenesis. In two provings upon himself, Jorg experienced the spinal pains specified by Hahnemann, of which the precise seat was in the spine itself as distinguished from the muscles of the vertebral column. One of his pupils, Engler, experienced something analogous. Jorg took five grains of the powdered root, and his pupil from fifteen to forty grains of the flowers. This is an additional answer to the numerous pleasantries which have been made in high and low places on the Hahnemannian pathogeneses. If all the wags had proved the medicaments, they would have formed an entirely different estimate of Hahnemann. These gentlemen give themselves magnificent airs of skepticism and denial. I should prefer to see them ex- perimenters; they would then have better manners. The action of Arnica upon the nervous system may also take the tetanic form. Some observations demonstrating this follow: Case 11.-A soldier of the royal guard, tormented by palpi- tation of the heart and by a convulsive movement of the right arm, was put upon a decoction of Arnica. The first glass caused nausea some minutes after swallowing it; at the same moment he felt a general shuddering, the twitching reached into the limbs, even to the extremities of the fingers ; • they wTere accompanied by sensations which he could not express. There were involuntary movements of the legs; expansion of the chest was difficult; the respiratory muscles were in a state of tonic contraction. (Barbier, loc. cit.) This first observation presents a kind of local tetanus caus- ing the chest muscles to firmly contract; the next observation ^ives us a general and even fatal tetanus, o o Case 12.-Louis Meline, 2S years, tall and strong, in excel- lent health, July 21, 1849, carried too heavy a load which caused him pain in the back and oppression, without cough or spitting of blood. Ilis mother made him drink a very strong infusion of Arnica. It seems that she had put a great handful of recently dried flowers of this plant into half a litre of boiling water. Soon after, Meline felt a general agitation * Joerg. Maierialien zu einer Kunftigen Ileilmitlellehre. 1825. 90 world's homceopathic convention. which grew worse until, at the end of the fourth day, lie had a general tetanus on the right side. This state continued three days, when I was called. Uis wife and he attributed all these symptoms to the too strong infusion which he had taken seven days before. By the inspiration of chloroform, I instantly stopped the tetanus and the patient was free from suffering. These inspirations were repeated four times in two days. The symptoms disappeared during two hours the first time; the second time during only an hour; the last time for scarcely half an hour. Meline died April 1. There was no autopsy. Externally nothing indicated an injury ; but if there was one, the violent action of the Arnica must have aggravated it, and this the patient himself believed. I once saw a large dose of Arnica, taken by a young girl for a culpable object, followed by very violent abdominal pains, simulating peritonitis and complicated by general nervous agitation. In this case I was able to save the mother and the child. One of my colleagues, Dr. Grillot, observed severe vertigo lasting several hours, preventing the patient from standing or sitting, and which was due to a large dose of Arnica [Jurck, Journal des Connaissances Medico-Chirurgicales, 1853]. This case of Meline may be disputed, inasmuch as it may be said that traumatism was the cause of tetanus. Yet the agreement of this case with all the facts, and above all with the following experiments, ought to cause its acceptance as a fatal case of Arnica poisoning, in which this drug produced tetanus: Case 13.-June, 1873, we injected into the rectum of a very large dog, at 2 p. m., two grammes of tincture of Arnica diluted with water. At the end of ten minutes, this animal was seized with a great excitement; he began to frisk, to howl, to tear the ground with his paws, to roll and groan. Rectal tenesmus followed, contractions of the diaphragm, but neither stool nor vomiting. At 2:30, the animal assumed a hyena- like gait and staggered, his hind legs separating to broaden his base of support. This paresis of the hind quarters alternated with contractions which bent the animal into an MEMOIR ON ARNICA. 91 arch, and affected now one, now the other, hind paw, then both at once. Finally these contractions disappeared, so that, at 4 p. m., there was only great lassitude, standing of the hair, eye dull, groaning and hiccough; the animal at last curled itself around and went to sleep. The next day he was as usual, except some loose stools. Administered by the mouth to the same dog, the same preparation and the same dose pro- duced a very abundant foamy salivation which lasted three quarters of an hour ; there were two vomitings, the contractile symptoms were much less marked. We know what objections may be made against alcoholic tinctures administered for exper- iment. • It is very difficult to isolate the effects of the alcohol from those of the active substance. We were obliged to avoid this error by giving our dog an equal dose of alcohol for com parison. We were convinced that on this animal a dose of two or even three grammes produced only a temporary excitement (Guillemot, loc. cit). The three preceding observations go strongly to prove the tetanic effects of Arnica. In his experiments upon animals, Viborg* has noted convulsions which he does not charac- terize, tremblings and once catalepsy, with inability to stand up and general insensibility, except at the nape of the neck. Mendel [IlujelancC s Journal^ 1801] has shown that a horse, after the injection of six grains of Arnica, had paralysis of the limbs, lasting several hours. There is also an intimation of convulsions in Alibert's observation. We add that this drug causes electric-like shocks in divers parts of the body, especially in the limbs, which has been noted by Collin,f Crichton and Hahnemann. M. Fonssagrives sees in Arnica only a drug of the Strychnine order, with minimum energy. This is to not half look at things. For him, "colic with or without alvine de- jections, nausea, vomiting, constrictive headache, vertigo, shiverings, involuntary movements of the limbs, a feeling of * Viborg, Nordisches Archiv 1801 f G Ilin, Annus Medicus. | Crichton- ' Some Observations on the Medical Effects of the Lichen Islandicus and Arnica Montana" [ The London Medical Journal, 1789]. 92 world's homceopathic convention. constriction in the attachments of the diaphragm are so many symptoms which are due to the tetanic action of Arnica. In larger doses, the muscular spasms attain a convidsive de- gree. * * * The paleness of the face, the smallness of the pulse (symptoms disputed, it is true, by some authors) seem to equally indicate a tetanic action exercised in the vessels by the intermediation of the vaso-inotor nerves." It is curious to see M. Fonssagrives recognize tetanic symptoms in the nausea, vomiting, paleness of the face, etc. ; a purely fanciful interpretation. In his recent work [Principes de Therapeutique General on le Medicament etudie au point de cue Physiologique^ Posologique et Clinique, Paris, 1875] the professor, more than once, accuses the Homoeopathic School of illuminism; but what ought one to think of all the illuminations which come to us from Montpellier ? Let us return to positivism and sum up the physiology of Arnica, as it is presented to us by the preceding observations. It is to be regretted that we do not possess a larger number of toxic facts. The result of these facts is that Arnica acts prin- cipally in two distinct regions; on one side the intestinal tract, on the other the spinal nervous system, in such a man- ner as to constitute, so to speak, two forms-the enteric and the spinal. The firs'; offers us different features ; cramp of the stomach with its different degrees up to cardialgia, gastro-enteritis, cholerine: morbid conditions, which we men- tion only for comparison. Here we see in different com- binations the feeling of acridity and of burning in the prim® vim, pains in the stomach, nausea, vomiting, tenesmus, profuse diarrhoea, choleraic coldness and collapse, and, among them, some accessory nervous symptoms, such as somnolence, head- ache, vertigo, tremblings and even convulsions. The spinal form is especially characterized by convulsions, paralysis and spinal pains. The convulsions were manifested by jumping in the limbs, fibrillar contractions, twitchings, tremblings, general shivering, fixed contraction of the pectoral muscles, general tetanus of the right side and opisthotonos; these convulsions have throughout a tonic character. The paralysis is presented under the paraplegic form; impossibility of ris- MEMOIR ON ARNICA. 93 ing and standing up, muscular weakness which obliges to sit down, paresis of the hind-quarters, catalepsy with general insensibility. We have already discussed the spinal pains. We add to these vertigo, somnolence, intermittence of the heart and some rare enteric symptoms. At the end of the last century Kausch thus formulated the principal actions of Arnica: the tongue, a disagreeable taste ; the nostrils, sneezing; the stomach, qualmishness ; intestines, flatulence; and in the case of extravasated blood, re-absorption of effused fluid. Jorg, summing up his experiments, laid stress upon the enteric action of Arnica. The dominant symptoms, among most experimenters, have been cardialgia and intestinal flatulence. Leaving out the rachidian pains, one would seek in vain for symptoms of convulsion and para- lysis. This is true of the ITahnemannian pathogenesis. Be- sides the doctrine of chances, we must plead the difference of dose. Jorg did not exceed forty grains of the flowers of Arnica, or ten grains of the root in tincture or in infusion. Hahnemann's doses were much less. Those which were ad- ministered in the thirteen preceding observations were much greater, and really toxic. The history of Arnica would be very incomplete if we were restricted to the meager picture presented by M. Fonssagrives, or even to the resume of our thirteen observations. The ad- ministration of the drug with a therapeutic object has revealed more than one curious physiological property; we must profit by all these materials and proceed to a detailed analysis of the symptoms. It is as important in pharmaco-dynamics as in nosography, to note with scrupulous care every symptom which appears alone or masks other symptoms, or is remarkable for its frequence or its rarity. Enteric Action.-According to Jorg, Arnica acts upon the intestinal canal from the mouth to the inferior orifice ; let ns study its numerous actions on this tract. The experiments which the German professor made on this substance, in concert with thirteen persons, mostly his pupils, amount to a hundred; they are of great value. 94 world's homoeopathic convention. The first effect of Arnica is upon the mouth, the throat and the oesophagus; its action is nowhere better described than in the Jorg's experiments. It is always the first symptom that appears; it is produced almost immediately after swallowing the drug. Most of the experimenters experienced it and have described it under different names: sensation of burning, scratching, scratching with burning, burning smarting. One of them changed the sensation of burning; later, for scratching. Its habitual locality extended from the root of the tongue to the extremity of the oesophagus ; at times the sensation existed only in the throat. The symptom lasted from a quarter of an hour to an hour. Schneller.* Co-experimenters of the Society of Vienna, to the number of eight, experienced analogous symptoms; they have specified dryness of the mouth and of the fauces, burning of the tongue and of the throat. Kausch had already noted the disagreeable taste on the tongue. The sensation of burning is shown in our cases one and two. The experiments of Jorg and of Schneller, physicians who were far from being Homoeopaths, perfectly accord with the Hahnemannian pathogenesis, which points out the dryness of the throat, the sensation of gripping, of constriction at the palate, heat at the bottom of the throat. I callM. Fonssagrives attention to these agreements. He has frequently ridiculed the pathogeneses of Hahnemann. The Montpellier professor also speaks of "guttural acridity which sometimes accompanies the use of Arnica. We usually attri- bute this, says he, partly to an irritating material which the flowers of Arnica contain, partly to a very fine debris of the -florets of the disk of the flower, which mechanically irritates the throat." If M. F< n sag;ires had read Jorg, he would have seen that the German professor took the precaution to filter his infusions in order to disembarrass them of the plumose egrets (aigrettes) of the Arnica which the Montpellier professor wrongly confounded with the florets fleurons. This annihi- lates the mechanical explanation. Cardialgia, in different degrees, generally succeeds these sensations of burning and scratching. Zeils chr ift der K. K. Gesellschaft der Aerzte zu Wien, 1845 u. 1846. MEMOIR ON ARNICA. 95 The action of Arnica upon the stomach is remarkable ; from the first, it has been classed among emetics. Vomitus, car- dialgian cum, periculo movet, said the physicians of Breslau at the beginning of the last century, and at the close of the same century Spielman insisted upon the necessity of beginning with weak doses, because he had observed that the drug often caused nausea and cardialgia. This last symptom habitually rules the scene. It has been expressed in different ways by authors, precordial anxiety, pains, cramps of the stomach. Hahnemann, in his treatise Fragmenta de Viribus drLedicamen- iorum says : " cardialgia forsicans, convulsiva, dolor ventri-, culi, cardialgia." Later, in his ddaieria bPdica Pura, last edition, pushing analysis to an extreme, he minutely describes in fjr y symptoms (from 180 to 220) the cardialgia of Arnica. He ought to have adhered to his first statements, without encumbering his pathogenesis with a crowd of useless details. How many things in his works must be pruned; not to speak of completing I In Hahnemann's place I would have said very simply : cardialgia convulsiva, periodica, flatulenta. Arnica exactly represents cramp of the stomach and flatu- lence. The cardialgic symptom is clearly presented in cases 1, 2, 3, 4, 5, 7 of this memoir, it is, moreover, quoted by almost all the writers on Materia Medica. Stoll, who often used this drug-, was struck by it. No one has better understood and treated this point of pharinaco-dynamics ; he has even collected the effects of Arnica observed on the sick. Here is what he says with regard to his experiments in putrid fever : " multis ventriculus plus minusque dolebat aut flatu et borborygmo vexebantur . .. cardialgia etiam graviores mitigabantur, aut ex toto cessabant, ubi refractior dosis propinabatur." He remarked the relative harmlessness of arnicalcardialgiaandthe absence of all inflammatory character: " saevior etiam cardialgia ab hoc remedio excitata, qualem ab alio quocunque medicamento inductum plurimum fuissemus aversati, tanquam ex inflamma- tione natamaegris nostris proeter molestum doloris sensum nihil mali fecit." Stoll gave the Arnica a half ounce or an ounce of flowers in a 96 world's iiomceopathic convention. litre of water ; of this decoction a cnp (vasculum) every one or two hours. He insisted upon the cardialgia force " vis cardialgica" of the drug in which he recognized a specific action on the stomach and he appealed for more extended experiments in order to utilize it in therapeutics. Arnica operates with so much violence says Lewis, that few persons dare to use it {Matiere Medicale., Paris, 1775]. Collin gave an ounce of flowers in infusion : but of this Alioni says: nostrates homines hanedosim ferre nequeunt, vomi- tione, cardialgia atque anxietate excitatis. Summa mihi dosis fuit drachmarum trium atque etiam partitis sicibus exhibita {Flora Pcdemoidana^ Turin, 1785]. The doses of the Vienna school were really too strong. This is one of a thousand instances of posological obstinacy, so often a sad thing for patients. Crichton speaks of a painful sensation in the stomach, sometimes accompanied by cardialgia. We must beware, says Rademacher, of giving to irritable stomachs powerful doses of Arnica flowers, because they produce painful sensations. I made the experiment twice. I took in succes- sion three glasses of warm infusion of ten grains; I soon felt a painful sensation of twitching in the stomach, which ex- tended to the throat and lasted half an hour. Doctors who give Arnica in large doses probably ought to use less active flowers.* Jorg, in his experiments with Arnica, has fully established the fact of cardialgia for those who .justly demand direct physiological studies (etudes). Almost all experimenters have had symptoms of cardialgia in different degrees ; they have mentioned constrictive pains, as if all the walls of the stomach contracted; cramps in the stomach ; painful pressure at the epigastrium, pinchings, diggings, heartburn, burning pain; pressure changing later into cramps; sometimes con- tinual pain during one or two hours; at other times coming by attacks as periodic. If we should arrange all the symp- toms described by Jorg and his experimenters and compare this table with that of Hahnemann, we should be struck by the correspondence. Schneller and his colleagues have noted the * Rademacher, Erfahrungsheillehre. Berlin, 1852. MEMOIR ON ARNICA. 97 transient pains in the hypogastrium, in the epigastrium and in the right hypochondrium. Hahnemann several times men- tions this same hypochondrium. In two-thirds of the cases cited in this Memoir we see cardialgic symptoms; cases 1, 4 and 7 offer a very marked periodicity in the pains. In case ten, there was an unendurable precordial anxiety, a symptom remarked by the first observers of Arnica. Schutt mentions in his thesis, among the effects of the remedy, " anxietas circa praecordia insignis." Alioni, as we have seen above, puts it beside cardialgia. These painful symptoms of the stomach are accompanied by nausea and vomiting. Kausch has de- scribed only qualmishness as the sole symptom of this organ. Schutt mentions even bloody vomiting; hence Burgins and other writers on Materia Medica have recognized emetic properties in Arnica. Giacomini pretends that the cardialgias of Arnica depend only upon its mechanical action connected with the resinous element of the plant, and that they are really entirely harm- less. The mechanical explanation cannot be maintained; even if the resinous element were alone the cause, which has not been proved, the rationale would not be of more value. Arnical cardialgia is far from being always harmless, witness the observations already quoted. The doctors of Breslau saw more clearly. Besides cardialgia, the dominant symptom, there is another characteristic symptom of the action of Arnica upon the intestinal canal-this is flatulence. There are few drugs which are so flatulent (Gazogene). This symptom frequent- ly occurs in Jorg's experiments: puffing of the abdomen, at times reaching a high degree of tympanitic distension of the intestines ; frequent eructations and frequent discharge of fetid wind with tenesmus. Schneller and his colleagues have also described the eructations and the flatulence. Schutt had already mentioned ructus ; Stoll, intestinal flatus. Must we add that these symptoms are in perfect accord with the Hahne- mannian pathogenesis ? Hiccough is very similar to eructation. To illustrate this I will give an observation made by myself at Nice. In the 98 world's homoeopathic convention. winter of 1870, I attended an architect for traumatism; he had fallen from a scaffolding four metres high and was picked up much contused. Immediately carried to his house, he was made to swallow a teaspoonful of tincture of Arnica in a glass of sugared w'ater; several vomitings followed. At the same time they applied compresses of the same tincture di- luted with a certain quantity of water. Called to the patient, I prescribed Arnica' internally for two or three days; the compresses are continued a week. At the end of this time the patient is seized with a constant hiccough of the most fatiguing kind, during forty-eight hours, which seems to yield to Nux vom. Noth withstanding the fall, the appetite con- tinued good. I was led to think that I had here a pathogen- etic effect of Arnica. I had seen it mentioned only in Hahne- mann and in Sachs, who, in his article upon " Arnica," violently abuses the founder of Homoeopathy, and yet admits in this drug the property of producing hiccough.* The poi- soned dog of case thirteen also had this symptom. Perhaps Arnica exerts also a positive action upon the liver. Stoll, in giving it for putrid fevers, noticed in a great num- ber of patients that the urine was almost saffron and icteric; some had a light jaundice, which was more evident in the white of the eyes than elsewhere. This is the only comment that we possess upon this action. Was it a symptom of Arnica or of the putrid fever ? I shall not attempt to decide the question. To cardialgia and to flatulence other symptoms are some- times joined, like constipation, tenesmus and diarrhoea. In Jorg's experiments we see at one time evacuations with colic, at another time colic alone ; then painless stools and, twice, a violent tenesmus. In Schneller's, the evacuations became less frequent and more solid. Cases 3, 5 and 7 presented profuse choleriac or watery diarrhoea. Cases 1 and 10, tenesmus. Viborg saw looseness in horses only once. Nevertheless Schutt, who represents tradition, tells us that diarrhoea has often been observed, even of a bloody character. These differences of action, not taking into account individual susceptibilities, mav * Sachs und Dulk, llanduioerterbuch, der prakt. Arzneimitellehre. 1830. MEMOIR ON ARNICA. 99 depend on differences of dose. Opposite effects of the drug have been remarked by Stoll: the bowels he says were very free under the use of the decoction, while they became indo- lent under that of the flowers in their natural state. All this accords with our pathogenesis. We will close our survey of the intestinal tract, by the action of Arnica upon the urine and the genital apparatus. Lobel is the first who described the diuretic properties of this plant; then came Reneaume who, in his nomenclature, gave it the name of diuretic. Bergius and others attributed this pro- perty to it. Schutt says : " Larga diuresis." This action is met only twice in Jorg's experiments; Viborg states it once; Schneller is silent. There is no mention of it in our thirteen cases. Diuretic action is frequently pointed out in the Hah- nemannian pathogenesis; we see there even, tenesmus and dysuria. It is quite the contrary for the emmenagogic pro- perties. Except an insignificant experiment on a young girl, Hahnemann restricts himself to quoting from Meza who described the excitation of the menstrual flux. Yet the first observers insisted upon this property of Arnica. Bergius classed it among the emmenagogues. But the best proof is in popular tradition. The German synonym, Mutterwurz, given to Arnica, is only the expression of an extra-scientific experience which we should prize. Among men, Hahnemann has several times remarked an excitation of the virile organ. To sum up, cardialgia and flatulence are the two salient and characteristic symptoms of Arnica in its intestinal action. M. Fonssagrives, with his peculiar way of making articles-on "Materia Medica" for dictionaries, has been silent on this point of dynamics which so attracted the attention of Stoll. It was important to fill the professorial gap on this and many other points. Action upon the Eyes, Nose and Ears.-Arnica acts on the eyes. Collin remarked that it produced shooting pains and heat. Hahnemann described many symptoms: contraction and dilatation of the pupils (see case 3), staring, pain, burning, hot tears, slight exophthalmia. In Schneller's experiments there was dazzling and itching, also described by Hahnemann. The following important cases confirm this : 100 world's homoeopathic convention. Case 14.-A woman who had tertian fever for four months took, by medical advice, a drachm of Arnica flowers for two cups of infusion ; which caused dulness of sight. The next paroxysm was more severe. The intervening day she was well; the next day, day of fever, she took two more cups of Arnica prepared by her husband; he made the infusion too strong, it was as black as coffee; a considerable dulness of sight ensued, vertigo, trembling, anxiety, violent vomiting and diarrhoea for some hours; a long deep sleep followed, from which she awoke in good condition. The fever disappeared. [Bird. Harles s Rhein Jahrbuecher^ 1825.] Case 15. -July 16 1869, Mr. X., 66 years, gouty and suffering from an affection of the heart, suffocation, intermit- tent pulse, etc., fell violently on his knee. Although the pain was severe he was able to return home. lie had scarcely sat down when he felt a strong rush of blood to the bruised knee. Fearing the gout would seat itself there, he had himself bathed and rubbed with the pure Hahnemannian tincture of Arnica for seven consecutive hours. He also took Arnica internally. In the evening, ten hours after the fall, all pain in the knee had disappeared. In the night, symptoms declared themselves whose nature it is impossible to mistake ; sleeplessness ; frontal pain, as if the forehead were strongly congested, full of blood; pain in temples especially when coughing; pain in nape of neck, especially when standing; apoplectic vertigo; pain in the whole body as if he were lying on pebbles; bilious vomiting ; mouth cool with thirst; desire for strong drinks; blurred vision, no oppression, pulse frequent, not intermittent. The next day Mr. X. complained of serious difficulty of sight; frequent diplopia; hallucinations of vision; he could not judge of distances and saw only half an object. Intelligence and memory good ; gait uncertain, awkwardness of motion ; want of appetite, thirst, desire for strong drinks ; still slight vertigo. 18th. Does not quite well know where he is, and does not recognize the rooms he enters. He constantly sees a bright light with his left eye, which disappears on closing that eye, but reappears on closing both. He feels better in the open air. Appetite moderate ; adypsia. MEMOIR ON ARNICA. 101 This drug-illness lasted four days; slight hallucinations of vision continued for some time, which should doubtless be attributed to imperfect general health [Gailliard, Journal du Dispensaire Hahnemann, de Bruxelles, January 1870]. The former of these two cases narrates a transient enfeeble- ment of vision in two different attacks ; the second is a typical case of arnical amaurosis. This is the first time experiment has demonstrated this pharmacodynamical action ; it must be added to the still incomplete Hahnemannian pathogenesis. Collin who employed Arnica in amaurosis did not suspect that this substance might accidentally produce amaurosis. Arnica also acts upon the nose. Gesner was the first to describe its sternutatory property ; this is why he gave it the name of " Ptarmica," whence, by corruption, came Arnica. Bergius classed it among the errhines. Linnaeus says that the peasants of Lithuania smoke Arnica ; the same is said of the peasants of the Pyrenees. The sternutatory property of Arnica is traditional; witness the name of " Tobacco of the Vosges," "Tobacco of the Mountains," which has been given it. According to M. Pomiers, Arnica flowers are apt to blacken in drying; they exhale ammonia and smell like tobacco. The ptarmic property can only be explained by the continuous development of ammonia. Simple Arnica is stern- utatory ; then the alcoholic tinctures exert a manifest action on the pituitary membrane, causing many symptoms. This action is plainly shown in Viborg's experiments. Two horses, to which he had given an infusion of Arnica, had, among other symptoms, a profuse flow of nasal mucus. In three succes- sive experiments, Arnica was injected into the veins of the same animal; it had a purulent discharge each time; same result from another subject. One of Jorg's experimenters, the second day after taking two ounces of flowers in infusion, had a night's rest followed by violent epistaxis. Schneller had slight epistaxis on the right side. The other experimenters were obliged to wipe their noses frequently ; they had also a little bleeding at the nose. Hahnemann obtained many symp- toms from experiments with his pupils: swelling of nose, 102 world's HOMOEOPATHIC CONVENTION. pain, pimples, ulcers, epistaxis, coryza, sneezing. Szontagh, Professor at the University of Pesth, also mentions epistaxis in a recent pathogenesis. Arnica, the Cinchona of the poor, should it have, like Sul- phate of quinine, a manifest action upon the ear ? This seems indisputable. Hahnemann is almost the only one whose experi- ments can be quoted. He found many ear-symptoms, pain in the cartilage, heat and glowing in the lobule, pressure around the membrana tympani, shootings in the internal ear, diminu- tion and exaltation of hearing; buzzing, ringing, roaring in the ears. Prof. Szontagh notes a faint musical noise in the right ear during a whole day, with headache of the same side. As we shall see, these symptoms are confirmed by clinical use. Action on the Nervous Centres and on the Heart.- This subject has already been partially treated. It appears, from the cases cited, that Arnica produces spinal pains, para- lysis of motion and sensation ; convulsions, especially tonic, trembling and catalepsy. These phenomena have been ob- served, though rarely, in man ; likewise in an experiment on a horse and a dog. Two cases of death from Arnica poisoning are recorded; we have but a single incomplete autopsy (Dr. Wilms). The experiments on large animals ought to be re- peated. These first results seem to promise an abundant har- vest from future experiments. Many drugs, as Arsenic, Aconite, Belladonna, etc., produce on the nervous system effects analogous to those of Arnica. The progress of all these symptoms must be studied, their characteristics, order of suc- cession and the lesions of nervous centres to which they cor- respond. These facts, well observed, would be excellent con- tributions to pathology and to therapeutics. Having men- tioned these desiderata, I must speak of two important symp- toms-vertigo, drowsiness or sleepiness. Vertigo is an essentially arnical symptom. Hahnemann, in his Fragmenta de Viribus Medico,mentoram, says it has only been observed once; it is mentioned six times in the pathogenesis of the Materia Medica Para. Jorg verified it once on himself and on one of his pupils. Viborg proved it on MEMOIR ON ARNICA. 103 animals. Dr. Grillot's case is remarkable in that this symp- tom appeared isolated and perfectly outlined. It appears in Schneller's experiments and in cases 4, 6, 8, 14 and 19. Prof. Fonssagrives in his article, " Arnica," avows that vertigo constitutes one of the most constant symptoms of poisoning by this substance. It is, says he, the result of deep-seated trouble in the phenomena of muscular co-ordina- tion-a solemn phase which pretends to explain vertigo but is simply illogical, being an explanation of the fact by the fact. Besides, vertigo does not belong to only toxic-doses; it is produced by small ones. The Montpellier professor adds further : " Arnica is consi- dered by Hahnemann as the drug of vertigo and we know the extended role it plays in the puerile and inoffensive therapeu- tics of his adepts. The delicate analysis of the complete etiology of vertigo which has lately been made by Messrs Max Simon and Trousseau shows that there is no anti-vertigo medi- cament, and that the clinical treatment of this so important symptom can only rest upon an appreciation of its cause" (Fonssagrives). This attack on the Hahnemannian School by the Montpellier professor, ought to be parried. I do not speak of the great impropriety of its form, I go deeper. Since Arnica causes vertigo, it is to be presumed, without being absolutely homoeo- pathic and resting on the ground of the substitutive method, that this drug ought to be anti-vertiginous. The Homoeopathic School has never pretended that Arnica could cure all cases of vertigo ; it simply affirms that there are vertigoes curable by Arnica, as there are others curable by Sulphur, Conium, Tobacco, Belladonna, etc. The studies of Simon and Trousseau demonstrate nothing if there are not anti-vertiginous drugs; they have not, to my knowledge, reduced to naught the facts relating to Arnica and other vertigo-drugs. The partisans of the Hahnemannian reform also take into account the diverse causes which produce vertigo. They harmonize their medica- tion not only with the etiology, but also with the special features of the vertigo compared with the characteristics of the drug. M. Fonssagrives had better study his adversaries 104 world's homoeopathic convention. before judging them so hastily. He mistakes the extended role which Arnica plays in Homoeopathy.* Except in vertigo, traumatism and some cerebral affections, its employment in general is quite limited, all the more that this drug is still very imperfectly known and studied. If the Montpellier professor had told us that he had several times vainly tried Arnica against vertigo appearing under such or such circumstances, w*e should begin to take his opposition into account; but to speak thus, ex cathedra, without any object except malicious opposition is to furnish proof of " puerile and inoffensive" opinion. M. Fonssagrives ignores doubtless that as regards Arnica Hahnemann simply confirmed a popular tradition. The Ger- man people created Arnica. Among many Synonymes they gave it the name Sch™indelkraut, vertigo-herb. They had there- fore observed from very early times that this plant caused or cured this malady; perhaps they knew both the physiological and the therapeutical fact. For a long time the common people have used Homoeopathy ; meanwhile the faculty reject it. Hahnemann published two important cases of Amical ver- tigo : " A man constipated but otherwise pretty well had, from time to time, attacks of vertigo, which persisted for weeks and even for months. Aperients did no good. Knowing that Arnica caused vertigo, I gave him this root a week, constantly increasing the dose, and obtained the desired result " {Essai sur un nouveau Principe, 1796]. A year after, Hahnemann published the following case in Ilufeland's Journal: " A man, otherwise well, had for several days a headache, probably caused by a prevailing influenza. lie took for it six grains of powdered Arnica. After eight minutes, palpitation set in, so violent and alarming that he could scarcely speak ; gaze fixed *This assertion of M, Fonssagrives proves how little he has studied Arnica. I commend to him Schmidt's Jahrbuecher to convince him that Arnica plays a more extended role in allopathy, witness the numerous observat ons found there on its employment in traumatism, alcoholism, arachnitis, acute hydrocephalus, apoplexy, paralysis, chorea, deafness, amaurosis, pneumonia, pleurisy, laryngitis, hemoptysis and hematemesis, mental maladies, cholera, diarrhoea and dysentery, amenorrhea mammary abscess, gout and rheumatism ; certainly Homoeopathic literature is ten times less rich. Rueekert complains that Homoeopaths have studied Arnica too little. MEMOIR ON ARNICA. 105 and anxious, general coldness of the body, severe vertigo accompanied by anguish and anxiety." Hahnemann's first case demonstrates the therapeutic action of Arnica in this same vertigo which it produced in the second. This last case of Hahnemann brings out in relief the action of Arnica upon the heart, action little studied and little known. Other facts support it. In case ten, we have already seen cardiac feebleness and intermittence. One of Jorg's experimenters with seventy-two and eighty-four drops of tinc- ture of the root, taken on different days, had each time palpita- tions which troubled his sleep. Schneller's experiments describe very strong palpitations. Hahnemann quotes several symp- toms obtained on three of his pupils : shootings, oppression and pain of the heart, agitation, very quick then very slow movements of the heart. Although Jahr has recommended Arnica in irregular beating and in rheumatism of the heart, I do not see that this substance has often been employed in such cases. The Clinique must verify more completely the contributions of physiology. The drowsiness, which was so noticeable in case one, confirms the symptom dormituritio mentioned by Hahnemann in Fragment a d. K. M. ; he was the first to speak of it. Later, he mentioned it several times in his Materia Medica Pura. We find it again in observations of Ferrand, Guillemot and Bird. It is noticed four times in Jorg experiments, where it is produced only by an infusion of the root in a dose of from two to five grains. Schneller's experiments report agitated sleep. The more cases accumulate the more they confirm Hahnemann's statements. In the case which he quoted, the symptom dormituritio followed 7 or 8 minutes after swal- lowing the drug; it followed under the same conditions in case one ; half an hour after in Guillemot's case, an hour in Ferrand's, after some hours in Bird's, as well as in Jorg's. The drowsiness is naturally related to the deep sleep which has been several times recorded. The Arnica Exanthems.-M. Fonssagrives has skipped the consideration of the Exanthems of Arnica; to speak of them he would have had to interrogate, above all others, the " adepts 106 world's homeopathic convention. of Homoeopathy." Montpellier would think it derogatory to go to this school; yet it must do so here as elsewhere. To fill this gap left by the professor, we give a pretty complete memoir upon the exanthem-producing property of Arnica ; it will be rather minute, because the matter is little understood, especially at Montpellier. The principal authority is Hahnemann-Materia Medica Pur a ; he mentions a red spot on the gland, a little itching pimple on the prepuce, little pimples under the nose with swelling of that feature. In the third edition, the symptoms are more numerous : a pustule on the forehead (s. 64); vario- loid eruption on the cheek (s. 98); cheeks swollen (s. 100); red swelling of the right cheek (s. 103); of the left cheek (s. 106); eruptions on the lips (s. 121, 122, 123); pimple on the hand (s. 429); itching miliaria after wetting the skin with the tinc- ture (s. 504) ; besides, itching in different parts is described several times. These minutise in the Hahnemannian description, this red spot on the gland, this little pimple on the prepuce, this pim- ple on the hand, here is something that will make Professor Fonssagrives smile. What matter if Arnica is the cause of it? We shall see Hahnemann corroborated in every particular, both by Allopaths and Homoeopaths. Jorg tried upon himself and one of his sons a decoction of Arnica flowers applied on the arm; another time he tried dry flowers bound upon the limb for six or eight hours. Each time, soon after the application, burning itching ; but, after the experiment, the skin was scarcely red. In the experiments made at Vienna by a society of physi- cians, Dr. Schneller, after having taken eight grains of the watery extract of Arnica flowers, had on the lower lip an eruption of several vesicles on which scabs formed. In another experimenter, hydroa of the lips followed [Zeitschrift der K. K. Gesellschaft, 1846]. Here symptoms 82, 83, 121, 122, 123, of the Hahnemannian pathogenesis, were confirmed by German Allopaths. Case 16.-A man, aged 50 years, rubbed his wounded hand with a weak tincture of Arnica. The wound healed quickly, MEMOIR ON ARNICA. 107 but erysipelas appeared around it. Sometime after he bruised his foot; new application of the same tincture ; inflammation again appeared around the injured part. Soon after, his ser- vant was wounded. He himself prepared a tincture of Arnica and applied the first compress, to show him how it ought to be done. The next day he was seized with inflammation of the hand ; in the evening it acquired a scarlatinous redness. In short, erysipelas followed, while the servant, who had ap- plied the compresses of Arnica for several consecutive days, was exempt; consequently the patient judged that the previous erysipelas was not the effect of traumatism, but of Arnica \Atcomyr. Primordien ewer Naturgeschichte der Krankr heiten, Wien., 1851]. Case 17.-Capt. S. burned his foot slightly in June, 1853, and applied a weak solution of Arnica to it. Some days after, on mounting his horse, he rubbed off a little skin, and this wound he also treated with Arnica, two drops to a teaspoon- ful of water, a compress soaked in this mixture. Some days after, an erythematous inflammation appeared about the wound with a severe infiltration of cellular tissue. This inflammation soon extended in all directions, invading the hands, the face, the eyelids, the right ear and the right side of the neck. Dur- ing sleep, he had held his hand wrapped in a compress of Arnica, on the right side of his face. The eruption increased for three or four days, causing much itching and ending in ex- foliation. Moreover there came little blebs on the face, wrists, thighs and lower abdomen ; some of them burst. A month later, the same captain bruised his nose. He applied, with the ends of his fingers, a very weak solution of Arnica (two drops of tincture) in a large glass of water, morning and evening, to the little wound. On the following days, erysipelatous inflam- mation of the face, with inflamed eyelids. Dr. Lowder, who reports this case, says that he has seen a child of six years who had nettle-rash as soon as it smelled Arnica ^Homoeopathic Times, Nov., 1853]. In 1861, Dr. Raymond called attention to the use of Arnica considered as a cause of erysipelas. Dr. Ozanam took this occasion to publish in C Art Medical, May, 1861, three cases 108 world's homceopathic convention. of erysipelas caused by the external use of Arnica in wounds or contusions, whence he concluded that this substance may produce bulbous and phlyctenular eruption, miliary and pap- ular eruption and smooth erythema. Dr. Bayes, an English physician, says on this subject, at a later date: " The poisonous effect of Arnica is a peculiar form of ery- sipelas. One patient had this Arnica erysipelas three times. I attended her on two of these occasions. She was extremely sensitive to the Arnica. Her first two seizures were from bathing the sprained foot of a friend with Arnica lotion. On the second of these two attacks she was attended by me ; the form of erysipelas was peculiar; the hands and arms and the face, especially the eyelids, were the parts most affected. The itching was intolerable ; the skin felt rough, and like that of a patient with small-pox, as if there were a number of scattered shot under the skin ; the pulse was very weak and the tongue furred. The third attack was much more slight, affecting chiefly the lips, eyelids and forehead-; it was caused by merely sitting in the same small room in which a patient was bathing his leg with Arnica lotion." In another case which I saw, of severe erysipelas of the thigh, scrotum and penis, it was brought on by the carelessness of the patient himself, who, for a sprained knee, applied the strong tincture of Arnica, without the addition of water. He had a sharp attack, which he richly deserved, for despising the printed directions, which recommended the Arnica to be diluted with twelve times its measure of water. My own experience leads me to use the lotion weaker than this : a teaspoonful of the strong tincture to half a pint of water is abundantly strong for most cases [Bayes, Monthly Homoeopathic Review, 1866]. Messrs. Galoni and Mazzoni, of Rome {Giorn. di Roma, June, 1867], describe vesicular eruption with redness and swelling, resembling phlyctenoid erysipelas, as having followed the local application of Arnica. According to them, it com- menced by slightly raised pink points on the place rubbed, which multiplied and increased and became an infinite number MEMOIR ON ARNICA. 109 of miliary vesicles, resembling, though less in size, the erup- tion produced by Croton oil (Croton tiglium). This eruption, accompanied by tumefaction, extends beyond the points touched, and with it may appear fever proportioned to the intensity of the eruption. M. Guillemot cpiotes the two Roman physicians in his thesis and adds : u Nothing being easier than to repeat this experiment, we rubbed the posterior part of our forearm with tincture of Arnica without the addition of water. This friction, made with a well-soaked cloth, at first produced only a uniform redness ; but in five minutes, at the root of each hair, a little sharp red point appeared which soon became a little papule, umbilicated on account of the presence of the hair bulbs." We could not long continue the Arnica without making a little blood exude from each. The rubbing was repeated three times during the day. The next day the papules were sunken, but some were converted into very small pustules, others had a black scab of dried blood. During and after the operation we felt, on the points touched by Arnica and a little beyond them, a tingling similar to that which one feels when the electric brush is passed over the damp skin. This eruption, caused by a drug, ceased with its use, and was not produced when we weakened the tincture with a considerable quantity of water. We satisfied ourselves that alcohol of the same strength may produce a diffused redness or a light erythema but never a veritable eruption accompanied by the local sen- sation which we have described (Guillemot, page 21). " It is a well known fact," says Richard Hughes " that an erup- tion follows the external application in very susceptible per- sons. I have even seen it produced by the internal use of the first dilution; it consists of numerous little vesicles with an erythematous base, accompanied by much heat and itching.* * At different times, says M. Gaillard, I have observed, in patients who were accustomed to use a too strong solution of Arnica externally, an at'ack of ery- sipelas or of erythema, or of lymphangeilis, or of pruriginous eruption. I know a lady who, having twelve years before made too free use of applications of Arnica, could not inhale Arnica without having erysipelatous spots upon different parts of the body [ Journal du Dispensaire Hahnemann, de Bruxelles, 1869, p.70J. 110 world's homoeopathic convention. Dr. Bayes, quoted above, recently, at the Homoeopathic Congress at Manchester, stated some singular facts with regard to the action of infinitesimal doses of Arnica. We cpiote his words: " The patient, a banker advanced in years, was threatened with cerebral congestion, for which I prescribed Arnica. He warned me that Arnica always caused erysipelas with him. In that case, I said, I will give you such a dose as cannot possibly produce such an accident; and I ordered him the 18th dilution. Next day he had decided swelling and erysi- pelatoid rash around the mouth and affecting specially the upper lip. I have also another patient, a lady of high rank, whose sensitiveness goes even beyond this. Her husband and children, fond of field sports and, of course, consequently liable to troubles, both from fatigue and from accidents, use, by my advice, a small quantity of Arnica in their bath after an unusually tiring day ; or an Arnica lotion or compress for bruises or strains. But, under those circumstances, if they go into the same room where lady X. is, either after their bath or after using the lotion, she invariably has slight erysipelas of the face, with puffiness of both eyelids and great irritation of the skin. Her last attack of the kind was induced by her having thoughtlessly mixed a dose of a dilution of Arnica for her husband, one drop of which fell on her finger, and although she immediately washed it off, she had erysipelas in the face the next day" [Monthly Homeopathic Review, October, 1875]. Professor Fonssagrives would perhaps explain these facts by the Greek word, idiosyncrasy-a figure for the Greek word, which states the fact and does not explain it. It appears that these infinitesimal doses which they call puerile, at Mont- pellier, are not always innocuous; it appears, also, that medicinal substances may act in extremely attenuated doses. We do not claim any thing else. Case 18.- On May 16, Mrs. W., aged about 50, sprained her ankle, and had applied to it a rag saturated with pure tincture of Arnica, which produced erysipelas in the course of twelve hours. Her friends then treated her with various MEMOIR ON ARNICA. 111 remedies and wet bandages, but the inflammation was only sometimes better, then worse. On the 26th they applied a lotion of Rhus, but this made matters so much worse, that I was sent for on the morning of the 28th, and found her in very great suffering with a band of inflammation about three inches in width, and nearly encircling the ankle joint; color dusky purple, the upper part raised into large flattened blebs, the lower part slightly suppurated, the foot and leg some what cedematous ; the swelling extended several inches; the whole most exquisitely tender and appearing like a severe scald or burn, more than any thing else ; the general disturbance was very slight, except from want of sleep ; one eye was slightly inflamed and the eyelids were swollen ; a small patch of erysi- pelas on the palm of the right hand. Gave tincture Bella- donna 1st. dec. and liq. arsenicalis alternately every two hours two-drop doses [Blake, Monthly Homoeopathic Review, Sep- tember, 1874]. The same author had previously published in this journal, in 1867, two cases of erysipelas, resulting from the external application of Arnica. One of these eruptions began thus: on the left shoulder and below the axilla, were seen patches as large as the hand, formed of vesicles, from the size of a hemp seed to that of a pea, full of clear serum. The largest were umbilicated like vaccine vesicles, the smallest very glob- ular and very prominent. The vesicles lay in even rows on a smooth erythematous surface. I now come to my own cases. In 1867, I received at the baths of Royat a young staff officer of the garrison of Moulins, lie arrived the 10th of July. The 12th of June preceding, he had applied to a hydrarthrosis of the left knee a compress of pure Arnica, renewed every six hours. Two days after- wards enormous swelling of the knee, and of the thigh. About the 16th, diminution of the swelling, but appearance on the knee of an eczematous eruption, with crowded lenticular bullae, which lasted three w'eeks. The compresses having naturally touched the right knee, there wras eczema here also, less severe but quite as lasting; it was also upon the Angers of the hand which had touched the Arnica. The eruption w'as 112 world's homceopathic convention. very painful. July 12th, the knee still had some charac- teristic red spots. I obtained the following facts from one of my patients: in 1871, he was at Liege where he strained his left wrist. Swelling followed, to which he applied Arnica ; a vesicular erysipelas of the whole arm ensued, lasting three weeks. A year after, he had erysipelas of the leg, after applying Arnica to an excoriation. In 1874, a month before coming to the baths of Royat, he had toothache, his dentist advised him to use a gargle of twelve or fifteen drops of the tincture of Arnica in a glass of water; the mouth and the lips became inflamed ; a severe erysipelas of the face followed, which lasted ten days. Quite recently I saw erysipelas pro- duced on a bruised arm to which the tincture of Arnica had been applied. A number of analogous facts ought to be published in the French and foreign journals; yet I think they are rare, and this is why I have related all those which have come to my knowledge. Now, ought it to astonish us to see, in a recent journal, an article entitled " The Tincture of Arnica Condemned?" Dr. James C. White, in a communication of January 21, 1875, to the Boston Med. and Surg. Journal, made a severe attack on Arnica. lie asserts that this tincture is a veritable poison to the skin. lie relates three cases where the application of a lotion of Arnica to excoriations occasioned severe attacks of eczema ; the evil action of Arnica must be much more frequent than it seems, and if its deleterious and toxic effects are seldom stated, it is because all the perturbations, which are due to this so-called remedy, are attributed to the wound. James White does not hesitate to declare, and he does it with a conviction based upon experience, that the only agent in Arnica capable of producing a salutary effect is the alcohol which it contains. The residue is a drug not only without value, but positively injurious. Without giving to this assertion the absolute faith of the learned doctor, we ought to say that, in our practice, we have several times been surprised at the manner in which Arnica acted, and we use it with extreme reserve. Ilebra sounded long ago the funeral knell of this " Cinchona of the MEMOIR ON ARNICA. 113 poor," whose medical properties he denies. The stimulating properties of the aromatic tincture of Arnica flow'ers do not belong to Arnica proper, they result from the canella and anise which enter into its composition ; if the other portion of Arnica tincture owes, according to Dr. White, Hebra and Til- bury Fox, its meagre therapeutic properties, to the sole presence of alcohol foreign to the plant, the last day of this factitious medicine has dawned. Dangerous in certain circumstances, having no other merit except what it derives from alcohol to which it serves as vehicle, a service which simple water fulfils better, Arnica will soon disappear from the pharmacopeia. It is to the credit of Dr. White to have put this suspected agent on the index of practical medicine and to have drawn to its misdeeds the investigating eye of science [Zc Mowement Medical, March 27, 1875]. The reporter of the French journal strikes hard when he demands the exclusion, of Arnica from medical practice. If drugs must be excluded because they are injurious, all must be suppressed, inasmuch as they are active or curative solely by reason of their noxiousness. Ubi virus, ibi virtus. More fully to understand all these things which, at bottom, are tra- ditional, it would be necessary to study the Hahnemannian reform. The time for this has not yet come for the young generations educated by the State Faculties. While waiting, we dabble and babble a thousand follies in pharmacodyna- mics. To sum up, Arnica is positively a producer of exanthems, whether absorbed by the stomach or applied to the skin ; in the latter way, its action is more frequent and energetic; this is the rule for all exanthematic drugs, Arsenic, Tartar emetic, Ruta, etc. The exanthem may be eczema, urticaria, erysipelas and probably others. Erysipelas appears perhaps the most frequently. Arnica acts omni dosi. The exanthem caused by simply smelling is not surprising; there are analogous instances in pharmacodynamics. By the law of similars, Arnica ought to be a good remedy for erysipelas and other eruptions ; but clinical experiment has yet to verify this. Attomyr has brought out the value of the 114 world's homceopathic convention-. physiological fact by collecting the symptoms which relate to erysipelas, according to the Hahnemannian pathogenesis and others. In the pathogenesis of Arnica we read (s. 396): " On the side of the nape of the neck a little pimple which is the seat of lancinating pain when touched, and causes the same pain that an nicer does." Hahnemann adds in a note : " this kind of pimple, so painful to touch, with a red inflamed areola which Arnica produces in a specific manner has the greatest analogy to a furuncle or boil. Moreover, these last are cured Homoeopathically by Arnica and are prevented by this drug in those persons who are very subject to them, as experience has taught me." This statement of Hahnemann has been verified. Muller claims that compresses of Arnica, a drop of tincture to an ounce of water applied to the furuncle, resolve it in a very short time." He claims in his manual that it is the best remedy for little furuncles. Diehl cites the fact of an individual afflicted with furuncles for a year; he had had thirty when he took Arnica', which cured him in three days. Six months later, the disease had not returned! " I treated," says Teste, "apatient, thirty years old, sanguine, in whom the disposition to furuncles constituted a veritable diathesis. For whole months a great number of them appeared successively on the face, neck and shoulders; then they disappeared, giving place to an intense angina. This went on for several years. I prescribed Arnica which, in a few days, caused the throat symptoms to cease, and the furuncles, which did not exist then, have not reappeared since."! Richard Hughes quotes Hahnemann and Teste; he adds that, for his part, in the treatment of furuncles he needs only Belladonna and Sulph. In the third edition of his manual, after mention- ing Hahnemann and Teste he quotes Grauvogl, who says that Arnica in repeated doses often aborts carbuncle. Still another application. Hahnemann says: " I have seen glandular tumors produced by an infusion of Arnica flowers ; I do not * Archiv.f. die Horn. Ileilkunst. f Archiv. $ Teste. MEMOIR ON ARNICA. 115 think I deceive myself in saying that they may also cure them when given in moderate doses." This great observer wrote this in 1796, in his Etsay on a New Principle, long before broaching infinitesimal doses. In Fraymenta de viribus JMddi- camentorum, he indicates, for Arnica, glandular tumors, and in his Nateria, Nedica Pura, swelling of the sub-maxillary glands; two of his pupil-provers had prominent and very painful swelling of these glands (s. 131, 135.) Jorg, who took an attitude of contradiction to Hahnemann, and yet by his experiments has only rendered him homage, was evidently inspired by the sayings of the great master, when he wrote : " I presume the dry Arnica flowers or the moist pulp, applied to indurated glands, ought to cause their resolution or deter- mine inflammation and suppuration." Jorg ought to have cited Hahnemann who had " presumed" this fact before him. This probably caused him to commend a weak infusion of Arnica for abscess of the breast, claiming that after its use there is no relapse and that, moreover, when half developed, it aborts the abscess. Meissner, recently writing in the Deuttshe Klinik of recurrent mammary abscess in parturient women, quotes Jorg. Should we recognize in Arnica anti- purulent properties as in Silicia, Hepar sulphuris, Chamomilla etc ? As analogous, we may mention its powerful influence in the absorption of extravasated blood in the tissues; the clinique must verify this. According to Richard Hughes, ancient authors have recognized its power to arrest suppur- ation ; Dr. v. Granvogl verified this on himself. Dr. Nan- kivell saw an abscess as large as a small orange resolved by this means in ten days. It was the sequel of a severe strain \Monthly Hom. Review, Vol. XIII, p. 358]. Arnica in Traumatism.-It is curious to hear Professor Fonssagrives give his opinion on the vulnerary properties of Arnica: " The name of Panacea Lapsorum, given to Arnica by Meissner, indicates the commonness of its use after falls to obviate cerebral concussion so frequent after such accidents. It is a hackneyed remedy which mothers, especially in the North, have always at hand, and which they use, intus et extus, with a credulity to which no opposition can be made if 116 world's homoeopathic convention. the doses are not too strong. They use the tincture, and the doses are too diminutive for the least inconvenience to be im- puted to its use." There are three errors in this statement: the first is the denial, with great levity, of the value of Arnica in traumatism ; the second, the affirmation that there is not the least harm in its use, in so-called diminutive doses, which is contradicted by facts; the third is to attribute to Meissner the name of Panacea Lapsorum, which had been given, more than fifty years before, by Fehr. This last error alone proves to me that M. Fonssagrives has not taken the pains to study Arnica at its sources, which obliges me to show him some facts. It is the common people who made Arnica in Europe, as they did Cinchona in the New World. We should always make much account of popular tradition while balancing an inventory of this kind; and the inventory of Arnica in traumatism is rich enough to merit the credence of physicians, despite Montpellier and its learned cabal. Arnica was certainly unknown to the ancients. It has been wrongly claimed that it was the Alisma of Dioscorides ; the proof is, that there is no Arnica Montana in Greece, so Sibthorp says. All its origins are German; the first docu- ments date from the sixteenth century. Taber naemontanus teaches us, in his old Kraauterbuch^ that, in Saxony and in the Baltic provinces, the people call it Wolverley,* but the doctors Arnica. This name must be a corruption of the name Ptarmica, given to it by botanists on account of it sternuta- tory qualities. In Germany it is commonly named Fallkraut and also Bluttrieb, herb for falls, blood-chasing, names which traditionally express its anti-traumatic properties. Following Tabernsemontanus, in Saxony, the people use this plant for falls and external violence. They boil a hand- ful in beer ; the patient drinks it all the morning, covering himself to induce sweat. lie feels great pain in the injured * Wolverley does not come from Wol vor Leyd, "good for pain," as is claimed ; but from the Gothic Wolves-leh, which signified " cadaver," or " death of the wolf"-kill wolf. Arnica is in Germany called Wolfstod, which agrees with its toxic qualities. MEMOIR ON ARNICA. 117 parts for two or three hours ; then he is cured. Those who are uninjured feel no pain. The old botanist adds that this plant is in great vogue at Dantzic, and that it is expressly sent for from Lower Saxony. Fifty years later Schroder said, in his Pharmacopoeia (1641): " I have seen the Alsatian peasants boil Arnica in beer and drink it -with success- contra grumosum et coagulatum sanguinem." Paulli men- tions the same tradition : " Rustici in mea patria appellant Wollvorley, foite Wolaevor leyd nominandum. Illi quippe arbitrantur, id innurneris fere malis tollendis aptissimum, quod coctum ex cerevisia bibunt frequentissime, ubi ex alto decide- runt, aut alias ex violentiori motu deterius valent, et certo ex- perimento sanguinem satis valide discutere et ab iis malis ipsos preservare quae plerumque grumescentum sanguinem comitari assolent [A. Paulli Quadrlpartitum Botanicum, 1640]. The use of Arnica had, then, been long traditional in Ger- many, when Michel Fehr (1678) launched it scientifically among the ephemeral curiosities of nature; he exhibited its diverse therapeutic qualities, especially in contusions and se- quences of falls, where, according to him, this medicament had no equal. He c died attention to the fact that Arnica, so soon as taken, rushed ad locum affectum, developing there great pain and sometimes great oppression, especially when in large doses. He added, like Tabernaemontanus : " Urbi autem nulla manifesta laesio, ibi quoquenullus ab hoc assumpta dolor." Fehr's work popularized Arnica at once in the learned world. Most of the collections and treatises on Materia Medica of the last century published numerous observations of its effect in traumatism, and celebrated its vulnerary virtues. Among the theses, ad hoc, we must distinguish those of Lamarche (Halle, 1719, pries. Alberti); of Meissner (Prague, 1736); of Horfichuch (Erf., 1741, pries. Buchner); and, finally, that of Schutt (Gottingen, 1774), which has been preserved in the Sy Hoge Opusculorum of Baldinger. I extract some important pas- sages from this thesis: " In eo consentient omnes observatores, decoctum Arnicse vehementes dolores et cruciatus effecisse, ut legroti insanorum instar parietes et pavimentum radant cum unguibus. Hunc 118 world's homceopathic convention. effectum jam observavit vetula, quae Schulzio communicavit arcanum. Dicebat ilia simul, hunc effectum praesagire bonum eventum, et dolores Iios vix ultra dimidium horse saevire. . . . Constant! vero lege in loco contuso aegroti ab usu Arnicae sentiunt augmentum doloris atque cruciatus vehe- mentes, insignem anxietatem. . . . Dolorem in parte affecta auctum nuperis exemplis confirmavit etiam Schroder in ' Diss. De ingress, intest.' Adeo vehementer interdum Arni- cam stimulasse legimus ut noxios effectus viderint observa- tores. Dolores in parte affecta post usum Arnicae augebantur nonnunquam eum in modum, ut aegroti morituris similes se haberent. Non immerito igitur Arnica virosam qualitatem tribuit Linnaeus et sapienter monuit Triller delicatioribus non- nisi caute praescribendam esse Arnicam." These Arnical pains developing at the point of lesion have been stated throughout all the last century here and there in literature. " We must bear in mind," says Tissot in his Traite des Nerfs, " that the ordinary general effects of Arnica are vomiting, pretty severe distress, pain through almost all the nervous system, extending even to the extremities and mak- ing itself especially felt in the affected parts, and abundant sweats." Moreover, Crichton, the Englishman, insists upon this curious and quite constant property of Arnica to aggra- vate pain in the affected parts, or even to renew it when it had recently disappeared. Kausch says the same thing : " After an experience," says he, " inexplicable but founded on thou- sands of facts." These same pains have been described by Alibert in his Elements of Therapeutics. He treated a para- plegic woman with pulverized flowers, and soon the patient felt formication in the limbs, and pains followed by complete restoration of motion and sensibility. An old thesis, of Mont- pellier, which may find credit with M. Fonssagrives, comes to our aid-it is that of Jean-Jean. " It has been remarked," says he, " that, in the treatment of convulsive maladies, and especially in opisthotonos, the administration of this remedy is followed by pain around the umbilicus, which lasts several minutes, and which changes in a moment from one hypochon- drium to the other. Sometimes the patients feel as if a very MEMOIR ON ARNICA. 119 warm liquid were poured on the neck and ran quickly over the space between the second vertebra and the sacrum. In certain patients this sensation is repeated several times, and then they can move the head freely as well as the trunk. The urine was at times red and more copious than the bever- ages taken ; bowels moved several times in the day, and from that time all the other symptoms diminished in intensity."* In his superb contempt of Homoeopathy, M. Fonssagrives certainly has neglected to study the pathogenesis of Arnica; I must show him the agreement of the symptoms enumerated in the Montpellier Thesis with the Hahnemannian symptoma- tology. Hahnemann, as well as Professor Szontagh, has sev- eral times mentioned the umbilical pains of which Jean-Jean speaks. This sensation of a -warm liquid along the vertebral column agrees with the experiment of Gautier La Croze (Case ten) and the numerous rachidian symptoms quoted apropos of this case. Burning pains and sensation are also often noted by Hahnemann. The painful physiological action of Arnica on the injured parts is corroborated by the facility with which it produces the same pains without external injuries. All the pathogenetic experiments bring out one fact, viz. : that these pains have a peculiar character ; contusion, luxation, tearing ; in fact, the character of traumatism. Hahnemann mentions about twenty- five times this peculiar character of the Arnica pains. It is, therefore, well established by many observers-Homoeo- paths have confirmed it. It is a remarkable instance of exacer- bation pointed out, first, by Fehr, who attributed it to excessive doses. Arnica ought, consequently, to be a powerful remedy m traumatic lesions, but this is not accepted by Professor Fonssagrives who ignores the physiological, and denies the therapeutic fact; but, what matter if this double fact is incontestible ? The former is sufficiently established; it re- mains to demonstrate the latter. We have here a con- stant and almost universal observation of nearly two hundred years. The best writers on Materia Medica in the last * Aper^u sur Li nature et hs proprietes de ? Arnica [These de Montpellier, 1817]. 120 world's HOMCEOPATHIC CONVENTION. century are unanimous on this point. Fred. Hoffman, writing a dissertation on specific remedies, extolls Arnica in traumat- ism : " Ob singularem qua pollet incidentem, resolventem et discutientem efficaciam." Even in our skeptical century belief in the vulnerary virtues of Arnica has grown considerably. Homoeopathy introduced this medicament into England, where, as an anti-traumatic, it rivals Calendula. It is in the baggage of every intelligent traveler, whatever his nationality- Its popular use is a strong point in the demonstration. Medi- cal observations in our day furnish likewise an important contribution. It is easy to produce documents.* Here are two recent ones: Loffler is convinced by frequent use of Arnica that its local employment is truly curative in all lesions accompanied by sanguineous extravasations. He considers this agent as an excitant of the muscular coat of the vascular walls. He ordinarily uses the tincture of Arnica diluted in ten or twenty parts of water and has the compresses which cover the wounds frequently wet with it. Loffler is physician in chief of the Prussian army. He is author of a treatise on gun-shot wounds.f Guillemot ends his thesis " by recommending to surgeons the local use of Arnica which has been sanctioned, in the case of contusions and tearing of tissues in sprains, by an almost universal custom. It is habitually employed, with unfailing success, in the military hospital of Val-de-Grace in the surgical clinic of M. Servier he then quotes two important cases in proof. These statements are worth as much as the denial of M. Fonssagrives who adduces no experiments in contradiction. He might, indeed, have cited Garrod, who edited the last edition of the English Pharmocopocia and who made some experiments on the comparative value of Arnica and alcohol *See among others Haurowitz and Bertels [Med. Zeitung Russlands, 1844-45] Cade [Journal des Conn. Med. et Chir.1856]. Balding and Mitchell [The Lancet, 1870]. Schmidt's Jahrbuecher, Bd. 156, 1872 Homoeopathic literature more- over is very rich in facts of the same kind. f Grundzuegunde Reglen fur die Behandlung der Schusswunden im Kriege, Berlin, 1859. MEMOIR ON ARNICA. 121 in bloody extravasations. He experimented on ecchymoses such as form after cupping. In a first series, six patients were ecchymosed at the same time on each side of the sternum. Arnica tincture was applied to one side; alcohol to the other, of the same strength with the tincture, without interruption for two or three days. In one case the result was in favor of Arnica, in another of alcohol; in all the other cases there was no noticeable difference. They experimented a second time upon six patients with three or four ecchymoses on the chest. One patient was treated with Arnica; another with alcohol; nothing was done to the others. Tw'ice the result was favora- ble to alcohol; once it was equal. The ecchymoses treated disappeared rapidly, the others were longer in resolution. In a third series, the experiment was on four patients with three or four ecchymoses on the back. They wTere treated ■with either Arnica or alcohol with oil-silk applied to prevent evapo- ration. In three cases alcohol gained the ascendency over the Arnica.* Garrod's experiments were too restricted and indecisive for us to accord equality or superiority to alcohol. The problem ought to be solved by taking Arnica internally, a proceeding more rare and more effective than its external application. Its influence on pain should also have been studied. In my opinion, sceptics will never be able to establish that, in traumatism, Arnica is not of more value than alcohol. A very simple fact shows that the plant does not act only through its alcoholic vehicle: On the back of one hand let some drops of alcohol evaporate and on the other some drops of Arnica tincture; the medicament produces an en- tirely different sensation from the alcohol, a smarting sensa- tion with heat. By this means, with practice, one may even distinguish a good from a bad preparation of Arnica. Finally, can Arnica, which produces traumatic pains, deter- mine in the body sanguineous extravasations or ecchymosis ? I reply by a case which is in itself doubtful ; but it is necessary for the problem ; the last case may completely solve it. Dr. Bayes has reported the case : " I have been asked by an opponent, why we claim Arnica * Schmidt1 s Jahrbuecher, Rd. 123, 1861. 122 world's iiomceopathic convention. as being homoeopathic to bruise ? Will it produce bruise, or its similar ? I once saw this occur. A girl who was using Arnica lotion for an old sprain, came and showed me her-knee, which after having been wrapped up in an Arnica compress some days, showed every sign of bruise : it was first blackish, then changed to a greenish, afterwards yellowish hue, before it recovered. This patient supposed it was " drawing the bruise out;" but, as the sprain was of many weeks standing, even that popular hypothesis would not explain it. I do not attempt to theorize on this point, but am content to record the fact." I will imitate Dr. Bayes but I should not be at all surprised if Arnica had the power of producing sanguineous extravasa- tions in the tissues of the human body. There are strong presumptions in its favor from facts already known. Epistaxis, diarrhoea, sanguineous vomiting, caused by Arnica, have been considered ; we must add hemoptysis. Collin described blind hemorrhoids. The Viennese experimenters noted the swelling of the hemorrhoidal vessels; add to this the emmenagogue properties of the drug. Schutt mentions, in his thesis, a case by Dr. Dilthey who had seen a red sweat appear on the chest under the influence of Arnica. Schutt also says: " nonnunquam ex parte afEecta sanguis erumpit." Trinks mentions hematuria. In Alberti's Lexicon there is reference to a case with the title : Arnica hmmorrhagias con- citat. Thus Arnica may be classed with some hemorrhage- inducing drugs like Mercury, Ipecacuanha, Arsenic, etc. I have given a complete history of Arsenic * in this connection and have demonstrated that it produces in the interior of tissues, brain, heart, muscles, etc., true ecchymoses and even numerous petechise in the skin. If we show, later, that Arnica produces sanguineous extravasations, the law of similars will completely and clearly embrace the region of traumatism treated by this substance. Nothing is easier to verify in the poisoning of dogs with a good alcoholic tincture. Therapeutic Applications.-" To sum up," says M. Fonssa- grives, " a medicament useful to arouse the forces of the econ- * Action of Arsenic on the Skin, Chap, X. ; on the Heart, Chap. V. MEMOIR ON ARNICA. 123 omy, to second the action of tetanic drugs in the treatment of the different paralyses, probably advantageous in certain forms of typhoid fever and dysentery; such is the real position which Arnica holds." This summary in three points is very meagre. M. Fonssagrives is not a good accountant. Arnica has other important qualifications which he does not suspect. To say that Arnica arouses the forces of the organism, is one of those vague statements of which we owe many to Montpellier and other places. As much might be said of almost all medicaments. In pharmacodynamics it is of the first importance to be explicit. That Arnica is adjuvant to tetanic remedies is a mere hypothesis. M. Fonssagrives does not ask whether this adjuvant is not rather antagonistic, as Opium is to Belladonna, as are generally all the medicaments which have a great similarity of action. Arnica is the anti- dote of Ignatia, and, according to Teste, of Cocculus, two drugs essentially tetanic. M. Fonssagrives will do well to dis- trust all these adjuvants; and, moreover, what is the use of this absurd polypharmacy ? Montpellier continues to live by it, but it is a deplorable life. In remembrance of Stoll, Fons- sagrives declares Arnica advantageous in certain forms of typhoid fever and dysentery. In view of its physiological properties, the drug ought to have been more successful in the hands of the immortal Viennese physician than all other medications in use up to that time. But Arnica could not be his sole remedy; it is applicable only under given circum- stances Let us follow Professor Fonssagrives in his rash affirma- tions : " Arnica," says he, " has greatly fallen, at least among us, from the therapeutic importance formerly attributed to it and which is shown by the somewhat confused list of maladies to which it was applied. To say to-day, with Murray, that Arnica is useful in gout, in rheumatism, in suppression of lochia, in convulsions, paralysis, intermittent fevers, etc., is to enlarge beyond measure its practical application, and naturally leads to the denial of the good it contains. Thus we encum- ber therapeutics and engender skepticism." Whose fault is it if, in France, Arnica and so many other 124 world's homceopathic convention. remedies have declined in therapeutic importance, if not that of the deplorable state of official instruction in pharmacodyna- mics? This instruction rejects homoeopathy, that is to say, the physiological study of drugs, which is the only means of saving it from the numerous errors which it propagates I M. Fons- sagrives is also implicated in this anti-scientific conspiracy. Is he sure, on the other hand, that therapeutics ought to be disen- cumbered of all the applications of Arnica indicated by the numerous authors who figure in Murray ? Assertion without proof. Contradictory cases would be proof; there are none. It is a signal mistake thus to destroy traditional symptoms with the stroke of a pen ; it is to deprive ourselves of the legacy they offer us. All this I must contradict by rebuilding the therapeutic history of Arnica. One part has already been done. Its vulnerary properties have been discussed at length. As to exanthems, we have shown its use in acute affections of the skin-like erysipelas, etc. ; cures of furuncles, tumors and mammary abscess, have also been discussed. This remedy acts principally upon the muscles and the cellular tissue. Hence it is that of the different acute affections of the skin, that which it produces, and which it cures, with the most certainty, is the furuncle. Hence also that it is more appropriate to the treatment of phlegmonous erysipelas and of deep burns, than to that of simple erysipelas (?) and superficial burns (Teste). The same author adds that Arnica frequently cures acne. Clotar Muller recommends it in the erysipelas of the new-born, because, he says, the malady is almost always due to wounding and inflammation of the umbilical cord. He also advises the same remedy in substance and externally applied in chilblains [Die Homoeopathic, Leipsic, 1854]. Arnica has even been regarded as anti-purulent. As regards the nervous system we have seen that Arnica convulses and paralyzes. Since M. Fonssagrives concedes to it only a tetanic action, which it is impossible to reconcile with all its physiological and therapeutical powers, how is it that he has passed in silence its application in tetanus ? Collin employed it successfully in this malady; Stoll advised it. M. Fonssagrives quotes the Spanish physician Escolar with regard to hemeralopia treated MEMOIR ON ARNICA. 125 by Arnica ; but this physician, in the same article, also gives a formula for antitetanic pills made with Arnica.* Was the Montpellier professor afraid to mention an application favora- ble to the Homoeopathic principle ? A priori, in virtue of its physiological properties, Arnica ought to be a remedy for tetanus as well as Arsenic which has already proved so ; as well as Aconite and Belladonna, all tetanus-producing drugs, not to speak of Nux vom. and Ignatia. Arnica flowers, said Vitet, far from irritating the nervous system, often quiet many convulsive maladies. They usually combat St. Vitus's dance, and up to this moment no remedy has been proposed which acts with more efficacy against this malady [Matiere Medicate, 1803]. J. Frank also says that Arnica is one of the best remedies against chorea. These, I think, are the only authors who have spoken thus of this remedy; there is nothing in homoeopathic literature on the subject. It would be important to verify this application. Stoll proposed to try Arnica for epilepsy. I think there are some cases in support of this, especially for traumatic epilepsy. This question of convulsions is naturally completed by that of paralysis with which it is often associated. Is it surprising that Arnica may be useful in paralysis since it is a paralysis- inducing agent ? Collin reports twenty-eight cases of paralysis cured by Arnica flowers. He shows that the pains, twitchings, tinglings which the subjects feel in the part affected are un- equivocal signs of the action of the remedy and of its efficacy. Paralysis is often symptomatic of apoplexy; Arnica has been frequently used in this malady also. Carl Hencke, in 1873, published, in the Ally. Hom. Zeitung, a long memoir in which he summed up the diverse employments of Arnica in Homoeo- pathy. In this collection of cases we see several instances of apoplexy and cerebral concussion happily treated. Thielman employed it with success.f Arnica seems to have rendered real service in arachnitis and acute hydrocephalus. Hanner succeeded with it in a case * Bulletin de Therapeutique, 1852. f In Gilded s Palsy, 12 grammes in 200 grammes of water, a teaspoonful every two hours. 126 world's iiomceopathic convention. of arachnitis with effusion, by continuing the remedy several weeks.* Meissner, in a treatise on the diseases of children, quotes Portenschlag who rejects calomel in acute hydroce- phalus, and prefers Arnica flowers as facilitating reabsoiption. Neumann says he obtained the most remarkable results from Arnica infusion in the beginning of acute hydrocephalus.j- Van der Kolk recognised its great value in idiopathic uremia with tendency to feebleness or paralysis. Huss employed it in chronic alcoholism; he specifies the indications at length. The alienists have made great use of it. In dementia, according to Guislain, Arnica is sometimes useful in the passage from the acute to the chronic state; in general paralysis it gives repose. Leidesdorf successfully utilized it in incoherence of ideas accompanied by involuntary stools and urine. In the Dutch Asylum of Merenberg it is employed against the tendency to paralysis; it has shown itself very useful there in the weakness and exhaustion following onanism.$ M. Fonssagrieves doubts the virtue of Arnica in amaurosis ; he holds by Vacca-Berlinghieri who declares these properties apocryphal, yet the physiology of the remedy favors its appli- cation. The facts adduced, above all Dr. Gailliard's case, prove its manifest elective affinity for the eyes, and in this regard rank it with Belladonna. Collin cites nine cases of amaurosis cured by Arnica. Several favorable cases exist in homoeopathic literature, especially of traumatic amaurosis (Hencke). It is a matter for investigation with the aid of the ophthalmoscope. Thummel published a case of grave con- junctivitis cured by the infusion. Neumann claims to have completely cured cataract by continued use of Arnica infusion and collyria. We must also remember, in this connection, that Cade doubled his success in operating on cataract by using Arnica [Journal des Conn. Med. Chirurgicales^ 1856]. The Homoeopath, Grauvogl, makes the patient swallow some drops of the tincture before the operation, which prevents the * Journal Kinder krankheiten. f Bemerkungen ueber die gebrauchl. Arzneimittely Berlin, 1840. J Schmidt's Jahrbuecher, 1851 and 1860. MEMOIR ON ARNICA. 127 development of traumatic fever ; then he gives three or four doses, third dilution, to hasten cicatrisation.* Arnica is sternutatory, provokes epistaxis and coryza, and ought therefore to be useful in nasal affections. Guided by observation, which confirms physiology, Homoeopaths have recommended it in traumatic epistaxis, also in spontaneous epistaxis with frontal or nasal premonitory itching (Hering). Buchanan points to it in influenza with epistaxis.-!* It is also a remedy in coryza. The physiology of the drug also favors its application to ear- diseases. In the German allopathic journals, there are good cases of deafness cured by Arnica.^ Hering says that this medicine is suitable in delicate subjects who have frequent otalgia, in cases of buzzing, especially on one side ; in deaf- ness following nervous fever. Few drugs cause cramp in the stomach so decidedly as Arnica. We must then consider it a remedy of the first order in this malady, in cardialgia, gastralgia, etc. No one has yet thought of it in Homoeopathy. The best manuals (Jahr, Hering, Muller) are silent on Arnica when speaking of cramp in the stomach. In the rival school, only one physician has thought of this application ; he saw cardialgia cured by Arnica and wrote of it in Hales' Rhein. Jahrbucher, 1819. Yet Trinks has pointed to its employment in cardialgia following chronic gastritis or great loss of the fluids of the organism. It has also been suggested for dyspepsia following study and gastricism by indigestion (Jahr); in gastric catarrh with eruc- tations of rotten eggs (Buchanan); in pains which follow in- gestion of food' (Richard Hughes). Boenninghausen recom- mends it in eructations, regurgitation, and flatulence. The physiology of Arnica has demonstrated its gas-engen- dering properties. We know beforehand its use in flatulent dyspepsia and intestinal tympanitis. We have seen that it pro- * GrauvogI, Lehrbuchder Homoeopathic, Nurnberg, 1866. f American Homoeopathic Observer, Vol. XIII J Trommel, Med. Zeitung von Preussen, 1834. Krebs, Med. Annalen Heidel- berg, 1835. Bruck, Journal de Casper, 1842. Eiseumenger, Wurt. Med. Cor- resp., 1843. 128 world's iiomceopatiiic convention. duces vomiting. From the beginning it has been successful against hematemesis in the hands of the physicians of Breslow, Boanninghausen and Hirschel have confirmed this. I remember that Stoll considered Arnica the best anti-dysenteric. Recent cases support this. Richard Hughes says that this remedy is held in high esteem in America for this use. It applies especi- ally to the colics and tenesmus. The diuretic action of Arnica shows a positive elective affin- ity for the urinary organs. Lobel employed it for dysuria; this has been confirmed by recent cases. Plenck, Richter, Merein, Kluyskens, advise it for retention of urine; Jahr and Boenninghausen also. Jahr suggests it in hematuria; Small has published cases of its successful use in nephritis, even calculous nephritis [U. S. Med. Surg. Journal, Vol. VI.] A long time since La Marche [These, 1719], Schulze and Cartheuser extolled it in similar cases. Dr. Bayes greatly praises the internal use of Arnica in old men in cases of ten- esmus of the neck of the bladder {Monthly Horn. Review, 1867]. Its emmenagogue properties are traditional and incontest- able. Grauvogl recommends it in uterine hemorrhages. Kratzel, in a violent case of uterine cramps after accouche- ment, obtained good results from high potencies [Al'y. Mom. Zeitung, Bd. 67J. Arnica has always been employed against amenorrhoea; I have had several opportunities to verify this. Stoll says one of his friends assured him he had derived benefit from a decoction of Arnica flowers in a whooping cough which nothing relieved; this has caused it to be said that he recommended it in whooping cough. This application has been verified. Dr. Gentil, of Amorbach, reports that in an epidemic of whooping cough in that locality he saw all the most vaunted means successively fail. In this very fatal epidemic Arnica alone did good service, in a dose of two to four grammes for a decoction to take in the course of a day [Jour- nal de Medicine de Bruxelles, 1856]. Trinks recommends Arnica in the third stage of whooping cough. Buchanan and Richard Hughes recommend it especially in cases where children have attacks of crying when the paroxysms begin. MEMOIR ON ARNICA. 129 At the beginning of the last century Arnica was extolled in true and false pleurisy, in pneumonia and catarrhal affec- tions, in pituitous asthma, in chronic stitch in the side, in spontaneous or traumatic hemoptysis : all this has been confirmed in our century by different observers. Hufeland recommends Arnica in capillary bronchitis. We find here and there different cases of catarrh, of pleurisy, and of pneumonia (see especially Scli'midt's Jahrouecher^ Hencke gives, in his memoir, the homoeopathic contingent: traumatic pleurisy, hemoptysis spontaneous or consequent on violent efforts, pulmonary congestions from dancing. Trinks also recommends Arnica in hemoptysis from different causes, pleurodynia, pleurisy, hydrothorax and traumatic pneumonia; Buchanan in stitch in the side and intercostal neuralgia. In the hoarseness of preachers and military officers, in conse- quence of their violent vocal efforts, Grauvogl gives with the greatest success four or five drops of Arnica tincture in a glass of water ; a teaspoonful twice a day. Dr. Bayes has seen Arnica (third dilution) cause the dis- appearance, in an old man, of palpitations caused by hard work and relieved by repose. lie earnestly recommends the long continued use of this remedy in the same dose in hyper- trophy of the heart, in young persons, consequent upon excessive muscular exertion. This leads me to an important action of Arnica on the muscular system. " I regard Arnica," says Rademacher "as the special remedy of the muscles. I have driven away by this means settled muscular pains which I consider to be primitive affections of these organs. After exposure to cold a man had rheumatism of the occipital muscle which resisted all anti- rheumatics. I cured him, in three days, with three cups of a warm infusion of ten grains of Arnica." This remedy acts principally upon the muscles, says Teste (without knowing the paracelsist, Rademacher). We may read this action of Arnica upon the muscles in the numerous symptoms of the Hahne- mannian pathogenesis. Richard Hughes says that Arnica is, above all, muscular, myotic ; and that it is the principal remedy for those affections which have been described under the name 130 world's HOMCEOPATHIC CONVENTION. of myalgia, due to over-exercise of the muscles. This suggests the foundering of horses. The febrifuge properties of Arnica are incontestable; in this respect it is worth what it is worth; in some circumstances it may even be superior to Cinchona. I close by noting a very curious application of Arnica in connection with its use in traumatism ; it was made by Dr. Fischer who very rapidly cured three hygromas of the knee with Arnica 3 and 30 \Allgem. Horn. Zeitwng, Bd. 58]. How few of the numerous applications of Arnica are given in the incomplete summary of Professor Fonssagrives I This remedy has already accomplished much, it promises yet more; we ought then, to study it profoundly, without giving the least credence to the contradictory statements uttered at Mont- pellier. APIS MELLIFICA. H. Goullon, Jr., M. D., Weimar. INTRODUCTION. Altschul calls Apis mel. " a new remedy investigated with great research by Hering in North America." It is then to the Nestor of Homoeopathy in the new world, to Dr. Constan- tine Hering, the indefatigable and thorough student, that we owe the introduction of Apis into homoeopathic practice. Since the publication of its pathogenesis, the fate of Apis has been somewhat peculiar. On the one hand, it has had en- thusiastic advocates, who, like Wolf, ascribed to it curative properties almost without limit; on the other hand, it has been decried and almost derided as a remedy. Repeated unprejudiced experiments, such as have been made up to the present time, induce us to assign to Apis a po- sition in Materia Medica more limited than that assigned to it by Wolf almost twenty years ago. Time and space do not permit the presentation of a complete monograph on this sub- ject. We shall hope, however, to touch upon all the peculiari- ties and remedial relations of the bee-virus, and to exhibit its analogies with other important remedies. I. The clinical results which homoeopathy has gained from physiological experiments with Apis concern, as one might anticipate from the effects of a sting, first of all, the skin. Or, 131 132 world's homoeopathic convention. to speak more accurately, such diseases were first cured as manifested themselves upon the skin ; as, for example, exan- themata with burning, smarting or itching pains, nettle-rash with red spots or white surrounded by a red areola ; papular eruptions on a bluish-red, hard, hot base; cedematous or ery- sipelatous swelling (with red stripes); or, finally, certain kinds of ulcers. Before mentioning the other anatomical spheres of action of Apis, we may here remark that, during the course of a cure by this remedy and especially of the cure of serious ophthal- mic diseases, an eruption resembling scabies has repeatedly made its appearance; and Jahr pronounces Apis one of the best remedies for suppressed exanthemata (scarlatina, measles and, above all, nettle-rash). In addition to the skin, the eye and its appendages (the lids and especially the upper lid) come under the curative influ- ence of Apis. It has cured inflammations of these organs with aching, itching, burning pains, redness of the margins of the lids, copious secretion of tears and mucus, ulcers of the cornea, obscuration and leucoma, staphyloma with inflammation, hor- deolum, oedema of the eyeball, lachrymal fistula. We might infer the influence of Apis upon the hair from its action on the skin. It has been used with benefit (gener- ally in the form of powder mixed with honey) for baldness and falling of the hair. The action of Apis upon the mucous membrane is very pro- nounced. Inflammations of the mucous membrane of the mouth, fau- ces and throat (tonsils, uvula); angina, either tending to sup- puration or the smooth, erysipelatous, fiery-red inflammation of the fauces, for which Belladonna, Rhus and Caustic, have been recommended, come within the curative sphere of Apis. The stomach and intestinal canal are likewise within the sphere of action of this remedy which seems particularly help- ful in a condition of subacute catarrhal irritation with a dry, thinly-coated tongue, appearing as if it were varnished (cracked lips), burning in the stomach and eructations, tenderness and fulness of the stomach, bilious vomiting, watery, mucous, green- APIS MELLIFICA. 133 ish-yellow diarrhoea (bilious or erysipelatous); morning diar- rhoea, the hands being blue and cold, the stools frequent, bloody and painless. Certain gastric or mucous fevers present symptoms much resembling those just recited ; and it may well be supposed that single cases or an epidemic might present, in addition to these, other striking Apis symptoms (anasarca, oedema or erysipelas) which would indicate this as the remedy for the case or the epidemic. Another most important portion of the sphere of action of Apis is the urinary apparatus, which may be said to be func- tionally intermediate between the skin and the mucous mem- brane. Strangury, retention of urine from inflammation of the bladder and likewise from Cantharides-poisoning, as well as Bright's disease have been cured by Apis. The powder of dried bees has been used for diseases of the bladder. In the Annual Record of Homoeopathic Literature, 1870, incontin- ence of urine with great irritability of the parts (worse at night and when coughing, R. Gardner) are mentioned as indi- cations for Apis. By analogy we infer, from the clinical re- sults of Apis in diseases of the female sexual organs, that the male genital system must be included within its sphere of ac- tion. Apis has cured ovarian dropsy in cases where the skin was uncommonly pale and almost transparent, ovarian dropsy of the left side with stitching pains, general anasarca and waxy appearance of the skin; * threatening abortion; swelling of the labia; amenorrhoea; dysmenorrhoea, with scanty discharge of blood and mucus; sharp, stitching pains in the uterus (or head), sometimes followed by convulsions. Independently of the anatomical seat of the disease, a pecu- liarly characteristic and reliable indication for Apis is the oc- currence of (acute) swelling and watery accumulations, and especially the sudden coming and going of these watery educts; the appearance and disappearance of oedema and swellings * A. Maylander, of Berlin, a warm but not indiscriminating advocate of this rem- edy, makes, in his Surgical Experiences, which I strongly recommend to our col- leagues, the cursor}' statement that Apis acts only upon pure ovarian cyst a not com- plicated by solid tumors, and that it does this by inducing a congestion which leads to inflammation of the walls of the cyst. 134 world's homoeopathic convention. (without thirst) in various parts of the body, especially in the face. These sudden changes appear sometimes to be depend- ent on changes of weather, the occurrence of rain, etc. Chronic dropsical affections may also call for Apis. We have already mentioned the oedematons swelling of the skin resembling the effects of a bee-sting ; we now mention especially : pale, livid oedema of the face and lids, oedema of the glottis, anasarca following scarlatina (the general concomitant of the nephritis cured by Apis), hydrothorax and ascites, and dropsies with dis- charge of bloody urine (without increase of thirst). Besides the skin and mucous membrane, with their append- ages and equivalents, the sphere of action of Apis includes certain portions of the nervous system. It acts upon the brain itself, and is a remedy for the following form of vertigo: ag- gravation when rising, amelioration when lying down ; sensa- tion of swashing in the brain as if there were water within the cranium.* Through its influence upon the sensory nerves, it is a rem- edy for rheumatalgias. Even psychoses (mania, especially, it is said, sexual mania, apathy) have been successfully treated by Apis. Nervous headache, megrim in the anterior part of the head, conjoined with disturbances of digestion proceeding from the abdominal ganglionic centres on the basis of a bilious "as- trie constitution, have found their remedy in Apis. The intermittent fever, so closely related to the neuroses which Apis has cured, is characterized by the chill appearing between 3 and 4 p. m., by sleep after the fever, and by sweat alternating with dryness. In typhoid malarial fevers, Apis removes the tenacious mucus from the throat, which is often so troublesome. A word now concerning its relation to the vascular system. Apis corresponds particularly to the fever which is aggravated in the evening, with quick, hard pulse, although most of the diseases that are cured by it are free from fever; and absence * The symptoms of hydrocephalus acutus are suggested by some of the symptoms of Apis-the child lies in a kind of stupor, sudden shrill outcry, strabismus, gnashing of the teeth, boring of the head into the pillow, one-half of the body twitching, the other paralyzed, head wet with perspiration, urine scanty. APIS MELLIFICA. 135 of thirst and scanty urine are, ceteris paribus, special indica- tions for Apis. It is often employed therefore, in treating the results of febrile inflammation, such as ascites following abdominal inflammation, or induration and suppuration of glands following diphtheritic inflammation of the throat. The Annual Record of Homoeopathic Literature, 1870, in- forms us of the successful use of Apis in heart affections, with feverish excitement, great anxiety, distress and restlessness; not relieved by change of position, with or without thirst. Among the large glands which stand in relation to the hsematosis, we mention the thyroid gland, pathological en- largements of which have repeatedly been cured by Apis; * and we may infer that it has important therapeutic relations to the spleen and the liver from its curative power in intermittent fever and in erysipelas and gastric bilious affections. We conclude our brief summary by citing the maxim which experience has established, that Apis is particularly suitable for diseases of children and women (especially widows). The following chapter is an experiment to detail the thera- peutic properties of Apium virus in a way that will be useful and available for the practitioner. We ask the reader's indul- gence for the inevitable repetitions. And we acknowledge its imperfection, inasmuch as no comparison has been made with Sepia, Puls., Caust., Lycop., Rhus tox., Merc., Sil., and especially with Mez., a gap which we hope at some future pe- riod to fill. As regards the repetitions of symptoms, just as every man has very many points of analogy with every other man, so every drug presents many points of close resemblance with every other drug. Or, in the words of one of the best representatives of strictly scientific homoeopathy, Prof. Imbert Gourbeyre, "Each drug is in fact a tqA polynome, and those who ridicule the multitude of symptoms in the Hahnemannian pathogeneses simply display their ignorance, and show that they have never seriously studied a single drug." * See Homoeopathic Observer, July, 1865, and my Scrofulous Diseases, p. 113. 136 world's homoeopathic convention. IL Apis mel. Compared with Other Drugs. Dr. II. Gross deserves the credit of having first made a comparison of Apis with a number of other drugs and it is gratifying to notice that he regards as most analogous to Apis those remedies to which we have been led to assign the same position, viz : Belladonna and Arsenic. Besides these, Gross has also compared Cantharis, Lachesis, Phosphorus, Pulsatilla, Phus and Sepia with Apis. But as he mentions only the symptoms in which these drugs differ from Apis, we believe our work, which gives in detail the analogous symptoms, is not altogether superfluous. We may add that, after Belladonna, Arsenicum and Can- tharis, we regard Graphites and Thuja only as deserving a comparison with Apis. 1.-Apis and Belladonna. a. Correspondences.-Both remedies affect the brain, the eye, the course of the pneumogastric nerve, the skin and mucous membrane and the glandular system ; and these are the chief specific affinities of Apis and Belladonna. As regards the brain or head, we note under both remedies: vertigo, congestion, headache, especially bearing the character of megrim, that is onesided headache, sensibility to light and noise, nausea. The eye symptoms also present an uncommon similarity: Apis has inflammations of the eye and lids with twitching, burning pains, copious secretions of tears and mucus. Under Belladonna the inflammation is fully developed ; swell- ings of the lids, heat and burning of the eyes, which are red and swollen. On the skin, Belladonna produces a uniform smooth shining scarlet redness on isolated spots or over the whole body ; while a miliary (nettle like) eruption with burning heat and stinging pains in certain circumscribed locations, like the sting of insects, is peculiar to Apis. Both remedies correspond to erysipelatous imflammations, although the full quick pulse which accompanies them calls rather for Belladonna. Whether APIS MELLIFICA. 137 the erysipelas appear in the form of a parulis, an angina, a paronychia, even a dysentery ; or as a simple erysipelas of the face and head, the choice will lie between Apis and Bella- donna. In as much as pathologists have long recognized the fact that many of these forms of erysipelas originate in the liver, it is of interest to study the physiological and clinical action of these remedies upon that organ. Meningitis has been very successfully treated with Apis and Belladonna. Acute Hydrocephalus furnishes special indica- tions for Apis; as do the acute initiatory stage of cerebral inflammation and the active congestion and convulsions and delirium connected wfith it for Belladonna. Finally, we men- tion the value of these remedies in peritonitis. When it occurs with sudden attacks of acute pain, great prostration and prospect of sudden death, Apis is indicated, according to the observation of American physicians; and, under similar cir- cumstances, Kafka warmly recommends Belladonna, parti- cularly Atropinum Sulphuricum. Indeed every homoeopathic physician would be apt to think of Belladonna, in commencing peritjnitis Z». Differences.-The chief difference between Apis and Belladonna has been intimated viz : that Apis corresponds to the later (therefore rather to the products) and Belladonna to the earlier stages of a series of pathologically related dis- eases ; although many affections throughout their whole course correspond to only one of these remedies. We must bear in mind first of all the difference already mentioned, viz: that dropsies (of the abdomen, ovary or cerebral cavities) are not likely to be relieved by Belladonna, but often find their re- medy in Apis ; and that convulsions (epilepsy, complications of whooping cough or of dentition, spasm of the eyelid, etc.) come rather under the curative sphere of Belladonna than of Apis.* The absence of thirst, which has been repeatedly mentioned as a characteristic of Apis, corresponds to a stage of disease in whicli the first (purely inflammatory) disturbance * A pis has been occasionally recommended for hysterical spasms and cramp of the stomach. 138 world's nOMCEOPATIIIC CONVENTION. has subsided. If this were not so, Apis would hardly be re- commended foi " chronic constipation, when the other symp- toms correspond." Indeed " habitual constipation " seems to be a direct indication for Apis, as it is for Graphites ; and it is interesting to notice that the latter, like Apis, is a dropsy remedy. We do not deny that Apis, under certain conditions is also a diarrhoea remedy; but the diarrhoea to which it cor- responds is rather an expression of weakness and paralysis and might either be included under the term dysentery ("frequent bloody painless stools"), or among typhoid processes in their advanced and passive stage.* The Apis diseases may be said to be more intense than those of Belladonna. They not only affect viscera which nature has well protected : the brain, spinal cord, liver, ovaries, uterus, bladder, fibrous and synovial tissues^ and even the bones (periostitis); but the character of the disease is more malignant. Thus the angina for -which Apis is indicated takes the form of diphtheria; the diarrhoea that of dysentery or typhoid, etc. Apis is not a cough remedy, whereas Belladonna ranks among the remedies for spasmodic cough. I have never read of a toothache cured by Apis ; but what homoeopathic physician wrould undertake to cure tooth- aches without Belladonna ? The reason of this difference is simply that most pains of this character depend upon an active, though local and tran- sient, congestion ; a condition wdiich does not call for Apis. We find among Apis symptoms, hands blue ami cold, skin un- commonly white and almost translucent (oedema or dropsy); white, fair appearance of the affected limb (in phlegmasia alba dolens). Although we believe that we have pretty clearly stated the (essential points of difference, we admit that it is not always easy to draw the distinction between the indications for these two remedies respectively. This is especially so at different periods of the same disease, when we are not always certain * The proposition that Apis corresponds rather to the results of inflammations is confirmed by the fact that Apis is recommended for opacities, etc. resulting from in- flammation of the 'cornea, for staphyloma, for lacrymal fistula and for ovarian and uterine hypertrophy. j Maylander's " Catarrhal Synovitis.' APIS MELLIFICA. 139 whether we have before us the active stage or the stage of re- action. We therefore cite the following comparison from Dr. Gross : " Apis affections (like those of Lachesis) affect the left side (those of Bellad. the right); external parts rather than in- ternal. They improve in the open air (for which there is an inclination) and by cold and wet applications ; the reverse of all this is observed under Bellad. The anxiety which accom- panies Apis symptoms seems to proceed from the head, that of Bellad. (and Arsenic.) from the heart or priecordia." I think it very questionable whether, as Dr. Gross affirms, sensitive- ness indicates Apis, and predominant insensibility (paralysis) Bellad.; clinical testimony does not confirm this assertion. 2. Apis and Arsenicum. a. Correspondences.-Who does not know the manifold phy- siological or pathogenetic effects of Arsenic, on the skin, which is likewise the part of the organism on which Apis preemi- nently acts ? Referring to the masterly treatise of Prof. Im- bert-Gourbeyre, on the " Action of Arsenicum on the Skin," we find that there is an arsenic-erythema, erysipelas, urticaria, papular, vesicular and bullous eruption, eczema and ulcera- tion; and, above all, an arsenic-oedema. Does not the patho- genesis of Apis present all those cutaneous affections ? The Apis-urticaria, with its biting, itching pain is as well known as the Apis-oedema; and the action of Arsenic, on the hair and nails finds a parallel in that of Apis which, under certain con- ditions, cures baldness, and causes and arrests the falling out of the hair. We know the influence of Apis on the eye, especially in scrofulous ophthalmia and its sequel®, opacities of the cornea, chronic irritation of the tear-passages, swelling of the lids and redness of their margins. Arsenic, exhibits a singular corre- spondence; witness the arsenical conjunctivitis, which is often the first symptom of poisoning, e. g., by green dresses or lamp-shades containing Arsenic. Syncope is often one of the first indications of such a poisoning, and is often observed also after the sting of a bee (still oftener after that of a wasp). 140 world's homoeopathic convention. Bearing in mind the importance of Arsenic, in typhoid and related morbid processes, and remembering the beneficial re- sults of the use of Apis in gastric-bilious inflammations with diarrhoea resembling that of typhoid, we must admit the thera- peutic resemblance of the remedies. This, however, is still more striking in dropsical affections, from simple palpebral oedema to collections of water in the large cavities. Both Arsenic, and Apis are remedies for intermittent. We read in Hering's Pathogenesis of Apis, the prover becomes chilly between 3 and 4 p. m. daily; she shivers and is worse in the warmth ; chills run over the back, the hands are as if dead. After about an hour there is feverish heat of the cheeks and hands without thirst, with a rough cough. This passes away gradually but she feels heavy and prostrate. Dr. Stens cured a quotidian with Apis'; there was no affection of the liver or spleen. Burning pain is often an indication for Arsenic. So it is for Apis, e. g., the burning pains of nettle-rash, the burning and hot risings from the stomach, the burning and fulness in the stomach, with the greenish-yellow diarrhoea peculiar to Apis and the burning haemorrhoids. But burning haemor- rhoidal tumors (luemorrhoides furientes) yield quite as often to Arsenic.; burning pains, internally and externally, being the most characteristic symptom of that drug. Such pains characterize the strangury of both Arsenic, and Apis. Arsen, cures retention of urine and haematuria; and Apis has cured retention of urine from cystitis (also from abuse of Cantharis) and dropsy with haematuria. The heart-symptoms of Arsenic, are so numerous that Im- bert-Gourbeyre has devoted to them a pamphlet of seventy- four pages. Apis has cured heart affection with febrile ex- citement, great anxiety, restlessness and distress. This affec- tion was sometimes, like those of Arsenic., accompanied by thirst, an exceptional fact for Apis. As already mentioned, both Apis and Arsen, cure erysipelas. The form for which Apis is appropriate is thus described: " Erysipelas of the face or scalp with typhoid tendency and gangrenous spots here and there; " a description which at once APIS MELLIFICA. 141 suggests Arsen, also. So do the burning, sticking pains which, according to Guernsey, accompany the sties and whitlows which Apis cures. Apis and Arsenic, both have aggravation in cold weather. b. Differences.-Absence of thirst for Apis, and burning unquenchable thirst for Arsenic; this is the most striking dif- ference between these remedies; it explains the clinical simi- larity which Dr. Gross affirmed to exist between Puls, and Apis. The cholera infantum curable by Arsenic, and the as- sociated dropsy, whether a concomitant symptom of liver dis- ease or not, are always characterized by thirst. So is the dia- betes for which Arsenic, is suitable. Indeed, in this disease, since it is always accompanied by thirst which is often intense, Apis, for this very reason, can hardly be a remedy, although, it must be confessed, many of its symptoms resemble those of glycosuria. One of these is furunculosis, which is almost path- ognomonic of diabetes mellitus. Dr. Stens cured with Apis', a chronic furunculosis with loss of appetite and emaciation. Another is the chronic catarrh of the stomach and intestine, with heartburn and yellow diarrhoea, a condition so uniformly observed in diabetic patients that Dr. von Dtiring, of Ham- burg, in his excellent treatise on that disease, attributed dia- betes to this saburral condition alone. Finally, we must not forget that Bright's disease, a frequent accompaniment, or, according to Schoenlein, the second stage of glycosuria has cer- tainly been cured by Apis (Lorbacher, Leipzig). But, as we have said, considering the absence of thirst which character- izes Apis, we dare not hope that this remedy will play an im- portant part in the treatment of diabetes. Apis has been used with success in softening of the stomach (gastro-malacia) when the abdomen is large, the extremities emaciated, there are painless diarrhoeas, the face and feet are oedematous, and there are typhoid symptoms. It must be con- fessed that the so-called cholera infantum resembles the affec- tion just described ; in which, however, we find no mention of the thirst, which is a constant symptom of true cholera in- fantum. The burning pain is a more pure and constant symptom of 142 wobld's homceopathic convention. Arsenic, than of Apis. With the burning of Apis there is as- sociated a sticking or stinging pain. And under some circum- stances tliis pain is absent under Apis, when it certainly would be present under Arsenic. Thus the erysipelatous or oedema- tons swellings of the eyelids, curable by Apis, are often pain- less. So are the doughy swellings of the ankles or of one side of the body, of the head or abdomen. Even the pruritus which Apis cures is not called burning so much as itching (as if pierced with needles), and makes one desire to rub it with a cloth; or as pricking and sticking, or, finally, as burning heat with stinging. According to Gross, Apis acts particularly on the left side and on external parts, and is characterized by somnolence in contra-distinction to the insomnia of Arsenic.; the pulse is quick and full, while under Arsenic, it is quick but small and weak. Apis affects the upper eyelids more especially, and Ar- senic. the lower. Arsenic, corresponds to affections of the in- ternal, Apis to those of the external ear.* Apis increases, Arsenic, diminishes the secretion of saliva. The Apis symp- toms are aggravated, and the Arsenic, symptoms are relieved by covering, by warmth, in a warm room, by movement espe- cially of the part affected, and after sleep. On the other hand, the cases which Apis cures are relieved by cold, uncovering, alcoholic drinks, perspiration and assuming the upright posi- tion. Another difference, not particularly important from the clinical standpoint, is that the bodies of those who have died from arsenical poisoning decompose very slowly, while those of persons who have died from bee-stings decompose remarka- bly quickly. 3. Apis and Canthabides. a. Correspondences.-We are invited to a comparison of these two remedies by their marked physiological relation to the urinary apparatus. Apis, like Canth., affects the bladder * It is uncertain whether Dr. Gross includes in the internal ear the eustachian tube and the tympanum. The curative relations of Apis to the brain being undeniable, we question whether the internal ear should be excluded from its sphere of action. APIS MELLIFICA. 143 and kidneys, yet their antagonistic relation is such that the retention of urine (cystitis) caused by Canth., is cured by Apis, a striking proof of the law of similars. Other forms of stran- gury and ischury are also cured by Apis, and the symptoms, frequent desire to urinate, with burning in the urethra, pain- ful micturition with scanty discharge of dark, turbid urine, or urine with brick-dust sediment, are niet with in the pathoge- nesis of Apis as well as that of Canth. Almost the same is true of the symptoms of the fauces and apparatus of deglutition; indeed, under Canth. these symp- toms reach such a height as to present a picture of hydropho- bia,* for which disease Canth. has been recommended as a remedy. It has been also warmly recommended in malignant inflammations of the throat in scarlatina, and in inflammations of the mouth, but especially in diphtheria ("in the beginning almost specific "). There is no lack of clinical evidence of the value of these two remedies in burns and in dysenteric diarrhoeas. It is re- markable, also, that inflammation of the ovary, in which Apis has proved of so great therapeutic value, finds its remedy like- wise in Canth. Dr. Hirschel (Arzneischatz, sixth edition, p. 85) mentions (after Hellebore) Apis as a remedy in encephalitis for the later symptoms which indicate effusion (pressure, heaviness of the brain, boring into the pillow, starting up in fright, muttering delirium, paleness, constipation), and proceeds to say: others speak of good results from Glon., Canth., lod., Antim. tart. Here then we have another pathological correspondence be- tween these two remedies. It was known to physicians before Hahnemann's day that large quantities of Canth. (one-half to two drachms of the tincture, or eight to twelve grains of the powder) produced nervous excitement, headache, delirium, stupor with accelerated pulse and respiration, heat and dryness of the skin. Larger quantities (one ounce of the tincture, twenty-four grains of the powder) produce syncope, vertigo, spasms, loss of consciousness. * Not only the symptom, burning thirst with dread of drinking, but also the follow- ing, renewal of the attacks every seven days, drew the attention of the homoeopathic practitioner to rabies canina. 144 world's homoeopathic convention. A Differences.-The organs to which Canth. is especially related are not many; being chiefly the urinary and sexual organs and the apparatus of deglutition. For, the cases in which Canth. is recommended in encephalitis are very few as compared with those which call for Apis. Canth. is by no means so universally a remedy for dropsy as Apis; we can recall only a few instances of pleuritic exudation in which French physicians have given this remedy.* While Apis affects the diphtheritic process and the parts concerned therein (tonsils, uvula, etc.) Canth. is of value in croupous inflammation, as Dr. Blau was the first to show (two clinical cases, A. II. Z., vol. xc.). These results are not sur- prising when we reflect that anxiety, dyspnoea, constrictive sensations in the oesophagus and the respiratory organs are among the physiological effects of Canth. Canth. acts especially upon the right side. The heat which characterizes Canth.-affections is (as with Arsenic.) accom- panied by thirst. There is a remission early in the morning and in the evening (until midnight). The Apis remission oc- curs during the day. Apis symptoms are aggravated by warmth, after lying down and becoming warm in bed. The opposite is true of Canth. 4.-Apis and Graphites. a. Correspondences.-In my monograph on Graphites the clinical observations are comprised under the following ru- brics : 1. Cutaneous pathological processes. 2. Disturbances of the female sexual sphere. 3. Affections of digestive organs. 4. Affections of the sensorium. 5. Nervous affections ; convulsions, paralysis, neuralgia. 6. Hydrocele and dropsy. 7. Specific scrofulous affections. * We must not foiget, however, that because of its diuretic properties Ganth. has long been used in dropsy with torpor and inactivity of the kidneys-especially after scarlatina This, however, is not a homoeopathic action like that of Canth. when it does good in diabetes. APIS MELLIFICA. 145 The therapeutic relationship of Graphites and Apis is so close and so complete that the same rubrics might be used, and would suffice, for a monograph on Apis. Not only is the central action of Apis exerted upon the skin (erysipelas first of all), but this remedy moreover, like Graph- ites, exhibits elective relations to the female sexual organism and we may add, to the age of childhood. If Graphites is par excellence the remedy for herpes, herpetic spots are likewise a valuable indication for Apis. The same is true of erysipe- latous inflammations in which both of these remedies do excellent service. We mention in this connection the influence which both remedies exert on the growth of the hair. Bald spots upon the scalp call for Apis ; moist eruption and scabs on the scalp, turning grey and falling out of the hairs even on the sides of the head, require Graphites. Both drugs are rich in symptoms relating to the sexual organs and functions. The efficacy of Apis in diseases of the ovaries has been already mentioned ; experience shows that Graphites likewise cures inflammatory enlargements of these organs. The value of Apis in menstrual disturbances has been shown; that of Graphites in suppressed, delayed, too scanty and too pale menstruation is not inferior. As regards the digestive organs the characteristic similarity of the two remedies seems to consist in this, that both may be serviceable in habitual constipation as well as in chronic diar- rhoea. Nevertheless, Apis is most suitable for diarrhoea or chronic diarrhoea especially in bilious or erysipelatous subjects; while constipation is a predominant indication for Graphites. We should add that cramp of the stomach is a much more fre- quent symptom in cases cured by Graphites. The rubric : affection of the sensorium, and the related ru- bric : specific scrofulous affections, offer many interesting points of resemblance between these two remedies and exhibit, in many particulars, their therapeutic equivalence. Opacities and great thickening of the cornea, obscured vision, etc., have been cured most remarkably by both Apis and Graphites. We know from the physiological experiments of Dr. Genzke how remarkably Apis acts upon the eye in general and parti- 146 world's homoeopathic convention. cularly upon the cornea. Photophobia, so peculiarly charac- teristic of scrofulous ophthalmia, and sties, which are not less pathognomonic, are indications for Apis as well as for Graph- ites. " The unhealthy skin," the glandular enlargements and the hydraemic condition of the blood which are peculiar to scrofulosis, are very characteristic pathogenetic and therapeutic features of Apis and of Graphites. A word should be said of the anti-dropsical qualities of the two remedies. Those of Graph- ites have been shown in the cure of anasarca, hydrocele, hydrarthrosis of the knee and oedema of the feet (accompanying amenorrhoea). Those of Apis in the cure of ovarian and uterine dropsy, ascites, pale swelling attending facial erysipelas, hydrocephalus, hydrothorax and hydropericardium, or finally oedema of the eyeball. We pass over the rheumatic-gouty affections, simply referr- ing to the fact that Graphites is indicated by " tension as from shortening of the muscles" and by contraction of a single limb ; while Apis shows a specific relation to rheumatic-gouty affections of the eye, and has also cured podagra, gout of the knee, the rheumatic pains of trichinosis as well as real gouty concretions. When we come to compare Apis and Thuja we shall see that Apis is an anti-sycotic in the Hahnemannian sense. The same is true of Graphites, not only by virtue of the characteristic shortening of muscles but also of the fact that the subjects whom the remedy suits take cold very easily (very sensitive to the open air), a well known feature of the so-called hydrogenoid constitution (v. Grauvogl). Not only then do both Apis and Graphites exhibit anti-herpetic, emmenagogue, anti-scrofulous, anti-dropsical, anti-arthritic, anti-rheumatic and anti-sycotic properties, both belonging to the category of re- medies which counteract the injurious influence of hydrogen upon the organism ; they resemble each other also in another line of action. They have the property of compensating me- tastatic morbid processes. There can be no doubt of this theory for those w'ho have the power to see ; even though, to the myopic eye and the limited vision of a pathological professor (Virchow) the essence of metastasis should be looked for exclusively in the material 147 APIS MELLIFICA. transport into the circulation of a foreign pathological pro- duct.* While cramp of the stomach and ear affections of me- tastatic origin call for Graphites; eye affections (as well as those of the stomach and intestines) require Apis. After the use of Apis during the cure of the secondary affection, pre- viously existing scabies or papular exanthems reappear; pure herpes more frequently reappears under Graphites. Dr. Bolle narrates a case in which, in a girl of eleven years, a complete opacity of the cornea disappeared after six powders of Apis; and at the same time an itch-like eruption appeared on the back of the neck. The patient had formerly had itch.t And Dr. Altschul relates that, in the case of a young man who had deafness after suppressed herpes, Graphites brought back the herpes and gradually cured the deafness.^: 5. Differences.-The difference in origin of these drugs from the animal and vegetable kingdoms respectively, would preclude their pathogenetic and therapeutic identity. Let us now examine in detail the intimate nature and extent of the similarities we have described. The herpes of Graphites has a different appearance from that of Apis. The former is well represented in herpes labialis and in zoster; therefore in what the dermatologist understands by herpes. The herpes of Apis is either the eczema impetiginodes of modern nomen- clature or a form of urticaria. Again, the erysipelas of Graph- ites runs a more chronic course, is liable to relapses, occurs in women during the climacteric years and generally occurs in the region of the zygoma ; it is usually accompanied by evidences of a general herpetic (orbilous) constitution, such as herpes in other parts of the body, anomalies of the growth of the hair, sensitive skin, irritable, peevish disposition and ha- bitual obstinate constipation. * We can give an example of a cure of even this kind of metastasis by Apis. Dr. Maylander operated on a chronic abscess behind the mammary gland. After a heavy chill, inflammation of the foot occurred (from thrombus in a thoracic vein.) It was successfully treated with Apis. The same author gives Apis and Sulphur for so called catarrhal synovitis. To the same class belong the secondary inflammations of the ankle in osteo-myelitis. + See Goullon's Scrofulous Diseases, page 112. J Goullon's Monograph on Graphites, page 67. 148 world's homoeopathic convention. Apis, on the contrary, is most appropriately used in the course of an acute erysipelas.* Graph., which is closely an- alogous in value to Ferr., Arsenic, and Sulph., affects the blood- composition and life much more profoundly than Apis. Both remedies have especial affinities for the female sexual organism ; but the purely emmenagogue action belongs rather to Graph., while Apis corresponds rather to threatening abor- tion, to metrorrhagia and to hysterical difficulties (except the clavus hystericus), which we find likewise in the pathogenesis of Graph. Finally Apis is more closely related to ovarian diseases, at least to such as do not involve amenorrhoea. Both remedies act upon the digestive organs. The dysen- tery or the typhoid which Apis cures, runs at least a subacute course; while the disorders which Graph, cures, the cramp of the stomach, the constipation or the diarrhoea (gastric and in- testinal catarrh) are thoroughly chronic. The same is true of the tape-worm symptoms which indicate Graph, (or Carbo veg.) but not Apis. Among the organs of special sense, the eye alone comes mark- edly within the sphere of Apis, which, as we have seen, has a manifold action on this organ, and may be indicated whether the disease be of scrofulous, rheumatic or gouty origin. Graph, on the other hand, has a special action upon the ear, although claims in this relation have been made for Apis, which are without scientific value (Dorfdoctor, Zurich, December 18, 1875). AV e do not know of any cures by Apis in diseases of the nose, although theoretically we might expect them. liering says: " Apis is indicated for dryness of the nose and throat, and for * We refer to the Surgical Experiences of Dr. A. Maylander, p. 128, for an exam- ple of the use of Apis in the sequelm of wounds. An officer received, at Gravelotte, a comminuted wound of the leg from a chassepot ball. After the extraction of sixty- eight fragments of bone, a completely new tibia was formed, without shortening or flexion. Says Maylander, "This is the first case, so far as I know, in which, after so serious a comminution, conservative surgery has gained so signal a triumph." Of course mechanical and other medicinal expedients besides Apis were employed. But it is instructive to know that this remedy was given-at first with Aconite on account of great vascular excitement then-in the course of the disease, when the granula- tions were covered with diphtheritic formations, and subsequently for a catarrhal- synovitis of the knee, complicated with a severe traumatic erysipelas. APTS MELLIFICA. 149 symptoms of hydrocephalus, but never in coryza." On the other hand, the various other organs of the mouth furnish a number of indications for Apis, in contradistinction to Graph., which, at the most, cures some herpetic rhagadesof the corner of the mouth, or a form of chronic pharyngeal catarrh (with a sensation of a plug on swallowing). Apis has been approved in neuralg'a of the lips, tongue and gums, as well as in swell- ing, inflammation, suppuration and cancer of the tongue; in (erysipelatous) inflammation of the palate and tongue.* And although anti-diphtheritic properties have been freely ascribed to our remedies, no one would include Graph, in this category; whereas, Apis, properly prepared, has eminent claims as a remedy for croup of the fauces (besdes being specific for ulcers and erysipelatous inflammation of the throat). Diphtheria, or at least a certain form of it, seems to me to be of a sycotic na- ture, or at least it attacks by preference sycotic subjects (its local manifestations involve the same regions in which sycosis is wTont to be localized, tonsils, uvula, larynx, pharynx, choanse; finally the diphtheritic ulcer resembles a chancre in form). Though, as we have said, Graph, (like Iron) may be used in sycosis, there is a difference here between Apis and Graph. Apis is a much more powerful anti-sycotic, standing between Thuja and Graph.f Some authors regard sycosis as identical with the hydroge- noid constitution. Then, in so far as Apis has the symptom " taking cold readily " in a less degree than Graph. (Gross says the Apis symptoms are relieved, by cold and wet), Apis is not so certain a remedy as Graph, for the hydrogenoid con- stitution. This peculiarity seems to be explained by the fact that Apis (like Graph.) is an anti-dropsical remedy, and there- fore modifies a too watery condition of the blood (which is manifestly a result, and one of the surest evidences, of the hy- drogenoid constitution). 5. Apis and Thuja. a. Correspondences.-We know that Thuja not only cures * kngina with swelling of the tongue, and burning, sticking pains in the throat -Dr. Charge. t My views on sycosis are stated A. H. Z., February 21, 1876. 150 world's homceopathic convention. the simple consequences of acquired gonorrhoea, but is of ser- vice also in the legion of maladies supposed to be connected with preexisting "blennorrhoeic" syphilis, and which can be diagnosed only with probability. Jahr speaks of a pronounced modification of the original chancre-virus giving rise to the in- dependent appearance of condyloma, mucous tubercle and sy- cotic growths; and he regards this modification as the specific curative sphere of Thuja. We look for the point of contact between Thuja and Apis in the first-named category, i. e., in the efficacy of both against the inherited results of a specific poison.* But the modifications above mentioned are not lo- cated in the parts affected by the original poison, but often in distant parts, e. g., mouth, tonsils, uvula, tongue, salivary glands, corresponding with the manifestations of blennorrhoeic syphilis on the mucous membrane. This is the focus of our comparison ; from this stand-point a wide range of clinical an- alogies between Apis and Thuja opens before us. Whoever is not content with our theory may continue to class these among " scrofulous affections." Apis and Thuja are particularly serviceable in affections of the mucous membrane of the mouth, of that of the rectum and urethra and their immediate neighborhood; and of that of the eye. Also the glandular tissues, from the simple lymphatic glands, which so uniformly sympathize with affections of the mucous membrane, to the more important and complicated glands, e. g., the liver, spleen, ovary, testes, etc., stand in al- most the same pathological relation to Apis and to Thuja. Even before Hahnemann's day, Thuja was esteemed as a rem- edy for dropsy; and our homoeopathic literature furnishes many credible instances of cures of ascites by Apis. It would be a mistake to suppose that Apis surpasses Thuja in anti-diphtheritic power. Dr. Ortleb, of Gotha, an excellent practitioner, has long treated his diphtheritic patients with Thuja, and with most excellent results.f * Jahr mentions persistent gonorrhoeal discharge as a positive indication for Apis. + The treatment consists in local application of the undiluted tincture prepared by himself. 151 APIS MELLIFICA. Another competent authority, Dr. Rentsch, of Wismar, has used Thuja (as a prophylactic as well as a remedy) in small pox. Even here, there is an analogy with Apis. For, although the the latter has not, to our knowledge, been used in small pox, it has been used in malignant pustule.* We have spoken already of the general utility of both reme- dies in affections of the eye ; they often agree in the special form which they relieve. Thus both have cured desperate cases of amaurosis; and obstinate scrofulous ophthalmia with excessive photophobia, opacity of the cornea and copious blen- norrhoea of the lids. Mention has been made of cures by Apis of intermittent fever and acute rheumatism, two diseases that have been like- wise cured empirically by Thuja; and certainly, so far as the arthritis is concerned, they were not always cases of the so- called gonorrhoeal rheumatism. On the other hand Apis has cured gonorrhoeal rheumatism of the knee. Even this, how- ever, does not exhaust the clinical analogy between these drugs. We know that an important indication for Thuja is the sensation of " having grown fast " (adhesion). This sen- sation often depends upon the actual formation of neoplastic conditions; and we meet with the same under Apis likewise. In other words, Apis and Thuja cure new products, tumors, cutaneous tubercles (condylomatous affections and the Apis- tubercular exanthema). If the reader has kindly read, between the lines, that we re- gard Apis as an anti-sycotic, like Thuja, we have only now to draw his attention to those properties by which it agrees with the hydrogenoid constitution. Its symptoms are aggravated by moisture, cold and bathing, a fact of which my experience has satisfied me, notwithstanding the assertion of Dr. Gross, that cold and moisture mitigate the Apis symptoms. More- over, the affections cured by Apis exhibit a certain periodicity most marked in intermittent fever, in which Apis and Thuja are very useful. * Maylander cured a very malignant carbuncle on the left side of the neck. Inci- sion down to the fascia, anti-septic treatment, Apis 6th internally, and, the effects not being satisfactory at first, Apis 2d. Apis 1st in dilute alcohol as an external applica- tion after disinfecting applications with the syringe, twice daily to the wound. 152 world's homceopatihc convention. b. Differences.-The physiological and therapeutic action of Apis in relation to the erysipelatous process is well known; we do not know that Thuja has ever been used in erysipelas. The form of dysentery which is analogous to erysipelas (urti- caria extending to the intestinal mucous membrane) calls for Apis; we have no evidence of any cure by Thuja, although not disposed to deny its possibility, particularly inasmuch as the malignancy of certain cases of dysentery-like that of cer- tain diphtherias-seems to depend upon a complication with sycosis. The usefulness of Apis in acute hydrocephalus and kindred pathological processes has been abundantly proved ; of Thuja we can only make the general statement that it has cured dropsy empirically. Bright's disease which is so frequently accompanied by dropsical symptoms has been repeatedly cured with Apis by Dr. Teller, of Prague, who used the second dilu- tion, and by Dr. Lorbacher, of Leipzig, who used the 30th potency. We have no record of a cure of this disease by Thuja. A case of hydrothorax was cured by Apis (in combi- nation, however, with Arsenic.) by Dr. Kirsch, of Wiesbaden (the allopathic physician previously in charge had regarded the case as one of incurable spinal degeneration). Thuja has played no part in the treatment of trichinosis, which is usually accompanied by oedema of the face; Apis, according to Biick- ert, is a prominent remedy. As regards those medicinal properties which Thuja possesses in a greater degree than Apis, we mention first its anti-condy- lomatous properties; indeed, as an anti-sycotic or an anti-syph- ilitic, Apis cannot compare with Thuja; hence the immediate sequelse of these specific diseases, such as secondary gonorrhoea and certain forms of leucorrhoea, are cured exclusively by Thuja. Prosopalgia also, if it spring from the same etiologi- cal root, is rarely cured by Apis but frequently, even in despe- rate cases, by Thuja. Only one remedy competes with it in this field and this, according to Gallivardin's observations, is Cin- chona. The same is true of sycotic sweats and headaches. In the cases described by von Grauvogl, as "precursors of a high grade of sycosis" and characterized by paroxysms of severe APIS MELLIFICA. 153 neuralgic pain (e. g., in the knee-joint) or in cases of the so- called muscular ataxia of Eisenmann, Thuja and Natrum sulph., render inestimable service; nothing similar is known of Apis. Besides warts and condylomata. Thuja has repeat- edly cured ranula; but the new formations in which Apis has induced absorption or retrograde metamorphosis have a differ- ent anatomical seat and histological character. Chlorosis, that had very profoundly affected the organic life, has been cured by Thuja, by Drs. Ruckert and Kunkel; we know nothing similar of Apis. (In passing, I remind the reader of the anti-chlorotic properties of Nitric acid, which is so closely related to Thuja.) JEgidi describes a pernicious form of diabetes cured by Thuja-in connection, however, with Natrum sulph. But Jahr cites not only albuminuria but also glycosuria as an indication for Apis. Atrophy of the longissimus dorsi muscles, as well as of the muscles of the lower extremities (paresis) has been cured by Thuja, not by Apis. The same is true of a series of spasmodic affections: chorea, epilepsy, asthma with sudden sense of suf- focation and whooping-cough; while spasm in the sphincters of the bladder and rectum is again a common field for Thuja and Apis. For completeness' sake, we must refer to the relation which Thuja bears to the sequelae of vaccination and revaccination, a complex of pretty constant symptoms to which we have else- where given the name of vaccinosis. We refer those who are interested in this subject to the observations of Dr. Kun- kel, of Kiel, published in the Internationale llomoeopathische Presse. We have thus completed our comparison of the therapeutic relations of Thuja and Apis. Success in the art of healing requires us to seek out and define these resemblances and'shades of difference; and, for this reason, the comparative study of drugs deserves our most diligent attention. Our efforts in this direction are commended to the indulgent judgment of the audience to which they are respectfully addressed. MEZEREUM: PORTION OF A PHYSIOLOGICAL STUDY. Adolph Gerstel, M. D., Vienna. Acceding cheerfully to the flattering request to prepare, as a representative of the Austrian Homoeopathic Society, for the World's Homoeopathic Convention, a physiological drug- study, I offer a portion of a study of Mezereum. The relations of Mezereum are almost exclusively with the various membranous tissues (skin, mucous, serous, and fibrous tissues), and I have therefore separated the work into four divi- sions, corresponding to these tissues. The time at my disposal has allowed me to finish only the study of Mezereum in its relations to the skin. The continuation of the work will ap- pear in the AUg. Hom. Zeitung, Vol. XCI1I. Daphne mez. is one of the first twenty-six remedies which Hahnemann considered worthy of a more extended proving, and whose symptoms appear in his Fragmenta de Vimbas, etc., 1805. This collection included only such remedies as Hahnemann had found experimentally approved for definite diseases in the old practice. It was precisely this circumstance which, after he had discovered the law of cure, " Similia Sim- ilibus Curantur," stimulated him to confirm and define this law, by investigating the positive effects of these remedies, as well as to find indications based on experience for their use in disease. We learn from Heil and Trinks, those diligent laborers in old school literature [H. V. S., 8, 51], as well as from others, 155 156 world's iiomceopatiiic convention. that it was not the Daphne mez. but other species of Daphne, found in the east, which were used down to the most recent period. We must therefore sift the evidence furnished by the old school, concerning the action and use of this drug. More- over, in accordance with Hahnemann's directions, wTe use the tincture of the carefully-dried bark, or of the fresh bark gath- ered during inflorescence, whereas, in many reported cases the fruit, known as Grana gnidii, or Baccse coccognidii, was em- ployed. Undoubtedly the latter contains essentially the same ingredi- ents as the bark; yet its action on the economy is different. It is therefore to be regretted that Hahnemann did not, in the case of this and a few other drugs, exercise, in this respect, a sharper criticism. The study of Mezereum is the more difficult, from the fact that, in our systematic works on Materia Medica (Jahr, Noack and Trinks), the symptoms from these various sources are given without reference to their origin; whereas Hahnemann, in the first edition of his ALat. ALed. Pur a, separated them and, in the later editions, gave the authorities. These differences are of great importance in Mezereum. We shall therefore confine ourselves to the symptoms produced by the bark and consider, subsequently, those resulting from other parts of the plant. In the Fragmenta, Hahnemann cites fifty-six symptoms as positive effects of Mezereum. Some of them were unques- tionably observed on the sick. Nevertheless these few symp- toms contain, with slight exceptions, the pith and substance of the Mezereum pathogenesis. The numerous excellent prov- ings since made, although adding something new, have served chiefly to elucidate and confirm these original symptoms. We find the first reproving in Archiv., IV., 2, 110, 1825, by Dr. Stapf. Eleven provers took part in it. Hahnemann's symptoms, of the Fragments, are included. In his introduc- tion, Stapf gives important practical directions for the use of Mezereum in disease, and calls attention to its value, which Hahnemann emphasized by including it, with some additional symptoms, in the " Chronic Diseases," second edition, 4, 1837. MEZEREUM. 157 It was therefore much used in homoeopathic practice; and our colleagues deemed it worthy of repeated reprovings. 1838. Dr. Theile, in his inaugural dissertation De viribus Mezerei, published a proving by himself and some friends [A. II. Z., 2, 14, 105]. 1857. Dr. Hartlaub [ K J. &, 8, 1], provings by the Lusa- tian Society, 1849 to 1852. 1860. Dr. Dunham [Am. Hom. Rev., 2, 164], published portions of a reproving of Mezereum by the late Dr. Wahle, Sr., of Rome. We learn, by private letter from Dr. Dunham, that with the permission of the son of Dr. Wahle, he copied these symptoms himself, in 1856, as well as some of Eupion, Kreos. and Myrtis com. 1867. Dr. Watzke's reproving on himself, Dr. Etterlin and Dr. Karl Wurstl, in 1863 [A. II. Z., 74]. From a careful study of all these provings it will appear that the seat of the morbid process whence all these symptoms proceed, lies in the membranous tissues alone ; and especially in the skin and fibrous tissues ; to a less degree in the mucous, and least of all in the serous tissues. Consequently, the seat of the morbific action of Mezereum is the connective tissue with the arterial, vascular and ganglionic nervous ramifications imbedded in it; this gives rise to many reflex effects. The practical application of the drug is, therefore, quite limited; and even within the sphere of action above described, its ef- fects are evident only in certain directions. The old school use Mezereum externally, after the manner of cantharides, by bringing the outer surface of a piece of fresh or moistened dry bark, deprived of its epidermis, into immediate and long contact with the skin. Redness and pain follow, the epidermis rises, serum and, subsequently, pus col- lect between it and the cutis. Sometimes, if the skin be ten- der, the application causes violent pains and eczema around it. Its continued use produces very painful itching, ulcers with a profuse watery discharge and peculiarly offensive odor, and sometimes surrounded to a considerable distance by a pustular eruption. These pustules often break and discharge freely. According to Pluskal [Oest. Wochenschrift, 1844, p. 1375], a 158 world's homceopathic convention. pale girl, fourteen years old, having been told that the leaves of Daphne mez. would give her a color and fatten her, went to the woods and rubbed her cheeks with the leaves. The whole face, especially the nose, eyelids and front part of the scalp, immediately swelled enormously, with burning pain. Persistent, violent and painful sneezing, delirium, severe dull frontal headache, disagreeable dryness in the throat and irritation provoking a dry, racking cough proved that the poi- son, by inhalation of the vapor or of some particles of the juice, must have reached the nose, the frontal sinuses, the tra- chea and pharynx. The face soon presented a picture of ery- sipelas bullosam, for on both cheeks there appeared confluent vesicles. The nares became entirely closed, so that she breathed only through the open mouth. The pulse was fever- ish, the urine burning and red. After using external cooling applications (oil and cold-water compresses'), the swelling began to subside on the second day; in a few days desquamation took place. She did not, however, regain her health. Weakness, de- spondency and indifference, bordering on imbecility, were ob- served in her. In a few weeks she fell into a typhoid fever, lasting twelve weeks, and thoroughly exhausting her vital powers. Nine months after the poisoning, she died of hectic fever. In this case, if we consider only the external skin, Mezereum produced, not only in the immediate point of ap- plication, an inflammation with serous exudation under the cuticle, which rises in blisters and then scales off, but also in the adjacent parts, eczema and a pustular eruption as well as itching and offensive ulcers. The seat of the latter processes is in the parenchyma of the papillary portion, as well as in the deeper layers, of the dermis. An essential feature, therefore, of this skin affection is an unusual serous secretion appearing, not only at the place im- mediately irritated, but also at distant points. This is the visible effect on the skin of the external application of Meze- reum. We possess many and remarkably accordant observations of its action on the skin after its internal use alone. MEZEREUM. 159 I. In liis Lesser Writings, published by Stapf (1. 212), we find the following observation by Hahnemann: " An other- wise healthy man took Mezereum bark internally for some difficulty, but, as he continued its use for some time after the cessation of his trouble, he got an intolerable itching over the whole body, which allowed not a second's sleep. He stopped the drug, and came to me after thirty-six hours, insisting that he could no longer bear the hourly increasing itching (the first direct action of Mezereum is of very long duration). After taking several grains of Camphor, the itching ceased." II. Among the symptoms in the Fragmenta, we find: 527.* Very obstinate itching for several days over the whole body. 236. Pimply, ulcerative eruption on the finger- joints, itching most in the evening. (In the original, " Erup- tio cutanea maxime vespere in lecto pruriens.") In Stapf's reproving [Archiv, 4], there were eleven provers besides Hahnemann ; the provings were made with the tinct- ure of the carefully-dried bark, or with the expressed juice (mixed with equal parts of alcohol) of the fresh bark gathered in early spring during inflorescence. From eight to ten drops of these tinctures, much diluted with water, sufficed to produce in most of these provers very marked and enduring symptoms; for some a few drops were enough. Almost identical skin- symptoms appear in seven provers.f In Theile's reproving [with eight, twelve to twenty-four drops of tincture. Allg. Hom. Zeitung,NA. 14, p. 114] three of the same skin symptoms are repeated : III. P-r. Brownish, miliary rash on the chest, arm and thighs (5 d.) 1). Vesicles full of clear serum on the nose and back skin under the ruptured vesicles inflamed; formation of a brown scab. * The numbers are taken from Chronic Diseases, Vol. IV. t These symptoms are given in works on Materia Medica, and especially in Allen's Encyclopaedia, to which accordingly we refer the reader -Translator. I As the symptoms of the later provings have not yet been collected in any schema, we designate them, provisionally, by letters, to distinguish them from those of the - M. M. Pura." 160 world's homceopatihc convention. e. Rono-hness and scaling of the skin here and there, o o d. N&cg troublesome itching in a sore, even after it had healed. IV. E-n. e. Violent itching in almost all parts of the skin : neck, chest, extremities ; compelling to scratch and thereupon changing location ; worse at evening; lasting several weeks. f. Burning, itching and tension on the back of the left ear; on scratching, the epidermis peeled off in patches half an inch large. V. Theile. g. Burning itching, especially on the nape and calves. h. Burning, red miliary pustules on the thighs. i. Burning vesicles with red areolae on the sides of the fin- gers, depressed rather than elevated. They dry up, leaving either bright red spots, or the epidermis peels off in round scales. k. Stitching pains in a scar on the end of the right middle finger, in which, for two years, there had not been the least sensation. We come now to the provings of the Lusatian Society: VI. Hartlaub. Hartlaub made four provings on himself with the fresh plant, which he inhaled while dividing and trit- urating it, and while preparing the alcoholic tincture, and took in substance both crude and in the form of tincture. The provings were from two to eight days apart. We connect the related symptoms. I. Itching on many parts of the body : nares, lower lip, vio- lent on the wrists, about the anus, scrotum and lower extrem- ities (217). tn. A large sugillation on the dorsum of the right hand above the index; a party-colored, not round, spot about one inch in diameter, painless; faded the next day. n. Violent itching on this hand but not on the spot of sugil- lation ; especially on the wrist, so that it was rubbed sore. An eruption appeared. Before scratching there were no pimples; but afterwards, many small, superficial, dark-brown scabs like those in scabies after it has been scratched and has dried. Just before falling off (twenty-two days) they were quite white and MEZEREUM. 161 had become much thicker (conical) and those which had healed left brownish spots the size of the scabs, with fading brownish areolae. o. Violent itching on the lower extremities when going to sleep; especially at the hollow of the knee, so that he scratched it sore ; it became very painful lasting several days. 119. p. Often waked at night by severe itching of limbs. q. A small pustule in the beard on chin ; a few pimples on the chest. That on the chin became a small ulcer with thin, oily, sticky discharge ; very painful. r. The liver-spots desquamate more than usual and are very dark (127, 207.) s. The skin, at least of the hands, is dead and rough. In three other provings, with the first dilution, by Dr. Link, a young man under direction of Dr. Speer, and a lady, we find : VII. Dr. Link. t. Burning stitching sensations like insect- stings on various parts of the body. u. Itching at the right eye and the side whiskers. Mrs. T-. v. Slight stitches here and there. w. Creeping and single stitches on various parts. VIII. Speer, x. Itching eruption like flea-bites, over the whole body ; vanished in three days; lasted longer on the head and there looked scabby. IX. Hering.* y. His long hair became more troublesome ; seemed more bristly; after some weeks it grew more curly and thicker. (Was this aggravation or curative action?) z. Small painless pimples, like millet seed, on the fore-head at the edge of the scalp. aa. Dandruff more abundant, whiter and drier than usual. bb. Small, red pimples on the forehead, itching but painless. cc. Twitching of the eyebrows. ■ dd. Constant itching behind the ears; small elevations appear after much scratching, which are scratched sore and pain. ee. His nose seems to him larger and shiny. ff. Severe itching at the edge of the lower jaw (fifth and following days.) * Some symptoms confirming and completing those in the Chronic Diseases. 162 world's homceopathic convention. gg. Burning in well defined spots at the outside of the wrists after using the hands in cold water. hh. A moveable, somewhat hard swelling under left knee. ii. Painful -walking as from hard tight boots. To this symptom Hering remarks : "Rejected from my MSS. by Stapf," we suspect, then, that " the medical student H." was our honored veteran Hering ; and perhaps W. was Wahle, as Dr. Dunham suspects. X. Lembke. Lembke made a truly self-sacrificing proving, for about two months, partly with two to twenty drops several times daily of the first dilution ; then with the tinc- ture, three to fifteen drops several times daily. The skin was but little affected ; the fibrous tissues very much. ■ kk. Burning itching in the left brow ; itching and biting in the skin of the nose. II. Burning on the alae nasi, end of nose, in the septum and nose, skin of cheeks, of nape, inner surface of forearms and at various points of leg. mm. Burning and stitching on inside of left arm, evening. nn. Burning and itching on inside of thigh and scrotum. XI. Wahle. Most of these symptoms of Lead and face are from observations on patients. From an observer like Wahle, however, they are valuable. oo. Head covered with a thick leathery crust, under which pus collects and mats the hair. pp. Large prominent white scabs on head ; ichor forms under them, becomes offensive and vermin breed in it. qq. The scabs on the head look chalky and spread to brows, nape and throat. rr. Gray, earthy complexion. ss. The child scratches the face incessantly; it is covered with blood. Face and forehead red and hot; great restlessness and irritability. At night it scratches the face so that the bed is smeared with blood. It constantly tears off the scabs from the face and on the -wounded places great " fat " pustules form. tt. The humor from under the scabs irritates other parts. uu. The skin of the face is deep red and the eruption is " fat " and moist (impetigo.) MEZEREUM. 163 vo. Honey-like crust about the mouth. ww. Betwen the buttocks four large scabs on a hard base with a dark red areola. xx. Itching in the hollow of the right knee. yy. The whole skin is covered with white elevated scabs. 22. Itching and burning in upper and lower extremities; after scratching violent stitching as with needles. aaa. The fiery-red inflammation on the joints of the left foot extends over the instep and calf. Hard pustules form in the connective tissue, and itch at the slightest touch, with vio- lent burning pain. bib. Vesicular eruption over the whole body. ccc. Pale red eruption over whole body, itching and scratch- ing ; the scabs adhere firmly and are depressed in the centre. ddd. .Ulcers covered with thick whitish or yellow scabs under which thick yellow matter collects. eee. Throbbing around the ulcer which has a bright red areola. fff. Burning in ulcer at evening. gyy. Fiery, shining red areola around the ulcer. hhh. Vesicles around the ulcer, itching violently and burn- inglike fire. After eight days, these vesicles dry up, leaving scabs, the removal of which causes great pain and delays the healing. Hi. The affected parts feel, but are not, swollen. jjj. The ulcers bleed easily. XII. Gerstel. While engaged in this study, 1 have made some provings on myself, hoping to learn what symptoms pre- dominate, their order and physiological connection. I took, at various times, some drops of the first, third and seventh decimal dilution, and once some drops of the tincture. Many Mezereum symptoms were confirmed. I will at present mention only those of the skin. X7rZ'. Oft-recurring, severe itching, compelling to scratch, now here, now there, on almost all parts of the body, and very soon after taking the drug; especially on the scalp above the forehead ; in one or the other eyebrow, also under the eye; and especially, a persistent, oft-recurring itching on the external ear and in the left concha. 164 world's homoeopathic convention. UI. The itching often extended over the whole body ; I felt it simultaneously on back, abdomen and scalp, impelling to scratch and relieved by scratching. I could perceive no dif- ference in the time of day. mm. At times it was a burning itching or a tickling as from insects on the chin, the shoulder, the clavicle, the right thorax along the lower ribs and the back; also the thumb and right middle finger. nnn. The later the itching began, the greater the inclination to scratch. ooo. Smarting in the eyes, compelling to rub them. ppp. Violent stitching and burning itching on the outer aspect of the right shoulder, as if in the flesh, as though an eruption would appear there. Mezereum contains a so-called acrid matter, daphnin, of a bitter and astringent taste and soluble in boiling water, alcohol and ether. Mezereum or its active principle, daphnin, may thus be readily absorbed and produce general effects corres- ponding to those of the local application. The normal secretion of the skin is a secretion from the arterial blood of the wonderful vascular network of the seba- ceous glands. Now, since the external application of Meze- reum evidently increases the arterial secretion, producing serous, easily coagulating, excretions, we can easily comprehend that the Mezereum atoms absorbed into the blood, will act similarly, showing, in quality though not perhaps in degree, a relationship and similarity to the aggregate of its external action. Experiment has shown that it is only the various membranous tissues which have a primary susceptibility to the action of Mezereum; and the degree is different in different individuals. The first appearance and form of morbid action on the skin is a pricking itching, compelling to scratch ; i. e. prurigo. The basis of prurigo, especially prurigo formicans (Bateman), is a morbid secretion ; it is always accompanied by white, smooth papules so small as often to escape notice, seldom red or inflamed unless they have been vigorously rubbed. According to other dermatologists, when itching occurs it MEZEREUM. 165 is the result of excoriation. The microscopic Mezereum atoms produce on a small scale the same effect as the external appli- cation of the bark, that is: increased secretion from the vas- cular network of the sebaceous glands and congestion or rup- ture. ■This congestion of the capillary network or the dried secre- tion produces the irritation of the sensory nerves felt as itching and prickling. This prurigo is the mildest and most universal form of the Mezereum skin disease. The irritation is general and moderate, and soon ceases after scratching, though it may reappear in other places. Single localities are especially affected and cer- tain nerve-twigs show an affinity for this Mezereum irritation. These localities are : the scalp, face, nose and ear; the stitches and itching extending into the ear. The irritation follows certain ffbres of the trigeminus, especially those of the optic ganglion. We shall see hereafter that the auditory apparatus is affected in another direction. The back, the shoulder, (the cutaneous sphere of the plexus cervicalis), the wrist and scrotum are also affected. The parts affected are especially, if not exclusively those in which the panniculus adiposus is almost entirely wanting. The itching is felt particularly at evening and is increased by warmth, hence also by the warmth of a bed. 1 consider burning a higher degree of itching ; it likewise depends upon congestion of the smaller vessels without loss of nerve sensibility. If the seat of the affection be near the epidermis, the almost imperceptible vesicles will be removed by the scratching and the itching will cease for a while; but if its seat be deeper in the cutis the exudation will remain in the cutaneous connec- tive tissue, and can only be removed by deeper scratching, i. e., until the blood comes (yule, 495 and Ilaubold's symptoms). The second form of the Mezereum skin affection consists of visible eruptions. Their forms and modes of origin are di- verse, but all tend to loosen the epidermis, to alter and exfol- iate it and even to form ulcers. 1. A pale suggillation which gradually fades out. 166 world's homceopathic convention. 2. An already existing suggillation exfoliates; even in a portion of cellnlar tissue rendered impermeable by a scar this tendency is manifested by painfulness (pityriasis). 3. When the exudation is deeper in the cutis, it is only brought out by scratching, and leaves dark-red or brown scabs colored by the blood); or it does not come to the surface but remains in the skin, forming papules (Wahle). 4. Herpes on the skin, with inflamed base, exudation of oily sticky matter, and exfoliation with brown scabs (Rupia). 4. Regular pustules form. With all these forms there is the characteristic itching and burning, worse at night; hence, especially in 4 and 5, the scabs are torn off and new eruptions form on the denuded spots. 6. Ulcers, of which we shall speak hereafter. In all these forms, and from corroborative observations, we must conclude that the morbid secretion induced by Mezereum is a pure serum, partly mixed with the coloring matter of the blood, resulting partly from rupture or obliteration of the fin- est arterial capillaries. If, therefore, we should regard only the exudation, the scrofulous eruptions could not be included in the sphere of action of Mezereum. But a single symptom can never suffice for an accurate diagnosis ; other circumstances must be considered in determining the choice of the remedy. And in this connection we refer to what Stapf has emphasized in his preface to Mezereum. He says: " Coldness, subjective and objective, either general or partial, and especially in the extremities, with intense thirst, is a characteristic and note- worthy primary effect of Mezereum. It accompanies other symptoms, as headache, stool, bone-pains, etc." The symptoms in the " Chronic Diseases " which confirm this statement are Nos. 45, 280, 482, 587, 588, 580, 501, 505, 56, 288, 583, 584, 585, 590, 592, 598, 593, 594, and 601. In Hartlaub's provings we find: " Chilly at evening. Feel- ing as of a cold w'n 1 blowing on the head. Chill runs over the body often at evening, also over single parts, down the left leg; pulse at the same time 80 to 90, and rather full. Chill runs down over the whole body, at evening, with yawning; MEZEREUM. 167 though the body and room were very warm, chilly, with cold hands and feet, quickened pulse (89 to 90); the skin, at least of the hands, dead, cracked and wrinkled, as from long expos- ure to cold and as if it w'ould peel off; increased thirst for cool w'ater with the chill. At evening he is rather too warm and yet chills run over him at the same time, especially down the left side of the back and the lower extremities." Theile's four provers report: " Constant chills, so that he cannot get warm the whole day." I also felt frequently slight chilliness on single parts of the body, not followed by heat. We perceive how trustworthy were the first provings of Mezereum. This symptom, men- tioned in them as a characteristic, is confirmed by all the later pro vers except Wahle. Why is this cold feeling a characteristic of Mezereum ? Chilliness, coldness of single parts, not being precursors of fever and not followed by heat, are, as physiology teaches, sub- jective sensations, having no necessary relation to the actual temperature, which is often not at all modified. These sensa- tions result from the immediate action of the morbific irrita- tion on the spinal cord, whose reflex action induces contrac- tion of the skin, producing cutis anserina, roughness, dryness and brittleness. From the same cause we may have a simultaneous deter- mination of blood to internal parts, producing actual external coldness. The Mezereum atoms, which, irritating the capillary system, determine the sensation of itching, act also specifically, so that a reflex action of the spinal cord produces cutis anserina, and a chilly feeling may ensue. But the chilliness of Mezereum has other peculiarities: 1. It is accompanied by thirst. Now, according to Budge, one of the prime causes of morbidly-in creased thirst is a rela- tive diminution of the serum of the blood, such as arises from its loss in excretory fluids; this loss, as we have seen, is pro- duced by Mezereum. We find thus a physiological connection in all these phenomena. 2. The other peculiarity is that there is no need of warmth 168 world's homceopathic convention. and no dread of cold air; perhaps, in the open air, the tone of the cutaneous nerves is altered and the normal condition sooner restored; moreover, warmth increases, while cold diminishes the itching:. Chilliness belongs so specifically to Mezereum as to occur independently of other kinds of skin-irritation ; it accompanies headache, bonepain, etc. But these symptoms are not accom- panied by thirst. Another characteristic of Mezereum is equally explicable; that which, in the skin, is itching, appears in the muscular parts as twitching or quivering. Thus we find: 102. Annoying muscular twitching in the left upper lid for eight weeks ; and by the same observer (Gss). 120. Frequent troublesome muscular twitching in the middle of the right cheek (eight weeks). 224. Muscular twitching in the scrobiculus, and transient shocks in that region (Gr., Gss.). 359. Jerking in the left side of the chest, transient and painful like electric shocks (Gr.). 386. A burning stitch and strong muscular twitching; under the left scapula (Gss.). 401. Dull pain and twitching in the shoulder, as after carry- ing a heavy load (Gr.). 491. Transient stitching-jerking on the upper part of the left shin-bone-when sitting with the knee bent. 505. Twitching about the right outer malleolus (W.). 512-513. Painful twitching, like nervous jerking in the great toe, like muscular twitching, or as if vesicles broke (Gss., Gr.). Ilartlaub also had twitching of the eyelid, muscular move- ments, shocks in the stomach, abdomen, back, etc. We find these symptoms uniformly located in those places where the muscles are in immediate connection with the firmer connec- tive tissue of the cutis, and where the panniculus adiposus is wanting. Mezereum seems, then, to act specifically on these places; hence the conclusion that it is especially suitable for slim, thin persons with rather dry skin and a lack of fat; and, as re- gards the itching, especially for pruritus senilis. Mezereum acts MP Z ER EUM. 169 specifically on the scalp, and has manifold relations with the hair; as might have been inferred from the action of Mezereum on the muscular structure of the skin, the smooth fibres of the arrectores pili being attached at the lower ends of the hair fol- licles, into which the glandule sebaceae discharge. By the contraction of these muscular fibres cutis anserina and horripi- lation are produced. Accordingly we find the following symptoms: 84. The hail* painful as if sore to touch (Gss.). 85. The hair much inclined to stand on end. And in the Lusatian proving, Hering's symptoms \vide XVI.]. These are the essential relations of Mezereum to the skin, in so far as we can deduce them from physiological provings. Let us see how far experience confirms these deductions. Dr. Kafka [A. II. Z., 91, 140] reports a brilliant cure of pruritus senilis in a man seventy-four years old, a subject of marasmus senilis, whose skin was wrinkled and in folds, and who could not sleep at night because of the itching. He was weak and dyspeptic. He could not refrain from scratching, feeling as though millions of insects were creeping on him compelling him to rub, successively, his arms, legs, abdomen and throat. On the parts scratched were innumerable, insular, white elevations on a red or reddish base, as in nettlerash, which, when deeply scratched, displayed in their centre a drop of blood the size of a pin-head and burned as if a bright coal lay upon them. By day the itching was tolerable, and there was no visible trace of morbid alteration in the skin; the blood spots ap- peared as small, brown points on the surface of the skin. During the violent itching and burning, the patient was chilly, feeling cold along the spinal column and in the ex- tremities ; and where the itching was most intense there wras a sensible diminution of temperature. After long and ineffectual allopathic treatment, he was cured in four weeks by Mezereum6, two doses daily. This case confirms the following characteristic Mezereum symptoms: the elevations of the cuticle filled with serum, the 170 WORLD'S HOMOEOPATHIC CONVENTION. pin-head drops of blood appearing after scratching until the itching was relieved, the burning like bright coals and the chilliness. Kafka mentions that, although many parts of the skin of this patient were tolerably fat yet, on the throat, abdomen, forearms, legs and face, the skin was not only atrophied, but in folds and wrinkles. The temperature of these parts was diminished, while that of the fatty parts was normal. And it was upon these atrophied parts that the prurigo established it- self. This observation confirms the inference that Mezereum affects especially those parts of the skin that are normally de- ficient in fat and reveals an essential characteristic of the drug. 2. A case of pityriasis versicolor (Bateman), Noack [A. U. Z., 14, 168]. A blond girl, aged eighteen years, of sanguine temperament, with scanty, intermitting menses, had, after the healing of an axillary abscess, large, irregular, sometimes con- fluent, distinctly-defined, copper-colored spots on the inner side of the thighs extending to the groin. They were not ele- vated, showed no disposition to suppurate, were the seat of a distressing burning itching, worse at the menstrual epoch, at which time the spots assumed a darker color, especially at the edges. This had lasted two years. She had occasional hemi- crania, stitches in the spleen, frequent chills, trembling of the limbs, and was morbidly fretful. Syphilis was out of the question. Graphites and Nitric acid did nothing; Coni- um but little. Mezereum3, one drop every three days, made a complete cure. The spots faded away, the itching ceased, menses became more copious, and the concomitants disap- peared. 3. Pityriasis capitis [A. II. Z., 81, 144].-Dr. Cooper cured with Mezereum, in twenty-seven weeks, a very severe case, accompanied by great vaginal irritation. It had lasted two years. He was led to give Mezereum by the pathogene- sis in Hahnemann's Lesser Writings (pile ante). 4. Wahle [A. II. Z., 14,116] told Noack that he used Mez- ereum with great benefit for a distressing exanthema, burning at night, compelling to scratch until the epidermis was re- M EZE REUM, 171 moved, and the denuded part was covered with a scab, or there was repeated exfoliation.* 5. Schultz [ V. J. 8., 8, 98] used Mezereum with advantage in Tetter (Flechten). They were dry, scaby, the scabs small, occurring especially in the bend of the elbows (therefore on a part destitute of fat) with red spots the size of a thaler. The following symptoms from the Fragmenta ascribed to Hoffmann, from taking four berries, have been admitted into the Materia Medica. 286. Very large al vine evacuations (hypercatharsis effrina). 182. Violent burning in the throat. 609. Violent burning fever. 532. Exfoliation of the entire skin (with emesis and thirst). 6. Kreisler [A. II. Z., 29, 153]. A woman had, by inherit- ance from her father, a growth as large as a thaler on the mid- dle of the forehead, projecting about four lines. It was not constant, as her father's had been, but came and went sponta- neously and suddenly. Mezereum" acted promptly and fav- orably. The swelling desquamated and gradually disappeared. Two years later it had not reappeared. The characteristic in this case was the scaly exfoliation of the skin, which we saw physiologically: «, in the case of poisoning cited by Pluskal; J, in proving XI. by E-d, symptom/" (q. v.). Hartlaub (XIII.) observed : " Habitual liver spots appear to exfoliate more than usual and are very dark." Liver spots and freckles are congenital or acquired organic changes of the epidermis, which may appear in the most diverse anomalies. We ae-ain call attention to the fact that in the cases cited the o parts of the skin destitute of fat were affected. Mezereum has also cured pustular eruptions. 7. Hahnemann [Introduction to Mezereum, Chron. Krankl\ cites as cured : " Moist itching eruption on the head and be- hind the ears." * Accordin'? to the provings contributed by Wahle, Jr. from his father's legacy the characteristic of the Mezereum sk'n affection should be-itching at evening in bed, aggravated by scratching and touch, and changed thereby to burning ; sensi- tiveness to touch ; ulcers with areola, sensitive, bleeding easily, painful at night; the pus forms firmly adherent scabs under which again much pus collects. world's homoeopathic convention. 172 8. Noack [A. H. Z., 14,166]: rupia prominens. A delicate unmarried woman, aged 63, with weak digestion, addicted to the use of coarse snuff, after great fatigue had a group of vesi- cles on the dorsum of the nose, itching excessively and dis- charging a pale, somewhat cloudy lymph'which formed a yel- lowish brown acuminated scab, easily separated but reappear- ing. The scab at last attained the size of a small bean. After using Calcarea, Spigelia and Aurum for three months without effect, a single dose of Mezereum15 cured. The scab fell off without a new one forming; the slightly-inflamed moist base dried in two days, leaving neither tetter nor scar. 9. Stens [A. 11. Z., 55, 29j cured a moist scabby eruption with Mezereum. 10. Fielttz [A. II. Z., 17,1] reports two cases of herpes crus- taceus. The leg, from knee to instep, of a woman aged 36, had for many years been covered with a thick yellow scab, from cracks in which thick yellow matter oozed on pressure. The scab falls off in pieces, leaving the skin deep red, sore, itching violently and exuding a thin, clear fluid, forming a thin scab under which pus again collects. The skin around the scabs is dark red, tense, hot, itching; the foot swollen, with painful stitches on beginning to walk. At night intoler- able itching and burning in the eruption. The leg emits a foul odor. General health undisturbed. Sulphur, Calcarea, Lycopodium, Graphites, Rhus, Clematis did no good. Meze- reum6, then third, every other day, then every day, almost cured the patient within two months, leaving only a few small patches of eruption. The patient declined further treatment. 11. Mentagra.-A vigorous countryman aged 32, had red pustules on the chin, very painful when shaving. They broke and formed a scab, which in 6 months presented the following appearance : The hairy part of the face was covered with a yellowish brown scab quarter of an inch thick, from cracks in which bloody lymph exuded, producing slight itching in the edges. Around the edges a dark red moist areola. The lids were inflamed, the lower lids beset with crusts and somewhat everted. Sulphur, Nit. acid and Rhus did no good. Mezereum3, one drop daily, effected a complete cure of face and eyes within six weeks. MEZEREUM. 173 12. A case of mentagra was cured by Elwert \Hyg., 20,103] with Mezereum1, six to eight drops every forty-eight hours. It had lasted two years and was cured in two months. No relapse. In the so-called herpes crustaceus reported by Fielitz, the following Mezereum characteristics occurred: a, clear or bloody secretion; 6, dark brownish scabs from admixture of blood [in crusta lactea and in scrofulous eruptions the scabs are a bright clear yellow] ; c, the location on parts devoid of fat; d. nocturnal burning and itching. Both forms of mentagra have their seat in the hair follicles with which, as we have seen, Mezereum has a physiological relation. In Hartlaub's proving \_Lusatian xSbc.] we find this symptom: " a small pustule in the beard, left side of chin ; also small pimples on chest at the base of hairs." We call attention to the fact that all of these cases occurred in adults, otherwise healthy; we regard Mezereum as scarcely indicated in the dyscrasise. Certain nerve-twigs have an especial affinity for Mezereum ; e. g. the infra-maxillaris, branch of the trigeminus. Herpes zoster or zona, which follows the course of one or more of the superficial nerves originating in the spinal ganglia has found its remedy in Mezereum (wide Baehr). But it can only cure when the concomitant symptoms correspond to the Mezereum characteristics; we would moreover suggest it, when the zoster appears in places devoid of fat or in thin sub- jects. It would correspond to the region of the ganglion cer- vicalo. Hendricks \_AUg. Hom. Zeitung, 51, 63] reports that after a zona cured by Rhus there remained great coldness of the body with burning pain in the seat of the zona. This condition was cured by Mezereum. Modern pathology regards such skin diseases as caused by parasites, which however can only take root when there is, in the patient, a predisposing condition. The predisposing con- dition may be removed by Mezereum when the concomitant symptoms correspond; then, the nidus failing, the seed dies. 174 world's homceopathic convention. Von Grauvogl says [All. Horn. Zeitung, 75, 27]: " Our opponents might for once try the experiment of giving, for eczema, Mezereum'0 for several weeks, every two hours four or five drops in a teaspoonful of water, and report the result. To prevent relapse, the remedy must be continued some weeks, even after the eruption has disappeared; for even a single living spore (especially a sexual) remaining in the spiral end of a sweat gland or in a fold of the skin might in a few days reestablish the eruption, if the condition of the skin-function still afforded nutrition for the parasite. The neglect of this rule, which many patients will neither understand nor observe, misleads physicians into the belief that the remedy used is of no avail." Among the cases cited, some may be ascribed to a vegetable parasite, e. g., Pityriasis vers., mentagra, etc.; they were cured by Mezereum without the favorite modern local treatment. 13. Wahle (Z. c.) says the symptoms observed by him (v. a.) indicate Mezereum for crusta lactea, various forms of uncom- plicated impetigo and syphilitic and mercurio-syphilitic ulcers on the lower extremities, so difficult to cure. He often saw the good effect of Mezereum300 in these cases, the lower attenua- tions having failed. To this we remark, as regards crusta lac- tea, the good effect of Mezereum is confirmed by Hr. Dunham in a letter; but, as we have said, we do not consider Mezereum indicated in scrofulous eruptions. We think the term crusta lactea an insufficient designation, and that Mezereum is indi- cated in these cases only where the characteristic itching and bloody scratching (as noted by Wahle) are present and the exudation is serous rather than lymphatic. As to the ulcers the cure of which is reported by both Wahle and Dunham, we find in the provings no symptoms describing that condition, except Wahle's (u a^\ and it is doubtful whether these were observed on healthy persons. They present, however, the same characteristic features-vesicular origin, itching and burm ing, scabs under which pus collects-as the pustular Mezereum disorder. The ulcer, then, is only a cumulative pustular con- dition on a limited space ; such an ulcerated surface results primarily from the local application of Mezereum. MEZEREUM. 175 The ulcer, in which Mezereum is indicated, must accordingly present the peculiarities we have noticed in the other skin af- fections ; the peculiar itching or burning at night, the scab formation, the occasional bleeding, the location on parts con- taining little or no fat (hence especially on the shin), finally, the other concomitant symptoms of Mezereum. Where the skin is in almost immediate contact with the fib- rous tissue, as on the front of the tibia, it is the more suscepti- ble to the action of Mezereum, since, as we shall see, Mezere- um affects the fibrous tissues, and especially the periosteum, in an equal, if not greater, degree than the skin. Indeed its indication in affections of the bones and teeth is only for such as originate in the periosteum. Vienna, January 16, 1876. HYDROCYANIC ACID-ITS VALUE IN EPILEPSY. By Richard Hughes, L. R. C. P., Etc., Brighton, England. Having been honoured by a request that I would read a paper at the World's Homoeopathic Convention, I have chosen as my subject a medicine which seems to me to have hardly received the attention it deserves, and an application of it which, if established as successful, will take rank among the prerogative instances of the truth that "Similia similibus curantur." I have said that Hydrocyanic acid has hardly received among those practising homoeopathically the attention it deserves. "Magis venenum, magis remedium" is obviously the first rough statement of the homoeopathic principle, and nowhere is its axiomatic force so habitually recognized as in the School of Hahnemann. Yet this potent poison, whose effects are so well known, whose modus operandi has been so thoroughly studied, takes no place in our Materia Medica corresponding with that which it holds in Toxicology. Nor can its exception to the general rule be justified by the allegation that we have no knowledge of the minute details and characteristics of its action. It has not indeed been proved by Hahnemann or by any of his disciples. But it has undergone this process at the hands of one whose results Hahnemann was always glad to incorporate with his own ; I mean Prof. Joerg. In that most valuable collection of provings of his which I think ought long ago to have been translated for the benefit of English-speaking members of the only school which can appreciate and utilize 177 178 world's homceopathic convention. it aright; in his Materidlien zu einer kunftigen Ileilmittel- lehre, durch Versuche der Arzneien an gesunden Menschen gewonnen und gesammelt von, published in 1825, he has given us the results of experiments on nine persons with the acid itself, and on nineteen with the distilled waters of the two natural substances which contain it most largely-the bitter almond and the cherry laurel. Of the latter plant, moreover, we have a pathogenesis in the Arzneimittdlehre of Ilartlaub and Trinks. From these materials we have full opportunity of learning what Hydrocyanic acid can do to the healthy body, and hence how it can best be used for the help of the sick. Neither can our neglect of the drug be warranted by lack of evidence of its medicinal value, and this mainly of the very kind we desiderate. Bitter almonds have been in repute since the days of Dioscorides and Galen. The Aqua laurocerasi was largely employed some eighty years ago, and was held in such esteem that it would pretty certainly be now in use but that the potent ingredient it contains has taken its place. The acid itself, since-by the labours of Gay-Lussac, Vauquelin and Scheele-it has been discovered, isolated and prepared for use, has taken no mean place among the therapeutic agents employed in the Old School. Although the expectations entertained by Brera, Magendie and Granville that it would prove a "contro-stimulant," and be curative in fever, inflam- mation and phthisis have not been sustained, it is still account- ed a trustworthy remedy in certain affections of the digestive and respiratory and circulatory organs. These are all of a spasmodic character-gastrodynia, vomiting, whooping-cough, angina pectoris; and if there is any one feature more marked than another in poisoning by Prussic acid it is the spasm which is excited. Besides this general homceopathicity, we have in respect of its most important use, viz : as a remedy for gastric pain and vomiting, this testimony of one of its warmest advocates, the late Dr. Elliotson. " An overdose " he writes, "will in every person occasion nausea, vomiting and a pain and tightness at the prsecordia. Even applied externally, it has caused nausea, vomiting, vertigo and syncope. It appears, therefore," he concludes, " to act specifically upon the HYDROCYANIC ACID ITS VALUE IN EPILEPSY. 179 stomach." It is evident that, here, as often elsewhere, ''speci- fically" means homoeopathically. There is, moreover, about the curative action of Hydrocyanic acid that contingent character which belongs to the truest homoeopathic medication. It will not cure every case of any typical form of disease; in some it will succeed brilliantly, in others it. will fail entirely. Thus Pereira writes of it in gastrodynia: " the beneficial effects of Hydrocyanic acid, in some instances of the disease, are most astonishing; while in others it totally fails. In all the cases in which I have tried it, I have obtained either perfect success or complete failure ; I have met with no cases of partial relief." And in whooping- cough Dr. West says that "it sometimes exerts an almost magical influence, diminishing the frequency and severity of the paroxysms almost immediately ; while in other eases it seems to effect little or nothing." Our explanation of such different results is that, where it succeeds, it is the true similar to the case; where it fails, it is not; and we seek by our prov- ings to be able to determine a priori when it should be given and when withheld. If it acted merely as a " sedative," it ought to benefit all cases more or less. Now Homoeopathy does two things with the medicines she finds in use. Having ascertained their physiological action, she first examines in the light thereof the curative applications hitherto made of them, with the view of ascertaining how far these belong to her sphere; and then using the rule " Similia similibus " as her guide, she seeks to extend further their em- ployment after the same manner. The result of following this course with Hydrocyanic acid has been that its uses as an " anti-spasmodic " in gastric, respiratory" and cardiac affections must be claimed for our method, and should be adopted by us. But we may not stop here. The general tonic spasm it excites should lead us to find a place for it in the treatment of tetanus; in one case of which, of the traumatic form, it proved evidently curative in the hands of our colleague Dr. George Moore. The " spasmodic oppression of respiration," noted from it by all toxicologists, induced Dr. Russell to give it when this condition supervened in a cholera patient,, with 180 world's HOMOEOPATHIC CONVENTION. great and speedy relief. I myself have frequently employed the acid with benefit in spasmodic asthma. But the disease, which its poisonous effects seem to me to resemble more closely than any other, is epilepsy ; and to this point I desire to direct your special attention. Let me read you a case of poisoning by the drug. It was communicated to the Lancet by Dr. Letheby. I cite : " A girl, aged 22 years, swallowed by mistake a dose of Prussic acid, equivalent to a little less than a grain of the pure poison. At the time when this was taken she was sitting in a chair; but she instantly jumped up, ran for a short dis- tance, holding up her arms and gasping, as it were for breath ; she then fell, became insensible and was violently convulsed, the muscles of her face undergoing great distortion, her limbs becoming spasmodically extended and her head drawn down upon her shoulders. In this state she was removed to her bed, and was seen directly afterwards by Mr. Watson, who found her lying on her back, with the body drawn a little for- wards ; the limbs fixed and extended in tetanic spasm ; the whole face swollen, turgid and almost purple from congestion; the jaws clenched ; the mouth covered with foam ; the eyes half closed, but prominent and glistening; with their pupils widely dilated, and quite insensible to the stimulus of light. She was breathing slowly with deep prolonged inspirations, and uttering a low, moaning noise. The pulse at her wrist could not be felt, although the heart still continued to beat with a feeble fluttering effort. " The symptoms so closely resembled an epileptic fit, that the medical men who were called in supposed at first that the patient was laboring under such an attack; but soon discover- ing that she was suffering from the action of Hydrocyanic acid, they instantly adopted means for her recovery, but without the least avail, for the breathing became slower and slower, the limbs at this time remaining fixed and immov- able ; and she died in from fifteen to twenty minutes after the ingestion of the poison. " The post-mortem appearances in this case were as usual in cases of poisoning in Hydrocyanic acid. The cerebral vessels, HYDROCYANIC ACID-ITS VALUE IN EPILEPSY. 181 both upon the surface and in the substance of the brain, full of black, fluid blood; the lungs highly congested, but free from tubercle or other disease ; the cavities of the heart full of black, uncoagulated blood." You will notice that the patient was at first supposed by the medical attendants to be in an epileptic fit; and the mis- take was surely a very natural one. The similarity between the two conditions is noticed by most writers on Toxicology and Materia Medica. Pereira's fourth class of " cerebro- spinants" consists of " epileptifacients," and is headed by Hydrocyanic acid and the substances containing it. Of them he writes : " The sudden loss of sensation and consciousness, with violent convulsions, which are the characteristic effects of this order of drugs, constitute also the essential symptoms of an epileptic paroxysm." Christison says: " Epilepsy resembles closely the symptoms caused by Prussic acid and, again, " the acid induces coma and convulsions-especially of the muscles of respiration, con- stituting phenomena not unlike those which characterize some varieties of the epileptic paroxysm." Taylor says of epilepsy: " This disease, in some of its symptoms, resembles poisoning by Prussic acid alone." Nor do I see any reason to dispute the correctness of the comparison. The sequence of events in a typical case of epilepsy is this : The patient suddenly falls unconscious with pale face, dilated pupils and tonic spasm of some of the muscles, especially those of respiration. After a while the face becomes turgid and dark, and therewith general clonic convulsions set in. As these pass off, the patient gradually regains consciousness, but remains dull, headachy and sleepy for some time afterwards. These phenomena are explained in the following manner. The central and primary seat of epilepsy is the medulla oblongata, which in all cases of the kind is in an irritable and somewhat hypenemic condition. The first step in the paroxysm is an explosive discharge of nerve-force from this centre, which falling on the sympathetic nerves of the head, dilates the pupils and cuts off the supply of blood to the brain and face, and also, through the laryngeal 182 world's homceopathic convention. nerves, interrupts the respiration. This arrest of breathing leads to the clonic convulsions of the second stage, which are those of asphyxia, and are, as Dr. Russell Reynolds says, in direct proportion to its perfection and continuancex The epiphenomena are those of shock to the brain combined probably with its temporary poisoning by carbonized blood. That Hydrocyanic acid produces this chain of effects is almost sufficiently proved by the single case before us, but the evidence derived therefrom is much strengthened by the perusal of a few other narratives of the kind, such as those which Dr. Madden and myself have collected in the twentieth volume of the British Journal of Homoeopathy. Of the spasmodic arrest of breathing caused by the poison, and the asphyxia consecpient thereon, I have already spoken. But we may with advantage notice the state of the eyes. They were " prominent and glistening, with their pupils widely dilated and quite insensible to the stimulus of light." This appear- ance is of such frequent occurrence in poisoning by Prussic acid, that Dr. Paris considered it as alone supplying decisive evidence thereof. It is, moreover, the precise condition induced by galvanizing the cervical sympathetic. Since, then, we have evidence-both phenomenal and physiological-of the pres- ence of two of the factors of the first stage of epilepsy in poisoning by the acid, we may infer that the third-the loss of consciousness-is similarly induced in both; and may con- clude with Pereira that " the condition of the brain in poison- ing by this drug is probably identical with that which occurs during an epileptic paroxysm." The only divergence appears in the feature of the second stage, where in epilepsy the convul- sions are clonic, while in poisoning by Hydrocyanic acid they are always tonic. But this is easily explained. The whole epileptic paroxysm starts from the medulla oblongata, so that only the muscles animated by this centre are thrown into tonic spasm, while those of the body generally are left free to be acted upon after the special manner of asphyxia. But in Prussic acid poisoning the entire length of the cord is (as Wedemeyer has ascertained) similarly affected, so that a tetanic condition is induced throughout the body. The asphyxia is 183 HYDROCYANIC ACID ITS VALUE IN EPILEPSY. there, capable of inducing its clonic convulsions; but the ex- alted polarity of the whole medulla spinalis compels the spasms to tonic persistence. I hold it as established, then, that Hydrocyanic acid is exquisitely homoeopathic to the epileptic paroxysm, that its effects as closely and truly resemble that disorder as those of strychnia resemble tetanus. Upon our principle, then, it should be remedial in certain casesand forms of the disease; and, could we establish the fact of such remedial activity, we should have a most potent argument to allege in support of the validity of our method. Let us enquire what facts of the kind we possess. It was hardly to be expected that old-school Therapeutics should make much use of Prussic acid in epilepsy. Neverthe- less, some experience of the kind is on record. Ilartlaub and Trinks, in the preface to their proving of Laurocerasus, mention that Gremmler found it diminish the frequency and severity of the paroxysms, though he could not effect a radical cure with it; and that Remer praises it in the epileptic con- vulsions of pregnant women. They also refer to a cure of epilepsy by cherry-laurel water, communicated by one Mueller to Ilufeland's Journal. I find that the patient here was a woman of twenty-two, who had had the fits for seven years, often twice a day. Aqua laurocerasi was prescribed, in doses increasing from twenty to eighty drops daily. By the time that four ounces had been taken, the patient was quite cured. Frank, in the first volume of his Magazin (p. 320), relates three of Gremmler's cases, which seem to warrant a more favourable account than that given of them by Ilartlaub and Trinks ; and also one from Koehler, in which a complete cure was effected. In his fourth volume he cites a narrative from the Bulletin of the French Academy of Medicine, which tells how an epileptic dog being delivered over to be poisoned instead of being destroyed by the Prussic acid given him with this intent, lost his fits, and became quite healthy. In homoeopathic literature I know of no record of the treat- ment of epilepsy by this drug. Baertl, in the exhaustive collection of cases of the disease which he communicated to 184 world's homeopathic convention. the Vierteljakrsclvnft in 1863,* finds no place for Hydro- cyanic acid. He mentions, indeed, some favourable results from Ferrum hydrocyanidum ; but this compound seems to have none of the active properties of the acid. I can only, therefore, speak from my own experience with the medicine. In 1860, my dear friend Dr. Madden and myself, then prac- tising together, carried on some studies in the " Materia Me- dica" in the light of modern physiology ; and amongst other medicines, worked at Hydrocyanic acid. We were so struck with that homceopathicity to epilepsy which I have now claimed for it that we proceeded to use it largely in the treat- ment of the disease. Our results at first were encouraging, and we hoped to be able to communicate many instances of cure from its administration. But in all, save recent cases, the fits soon returned. We thought that Dr. Bussell had noted a fatal weakness in the medicine when he pointed out the evanescent character of its action, and we supposed that thus our fleeting successes were explained. Save, then, in recent epilepsies-as from fright-I made little use of Hydrocyanic acid until last year. Having then to lecture on the drug at the London Homoeopathic Hospital, the fresh and more extended survey of the facts which I made led me to think that I had been hasty in abandoning it as an anti-epileptic. I thought it likely that some part of our failure had arisen from not giving the medicine strong enough or long enough, and that thus the evanescence of its effects might obtain compensation. I altered my plan accordingly. It is too early yet to speak of results; but I am greatly encouraged by what I have seen, and hope ere long to be able to communicate several solid and lasting cures effected by the drug. It is my practice now to give from five drops of the third decimal attenuation to three drops of the first centesimal four times a day. I may mention that by the British Homoeopathic Pharmacopoeia these dilutions are so prepared as to represent by their numbers the proportion of the pure acid they contain. My object, however, in bringing this subject before the Convention was not so much to relate what has already been * Translated in the British Journal of Homaopathy. HYDROCYANIC ACID ITS VALUE IN EPILEPSY. 185 done, as to indicate a direction in which further success is possible and desirable. Our treatment of epilepsy is not so perfect that we can neglect so promising an addition to our remedies for it. We are liable, moreover, to be challenged by our opponents if our law fails us in so obvious an instance of its applicability. And they can do so with the greater confidence, as they are themselves now exulting in the possession of an anti-epileptic which rarely fails them. I allude to the Bromide of potassium. We justly allege that this remedy is but a palliative, and that epilepsy is only suspended during its use by the continuous poisoning of the system which it induces. But to make good our objections to the adoption of their practice, we ought to be able to do better with our homoeopathic curatives than they do with their antipathic palliatives. It is in the hope that Hydrocyanic acid will aid us in this task that I have advanced its claims to notice on the present occasion. SOME THERAPEUTIC EFFECTS OF CURARE. Paul Pitet, M.D., Paris, France. The remarkable labors of the last twenty-five years, under- taken to discover the physiological action of Curare, should not be lost to the art of healing. The eyes of allopathic physicians seem to be so blinded that they see, as a result of their unceasing researches into the action of medicinal substances, a simple extension of the field of phys- iological science, but no profit for humanity, nor for the thera- peutist. But the relations between man sick and man in the physiolog- ical state are not illusory, and the untiring researches of our learned confreres on the action of animal, vegetable, and min- eral substances upon the physiological organism, should not be regarded as a simple scientific enjoyment without relation to the organism in a pathological condition. Homoeopathy proves and illustrates this every day. Indeed we could not conceive that a substance capable of ex- ercising on the physiological organs and apparatus an action energetic enough to alter these organs and modify or even sus- pend their functions, could be without action on the same or- gans and functions when in a pathological state. Nor is this the case. The infallible means of ascertaining the necessary rela- tions which exist between the so-called pathogenetic action and the therapeutic virtues of toxic substances is evidently experimen- tation. Now a knowledge of the pathogenetic actions of various substances at once exhibits the relation between the toxic agent and the diseased organ in the broadest and most general modality ; and it is the part of the experimenter, that is, of the physician, to de- termine the special therapeutic application of each substance. The synthesis of the dynamo-therapeutic applications of a drug ought to follow from an analysis of its dynamo-pathoge- netic effects; Hahnemann having demonstrated that in every case of disease the initial phenomenon of the morbid process is a dy- namic disturbance of the functions, and that organic lesions are 188 world's homoeopathic convention. only consecutive disorders; and the substance which repairs the lesions and restores harmony of functions has been justly re- garded as a kind of force which is able in certain cases to dis- turb functions, and in others to put an end to existing disturb- ances. We use the terms dynamism and dynamic to designate these varieties, to distinguish them from purely chemical actions, which are wholly different and are never primitive in the organism, except in cases of sudden lesion from some external cause. But reflex actions, such as contractions of the heart and dia- phragm, actions of the vasomotors, their paresis or paralysis, are not chemical actions, although their initial cause may depend on a physical or chemical action. Voluntary and involuntary con- tractions are not chemical actions; still less so is the effect of the special fluid agent which stimulated them, electricity, or the bio-electric fluid. The formation of normal gastric and pancre- atic juice, of bile and saliva, etc., is a chemical act; but the primitive stimulus which governs these operations in the physio- logical and pathological state, arises from the cerebro-spinal cen- tres where the nerves originate which supply these glands, and transmit to them orders and power to execute their func- tions. It is these orders and transmissions of power, etc., which we call dynamic. The neuro-psychic stimulus arising from fear, surprise, anger, and which, in an instant, disorders the circulation, disturbs and sometimes suspends the whole vital mechanism, considered in its initial movement, is not chemical or physical, but belongs to the higher order which we call dynamic. The action of virus of poisons, Curare in particular, which suspends the mechanism and produces death in a few moments, before there has been time to produce any anatomical change, is absolutely different from the molecular actions peculiar to physics and chemistry ; the only appellation which suits them is dynamic. Moreover, chemistry herself exhibits operations in which the mere contact of certain substances brings about complete changes of condition without any interchange of elements, operations which have been called actions of contact or catalytic. The homoeopathic school has always viewed facts from this elevated philosophical standpoint, and thus it has been able to establish the therapeutic synthesis which is its glory. It was the first and is the only school that has compared the functional and organic disorders existing in diseases with the physiological and anatomical disturbances which active substances of the three natural kingdoms produce in the organism; has proved experi- SOME THERAPEUTIC EFFECTS OF CURARE. 189 mentally and logically that these pathological phenomena are to be regarded as pathological equivalents, destined to reciprocally7 neutralize each other, just as similar electricities cancel each other, as the same electric spark which decomposes water like- wise recomposes it, as the same current decomposes and recom- poses sulphide of carbon, as the same current which arrests the heart's action will, when less in intensity, restore to it move- ment and life, just as Iodine, which in its initial action causes in- crease of fat, and, in infinitesimal doses, is the remedy for the disease known as progressive muscular atrophy with fatty mus- cular degeneration. Our allopathic confreres, who give Chloral and Potassic bro- mide to quiet directly disturbances of the motor nerves, without seeing the real cause of the evil or the inevitable reactions from these dangerous substances, hastened to give Curare in chorea and epilepsy; and the failure of this practice has not sufficed to open their eyes to the falsity of their therapeutics. Let us show them the absurdity of the law of contraries by proving experimentally that Curare, which causes death by paralysis of the roots of the motor nerves, is a remedy7 in motor paresis caused by7 an ady- namic condition of these same roots. I propose to give a succinct resume of the recent remarkable works on Curare, in order to bring to view the striking relation between its morbific properties and its therapeutic virtues. Curare comes chiefly from Brazil. It is not easy to procure it from the Indians, who carefully conceal the mode of its prep- aration. The nature of its active principle is still in dispute; some regard it as the venom of a reptile, or Batraehian, and others as of vegetable origin. C. Bernard, in his work on The. Effects of Medicinal and Poisonous Substances, vol. i, p. 255, 1852, shows that the prep- arations made by the Indians on the banks of the Amazon from the venom of the toad, cause death in the same manner as Curare. It appears from all the facts hitherto gathered, that Cu- rare is a mixture of animal and vegetable substances of deter- minate species and analogous effects. Strychnos toxifera cannot be its base, as some have supposed, for its effects are the direct opposite to those of Curare. Subsequently, Bernard, having found some little seeds in a pot of Curare, sent them to M. Tulasne for identification. M. Tulasne found them to belong to the Paullinia cururu. It was natural to suppose then that this plant furnished the active principle of Curare. To determine the fact, besought and found in Herbaria enough seeds of the same species to make a little in- 190 world's homceopathic convention. fusion, the injection of which caused in frogs symptoms identi- cal with those of Curare-poisoning.-Revue des Cours Scientifiques, p. 573, 1869. Not only Curare, therefore, but also the Paullinia cururu should be subjected to pathogenetic researches. According to Bernard, Curare was first brought to Europe towards the end of the sixteenth century, by Sir Walter Raleigh, from Guiana. Brodie first saw it produce death by asphyxia, and saw that death might be prevented by artificial respiration. Curare may be taken with comparative impunity into the in- testinal canal, because it is very slowly absorbed, especially when there is also food in the intestine, and is very rapidly elim- inated by the glands, whose activity it stimulates. It is rap- idly absorbed by the laryngeal and bronchial surfaces, but most rapidly by the capillaries after subcutaneous injection. Bernard has demonstrated that Curare, like the venom of the salaman- der and toad, may also poison by absorption through the intes- tinal tube, all that is necessary being to retard its elimination. According to this experimenter, Chlorine and Bromine are abso- lute antidotes of Curare. After death by Curare, galvanization of the motor nerves ex- cites no movement; that of the muscles, however, provokes ener- getic contractions ; Curare, therefore, attacks only the motor nerves, and death results only from paralysis of the nerves of respiration. Consequently, under artificial respiration, the circu- lation continues, the poison is gradually eliminated, and life and motion are gradually re-established. The eliminated Curare is found in the urine. Small doses of Curare produce a gradual and progressive poisoning. The nerves of the extremities are first affected, then those of the head, then the thoracic, and finally the diaphrag- matic nerves. " I have thus," says Bernard, " been able to par- alyze the four extremities only of animals; or the four extrem- ities and the head ; or to go still further, and paralyze the tho- racic movements, preserving only the diaphragmatic nerves, which was sufficient to prevent asphyxia." . . . He also says : " We notice, from small doses of Curare, a kind of painful agita- tion of the extremities, by virtue of the law, that every substance which, in large doses, destroys the properties of an organic ele- ment, excites them in small doses." Bernard, as is well known, was the first to establish the fact, that when the heart's contractions have been suspended by means of an energetic current of electricity, they may be re-es- tablished by a feebler current of the same order. " I do not care SOME THERAPEUTIC EFFECTS OF CURARE. 191 to know," said Bernard, to me one day, " whether my experi- ments are favorable to homoeopathy, or not. My object is to establish the truth." MM. Voisin and Lionville have made many experiments which confirm Bernard's conclusions : 1. As regards the general paralyzing action of Curare. 2. That sensation and volition are not affected. 3. That muscular contractility is not impaired; but the special seat of the action of Curare is in the motor ' and vasomotor nerves. 4. Small doses produce fibrillar tremblings and agitation in the muscles of the head, extremities, and trunk, subcutaneous twitchings, gooseflesh, and chattering of the teeth. 5. At the beginning of the asphyxia, acceleration of the heart's action and elevation of the axillary temperature. 6. The presence of sugar in the urine, and marked increase in the quantity of urine. 7. Somnolence ; one of the patients experimented on begged to let him sleep on quietly. 8. Intense chill, acceleration of pulse, febrile movement, much thirst, moisture of the skin, and profuse sweat after the fever. 9. Dicrotic pulse, sometimes irregular, small, soft, frequent. 10. Failure of visual accommodation, due doubtless to defect of parallelism in the axes of vision. 11. Failure of equilibrium when stand mg erect, and especially when walking. 12. Failure to co-ordinate motion, especially in the limbs and trunk. 13. Paleness of the face in one patient; redness in another; redness of the ears, with heat; injection of the conjunctiva : re- sults of the action of Curare on the vasomotor nerves. I will not linger on the hypothetic explanations given by these gentlemen of the action of Curare, nor on their thera- peutic deductions; both are unreasonable. This is a resume of the experiments hitherto made with Cu- rare. They open a wide field for the application of this sub- stance in the treatment of disease. I am far from having tried it in all cases in which it seems to me indicated by the effect of toxic doses; or, rather, the cases in which I have tried it are neither numerous nor conclusive enough to be communicated in full. I will record only some of the facts which are beyond doubt and should command the attention of the friends of ho- moeopathy. 192 world's homoeopathic convention. Case I.-August 26th, 1868, I was called to Mlle. Cramer, aged 17 years, delicate and feeble, who had been seized about a year before, without known cause, with general locomotor pare- sis. The muscular weakness, though variable in degree, was almost constant. After taking four or five steps her lower ex- tremities gave way and she could walk no further. She could not adjust her dress, nor comb her hair, nor carry objects beyond a certain weight, nor continue to feed herself. Her arms soon became powerless and fell. Mastication was, in a short time, very fatiguing, and ceased. Iler voice was weak and veiled, as though the vocal cords lacked tension. She had sometimes sud- den and sharp attacks of palpitation. The respiratory move- ments were not perceptibly interfered with. At the beginning of the disease she often had cramp in the calves, even when walking; rarely of late. There had been no formication. There was cutaneous hyperesthesia; the least touch of the skin, espe- cially of the legs, was unpleasant and painful. For six months the menses had been pale and scanty; constipation was habitual; appetite moderate. I ascribed her condition to cerebral anemia, and whether the diagnosis were right or not, prescribed Curare, 6th centesimal, one drop in 150 grams of water; a dose, night and morning, for ten days. The 8th of September, eight days after commencement of treatment, there was a slight but appreciable improvement; the movements of the liml's and arms were easier and longer sus- tained. I omitted to mention that the muscles of the forearms were exempt from the paresis, which had invaded all the muscles of locomotion. She could clench the fist with considerable and persistent force. I prescribed the same remedy at intervals of twenty-four hours. September 15th. The improvement is decided. Strength has gradually increased, and the patient can use her arms and can walk. Curare 4th dilution, five days, night and morning, after three days interval. The treatment was continued, notwithstand- ing a sharp pain occurring frequently in the region of the heart and extending to the left shoulder, accompanied by palpitation and vertigo. September 23d. Continued general improvement, but the prse- cordial pain continues also. I hesitated between Causticum and Sepia, but gave Causticum 30th, seven doses, night and morn- ing. October 14th. Since October 2d the patient has walked per- fectly well ; she could even run for a few instants. As her SOME THERAPEUTIC EFFECTS OF CURARE. 193 powers of locomotion increased she felt, especially in the thorax, frequent fibrillar contractions such as result from small doses of Curare. The prsecordial pain had disappeared ; she had neither vertigo nor palpitation by day, only slight palpitation in the evening. For these symptoms I gave Pulsatilla 30th at even- ing, on retiring for four days, and at the same time Curare 6th in the morning. November 9th. The patient has continued to improve, with prospect of a complete cure. I ordered Curare in various dilu- tions at long intervals.* Case II.-Towards the end of January, 1873,1 was consulted in behalf of the young brother of Case I. This lad, aged 7 or 8 years, had pathological phenomena somewhat like his sister's above described. For some days they had noticed that he could not stand long without his legs giving way, and complained of great fatigue, and when his legs were flexed he could not extend them without the aid of his arms. He was easily tired by walking, and at table sat bent over and leaning on his elbows. Now and then he took a deep inspiration as if to supply a deficiency in the automatic respiration. I immediately prescribed Curare 4th, one drop in 150 grams of water, a dose every night and morn- ing for five days. February 24th. The boy, who had repeated the Curare at in- tervals, was evidently improving. He continued to take Cu- rare in various dilutions (6th and 12th) and improved. In November of the same year he had a relapse, but Curare being resumed made a definite curef Case 111.-Mme. Martinel, actress, aged 30 years, whom I was treating for uterine disease, suffered vexations and annoyance, and sent for me, June 27th, 1869.. For some days she had had strange symptoms in the morning. Suddenly on waking the eyes became fixed, and then, though perfectly conscious of her situation, she could neither speak, nor move, nor make the least manifestation; respiration was difficult and embarrassed, as if the regular motors could not act. As usual, this state lasted * Two years later, in the night of October 16th, 1870, without known cause, Mlle was seized with uncontrollable vomiting of bilious water ; she was vomiting for the twenty-seventh or twenty-eighth time when I gave her Ipecac. 12th. At the first spoonful the vomiting ceased, but desire to vomit returned occasionally till morning, ceasing under the action of Ipecac. f The father of these two patients has had, for several years, an eczema of the scrotum, characterized by bright redness, an imperceptible serous ex- udation, causing squamous scabs, with intense itching, especially in the evening and at night. Of five or six remedies, Curare is the only one which has relieved and promises to cure him. He is still under treatment. 194 world's homceopathic convention. from a half hour to an hour, accompanied by anguish, restless- ness, and physical insensibility, and followed by copious sweats and general lassitude. For several hours she could not walk easily and her limbs gave way. Should I give Ignatia or Cicuta, or some analogous remedy ? The embarrassment of the muscles of respiration, as well as of the extremities, fixed my attention, and I gave Curare, after which these attacks were not repeated. This case may suggest many reflections. Case IV.-August 16th, 1868, I was called to Asnidres (suburb of Paris) to treat a patient aged 63 years, who had been four months treated allopathically for bronchial catarrh, and was now in a deplorable condition. I found him in the midst of an attack of terrible orthopnoea. He was cold, livid, and I thought had but a few hours to live. The chest was very sonorous throughout, the respiratory murmur infrequent, rough, and mingled with sibilant and rhonchous rales; the patient had no strength to cough and expectorate; the cardiac pulsations were imperceptible, masked probably by the thoracic sounds; pulse small, unequal, irregular, intermittent, almost impercepti- ble. After some months of constant dyspnoea it appeared as if emphysema had come to play an important part in the difficulty of respiration. I determined to try the effect of Ammonia, a most efficient remedy in emphysema, and I gave Ammonium carb. 12th, a drop in 150 grams of water, a dose three times during the first hour, and subsequently every three hours. The patient was promptly relieved, and remained so for thirty-six hours. After this time, however, the orthopnoea returned in greater intensity, and I found the patient in agony, notwithstanding the Ammo- nium carb. Examining his chest anew I found that air entered the lungs freely, and that' the extreme difficulty of respiration was due not so much to the pathological condition of the lung's as to the progressive extinction of the motor influence in the res- piratory nerves. The heart was in an analogous condition ; its pulsations, masked indeed by the sonorous rales, were feeble, in- distinct, etc., and the pulse imperceptible; deglutition was very difficult; the skin of the extremities cold, etc. I had the patient's head elevated, and slowly introduced into his mouth a teaspoonful of a solution of the 4th dilution of Curare. After fifteen min- utes the extreme oppression began to abate, and by degrees the radial pulse became perceptible, and the patient came back to life. The Curare was continued at intervals during the day, and for two days and nights, during which his state was satisfactory. But the third day I was again called, the patient being in agony. He died before my arrival. Case V.-M. Duperouze, aged 55 years, had suffered many SOME THERAPEUTIC EFFECTS OF CURARE. 195 years with chronic catarrh, complicated with emphysema, with occasional attacks of dyspnoea, in which sometimes the nervous element, sometimes the catarrhal, and sometimes the emphysema- tous predominated. These various attacks accordingly called for and were relieved by various remedies. In one of these cases, of which I made precise observations and notes, Chlorine gave re- lief. I may remark that this remedy seems to me indicated where the oppression seems due chiefly to contraction of the en- tire bronchial ramifications (?). Eight days after this attack the patient had another; the cough was frequent, troublesome, and expectoration difficult; the vesicular murmur was subdued, and masked here and there by sibilant and rhorichous rales. The habitual oppression was not intense, except during motion, but there was frequently a sudden, almost complete suspension of respiration, inspiration being suspended beyond the usual limit, and the patient panting and seeming ready to perish. No remedy seemed to me more appropriate than Curare to this pathological condition. I gave it in the 6th dilution. The attacks gradu- ally subsided within a few days, and have never recurred. Case VI.-Last year (1875) I had charge of a consumptive, aged 37, in the last stage of the disease. Emaciated and too feeble to raise his head, he awaited his end with resignation. I gave him one day several doses of Curare 4th. In the course of this day he seemed to regain a certain degree of vitality, and sat up in bed for a moment, quite astonished, saying: "This drug seems to have brought me back to life." He lived three days, employing his renewed strength in quarrelling with his wife, as his custom was, and once he rose and opened the window to throw himself out, enraged that he .could not live. He was restrained and died in two days. Case VII.-I gave Curare to a girl of 17, who had had gen- eral paresis for several weeks, with cutaneous hypersesthesia, and, what I have never seen save in this case, formication in the arms and legs. She was promptly cured. Ten or twelve times I have been consulted by patients, male and female, who, from anaemia or some psychical cause, had the following peculiar sort of oppression. The ordinary automatic respiratory movements seemed short and insufficient, so that now and then the patient had to supplement them by a long, deep, and difficult inspiration. Curare has been the constant remedy for this pathological state, which seems to be not uncommon. Case VIII.-Blanche Piete, aged 17 years, deformed, club- footed, pale, anaemic, had never menstruated. I pass the details and the treatment, under which, although it was not faithfully pur- sued, she greatly improved during the year 1874, and menstruated 196 world's homceopathic convention. in December. In March, 1875, however, her limbs became very feeble; they gave way, and she sometimes fell suddenly when walking ; moreover, for eight davs, she had been unable to retain the faeces. I immediately prescribed Curare 6th, night and morning, for six days. Gradual improvement took place, and before the sixth day she could retain the faeces, and was more se- cure on her limbs. After an interval of some days I gave Cu- rare 12th. The cure was complete and permanent. Case IX.-M. Carrichon, aged 40 years, consulted me February 20th, 1867. For a fortnight, every time he began to walk, after a few steps, he had found great difficulty in advancing his lower extremities, and felt, chiefly in the anterior parts of the thighs and in the legs, a painful fatigue, such as follows a walk of many miles. Fie was compelled to stop. I ascribed his state to sexual excess, but he denied it. I gave Curare 6th, and the patient said : " After the first spoonful of the solution I felt strength re- turn to my muscles." The attacks never recurred. Case X.-Mme. Bar, aged 82, had had for some time great weakness of the limbs, headache, heaviness in the head and diplopia when reading. At one hundred and two hundred meters she saw distinctly, but at twenty and thirty centimeters objects appeared double and superimposed. She took Curare 6th three days in the week, night and morning, for two weeks. The diplopia ceased and the other symptoms were ameliorated. It is well known that Curare produces diplopia. I will remark, incidentally, that this patient afforded me, fif- teen years ago, a remarkable opportunity to verify the efficacy of Lamium album in haemorrhoids. She had had this trouble for years. The anus was.encircled by large tumors, and when I was called they were excessively tense, bleeding now and then, and suddenly the rectum prolapsed. The tumor I found as large as my fist, strangulated, livid, gangrene seeming imminent. I ordered immediately Lamium album 30th, four times a day, with an occasional application to the tumor of a very soft pomade, containing about a gram of the fresh juice of the Lamium al- bum. In subsequent cases I have used the alcoholic tincture, one or two grams to thirty grams of pomade. After twenty- four hours of this treatment the whole aspect of the case had changed ; the color of the tumor had become a bright red, and the circulation in it was free. In twelve days resolution was complete. Lamium album was taken internally only six days. In my experience Lamium album has been the most fre- quently successful remedy in external haemorrhoids, as Anacar- dium occidental (?) has been in internal haemorrhoids, especially with very painful cracks and fissures. The dangers incident to SOME THERAPEUTIC EFFECTS OF CURARE. 197 hsemorrhoidal tumors with prolapsed rectum, when treated sur- gically, are well known. To these incidental remarks I may add another; that I cured the husband of this lady of a double cataract, so far advanced that he could no longer read manuscript nor large handbills near his windows. Ammonium carb. 30th was the only remedy used. It was given at intervals, and improvement began very soon. I have also cured with the same remedy a lady nearly 80 years old. These are good instances for those of our friends who do not believe in the power of the 30th dilution. Case XI.-Curare was also the chief agent in the cure of a case of so-called angina pectoris. July 16th, 1872,1 was consulted by the Baron de PI , aged 28 years, and who had suffered with this disease since his twelfth year. Of medium stature, thin, ruddy, light-haired, active, en- ergetic, he had shown manifestations of psora in childhood, and for the last two years had had furuncles. For several years the attacks of angina had been infrequent, two or three a year; but for several months, in consequence of great vexation, they had occurred daily, and even several times a day ; mental emotions and riding on horseback habitually caused them. Intellectual excitement and the act of eating or taking a little rum would sometimes check them at the beginning. For a time they were accompanied by violent tumultuous palpitation. They lost this character under the action of Cactus, given by Dr. Arnulphy during the patient's sojourn at Nice. The worst attacks were at evening or in the night. They were preceded by sadness and apprehension, and accompanied by anguish and belief that death was imminent. The pain consisted chiefly in a pressure and weight in the epigastrium, with a sensation of constriction and torsion on the left border of the ribs as if these were pressed out- wards and bent upon themselves; at the same time there was great difficulty in breathing. I often observed him during a paroxysm, and it was evident to me that the respiratory move- ments were, as it were, suspended, and the patient made violent efforts to escape an imminent asphyxia, yet the heart's action was quiet and often slower than after the paroxysm. I at first thought of Spigelia, with which our colleague, Dr. Gastier, relieved a case presenting these symptoms of torsion, etc., and finally cured it, but I decided to give Aurum. There super- vened, however, a series of paroxysms recurring on the slightest emotion, often several times in one night, and more than once I thought the patient would die before my eyes. During the par- oxysms it was evident that the respiratory muscles were in a state of inertia. In paroxysms of nervous asthma, of that peculiar 198 world's homceopathic convention. form in which the diaphragm alone is in a state of paralytic in- ertia, Silicea is the infallible remedy, bat this was not the case with my patient. AH the respiratory muscles were affected at the same time. This decided me to give him Curare. From this moment there was a notable and progressive change in the paroxysms, which became less frequent and less violent. lie continued to have them, however, as a sequence of grave imprudences. At the beginning of the treatment he had violent paroxysms, preceded and attended by intense general coldness, especially of the extremities, with slow and feeble pulse, faintness, and feeling as if death were impending; circu- lation almost suspended, so that sinapisms applied to the legs by his attendants produced but a very slight effect after three or four hours, when the circulation had become more active. Vi- pera controlled these symptoms and took this pathological char- acter from the paroxysms. The violent paroxysms at night lasted never less than three or four hours. It sometimes seemed to me that a fatal termination in a paroxysm was averted only by repeated small doses of rum, to sustain vitality and gain time. At present the Baron de Pl is quite well; it is more than two years since he has had an attack. From time to time I give him a dose of Curare. Lack of time and space forbids more than a brief mention of other therapeutic effects of Curare. I might otherwise cite nu- merous cases which prove that this is one of our best remedies for the moist eczema of infants, especially when it occurs on the face and behind the ears. I have, however, succeeded with it in the case of aged women. It seems to act most rapidly in scrofulous children. A little scrofulous girl, who had suppurating cervical glands and furuncles, or rather a series of little scrofulous and furunculous abscesses all over the body, had also patches of ec- zema here and there in all parts of the body, even to the exter- nal aspect of the labia majora. Curare alone, repeated at inter- vals during some time, and recurred to when relapse took place, made a complete cure. A lady of 28 or 30 years had had for two months a large patch of eczema in the right popliteal region. Several remedies were tried without success, but the eruption rapidly improved and soon disappeared under Curare. I might cite other applications of this drug, but deem it wiser to wait until a larger experience shall have confirmed them. Let us hope that the physicians of America, who have added so much to our Materia Medica, may one day give us a patho- genesis of this important substance. Paris, June 2d, 1876. NECESSITY OF THE STUDY OF THE CHARACTER- ISTIC SYMPTOMS IN HOMOEOPATHIC THERAPEUTICS. By Dr. Don Tomas Pellicer y Frutos, Madrid, Spain. " The sole duty of a physician is to restore health in a mild, prompt, and durable manner."-OrganOn of the Healing Art, g 1. The homoeopathic therapeia is, in our opinion, a subject of such vital importance that the homoeopathic physician will not be able to cure his patients unless he obtains a complete knowl- edge thereof. Sickness is always the result of a want of harmony of the vital forces, occasioned by a cause which produces in the organism an abnormal impression. This want of harmony, simple, perhaps, at first, becomes complex; the functional alteration becomes general, and manifests itself in symptoms; and, finally, sickness results. The manifested disease has a name in the allopathic nosology, which we, imitating Hahnemann, omit; for the diagnosis, accord- ing to the old-school system, would lead us to employ empirical and antipathic remedies. Our duty is to study the group of symptoms as told by the patient, noting the pathological state with all the concomitant circumstances that the homoeopathic physician needs to compare, in the most perfect manner, with the group of symptoms most similar to be found in our pure materia medica. To assimilate the group of a patient's symp- toms so they shall harmonize with a group of similar symptoms in a drug, and to choose wisely this drug, are conditions without which all other proceedings in medical practice would be of no avail. To aid us in the choice of a remedy we propose the following: I. Characteristics per se, which have to be searched for within the sphere of action of each remedy. II. The individual char- acteristic, or those which relate to the individual. III. The characteristics of causality, which point to the cause which pro- duced the disease. I. Of the characteristics per se, Hahnemann speaks in his 200 world's homoeopathic convention. Organon (§ 153), where he declares that the extraordinary and peculiar (characteristic) symptoms are those upon which /the physician must rely for the selection of the most appropriate medicine, because such general and vague symptoms, as want of appetite, headache, languid feeling, restless sleep, uncomfort- ableness, etc., deserve but little attention, as almost all diseases and medicines produce something of such general nature. Boenninghausen, in his work on Homoeopathic Therapeutics, cites the case of an epidemic of whooping-cough of a malignant nature, in the beginning of which the common indication of Drosera seldom presented itself, without there being present the indications of the common remedies used for this disease. He, however, observed that in the children attacked an inflammation or swelling appeared above the eye, between the eyelid and eye- brow, which frequently formed a kind of small bag, and which symptom had been observed only in Kali carb. "In fact, this medicine since the beginning of that epidemic produced quick and lasting cures." Hahnemann, in the two practical cases described in the first volume of his Materia Medica Pura, clearly points out the proper characteristic of the medicines with which he cured his patients. One of these cases, that of the washerwoman, was worse on any movement, especially when making a false one. She had a stitch in the pit of the stomach which came from left side. When lying down she felt quite well. She relished her food, but after eating a little felt sick. Water collected in her mouth with empty eructations. Her temper was passionate, disposed to anger. Whenever the pains were severe she was covered with perspiration. After a comparison of medicines Hahnemann chose Bryonia, because the characteristic of Bryonia is to excite or make the pains worse by movement, particularly at a false step. The gastric symptoms also corresponded, and particularly the temperament of the patient corresponded with the character- istic mind symptoms of Bryonia,.which speedily proved to be the curative agent. Thus Bryonia was the curative agent, because it corresponded to the characteristics (of the case) per se,-i. e., it corresponded to the extraordinary and peculiar symptoms. II. What we have called the individual characteristic corres- ponds to all that which, having relation with the individual, may have an influence in the individualization of the case, whose cir- cumstances, though independent from the proper action of the medicament, have a powerful influence in its selection. The conditions of age, morality, temperament, habits, and precedents of the patients should be learned. There is not a homoeopathic physician who does not under- SYMPTOMS IN HOMOEOPATHIC THERAPEUTICS. 201 stand that infancy, adult, and old age, as well as the critical period in woman, have their proper medicines and their special characteristics, deduced from the provings, or from clinical experience. There is no criterion but that of similia, as much for the young as for the old-for man as for woman. Children have their proper medicines, which, by their known constant effects, might be called the polychrests of infancy. So with old age, there are some remedies like Opium, Baryta, Secale, Nux vom., Carbo veg., China, and others which will merit the prefer- ence in given circumstances. The critical period in woman de- mands also the use of certain remedies which respond best for the sufferings that are common to that time or period, such as Laches., Pulsat., Cocculus, Conium, Sepia, and Graphites. The difference in the moral state in the sexes and the temper- aments are no less important in establishing the diagnosis which leads to the exact therapeutic indications. To be convinced of this it is only necessary to remember what Hahnemann says about Aconite, Bryonia, Nux vom., Pulsat., etc., each one having their individual peculiarity, which will determine the selection of the right remedy ; and further, it is necessary to know the habitual diseases of the patient, their origin, their reappearance, incurabil- ity, etc., and it is indispensable to know what remedies have been employed for their past treatment. The allopathic system employs different means to change the nature or suppress many diseases that nature tries to banish from the vital centres, as, e. syphilis, dermatoses, etc. This change of nature, or sup- pression of the forms in which these affections usually appear, may give rise to the presence of anomalous or rare groups of symptoms, which origin being not known, it is sometimes diffi- cult for the well-Selected remedies to correct. III. We now come to discuss the importance in therapeutics of the causa morbi. Since our conversion to homoeopathy this study of causality was ingrafted upon us by the clear and incisive affirmations by Hahnemann in his first volume of the Chronic Diseases. He describes therein the interruptions which may take place in the treatment of a chronic disease by merely acci- dental causes, and he says: "An indigestion produced by over- loading the stomach, may be relieved by eating some thin broth and taking a little coffee; derangement of the stomach by eat- ing fatty substances, particularly pork, is cured by fasting and Pulsatilla; coldness of the stomach, caused by eating fruit, with Arsenic, by olfaction; troublesome consequences of using spirit- uous drinks, by Nux vom. If the departure from health is caused by fright or terror, and the physician arrives immediately, 202 world's homceopathic convention. Opium; sadness or grief, caused by deep sufferings, should be treated with Ignatia; that which originates in a fit of anger, with a subject of violent temper, rashness, or peevishness, with Cham- omilla; if it has been on account of indignation, with Staphisa- gria; if for indignation, with silent internal grief, Colocynthis; if the disturbance is produced by unhappy love, and there is sad- ness, Ignatia; if there exists, besides, jealousy, Hyoscyamus. A decided cold inside of the room, or in bed, is in the domain of Nux vom.," etc. Any one might think after reading these aphorisms that they obeyed another law than that of similitude. But Hahnemann when advancing these principles could not guide himself by any other criterion than that of similitude; and the deductions from these affirmations are that he had a perfect knowledge of the above-named medicines and of the natural effects produced by the causes of those diseases he mentions; for when proving these remedies he learned that their pathogenetic effects corresponded homoeopathically to the symptoms produced by such and such causes of disease. When studying Ignatia, for example, and observing that it produced in a healthy person great sadness, with sighing and tears, deep grief, disinclination to speak, aver- sion to light, excessive sensitiveness to the slightest noise, anx- iety, trembling, palpitation of the heart, etc., he could well assume that Ignatia ought to be the specific for the effects of certain moral causes which produce sadness, tears, and sighing, and well could he affirm in the synthesis made on that sub- stance, that the St. Ignatius bean is a capital remedy in eases of diseases induced by offences in persons who are not inclined to vengeance, or to rouse themselves in fits of anger, but on the contrary, they keep to themselves their grief or worriment; or, for those who are in the habit of grieving or worrying on account of adversities. He remarks, also, that it is not only a remedy for these states, but for those diseases which owe their origin to such causes. With his experience and great authority, well could Hahnemann have said that such a disease, produced by this or another cause, would be cured by such a medicine, without losing sight of his fundamental principle, similia similibus. But there are other considerations that we must not forget. Generally all the causes of diseases, and particularly those indi- cated by Hahnemann in his work on Chronic Diseases, act in such a rapid manner that most of the time their action passes unnoticed, either because sufficient importance is not given to them, or because their effects are not immediately felt. And even when they7 are experienced very rarely are they remedied SYMPTOMS IN HOMOEOPATHIC THERAPEUTICS. 203 with the proper medicines. Those who are not acquainted with homoeopathy practice bleeding, purging, use empiric remedies, or do not use anything. Those who are acquainted with homoe- opathy, only exceptionally send right away for the physician. As a general rule, when they come, or send to be prescribed for, the first manifestations or forms of the disease are usually changed, if not severely complicated, on account of some incom- patible treatment they have been using or applying themselves. If therefore the physician, guided by these states, has to choose by them the seemingly indicated medicine, it is very sure that he will not cure the disease. The patient keeps latent and active the dynamic impression of the cause which produced the sickness, and if he desires a cure it is necessary that he should be under the influence of the remedy that was indicated for the first state or symptoms. Let it be observed how Hahnemann, with so much reason, proposed to deduce the characteristic by the cause, and not pre- cisely by the symptoms; for he understood that the later symp- toms could not present the genuine expression of the suffering which it was requisite to cure. This thought is perfectly ex- pressed when he says, in speaking of Ignatia, " that this sub- stance is the best remedy for the diseases whose origin are the causes that he has pointed out." We are in possession of enough clinical cases to corroborate these assertions, facts that we should like to present for the consideration of the Convention, if we w'ould not fear to lengthen this essay. However, we shall de- scribe only one, which narrative is short. We were consulted by a person of high rank about a gastric indisposition, to all appearances merely of a simple nature, and was only attributed to some dietetic blunders; accordingly we prescribed the usual remedies that cure these troubles ; but as she continued to complain of malaise, pains, and other symptoms in the abdomen, with sleeplessness or troublesome dreams, we inquired if any moral cause had an influence upon her sickness? She confessed that she had experienced a great mortification of a humiliating nature, the remembrance of which was preying on her mind. We accordingly prescribed only one dose of Colo- cynth of a high dilution, and it was enough to produce a favor- able and permanent change for the better inside of twenty-four hours. There is another order of causes of diseases, the study of which is of the greatest interest in practice, and of which we are sorry not to be able to occupy ourselves with more extensively. We mean the diseases caused by the medication of the old 204 world's homoeopathic convention. school, referred to by Hahnemann in paragraph 74 of his Or- ganon. We are in possession of remarkable facts on this subject, es- pecially those referring to the abuse of bloodletting, purgatives, Quinine, Iron, and Mercury. The most recent of these cases was a young lady, aged 19 years, of flaccid fibre, but sensitive and im- pressionable, previously of good health. On account of purely accidental causes she suffered with retarded menstruation, though not attended by troublesome symptoms. Her allopathic physi- cian applied two dozen leeches in the internal aspect of the thighs, and an excessive amount of blood was drawn, with very bad consequences, as we shall see. She fell into a prolonged fainting spell, on coming out of which she remained in a com- plete state of chorea. She was treated during two months with every kind of medicines, such as Belladona, Valerian, Sulphate of quinine, Opium, Digitalis, Iron, and many kinds of oint- ments and liniments, also purgatives, and everything which occurs to allopathic minds in such difficult cases. When we saw this young lady for the first time she presented a very discouraging picture of disease. A clonic convulsion was in possession of all her body; she was obliged to sit in an arm-chair without being able to use the legs; for two months she had not slept; was very much emaciated, being unable to take nourish- ment or to swallow even water. We could not find any pulse the first two weeks of our attendance on account of the inces- sant movements of the hands and its tendons. The menses had not made their appearance, but she experienced no troubles which could be referred to a uterine nature. When she was moved from the chair to the bed, or to another apartment, convulsions of an epileptiform nature would appear until the former state was resumed. After advising the best hygienic measures possible, we prescribed a dose of Nux vom. 200th, to be taken at night, which produced a slight amelioration. We repeated the dose three times, and were satisfied with its action so far. But that state had been brought on by a sanguineous excessive evacuation, and this circumstance of antecedent causality required without much loss of time the prescription of the medicine ad hoc. China had to be the remedy, and we prescribed it; but as our patient could not swallow the liquid form we began by putting on the tongue some pellets of the 12th dilution, which we daily repeated until reaching the 20th, observing that since the first dose our patient began to sleep more every night. At the fifteenth day I could find the pulse, which was soft and small; she could take some nourishment, and rested from five to six hours in sleep. We SYMPTOMS IN HOMOEOPATHIC THERAPEUTICS. 205 continued the same plan another two weeks, with constant im- provement, until the menstrual period reappeared, when we found her sad, nervous, with bloated and flushed face, and palpi- tation of the heart. Three doses of Pulsatilla 200th were enough to calm her, though the menstrual flow did not appear. We returned to China every third day first, then every fourth, until the following month, when, she being able to walk and to feed herself, without any convulsion, and having some strength, the catamenia appeared, though scanty. Two months spent in the country finished the cure completely, giving her a rounder physi- cal form and better health than ever previously enjoyed. We do not claim to have presented anything new in this es- say. Exclusively occupied with the practice of our profession, and striving with the great difficulty attendant upon the choice of the remedy most appropriate to produce a cure, we have merely discussed the way to find it, sustained by the teachings of the master and the opinion of experienced practitioners. We have put in a more or less concrete form the ideas scat- tered in other works, wishing to imitate the first disciples of Hahnemann, who zealously applied themselves to the study of the subjects which could enlighten them in understanding the materia medica, and the application of the principles upon which is founded the homoeopathic system. They neither searched for reforms nor advancements, because they believed, as we do still, that there is a great deal to study yet within the good principles established by our immortal master, and make under his guide great and profitable acquisitions. Experience at least teaches us so, and the curative results obtained give us the best sanction to what we can aspire; and they also constitute the most beautiful reward of the toils that we have imposed on ourselves for the benefit of science and humanity. A FEW THOUGHTS ON THE STUDY AND PRAC- TICE OF HOMOEOPATHY. David Wilson, M.D., London, England. Deeply sensible of the honor conferred upon me by the courteous invitation of the Chairman of the Committee of Ar- rangements, to contribute a paper for the " World's Homoeo- pathic Convention," I must frankly confess that it roused in my mind a question which has forced itself upon me daily ever, since, viz.: What can be said or done to advance the cause of homoeopathy better than the luminous instruction contained in the writings of Hahnemann and the untiring exertions of his early disciples, some of whom are still working amongst us? This reflection naturally suggests the pertinent inquiry, Have Hahnemann's works been studied as they require to be? and what evidence have we, affirmatory or otherwise, that enables us to answer the question ? It would be false to the principles which I profess were I not, in limine, openly to state my opinions fully and candidly upon a subject of such vital importance. To sustain my proposition, it will be necessary to quote from our great master's writings, for which no apology will be neces- sary, seeing that when our object is solely the elucidation of truth it is far better to go to the fountain-head at once than to assume an originality not our own. Hahnemann tells us, as we all ought to remember, that his doctrine of homoeopathy rests exclusively upon the result of experience. He tells us in his Organon how we are to apply his doctrine in practice so as to gain pure experience. He tells us in the same invaluable Organon how we are to proceed in acquiring a knowledge of medicinal agents, so that they may be used as remedies in healing the sick; in other words, he instructs us how we are to proceed in proving remedies upon ourselves and others when in ordinary health. He points out clearly in the same work how we are to examine the sick. He enters into many other important matters in that essential work which must be studied attentively from board to board, again and again, until ON THE STUDY AND PRACTICE OF HOMOEOPATHY. 207 every precept has been thoroughly understood and impressed upon the mind for our guidance when entering upon the respon- sible and solemn duty of ministering to the sick. I repeat, there can be no flinching from this absolute moral duty; and if we cannot conscientiously comply with Hahnemann's injunctions, then let us not falsely call ourselves his disciples. The learned chairman, Dr. Carroll Dunham, has most forcibly remarked in an article published in the Philadelphia Journal of Homoeopathy, vol. iv, 1855, No. 8, which I should recommend every one to read even a second and third time if they have not already done so : " When a scientific man undertakes to imitate the experiment of another for the purpose of testing the results of the latter, he is inexcusable if he deviates in the least partic- ular from the course pursued by his predecessor. He has no right to assume that in this or that point lies the essential prin- ciple, and that the other matters are superfluous. What would be thought of a chemist, who, wishing to repeat the experiments of another, and obtain a certain precipitate, should take it for granted that it matters not how much Ammonia, for example, he may add to a given solution. Whereas, a certain quantity will give the precipitate, but an excess will redissolve it, and spoil the experiment." Nothing could be said more conclusively in support of our argument than this. Now let us heai* what Hahnemann says : " Imitate my mode of practice accurately and carefully, as pointed out in the Organon and Chronic Diseases, and you will find it confirmed at every step." He says further : " Take one case of disease after another, note down all its perceptible symptoms in the special manner as has been pointed out in the Organon, and with such accuracy as shall defy the founder of homoeopathy to take any exception to it, then, guided by the characteristic and striking symptoms,* select the appropriate remedy and administer it in the smallest dose, according to the strict rules and observances pointed out in the Organon, and if it does not afford speedy, gentle, lasting help, publish the failure to the world, and the doctrine of ho- moeopathy shall stand abashed." He urges upon us, who are his disciples, to go on proving remedies, so that the range of our curative means shall be equal to every emergency, because it is needful, as a matter of course, before we can prescribe for every particular ailment that we shall be acquainted with a correspond- ing remedy, the symptoms of which are harmonic or homoeo- pathic to those of the patient. * See preceding Essay, page 199, et seq.-Ed. 208 world's homoeopathic convention-. Then, with regard to the infinitesimal character of the dose and its repetition, his injunctions are equally imperative, while he wisely makes a provision for every emergency, so that the dose may be repeated in the highest dilutions every five minutes if needful. His rules, as laid down in the Organon, for the dis- covery of commencing improvement and how then to proceed, are pointed outwith unerring certainty, and must be very carefully studied. As we ponder over Hahnemann's writings, not forget- ting his instructive introductions to his remedies, we soon discover why he gradually reduced his doses, chiefly because they acted too energetically and inflicted unnecessary suffering and exhaustion. While imbibing all these facts and practical details, let the student keep constantly in remembrance that he has to separate Hahnemann's facts from his theories, a caution which the founder himself thought it needful to give, but which his ungenerous and carping critics have pounced upon as capital for their unbe- coming ridicule, being unable to overthrow his facts, which stand as firm as the ocean rock, though lashed on all sides by the waves of ignorance and superstition 1 He says, in vol. iv, of Chronic Diseases: "In bringing forward my doctrine of the homoeo- pathic system of healing, it was very natural for me not to ven- ture an explanation how it happens that cures are effected in the sick through the action of certain substances that have the power of producing very similar morbid phenomena in healthy people. It was with a feeling of doubt that I gave my conjecture, with- out attempting anything like an explanation or asserting anything positive, for it is only incumbent upon us to heal according to certain recognized laws of nature (as expounded in the Organon and Chronic Diseases), which are being continually confirmed by our experience, and not to make a boast of abstract explanations and leave the patient uncured all the while, a mode of proceed- ing hitherto adopted by physicians of the old school." It will not, I trust, be considered presumptuous on my part if I give my most cordial assent to the close of Hahnemann's sentence, seeino- that I was an active member amongst the old fraternity for many years, sufficient to enable me to superintend not less than two thousand births in general practice ; and the last four years of my allopathic practice afforded me the opportunity to test homoeop- athy, to which I have devoted the last thirty years of my life in hard study of its materia medica and active practice. Now it may be asked what evidence have we that the majority, if not all, calling themselves homoeopaths have failed to comply with Hahnemann's injunctions? The answer is to be found in the character of homoeopathic literature, and in the majority of ON THE STUDY AND PRACTICE OF HOMOEOPATHY. 209 the editorial staff, who do not fail to chide the pure Hahneman- nians as being, on this side of the Atlantic at least, a very in- finitesimal sect of Hahnemannians. What proof could we have more conclusive than this? They seemingly forget, however, that " minorities are often in the right." Then, with regard to modern, so-called, provings, have the injunctions so specially laid down in the Organon been complied with? I answer most emphatically no. they have not; and if we examine carefully the records of the Vienna and other provers, we shall find Hahne- mann's predictions verified when he says, par. cxxviii, and fol- lowing : "The most recent observations haveshown that medicinal substances, when taken in their crude state for the purpose of testing their peculiar effects, do not exhibit nearly the full amount of their hidden powers as they do when potentized by proper trituration and succussion. . . We now find it best to prove medicines by giving from four to'six globules of the 30th dilution every morning on an empty stomach If the effects are but slight we may add a few more globules every morning, until the symptoms become more distinct and stronger. If the first dose administered has been sufficiently strong to arouse symptoms, then the experimenter learns the order of their succession, and can accurately note the period when each occurs, which is very useful in leading to a knowledge of the genius of the medicine, and the order of the primary and alternating ac- tions is acquired in the most unambiguous manner. . . On the other hand, if increasing doses of a strong preparation are re- peated (as was the case in most of the Vienna provers), we may learn, no doubt, the various morbid states such strong doses are capable of producing, but we do not ascertain their order of suc- cession, and the subsequent dose often removes, curatively, some one or other of the symptoms aroused by the previous dose, or develops in its place an opposite state." What has been here quoted in a condensed, but nevertheless strictly accurate manner, plainly shows the chaos into which some of our would-be heroic provers have plunged the materia medica since Hahnemann's time. Without mentioning the names of such provers, which might seem discourteous, and would render very little service, every industrious and careful student can discover for himself these blemishes to which I have alluded. Also the fact men- tioned by Hahnemann has been verified, for when the same prover substituted for his massive and poisonous doses dilutions of the same remedy, then he obtained finer shades of minute symptoms, such as are to be observed in disease. It becomes a question, however, whether the symptoms furnished by provers through 210 world's homoeopathic convention. taking attenuated doses almost immediately after they had en- deavored to poison themselves without success by massive and crude doses, are to be entirely relied upon. For example, one would scarcely consider a man, who had taken in sixty-eight days the enormous quantity of five thousand drops of a poisonous tinc- ture, in a perfectly healthy condition so as to resume, after a few days' cessation, the proving of the same remedy in diluted doses. We are .cautioned by Hahnemann to examine into the perfect purity of substances before we undertake their proving as reme- dies, and, while we are under medicinal influences, to abstain from other experiments and repetitions that may annul the integ- rity of our observations. As to the time needful for the organism to regenerate itself, I must leave others more capable to deter- mine, without entering; into the biological and mathematical speculation myself of that process being accomplished in thirty- five days, the time required, according to Grauvogl, for a proving to have its effects observed, under the most varied circumstances possible, upon persons of various ages, constitutions, etc. He adds that it is " only after the fulfilment of all these demands that we can say we have undertaken a drug proving, and gained available results." We have it in evidence too clearly, however, that, whatever may be the length of time for the organism tore- construct itself, the interchanges do not, unfortunately, expel for a very long time many substances that have entered it by design or otherwise. Grauvogl himself, indeed, tells us that "there are substances which, when introduced into the organism in immod- erate quantities, are suddenly rendered innocuous by their enter- ing into insoluble compounds, which remain deposited in some part or other, and thus become inaccessible to the motions of the organism, and continue to be so, till some other substance, intro- duced accidentally or intentionally into the organism, enters into combination with the very same organic parts in which those substances are deposited, and thus, made accessible again to the organic motion, they may forthwith be expelled from the system." Such substances may be of a character to be detected by the acute analyst in company with the various excretions. Quicksilver, for example, may be detected, chemico-physically, in the urine after many years, during which period it may now and again have given rise to a series of suffering phenomena. Such cases falling into the hands of the over-enthusiastic Tyros of our system may easily lead them to undertake cures no longer possi- ble, and therefore calculated to inflict cruel disappointment upon those most deeply concerned. Such cases require antidotal and eliminative treatment to begin with, as ably pointed out by Dr. ON THE STUDY AND PRACTICE OF HOMOEOPATHY. 211 Lippe in an admirable article entitled "Homoeopathy Misap- plied," in the North American Journal of Homoeopathy, 1872. If we wish to test Hahnemann let us abide strictly by his rules in every essential particular, and afterwards we may indulge in our own theories. We shall now inquire how the examination of the sick requires to be conducted, which, in my opinion, strikes at the root of the whole matter under discussion. Here we have full scope for our anatomical, physiological, histological, pathological, chemical, and scientific knowledge generally. Boenninghausen informs us that before he devoted himself to the study of "that great science," homoeopathy, he had previously prepared himself " by studying with great care the natural sciences and even the old system of medicine." Does not this give us some clue to his great success ? Yet even that great man and scholar, thus trained, and who pos- sessed the requisite talent and perseverance for his praiseworthy task, tells us that he found it a very difficult business to study some valuable drugs that had not been thoroughly proved in reference to peculiar conditions, and he had to supply the deficiency by con- trasting the totality of the symptoms of various drugs, and by studying the genius of a drug from its symptoms. Dr. Carroll Dunham, in the article to which I have referred in the Philadel- phia Journal of Homoeopathy, says of this great man : " Certainly,- whether he studied in youth, or in middle age, when his facul- ties were more mature, I have never conversed with a medical man more learned." I must be excused for thus dwelling upon the merits of Boenninghausen, because he also had to fight for the truth amongst the minorities; moreover, in my opinion, his works are the very best that can be put into the hands of the student who desires to study homoeopathy thoroughly, and to practice it in accordance with the strict rules of Hahnemann. By drug provings we have learned the general forms and variety of the individual constitution. For this, adds Grauvogl, " Hahnemann again laid the foundation by his doctrine of concomitant circum- stances, and no one has understood how to carry out more strictly the consideration of the indication from these circumstances than Dr. von Boenninghausen. His Therapeutic Pocketbook (Munster, Coppenrath, 1846), is an imperishable work of the greatest im- portance for practice, and could be prepared only by an eminent intellect, and by unwearied theoretical and practical studies." On this I will venture to add a slight correction, as the same Therapeutic Pocketbook (Taschenbuch) has been referred to in the introduction to Dr. C. Hering's Analytic Therapeutics as Boen- ninghausen's Repertory. This is an error, and seems strangely 212 world's homoeopathic convention. inexplicable how it should have escaped Dr. Hering's notice. No doubt the Taschenbuch, as its title-page implies, is intended for the sick-room as well as the study of materia medica; but Boen- ninghausen told me most impressively when I conversed with him at Munster in 1850 that he had compiled it chiefly for the latter purpose; whereas his Repertory, to which he was then adding copiously from his extensive practice, was really the proper work to be used when prescribing for the sick. He said that he should leave his sons to publish a new edition of that work, and it is greatly to be deplored that they have not done so since their father's death. We know that Hahnemann used Boenninghausen's Repertory entirely, and that he considered it indispensable. The Taschenbuch is unquestionably of great value in the sick-room, when used by one who has a fair knowledge of materia medica and is blessed with a retentive memory. For the examination of the patient, however, I most unhesitatingly declare a good reper- tory to be indispensable, and I do not believe the physician exists who can honestly examine a patient properly without such help. This can be readily illustrated from any rubric we may select. Let us take, for instance, the stomach and other viscera-organs of digestion and assimilation-and glance over the symptoms as registered in the British Repertory under appetite, taste, and digestion, or under acidity, eructations, hiccough, nausea, and vomiting-each symptom in connection with either of these being composed of sundry elements under diversified rubrics or head- ings, demanding patient investigation before we can prescribe suc- cessfully. We will take, for example, the rubric Aufstossen, eruc- tations, with all their concomitants, and let us see whether there be a single practitioner who can retain mentally all these details; and unless he can command them when examining an ordinary case even of stomach derangement, in which almost all our troubles originate, I defy him to do his duty so as to make an ap- propriate and strictly homoeopathic selection, simple as the epithet dyspepsia may seem. Under the rubric Aufstossen, then, we have in one of our repertories upwards of 250 subdivisions; and these are not all, as Dr. Allen's Materia Medica will prove when completed, including time of occurrence, conditions, circumstances, and concomitants, etc. And many of these subdivisions include different remedies, which must be examined in the materia medica itself, when we have through these general indications noted the remedies that correspond in the greatest compass to the individ- ualities of the case before us. Now let us see what Hahnemann says: " While inquiring into the state of chronic diseases, the particular circumstances of the patient with regard to his ordinary ON THE STUDY AND PRACTICE OF HOMEOPATHY. 213 occupations, his usual mode of living and diet, his domestic situ- ation, and so forth, must be well considered and scrutinized to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may be promoted." (Dr. Dudgeon's translation of Organon.) Again, in the Chronic Diseases, Hahnemann says regarding the proper selection of the remedy: "The first duty of the ho- moeopathic physician who appreciates the dignity of his character and the value of human life, is, to inquire into the whole condi- tion of the patient, the cause of the disease, as far as the patient remembers it, his mode of life, the nature of his mind, the tone and character of his sentiments, his physical constitution, and especially the symptoms of the disease. This inquiry is made according to the rules laid down in the Organon. This being done, the physician then tries to discover the true homoeopathic remedy. He may (I say must, D. W.) avail himself of the ex- isting repertories, with a view of becoming approximatively ac- quainted with the true remedy. But, inasmuch as those reper- tories only contain general indications, it is necessary that the remedies which the physician finds indicated in those works should be afterwards studied out in the materia medica. A physician who is not willing to take this trouble, but who con- tents himself with the general indications furnished by the repertories, and who, by means of these general indications, dis- patches one patient after the other, deserves not the name of a true homoeopathist." I repeat that without a repertory we cannot properly interro- gate our patients, many of whom are burdened with symptoms of which they only become aware when elicited by the capable examiner. This is often a very difficult undertaking, requiring great tact. The investigation of cases of long standing must be undertaken with care, and conducted as circumstantially as pos- sible; the most minute peculiarities must be attended to in chronic diseases because most characteristic, and cannot be too accurately noted, " partly because the patients become so used to their long sufferings that they give little or no heed to the lesser accessory symptoms, which are frequently very pregnant of meaning (characteristic),-often very useful in determining the choice of the remedy,-and regard them almost as a necessary part of their condition, almost as health, the real feeling of which they have wellnigh forgotten in their sometimes fifteen or twenty years of suffering, and they can scarcely bring themselves to believe that these accessory symptoms, these greater or lesser deviations from the healthy state, can have any connection with 214 world's homceopathic convention. their principal malady." Who has not met with patients who have told us at first that their appetites were excellent, but after a few doses discovered that they were eating much better than formerly 1 I could give numerous cases in proof of what Hahne- mann has so profoundly said, but all medical men must have had ample experience of these facts. Finally, it may be asked whether I really mean to contend that these rules of Hahne- mann, on which so much stress is laid, have not been faithfully observed by the bulk of homoeopathic practitioners ? Yes I do most emphatically declare this to be my honest conviction-a very painful one; and those who question the fact have only to converse with the public, the profession, and homoeopathic jour- nals, where they will learn more than I have set forth. In con- clusion, I would earnestly recommend that practitioners make themselves thoroughly well acquainted with Boenninghausen's Concordances. I have derived the greatest help from them in practice. While the laborious volumes of Dr. Allen are issuing from the press, I would also recommend each one to construct a repertory for himself on the plan so well executed by Dr. Esrey to the first volume of Transactions of the American Institute of Homoeopathy. This will prove an invaluable line of study, by which great command will be acquired in the knowledge and use of materia medica. Similar groups of different drugs can be classified under the same rubric, their similarities and differ- ences noted, with conditions and concomitant circumstances belonging to each. This is also the line of study I would impress upon the student, very different to that which is now being promulgated in order to enlist converts. Considerable experience in giving clinical instruction to gentle- men who attended my practice at the late Hahnemann Hospital, as well as at my own free dispensary during the last twenty-five years, has satisfied me that very few will devote themselves to hard study such as the materia medica requires. This is more especially the case if they are already in possession of an allo- pathic legal qualification. They are contented with a superficial smattering in too many instances. Dr. C. Hering has pertinently remarked; "Young homoeopaths get their stereotype notions from their earliest acquaintance with the subject, and at last cannot conceive of any other way of thinking." This is per- fectly true, and so many beginners fall into routine habits when no longer under our observation that teachers cannot be too care- ful how they initiate students and inquiries in the proper course of study. I have made it a rule for some time to admit no one to clinical study in dispensary practice until he has read the Organon of Hahnemann, and so far prepared himself to under- ON THE STUDY AND PRACTICE OF HOMCEOPATHY. 215 stand principles of homoeopathic action. The late Dr. von Boenninghausen told me in 1850 that he had read the Organon fifteen times, and that on each occasion he always acquired some- thing new and valuable. Almost every page is rich in precept, and the student is constantly reminded that the only thing which can determine the choice of the most appropriate remedy is the totality of the symptoms ; the sole thing, in fact, which the physician has to take note of in every case of disease. The whole of the perceptible signs and symptoms which we can observe, ex- pressing themselves through sensations and functions, must be the sole indication to guide us in the choice of a curative remedy. To multiply quotations to the same invariable effect would be useless waste of time, if not an insult to our understanding. Nevertheless, with these plain facts before our eyes all through the Organon, the students or audience, at an introductory lecture delivered at the London homoeopathic hospital, and published in the British Journal of Homoeopathy, January, 1876, were deliber- ately told that" a treatment founded on the ' totality of the symp- toms' alone, must fail to give us the true indications for treatment. Simple symptom-treatment will fail to enable us to judge between pleurisy and rheumatism of the intercostal muscles, or between pneumonia and bronchitis. It will not give us any indication as to the true lesion in diabetes, nor of the real indication for treat- ment in Bright's disease. At the same time ordinary diagnosis alone will not suffice to enable us to treat a case successfully by homoeopathic therapeutics, unless we also consider the symptoms presented by each individual case, i. e., we cannot treat disease by specific remedies, according to its name; but, having defined the disease by an accurate diagnosis, we then turn to our reper- tory, and find the varied morbid states which are likely to be presented to our notice in individual cases, each set forth under the head of the medicine which has the power to induce these states, and we select the remedy from one or other of these medic- inal drugs, taking that which most closely corresponds to the morbid state of the patient we are about to treat; not according to the name of the disease alone. Our diagnosis reveals the morbid species, but our collection and arrangement of the symp- toms enables us to individualize the exact tract, part, or organ most needing strength and support, to enable it to recover its lost tone, and to rally it from its state of disease." The last sentence clearly informs us that the lecturer considers it necessary to theorize upon the nature of the malady before we have recourse to our repertories, forgetting that homoeopathy is a theory of cure (pimilia similibus curantur), and not a theory of 216 world's homoeopathic convention. disease. Besides, the latter proceeding immediately admits into a pure practice an intermediate theory, involving us in the most unsatisfactory speculations, against which Hahnemann very prop- erly and wisely turned his back. The lecturer says: "Perhaps the most complete introduction to the study of homoeopathy is to be found in Sharp's Essays; but every one wishing seriously to study the system should read Hahnemann's Organon, his Chronic Diseases, and Lesser Writings; he should, however, read them (as he would Hippocrates, Celsus, or Sydenham), as the classics of the system he is about to investigate, and should remember that these works were written before pathology had a right to be called a science." The latter part of this sentence also demands a little serious attention. Surely no one who pos- sessed a proper self-respect and a conscientious sense of his re- sponsibilities when human life might be in his hand would undertake important studies in any other light than seriously. Why any apology should have been deemed necessary for Hahne- mann's standard works on the pretext that at the period they were written pathology was at a low ebb, does not appear quite satisfactory. It is surely not meant to be implied that, as an advance has been assumed to have taken place in allopathic practice since the days of Hippocrates, Celsus, and Sydenham, which many very able allopathic physicians and surgeons of the present day question, therefore the doctrines and practice of Hahnemann have been improved upon by the modern pseudo- homceopaths. We have in this paper very cursorily glanced at his Organon, by which homoeopathy must stand or fall. His Lesser Writings preceded the Organon, and form much of its basis. The first volume of Chronic Diseases is a continuation of the principles enunciated in the Organon, and the other four volumes contain the symptoms of forty-nine remedies of price- less value. Although many of these symptoms have been ac- quired through clinical experience, capable practitioners have confirmed their reliability and worth. Dr. Drysdale's apposite remark recurs to me here very forcibly, for though many other matters may undergo change, " the effects of drugs on the body (as he says) are immutable and unchangeable, and a plain and faithful description of them can never become antiquated or other than correct." It gives me very great pleasure to quote Dr. Drysdale when he is dealing with matters of fact; and this seems an opportune moment. Regarding the provings made and collected by Hahnemann in his Materia Medica, now undergoing revision and additions by Dr. T. F. Allen, Dr. Drysdale very significantly ON THE STUDY AND PRACTICE OF HOMOEOPATHY. 217 writes in the introduction to the Hahnemann Materia Medical Part I, 1852 : " How is it that we have got on so well with Hahnemann's own early provings? To this I reply : 1st. They are good [(rov- ings, and the symptoms were really produced by the medicines. 2d. A great many of his numbered paragraphs consist of single symptoms and small groups of symptoms, which really occurred in an independent and isolated form from the action of moder- ately small doses. They are, therefore, short cases of disease re- duced to its most essential elementary symptoms, and divested of all merely sympathetic symptoms or after-effects. (See Or- ganon, par. cxxxvii.) 3d. Where he (Hahnemann) has split up larger groups, he has for the most part given us the key in the introductory remarks, or the same has been done by the thou- sandfold repeated experience of homoeopathic practitioners of the usus in morbis." The beginner would indeed have a feeble mind, not at all fitted for homoeopathic study, who might be apt to have it con- fused by such plain valuable reading as Hahnemann's Materia Medica, which, with the larger editions of the Symptomatology, the lecturer informs us "are all useful as works of reference," but "are apt to confuse the beginner." In their stead Hull or Snelling's Jahr is recommended, in two volumes, "the one con- taining the symptomatology, i. e., a record of the symptoms in- duced by each medicine, the medicinal drugs being cataloguedin their alphabetical order; the other volume being the repertory, in which the diseases are named, and each drug which is likely to be useful in a disease is pointed out. Few symptoms of disease ever come before, us which are not to be found in these volumes, and, what is more, few combinations come before us which are not here set forth." I only wish for the well-being of humanity that homoeopathic study could be reduced to such a nutshell compass. But my own experience has led me to the opposite conclusion. It is by such works as these being placed in the hands of educated gen- tlemen that so much ridicule is cast upon homoeopathy ; whereas if they were to read Hahnemann's own Materia Medica and compare "the short cases of disease reduced to its most elemen- tary symptoms" in the numbered paragraphs, and compare them with similar groups in other drugs all through the Materia Med- ica, they would then take a physiological and pathological interest in such reading, and be enabled to make their own comparisons amongst similarities and differences. They would soon learn to discover the value of conditions and circumstances. They would 218 world's homceopathic convention. even begin to see the need of a complete repertory to help them in the examination of the sick, so as to elicit what the patient himself has failed to reveal. The student will learn from the Organon the detailed minutiae that requires to be gone into. (See notes to pars. Ixxxvii to xciv of Organon.) These notes also inform the provers how accurately they must observe all their symptoms whilst making trials with various drugs. In par. cxxxiii we read, " On experiencing any particular sensation from the medicine, it is indeed necessary, in order to determine the exact character of the symptom, to assume various positions while it lasts, and to observe whether, by moving the part affected by walking in the room or the open air, by standing, sitting, or lying, the symptom is increased, diminished, or removed, and whether it returns on again assuming the position in which it was first observed ; whether it is altered by eating or drinking, or by any other condition, or by speaking, coughing, sneezing, or any othei' action of the body ; and at the same time to note at what time of the day or night it usually occurs in the most marked manner, whereby what is peculiar to and characteristic of each symptom will become apparent." To do full justice to this matter I should require to cite the entire Orga.non of Hah- nemann. Let an intelligent student read any of Hahnemann's polychrest remedies already published in Dr. Allen's Materia Medica, and compare the same with the symptomatology recorded in Hull or Snelling's Jahr, and he will soon discover how the remedies have been pruned in the latter works of most important characteristics, and each drug "presented to us a short, compact, stemless stick all ready to be tied in a faggot." In this cursory view of matters I must not omit to take notice of Pathology-a very big word amongst us-but I should like to know what service has been rendered to homoeopathy by all the progress it may have made since the time of Hahnemann ? None whatever, in my opinion. Moreover, it would be well that those who make frequent use of the word should state what they mean, seeing that it has a double signification. A very learned allopathic writer says: "When I speak of the pathology of a disease, I do not mean those obvious alterations in the structure-of an organ which we meet with in the post- mortem examinations, but the so-called functional changes which precede and are the cause of both them and the symptoms." Will any one who has read the Organon attentively, make so bold as to deny that Hahnemann did not attend to these "func- tional changes" which reveal themselves by signs and symptoms indicating the remedy needed, if we know how and where to ON THE STUDY AND PRACTICE OF HOMOEOPATHY. 219 search for it? It was in this latter sense, I presume, that Dr. C. Hering wrote: "Not only is a study of pathology indispen- sable, but its employment also, in the investigation of every actual case of disease, both for diagnosis, prognosis, and prophylaxis. We differ essentially, however, if, on the one hand, we conduct the examination of the patient on the true Hahnemannian plan, and choose the best remedy according to the law of the similarity of the symptoms ; or if, on the other, we make only a patho- logical examination, determine the nature of the disease, and then administer the.remedy that is set opposite that name in the repertories." He further adds, " It will be found that all those who use high potencies examine the patient in the Hahneman- nian fashion, and choose the remedy from the symptomatic indi- cations ; while those, on the other hand, who are entirely or mainly led by the pathological indications, rely wholly or prin- cipally upon the lower attenuations." If the lecturer had in his mind the pathology implying " altera- tions in the structure," such as have taken place too often in diabetes and Bright's disease before the sufferers seek homoeo- pathic treatment, then we would beg to remind him that homoeop- athy does not profess any more than allopathy to cure organs that have already passed into states of disorganization, although, in this respect even, I have found remedies selected according to the symptoms afford the greatest relief. When not guided by the symptomatic indications, all becomes guesswork and chaos. I have made my strictures with less reserve than I might otherwise have done had I not been aware, through the British Journal of Homoeopathy, that amongst the approved papers, con- tributed to the World's Homoeopathic Convention by live mem- bers of the British Homoeopathic Society, two of them, prepared by lecturers at the hospital, have reference, respectively, to "Ho- moeopathic Education," and "Homoeopathic Literature," subjects of vital importance to homoeopathy, demanding not only earnest thought but energetic action. The hospital and society are united as one body, under a rule which I have formerly discussed in my History of the London Homoeopathic Hospital. I trust it will be found that my opinions are based on facts, without any wavering or dubious uncertainty, differing entirely, in my judgment, from opinions which have gained the assent of the understanding by the evidence of probability alone. Finally, as a British homoeopathic physician, I make this pub- lic protest against the unjustifiable falsification of Hahnemann's doctrine and principles of practice, whether adopted in Great Britain, America, or elsewhere, until he, our great Master, shall have been tested, according to his own rules, and found wanting I POTENCIES AND DOSES IN TROPICAL CLIMATES. By Jose T. Navarro, M.D., Santiago de Cuba. There is in my mind no reason why large doses or low po- tencies should be used for the treatment of disease under the burning sun of the tropics. It is true that climacteric influences should be considered in the treatment of disease, and for that very reason high potencies and small doses are required in hot countries. I believe it would be a violation of the law of simi- larity to prescribe otherwise; it would be contrary to the homoeo- pathic principle to administer large doses and low dilutions in regions where everything is highly dynamized. The sun is the dy- namizer par excellence of our planet, and while dynamizing the aroma of flowers that perfume this tropical air, it at the same time dynamizes the deadly miasm of swamps and marshes, and sustains it in our atmosphere in a completely dynamized state, pro- ducing by inhalation of truly infinitesimal doses, such pestilen- tial diseases as small-pox, yellow fever, Asiatic cholera, and paludal fevers. There is another reason why the action of high dilutions should be more easily developed in natives of the tropics, for the more impressible the nervous system of a patient, the more highly dy- namized should be the remedies and the smaller the doses em- ployed. And where shall we find a nervous system more impul- sive, more susceptible and inconstant, than that of the sons of the tropics ? Since in the tropics the miasms that produce certain diseases are in a state of dynamization, and since the nervous organiza- tion of natives of tropical climates is so highly excitable, I be- lieve we should use, as a rule, high potencies and small doses. But as there are exceptions to all rules, it is not to be understood that I advocate for tropical or other climates the exclusive use of high dilutions. There are many cases in which we are obliged to use the low, and even the crude substances. This may be because we have not selected the proper remedy; for, if high dilutions act in many cases, why should they not in all ? In this island POTENCIES AND DOSES IN TROPICAL CLIMATES. 221 the majority, if not all, of the practicing homoeopaths use high dilutions. On my return from the United States in 1862, I found Dr. Iturralde, one of the best physicians that ever prac- ticed here, using exclusively high dilutions. On his departure came Dr. Vilardell, now in Habana, who used also, as a ride, Jenichen's preparations. Dr. Chacon, my only actual colleague here, uses also Jenichen's high potencies. The last two physicians are now, by my advice, giving a trial in their practice to my fa- vorite preparations, Dr. Dunham's 200ths. Add to these three names those of so many of our school who have practiced in the island since homoeopathy was introduced, and I think the testi- mony in favor of high dilutions is of great weight, at least in regard to Cuba. I, as a rule, use the 200th potency (Dunham's preparations) for all cases under my treatment, unless, of course, I desire a mechanical or chemical effect, as for instance, in cases of poisoning, when I administer emetics and the proper chemical antidotes. Also, in urgent cases of cerebral congestion or violent convul- sions, in order to produce the primary effects of the drug, viz., abatement of arterial excitement, etc., I give sometimes low po- tencies. I coincide with Dr. Hale in his rule for using high or low di- lotions, according as we wish the remedy to produce primary or secondary effects; but we should strive to attain such a perfec- tion in prescribing that we may be able to use our remedies only for sake of their secondary effects, and then only high potencies can be used; but, in the meantime, if we cannot cure dynami- cally and quickly, we must palliate the sufferings of the patients intrusted to our care. This course I have followed in my prac- tice, making the least possible use of low dilutions, which I con- sider generally as only palliatives, in a scientific and therapeutic point of view. I now come to an important point that has been warmly dis- cussed by homoeopath ists, viz., the use of Sulphate of quinine in intermittent fevers. Quinine is believed by a great number of practitioners of our system to be homoeopathic to intermittent fevers. I do not take this view. I think Quinine is homoeo- pathically indicated in very few cases of intermittent fevers, and in these cases China high, 200th for instance, will cure like magic; this 1 have repeatedly verified in my practice. If we are sometimes compelled to resort to Quinine in substance, we should not try to cover our apparent inconsistency under the as- sertion that we are acting homoeopathically. I agree with Dr. Lord in his opinion that Quinine in massive doses for intermit- 222 world's homceopathic convention. tents acts only as a palliative, that is to say, as an anaesthetic to the cerebro-spinal system, and in this way arrests the paroxysms as long as the anaesthesia lasts. I am aware that this use of mas- sive doses of Quinine is condemned by the homoeopathic profes- sion at large, but I challenge the strictest purist to settle in a malarious country and not have recourse to Quinine in some cases. I doubt if any one would be willing to allow the loss of a life that might be saved, for the sake of purity in practice. To this some will respond that the good results might be attained with high potencies of the remedy homceopathically indicated ; Ido not doubt the truth of this assertion; but experience has shown me the efficacy of Quinine in some cases, without the loss of time in the selection of a remedy which might not be the ap- propriate one, when we might lose our patient while finding the proper medicament. Only in these extremes do I use Sulphate of quinine, and then only in doses sufficient to merely arrest the paroxysms, but never in the large quantities given by some allo- paths. Two years ago we had in this city an epidemic of per- nicious fever, and the mortality under allopathic treatment was very great, in spite of enormous doses (200 or 300 grains) of Qui- nine. I had the good fortune not to lose a single case; my plan being to treat the patient with dynamized remedies, generally Dunham's 200th, during the paroxyms, and to administer during the first apyrexia 18 grains of Quinine, and 12 during the second. To prove that high potencies do act in the tropics, I could ap- pend numerous cases taken from my notebook, both of common diseases and those peculiar to hot climates, occurring in patients both of the Latin and Anglo-Saxon races. From 1868 to 1870 we had a terrible epidemic of Asiatic cholera and small-pox ; in these diseases homoeopathic treatment was so very successful that Dr. Vilardell and myself, the only two homoeopaths at that time in Santiago, had charge of nearly all the patients, the allopaths treating only those cases that we could not take charge of for want of time. In the treatment of both diseases we used high potencies, although on the appearance of this scourge among us (being my first cholera experience), I prepared a pocket-case con- taining the remedies recommended for its treatment, in the form of powders and liquids of low dilutions, for I imagined that this violent malady would not yield to high potencies. After a few days' trial, the pocket-case fell into disuse, for I began to treat my cases with globules of the 30th, and afterwards with Dr. Dunham's 200th, experience having forced this change upon me. My experience in tlje treatment of variola fully coincides with that of cholera, the dynamized remedies proving wholly effica- POTENCIES AND DOSES IN TROPICAL CLIMATES. 223 cious in the most desperate, and even apparently hopeless cases. In 1870 I attended a man, set. sixty-five years, of marked psoric diathesis, eczema having spread all over his limbs for over twenty years. After a severe attack of rheumatism he was at- tacked by paralysis of both legs (paraplegia); had been a cripple for eleven years; had consulted all the medical men of Jamaica, and some of England, but found no relief. In my presence he was carried in the arms of two servants from his bed to the sofa, where his days were spent till taken to his bed again at night in the same way; never had tried homoeopathic treatment. 1^. Causticum 200th (D.); he improved so rapidly that in twenty- two days he was able to attend to his business in the foundry, and soon after I left him quite cured of the paralysis, and the eczema greatly improved. Master de Cordova, set. eight years, lympathic temperament, belonging to one of the first families of Jamaica, was brought to me with the following history : Had been subject since the age of six months to fits of suffocation, at first every month, but now every week ; these attacks lasted two days, and during them the family suffered great anxiety and alarm, for the doctors had said that the child might die in one of them. On examination I found a protuberance in front of the chest, which lifted up the sternum to a considerable height; this, I was informed, had been increasing in size as the disease progressed. He had been treated by all the Jamaica practitioners, and by their advice had been taken to Eng- land, where the best physicians had been consulted, all to no avail. There was no difficulty about the diagnosis, for the mother of the little patient, a very intelligent lady, told me that an older son who suffered in exactly the same way, had died in one of" the attacks, and by a post-mortem examination it was found that the thymus gland was hypertrophied, greatly enlarged, and so hard that all the thoracic viscera were compressed against the vertebral column. I therefore knew that I had to deal with a case of thymic asthma, which, taking into consideration the state of the patient and previous history of his brother, would almost certainly terminate in death. I decided not to prescribe until I had observed the child during one of the attacks. Three days after I was summoned in haste, and found the child'in a distressing attack, as similar to asphyxia as possible; the incessant nausea and mucous rattling in the bronchia led me to prescribe Ipecac. 200th (D.), every five minutes. In about an hour, to the aston- ishment of the family, all the symptoms had disappeared. The next attack came on three weeks afterwards, but was milder and yielded to the same remedy. Under the influence of Spong ia 224 world's homoeopathic convention. 200th (D.), with an occasional dose of Sulphur 200th (D.), the child was completely cured in the space of six months, and has remained well ever since, without any perceptible sign of the ex- istence of the thymus gland. During the summers of 1871 and 1872 I treated in Kingston many cases of yellow fever on board of vessels in the harbor, with the loss of only one case, the patients being of different nationalities, English, Americans, and Germans. I adminis- tered only dynamized remedies, the principal one being Fiebre amarilla 30th. In regard to this disease, peculiar to the tropics, the result of homoeopathic treatment has been so favorable as a rule, that it does not inspire so much terror as in other places; for we possess a medicament prepared from a Cuban plant by Dr. Iturralde, which is regarded almost as a specific. Being unacquainted with the name of the plant, as the discoverer kept it a secret, we call the remedy Fiebre amarilla (yellow fever). Numberless cases of this fearful malady have been cured in this city by myself and other homoeopathists by means of this valu- able Cuban remedy. We use the remedy in a dynamized state. I generally prefer the 30th, the highest potency that I have. The following interesting case, belonging to a class of diseases to which I pay particular attention, and for which some gynae- cologists claim low dilutions and local applications to be indis- pensable, is an instance of the efficacy of high potencies in this climate. Doha M. V., a Cuban lady, age 36, married, and the mother of several children, suffered for many years with what was considered to be cancer of the womb. She was treated by several medical men (allopaths), and was at last pronounced in- curable. I found the patient greatly emaciated ; suffering from very severe pains in the region of the uterus ; copious mucous discharges, sometimes bloody, from the vulva; occasional copi- ous haemorrhages; anorexia, adipsia, vomiting of food; watery, offensive diarrhoea; during the last few days slight night- sweats, low spirits; inclined to weep on least excitement; desire to be alone; annoyed by conversation. 1^. Pulsatilla 200th (D.), and proposed an examination per vaginam. On calling three days afterwards, I found the moral symptoms greatly modified. I proceeded to make a digital examination. The os felt hard and uneven, and was very painful to contact. I then introduced Simpson's speculum, and found in the posterior lip a deep ulcer the size of a twenty-five cent piece, with ragged edges, and dis- charging a sanious, bloody pus. Both lips were thickened and indurated, and the bloodvessels were visible, much injected, run- ning from the ulcer. 'This serious case, that had resisted all the POTENCIES AND DOSES IN TROPICAL CLIMATES. 225 strong allopathic appliances, was cured in eight months by the use of Sulphur, Mezereum, Sepia, and Graphites, all of the 200th (D.). This was nine years ago, and the patient enjoys good health to the present time. My cures with the high potencies in the severest acute dis- eases, including peritonitis, pleuro-pneumonia, etc., peculiar to this climate, are so numerous that I could not pretend to enu- merate them. I have had about 26 cases of tetanus, one of them traumatic; and all except the first one were cured with the same treat- ment, viz., homoeopathic remedies in the 200th (D.). The med- icine most generally indicated in my cases was Secale. I think I have sufficiently proved in this paper that high po- tencies are as efficacious in the torrid as in the temperate zone; and reiterate, in conclusion, that my own practical experience has dictated the use of high potencies as a rule, and low ones as the exception. SURVEY OF MEDICAL SCIENCE. A SURVEY OF MEDICAL SCIENCE PRIOR TO THE INTRODUCTION OF IIOMCEOP- ATHY, THE METHODS PRESCRIBED BY HOMCEOPATHY FOR ITS REFORMA- TION AND DEVELOPMENT, AND THE MODIFICATIONS WHICH THE INFLU- ENCE OF THE NEW SCHOOL OF MEDICINE HAS WROUGHT IN THE PRAC- TICE OF THE OLD. Conrad Wesselhceft, M.D., Boston, Mass. Review of the Science of Medicine before the time of Hahnemann. -The term " medicine " was originally applied to certain sub- stances derived from the mineral, vegetable, or animal worlds, in which accident or experiment had revealed curative powers; and the physician was one who was supposed to employ these agents intelligently in the treatment of disease. In our day medicine proper occupies but an humble position in the assemblage of sciences that are connected with the healing art, at least as the art is practiced by the dominant school. It is the object of the new school to rescue the science of medicine from that anomalous position and restore it to its true rank. A student of the history of medicine might reasonably ex- pect that it would chiefly consist of the successive discoveries of medicinal substances, their effects upon the living organism, and their employment in the cure of disease. On the contrary, that history, as hitherto written and taught, has little to say of medicines, but very much to say of philosophical problems concerning life, and the various ingenious solutions of those problems offered by physicians, with the hypotheses and theories they framed and the conclusions they reached. We search medical literature almost in vain for evidences of progressive improvement in the treatment of disease by medicinal agents. Though medicine is much older than the age of Hippocrates, we will not search the periods of time which preceded him. We will assume that he reconstructed the science out of traditions and fragments as he found them. He might be compared to a captive in a gloomy dungeon, working his way through its walls with a crooked nail, and accomplishing by his keen intellect, sagacity, and force of will a task which might baffle an engineer with liberty of action and choice of methods. But from the SURVEY OF MEDICAL SCIENCE. 227 time of Hippocrates to Dioscorides, and from him to Theophras- tus von Hohenheim (known as Paracelsus*), materia medica was literally nothing more than the word implies,-a mass of medicinal substances regarding which much was conjectured but very little actually known. During the two centuries intervening between Hohenheim and Hahnemann changes occurred which culminated in giving the char- acter to medical science which it bore at the end of the eighteenth century. But these changes had little to do with advancing the knowledge and use of medicines, as they chiefly concerned the varying philosophical or sophistical systems and the hypotheses and theories about the nature of life, which had only an indi- rect bearing on the healing art. Though anatomy, physiology, chemistry, etc., crept steadily on, they were too imperfect to affect the methods of healing; and having to proceed under the guidance of the spirit of the age, they were impeded by its vague theories and speculation. Witness the archaeus of Van Hel- mont, as also the theory of Sylvius, that the spleen elaborates the finest ferment, a kind of tincture; that the blood is prevented from coagulation and returning from the kidneys by means of the suprarenal capsules, and that the effervescence of the blood is subdued in the left ventricle by means of a fine salt generated in the right ventricle. His notion of acrid humors was based on similar views. The discovery of the functions of the heart by Harvey (1619) and that of capillary circulation by Malpighi (1661), though steps of vast importance, did not improve the skill of physicians in the use of the Materia Medica. The influence of Descartes and Bacon on philosophy had as little power to change the pre- vailing ideas concerning the treatment of the sick. Only the ingenuous Sydenham was thus led to abandon the dogmatism of his age, return to the pure empiricism of the ancients, and be- come the best practical observer of his time. The pure spirit of science was, however, doomed to succumb again and again to philosophical speculation. Scarcely had the mind of an eagerly learning generation welcomed the guidance that showed the safe path of knowledge, when it was distracted by the seductive brilliancy of a new theorist, J. E. Stahl (1660- * Dr. 0. Hering possesses a genuine copy of Hohenheim's first work, which was printed during his lifetime (1493-1541). In this little book, On the French Disease, the author's name is given simply as " Theophrast von Hohenheim," so that the high-sounding name, Philippus Aureolus Theophrastus Paracelsus Bombastus ab Hohenheim, seems to have been con- ferred upon him by later editors of his works. See also Internationale Homoeopathische Presse, vol. iii, No. 4, p. 294. 228 world's homceopathic convention. 1734). Abhorring the materialistic views which macle life depend- ent on chemical and mechanical processes, he explained the manifestations of life as originating in a principle which he called "anima," resembling the archseus of van Helmont. To apply his ideas of anima to practice, Stahl advanced the hy- pothesis of plethora, which he combated by evacuants and vene- section ; these, with arcana, constituted the sum and substance of his profound system. In direct opposition to Stahl stood F. Hoffmann (1660-1742), with his medicina mechanica born of a materialistic philosophy, supported by Descartes and Leibnitz, but chiefly by the physi- ology of Baglivi. But the scope of this article forbids an extended notice of these systems of medicine, so called, and permits only this brief reference to the scientific aspects of the period just preceding the time of Hahnemann. The doctrines and tendencies of that age, as set forth, are sufficiently illustrative of the character of those that followed, and the kind of practice they gave rise to. Great, indeed, were the scientific attainments and the fame of Boerhaave, Stahl, and Hoffman; great the number of followers of each, and bitter their partisan strife. But we find no page of their historv showing curative results from exact knowledge and pure empirical research. Only a controversy rages over humoral pathology, the spirit-principles of Stahl and Van Hel- mont, and the mechanical theories of Hoffmann. To those theories may be added Haller's doctrine of Irrita- bility. Although this doctrine was promulgated without direct reference to therapeutics, it subsequently exerted a great influ- ence on that branch of science. Haller distinguished the irrita- bility of the living from the elasticity of the dead fibre, and separated both from the all-pervading nerve-power, or sensibility. He recognized the difference between voluntary and involuntary muscles, and drew inferences of vast importance from his dis- coveries. This general survey brings us to the dawning-time of the most remarkable revolution that ever shook the foundations of medi- cal superstition, and to the consideration of Materia Medicaat the time of Hahnemann.-We cannot think of the innovations inaugurated by Hahnemann without being reminded of William Cullen (1709-1790). It was he who led the minds of bewildered theorists to recognize the importance of rearranging, systematizing, and applying the scattered Materia Medica. This he did in accordance with his nerve-pathology, a system based upon the advanced views of Haller. He taught SURVEY OF MEDICAL SCIENCE. 229 that morbid as well as medicinal effects are produced through the " sentient " nerves, causing sensations. It is not, however, Cullen's pathology that interests us now, but his labors to reform the Materia Medica; and as Hahnemann himself selected Cul- len's work as worthy of supplanting the writings of his country- men (1790), we may safely consider it the standard work of the age. Next to Cullen, Gren, Arnemann, and Jahr, deserve men- tion as authorities. Rejecting the method of classifying medicines according to the botanical order of Boerhaave and Lin mens, as well as the alphabetical arrangements, Cullen proceeded to classify them by the virtues they possess in common. He thus formed twenty- three classes, beginning with "astringents" and ending with " emmenagogues." Astringents produce contraction and con- densation upon the "soft solids," their effect becoming apparent "from their use in tanning and making of leather." The body consists of " simple solids, living solids, and fluids," and astringents act only on the solids; their action on the simple solids being "of much the same nature in the dead as in the liv- ing body," while the living solids " have qualities and powers only as they exist in the living body." The mere arbitrary dis- tinction of simple and living solids, substituted for the organic idea of Hohenheim, owes its origin to narrow views of the action of drugs. Astringents could only be astringents. Cullen, how- ever, does not limit their action to the parts in contact, but holds that by means of the sentient nerves, and perhaps of a small quantity taken into the circulation, it can reach distant parts. Thus he says : "Some of the most simple astringents taken into the stomach very soon after prevent the recurrence of an attack of intermittent fever, which implies a very general operation on distant parts." While Cullen, as an excellent observer, does not deny the more general curative effects of drugs, he is unable to divest himself of the binding; force of dogmatism, and having once classified certain drugs as "astringents," is bound to ex- plain their action accordingly. The substances so classified are, besides numerous vegetable matters, Alum, Iron, Copper, Lead, Zinc, etc. The affections in which they have proved curative or beneficial are often described with great nicety of distinc- tion, showing unusual practical ability. He commends Alum in diarrhoea, because he has often found it useful in such cases. This drug failed him in haemoptysis, but proved beneficial in menorrhagia and uterine haemorrhages, where it is often service- able when administered internally, the reason given being that 230 world's homoeopathic convention. it is hurtful in active but useful in passive haemorrhages. Cullen has little to say about Iron, evidently puzzled by its evincing sometimes an aperient, at others an astringent power. But hav- ing once been classed as an astringent, it can cure "retention of menses" when depending on "weakness of the vessels of the uterus," "only by invigorating the force of the vessels, and may thereby appear to be aperient." Baron Van Swieten, says our author, discovered Copper to be useful in epilepsies, "which is the same thing as if Van Swieten had said it possesses a tonic power." Of Lead, Cullen says that its astringent powers are now sufficiently ascertained, but admits danger in its use on account of " a sedative power" it possesses, "extremely noxious to the human system." While admiring his caution, we dare not accept the reason assigned in the word "sedative," which, like "astringent" and "tonic," is employed to day in the same sense, or no sense, as in Cullen's time. Vege- table substances, metals, acids, are counted as astringents, and their action is regarded as the same,-"like the process of tan- ning." We cannot but marvel at the ability by which this effect is made to appear under so great a variety of circumstances. With all allowance for the state of science when Cullen wrote, it may be asked, Are the definition and classification of drugs at this day, in the old school, practically better? A general survey of Cullen's class of " tonics" will aid us to appreciate the actual state of medical knowledge at the time of Hahnemann. Tonics are defined as medicines having an effect similar to astringents. While, however, the latter act on the solid portions of the moving fibre, the real tonic acts, without an astringent effect, upon the inherent nervous power of the fibre. This is certainly an ingenious hypothesis; but unless we admit a difference between tonics and real tonics, it is difficult to see how they can have an effect similar to astringents, without producing an astringent effect upon the nerves of the moving fibre,-"tan- ning" them, in short. "The tonic power of substances is chiefly the same that gives them their bitter taste; for, except the astrin- gents, I know no other substances possessed of tonic powers but the bitters." Without attempting to explain the nature of bitterness, it is considered as the principle which produces all the wonderful effects attributed to tonics. These are said to act on the mus- cular fibre of the stomach, thus il increasing appetite and pro- moting digestion;" a phrase which tradition has respectfully handed down to us, and which is still mechanically repeated, as if it really meant something which a rational mind could appro- SURVEY OF MEDICAL SCIENCE. 231 priate as information. That the influence of tonics on the digestion is by that means communicated to other parts of the system, is regarded by Cullen as "sufficiently probable" or "of little doubt." But to-day all doubt has disappeared; and all the textbooks and authorities of the old school on Materia Medica, including Beck, Wood, and the U. S. Dispensatory, are of one mind of assured certainty on the subject. The action of tonics in removing visceral obstructions, or causing: diuretic effects, is ingeniously made to coincide with Cullen's theory. The well- known fact that many so-called tonics relieve or cure intermit- tent fevers is met by the hypothesis that these fevers depend on "atony in the extremities of the arterial system," and hence if they are cured by tonics, it must be the " tonic power" of bitters communicated from the stomach to the most distant parts of the system. Although numerous results, beneficial and otherwise, cannot be explained at all by the theory of tonic action, yet these agents having once been forced into a class, must be retained there at all cost; and the fertile imagination of our author is equal to the task. Tonics, for instance, had been known to cure gout. This is hard to explain, but explained it must be, or down falls the class of tonics in hopeless confusion. Too much "strength of tone in the stomach," says Cullen, "produces a paroxysm of gout." Now if atony of the stomach prevails, and is too long continued, no inflammatory paroxysm ensues, and the person remains in that state which I have called atonic gout; and it seems as if bitters (tonics) long continued in use actually produce this greater degree of atony, so that they prevent inflammatory paroxysms. Although Cullen maintains that the curative effect is due to the medicine as a tonic, he admits afterwards that he cannot under- stand why bitters, as powerful tonics, should have this contrary operation. Moreover, he ignores the palpable encroachment upon the class of " sedatives" whose part he makes his tonics assume in his explanation of the cure of gout. Peruvian bark is of historic interest to us, and Cullen's teach- ings on the subject throw much light on the Materia Medica of his time. No attempt is made to explain the great variety of phenomena resulting from the use of bark ; it is deemed suf- ficient to attribute its curative action, particularly in intermit- tents, to its tonic power on the stomach. " For," says Cullen, " I see no foundation for referring it to any mysterious and un- explained specific power, which, however, some writers seem still disposed to maintain." Why the tonic theory should throw a clearer light on the action of bark than the assumption of a 232 world's homceopatiiic convention. specific property it is rather difficult to see; yet not only Cullen, but his successors in our day, are persuaded that it does so. But leaving his ambiguous theory to take care of itself, Cullen's superior practical ability and tact are shown in laying down the best indications and conditions for the use of bark in intermit- tents, continued fevers, rheumatism, etc. In the latter disease he declares the drug to be manifestly hurtful during the acute stage, but recommends its use when the disease exhibits remis- sions of a periodical character. Such observations are frequently verified in homoeopathic treatment of certain stages and forms of rheumatism. The importance which Cullen attaches to bark in the treat- ment of gangrene, is also noteworthy. " The theory of this" says he " has been considered very mysterious, but it seems to me that it may be made very plain. In all cases in which I have observed the cure of gangrene by the bark, I have found that it was by exciting a degree of inflammation and suppuration around the gangrened part, and that by this the dead part was separated from the living, and thus disposed to be thrown off." Many homoeopathists will have verified these observations in cases of indolent and sloughing ulcers. It is but just to add that in the many other diseases in which Cullen recommends bark as a beneficent remedy, he invariably shows a nice discrimination in giving indications for the medi- cine, the correctness of which in many cases is to be seen in our practice of to-day. In Cullen's. Materia Medica theories are invented for each class of medicines, and we cannot but admire the vigorous con- sistency with which each class is limited by these theories. Turning to later works on the subject, founded on a larger ac- quaintance with the action of drugs, we find an obvious though reluctant recognition of varied and theoretically opposite effects of single medicines. The line of class demarcation is no longer strictly drawn ; the classes of drugs merge into each other, medicines of one class often reappearing in several others. But the adversaries of the new school, though sorely perplexed by their discoveries are still in the trammels of traditional classifi- cation and nomenclature. There was undoubtedly a " Materia Medica" in the eighteenth century, if we count the number of drugs recommended in connection with the names of diseases. There was also a continual introduction of new remedies and a discarding of the old. Many metals had been introduced by Paracelsus, and their number was afterwards increased by the addition of Bismuth, various antimonials and preparations, such SURVEY OF MEDICAL SCIENCE. 233 as James's powder, Zinc, Tin, Lead, etc. These having been sub- jected to some experiments, were commonly and often efficiently employed, Magnesia, Lime-water, and Alkalies also came gener- ally into use; while the value of acids was more fully appreciated as "tonics" " antiphlogistics," and antisyphilitics; chiefly Muriatic, Nitric, Phosphoric, Acetic, and Oxalic acids. The ad- vancement of chemistry led to the therapeutic use of gases. Phos- phorus, long known as a poisonous substance, was now beginning to receive attention as a "stimulant." Amongst the vegetable medicines, Cicuta, Belladonna, Stramonium, and Hyoscyamus became better known, especially through the enthusiastic efforts of Stoerck, and were merged amongst " narcotics.'" But with the assignment of Phosphorus to the class of " stimulants " and the after-mentioned vegetable medicines to that of " narcotics," all progress in knowledge concerning them ceased, and research was lulled to rest. During this period other drugs of vegetable origin were intro- duced or reintroduced. Thus Rhus toxicodendron was used in para- lytic affection, and Pulsatilla,Clematis, Aconite, Digitalis, Bryonia, were recommended as "specifics" for various diseases. At the same time certain substances were discovered and put forward as substi- tutes for Peruvian bark. Theclass of tonics was augmented by the introduction of Polygala amara, Quassia, Simaruba, Colombo, etc., while Catechu began to be regarded as an astringent. The mere addition of the substances named to the number of drugs is all the eighteenth century can boast of. Having been found efficacious in practice, here and there, they were assigned by the learned their places in the Materia Medica, ranged under already existing classes, such as "tonics," "astringents," etc., where they figure to this day. The preceding review however imperfect, may suffice to show the character and value of the Materia Medica, when Hahnemann inaugurated his great reform. It now remains for us to inquire aside from theories governing the classification of medicines, how these were actually used in practice. Therapeutics and Practice at the time of Hahnemann.-It might reasonably be supposed that the practice of medicine at the time we refer to would accord with the actual knowledge obtained of the qualities of drugs, and with the rigid classification and appa- rent inflexibility of theories then in vogue. On the contrary that practice seems to have been governed by independent pro- cesses of reasoning, and by "systems" originating in the minds of leading, men. These systems arose independently of each other at different times and places, seemed often to be based on 234 world's homeopathic convention. different principles, and necessarily therefore to conflict with one another. A prominent system of mingled pathology and therapeutics was originated by John Brown, of Edinburgh, author of The Ele- ments of Medicine. He taught* that the nature of life consists in that it is affected by external stimulants, and certain inner active processes, from which vital manifestations result. Life itself therefore depends on stimulus. Amongst stimulants are reckoned all ingesta, blood, air, the bodily functions, senses, pas- sions, etc. The acting principle is called excitability. The stimulating potencies are general and local. The nature of ex- citability is unknown, and it is of no consequence whether it is matter or force. Force and quantity of excitability are variable. All stimulants act either in excess in due proportion to the sus- ceptibility of the organism, or insufficiently, but always with an effect proportioned to their power. Proportionate stimulation results in health ; excessive or deficient stimulation in disease. When the stimulus is excessive, excitability is exhausted ; when deficient, excitability is accumulated in great amounts. Passing the limit in either case results in death. Medicines, according to the Brunonian system are stimulating potencies differing only in degrees. In asthenic diseases they act by increasing the excitation and lessening accumulated exci- tability ; in sthenic diseases they act by lessening the irritation and increasing excitability. One remedy at once is insufficient, several are always needed to insure greater equality of action. Their effect is not local but general. Medicines capable of curing one disease, will also cure all others of the same genus, because all diseases, like medicines, differ only in degree; diag- nosis is only required to determine thecauses according to which diseases become sthenic or asthenic. Brown denies the curative power of nature. Hahnemann is supposed also to have maintained this view; but this supposi- tion is erroneous, for he invariably refers to those cases in which the curative power is merely insufficient, e. g., in " genuine chronic diseases." In classifying his remedies, Brown enumerated as producing asthenia: bloodletting, purgatives, emetics, vegetable diet, sudorifics, cold, abstinence from food and rest; and under the sthenic or tonic class: Musk, volatile Alkali, Ether, Opium, animal food, spices, warmth, wine, and exercise. This system w7as a vigorous attempt to make therapeutics con- form to pathology, by reducing practice to a few simple but * Vide Hirschel's History of Medicine. SURVEY OF MEDICAL SCIENCE. 235 comprehensive principles. It promised more than those of Boerhaave, Hoffmann, Haller, and Cullen, by holding out hopes of release from the thraldom of pre-existing theory and dog- matism, and the simplicity, precision of expression, and fascina- ting style of its author helped to win many adherents. But this was not the medicine of experience, and it had not in it the ele- ments of longevity. It became popular because it resembles the manifold attempts of all ages to make thinking easy. The key was supposed to have been found which would unlock every mystery of the art of healing. When the system came to be largely applied in practice, its defects became apparent to the minds of conscientious practitioners, and only the mass of rou- tinists went on blindly in the fashion of the hour, awaiting some new leader to present something still more attractive and plausi- ble. " It is the curse of medicine" said Rush, " that no one is made wiser by the experience of others." But if we consider that this " experience " has so often stood for incoherent practice, and uncertain results, based on a priori reasoning, we cannot much wonder that " no one is made wiser by it." The Brunonian system met with no great success in France, but in Italy, Massini, Rasori, and particularly Joseph Frank, professor at Pavia, labored zealously in its behalf, attracting many eminent men to their side. Passing from Italy to Ger- many the system of Brown found many ardent admirers. In 1790 it became known in America through the labors of Dr. Benjamin Rush, who edited the Elements of Medicine and adopted a portion of the system. By the energy it imparted to inquiry and speculation, it became the parent of other theories, notably that of stimulation, by J. A. Roesch 1 anb, professor at Wurzburg in Germany, which for the most part may be de- scribed as an attempt to base the teachings of Brown on a more matured scientific foundation. But Roeschlaub's theory rapidly declined in favor, and its propounder gradually receding from point to point, finally acknowledged his own errors. In Italy a kindred doctrine, known as "contra stimulus" was put forth by Giovanni Rasori ( 1763-1837), of Pavia, which was subse- quently spread abroad by his pupil Tommasini, and exerted an immense influence on therapeutics. In this system the sthenic and asthenic states of Brown, were supplanted by others corres- ponding to the strictum et laxum of the ancient methodic school. The first of these is called "diathesi di stimulo," and the latter " diathesi di contra stimulo." These conditions vary in form according to the various systems composing the body, appearing as delirium in sensibility, as convulsions in irritability. Disease 236 world's homceopathic convention. is a vital process, running a definite course. The distinction of stimulants and counter stimulants belong also to medicines. As it is difficult to recognize the true character of disease from the uncertain nature of symptoms, the different diathesis are to be judged from the effect of the two categories of medicines. But even our judgment of medicinal action is uncertain ; hence this action should be compared with that of a positively known contra-stimulant, which serves as a standard, namely, blood- letting. Hence experimental bloodletting is admissible as an aid to diagnosis. Rasori, like Broussais afterwards, believed in local diseases, therein differing from Brown. But on the whole his classifi- cation of diseases, as well as of remedies, was exceedingly imper- fect. The amount of real knowledge which governed the clas- sifying of drugs may be easily appreciated by any tyro in medicine who lias ever heard of drug provings; and it is discreditable to medical science that such a classification should have been accepted even for a short time. The practice was like the theory. Bloodletting was often resorted to ten times in a few days; Tartar emetic was prescribed in half-drachm doses, Nitre in quantities of several ounces, and Flowers of zinc in doses of four scruples I The recommendation of test-bloodletting to de- termine the diathesis closely resembles the mediaeval tests of witchcraft. The poor wretches under suspicion were tied up in sacks and thrown into deep water; if they sank and were drowned, innocence was proved ; if they came to the surface their guilt was manifest, and they were burned at the stake. Let us, however, be just enough to acknowledge the partially divined truths underlying the mass of errors. No one, for in- stance, will deny that Rasori's diatheses bear a relation to con- ditions which we recognize as acute and chronic diseases. The teachings of Rasori found an able, but not slavish adhe- rent in Giocomo Tommasini, of Bologna (Isensee ii, p. 690). While the former started from the general diathesis, holding phlogosis to be a symptom only, the latter held that phlogosis were primary, and general disease to be dependent on local affec- tion through reaction. He considered that excitation could be- come localized, according to the ancient dictum, "ubi stimulus, ibi fluxus." Locally increased irritation imparted to the entire living body calls forth inflammation, the cause of almost every disease. In his researches regarding inflammation Tommasini was a worthy precursor of Broussais, the leader of local path- ology. Pathology and therapeutics, however, suffered greatly by these SURVEY OF MEDICAL SCIENCE. 237 doctrines, and the phlogistic theory especially led, in practice, to serious abuses. It is recorded that twenty-five pounds of blood were often abstracted in a single case of pneumonia, while two hundred grains of Digitalis were administered. The few good results here and there obtained were due to a practical modifica- tion of the doctrine, and the empirical use of a few well-known drugs, such as Tartar emetic in pneumonia, Gratiola in mania, Cicuta in scrofula, etc. The renowned Francis Joseph Victor Broussais (1772-1838), a contemporary of Rasori, became a follower of the latter, and pursued extensive researches into the phenomena of inflamma- tion. Like Tommasini he held inflammation to be the cause of every disease, starting in some special organ or system. Gastro- enteritis was supposed by him to be the cause of all essential fevers, as well as of hypochondriasis, dyspepsia, cardialgia, dropsy, etc. The therapeutic principles in accordance with such views were strictly antiphlogistic debilitating or derivative. In- flammation and fever were suspected every where, and combatted by excessive and frequent bloodletting, In from seven hundred to nine hundred cases Broussais used 100,000 leeches as aids to the lancet, on the principle that disease must not be allowed to grow (?), but should be crushed and rendered abortive. In Germany the nerve-pathology of Cullen, together with his interpretation of irritability and sensibility, gradually devel- oped solidism in pathology, which, modified by the theories of Hoffmann, Stahl, and Boerhaave, gave rise to the utmost confu- sion of ideas with regard to the treatment of the sick. Hu- moral pathology, on the other hand, founded upon chemistry, reached its culmination in the older Viennese school. Its prin- cipal representatives were Gerhard von Swieten (1700-1772), a strict follower of Boerhaave, and Anthony de Haen (1704- 1776), a man of great ability, but inclined to superstition. He made frequent use of purgatives and bloodletting, which latter he practiced excessively during the prevalence of the plague. He afterwards became an earnest denouncer of the abuse of purgatives. But humoral pathology is depicted in a few lines conveying the dicta of Boerhaave: "A disease is not prop- erly cured unless the patient is rendered pallid even unto death; unless he is steadily emaciated ; unless during treatment he is nourished by the least fatty nutriment; unless the treat- ment is prolonged until the ancient humors have entirely de- parted from the body" (Isensee). Although Mercury was not used, according to Boerhaave, in primary syphilis, cervical swel- 238 world's homoeopathic convention. lings were treated by mercurial salivation, and Corrosive subli- mate was substituted by von Swieten. To Anthony von Stoerck (1731-1803) belongs the credit of introducing numerous new remedies, including Stramonium and Cicuta, and to his contemporary Maximilian Stoll (1742-1787) some improvement of De Haen's pathology by his distinction of fevers. In his very comprehensive treatises on bilious fever (Isensee ii, p. 568) Stahl considers superabundance of bile as causing an endless number of diseases, a doctrine which finds a traditional acceptance at this day. Amongst his followers there prevailed a belief in gastricism as the only cause of disease, which gave rise to terrible abuse of purgatives, emetics, and bleeding ; for every patient was presumed to have inflammation and dealt with accordingly. Finally comes J. K. Ksempf's doctrine of infarctions, founded on Stahl's theory of stoppage in the portal system, referring gas- tric and most other diseases to a thickening of juices. But a passing mention is all that need be accorded to it. In concluding this part of our subject, it may be said that there never has been a theory in medicine however narrow and unfounded, that did not once find its votaries. Thus it happened that a practice literally revelling in filth grew out of humoral pathology. The organism was regarded as little better than a sewer, as a thing whose only function is the production of excrements. Such views were actually maintained, and governed the practice of men like D. A. Koch, J. L. Schmid, Tissot, Brodbeck, and Zim- mermann. The Influence of Homoeopathy on the Development of Medicine Proper.-Knowledge is built up slowly; its growth is like that of the oak tree. But the great error of the time impeding the growth of true knowledge was, and still is, the assumption that the methods of applying the Materia Medica are derivable from pathology, and the strange idea that knowledge of disease implies knowledge of its curative agents, whereas experience shows that the science of Materia Medica proper, is as distinct from pathology as chemistry is from mineralogy, or astronomy from mathe- matics. Appalled at the course physicians were taking, and more and more convinced of the hopelessly chaotic state of the prevailing ideas and practice, Hahnemann set himself to reconstruct the science and art of healing the sick. Taking his stand on the broad principles of humanity, he declared the true aim of the physician to be the speedy, gentle, and permanent restitution of health (Organon, § 2). To accomplish this object, he separated the SURVEY OF MEDICAL SCIENCE. 239 work of investigation and treatment, prescribing two methods of observing actual, unequivocal facts: first, the close and careful study and clear recognition of disease; and secondly, an equally close and careful study of the virtues of drugs. The principle which guided Hahnemann in the progress of his work, was to distinguish carefully and fearlessly, what we actually know from what zee do not know; facts from fancies, rational induction from wild conjecture. Thus he says in the Organon (§7): "The totality of symptoms, this outwardly reflected image of the inner nature of disease, i. e., of the suffering vital force, must be the chief and only means of the disease to make itself known." Hahnemann was the first to stem the tide of speculation. In an article on the speculative systems of medicine published in 1808 (See Lesser Writings'), he says that " men have endeavored to explain too much, because they sought to gratify their pride by considering the essence of medical science to consist in ex- plaining everything, even the impossible. I hear it said that we need a theory to guide us in our practice; very true. But such a theoretical guide should be neither a flimsy cobweb nor a mis- placed guideboard, or else it is worse than useless." Further on lie says : " To penetrate the essence of the human soul a, priori was not the destiny of mortals. The wise pedagogue clings to that which he can establish a posteriori, to that which the soul manifests in fact, acting on our senses; he clings to the science of experience." This is what is now called "inductive reasoning." It was the force of his inexorable logic which brought Hahnemann into collision with the defenders of existing theories. He was irrefu- table, because his arguments were based on exact experiment, and that is the chief reason why he or any other reformer ever made enemies. This animosity to unanswerable logic has been trans- mitted now to the third generation, in the form of bitter partisan hatred of the new school. Hahnemann marked out the course to be followed in the in- vestigation of disease, not to penetrate to its essence and inner nature, but to discover what salient points it offered, what phe- nomena it presented, which could be recognized without a shadow of doubt, as distinct from all speculation or hypotheses, in short, what is curable in disease (Organon, § 3). This was the first step. The next step was to discover in medicines what in them is curative; what are their actual perceptible effects, distinct from any theory of their modus operandi. Accidental poisonings were unreliable. Curative effects could not be attributed to the 240 world's homceopathic convention. virtues according to which medicines are ordinarily classified, they must reside in properties less vague and ambiguous. The early history of Hahnemann's labors is too well-known to need repetition here. It is only necessary to point out that what homoeopathy required of pathology; it also demanded in regard to drugs, to reject absolutely and finally, all speculation, all theoretical classification, based on fictitious conceptions, and to accept only the positively knowable, positive, determinable facts, since these alone are of any importance in the treatment of the sick. How this knowledge was to be acquired is clearly set forth in the writings of Hahnemann and his distinguished fol- lowers. Though the law of curative action expressed in the formula " Similia Similibus Curantur" was not discovered by Hahnemann (who distinctly disclaims the title of its discoverer), yet, it was he whose labors culminated in establishing its truth. Hence grew the proper scientific method of discovering the powers of drugs; for it is not possible to apply the ride of simi- lars without a knowledge of the effects of drugs upon the healthy organism. These known, we have our remedy in a given case indicated. Pseudo-reforms, based on theories and hypotheses like that of Brown, though they may captivate the minds of the multi- tude at first, soon decline under the pressure of newer and an- tagonistic systems. True reforms on the contrary, if of slow prog- ress, are yet persistent, and bear the stamp of permanence. Such is the character of the reformatory movement in medicine known for about eighty years .as homoeopathy, and imperfect as this new school of medicine may yet be, it undoubtedly bears within itself the elements of a powerful revolution. For the first few years of its existence homoeopathy was ig- nored, and then despised by the prevalent school. In the year 1810, fourteen years after Hahnemann first published his views in Hufeland's Journal, the new principles he advanced had ex- cited but little attention. But the publication of the Organon, a new edition of which appeared in 1819, and the Materia Medica Pura, which passed through several editions from 1811 to 1822, materially aided in disseminating a knowledge of the principles and practice of homoeopathy. Many thousand copies of these works having found their way to all parts of Germany, were soon translated into other languages. Hahnemann's writings belong to a class which command at- tention, whether openly or secretly studied by the liberal minded, or regarded with the narrow prejudice of bigotry and ignorance, they could not be ignored. The new method of cure had be- SURVEY OF MEDICAL SCIENCE. 241 come well-known in 1820, and though the practicing followers of Hahnemann were few, the fear with which they inspired practitioners of the old school and their faithful allies, the apothecaries, was great. Although the few busy practitioners of homoeopathy could scarcely at that time have perceptibly re- duced their opponent's gains, the opposition which arose was both methodical and fierce. The apothecaries, stirred up by jealous physicians of their school, appealed to authorities of city and State, to enforce a law which prohibited physicians from dispensing their own medicines, hoping thus to crush the medi- cal heresy at a blow. This attack called forth Hahnemann's masterly reply, showing that the rights claimed of necessity by homoeopathic physicians, to prepare and prescribe their own medicines, were neither unreasonable nor incompatible with the law. (See Lesser Writings.) The early professional opponents of homoeopathy having stirred up the apothecaries, had of course something to wage from their own standpoint. The most serious objection was the presumed unscientific character of homoeopathy, since it required (so ran the lamentation) neither anatomy nor physiology. Hufeland, himself, pronounced homoeo- pathy il the grave of scientific medicine." Such arguments (if one maysocall them) were successfully metnotonly by the founder of the new school, but also by his followers, amongst whom may be named Rummel, M. Muller, and JEgidi. The influence of homoeopathy has been felt in two directions: Firstly, upon the people; and secondly, upon physicians. The rapidity with which the new method of cure has extended itself throughout the civilized world, in spite of the bitterest opposition, bears testimony to its influence over the laity. Nor is it a fact of small significance that a very large proportion of its converts and firmest adherents have usually been found amongst the refined and cultivated. Professional (non-medical) men and statesmen were at an early day ranked amongst its ad- herents. The history of homoeopathy in general, as well as its progress in America, will be so fully treated of by other contributors to this volume, that I shall omit it here, but will add some histori- cal points which are not generally known with regard to the time of introduction of homoeopathy here. The sources of information are not many, but such as are about to be drawn upon in chronological order have the im- portance of documentary evidence, much of which was recorded at or near the time of the events narrated. From the time of Hahnemann to that when homoeopathic col- 242 world's homoeopathic convention. leges were first established in this country, the new system depended for accessions to its ranks exclusively on converts from the old school. Hahnemann's earliest disciples were grad- uates of the old school at Leipsic; and those who in various countries and at later periods adopted homoeopathy had, almost without exception, not only graduated in old school colleges, but practiced medicine on the old method. The number and char- acter of these converts is a noteworthy feature of the influence of homoeopathy on dispassionate and intelligent physicians. On the other hand, the measure of its power over the profession in general is partly shown in the fierce, blind, and unreasoning opposition offered to its progress at every step. A barrier was raised from the beginning of the new era between the old and the new schools of medicine, not by the supporters, but by the opponents of homoeopathy. The former were ever ready to wel- come accessions to their ranks, and in order to cope successfully with a powerful opposition kept themselves diligently instructed in the progress of every branch of medical science, faithfully studied the writings of their opponents, and frankly acknowl- edged the worth of whatever they found of value in those pages. Evidence, of the Influence of Homoeopathy, Expressed, by Disap- probation of their Practice by Old school Physicians.-Long before Hahnemann's time many voices were raised in doubt con- cerning the prevailing therapeutic systems, and the tone often seems like that of despair. Imbert Gourbeyer, in his "Lectures on Homoeopathy,"* quotes Stahl as exclaiming: " Will not some bold hand cleanse this augean stable?" Bichat, Bayle, Pinel, Barbier, Rouillard, and Chomel, were equally emphatic in ex- pressing their doubts and disapprobation, but none could find a way out of the darkness and confusion; and still, with a strange inconsistency, the cry is echoed in modern times by writers who, yet obstinately, repel the guidance of which they confess the need. Yet, whoever compares the practice of medicine as it was seventy-six years ago, with that which obtains at the present day, will recognize most important changes, evidently wrought by the influence of homoeopathy. As the more gentle, speedy, and permanent cures of homoeopathy recommended the system to the laity, and drew around it large numbers of intelligent and zealous laymen, the professional mind of the old school was driven to take cognizance of it, and to modify its own repulsive methods. Formerly, to effect cures by the removal of supposed causes of disease, physicians employed bloodletting to an enormous extent, * Alegemeine Homceop. Zeitung, vol. 91, p 18. SURVEY OF MEDICAL SCIENCE. 243 destruction of tumors by artificial suppuration, cauterization, fontanelles, setons, etc. These painful external or local applica- tions, without anaesthetics (then unknown), were aided by ex- cessive and debilitating purgatives and emetics to expel the causa morin peccans, or these were administered as " derivatives," com- bined with diuretics and diaphoretics, all of which might or might not achieve the purpose aimed at; some effect, and proba- bly a very undesirable one, was pretty certain to be occasioned. But whatever difference might be observed in the use by dif- ferent physicians of various classes of drugs, there were four agents which were always resorted to under nearly the same con- ditions, viz., bloodletting, Opium, Mercury, and purgatives. There is no question that these agents were used in excess heroi- cally, as it has always and most improperly been called, and that gradually a change of opinion determined, at first their restric- tion, and lastly, in very many instances their abandonment. Such voices as that of Sir John Forbes, M.D., though heard in silence, were not unheeded. Speaking of the changes in practice in favor of milder measures he says:* "On this point we need only refer to the history of any one or two of our principal diseases or prin- cipal remedies, as for instance fever, pneumonia, syphilis, Anti- mony, bloodletting, Mercury. Each of these remedies has at various times been regarded as almost specific in the case of the first two diseases, while at other times they have been rejected as useless or injurious. What seemed once so unquestionably, so demonstrably true, is that venesection was indispensable for the cure of pneumonia. And what is the conclusion now, deducible from the facts already noticed in the present article, and from the clinical researches of Louisf and others? Is it not that pa- tients recover as well, or nearly as well without it? Could it have been believed by the practitioners of a century ago, that syphilis could be safely treated without Mercury? or that it could ever be questioned that Mercury was not a specific in the cure of this disease? And yet what are the opinions and prac- tice of the surgeons of the present day, and the indubitable facts brought to light during the last thirty years? Are they not that Mercury is not necessary (speaking generally) to the cure of any case, and that it is often most injurious in place of being beneficial ? Thus retreating from an untenable position, and throwing away those terrible weapons, the lancet, Mercury, drastic purga- * Homoeopathy, Allopathy, and young Physic, British and Foreign Med. Review, No xli, January, 1846. f Louis's Reeherches sur les effects de la Saignee, Paris, 1835. 244 world's homoeopathic convention. tives, etc., nevertheless the majority of old school men were not willing to admit, with many of their leaders, that their tactics were wrong, or that it has been possible to learn anything from homoeopathic practice. They and their predecessors were quite right, but now they say times have changed, climates too, and constitutions most of all. People cannot now endure the vigor- ous treatment which their fathers bore and lived under. The modifications in practice are not due to its errors, but to modern effeminacy. Dr. Forbes, on the contrary (/oc. cit.), regards homoeopathy as likely to "be the cause of more important fun- damental changes in the practice of medicine than any previous system since the days of Galen." .... "In this respect if in no other, the doctrine of Hahnemann will have conferred an inestimable benefit on the healing art. Regarding homoeopathy .... as a system of medicine which essentially leaves diseases to the operation of nature, we must consider it .... as insti- tuting a grand natural experiment in therapeutics which, though of vital importance to our art, could not have been compassed by any other means we know of." Quoting a number of Dr. Henderson's reported cures, he remarks that several of them, "if occurring under ordinary treatment, would unquestionably have been regarded as not only striking, but triumphant." As an illustration of the effect of Dr. Forbes's critique, and of the agitation caused in the medical mind of the old school by the steady advance of homoeopathy, we turn to an essay of Dr. Jacob Bigelow, of Boston.* Dr. Bigelow, whose learning, candor and kindly precepts will always be cherished by those who have known him, still enjoys, in his old age, the reminis- cences of a long life of usefulness. Alluding to Dr. Forbes, Dr. Bigelow says that the "article bearing the title of 'Young Physic'" (he omits the rest of the title), "which, though some- what startling in the novelty of its positions, and by many dis- approved of, for the credit given to statements of questionable parties, had, nevertheless, the effect both in England and in this country, to increase public attention to inquiries which the pres- ent volume is well adapted to satisfy." The "questionable parties" here alluded to are of course Professor Henderson, of Edinburgh University, and the homoeopathic physicians quoted by him, who are assumed, with a lamentable spirit of partisan- ship, to base their credibility on their adoption, after trial, of homoeopathy. Yet no one will question Dr. Bigelow's testimony to the merits of his own school as entirely sincere, as well as * Exposition of Rational Medicine, by Jacob Bigelow, M.D., etc., con- tained in a volume entitled Modern Inquiries, etc., Boston, 1867. SURVEY OF MEDICAL SCIENCE. 245 intelligently modified by homoeopathy beginning to exert its influ- ence. "When carried to its heroic extent," says our author (p. 227), "artificial medicine " (meaning the common practice) "undermined the strength, elicited new morbid manifestations, and left more disease than it took away. The question raised was not how much the patient had profited under his active treatment, but how much more of the same he could bear. Large doses of violent, deleterious drugs were given as long as the patient evinced a tolerance of them; that is, did not sink under them If diseases proved fatal, or even if. they were not jugulated or cut short at the outset, the misfortune was attributed to the circumstance of the remedies not being suffi- ciently active, or the physician not having been called in season. "A considerable amount of violent practice is still maintained by routine physicians, who,without going deeply into the nature or exigencies of the case before them, assume the general ground that nothing is dangerous but neglect. Edge-tools are brought into use as if they could be nothing more than harmless play- things. It is thought allowable to harrass the patient with daily and opposite prescriptions, to try, to abandon, to re-enforce, or to reverse; to blow hot and cold on successive days, but never to let the patient alone, or to trust his case to the quiet guidance of nature." Dr. James Rogers * admits that there is nothing fixed or sta- ble in therapeutics, and though he includes homoeopathy amongst the instabilities, the sentence falls heaviest on the school which claims his allegiance. He says of its Materia Medica (p. 2), "Even at the present day our Materia Medica is in a state of chaotic confusion, and its history is merely a summary of the fruitless efforts of thousands of gifted men, ever searching, as it were, in the dark, for the curative powers of drugs. Whilst we pro- test against the falsity of Hahnemann's statement, viz., that as far as his knowledge goes, he is the first person who tried to ascertain the action of drugs by trials on healthy individuals, we must admit that homoeopathy has hitherto given us the greater por- tion of our well-grounded, knowledge of the properties of medicines." In correction of the corrector of Hahnemann's "false statement," the reader is referred to the Organonf "But," continues Dr. Rogers, "the unsatisfactory state of our art has been so generally and so explicitly admitted by its most distinguished professors, that it would be useless to make * On the present state of Therapeutics, London, Churchill, 1870. f £3 26 and 110, Organon of the A rt of Healing ; 5th American Edition, translated by C. Wesselhoeft, Ml). Buericke & Tafel, 1876. 246 world's homoeopathic convention. a formal examination of the subject." In proof, he cites the bitter discussion on acute rheumatism, which took place at the Academy of Medicine in Paris in the year 1850, adding that the views of practitioners respecting the treatment of other dis- eases (except perhaps intermittent fever) will be found as various and conflicting as those regarding acute rheumatism. D DO " Until about thirty years ago, medicine might have laid claim to something like fixed principles {sic?} but since that period, the results of expectant and homoeopathic practice, as well as of the restorative treatment proposed by Dr. Hughes Bennett, have clearly shown the fallacious nature of the views so long enter- tained on that subject." Alluding to the expectant practice of Dr. Bennett, he says, that of 129 cases of pneumonia, only 4 died, while of 107 uncomplicated cases treated by M. Louis* of Paris, by active antiphlogistic measures, 32 died, equal to 30 per cent. The direct influence of homoeopathy on the old-school practice is well illustrated by Dr. Rogers in his analysis of Dr. Fleischmann's cases, which he reviews more accurately and fully than Sir John Forbes. " It was the results obtained by Dr. Fleischmann of Vienna, that suggested to Dr. Dietl in 1849 the idea of employing the expectant treatment in that disease," (pneumonia) "audit must be confessed that the conclusion at which he arrived . . . took the medical world by surprise. Out of 189 formidable cases he lost only 1 in 13J, and all fatal cases were complicated." After Dr. Dietl left the Wiedner Hospital, and the usual mode of practice was resumed, the mortality rose to 20 and even 27 per cent. Dr. Fleischmann's results with homoeopathy were more successful than the expec- tant method, which Dr. Rogers, of course, accounts for by discrep- ancies in diagnosis and statistical arrangement. It would be dangerous in these days for physicians of the old school to admit the inferiority of its results to those of its young rival, without signifying at the proper time and place their own unfailing allegiance to their party, to Dr. Forbes. Be this as it may, we concede at once to him (Professor Henderson) " the truth of his general proposition, and still adhere to allopathy ! " Again: "From these our free expressions and bold denuncia- tions of the faultiness and uncertainty of therapeutics, it may possibly be inferred that we are entirely skeptical of the truth of medicine as a science, and think most meanly of it as a practical art; and yet this is not so ; on the contrary, etc. * Traite Pratique de la Pneumonie : Paris, 1841. SURVEY OF MEDICAL SCIENCE. 247 Wunderlich (quoted by Hirschel) admits a homoeopathic effect in some of his cases, while Kissel (on the same authority) declares 11 similia similibus " to be a law of nature.* Rademacher's system was little more than an attempt to escape from the hopeless condition of the Old School. It might be described as a sort of homoeopathy without the recognition of the homoeopathic law. The liberality of Trousseau, in advocating medical reform, was no doubt owing to the knowledge he had acquired and boldly avowed of the teachings of Hahnemann. "To look," says he,f "at the pertinacity of our medications ; the incessant and tumul- tuous activity of our therapeutics, one would suppose that it is our duty to distrust nature, and that we are jealously desirous of doing all ourselves, without her aid." . . . "Homoeopathy, very unintentionally and unwittingly, I admit (sic?) came very opportunely to teach us to recognize the inherent forces of the living economy. Their successes based with precision upon cures, which they attribute to themselves, but which belong exclusively to nature, have been useful lessons to us. They have taught us to rely a little less on ourselves, and a little more on the wonder- ful aptitude of the tissues and apparatus which constitute the animal machine." But while Trousseau seems here to attribute the cures of homoeopathy " exclusively to nature," his admis- sions further on (p. 19) bear another interpretation. While speaking of Corrosive Sublimate, Potassa, Soda, etc., he points out " that the primary effect of these different agents is analo- gous to that produced by inflammation ; and it is easy to under- stand that inflammation, artificially induced in tissues already the seat of inflammation, has led, to a cure of the original inflammatory attacks." Surely it was this author himself who " unwittingly " both learned and taught the lesson here enunciated, viz., that cures under the homoeopathic law are not only recognizable facts, but " easy to understand." Without admitting so much as is conveyed in the last quota- tion from Trousseau, some others of the greater lights of old-school medicine have conceded the force of the evidence adduced by the followers of Hahnemann in favor of hissystem. "Whatobjec- tion," say they, " can the man of mere experience, the rejecter of all theoretical deduction, urge against the multiplied testi- * Grundriss der Homoeopathic, etc., Leipsig, 1854. f What is Chemical Medicine, by A. Trousseau, translated by J. JR. Cor- mack, vol. 2, p. 12. 248 world's homoeopathic convention. mony that is now presented to us in favor of the homoeopathic doctrine ?"* The expressions and style of some authors we have quoted, especially Drs. Forbes, Bigelow and Wunderlich, strongly suggest an unwitting plagiarism of Hahnemann's Review of physic, with which he introduces the Organon. It is well known that this Review was formerly quoted surreptitiously by some old school writer, from whom others have since copied it without knowing its source. A curious testimony to the force beginning to be ex- erted by homoeopathy. Amongst proofs of the unacknowledged though obvious in- fluence of homoeopathy upon the old school, stands the hand- book on therapeutics by Sidney Ringer. This volume, of which a fourth edition was issued in 1875, literally swarms with reme- dies which homoeopathy alone has introduced, and with direc- tions for their use on principles purely homoeopathic, though this is not stated. For examples may be cited, the indications for Aconite in fever, croup, pneumonia, etc., which diseases are not associated with that medicine in the usual teachings of of the rival school. Nux vomica is recommended in certain forms of indigestion, sick headache, constipation, etc., the indica- tions for which betray the source they have been derived from without acknowledgment, and in the way of literary piracy. So of Chamomilla, recommended in the summer complaint of chil- dren, when stools are green, many-colored or slimy. Ipecacu- anha is freed from its thraldom as an " expectorant" in the ab- sence of bronchial secretion, and is to be given when the secretion is abundant, and so on with other remedies. But apart from its interest as showing the influence of homoe- opathy on the professional mind, this literary and scientific plagiarism invites no comment. The Influence of Homoeopathy on the methods of Investigation as practiced by Experimenters of the Old School.-From the time when the new school began to be a power whose progress could not be gainsaid, its more thoughtful opponents have been aroused to the necessity of some reform of their Materia Medica. Its de- fects were too obvious to be disregarded any longer with safety, and it was probably suspected that a passive reliance on the prestige of time-honored traditions and usages would not suffice in an age of searching inquiry. * Cyclopedia of Practical Medicine, Edited by Sir John Forbes, M.D., F.R S.. Alexander Tweedie, M D., and John Connolly, M.D., late Profes- sor of Medicine in the London University. SURVEY OF MEDICAL SCIENCE. 249 Within a few years it has beeo suggested by the President of the British Medical Society of London, and one or two other prominent physicians have urged that drugs should be proved upon the healthy human subject by competent and vera- cious experimenters. The condition laid down of competence and trustworthiness constitute sufficient evidence that these re- formers heard of Hahnemann or homoeopathy, but the sug- gestion itself has apparently fallen on barren soil. But another method, involving less personal inconvenience, has been pursued, viz., of experiments with large quantities of powerfid drugs on animals. Indeed, under the influence of the new school, the conviction has gradually gained ground, "that to insure the full understanding of the effects of a poison it should be thoroughly tested from the least efficacious dose to that point where further increase ceases to have an effect." Thus Hermann* teaches that not only are fatal effects undesirable, but particular attention should be paid to the manner of recovery from and elimination of poisons. This agrees with the method of homoeopathy, in which excessive doses are avoided, since it is important to dis- cover the manner of reaction evinced by the organism, which can only be gathered from the phenomena under which the prover, man or animal, recovers. Experiments on animals will undoubtedly, in the course of time, yield exact though limited knowledge of the powers of drugs. Hitherto no decided advantage has occurred to therapeu- tics from that source. Hahnemann foresaw this, and under the conviction, shared by all his followers, that the growing demand for a speedy, certain, and gentle method of cure, could not wait till (as Binz expresses it) "the whole structure" (of medical science) shall have been built upon a scientific basis to the utmost degree of perfection; he chose the most direct and conclusive way of testing drugs^ viz., upon man. An example of the relative value of the two methods is fur- nished by a comparison of the effects produced by experiments with Osmic acid on frogs, birds, dogs, and horses, and those involuntarily, caused in the experimenters themselves by the acid.f The injection of this acid into the eyes of animals caused effects hardly distinguishable from those of other acrid substances, or from mechanical irritation. In like manner, when injected into the rectum of dogs, the cramplike motions, distortions or * Lehrbuch der Experimencateller Toxicologic, Berlin, 1874. t Die Ormiumsaure in ihren Wirkungen und Menschen und Phiere, eine physiologische Abhandlung von Grof. Dr F. Brauell. We may add: Res- cued from oblivion by the translator, Dr. 0. Bojanus. 250 world's homceopathic convention. body, howling and coughing, which resulted, could not properly be held to be specially characteristic of the drug. The doses, (one scruple to an ounce) were large, and many of the symptoms were evidently due to the corrosive quality of the acid. Finally, death took place under appearances not dissimilar to those oc- casioned by many other powerful poisons. The action of the acid on Professor Brauell and his assistants, subjected only to its fumes, developed many peculiar and inter- esting symptoms : such, for example, as lachrymation, mucous discharge from the nose, salivation, expectoration, with nausea, desire for air (Lufthunger), great prostration, blurring of letters in reading, wheezing respiration, dry cough, heaviness in the head, backache, pressure in the groins and testicles during cough, protracted pain in the testicles, and swelling of inguinal glands, itching of the skin, etc. It has been thought that the materia medica of the old school might be rendered more available by an improvement in classi- fication. Prominent amongst works of later times, having this purpose in view, are those of Dr. J. A. Paris,* President of the Royal College of Physicians, London ; Dr. F. AV. Head land,f Dr. F. E. Anstie* and Dr. Fronmueller.§ The labors of Drs. Paris and Headland yield nothing which calls for other remark than this, that the changes of classification are little more than the substitution of new ambiguous terms for old ones. Dr. Anstie's treatise evinces a great deal of research in the form of direct experiment. His observations on Alcohol are of no little interest, after showing that it produces coma, convulsions, etc., in various animals (Part I, narcotic effects of alcohol), the author continues (Part II, alcoholic stimulation) as follows: "It would be a great mistake to suppose that drowning a patient in drink will dissipate the convulsive tendency. On the contrary, it is well known that some epileptics, who are tolerably free from their convulsive attacks, except when they take so much liquor as to become nearly comatose, on the induction of the latter state are certain to experience a seizure. The effect of alcohol in arrest- ing the convulsions of teething is one of the most remarkable * I'harmueologia, collected and extended in accordance with the London Pharmacopoeia of 182-5, and with the generally advanced state of Chemical Science, by J. A. Paris, M.D., F R S , F.L.S.. etc., 1825, Amer. Ed. j The Action of Medicines on theSystem, by F. W Headland, M.D , B.A., F.L.S., etc., 1863, Amer Ed. | Stimulants and Narcotics, their Mutual Relations, etc., by F. E. Anstie M.D , F.R C.P., 1865 Amer. Ed. § Klmische Studien ueber die Schlopmacbende Wirkung der narcotischen arzneimittel, von Dr. Fronmueller, Erlangen, 1869. SURVEY OF MEDICAL SCIENCE. 251 instances of real therapeutic influence which can be witnessed. For my own part, there is no other plan of treatment from which I have seen such benefit produced, as has resulted from this, and I may fairly say that I have seen every kind of treatment. There is not the least necessity for intoxicating the little patients ; a minute dose of wine or brandy (for young infants, a few drops at a time, in a little water) is amply sufficient for any good pur- pose that can be effected." What our school demands are facts. We care little for their exploration at the bedside, however desirous we may be of penetrating the mysteries of organic life. Dr. Anstie has brought much to light that is of practical value, although he leaves us still in the dark concerning the difference between stimulants and narcotics. The fault lies in the perti- nacity (common to other writers on the subject) with which he clings to the terms stimulation and narcosis, as if they represented well-understood principles, instead of embracing a diversity of substances and their effects, which only perverse ingenuity can force into such classifications. Place beside the voluminous arguments of Headland and Anstie, these simple words: 11 Each drug manifests particular effects in the human body, and no other drug will produce effects of ex- actly the same kind" {Organon, § 118), and the mistiness of specu- lation vanishes, the question is placed before us in its true light, and the broad distinction made plain between the path of pure empiricism and the way of sophistry and vain speculation. But with all their shortcomings we must admire the learning and patience bestowed by our rivals on researches to which homoeo- pathy gave the first marked impulse, and recognize their pur- pose to discover better methods of curing the sick than are found in the systems bequeathed to them. And we may not unreason- ably expect that as these researches extend they will in a measure approximate even in method to ours, and guide the experimenters to similar results. Some evidence of such an approximation may be discerned in A Report on the Antagonism of Medicines * by Dr. J. Hughes Bennett, published last year by Churchill, of London. The author was appointed one of a committee for the purpose mentioned in the report. The labors of this committee extended over four years, and embraced six hundred and nine- teen experiments, verifying certain conclusions with regard to ten drugs. It was found that Strychnia and Chloral hydrate antagonize each other, and that especially Chloral may save life endangered * Since that time voluminous researches of that kind have been published in Archiv fur Experimentelle Pathologie et Therapie, 1873 to 1880. 252 world's homoeopathic convention. by Strychnia. Sulphate of atropia antagonizes, to a slight ex- tent, Calabar bean. Hydrate of chloral will in some cases save life from fatal doses of Calabar bean. Hydrochlorate and Meconate of morphia do not antagonize Calabar bean. The Sul- phate. of atropia is antagonistic to Meconate of morphia, within a limited area. Meconate of morphia does not act beneficially after large doses of Sulphate of atropia, for in these cases the tendency to death is greater than if a larger dose of each substance had. been given alone* With regard to Strychnia and Calabar bean, it is remarkable that while the symptoms produced by each were considerably modified by the action of the other, there was no instance of recovery from a fatal dose. A distinct physiological antagonism was observed to exist between Bromal hydrate and Atropia, etc. The object of all these experiments appears to have been to determine: First, the minimum fatal dose of each substance tested; and secondly, if fatal doses of two drugs would counter- act each other. Such researches are extremely valuable, and it is to be hoped will be prosecuted further; also that similar ex- periments may be made to ascertain if recovery can be hastened by one drug in case of poisoning with another. Atropia and Morphia not only fail to antagonize (antidote) each other, but even hasten death, especially when Morphia is given after large doses of Atropia. This effect is much more evident in the trials of Calabar bean and Strychnia. "It will be seen," says the report, "that not only was there no instance of a recovery from a fatal dose of Strychnia or of extract of Calabar bean, but that death ensued, after the introduction of even non-fatal doses of both substances. It appeared during the progress of these experiments that the animal was more likely to recover if subjected to the action of one or other of the substances alone than when both were introduced." The results of the experiments so briefly detailed, not only seem to illustrate the law of similars, but also the law of the dose as governed by the law of similars, and to sustain the views expressed in a former page of this essay. It appears that when substances are not too closely related in their action, a minimum fatal dose of one will prevent death from the other, as in Chloral and Strychina. But when they are closely related, as we know Strychnia and Calabar, Atropia and Morphia to be, one will not only hasten the fatal effects of the other, but cause death where life would have been spared without it. * The Italics are ours. SURVEY OF MEDICAL SCIENCE. 253 May not these trials explain the difference between enantiopathic and homoeopathic effects, and show us why we should use small doses in case of great similitude between disease and remedy? If such inferences are admissible at this stage of our knowledge, researches like those of Dr. Bennett and his coworkers hold the key to the law of medicinal action. Such are some of the direct and indirect influences which the new school has exerted upon the old. Much more and perhaps better evidence on the subject, and throwing clearer light on the historical development of medicine, is accessible in the literature of the past and present century. We have censured the old school for excess of theory and blind devotion to ancient preju- dices. Let us study the criticisms of our own system, not always unjust or erroneous, and learn wherein we, too, are at fault. Gradually, with a better knowledge by each school of the other, will the ancient evil of partisan opposition lose its acrimony; merging first, perhaps, into toleration, and lastly into mutual respect. May we not even hope that before the lapse of the present century the divergent paths in which physicians now seek the most certain mode of curing the sick, will converge and form one grand high road to the goal which all are striving to reach. DISCUSSION. SECOND SESSION. Tuesday, June 27th, 1876. The Second Session of the World's Homoeopathic Convention was called to order by the President, Dr. C. Dunham, immedi- ately after the adjournment of the American Institute of Homoe- opathy, Tuesday, June 27th. The order of business of the day, as announced by Dr. Dunham, being the discussion of subjects relating to the Bureau of Materia Medica and Therapeutics. Drs. C. Hering, of Philadelphia, John F. Gray, of New York city, Richard Hughes, of Brighton, England, Clotar Muller, of Leipsic, Germany, and Albert Haupt; of Chemnitz, Saxony, were by a unanimous vote made honorary Vice-Presidents of the Convention, and took seats on the platform. Dr. C. Dunham then named the papers which were for dis- cussion. Dr. A. Korndoerfer, of Philadelphia, then presented a sy- nopsis of the paper of Dr C. Hering.* Dr. J. P. Dake, of Nashville, Tenn., in discussing Dr. C. Hering's paper, spoke as follows : MATERIA MEDICA AS A SCIENCE. I. Definition of a Science: 1. Ascertainment of Facts or Data- 2. Classification of Data. II. The Data of Materia Medica: 1. Allopathic Gatherings: a Physiological Experimentation; b. Records of Toxicology; c. Clinical Records. 2. Homoeopathic Gatherings: a. Fragmentary Observations; b. Materia Medica Pura; c. The Chronic Diseases; d. Allen's Encyclopedia; e. Bureau Reports of Provings; f. Prov- ings reported in Journals. 3. Classification of Data. III. The Science of Materia Medica : 1. The Data Required. 2. The Obtaining of Data. Mr. President : Recognizing this as an assemblage of earnest, honest advocates of homoeopathy, gathered from all parts of the world, and persuaded that, beyond the exchange of compliments * For this paper, Historical Sketch of Materia Medica as a Science, see Appendix. DISCUSSION ON MATERIA MEDICA. 255 and congratulations incident to the occasion, there is a purpose here to consider the state of medical science, and the best ways and means for its advancement, 1 shall proceed at once to the discussion of the subject brought forward by my distinguished colleague, Dr. Hering. Materia Medica, as a branch of study, is intended to display a knowledge of the properties and powers of the means employed in the treatment of the sick. Whether it is worthy of the name science, as it now stands, is a question of which 1 am compelled to assume the negative. Whether it ever can be worthy of that-name is a question of which I am ready to maintain the affirmative. I. DEFINITION OF SCIENCE. The first step in our discussion must be to arrive at a proper definition of the term science. Archbishop Whately says "Every branch of study which can at all claim the character of a science requires two things: 1st, A correct ascertainment of the data from which we are to reason ; and 2d, correctness in the pro- cess of deducing conclusions from them." A late writer in the Popular Science Monthly defines science as " real knowledge properly classified while another, and per- haps more liberal writer, says it is "classified probabilities." 1. Ascertainment of Facts-Gath ering of Data.-The correct ascertainment of data in any department of learning in- volves much of acuteness in the observation of phenomena, much of thoroughness and exactitude in the performance of experiments, much -of discernment in the separation of the real from the seeming, the true from the false, and much of clearness and pre- cision in the statement of results. The progress of such work in the formation of the sciences as we have them to-day has been slow and difficult. Many of the accepted facts of one century, viewed in the light of subsequent centuries, have turned out to be no facts at all, but only fancies. Methods of observation adopted in one age as the best have been discarded in succeeding ages as of little or no worth ; and means of observation and experimentation, once considered suf- ficient, have in after times been found entirely inadequate. The logical result of all these failures of facts and methods and means, and the constant displacement of old ones by new, has been to make honest and learned men less positive in claim- ing for their discoveries the character of " real knowledge :" and hence among the truest philosophers of the day it is thought best 256 world's homoeopathic convention. to speak of the data of science as only so many "probabilities." Among probabilities degrees are, of course, recognized. They range all the way from the axioms down to the faintest possi- bilities. When, after the best observing or experimenting talent has been exercised, in ways the most thorough and with means the most approved, occurrences are stated as facts in regard to a heavenly body, or the properties of a chemical substance that has been under examination, the highest place is accorded to them as astronomical or chemical probabilities. And when a less intelligent observer, less favorably situated, or poorly supplied with instruments for scanning the heavens, proclaims an original discovery in astronomy-or when an experi- menter not thoroughly versed in the mysteries of chemistry, or destitute of necessary apparatus, declares a property before un- known in some familiar substance-the discovery claimed in the one case, as well as the other, barely reaches the plane of the probable. The learned world, knowing the fallibility of all experimental knowledge, and in the absence of repeated and thorough exam- inations may hesitate to pronounce the data furnished by such observers and experimenters false; and yet they will hold them as of very little worth for scientific purposes. Some probabili- ties, then, are so strong as to be almost self-evident, while others are so weak as to be just a trifle more than possibilities. What is mathematically demonstrated is of the highest rank, and what rests upon insufficient investigation is of the lowest. As already intimated, below the plane of the probable is the plane of the possible. An observer whose character or ability, or whose opportuni- ties and means for correct observation are unknown to us, may cry out " Eureka 1" in a department of learning where mysteries and difficulties abound,-or an experimenter, known to be visionary and exceedingly ambitious of discovery, more given to the sup- port of theories than to careful research for the discovery of prin- ciples, or one ignorant of the elements and the means with which he presumes to deal,-or one situated so unfavorably, or supplied with apparatus so poorly, as to prevent exact experimentation,- may declare new substances or new properties in chemistry, in physiology, or histology, and it will be out of the question for us to accept his facts as anything more than possibilities. Nto very naturally say, possibly they are true and possibly not, but we would be very far from according to them a place among the data of science from which to reason and upon which DISCUSSION CN MATERIA MEDICA. 257 to base our action in the exercise of a useful art. And below the possible we find the plane of the impossible or absurd. An observer whose character for veracity we know to be bad, or whose purposes in the case are evil, or who has never placed his eye to a telescope or gazed into the sky except when overcast with clouds-when such an observer tells us that Venus has three rings and Saturn none, and that Jupiter is smaller than our earth, we do not hesitate to characterize his pretended discoveries as so many absurdities. And we do the same with emphasis when an observer, ever so learned and ever so well situated and supplied with astronomical apparatus, tells us that our moon sup- plies the sun with light. Or, when an experimenter, placing an unknown substance in the crucible or receiver with two or three other substances whose chemical reactions he is ignorant of, presumes to tell us the precise properties, qualitative and quantitative, of the new substance, we are obliged to declare his experiment worthless, and his con- clusions as rank impossibilities. Such are the distinctions that must obtain and such the classi- fications of human knowledge so long as an appeal is made to the tests of human observation and experiment and reason. If the appeal is not to such,-if the items of knowledge are claimed to be direct revelations from the Creator of all, or to be obtained by way of clairvoyance or any other short cut opened up only to a few favored mortals,-then science is not concerned, and has nothing to say or demand in the premises. 2. Classification of Data.-And beside reliable data, every department of knowledge, aspiring to the rank of a science, must have classifications as the fruits of a correct generalization. An eminent logician has said most truly: "Unless we arrange and classify facts, and condense them into general truths, they soon surpass our powers of memory, and serve but to confuse." A simple aggregation of facts, however well authenticated, having no special order among themselves, has neither the prin- ciples of a science nor the rules of an art. But it is hardly pos- sible to think of any such collection of facts without, at the same time, thinking of some truths and some rules which lie beyond, as logical resultants. The philosopher, the student, and even the casual observer, in looking over such a collection of data, will endeavor to bring together into groups, such as resemble each other in one way or another till all are classified. The earliest arrangements are governed by superficial resem- blances and are, therefore, liable to errors and fluctuations. 258 world's homceopathic convention. As comparisons are more thoroughly made, taking in charac- teristic points, the resulting classifications and principles must be more stable and of greater practical value. And when logical methods have been applied, laws have appeared, reaching forward not only into the realms of philosophy, but also into the walks of practical life. Chemical data, logically treated, have furnished chemical laws, which not only give shape to the science of chemistry, but, as well, to the great industrial arts of the world. In conclusion, then, and as supplemental to the definition of science, I may add that science requires no more of its data, as to reliability and logical methods, than is imperatively demanded by the multitude of useful arts which are dependent thereon for practical rules. II. THE DATA OF MATERIA MEDICA. We are now prepared to consider how far the facts or data of Materia Medica come up to the requirements of science. 1. Allopathic Gatherings.-Looking at the display fur- nished by Pereira and others, who adhere chiefly to the allopathic theories of medicine, we find a motley collection, made up from the following sources: a. The trial of drugs upon the healthy. b. The trial of drugs upon the sick, each being exhibited alone. c. The trial of drugs upon the sick, two or more being ad- ministered together. cl. The action of drugs in cases of poisoning, no antidotes being employed. e. The action of drugs in cases of poisoning when modified by antidotes. f. The action of drugs upon the lower animals. g. The action of analogous substances, botanical or chemical. An examination of the several sources mentioned, as to the methods followed and means employed, will disclose a complica- tion of causes, operating in nearly every case, that must render the effects of the agents brought under observation exceedingly O O O J problematical. The trial of drugs upon healthy persons, although long since recognized as the purest source of drug symptoms, has con- tributed but very little to the Materia Medica of the old school. Till quite recently no such trials had been pushed with any earnestness or success, the opinion being prevalent that for prac- tical purposes it was unnecessary to have a knowledge of the DISCUSSION ON MATERIA MEDICA. 259 positive or pathogenetic character of drugs. Physiologists, more than pathologists or practitioners, have desired such knowledge; and they, almost alone, are to-day seeking it in some of the uni- versities of Europe. The trial of drugs singly, in cases of disease, has likewise been rare, the almost uniform habit of practitioners being to combine several in each prescription or dose given to the sick. Where one drug has been allowed an uninterrupted action, so as to develop distinct effects, the practitioner has been puzzled to determine how much of those effects to attribute to his drug, how much to the disease, and how much to their simultaneous action. The morbific force in the case being inconstant, perhaps pecu- liar to the time, place, or surroundings, and never to be exactly repeated, or the individual patient, having peculiar susceptibili- ties that may not again be met with, the changes or symptoms observed could not be assigned, with any degree of certainty, to the drug under trial. And to assume that such changes or effects would follow its administration to any other person, sick or well, would be a most unwarrantable stretch of logic. The information gained by such trials, so far as the true nature and influence of the drug in the human organism is concerned, could not rise to the plane of the probable. Its place would be among the possibilities of medicine. The trial of drugs upon the sick, two or more combined in one dose, has been the most prolific source of knowledge, as gathered in the current compilations of Materia Medica. If it has been difficult where but one drug has been administered to distinguish drug symptoms from morbid symptoms in the pa- tient, it is certainly more difficult to assign to each cause the kind and measure of effects produced by it, where two drugs are simultaneously acting in an organism already suffering under the weight of disease. And when three, four, or half a dozen differ- ent drugs are acting together, it would be entirely out of the question for any observer, however highly endowed or culti- vated, to properly refer effects to causes, or to infer causes from effects observed. • Any supposed knowledge, as to the real nature and uses of the several drugs thus employed, would partake too much of the improbable to be of any scientific or practical worth. The action of drugs in poisonous doses, taken by accident or otherwise, when not interrupted by antidotes administered to save life, may exhibit some of the violent pathogenetic effects and real charac- teristics of the respective drugs. The misfortune in such cases has generally been that little or no opportunity has been given 260 world's homceopathic convention. for the proper observation and recording of symptoms. Where competent attendants have been present to observe the workings of the poison, antidotes have been more or less employed, render- ing the results very uncertain. Cases of poisoning, or the records of toxicology, have, therefore, not yielded largely of the inform- ation which is entitled to rank among the probabilities of medi- cine. Experimentation with drugs upon the lower animals has afforded some data as to the emetic, cathartic, and other objective and pathological effects; but all the knowledge thus gained is but comparative, and cannot apply to the human organism, except by very uncertain analogies. Possibly similar results would be experienced from the same drugs given to men, and possibly not. Since chemistry, with its analysis and synthesis,'and botany, with its classifications, have entered the domain of medicine, drugs have been introduced on the assumption that they must possess pathogenetic and curative powers the same as attributed to certain other and familiar articles which they resemble chem- ically or botanically. The fruits of this assumption, even where the medicinal qualities of the familiar typical drugs are reason- ably well known, are no better, if so good, as those based upon the analogies traceable between men and the lower animals. The data of the old or current Materia Medica, gathered, as we have seen, from impure sources by defective methods, must be regarded for the most part as mere possibilities. But a small part can be regarded as "correctly ascertained " and as " real knowledge," suitable for a basis in science or guide in art. Such data not coming up to the primary and principal requirement, it matters little that correct processes of deducing conclusions from them should be followed out, nor that they should be the subjects of the most careful classification and arrangement. The branch of study of which they are the ma- terial cannot be regarded as a science. 2. Homceopathic Gatherings.-Turning now to the ho- moeopathic Materia Medica,-that which claims for its data the character of greater reliability,-let us examine its sources and methods and qualities. In the year 1796 Hahnemann, writing upon the current methods of gaining a knowledge of the curative powers of drugs, concluded in the following words: "Nothing then remains but to test the medicines we wish to investigate, on the human body itself."* And after showing the necessity for some "normal * Vide Hahnemann's Lesser Writings. DISCUSSION ON MATERIA MEDICA. 261 standard" of drug influences, he said: "This standard, me- thinks, can only be derived from the effects that a given medicinal substance has, by itself in this or that dose, developed in the healthy human body."* Being fully convinced that the information concerning drugs, displayed by Cullen and Haller, related more to their influence upon the sick than the well, that their uniform action in the human organism, their positive powers, could not be learned therefrom, he endeavored, from the reports of cases of poisoning and by experiments upon himself and others in health, to obtain further and better information. Fragmentary Observations.-He searched the records of toxicology and experimented with drugs during a period of nine years, when he brought forth the results under the modest title, Fragmentary Observations Relative to the Positive Powers of Medicines on the Human Body. Although his search and experimentation had been carefully conducted,-the former altogether by himself, and the latter by himself and by others under his personal supervision,-and although the drug symptoms furnished thus have alwavs, since, been considered among the most valuable contained in the homceopathic Materia Medica, Hahnemann, in his great wisdom and candor, did not dignify them as " data correctly ascertained," nor as the pure effects of drugs, but as fragmentary observations merely. Fierce opposition and abuse from his professional brethren had not yet made him so much of a zealous partisan that he would magnify his own work, or claim for his cause more con- sideration than it deserved. But in the same year (1805) he issued, at Leipsic, his famous essay, entitled PEsculapius in the Balance, in which the favorite medical theories and systems of the day were made to " kick the beam," as so many pleasing but empty baubles. And, as if to complete the discomfiture and vexation of his old-school breth- ren, in the same year he demonstrated a new and better way of healing, in a publication at Berlin, entitled, The Medicine of Experience. Aroused into active opposition by these essays, the sons of JEseulapius turned upon the reformer with every kind of antagonistic argument and means of abuse known to the logic and cunning of the day. Though Hahnemann worked right on, extending his field of research and increasing his number of drug-provers as the num- * Vide Hahnemann's Lesser Writings. 262 world's homoeopathic convention. ber of his followers increased, he could not escape the transform- ing influence of the violent opposition encountered. Materia Medica Pura.-His timidity forsook him; his self- appreciation arose; his work seemed more important; and when, half a dozen years afterward, he published his gatherings in a larger form, he no longer called them Fragmentary Observations, but The Materia Medica Pura. I am convinced, however, that the term "pura" was added, not so much because Hahnemann considered the work more free from faults than that of 1805, but in contradistinction to the old Materia Medica, then not merely spurned by him, but detested most heartily as the great storehouse of medical impurities. The views of the master sober were more nearly right than those of the master excited. In the year 1796 Hahnemann had written in HufelanJs Journal concerning the trial of drugs upon the sick : "The re- action of the diseased organism, however, to an untested or im- perfectly tested remedy, gives such intricate results that their appreciation is impossible for the most acute physician. Either nothing happens, or there occur aggravations, changes, ameliora- tion, recovery, death, without the possibility of the greatest practical genius being able to divine what part the diseased organism and what the remedy played in effecting the result. They teach nothing, and only lead to false conclusions."* But as the opposition to his proposed improvements grew in breadth and intensity, so grew the anxiety of Hahnemann to extend his armamentarium, to take in more drugs, and to dis- play more pathogenetic symptoms, in order the sooner to cut loose entirely and forever from the old Materia Medica in the applications of his therapeutic law. The Chronic Diseases.-Such was his anxiety, and such the zeal of his early followers, that he was induced, contrary to his previously well-formed and well-expressed convictions, to accept for the pages of his Chronic Diseases (an extension of his Materia Medica) the aggravations in the patient, while under the influ- pnee of a drug, as genuine drug symptoms. And symptoms appearing for the first time in the patient, while under drug influence, were also accepted and published as drug symptoms. Thus the symptoms, which Hahnemann so properly said "teach nothing, and only lead to false conclusions," came gradu- ally up from under his ban-at first with brackets, and finally without them-into our manuals of Materia Medica, into our * Hahnemann's Lesser Writings. DISCUSSION ON MATERIA MEDICA. 263 repertories and comparative compilations, and now, also, into the great Encyclopedia of Pure Materia Medica. And it was thus the great mind of the master, in part forced by the opposition of his enemies, and in part led by the mistaken zeal of his friends, was brought to abandon the high groilnd at first assumed as the basis of the new Materia Medica. Allen's Encyclopedia.-To show the results that have fol- lowed-the extent and character of the provings and collections made-and the kind of data now being presented to the medical world, I must refer to the latest exhibits in that direction,-to Allen's Encyclopedia of Pure Materia Medica, now partly issued, and to provings recently published by the American Institute of Homoeopathy in its volumes of Transactions, and by individual provers in the journals of the day. The three volumes of the Encyclopedia now published present two hundred and forty-eight different drugs. Twenty-two of them have gone through no form of proving, and are known only by a few poisonous or empirical effects. fiixty-eight have had but one prover each; thirty have had but two provers, twenty-nine over two and less than five provers, and thirty over five and less than ten provers, each. Considerably over one-third of the entire number have either had no methodical proving upon the healthy at all, or a simple trial by one prover each. I should here mention that the best portion of our profession are so unwilling to take the drug symp- toms coming from but one observer or prover as reliable, as in any way belonging to the "probabilities," that the American Institute of Homoeopathy, under whose auspices we are assem- bled, has a standing resolution forbidding its executive committee to publish the reported symptoms of any drug which has had but one prover. It must therefore be clear, beyond question, that considerably more than one-third of all the drugs brought forward in the Encyclopedia have no rightful claim to a place in the homoeo- pathic Materia Medica, and that the information concerning them cannot be at all ranked among the "data correctly ascer- tained," such as demanded in the groundwork and building material of a science. They might do in an appendix of faint suggestions. Looking after those drugs which have had two or more provers each, we find so many and so serious difficulties in the way of certainty that we must regard the information concerning them, taken as a whole, as of a very doubtful character. Taking Aconite as an example, the reporters or sources of its 264 world's homceopathic convention. symptoms are given as forty-three. Of this number one ob- server reported the effects of Aconite "when mixed and taken with antimonial wine;" one "when administered to patients a long time;" one "when acting upon nine patients variously afflicted with indurated cervical glands, mania, hemiplegia, dropsy, epilepsy, tumors, and general ill-health." One observer reported the symptoms of Aconite "when ad- ministered for the purpose of testing the bezoar-stone as an antidote." One reported symptoms attributed to Aconite administered as a remedy in "cases of pleurodynia, sciatica, neuralgia, iliac swelling, and cervical tumor." One prover furnished symptoms, as having occurred in himself, from the 60th potency while, as a practitioner of medicine, daily dispensing medicines to the sick, the emanations from which he was obliged more or less to inhale. Another physician and prover furnished ninety-nine symp- toms as produced by potencies of Aconite ranging from the 30th to the 4000th. And a physician, a professed homoeopath, gave symptoms as experienced by himself which, as a strong allopath to-day, he must look upon as the merest moonshine. Twenty-five symptoms were reported as those which had been removed by Aconite, acting as a remedy in the sick. Two hundred and ninety symptoms were culled from reported cases of poisoning. Beside the medical men, already referred to as having acted as provers of Aconite, there were many others who reported symp- toms experienced while actively engaged in the practice of medicine. A critical examination of the sources of the symptoms attrib- uted to Belladonna and Arsenicum shows that, as to purity, they are in nowise superior, if indeed equal, to those of Aconite. If the information concerning three such important drugs is so uncertain, what must be the character of the gatherino's con- cerning those which have been subjected to much less proving and observation ? Bureau Reports of Provings.-To see the character of the work now being done, let us turn to some of the provings lately published. In the report of the Bureau of Materia Medina, in the Ameri- can Institute of Homoeopathy for the year 1874, are the reported provings of the Physostigma venenoswn, or Calabar bean. Beside a number of old-school authorities cited there are men- DISCUSSION ON MATERIA MEDICA. 265 tioned forty-four homoeopathic provers, of whom thirteen were physicians in active practice, hourly handling other drugs, and exposed to all the sick-room influences and irregularities and hurry and care incident to their daily occupation. One of this number, a learned professor, took a powder of the 30th potency of the Calabar bean and shortly after smoked " a good cigar.'7 The next morning he felt well as usual, but after attending to his patients he came home fatigued. In the afternoon severe headache (habitual) came on, increasing towards evening. The next morning he awoke with a griping pain in his bowels ; had to go to the water-closet about 5 o'clock, and before 9 o'clock he had eight or nine large watery stools, the first ones mixed with fecal matter, the later ones light yellow, watery, gushing out in a stream, with faint feeling and cold sweat on his forehead; griping pains usually before stool, but not much re- lieved by stool. He took Veratrum album 30th, and as that did not relieve he took a tablespoonful of old rye whiskey (which sometimes gave relief in similar attacks), but it failed. Pains and stools continued, with nausea and waterbrash ; the smell of "good Havannas " he could not endure. He took several doses of Yucca filamentosa after Coloeynth had failed to relieve. The next day he took Dioseorea and Lilium, but still the pains, with but slight change, continued. He had a chok- ing sensation and fluttering of the heart (a nervous affection to which he was subject when from sixteen to twenty years old), and took Bromine 30th without relief. He had gripings, head- ache, and perfect disinclination to any mental work. A brother professor, coming in, prescribed a dose of Sulphur 30th, causing an aggravation for about fifteen minutes. After the lapse of a week the professor was able to return to his daily labor. Considering now the habitual tendencies of the prover, his work among the sick, his good cigar, and the use, one after another, of Veratrum, and whiskey, and Yucca, and Coloeynth, and Dioseorea, and Lilium, and Bromine, and Sul- phur, the question is, were any of the symptoms reported by the professor the effects of the Calabar bean, and if so, which of them ? A female prover, vouched for as having "a mind of much re- finement and discriminating power," took a dose of the 3d cen- tesimal potency of the Calabar bean. Her report runs thus : "Almost instantly I felt a shuddering and trembling run down through all the nerves of the body. The sensations appeared to 266 world's homoeopathic convention. begin in the head and run down through the pit of the stomach, where they were strongest of all, and through the womb and all the body. The chief sensation in the head was the one in the middle of the forehead, between the eyes, above and over, and in the left eye a pain with muse® volitantes. These symptoms were in the left eye only, and the medicine seems to me to act more on one side than the other. The severest pain in the left side, and entirely unlike any pain in the lungs that I have for . . . time had. The chief action of the medicine seems to me to be in the nerves; all the other symptoms have been en- tirely accessory or secondary. And it seems to me, so far as I can judge, to have a very curious double action on the nervous system. The nerves in front of the body, which, I believe, are the voluntary nerves or nerves of motion, it appears to excite to involuntary motion, causing tremblings and going up and down in wavelike motions all down through. But the nerves in the back of the body, the passive nerves or nerves of sensa- tion it seems to paralyze and numb, and during this numbing process it causes a good deal of pain, very similar to a pain in a tooth when its nerve is dying or being killed." These symptoms run through two or three days. The dose had been taken on Monday, and she writes : " All Thursday forenoon (following) I was engaged in packing a camphor chest. I was in the midst of crude camphor which suspended the symp- toms entirely for the time; but they soon returned, in less than an hour the same pain in the forehead and eye being quite strong. I never found that camphor will stop the action of a medicine, but only suspend it temporarily." The next day, among other symptoms, she had " a pain across the back of neck and a feeling of loss of power and sensation in the back of head, as if the head would fall over forwards, and the natural supports of the head would no longer hold it back." This was followed by "pains all down the back of the neck, es- pecially in the most prominent bone there, and on each side of it, drawing whenever the head was turned." She also had " a sensation as if the nose was going to bleed." A day or two later she had " leucorrhoea and much weakness;" also "pain in back between hips;" also "a sensation as of a drawing of cords be- hind the leg and knee, making it hard to walk, especially up- stairs." Taking into account, now, the workings of a lively imagina- tion, the efforts at physiological and pathological induction, the probable effects of half a day's stooping over a packing chest, and the antidotal powers of camphor, how many and which of DISCUSSION ON MATERIA MEDICA. 267 the symptoms just read may be fairly attributed to the one dose of the 3d centesimal potency of the Calabar bean ? The method, hitherto followed, of letting " the tares remain with the wheat till the harvest "-the spurious symptoms with the genuine till separated by clinical experience-would require the retention and collation of all the symptoms reported by both of these provers. Provings Reported in Journals.-Looking into our journals we find provings reported from time to time, made by phyiciasns and their friends apparently, without much forethought or critical care. Dr. B., of London, reports in the North American Journal of Homoeopathy: "Mr. took Cocculus ind. 30th solution. It caused a feeling as if the brain were rolled up or compressed into a smaller bulk." In the same journal he says: "Mrs. took one dose 'of Chamomilla, 4000th (Jenichen), and, two or three days after, had several times during the day, a feeling as if hot water were run- ning out of her right ear." And again: "Miss (a patient) took one dose of Causti- cum 6000th (Jenichen), and had, beginning on first day, stye on left lower lid, at outer end, lasting three or four days; and on the eighth day had a stye on the inner end of same eyelid, with watering of left eye for a day or two." In the same journal he again reports: "Mrs. took a dose of Conium 30,000th (Fincke), and on the third day, at 10 o'clock, after sunset, she heard a crash with right ear." Now, with drugs so highly attenuated, cast around so indis- criminately among the male and female blanks, some of whom were sick and under medical treatment, and all of whom were reporting to one of the most credulous of high-potency provers, how could the symptoms, which I have just read, be entitled to rank among the reliable data of Materia Medica? And yet, strange as it may appear, they are all displayed in Allen's Encyclopedia of Pure Materia Medica. When will our book-makers learn that quality is of greater importance than quantity? It has been said, most truly, by an eminent author: " False facts in science are more mischievous than false theories. A false theory is open to every person's criticism, and is ever liable to be judged by its accordance with facts. But a false or grossly erroneous assertion of a fact often stands in the way of science for a long time, because it may be extremely difficult to prove the falsity of what has been once recorded."* * Jevon's Principles of Science. 268 world's homoeopathic convention. False facts, in regard to drug influence, once put on record in our journals are copied into books on Materia Medica, arranged in repertories, displayed in works on practice, and so perpetuated for generations. Though never verified by clinical experience, the compiler does not dare to deny them a place, for fear the peculiar cases, the possible opportunities for their verification, may yet appear! We talk and write much of the false theories of our allopathic brethren, and yet we are cherishing false facts enough in our Materia Medica, to seriously hinder, if not effectually defeat, the applications of our great therapeutic law. I may be allowed, in passing, to remark that it has been my endea vor, on other occasions, to speak of the false and the worth- less in our drug pathogenesis, when I considered it sufficient to show that the methods and means of proving drugs, usually employed, were wrong and inadequate. It seemed to me a very plain statement-almost an axiom, indeed-that the numbers two and three added together could not make six; and, as propositions needing no elaborate proofs, that copper and zinc melted together could not yield gold ; that thorns would not produce grapes nor thistles figs. It seemed to me a work of supererogation, even if it were practicable, to enter the great storehouses of wheat and tares, of genuine and spurious drug symptoms, to prove by the accumu- lations there, the erroneousness of the methods followed in the gatherings made. On this occasion it has been my aim to reach the erroneous methods through a careful, though brief, consideration of the symptoms furnished by them. I have shown the sadly defective character of the data presented in our latest work on Materia Medica, and of the provings published to the world through our society reports and our medical journals. Reversing my former mode of reasoning, I am now prepared to maintain that such defective information, such a mixture of the true and the false, the good and the bad cannot come from sources that are pure, through channels that are clean. Till the long established and well-known order of nature is changed, whereby causes may be judged by effects and effectsby causes, we shall be justified in the conclusions, so far arrived at, regarding the sources and data of our Materia Medica. 3. Classification of Data.-As in the case of the allopathic Materia Medica, I might say of the homoeopathic, that, failing in correctly ascertained facts, in real knowledge, it is hardly worth while to consider how its data have been classified or DISCUSSION ON MATERIA MEDICA. 269 generalized, or if they have been at all subjected to logical pro- cesses. But I am pleased to say that, notwithstanding the defective- ness of the data, the methods of their arrangement have been correct. The tissue, or strictly organ, or strictly function basis for the classification of drug symptoms, is not yet practicable. If every pain felt, every symptom, could be referred directly to the tissue primarily affected, or even the organ, order and certainty would be much greater in our drug pathogenesis; but such can never be the case, to any extent, in our present state of physiological and pathological knowledge. The best we can now do is to follow the method adopted by Hahnemann, and generally followed by compilers of Materia Mediea, the regional plan of locating and describing symptoms. In conclusion of this part of my discussion, I must say that the homoeopathic Materia Mediea fails to be a science on account of the impurity of its data, and not for the want of logical meth- ods in their arrangement. III. THE SCIENCE OF MATERIA MEDICA. In the beginning of my speech I said that I was ready to maintain the possibility of the Materia Mediea becoming a sci- ence. I will now explain. The branch of learning called Materia Mediea is expected to show the relationships of drugs to the human organism. Those relationships can be expressed in no other language than that of symptoms, and symptoms appear only as the effects of the sev- eral drugs operating in the human organism. That organism, in a normal state, except as disturbed by the drug power, gives the positive or pure symptoms of the drug; while the same or- ganism disturbed at once by morbific and drug forces, gives only the relative or modified symptoms of the drug. The Data Required.-The data of Materia Mediea, then, must consist of the positive symptoms of drugs, to obtain which the drugs must, each by itself, be tried upon persons in health. Now it is well known that all persons, though having a gen- eral anatomical and physiological resemblance, are in some par- ticulars often quite unlike each other, so that the same influence brought to bear will affect some in one way and some in another. When, as provers, a number of persons are subjected to the same drug power, the effects experienced will be varied accord- 270 world's homceopathic convention. ing to the peculiarities of the different persons, so that one may have some symptoms not experienced by any other, some symp- toms common to several others and a few such as are common to all. Now it must be plain that the symptoms or data furnished by drug trials are not all of the same character or practical value, even where the same care and skill have been exercised by all the provers. It is a recognized principle in logic that "no number of par- ticular cases, as particulars, enables us to pass by inference to new cases." We could not, therefore, be justified in predicting the occur- rence in any individual, of a drug symptom that had appeared in the experience of but one prover. In accordance with the teaching of Aristotle, who long ago said : " No art treats of par- ticular cases; for particulars are infinite and cannot be known,"* individual symptoms, such as are reported by only one prover, are of little if any value in the art of-healing. Only in rare cases, and at long intervals, may they be of service to the prac- titioner under the homoeopathic law. But when a symptom has appeared in the trials of two provers there is a slight probability that the same might appear in trials made by a third. As the number of pro vers experiencing a particular symptom is increased, the probability of its occurrence in the experiences of others is increased; till we may be justified in saying that, symptoms reported- by a majority of a well-selected representative number of careful and well-observed provers of a drug, are char- acteristic of the genius and power of that drug, and applicable to the generality of mankind. The data of scientific Materia Medica should therefore be made up from positive drug symptoms, each of which has occurred in the experiences of not less than two provers. And the symp- toms, when collated should have small numerals attached, show- ing the number of provers reporting each one. The individual symptoms, or such as may be reported by only one prover, should remain in the records of the provers, or be published in a separate compilation, where they may be referred to in rare and puzzling cases. The symptoms gathered from the records of toxicology and from the reported experiments upon the lower animals, so far as found reliable, should also appear as a supplement to, and not as a part of the pure pathogenesis of each drug. * Aristotle's Rhetoric, Liber i, 2, ii. DISCUSSION ON MATERIA. MEDICA. 271 The Obtaining of Data.-I have spoken of the character of the data required in scientific Materia Medica, and now I will indicate briefly the methods and means necessary in gathering them. The French philosopher, Lavoisier, once wrote : 11 In perform- ing experiments it is a necessary principle, which ought never to be deviated from, that they be simplified as much as possible, and that every circumstance capable of rendering their results complicated be carefully removed." Now the simplification of experiments referred to, does not mean that the work should be placed in the hands ^simpletons ; nor that it should be performed so as to obtain simple results, in the sense of superficial. It does not mean that doses of one drug, or another should be handed out for proving, to persons coming casually into the office of some enthusiastic disciple of Hahnemann, with a request to report all symptoms experienced, the passing prover to be under no proper direction or care, and to have no means of testing drug effects beyond his own unaided and undisciplined senses, while he goes forth to perform one of the highest and holiest duties laid upon man, that of ascertain i ng th e real a nd posi t i ve effects of a d rug in the human organism, upon a correct and complete knowledge of which hundreds and thousands of human lives are to depend. But it does mean that, but one influence should be under trial at a time, and that to its action uncomplicated and uninterrupted, the closest attention should be given. The removal of every circumstance calculated to render the results impure and uncertain requires the provers to be not only in good health, but likewise to be free from all occupation and habits, in any way liable to disturb the harmony of the organism during the trial of a drug. Sir Humphry Davy once said : "Nothing tends so much to the advancement of knowledge as the application of a new in- strument. The native intellectual powers of men in different times, are not so much the causes of the different success of their labors, as the peculiar nature of the means and artificial resources in their possession." The prover of drugs trusting too much to the subjective, or to his unaided senses may mistake drug effects, and misrepresent qualities and quantities, which the application of proper instru- ments and tests would enable him to detect and measure with great precision. The advances in physiological and pathological learning and the improvements in diagnostic means during the last half cen- 272 world's homoeopathic convention. tury, both call for and render possible, symptoms before unheeded and unemployed. The immense strides in astronomical discovery, the extension of the field of optics, the improvement in chemis- try and mechanics, all are due to new and improved instruments and resources ; and why should we not extend our scrutiny and explorations in the great field of pathogenesy in like manner, by the employment of the latest and best of instruments and resources within our reach ? And again, the provers of drugs, besides being truthful and observing and discriminating in their habits, should approach the trial of a drug without prejudice and without any pet theories to sustain. They should in no case be informed as to the name, character, or supposed effects of a drug under trial, but should submit to proper instruction and direction from the most acute and experienced of observers. It is said that, " When the great table of logarithms of the French Revolutionary Government was worked out, it was done by a staff of sixty or eighty computers, most of whom were acquainted only with the rules of arithmetic, and worked under the direction of skilled mathematicians, yet their calculations were usually found more correct than those of persons more deeply versed in mathematics."* Now the data of scientific Materia Medica are quite analogous to the logarithms. They are for daily reference and application, not alone in one case, but in all cases in which pathogenetic and therapeutic actions must be governed by the law similia. If in mathematical calculations, much depends upon the cor- rectness of the logarithms, in medical practice even more depends upon the correctness of the symptoms recorded in the Materia Medica. As the logarithms must be mathematical facts applica- ble not in a single calculation only, but in all calculations, so symptoms of drugs should be pathogenetic facts, applicable not to one patient, but to all patients. To avoid the vitiating influence of theories not uncommon to " persons more deeply versed " in medicine, the tables of symp- toms, like the tables of logarithms, should be wrought out by students. Students of medicine, male and female, should be the provers of drugs. Being well versed in anatomy and physiology, and made acquainted with the best methods and means for the observation and notation of symptoms, they should be kept under the hourly observation and scrutiny of skilled physicians. * Babbage, Economy of Manufactures, p. 194. DISCUSSION ON MATERIA MEDICA. 273 If in making up tables of logarithms, and if in making upthe data of philosophy and astronomy and chemistry, for the uses of the world, it has been necessary to exercise so much care in the selection of men, and means, and methods of observation, and experimentation and calculation, removing the task away from the busy haunts of men, the noise and hurry of life's great work- shops, into secluded places where the highest skill in each depart- ment governs the experimental laboratory, why should not the data of Materia Medica, upon which health and life depend, be gathered up with like care, and order, and thoroughness and most skilful supervision? I am happy, on this occasion, in this first assemblage of homoeo- pathic physicians from all parts of the world, to declare that within easy reach are the men, and the instruments, and the means for the gathering of data, that would place Materia Medica where medical art demands that it should be, well up among the sciences. Dr. Richard Hughes, of England : The point on which I desire to address you is that raised by my country man and friend, Dr. Sharp, when he endeavors to account for homoeopathic cures by maintaining that small doses of drugs act in opposite direc- tions to that of large ones. I wish I could think with him that thus the true explanation has been reached, and one dose more closely interlocked than ever with our principle by appearing to be the essence of its modus operandi. But I cannot. I must think that the doctrine of the opposite action of large and small doses is a hasty induction from insufficient data. I must agree with Dr. Lander Brunton, whose remarks our president quoted yesterday, that if homoeopathy rests upon this basis, it is very far from being a universal system of medication. The more I study the action of drugs, the less evidence do I find of any really op- posite actions exerted by them, save where excessive stimulation is followed by exhaustion, and of this I am not sure whether it is right to speak of it as a continued action of the drug. I am more and more convinced that (with this apparent exception) every drug affects those parts of the organism on which it acts in one, and one only way, i. e., either as an excitant or a depressant of function, or as an irritant of substance. The grouping and sequence of the phenomena it causes are often very complex. They may be the product of several factors. But when unravelled and reduced to their elements, I am continually being satisfied afresh that those elements are simple and uniform, and capable of being stated without any theories of primary and secondary, 274 world's homoeopathic convention. or of opposite actions. It seems to me that it must be so ; that it is simply unthinkable that a medicine should affect the func- tions it influences in two opposite ways, through some small dif- ference in the quantity in which it is given. This is my objec- tion to Dr. Sharp's explanation of homoeopathic action. Nor is it valid (I concede) for him to reply,-as he has done,-" I care nothing for your theories about the facts ; I allege the facts them- selves." But Dr. Sharp himself is assuming that the facts,-that is, the phenomena,-reach down to the inner working of the drug, and imply real opposition there also, or they would not account for likes being cured by likes. If I can explain these phenomena in another way-in a way which seems much more rational-he must defend his theory of the facts, for it is this which is impugned ; of the facts themselves,-such as they are,-there is no dispute. There are other objections to Dr. Sharp's theory, notably this, that it applies only to those comparatively few cases, in which op- position is possible, where the ^u«and minus of function alone are concerned. But I want to say a few words upon some other expla- nationsof homoeopathic action, which have been offered. We all know that of Hahnemann. He supposed that every drug, whether given in health or disease, produced two series of effects, the secon- dary being precisely opposite to the primary; that, if given in mor- bid states corresponding to its secondary effects, it acted at first as an antipathic palliative, but then its own secondary operation supervening, increased the disease, while, if given when a condi- tion answering to its primary effects was present, it caused a temporary aggravation indeed, but then by its secondary effects, which were opposite to the disease, a considerable amelioration thereof. To this there seems to me to be an unanswerable objec- tion. In such primary and secondary phenomena, the reaction must be to some extent as the action. Hahnemann himself ad- mits this, when lie says of provings (e. g., of that of Pulsatilla), that moderate doses only having been used, the symptoms are mainly primary, that is, that little reaction supervened. Now, if this be so, we could only get much benefit from the secondary action of a remedy at the cost of a considerable primary aggra- vation, and the reduction of the dose to avoid the latter would correspondingly diminish the former, whereas the facts are just the other way. Then there is the theory of Fletcher, which has been so ably expounded and maintained by my friends, Drs. Drysdale and Dudgeon. This supposes that all drugs are primarily stimuli, though the secondary depression which follows is the most obvi- ous and lasting phenomenon of their action. It considers, more- DISCUSSION ON MATERIA MEDICA. 275 over, that inflammation is the typical form of disease, and that here we have a primary contraction and secondary dilatation of the capillaries, the latter being the condition which characterizes the process, and in which we are ordinarily called upon to treat it. Acting, then, upon the rule, similia similibus, we are, never- theless, really applying a stimulus to the dilated capillaries of the part, and if our dose is not too large, shall do nothing more than contract these to their healthy standard. I am no more able to accept this explanation than those which have preceded it. I cannot allow that inflammation is the type of all diseases, or that in inflammation itself the condition of the capillaries is the fun- damental cause of the process. Still less can I admit that all drugs are primarily stimuli. I see nothing stimulant in the action of Conium and Gelseminum upon the motor centres, or in that of Glonoin or Amyl nitrite upon the sympathetic. And there is the doctrine of my friend, Dr. Bayes, who thinks that all drugs are nervous paralyzers in large doses, and stimu- lants in small; and that on paralysis of some element of the ner- vous supply of a part all diseases depend, so that small doses of a drug, which in large would stimulate such phenomena, will just raise the part to its true height again. Here also I am unable to accept the hypothesis, either as regards drugs or disease. I can see nothing paralyzing in any dose of Strychnia. And, more- over, I cannot admit the assumption that all disease and drug- action reside or even begin in the nervous supply of a part. What, then, remains to be advanced, if all these hypotheses are rejected. It seems to me that they all err in supposing that sim- ilarity of action is apparent only ; and that the deeper working of a drug must needs be antagonistic to the diseases it is to neutralize. I cannot see this. I can quite believe that similia similibus cu- rantur may be true of the real, as well as of the phenomenal operation of remedies. And if you ask me what analogies we have in return for such a process, I point (no others have done before) to those physical forces which have been ascertained to consist in vibrations or undulations, and where we have frequent instances of two similar streams of influence neutralizing one another, I believe that it is in this direction that we must look for the explanation of homoeopathic cure, and that it will lead us to the dose, as well as to the principle. Conrad Wesselhceft, M.D., of Boston, then spoke as fol- lows : Mr. Chairman, Ladies, and Gentlemen : The papers, which have just been alluded to, as well as the gentlemen who have spoken upon them, have advanced a topic, upon which I desire to make a few remarks. I do not wish to have it understood 276 world's homceopathic convention. that we concede the truth of the points that have been made, but hope only to add a suggestion here and there. The subject of the action of large and small doses upon primary and secondary symptoms has been thoroughly advanced. I would like to make a few remarks on the theory and the modus operandi of the ho- moeopathic remedy, as bearing upon the proving of drugs, and upon the different classes of symptoms generally known. This question is a very broad one, and would require an hour or two in its elucidation, even on the part of an accomplished speaker and scholar. It is divisible into two sections, as above, neither of which can be intelligibly explained, without reference to the others, which are very intimately related to it. I will briefly touch upon some suggestions and experiments that have been made, regarding the modus operandi of homoeo- pathic medicines. Dr. Hughes has just given you a number of authorities, who have endeavored to throw light upon that subject, and I would add one or two more of great eminence, not the least of whom is Hahnemann himself. Hahnemann says, " simiUa similibus cu- rantur" or wecure by the great law of the similars in the following manner: A weaker or dynamic affection is permanently oblit- erated by a similar but stronger affection, differing in kind. In another place Hahnemann says: "The instinctive vital force, vitality, or whatever you choose to call it, is now the one thing, under the influence of a drug, when given for the purpose of cure, only more intensely diseased." We have no other explanation of the modus operandi of the drug, and we know the modest expressions with which Hahne- mann introduced his explanation. I would offer another explanation, as given by Dr. Hering, who says in his preface to the proving of Glonine, "According to my opinion a cure is alone possible by an opposite direction of equals, as e.g., waves of water are smoothed by waves waving in in an opposite direction, or where intervening of equal waves of light result in non-light by neutralization." I would also quote Dr. Dudgeon's opinion, although as you have already heard it stated by Dr. Hughes much more lucidly than I have power to state it; I can only say that Dr. Dud- geon considers disease essentially as weakness following overex- citement of parts, and a cure results from similia similibus curantur because similar medicines "stimulate" weak reaction up to normal action by their primary effect. Now let us briefly analyze these theories of the rule, similia DISCUSSION ON MATERIA MEDICA. 277 similibus curantur. It appears that others have observed a weak point in the explanation of Hahnemann and have endeavored to strengthen it in their own way or to adapt it to their own way of thinking, and this is the light with which I look upon these explanations. Now it is positively impossible for the student of medicine, be he young or old, to understand why the vital force if stronger diseased-I accentuate the word-should lead to a cure? And also, if stronger, why it should be readily overcome by vital force after cancelling the natural disease? How can a vital force overcome a stronger medicine when it cannot overcome the natural disease? That is not what Hahne- mann meant, but that is the expression. Dr. Hering's views strike me as being quite lucid and satisfactory, having been drawn from natural analogies, which we all understand, and which appeal to our ability to comprehend facts. Dr. Dudgeon, on the other hand, objects to the superseding of a weaker by a stronger effect, and maintains that the curative process is one of stimulation. It appears to me that Hahne- mann's expression of "stronger medicinal disease" and Dr. Dudgeon's idea of stimulation are convertible terms. Dr. Dud- geon says "stimulate" where Hahnemann says "stronger." And it seems to me that both these explanations, for I adhere to the original words, as I have a perfect right to do, are open to the same objection. Each and every writer understands his own meaning best. Every reader has a right to be his own interpreter. These ex- pressions are inappropriate. The whole question hinges on the expression "stronger diseased." To be sure, the organism is diseased, in a certain sense, when under drug action. This is very evident when the drug is given in health. But it is not so evident when it is the correctly chosen medicine in disease, and when that medicine becomes a remedy, resulting in a cure. Can we consistently say, then, while the remedy is curing a cancer, or battling with typhus,that it is so by causing more disease? No. Whatever it is or may be, it is not quite consistent to consider that disease, morbid, under the conditions and process of cure, under similia similibus curantur. We are all able to conceive it to be something else, with Dr. Hering, as an opposite direction of equal forces, or as plus cancels minus. We need only substi- tute another expression or term for a correct idea. In the place of "stronger diseased," or "stimulus," let us conceive the (rela- tive) morbific effect of a medicine to become a healthful restora- tive, or what is usually called a physiological process, under 278 world's homoeopathic convention. which tissues and their vital force, so called, tending naturally and unaided to become more diseased, retrace their action, cease to deteriorate, and return to their normal state. Let us view it in that light, and then express this mental conception by the term, reinforcement of the ever-present endeavor of the organism to return to its normal state, and we may comprehend at least a part of what always will be a mystery. The morbific action of a drug ceases to be so under the rule of similars. It is not the similitude which causes the cure, after all, but the difference in kind. Similitude leads us to the remedy; but the difference in kind, as expressed by Hahnemann, or the action of equal forces, acting in opposite direction, as defined by Dr. Hering, should be regarded as the principal essential to the process of a cure. The only new element which I would venture to introduce into the argument is this, that the recuperative reactive tendency of the organism never slumbers. I have seen a wound produced by a pin-scratch heal in a pa- tient who was moribund, where death was coming very slowly, and it was evidence that reaction lasts as long as life. It is ac- tive till death has actually occurred. In many cases it does not regain the ascendency. In others, again, it does, and those are the instances in which it has been reinforced by a medicine acting as a remedy. This subject is so closely connected with the value of symptoms in relation to their chronological order, that a few words are re- quired by way of explanation. Hahnemann regarded primary symptoms as resulting from the drug, secondary symptoms as owing to the reaction of the organ- ism. As a rule the two are opposite. In Hahnemann's sense secondary symptoms cannot be available in curing, because they are already returning health. But those symptoms actually due to the drug are often no less opposite and different in ap- pearance, and this has given rise to confusion and misunder- standing of Hahnemann's original proposition. These series of symptoms, actually resulting from the drug, are divisible not only into primary and secondary, but into as many parts as the section of a curve, and so are those of a disease. We may not always practically be able to do this, because we may not always be able to perfect our provings to that degree. We are at best enabled to see only groups or fragments from the beginning, the middle, or the end of a series. Intermediate links are lost or not perceived by the prover or his-observer. Hence many of these fragments may appear as opposite, while DISCUSSION ON MATERIA MEDICA. 279 they would not appear so could we see in a single prover the entire succession of symptoms, in uninterrupted progress from first to last. In this sense itis erroneous to consider secondary, tertiary, quar- ternary symptoms as unavailable. It is absurd, in this view of the case, to say that a symptom which appears later than the first needs such a potency, and one that appears earlier such another potency. My axiom thus far is that the entire range (with the exception of those of actual death, and those of returning health, or Hahnemann's secondary symptoms) are available, because they also invariably correspond to the stage in the scale of the natural disease to which they are "homoeopathic" under the guidance of the rule of similars. Dr. Ad. Lippe then discussed the paper on " The Founda- tions and Boundaries of Modern Therapeutics, as follows:" Dr. Sharp has favored us with a paper entitled the Founda- tions and Boundaries of Modern Therapeutics. The paper honestly elucidates Dr. Sharp's own opinions on the subject, and we must surely thank him for the candor and earnestness with which he addresses us. We are glad to find that Dr. Sharp is an advocate of the single remedy; but we are sorry to say that we do not agree with him when he urges us to examine into the pathological changes which have been the cause of the symp- toms produced by drugs, and constituting our 'Materia Medica as left to us by Hahnemann, and as it was fuller developed by his followers. He claims that we must find the seat where the symptoms are manufactured, and that the changes which have been made in its condition, must, as far as possible, be under- stood ; he says the action must be on the organ or part affected. When Dr. Sharp compares the results of Hahnemann's provings and the existing Materia Medica with the ever varying new figures in an endless succession as they appear in the kaleido- scope when slowly turning the box, he might have gone on logically, and told us, that diseased conditions were likewise presenting to the observer ever varying new figures in endless succession; and that, therefore, under the proper comprehen- sion and application of the law of the similars we possessed just what was wanted for therapeutic purposes. But unfortunately Dr. Sharp does not see it in that light; he wants to open the box, examine the small pieces of colored glass, the cause of all this variety of appearance, and in like manner does he claim we should examine the pathological changes which have been the cause of all this variety of appearance-of the symptoms of 280 world's HOMOEOPATHIC CONVENTION". our Materia Medica. And here Dr. Sharp commits the great blunder which underlies all his arguments. In the kaleidoscope we have to deal with inorganic matter, with small pieces of colored glass, while in our Materia Medicawe deal with organic matter. He plainly holds on to the materialism which has been the bane of medical science, and which Hahnemann so effectually combated. We can look inside the box of the kaleidoscope, but can we look inside of the ever hidden processes of the living organism ? Never! After charging Hahnemann with indiscretion he says: "The fondness of a theory of his own was another great impediment to the general reception of his real discoveries." Hahnemann never exacted the worshipping of theories or images set up by himself, as Dr. Sharp has it. He had found principles, and founded his new system of medicine on these principles ; he did with perfect reliance on logic say, that the practice could not be successful if these principles were tampered with; and that is exactly what Dr. Sharp tries to do. When Dr. Sharp tells us that Hahnemann, "later in his career, from the unhappy circumstances in which he was placed, began to use what are called infinitesimal doses; a practice which has imported enormous difficulties into the whole subject, and which has been an almost insurmountable barrier against the progress of the system," I take the liberty to contra- dict him. The infinitesimal doses became a necessity in the development of homoeopathy. They never have been an "almost insurmountable barrier" against the progress of the system; nay, to the contrary, as the development of our medical art pro- gressed the dose was made far more infinitesimal than was ever used by its founder, and the beneficial curative influences of the properly administered more infinitesimal doses have caused an unprecedented progress of the system. This is denied by those whose ability to cure with infinitesimal doses is wanting; but what does such denials prove? One man takes up a rifle, aims at a barn-door, and misses; while he condemns the rifle, another man, better skilled, takes up the same rifle, and in a dozen shots hits the bull's-eye each time! Whose testimony would be ac- cepted by an impartial listener when the question of the merit of the rifle comes up? Does Dr. Sharp really intend to set aside the testimony of the many who have through long years of active practice relied solely on the infinitesimal doses for the cure of the sick, and will Dr. Sharp charge them, one and all, with having imported enormous difficulties into the whole subject, thereby creating an " insurmountable barrier" against the-progress of the system ? DISCUSSION ON MATERIA MEDICA. 281 Dr. Sharp treats us to a sharp remark, which we must treat according to his dismerit. He says : " Those who remain of the first generation of homoeopathists must not be angry if they see a second generation endeavoring to carry on the building of the temple of medicine not exactly after the first model." And why should they? Who of the first generation of homoeopathists is angry when they see some of the second generation make an attempt to return to Materialism, trying to find the hidden causes of diseases and symptoms which proved drugs produce on the healthy organism. Return to the physiological school of medi- cine, ignoring the marvellous teachings of Hahnemann ? Angry? No, surely not angry ! It is self-evident that such a caricature of a medical school as Dr. Sharp tries to establish will be a very short-lived affair; it cannot live, and so we are not angry ; it will die a natural death. Besides this, Dr. Sharp does not seem to know that every one of those whom he imagines to be the first genera- tion of homoeopathists will leave behind him a score of faithful followers of Hahnemann ; and there are here in this assembly to-day, within the reach of my voice and within my sight, dozens of true homoeopathicians, taught and encouraged by the old pioneers of the first generation, who have, during a long life, shown to the coming generation that the adherence to the teach- ings of the master, including the infinitesimal dose, must lead to success. And, wherever their field of usefulness has been, they have proven, by superior success, especially in the treatment of epidemics, that the only highroad to such success lies in a faith- ful adherence to the master's teachings. When we see such papers as Dr. Sharp presents, and hear his last-mentioned re- marks, the question arises, What are the relations of physiology and pathology, as those sciences stand at the present day, to the science of materia medica and to the science of therapeutics (homoeopathy)? or, in other words, has the progress made in physiology and pathology advanced the knowledge of materia medica, and, by its application, the science of therapeutics of heal- ing the sick ? As far as the com mon school of medicine is concerned., its advanced knowledge of physiology and pathology have not advanced the science of therapeutics; their mortality has not been diminished; and, as it appears to the casual observer, the only diminution has been in the length of the diseases; more violently acting drugs have been introduced, and, as all their professed advances are based on Materialism, so they, as in the ante-Hahne- mann days, still imagine to be able to find the seat of the disease, and attack that seat, forgetful of the fact that they only observe the result of an internal, hidden disease; all these materialistic 282 world's homoeopathic convention. notions have not improved their therapeutics. Shall we, with Dr. Sharp, endeavor to shape our materia medica to suit these progressive sciences, basing our therapeutics on the guesswork of a diagnosis? Shall we claim, with those of his way of thinking, to be able to find where the seat of the disease is, when they so often fail? The knowledge of the advanced physiology and pathology will, nevertheless, be of a negative advantage to our school, as it will enable us to better examine the sick, and thus to ascertain the characteristic symptoms which, by experience, we know to be just those which do not necessarily belong to the form of the disease the sick are suffering with; it will enable us to "prognosticate," and we know what an impor- tant point this is; how even Hippocrates dwells on it at length as the means of inspiring confidence; it will further enable us to better understand and order the necessary regime in each indi- vidual case; but it must never be considered a guide in our therapeutics proper. Our guide, so far as the selection and ad- ministration of the proper medicine is concerned, will be forever found in the teachings of our great master, who has pointed out to us the foundations of therapeutics; and no modern discoveries will ever shake the foundation established by the master. Modern discoveries must forever become subservient to them. Dr. William Owens, the next in the order of debaters, was introduced by the President, and spoke as follows: The subject of the paper which I intend to discuss is "The Foundation and Boundaries of Modern Therapeutics." The con- sideration of this proposition demands of us at least a thorough and masterly knowledge of anatomy, from which springs as if by spontaneous evolution physiology and its twin-brother pathology, which is but morbid, perverted physiology; this again leads us by graceful and easy steps to seek remedial aid in " modern therapeutics." Homoeopathic therapeutics, which, under the law "similia," indicates the selection of a medicament from the vast fields of nature or of art, adapted to the correction and removal of morbid processes which take place in the human organism. We shall not accept Dr. Sharp's assumption that electricity is not a proper medicament, but claim that it is as much a proper medicament as Pulsatilla, or any other drug in the whole range of the Pharmacopoeia. This is also true of light, heat, magnet- ism, moral and social relations. We have heard reference to the death of one of our ablest countrymen, Charles Sumner, who died of mortified pride. That was just as fatal to Charles Sumner and Horace Greeley as Hydrocyanic acid would have been to DISCUSSION ON MATERIA MEDICA. 283 Dr. Hughes's patient. It is simply the amount of power that these various agencies exert on the nervous svstem which bring about the change. The discussion of this subject will naturally involve an inquiry into some of the leading principles which underlie therapeutics generally, and into the application of our therapeutic law in the light of modern physiological and patho- logical sciences, as derived from the study of drug action upon the normal organism. And under the first head we will submit the following propositions: Proposition First.-1That the human organism is endowed with two distinct, yet united, natures,-a physical, or physiological, and a mental, or psychological. Proposition Second.-To the first of these pertains a special nervous structure, known as the sympathetic, ganglionic, vege- tative, or organic nervous system, which controls all the functions essential to animal existence. The elements of animal death must then be nearly correlated. Proposition Third.-The second or cerebro-spinal nervous sys- tem has also a special nervous structure differing in no respect anatomically from the former, yet it presents us with all of the psychological phenomena, all volition, and all sensation, both general and special, that we find in the human organism. Proposition Fourth.-All morbid processes or phenomena which we witness and which we recognize as constituting a state of so-called disease, except those arising from trauma, whether induced artificially or arising from alleged natural causes, are primarily only modified functions. Proposition Fifth.-Hence all such processes, ■whether physi- ological or psychological, are but the palpable expression of a disturbed condition of the organic nervous system, and can in all cases be traced directly back to, and an intimate relation- ship established with, the nerve centres of organic life. Under the second head, viz., the application of our thera- peutic law, I would also respectfully submit: 1st. That all function normally performed may be increased by irritation, whether from artificial or natural causes. 2d. If the irritation be applied with too much energy or be greatly prolonged, the nerves to which it is applied will become exhausted and paralyzed, when loss of function ensues with atrophy or death of the organ. 3d. Morbid conditions artificially induced (drug pathogeneses), impress the same class of nerves, disturb the same functions, and cause the same phenomena to appear that we shall witness in a case of so-called natural disease. 284 world's homceopathic convention. 4th. The well-recognized physiological principle that morbid impressions long continued or greatly intensified will induce organic change, is happily illustrated in many cases of drug pathogenesis. 5th. It is a well-recognized fact among homoeopathic physi- cians, that all drug pathogenesis is the result of repeated and successive nerve impressions or irritations until nerve force is energized, modified, or possibly exhausted. 6th. Modified nerve force induces modified circulation, which secures increased or diminished nutrition, which can only be measured by the intensity and persistence of the morbid influ- ence, and the capacity for resistance on the part of the organism. 7th. Drug pathogenesis clearly demonstrates that a specific affinity and relationship exists between many organs and tissues of the organism, and that it disturbs their functions. If the foregoing propositions, to which your careful attention is respectfully invited, should prove correct, they will demon- strate the fact that modified function arises from a force re- siding within the organic nervous system ; and that modified function is only a more simple and natural expression of the term disease; and that disease is the same whether arising from supposed natural or artificial causes, and that the morbific agent that induces these conditions does so by disturbing the organic nerve centre, or by irritating its periphery upon the surface of the body or within its interior glandular structures. The dem- onstration of these fundamental principles and their applica- tion under the law "similia," furnishes us a solid scientific basis for our therapeutics; not only in relation to the law of "similia," but will afford us a rational explanation of the true relation of the totality of the phenomena in each case of disease and their uniform reproduction and similar conditions. It may also lead us to the source and cause of all morbid phenomena, to the seat where all symptoms are manufactured. I will explain as far as can be explained at the present time why large doses of Opium, Belladonna, Aconite, and many other drugs poison the organism each in its own peculiar way, and by its own peculiar process exhausts the nerves of organic life, and may furnish us a clue to the reason why under certain circumstances these same drugs aid nature to restore her function and re-establish health. It may also furnish us with a reason why Secale is almost if not quite absolutely limited in its influence to the nerves which supply the non-striated muscular fibres; how it is that by its power to irritate the vasomotor nerves it arrests haemorrhages, causes gangrene, and many other well-marked phenomena; why DISCUSSION ON MATERIA MEDICA. 285 Calcarea has a specific relation to a certain class of tissues and certain morbid growths; why Silicea modifies the suppurative process; why instantaneous death results from too free use of Hydrocyanic acid; why it should induce prsecordial distress, angina pectoris, tightness of the chest, and dyspnoea; why it should relieve whooping-cough and gastralgia, improve diges- tion, remove flatulence and enteralgia, from all of which arise its power over function. By a careful study of the phenomena arising from disturbed function and their sequences we shall be able to comprehend. Aconite and Belladonna both disturb the functions of the heart and arteries, and through that disturbance induce changed cerebration, the change corresponding in great measure to the intensity of disturbed circulation. Mercury causes increased secretion of the glands of the alimen- tary mucous membrane and its appendages; in small doses the secretion is mild in type, but the increased dose or persistence will establish a severe form of intestinal catarrh, with exfoliation of the epithelium, ulceration and destruction of the intestinal wall, not by virtue of its local irritating effects, but by to increas- ing the intestinal secretion, until exhaustion of the organic nerves takes place and death of the tissue follows as a natural result. But I must not detain you longer. One word in regard to pri- mary and secondary action of drugs. In reference to the first, the drug may be applied locally, hypodermically, or by ingestion, and may produce its specific effect generally, or locally, upon all or- gans for which it seems to have a relation, irritating to the point of stimulation only on increase of function, and if the potion be excessive, death. In the second, if the potion be not powerful enough to cause death, reaction takes place, and nature endeavors to restore her functions. T. F. Allen, M.D., of New York : Mr. Chairman and Gen- tlemen : The duty was assigned to me of introducing the subject of physiological materia medica of the old school and pointing out its application to homoeopathy, together with the modification it has exercised on the practice of homoeopathy. It was beyond my ability to prepare a paper on this subject, so it became my duty to open the discussion upon the physiological discoveries of the old school. It is doubtless true, that speculations of all kinds had reached their greatest height during the past century, both in medicine, philosophy, materia medica, and regarding drug ac- tion. About the year 1760, Dr. Von Stcerck made provings upon himself and others with a number of vegetable substances in order 286 world's homoeopathic convention. to ascertain their physiological action and positive effect upon hu- man beings. This was prior to Hahnemann's published experi- ments, and it was doubtless true that to the old school belongs the credit of priority of making provings upon a healthy human being. Another branch of physiological investigation was ush- ered in by Magendie in Paris in 1809, who commenced to exper- iment with different drugs upon animals, for the purpose of as- certaining more precise knowledge of the physiological function. Thus physiological materia medica originated in the old school from two distinct sources, the provings upon human beings, and provings upon animals. The development of provings upon the human species speedily came into disfavor, owing, I think, mainly to the fact that the therapeutic application of drugs was based upon the crude principle of inducing in the patient physiological processes similar to those which would be induced in the healthy person or animal by the drug, very little attention being paid to the finer points developed in the drug proving, which they considered so much rubbish, and so much in the way of prov- ings; so the provings came more and more into disfavor, and were less favorably received from time to time, and degenerated into the mere observation of the nature of the bodily secretions and excretions as indicative of disease by Boecker and some of his contemporaries, until at the present time very few provings are made upon human beings, owing to the fact that very few prov- ings can be pushed so far upon human beings as to induce those changes of tissue and function which only are sought for by theold school. The provings upon animals have been increasing until at the present time laboratories are established in most of the uni- versities, and are maintained for the express purpose of testing the effects of drugs upon animals, and ascertaining what portion of the body is affected, and in what manner. The methods at present followed are those especially adapted to bring out the full physiological effects of the drug upon the animal, and usually some portion of the animal is selected for the experiment. The action of the drug is tested and examined, especially as to its action upon the heart, or upon one or another portion of the nervous system. Different portions of the body of the animal are subjected to experiment and the changes carefully noted, so that the proving is made in piecemeal, as it were, a portion upon one animal and a portion upon another, and thus a series of results are obtained which, to a certain ex- tent, are independent of each other. This, of course, has the drawback that a drug is seldom allowed to have its full action upon the organ, and the reaction DISCUSSION ON MATERIA MEDICA. 287 of one organ upon another is frequently checked, so that we have the purely local effect of the drug, and such results are utilized for the purpose of producing in human beings physiological effects to correspond. Thus it is ascertained that Digitalis affects the heart, producing either acceleration or diminution of its beat. The knowledge so obtained is utilized to produce a corresponding acceleration or diminution of the heart's action, either as a tonic or depressant, according to the case, and as it is desired to vary the action of the drug. All the utility of the phys- iological provings of the old school depend, as I have said, upon the ability to produce the full physiological effect we desire upon the patient. It is necessary that this effect should be positive and invariable, and all effects which cannot be repro- duced at will upon different animals are discarded. If the exper- iment cannot be duplicated or verified exactly again and again it is thrown aside as useless. Only those experiments capable of repetition are accepted by the old school, and this is made the criterion of scientific investigation. I know, if it be necessary to establish a scientific fact, that the observation must be tested by various observers in different parts of the world, and the results must always be the same in order that the fact be thoroughly established, and if the result varies doubt is cast upon the nature of the result thus obtained. While tissue-changes may be produced upon animals it is not often possible to produce them in the human organism, and we have this to contend with. How far this knowledge of physiological provings obtained by the old school can be utilized by us is a matter of great doubt in the minds of very many. My friend, Dr. Lippe, is inclined to deny entirely the possibility of the knowledge obtained by provings upon animals being useful, and objects to giving paramount importance to the tissue-change that can be induced. I desire to illustrate, and hope I may not be considered as tres- passing upon anv personal conversation, but Dr. Hughes was recently in New York, consulting with a physician who had a very severe case of endometritis. The physician in attendance was perlexed and troubled and could not find the remedy, or the remedies that he had selected did not have a good effect. Dr. Hughes said, "I would give Arsenic." "Why?" "Because Arsenic has produced endometritis and is the only distinct rem- edy so far as I know." The doctor said that his patient had no symptoms of Arsenic, neither thirst, restlessness, internal burning heat, nor any of the other prominent symptoms of that drug. 288 world's iiomceopathic convention. "Never mind," Dr. Hughes replied, "Arsenic produces endo- metritis. Here is the most characteristic and important symp- tom ; therefore you must give Arsenic" It was given, I do not know with what result, but believe that the patient on the following day was better. I have not the facts as to this case, but merely cite it to illustrate the importance of carrying out experiments upon animals as well as on human beings. Some are inclined to accept as greatest and most positive, the tissue-change induced by drugs. Others are inclined to ac- cept, of not less importance, the subjective and phenomenal symptoms that are always dependent upon tissue-change. I am satisfied that symptoms are sometimes removed from the patient while the disease goes steadily on. The symptoms may be re- moved by a remedy and the patient be left almost free from sub- jective symptoms, and yet the disease may be unchecked. I know that is true, for I have noticed it in melanotic, cancerous, and other diseases, in which there has been distress and pain in various organs, which have been relieved by some remedy, and yet the tissue process has been entirely unchecked. I have seen it in melanotic diseases, in which the inflammatory process and tissue-changes have continued. The disease has been un- checked, running its whole course, while painful and distressing symptoms, with various remedial indications, have been removed from time to time. Now it may be said that in these cases the physician fails to prescribe according to the totality of the symptoms, and that is the point I wish to make this morning. These tissue-changes may be reproduced, and must be used in order to obtain the totality of the symptoms, and a complete knowledge of the whole case; and we must, as conscientious homoeopaths, study the pathological processes in our patients, and the so-called physiological effects of drugs. The " proving" of a disease varies with the development of the tissue-changes, and, while it is not always possible to develop similar tissue- changes in individual provers, it is our duty to take cogni- zance of such changes when they do occur. High dilutions in our provings develop large numbers of nervous phenomena, and very rarely have produced tissue-changes. The question, then, arises as to which is of the most importance, and I am inclined to take ground between these two extremes, and to think that we ought to take in the whole view of both sides, and to utilize the various observations made on animals ami upon man in large doses; and also to utilize, as serving an DISCUSSION ON MATERIA MEDICA. 289 important, and sometimes an absolutely necessary end, the prov- ings and observations made with minute doses. Now it frequently happens that we are obliged to treat cases of pathological tissue- change when we know we have no remedy that produces a like tissue-change, and we are obliged to establish the possibility of such change upon the basis of pure nervous phenomena. It fre- quently happens that the remedy can only be selected by atten- tion to these phenomena, since our knowledge of physiological provings and of the tissue-changes that can be produced by reme- dies is, as yet, very limited indeed ; yet I believe, as every year goes by, it brings us larger experience and more knowledge on this point; and the more we avail ourselves of it the greater will be our ability to cope with disease. Dr. S. M. Cate, of Salem, Mass.: Dr. Richard Hughes, in his able paper upon "Hydrocyanic acid; its Value in Epi- lepsy," makes a laudable attempt to establish a relation between this remedy and this disease. To place a new remedy before us capable of curing a certain form of epilepsy; to show us the form and how to apply the remedy with some degree of precision, is a work to be commended and encouraged. Keeping the importance of such a work fully in mind, some friendly criticism upon Dr. Hughes's paper will be attempted, with the hope of assisting, rather than hindering, the attainment of the end sought. New light constantly breaks upon every department of pathol- ogy, clearing up difficulties and placing our feet upon more firm and satisfactory ground. The pathology of epilepsy is still quite defective, and much is yet to be added to its culture and devel- opment. It seems to me that Dr. Hughes confounds the epileptic fit with the diseased condition which causes it. Whatever patho- logical views are held as to the organic changes which cause the epileptic fit, all must agree that the phenomena of the convulsion is an outward and distinct expression of some peculiar diseased action, or of some impression made upon the system. More care- ful consideration may also show that quite a number of different diseased conditions may produce epilepsy; and may also show that quite diverse and distinct impressions made upon the human organism may produce convulsions closely resembling epileptic fits. An accurate description of an epileptic fit, too lengthy to quote here, may be found in A Treatise on the Diseases' of the Nervous System, by William A. Hammond, M.D., pp. 669-670. Medical men at once recognize in the picture referred to a real epileptic fit. The convulsions of infancy and childhood from teething; from gastro-intestinal irritation; those marking the 290 world's homceopatiiic convention. invasion of acute disease, such as measles, pneumonia, scarlatina, or any other acute disease, have all the external appearance of an epileptic fit. The list of the causes of non-epileptic convulsions can be considerably enlarged when we take in the cases of con- vulsions produced upon persons in more advanced life by various narcotic and acrid poisons, alcohol, mechanical injuries, and parturition. In all such cases, however, the convulsion is easily connected with its exciting cause. If we now attempt to analyze the internal changes which take place during the occurrence of an epileptic fit, we shall find that, according to the opinions of Dr. Reynolds and Dr. Hammond, the primary seat of the derangement, or, if better stated, the pri- mary seat of the impression resulting in the fit, is the medulla oblongata and upper part of the spinal cord. Fox, as quoted by Dr. Hammond, gives the post-mortem appearances, which may be found in the Pathological Anatomy of the Nervous Centres, p. 305. Brown-Sequard has shown that epilepsy can be caused by irritation of the peripheral nervous system. It seems reasonable to suppose that any of the larger nervous tracts are capable of receiving and transmitting an impression to the medulla oblon- gata that would result in an epileptic fit. So many kinds of disease with many different locations may act as sources of con- stant irritation, and with an irritability of the medulla oblongata may result in an explosion of nervous force manifested in a convulsion. Schroeder van der Kolk likens the cells of the medulla oblon- gata to Leyden-jars charged with electricity, or to the electrical organs of the conger eel and torpedo. In a state of health, the fluid which is produced from these cells is spent in carrying on the ordinary functions of life; but in certain diseased states of the body, it accumulates and is discharged, and the explosion produces an epileptic fit. Then follows a period of waiting till another quantity of the electric fluid accumulates, before another discharge can take place. No doubt this is a crude way of stating some of the processes that take place in this disease. But we must not lose sight of the fact that there is some diseased action which makes its im- pression upon the medulla oblongata and brain and produces the epilepsy, and that the fit is not the disease but only one of its expressions. With this in view, we see that we can predicate no treatment upon the epileptic fit alone. In fact, in any case of epilepsy which is to be cured, the general symptoms and the particular DISCUSSION ON MATERIA MEDICA. 291 organic lesions or functional derangements which present them- selves are of much more importance than the fine shades of the convulsion. But I waive the discussion of the question of the existence of epilepsy without organic lesion and fall back upon the ground that there is, in all cases, either organic or functional derangement which causes the disease. In a therapeutic point of view, remedies must be sought for the cure of epilepsy among those capable of producing, as a primary effect, a slow and persistent impression upon some part of the nervous system. On the other hand, those remedies which produce epileptic convulsions by their violent toxic quali- ties, such as the narcotic poisons, have homoeopathic relation to real epilepsy only when such remedies correspond to the dis- eased state which produces the convulsions. If we take a super- ficial view of the subject, we may conclude from our provings of Belladonna, Cicuta virosa, Conium, Hyoscyamus, Stramonium, and other remedies of the same class, that large results would be derived from the use of these remedies in epilepsy. Though clinical reports show some cures with the use of these remedies, the number is very much less than the provings would seem to warrant. And I venture to assume that where cures have been made with Belladonna, for instance, it was done by removing some spinal or cerebral hyperaemia to which this remedy was homoeopathic, and not because it has produced convulsions. Dr. Hammond divides epilepsy into two classes: those which are caused by hyperaemia, and those which are caused by anaemia of some important parts of the nervous system. Such a classifi- cation, though open to the criticism of crudity, is still of large practical value to the therapeutist. Thus, when making the analysis of the symptoms presented in a case of epilepsy, suppose we conclude from the symptoms presented that the local dis- turbance causing the disease is located in the cervical portion of the spinal cord. We find that portion of the spine sensitive to pressure, attended with aching and shooting pains; and learn from the history of the case that the development of the disease was preceded by severe exposure, prolonged overexertion and debilitating losses. We should rightly conclude that the spinal anaemia and waste was the real disease to be cured. In such a case, if Nux vomica proved the curative remedy for the epilepsy, it would be because it could cure the spinal anaemia, and not because, in its toxic effects, it can produce convulsions. Some forty years ago, a lad of eight years, then in good health, took three teaspoonfuls of a strong tincture of Camphor to pre- 292 world's HOMOEOPATHIC CONVENTION". vent taking cold, which it was feared might arise from a severe wet- ting he had received. An hour after he fell down in a convulsion having all the appearance of an epileptic fit. He slept a short time after the fit, was a little sore from the muscular spasms for a day, and then was as well as ever. He is now a hearty man with a healthy family ; epilepsy is unknown among his ancestors. From such a result as this, should we select Camphor, expecting it to cure epilepsy? I think not. For acute convulsions, from some passing cause it may be the remedy, but I think it lacks the element of slow persistence which belongs to the diseased states which usually cause this disease. The action of Camphor is quick and intense, and quickly passes away, hence the great value it has in diseases of a violent and rapid course, like Asiatic cholera. What we know of the action of Hydrocyanic acid places it among the remedies of quick and intense action. It can produce acute convulsions, and, in a concentrated form, instant death. Can it produce a slow, moderate, persistent impression upon the nervous system which may result in confirmed epilepsy? I think it cannot in any general or extended way. Investigation may show that it has the power to do this upon some particular but not large branch of the nervous system; hence it may be a remedy for a peculiar but rare form of epilepsy. It may be the remedy for some acute convulsions, not confirmed and constitutional, but from accidental cause. The experience of Dr. Hughes, so far as published, confirms this view. In the light of the views I have presented, Calcarea carb., Baryta, the Bromides, Phosphorus, and Zincum will be found better therapeutic studies for one, andNux vomica, Pulsatilla, Strychnia, and Ignatia for another type of this disease. But in all cases, the totality of the symptoms must decide upon the remedy. Dr. I. T. Talbot, of Boston, Mass.: We have with us to- day Dr. G. R. Naylor, of Calcutta, India, who, though not strictly a homoeopathic physician, is not so much prejudiced that he can- not inquire into the truths of homoeopathy, and who is willing to meet with us to-day. lie is the friend of our friend, Dr. Siercourt, of Calcutta, and I move, Mr. President, that he be in- vited to a seat in this Convention. This motion was carried, and Dr. Naylor addressed the Convention as follows: J/r. President, Ladies and Gentlemen: It affords me very great pleasure to be present with you to-day. I must mention that I belong to the old school, and that I have been for the last thirty- nine years connected with the public service at Calcutta, where DISCUSSION ON MATERIA MEDICA. 293 I have a charitable dispensary under my charge. I am not a homoeopathist, neither am I an enemy to homoeopathy, for I know very little of it. I have seen and watched some cases treated bomoeopathically by my friend and fellow-student, Dr. Siercourt, of the Calcutta Medical College, and I have been led to read homoeopathic books, and inquire into the system. I have long felt a wish to examine more minutely into homoeopathy and see what it really is, but this I could best do at the bedside of patients, and in India we have no opportunities to do this, as we have no homoeopathic hospitals. I was informed that in Amer- ica there were homoeopathic institutions and hospitals, and in traversing the weary thousands of miles in coming, this has been an incentiveto me; for I have wished to watch the effects of ho- moeopathy clinically, and then to follow the command of my Master, who has said: "Search all things, and cleave to that which is good." I have not yet had the opportunity, but I am told that there is a large homoeopathic hospital at New York, which, through the courtesy of our worthy President, I have been in- vited to visit, and to watch the treatment of disease, and I mean to avail myself of this opportunity. As I have told you, I yet belong to the old school, and by rights, perhaps, I ought not to have put myself so forward to-day; but I am an inquirer, and I conscientiously feel that every man is in duty bound to inquire into, to see, to learn, to know before he condemns. And that has been my object in coming here, and God willing, I intend to know moreofthe homoeopathic treatment; what the result of my inquiry will be time alone can tell, and it may be that these principles will only be carried out in the even- ing of my life. I have been in charge of a dispensary, where I have averaged two hundred patients a day, whom I have always treated according to the old system, and I must confess that if I could find anything that would ameliorate or cure dis- ease, and benefit my fellow-creatures by globules instead of pills, draughts, and other paraphernalia that we use, I would consider it a god-send. Homoeopathy is now practiced in Calcutta by Dr. Siercourt, who has a large practice and a dispensary at his house, at which he receives from eighty to one hundred patients daily. He was educated at a medical college, was a memberof the British India Association, and of the Old-school Association, which we had at Calcutta, as a branch of the association in England. He felt drawn to homoeopathy and said so at one of the meetings of our society, and since that time has been a member of the other camp. The fact that he has a large practice testifies that accord- 294 WORLD's HOMCEOPATHIC CONVENTION. ing to his mode of thinking, the homoeopathic is the best treat- ment. I will trespass no longer on your time. Dr. Dunham: We will now hear Dr. E. A. Farrington, of Philadelphia. Dr. Farrington: In reviewing Dr. Sharp's paper, T cannot but think that he has founded his arguments upon fallacious premises. " Among the precious fruitswhich Hahnemann gath- ered," writes the doctor, is (3) "The use of much smaller doses than had before been given." And yet in a subsequent para- graph, because Hahnemann began to employ infinitesimal (loses, the doctor deprecates the practice as one which has been "an almost insurmountable barrier against the progress of his sys- tem." Hahnemann, as we well know, was not the first to dis- cover the law of similars, no more than he was the first to make experiments on the healthy. Yet no predecessor ever investi- gated the subject so thoroughly or systematically as he, because no one had so clear a conception of the great fact. What was original with him was this disputed potentization of medicaments, this " precious fruit," which Dr. Sharp acknowledges, but refuses to profit by its cultivations. When Hahnemann began to dilute his remedies to avoid aggravations, he did not find, as he ex- pected, that their action ceased. Indeed, they multiplied, though their nature was considerably altered. At this stage in his mental growth a new world opened to view. He saw, in the unexplored panorama before him, means for the relief of the sick hitherto unnoticed, or silently rejected. He was enabled to penetrate the secret recesses of the body, hold- ing, as it were, communication with the soul within, working thence to coarse and less vital parts. He began to appreciate the delicate qualities of symptoms, their relative value, and their adjectiva. Thus the effect of emotions, of temperature, of weather, time, position, etc., became of great practical value. And is not science toTday elucidating these very points? Does not physi- ology teach us that certain hours in the daily cycle mark posi- tive changes in the human economy ; such as maximum electric tension at 10 a.m. (Natrum mur.); minimum, 4 to 8 P.M. (Ly- copod.)? And who will deny the opposite physical changes caused by north and south, or northwest and northeast winds? So, too, in the domain of psychology none but the potencies will develop the many mental symptoms which Hahnemann and experience make the most important in practice. It is no wonder, then, that he made every remedy have a general action upon all parts. Each drug has its prominent points of attack ; but the system is a unit, and suffers as such. Centrally are those symp- DISCUSSION ON MATERIA MEDICA. 295 toms which distinctly characterize the drug; while concentrically distributed are those of less import, receding like the centrifugal ripples following the splash of a stone into water. The highest potencies will produce and demonstrably have cured symptoms, primary and secondary, subjective and objective. In this one indisputable fact lies the answer to all arbitrary attempts to limit the range of potencies. That large and small doses have a contrary action is only an apparent truth ; or, at least, is of no importance to us. Years ago the question was asked, "What is the peculiar, the characteristic, which cures?" The answer came simultaneously from both sides of the water, "Those symptoms of a drug which have distinct opposites, all the rest being only accessory." Then came the experiments with Glonoin and the sphygmograph, proving incontestably that these opposites are but variations in the waves of motion. The smallest doses will cause them just as certainly as will the largest. From my standpoint the doctor's charge against Hahnemann, that he was an iconoclast, " breaking the old, but worshipping new images of his own make," seems as unjust as it is un- merited. Until it can be proved that potentized medicines do not act, do not cure, all attempts to bound therapeutics to their exclusion must fail, because fallacious. Again, we are asked to exchange Hahnemann's schema for Sharp's organopathy ! Call the former, if you choose, a kaleido- scope; you do but express its immensity, not its uselessness. The kaleidoscope is constructed on scientific principles, as is homoeopathy. 'The kaleidoscope obeys fixed laws, as does ho- moeopathy. "The kaleidoscope," says one authority, "is of great use to patternmakers, to whom it supplies endless varieties of figures;" so with Hahnemann's homoeopathy. It supplies the student with an endless variety of similima from which he may choose that corresponding to his case. As the patternmaker thus increases his usefulness, so does the homoeopathician increase his opportunities to heal the sick. The time will come when this new science of homoeopathy will become definitely systematized, but never through organopathy! In the words of our good friend, Dr. Lilienthal, "only a master, but not the apprentice, dares override fixed rules." We are all apprentices. Let us gather up material until time shall develop the master who is to lighten the burden, but not lead us astray. I would like to say a few words more regarding Dr. Hughes's paper. Dr. Hughes has very clearly revealed the similarity 296 world's homoeopathic convention. between epilepsy and Prussic acid poisoning, especially in that form which has been termed le grand mal. Hydrocyanic acid has already been used by homoeopathicians in spasms from various causes. Thus Buchner recommends it in uraemic convulsions, placing it with its relative, Tabacum, or Nicotine. H. N. Guernsey characterizes it thus: "Gasping for breath; bluish tint of the skin; muscles of back, face, and jaws principally affected." So there is an agreement between these two authorities,-Buchner terming the condition asphyxia,from its known power to suspend blood-oxygenation; Guernsey pic- turing the cyanotic surface resulting therefrom. It would appear, then, that the acid corresponds to those forms of epilepsy which present this marked dyspnoea and cyanosis. Hence it is not applicable to le petit mal, with its mild par- oxysm, and which progresses insidiously towards irreparable im- becility. We must, however, remember that the remedy simulating the paroxysm only is, at best, merely a palliative. In our therapeu- tics there are so many contingencies to be noted that we are safe only in a recognized study of all the symptoms of the patient. A remedy may cure a case even though it possess a very imper- fect resemblance to the symptoms of the paroxysm. For in- stance, Sulphur, after suppressed itch ; Calcarea in fleshy, scrofu- lous women with profuse menses, after suppression of chronic eruptions. Bufo, after internal suppurations; Nux when the aura starts from the solar plexus; Silicea, scrofulo-rachitic per- sons, etc. Each of these remedies may possibly produce a pic- ture of an epileptic convulsion, but its distinctive characteristic lies outside this similarity. While, then, we welcome this addi- tion to our armamentarium, let us not treat it as a specific; but, in the language of Dr. Hughes, let it aid us in the task of curing this formidable disease, epilepsy. The President then introduced the next debater, Dr. II. H. Baxter, of Cleveland, Ohio, who spoke as follows: Mr. President, Ladies, and Gentlemen of the Convention: It is my purpose to deviate somewhat from the course which the discus- sion has hitherto taken, and to discuss a paper which has not yet been mentioned,-the admirable paper of Dr. Imbert Gourbeyre, of France, on "Arnica," which is so full and covers all points so completely as to leave little, if anything, more to be said. I have no intention of attempting to supply any omissions which may be supposed to exist in the paper. There are one or two points which interested me especially, and it is upon these that I DISCUSSION ON MATERIA MEDICA. 297 propose to speak. We are familiar with the use of Arnica in injuries, especially in those characterized as bruises, or when ac- companied by extravasation. We all know that it is capable of producing soreness and a bruised sensation; but I think it is new to many that Arnica will produce actual extravasation, as it seems to have done in one, and, I think, in two cases reported in this paper. Although experiments subsequently mentioned do not result in favor of Arnica as a therapeutic agent in such cases, they are by no means to its disadvantage, especially in view of the universal testimony which has so long been borne in its favor. There is one form of extravasation, however, which is not included in these experiments, and to which we have considered Arnica as less intimately related. I refer to the cerebral form, or apoplexy. In this affection it has been but little used, or at least but little spoken of. In several cases reported the condi- tions produced are such as to give rise to suspicion of apoplexy. In no case, however, so far as I know, has the proving, either intentionally or accidentally, been pushed so far as to actually pro- duce cerebral extravasation. Consequently we must, as the author remarks, rely upon clinical experience to confirm or re- ject the inferences which we may justly draw from its pathoge- nesis. Arnica certainly seems to have power to produce a weaken- ing or disintegration of the walls of the vessels, conditions which are favorable to effusions, and cerebral as well as other extravasa- tions. It may be urged as an objection that, in the cases referred to, this effect was produced by the local application of the tincture, and not when administered internally; and we cannot, therefore, infer that it would produce such an effect upon the cerebral ves- sels. To this it may, perhaps, be a sufficient reply to say that other conditions produced by Arnica, locally applied, have also been produced by its internal administration,'when the experi- ment has been carried far enough ; and the time may come when we shall note an apoplexy produced wholly by Arnica. In the meantime, if experience shall go to show that it will benefit apo*- plectic conditions, we may be reasonably well convinced of its pathogenetic powers in this direction. I think I have seen beneficial effects follow the administra- tion of Arnica in cases of this character, even though ultimately the result was fatal. In no case, however, was the effect so decided as to form a basis for an opinion or theory, unless sub- stantiated by many others. One case which presents some in- teresting features I will briefly relate. It was that of a man, 57 years of age, of good habits generally, but a very hearty eater; he had had two slight premonitory attacks. One day while writing 298 world's homceopathic convention. in his office, he fell from his chair in an unconscious condition. He soon rallied from this and was removed to his home, where I saw him about two hours after. I found him conscious and rational, with no pain except a slight headache; there was com- plete paralysis of the left arm and leg, with great restlessness of the right leg; incontinence of urine, slight dimness of vision; difficult articulation, but no paralysis of the tongue; pulse full and regular but slow, about fifty per minute. He had taken a cup of tea, which had been rejected by the stomach. I prescribed as circumstances seemed to require, giving at the same time an unfavorable prognosis. At the end of thirty-six hours, the dimness of vision had become total blindness, the difficulty of articulation had increased, the stomach would bear only a small quantity of fluid, and there had supervened a peculiar respira- tion. The respiratory movements would be entirely suspended for from two to three minutes, after which they would begin with short quick inspirations, gradually growing deeper and fuller till they were almost stertorous, when they would subside in the same manner to entire suspension. I will say in passing that I have only encountered this symptom in but two in- stances. (The other was the case of a child suffering from men- ingitis with effusion, and in both instances the case terminated fatally.) I prescribed Arnica, after which, to be brief, the restlessness ceased, the difficulty of articulation became less, and the patient seemed more comfortable. This condition of things lasted for seven days, when the respiration became more im- peded, and a stupor set in, and when he was with difficulty aroused, he would sometimes answer coherently sometimes not. He died on the morning of the tenth day, having spoken ap- parently rationally a short time before. A post-mortem revealed the meninges and whole encephalic mass considerably congested, and at the base of the brain on the right side, fully a fluid ounce of dark blood coagulated almost solid. There was no appear- ance of fluid blood, except a small quantity of slightly discolored serum, within the ventricles. From this it would seem that effusion had ceased sometime previous, and the question arises, was the Arnica the cause of it. I will leave each of you to answer for himself. Another point mentioned in the paper is the effect of Arnica upon the absorbents, and its power of removing extravasations and chymosed conditions. The experiments cited go to dis- prove our previously long-entertained opinions on this point. If it has no power to cause reabsorption of extravasated blood, its usefulness in apoplexy is very much curtailed. One thing DISCUSSION ON MATERIA MEDICA. 299 may be considered as well established, however, namely, that Arnica is of no service in such cases when locally applied. There still remains the probability that it will prove beneficial if administered internally. In confirmation of this I will say that I have seen two cases of apoplexy, where I had reason to believe that extravasation had taken place, recover quite rapidly under the use of this remedy; but as in other cases, I could not with certainty attribute the result to the medicine. Dr. Dunham then read a list of papers which were to be dis- cussed on the next day, and announced the next debater in order to be Dr. C. B. Knerr, of Philadelphia. Dr. Kxerr then spoke as follows: I wish to call attention to a slight error in the essay on Arnica. The author of the Memoir says on page 36, "The people in Saxony and in the Baltic provinces call it Wolverley, but the doctors Arnica." In the footnote he says Wolverley does come from Wol vor Leyd, "good for pain" as is claimed, but from the Gothic Wolves-leh, which signified " cadaver " or " death of the wolf"- kill-wolf. The qualities of the growing plant are not considered suffi- ciently poisonous to kill, nor is it supposed that a wolf would partake of it. In all probability the word Wolverley is a cor- ruption of the German Wohlverleih; Verleihen means to give or bestow. Wohl in this case means well-being or relief. Wol- verley thus is a name the people give to the plant whith does good to their injuries. I have some remarks by Dr. C. Hering on the Memoir which I am requested to read. "The valuable Memoir on Arnica," by our very learned col- league, Dr. A. Imbert-Gourbeyre, will not be depreciated by an additional remark of practical importance. Hahnemann gave us his Monograph on Arnica in five successive editions. In 1805, Fragmenta, p. 17; 1811, his Materia Medica Pura, vol. i, p. 236 ; 1822, second edition of the former, p. 471; 1826, a trans- lation, somewhat abridged ; 1830, third edition of the Materia Medica. In each one, from first to last, it is always the root of the Arnica montana, and not due flowers, that were used for provings, as well as in practice. In 1790, in the note to Cullen, vol. ii, p. 106, Hahnemann says: "In later times the flowers have been oftener used than the root, which is much more powerful, but in 300 world's homoeopathic convention. 1795, in his Apotheker Lexicon, vol. ii, p. 284, he only mentions flowersand leaves." In the Latin Materia Medica the prepara- tion ordered is 50 grains of the fresh root powdered, with 1000 drops of Spiritus vini. Only in the third and last edition this most unfortunate sug- gestion is made in the preface: " Where the plant can be had fresh, the juice of the whole plant, before the flowers open, might be taken." In Schwabe's Pharmacopoeia it is stated, the root is to be pre- pared for internal use, and the green plant for external use. This is decidedly wrong, as the flowers act much more on the brain, and the root far better in injuries. The very serious objection to the use of the flowers is the insect nearly always to be found in the calyx of the flower, a fly belonging to the family of Diptera, called by Linne, Musca Arnicae, later Thrip's Arnicivora, now, according to Walker's Insecta Britannica, Try- peta arnicse.. This insect deposits its eggs in nearly all the flowers of the Arnica montana, even before they open. These larvae live on the fleshy pappus, finally form a pupa, fall in the hands of the herb collectors and so come into the trade. Francois Mario Mercier (not Lemercier), from Rochefort, France, a very good observer, communicated, in 1807, a very remarkable cure with Arnica to Sedition's Journal, and published in 1811 a "Memoire sur les alteration que les cents et les larves de certain insectes impriment ou Proprietes physico-chirniques et medicinales des fleurs de l'Arnica montana," in the Annates de Chim., t. 17, p. 137-150. This treatise was reprinted in other French journals and translated into German. In Koteletzky's Medicinal Flora of 1821, we find the remark : "Some suppose the larvae or pupae of an insect to be the cause of the unpleasant effects, sometimes found in the use of A rnica." The author mentions that Arnica flowers are sold in the shops "cum pappis, ou suis pappis." Of course this was a measure taken to avoid the poisonous insect. In 1827, we find in J. A. Buchner's rloxicology, on page 35: " Atherix maculatus meigen lays its eggs in the flowers." After giving a description of the larva and pupa, he mentions as symptoms produced by them : sensa- tion of heat, constriction in the oesophagus and stomach, pressure in stomach, spasm in stomach, nausea, and vomiting ; and con- tinues: "The bad effects observed sometimes after the use of Arnica flowers seem to be caused by this insect." In 1840, in Joseph Buchner's Homoeopathic Pharmacopoeia-the only one written by one who really understood chemistry, botany, and zoology-the former toxicologist is corrected, and it is stated, DISCUSSION ON MATERIA MEDICA. 301 that it is not the Atherix maculatusbut the Musca arnicse which deposits its eggs in the Arnica flowers; and adds that all these flowers should be purified before they were used as a medicine. But the eggs are not easily found and the excrements of the worm not easily removed. About 1843, when the first homoeopathic pharmacy was estab- lished in Philadelphia by Rademacher, the sale of Arnica tincture for hurts was already an item, and all apothecaries sold it very cheaply. Arnica flowershad been imported in large bales, one of which Rademacher had bought. To prevent the fre- quent bad consequences following the use of the flowers, such as erysipelas in lockjaw (in 1837, in the Allentown Correspondenz- blatt, Dr. G. Bute reported two cases of trismus following the abuse of Arnica tincture from the shops), some of the flowers were opened and the insect pointed out. He had the larvae and pupae picked out, and soon collected a large wide-mouthed jar full of them. In 1845 Gruner recommended the preparation of an absurd mix- ture of root, herb, and flower, suggesting that the calyx of the flower be opened and the larvae removed. The eggs and excre- ment of course remained. Careful experiments and compari- sons have shown evidence that in most plants the various parts differ in their effects. All parts of the Belladonna plant contain Atropia, and are so far similar; but tincture from the berries acts much more powerfully on the head and nerves, the leaves on the heart and bloodvessels, the roots on the bowels and skin. From all this we conclude that only the roots of the Arnica montana ought to be used, not those dried, old, or mouldy, but the fresh roots. All tinctures from the flowers are untrust- worthy, particularly if not clearly stated: flores sine pappis. Jorg made his careful experiments in 1825; he proved the roots and the flowers separately. He got his drugs from an old- school apothecary, and did not state whether the roots were fresh, which he ought to have done, as they lose a great deal if dried or old. He further did not state whether the flowers he used were such as in the shops are called sine pappis. His conclu- sion that "the flowers act much stronger" is objectionable, as he may have used weak roots, and flowers cum pappis, that is with insects. All insects which feed on one plant have a great similarity in their effects with the effects of the plants they live on ; for instance, the aphis of the Chenopodium, the larva of the Sphinx with Belladonna, the Doryphora with the Solatium, etc., and all 302 world's homceopathic convention. have the sharp acrid effect of most insects, which cannot be elim- inated. It is of very great importance that with all the numerous cases of poisoning or ill effects of Arnica, observed after the use of the flowers, there is only one case where the root is mentioned, and it cannot be called a poisoning, and in nota single instance in all cases we find quoted in the memoir, is it stated that the flowers which had been used were sine pappis. In Van Hassel's, the Hollander's, Toxicology we find : "Le- mercier's supposition that the effect of Arnica did depend on the larvae of the Trypeta arnicivora is forgotten." We hope it will never be forgotten in our school, the only one with an exact method, that all the symptoms obtained from poisoning with Arnica flowers, be marked as such. They are to be considered as the effects of two substances, an animal and a vegetable, like the Curare, and may be none the less useful. Careful practitioners ought to give the root, by which all trust- worthy cures have been made. Dr. Dunham : The subject of lc Materia Medica and Thera- peutics" is now open for general discussion. Are there any fur- ther remarks? If not, permission will be asked on behalf of the essayists to close the discussion on their papers; but in every de- liberative body the privilege is conceded to a man, whose paper has been discussed, to defend or explain his paper, if he desires. This will require a suspension of the rules, as they forbid any one speaking in this Convention more than once on the same subject. It was then voted that the rules be so amended as to allow the essayists to close the discussion on their respective papers. Dr. Richard Hughes : Dr. Cate very justly pointed out that epileptic convulsions have their analogues in something which caused the convulsion, as those during the dentition of children, or in puerperal convulsions, and I entirely agree with him; but I believe the convulsion in every case starts from the same seat, and is pathologically identical. I think, and my expe- rience bears out the thought, that the convulsions of children dur- ing dentition, and the convulsions produced by Hydrocyanic acid are very similar, and the acid is as good a remedy for them as for general palsy. Dr. Farrington has justly pointed out that it is useful in le grande mal, and not in le petit mal; palsy has been treated by Hydrocyanic acid, and it is an estimable remedy, but is not so useful in le petit mal. My own experience entirely confirms this statement. I have carefully treated two or three cases of le petit mal with Hydrocyanic acid, and have never seen DISCUSSION ON MATERIA MEDICA. 303 any effect from it; le petit mat is a disease for which we sadly need a remedy. In the old school, where they can suspend the paroxysm in le grande mat for a time with Potassium, they can- not touch le petit mal, nor have the homoeopathists found a rem- edy for it, and he who discovers one will confer a great boon on humanity. Dr. Farrington has also fully and justly stated that Hydro- cyanic acid cannot be a specific for epilepsy. There are other remedies necessary in the treatment of these diseases that are not obviously homoeopathic to the paroxysm, and yet have a true relation to the morbid condition which produces the paroxysm. I think the term epilepsy is used for a form of disease for which Hydrocyanic acid is very useful, and which begins with a par- oxysm, and in which there has been no previous history of the inheritance ; but the patient presents no indications for the use of remedies, and epilepsy supervenes from some exciting cause, and a paroxysm occurs in which all the mischief is due to the paroxysm, and the party improves in general health,-in such cases this remedy is valuable. The patient would come to me looking more like an animal than a human being, on account of the deadening and debasing effect of alcohol upon the brain, and Hydrocyanic acid would almost immediately arrest the paroxysms, reducing them from five a day to one a week; the patient begins to brighten up, and regains the natural look of the eye. In cases where epilepsy supervenes in a patient who has scrofula or any other definite disorder, Hydrocyanic acid will act only as a palliative, and in such cases I should treat the general condition with Calcarea low, or some other antiscrofulous remedy. Just before I left England I saw an interesting case of this disease, well developed, which was reported in my paper. Hydro- cyanic acid is seldom the remedy for angina pectoris and epilepsy. This patient was first attacked with angina pectoris, and after- wards with epilepsy, and finally the- two diseases seemed to coalesce, so that about once a month she had an attack of angina pectoris and epilepsy coming on about the same time, and the attack would be ushered in by premonitory symptoms lasting about three days, which were very severe and distressing; this patient was utterly unfit for all the functions of life. Hydro- cyanic acid has almost completely checked the epileptic parox- ysm, which, when it did recur, was very light, and her whole trouble, which formerly lasted a fortnight, was limited to two or three days' duration. It is certain that a great amount of dis- tress, both in epilepsy and external palsy, is alleviated by this 304 world's homoeopathic convention. remedy. Regarding the potency-in epilepsy I have used five (5) drops of the 3d decimal potency several times a day, and have increased the dose; I have given three drops of the 1st centesimal potency several times daily. I think my dilutions are made with water, but am not very certain. Dr. Dunham announced that as there were no further remarks on the subject-matter of debate the discussion was closed. He then announced the subjects for discussion on Wednesday, and gave notice that the essayists and debaters in the department of obstetrics and gynaecology would hold an open meeting in the large hall on Thursday, this meeting not to be a regular session of the Convention, and invited those interested in these subjects to be present. A communication was read from the Secretary of the Hahne- mann Medical College of Philadelphia, inviting the members of the Convention to visit that institution. Dr. Dunham: Essayists and debaters in the department of clinical medicine are requested to meet the President and Sec- retary immediately after the adjournment this morning to deter- mine upon a programme for the morrow. The Convention then adjourned to meet the following morn- ing at 9.30 o'clock. DEPARTMENT OF CLINICAL MEDICINE. Genesis and Etiology of Acute and Chronic Dis- eases and Deductions for their Treatment, . CONTENTS. Marquis de Nunez, M.D., Madrid, Spain. Miliary Pneumonia: Tarantula, .... Hahnemannian Society, of Madrid, Spain. Latent Pneumonia in the Aged: Digitalis, . . P. Jousset, M.D., Paris, France. Primary Congestion of the Lungs,.... J. Meyhoffer, M.D., Nice, France. Cirrhosis of the Liver L. Salzer, M.D., Calcutta, India. Intermittent Fevers A. Charg4, France. Intermittent Fever in Italy, C. F. Fanelli, M.D., Naples, Italy. Roman Fever, Pompili, Rome, Italy. Eruptive Fevers, P. P. Wells, M.D., Brooklyn, New York. Certain Diseases of Children (Diphtheria, Can- crum Oris, Croup), B. F. Joslin, M.D., Brooklyn, New York. Diphtheria, Ad. Lippe, M.D., Philadelphia, Pa. Angina Pectoris; A Symptom, .... E. B. de Gersdorff, M.D., Boston, Mass. Modifying Influence of Epidemics on Thera- peutics, A. W. Woodward, M.D., Chicago, Ill. T. C. Duncan, M.D., Chicago, Ill. GENESIS AND ETIOLOGY OF ACUTE AND CHRONIC DISEASES AND DEDUCTIONS FOR THEIR TREATMENT. Dr. Marquis de Nunez, Madrid, Spain, Grand Cross Knight of the Royal and Distinguished Order of Charles III, and of the Beneficenza, officer of the Legion of Honor, physician of the bed chamber of His Majesty, authorized by royal decree to practise medicine throughout France, honorary Doctor in Medicine of the Homoeopathic Medical College of Philadelphia, President of the Hahnemannian Society of Madrid, corresponding member of various scientific societies, etc. Desiring to respond to the invitation with wdiich the Com- mitee of Arrangements of the World's Homoeopathic Conven- tion has honored the Ilahnemannian Society of Madrid, and all its members, 1 have felt an obligation, as President of this Society, to present a brief .memoir, comprising an exposition of what I regard as the key-note of my practice. My pupils and friends have supposed that the fortunate results of my clinique depended on superior intellectual capa- city of some kind. In reality, however, they come simply from my method of apprehending the genesis, etiology and evolution of disease and of interpreting the action of remedies, in the selection and administration of which I am guided by the above mentioned appreciations of the morbid processes, acquired by a long experience. I have, then, no other merit in this than that I have closely observed nature; and unless in this respect, the results of my medical practice should not be ascribed to qualities superior to those of my colleagues in the practice of Homoeopathy. 307 308 world's homoeopathic convention. With these preliminary remarks, I enter on my subject. Organization is simply a special manifestation of dynamism (energy), realized in the progress of the cosmos, as a necessary evolution in the series of processes of the life of the uni- verse. Vital force, like attraction, magnetism and electricity, demonstrates its existence by its manifestations. We can neither apprehend nor define the intimate nature of such forces. When dynamism (energy) unites and blends with chemical and organic elements, to which itself has given being, under definite conditions, this constitutes the existence of organized and living beings. The vital force, which resembles the electric or magnetic fluid, and may be a special modality of this agent, resulting from its union with organisms, enables the tissues, liquids, cells and molecules to maintain themselves in a definite nor- mal state, which we call health. Changes and modifications in this force, occasion changes in the organs, functions, cellular proliferations and in the chemical atoms themselves, which give rise to an anomalous condition, that we call disease. But disease is not exclusively, the modification of function, organ, cell, or atom, nor of dynamism itself, but of all of these united, a modification resulting from various causes, which operate on some of these elements, making a more or less direct impression through the organs upon the force which presides over and maintains them. But everything lias its origin in force (energy) and nothing happens save by virtue of a law to which all phenomena are subordinate. The vital force in every organism is unique, simple, homogeneous and indivisible, like every force ; conse- quently its modifications affect its totality, and therefore dis- eases are, in the beginning, general and dynamic, however, in their evolution, they may become localized in definite appa- ratus, organs or tissues. From the polarization of the chemical atoms, the movements of cells, assimilation and disintegration, to sensations, ideas and thought, everything results from the modification which genesis And etiology of diseases. 309 the vital force experiences under the influence of morbific causes. All physiological, pathological and therapeutic phenomena are governed by a law which emanates from the vital force. It is the law of elective affinity. By virtue of it, every ele- ment goes to a definite point in the organism; and the differ- ent tissues assimilate, from the nutritive fluids, those of which they have need and no others. In like manner, in disease, this law impels pathological products to different organs, as we see in eruptive fevers, in herpetic eruptions in which they are sent to the skin, and in the lithic diatheses in which they go to the kidneys or to the vicinity of the articulations. It is the same with medicaments, which while producing a general effect, yet manifest greater affinity for some tissues than for others. Thus Mercury shows an elective affinity for the mucous membranes and the lym- phatic ganglia ; Arsenic for the great sympathetic and the liver ; Nux vomica for the spinal cord, etc. This explains the localization of diseases and the secondary, local effects of drugs, both having, in the first place, modified the organic dynamism in its totality. Sometimes, in these dynamic and organic deviations which we call disease, there is no vital reaction, no spontaneous effort by which the normal condition of the organism is rees- tablished. These cases require the assistance of art to accom- plish this end. But sometimes there is a reaction against the changes induced by morbific causes ; and by virtue of the law of elective affinity, spontaneous crises take place, whether in the course of therapeutic treatment or under the simple appli- cation of hygienic measures which favor the tendency of Nature towards a cure. Inasmuch as every organism has its own special mode of existence, which we express by the words : idiosyncrasy, tem- perament, constitution, it follows that the effects of morbific causes must correspond, not only to the nature of these causes, but also to the conditions of the subject on which they act. In this the disease is individualized and assumes a character, direction and color corresponding to the particular circum- stances of each patient. 310 world's homoeopathic convention. Among these general conditions, there is one, called by the ancients diathesis and which Hahnemann included in the three miasms which he regarded as the causes of chronic diseases, and which, as we shall see, are likewise the causes of many acute diseases. These diatheses, a term which we use as synonymous with miasm, are transmitted from generation to generation and when acquired by inheritance may remain dormant for a considerable time, and may be manifested in very various ways. It is not, however, the disease itself which is transmitted, but rather the dynamic method, the plastic state of the tissues, together with the evolutionary morbid conditions of the progenitor. The diathetic or miasmatic states to which we allude are not always inherited ; they may be acquired by simple violation of hygienic principles. When an acquired or inherited diathesis exists in an indi- vidual, and accidental causes give rise to disease in him, the latter, instead of presenting only transient phenomena of vital reaction, becomes a chronic disease, or an acute disease com- plicated by phenomena peculiar to the diathesis, and which may disappear along with the acute symptoms, or, more fre- quently, persist after the subsidence of the latter. Diatheses, then, are specific constitutional affections, various and mutable in form, but identical in origin and essence, com- patible with a certain degree of health, so long as the condition of equilibrium is preserved, but tending always to produce noxious organic changes; so that if not extinguished by art, they end by the establishment of deep-seated disease, and in the degeneration of the race, for, unless they (diatheses) local- ize themselves in accordance with their natural elective affini- ties, they give rise to abnormal, acute or chronic sufferings which imperil life, as often happens in the case of children who die of hydrocephalus, meningitis, tabes mesenterica, or other maladies, because the diathesis to which they are sub- ject has not localized itself in the organs or tissues to which it had a natural affinity, or because such manifestations having taken place, the salutary crisis has been suppressed by injudi- cious measures. In all cases analogous to those just cited, an acute or chronic GENESTS AND ETIOLOGY OF DISEASES. 311 disease is ameliorated or cured, when the physician succeeds in giving to the diathesis its proper localization and its legiti- mate aud unmodified manifestation. This mode of studying diseases is of immense importance, because of its influence on the selection of remedies. We often fail to cure a case of asthma, of pneumorrhagia, or of epilepsy, for example, be- cause we do not take into account the fact that these affections depend upon an eczema or analogous cutaneous affection, the suppression of which has induced the disease, or the legitimate localization and manifestation of which has not taken place, because of the psoric vice latent in the system. We will add, that diathetic conditions, virus or miasms re- garded as dynamic or plastic states, and not as entities en- dowed with individuality, often result from conditions in the parents, although the latter may not have themselves acquired them by inheritance or in any other way. Lack of harmony in the constitutions of the parents, morbid influences during gestation, etc., may impart to children con- stitutional or diathetic conditions not possessed by their par- ents, but which they may transmit to their descendants. Diatheses and diseases capable of transmission by inherit- ance may be metamorphosed in the transit, either in form or in species. This occurs when a herpetic father begets a child who suffers habitually from gastralgia or some other neural- gia ; or when one affected with blenorrhagia begets a scrofu- lous child, although neither parent may have given evidence of a scrofulous diathesis. In all these matters, we observe a multitude of morbid af- fections, subject to constant laws, which I do not now propose to discuss, but which govern and control the metamorphoses of diseases. When, therefore, we say that a person has inherited a dia- thetic disease, we mean that there is a dynamic and organic modality, a special kind of activity in his cellular proliferations and in all that pertains to his life. Under these circumstances, the organism is subjected to a predetermined order of disease, variable in form and seat, but identical in origin; and the most insignificant causes give rise 312 world's homceopatiiic convention. to obstinate maladies, which persist or are metamorphosed into others, preserving hardly any relation of causation to the accidental exciting agent, but rather to the specific organic condition which prevailed in the individual. So that the knowledge of the manifestations peculiar to each diathetic condition and of its morbid similitudes, as well as of its me- tastases and metamorphoses, leads to that of the most favor- able crisis, or of the provocation of proliferations in the tis- sues which should be the elective seat of its germinal activity. However great may be the differences observed by us in some diseases, this does not always point to a difference in origin; for, even when various neoplasms are produced, the special agent may be the same in all. Even in varieties of diseases which do not suffer metamorphosis, in the same indi- vidual, we observe this phenomenon in successive generations. The tubercles of a phthisical subject, for example, are not transformed in him into pellagra, nor into cancer; but in the course of the changes which the pathological elements undergo in the act of procreation and during embryonic life, the tuber- culous parent gives birth to scrofulous children ; the scrofu- lous to tuberculous ; the pellagrous to diabetic ; the herpetic to cancerous; the cancerous to neuropathic children. It follows from all this, that each individual is born with a foreordained tendency to a determinate series of diseases; or, in the course of his existence, circumstances subject him to such a series. For the organisms are very rare which are free from these congenital or acquired tendencies; hence the in- vestigation of the germ of a patient's diseases, gives the key to their treatment It is not, therefore, in chronic diseases alone that we are to study the influence of diatheses or of the miasms as they are called in the homoeopathic school, but in all acute diseases as well; for even in epidemics we perceive their influence, although in these it is less potent, by reason of the energy of the exciting cause of the epidemic. Herpetism is the most widely-spread and prevalent diathe- sis affecting the human race; but what is said of it applies equally to the other constitutional vices admitted to be diathe- ses capable of generating various pathological manifestations. GENESIS AND ETIOLOGY OF DISEASES. 313 At the Paris Homoeopathic Congress, of 1851, I published, for the first time, my views on the metastases and metamor- phoses of the herpetic eruptions, calling the attention of our School to this very important subject; and I have since that time often taken occasion to lay before my colleagues evidence gathered in ray extensive practice, and which has confirmed me in these opinions. If, from this standpoint, we examine any case of disease ; from a slight irritation of the mucous membrane to congestion of the parenchymatous organs; from a simple neuralgia to the gravest neurosis; from a fever of any kind or class to pro- found alterations of tissue; we always meet one of these germinal diatheses, most frequently the herpetic ; the disease of the individual being nothing else but the expression of this vice, the illegitimate localization and manifestation of a metas- tasis, which is repeated in a long series of organic changes, producing, in the course of the patient's life, various maladies, sometimes not analogous among themselves, but always ident- ical in origin. In all these cases, the important matter is to divert the mor- bid elements to some other point of the organism, to provoke a manifestation more compatible with existence than that which we are combatting, and to which we put an end by es- tablishing a new one. The vital force, notwithstanding its auto-dynamism, does not act intelligently nor always in the direction of i s own conservation ; consequently, its critical ten- dencies are not always in the direction of a favorable termina- tion. There are consequently, in diseases, complete and in- complete, favorable and injurious crises; the favorable being such as consist in the proper and legitimate manifestation of the diathesis which is at the bottom of the disease we are treating. When, for the first time, I said that certain pneumonias, such as we meet in Madrid, were nothing but an acute form of the herpetic diathesis with pulmonary inflammation, and that the patients recovered if a cutaneous miliary eruption ap- peared opportunely, the statement caused much wonder, and was, at first, received with great doubt. But, in the course of 314 world's homceopathic convention. time, this practical view has been accepted by the homoeopaths who now see, as we do, miliary pneumonia in cases which were formerly regarded as purely inflammatory. And this phenomenon occurs not only in the thoracic malady referred to, but in a number of acute and chronic diseases which recov- er on the appearance of an herpetic eruption, as a most favor- able and natural crisis; but in which the patient incurs grave danger if the eruption does not appear, and succumbs or suf- fers from various affections, until finally the crisis necessary for recovery sets in. It is evident, therefore, that the therapeutic indications, ac- cording to sound homoeopathic doctrine, are not exclusively those which -we may deduce from the similarity of the patho- geneses of the drugs and the symptoms actually present, at the moment, in the patient we are treating; but that, in addi- tion, we are to examine whether the disease is maintained by or associated with some diathesis; what metamorphoses it has undergone since its first appearance in the patient; and what are the most natural and convenient crises. Taking all these facts into account, we are to select a remedy which contains, in its pathogenesis not only characteristic symptoms analogous to those presented by the patient, at the moment, but also symptoms similar to those of the crisis which we desire. In vol. vii. of El Criterio Medico, we published several articles on this subject, with examples to illustrate and confirm these views. We said that often the sudden suppression of eruptions of the head, by injudicious treatment, produced epi- lepsy, phthisis and bronchial catarrh ; and that it is, therefore, necessary to the cure of these affections that we reproduce the eruptions, by means of remedies whose pathogeneses contain analogous eruptions, such as Graphites, Calcarea, Lycopodium and Sulphur. In this way, an epilepsy of this character might be cured by Calcarea carb, or Sulphur, and sometimes a phthisis of similar origin by Kali carb.; and for the same rea- son, under analogous conditions, Hepar sulphur, and Silicea might be most clearly indicated in bronchial catarrh. The suppression of these eruptions may, likewise, induce obstinate ophthalmia which may require, for the same reason, Bellad., Mercur., Hepar., Delphinia, Euphras. or Puls. GENESIS AND ETIOLOGY OF DISEASES. 315 The suppression of eczema behind the ears may produce, in young subjects, spasmodic cough, pharyngitis and laryngitis, which begin acutely, but take on a chronic form ; and in aged persons it gives rise to encephalic affections. In the former case, the remedies most likely to provoke a curative, critical eruption are : Kali carb., Carb, veg., or Lycopod.; and in the latter case, Lachesis, Opium, Baryta carb., Cuprum met., or Arsenic. Laryngitis and pharyngitis sometimes result from the sup- pression of palmar eczema. Nitric acid and Sulphur are, then, the most appropriate remedies; or, if the eczema was on the back of the hands, Arsenic, and Sulphur. The metastasis of eruptions from the genital organs to the throat requires Canth., Cann., Phos., Argent., or Carb. veg. Gastralgia dependent on metastasis of herpes from the bor- der of the anus, is successfully treated with Nux vom., Lyco- pod., Caust., Chelidon., Cocc. or Sulphur. If the eruptions of the anus and scrotum have been repelled to the liver or intes- tines, we should have recourse to Nux vom. in the former case, if there be no icteric color in the conjunctiva; and to Mercur., Lach,, and China for the other herpetic disorders af- fecting this organ ; in the case of intestinal disease of this ori- gin, to Lycopod. and Phos. If the metastasis is to the urin- ary bladder, Cann., Canth. and Berberis will be suitable reme- dies. If to the uterus, Carb, anim., Graph., Tarantula, Aur., Thuja or Con. mac. Impotence and spermatorrhoea resulting from suppression of herpes of the scrotum and nates, will re- quire, in preference, Sulph. and Phosph. Herpetic leucor- rhcea, Corallia, Puls, or Sepia. We often observe rheumatism occurring as a sequence of the suppression of cutaneous herpetic eruptions. The reme- dies suitable to such cases, because of the symptoms and of the dermic crisis which should be induced, are Rhus tox., Colch., Led., Thuja, Sabina, or Rhod. and China for cases in which there is, at the same time, oedema. If there has been metastasis to the heart, producing an acute affection of that organ, our choice will fall upon Aeon., Cact., Caust., Lach., Bellad., Nux vom. or Bry.; or, if it be chronic, on Lach., 316 world's homoeopathic convention. Caust., Graph., Spigelia, Carb, veg., Lycopodium or Baryta mur. These examples, then, will serve to show the necessity of always paying attention, in the homceopathic clinique, to the origin of the disease and to its relations with eruptions that disappeared ; they show, also, the efficacy of remedies, whose pathogeneses contain not only the symptoms actually present at the moment of prescribing, but also eruptions correspond- ing to those which have been suppressed. For under the ac- tion of these remedies the eruptions will reappear and the pa- tient be placed in the way of recovery. The facts occur likewise in a multitude of acute and febrile diseases, which are treated without attention to their true cause, but which, in reality, are the result of vital reactions for the elimination of a morbid germ, which, having been latent, has been set into activity by some accidental cause. This explains their frequent termination by critical erup- tions or by other crises in different organs, as by sweats, diar- rhoea, haemorrhage, enuresis, etc., the most favorable being, however, those which occur in the skin. Hahnemann had no opportunity to observe the influence of the three miasms, the psoric, sycotic and syphilitic, on acute diseases, because his clinical studies were almost exclusively of chronic diseases. The organic processes conducing to the cellular proliferation indispensable to the establishment of a critical dermatosis are very slow; and are accompanied by more or less grave and permanent perturbations of various apparatus and functions, until, under appropriate treatment, the crisis takes place in some tissue which the vital force elects for these movements, the most frequent and most favorable being the dermis. I have observed, in my practice, that such crises are not wont to occur save under the action of single doses of the ap- propriate remedy. In acute diseases the crises are more difficult and their non- appearance more dangerous than in chronic diseases. The effort to establish them is evidenced by high fever, congestions of the brain and other important organs, by nausea or vomit- ing, general restlessness, persistent insomnia, and various other GENESIS AND ETIOLOGY OF DISEASES. 317 symptoms according to the patient's condition and to accidental circumstances. In these cases, if the treatment has been judicious, the crisis may occur on the third or fifth day; if not, the violence of the fever augments and a cerebral lesion occurs on the seventh day, soon followed by death, unless the encephalic symptoms are overcome by remedies, and the eruption appears. This is what happens, for example, in miliary pneumonia, in which Aconite would be inefficacious, while Ipecac, corre- sponds much better to the morbid condition, and facilitates the critical eruption ; and Bry., Puls., Phosph, or Sulphur may be subsequently required, according to the patient's symp- toms. The critical eruption once developed, it should be carefully maintained, a fatal cerebral affection being the very frequent result of its premature suppression. If the crisis does not take place on the appropriate days, and the patient exhibits restlessness, insomnia, violent delirium, exacerbated , fever, with desire to throw himself out of bed, Strain., in repeated doses, will allay all these symptoms, and cause the eruption to appear and put an end to the patient's danger. Crises, then, in acute diseases, are a result of vital sponta- niety, aided and directed by appropriate treatment. But we ought to know what critical movement would be most favor- able in each case, and what curative agent is capable of pro- ducing it, in concert with the organic dynamic forces. In some diseases this is shown at the very outset, by epistaxis, diarrhoea, urinary deposits, etc.; and when this does not occur, and the fever is not very violent, the accomplishment of the crisis may be delayed until the seventh or fourteenth day. Many gastric fevers, for example, terminate in forty-eight hours by an easy critical phenomenon, either spontaneous or by the aid of reme- dial measures; in this case the disease is said to " abort," others last five or seven days; but if the crisis does not occur during this period, the fever passes to the second week and becomes a more serious affair; the miliary eruption no longer suffices to ensure a favorable termination to the disease ; but the occurrence of furuncles or of diarrhoea, becomes a neces- sary part of the complete critical movement. 318 world's homoeopathic convention. If we reflect deeply upon the intimate nature of diseases and the manner in which they are affected by medicines, we perceive the analogy which exists between these phenomena and those of electricity, the only difference being such as exist between vital and mechanical electricity. In fact, in all physiological and nervous actions, there are electrical currents, and no func- tion, however insignificant and simple, is performed without some electrical movement. It takes place in all the incessant chemical reactions which occur in all the tissues and in the pro- liferation of cells. There are, as Bois-Reymond says, electrical molecules in the organism which serve as little centres of the chemical actions by which normal life is maintained. Acting electrically upon one another, they preserve the normal equilibrium of polarity. A change of polarity in these molecules may constitute the ultimate essence of disease. Then, the drug which can act electrically on these molecules with the power to restore their normal polarity, will most promptly effect the cure. This view is not a pretense to include life under physical laws; for as elasticity is not the same as organic contractility, so vital electricity may obey different laws from mechanical electrici- ty ; but there are great analogies between their respective phenomena; and the agent which produces them all may be identical, emanating from an all-pervading energy of Nature. In the muscles, nerves, capillary vessels, arteries, blood, bones, there are electrical phenomena. That there may be ar- terial blood, for example, oxygen fixes itself in the haemato- sine by a special affinity. The surface of those vessels which is in contact with the blood, is the negative pole and the oppo- site surface is the positive pole of circuit. The electrical cur- rents overcoming all affinities cause the oxygen to be deposited in the globules which are electro-positive, in the interior of the negative capillary walls. It reacts on the surrounding combustible matters producing carbonic-acid gas, which enters into the capillaries, by the action of the dissolved electro-posi- tive compounds. These are not then simple phenomena of endosmosis, as many physiologists claim ; they could not take place so rapidly as they do, without the intervention of elec- GENESIS AND ETIOLOGY OF DISEASES. 319 trical action. The walls of all the tissues serve as electrodes to the electro-capillary circuits; and these are themselves sub- jected to electro-chemical action undergoing continual compo- sition and recomposition of their organic elementary principles renovated unceasing by impulse of the electrical movements. These facts which the homoeopathic school comprehends in its formula of vital dynanism, explain satisfactorily how the normal physiological state, or health, is maintained; how it is transformed into sickness ; and how a cure is effected by the agents of our Materia Medica, which act by producing electri- cal changes modifying the polarity of the molecule and the capillary currents. Health then may be considered as an ac- tive electro-positive condition ; and sickness, as a deviation from it, having an electronegative character; w'e therefore need, to reduce this force to its normal conditions, an electro- positive medicament, which will destroy the negative electri- city of the organism which sustains the disease. When the remedy is suitable to the case we never see the so-called medicinal aggravation, which some admit, but which I do not hesitate to regard as a chimera. Aggravations do not occur unless the remedy given was not properly indicated, in which case the disease pursues its course and the patient becomes worse, not because of the remedy, but for lack of the right remedy. This doctrine of medicinal aggravation has been unfortunate for Homoeopathy, many persons having feared to submit to a treatment which wTas said to aggravate the diseases subjected to it ;• and our adversaries have taken advantage of this error on the part of our school, by dissemi- nating the notion that our medicines are dangerous and that we cure by means of poisonings, the bad effects of which will be observed at a later day. Similar views led Trousseau to formularize a kind of homoeopathy under the name of " substitutive medicine." He held that homoeopathic med- icines produce an artificial, which takes the place of the natural, disease. We see, then, how important it is to repudiate this error of the early days of our school, and to proclaim the truth that our remedies produce neither aggravations nor artificial diseases. Occasionally, ponderable doses, in very sensitive 320 world's nOMCEOPATIIIC CONVENTION. subjects, may produce primitive symptoms peculiar to the pa- thogenesis of the drug; but when the remedy is truly indi- cated, there is no aggravation, and the cure proceeds rapidly or with the phenomena of the favorable crisis. From what has been said of the importance of regarding health, disease and the process of cure as electrical phenomena of the organism, we deduce the necessity of medicinal dyna- mizations (dilutions or potencies); for by the process of dyna- mization we develop the electricity peculiar to each drug, the different dynamizations, like different diseases, differing in the intensity of their electricity. Of the hundreds of cases which we might cite to illustrate the electrical action of reme- dies and the non-occurrence of medicinal aggravations, we will mention only one : a patient whom we found, years ago, at the point of death from a terrible attack of asthma. Four globules of Arsenic8000 were placed upon his tongue ; in ten minutes his sufferings were mitigated; in a quarter of an hour he could lie down, and soon after he was sleeping quietly. The next day he was well. If the action of Arsenic had not been electrical, I think the favorable change could not have been so rapid ; and the patient's condition was so critical that I think any medicinal aggravation would have killed him. Having expressed my dissent from the illusion with respect to homoeo- pathic medicinal aggravations, I will mention what I regard as another error, viz: that our remedies have been considered to be antidotes to one another. There are no such antidotes, in the sense in which our school have understood the word. We observe an analogy of action among our remedies, and we may administer analogous remedies, one after another, to complete a cure. The second remedies finish what the first had failed to complete. But such a proceeding is proper, only where the first remedies have produced an evident amelioration. In affections which are purely dynamic without appreciable material change, cures are generally rapid and not attended by crises, a chemical change sufficing to produce them. But when there are modifications of tissue, or, to use modern language, anomalies of cellular proliferation, the organic or chemical elements which had acquired abnormal proportions GENESIS AND ETIOLOGY OF DISEASES. 321 during the course of the sickness, need a point of elimina- tion ; and this pathological process of elimination constitutes a true crisis which leaves the organism free. If this does not take place, or if these abnormal elements are not directed to their natural emunctory, we then have a metastasis, and chem- ical and electrical changes occur in other regions, resulting in local and general morbid phenomena more serious than those which previously existed. We should therefore obviate me- tastases and aid the forces of the organism in the production of crises by administering remedies in whose pathogeneses we find symptoms analogous to the crisis most desirable for the case we are treating. In acute diseases we ought not to administer more than one dose of the remedy indicated, nor repeat it before we have ascertained its effects ; and however slight the amelioration, we should not give another dose while that amelioration con- tinues. If the first dose produce no amelioration within five or six hours, we should conclude that the remedy was not indicated and give another which corresponds better to the cause and the symptoms of the case. Improvement having been observed, the dose may be repeated when we judge that the action of the former dose is ceasing. In chronic diseases, the crises are slower, requiring for their development two, three or four months, or even a year from the commencement of the treatment, which should consist in the administration of single doses of the remedy indicated, without repetition or recourse to other remedies so long as improvement continues. A good observer will know, within 24 or 48 hours whether the remedy administered in a chronic case, is likely to be of service. lie will judge chiefly by changes in the patient's mental and moral symptoms, by improvement in appetite and in sleep. If these changes occur they will speedily be followed by general improvement. In such a case the remedy should not be repeated. Should a crisis in the form of a cutaneous eruption appear, the remedy should not be repeated for 30 or 40 days, lest we repel the dermatosis, a circumstance to be carefully avoided. This course of treatment in acute and chronic diseases, re- 322 world's homoeopathic convention. suits in brilliant cures, such as we do not obtain if we act hastily and give medicines profusely without allowing them to develop their effects and without regarding the critical phe- nomena which generally terminate the morbid process. These are the views of the genesis and development of human diseases which have guided me in the practice of ho- moeopathic medicine. MILIARY PNEUMONIA-CLINICAL STUDIES OF THE TARANTULA. A Memorial from the Hahnemannian Society of Madrid to the World's Homosopathio Convention, to be Celebrated in Philadelphia in June, 1876. Introduction.-America, youngest of the nations, but pre- eminent in science, arts and industries, we salute thee, country privileged above all others. We, of the distant, occidental lands of ancient Europe, hail thee as a bright beacon, illum- ining the world, where the fraternal union of liberty and labor make man most like to his Creator ! In those peaceful contests by which civilization is abolish- ing the antagonism of nationalities and preparing for the day when the human race shall constitute only one family, Medical Science takes a prominent part. The science of Anthropology, born within our day, has made marvelous advances. Its vari- ous departments, Physiology, Pathology, Hygiene, Toxicology, Nosocomiology, Sanitary Science, are established on the firm basis of exact observation and experiment. One feature is lacking in this picture of the advancement of Medical Science. Therapeutics should have kept pace with this progress and made it all available in the cure of dis- ease. That it has not done so, in the school wrongly called " regular," is universally conceded. Homoeopathy, as unfolded by Hahnemann, supplies this lack. Homoeopathy is the true and legitimate complement of that science which has for its principal object the knowledge and cure of disease. It is the crowning glory of medicine, com- 323 324 world's homceopathic convention. pleting the chain of its wonderful advances. Without it, all would be, as it were, barren, because conducive to no practical result for the cure of disease. These considerations move the Hahnemannian Society of Madrid to address this communication to the World's Homoe- opathic Convention of Philadelphia, trusting to its kind reception, not on account of any merit it may possess, but for the good intent of the author. The Hahnemannian Society of Madrid represents thirty years of constant struggle and labor to propagate Homoeopa- thy and defend it from the numberless attacks of its enemies. Books, periodicals, public discussions and meetings, the sup- port of dispensaries, the creation of a hospital, statements to government vindicating the rights of homoeopathic physici- ans ; in one word, a constant strife, always sustained with ardor and faith, and rewarded with the sweet and ineffable satisfaction of witnessing the spread of the doctrines it main- tains and their acceptance by all classes of society. In this agitated and arduous life, the society and its mem- bers have maintained in their purity the principles of the doctrine of Hahnemann, a purity which is inseparable from and owes much of its success to our worthy President, the distinguished and learned Dr. Marquez de Nunez. Without denying the general progress of Medical Science, but on the contrary admitting all that ought to be admitted, our as- sociates believe that the future of Therapeutics is wholly in- cluded in the sacred formula " Similia similibus curantur," and that this is not antagonistic to, but, on the contrary, greatly aids the progress of Medical Science in its varied branches. And, as a proof of this, the following brief com- munication, relating to Pathology as well as Therapeutics, demonstrates that the principles laid down by our immortal master, Hahnemann, are always our safest guide. Miliary Pneumonia.-The peculiar situation of Madrid in the centre of Spain, about 2,100 feet above the level of the sea, with the elevated ranges of Guadarrama, Nevacerrada and So- mosierra to the north and northeast, whence blow the prevailing winds in winter and spring, has always made the climate of MILIARY PNEUMONLa.. 325 the city peculiarly trying, tending frequently at these seasons to inflammations of the respiratory tracts and especially the lungs. These winds, though somewhat diminished of late by a modification of the climate, have always been dreaded by both natives and foreigners. These pulmonary troubles presented no symptoms worthy of special notice ; they were treated by the methods in vogue, according to the dominant systems. The excessive mortality was a matter of course-nothing more. But, twenty years ago, the learned Dr. Nunez called the atten- tion of physicians, in the official journal of the Hahnemannian Society, to the great difference between that pulmonary affec- tion which, at a certain stage, presented a miliary eruption, and that which presented no such phenomenon ; for the former was cured quickly and easily, while the latter was fatal or cured with difficulty. Were these exceptional cases coming under the notice of the renowned master or had other physicians been faulty in observation ? Were they true pneu- monias or an especial form of pneumonic fever, dependent, as the ancients said, upon certain individual conditions ? Was the miliary eruption a crisis, or a symptom of the disease noted ? These questions, seemingly so complex and difficult of solution, have been gradually answered in the series of years which have elapsed since they were first propounded. This is, by no means, a rare case of which we treat, for members of the Society and others have recounted many more in the annals of the same and in the sixteen volumes of El Criteria Medico. Before proceeding farther, let us state in a few words the symptoms ordinarily presented in these cases; after having passed the transient stage of suppression of perspiration, chil- liness, etc., the patient is attacked with a violent chill of long duration, with the thermometer indicating an increase of one degree above the usual temperature, nausea and at times vomiting, febrile re-action, pulse 120 to 130, intense headache, countenance suffused and mottled, respiration agitated, short and difficult, pain more or less acute in one side, with inability to lie down, a violent, painful cough at first dry, afterward followed by expectoration viscous, sanguinolent or even of 326 world's homoeopathic convention. pure blood, diminution of the natural resonance of the chest and development of a dry and vibrating respiratory sound, becoming afterwards bubbling and moist. With these symp- toms the general malaise keeps pace, with anxiety, racking pains in the whole body, etc. Is this a true pneumonia ? Pinel has said that it was extremely uncommon to find a purely inflam- matory case of peri-pneumonia, without some complication. But given some modifications induced by the condition of the individual and particularly hereditary or acquired tendencies to disease, and we must admit that the cases coming under our observation, and which form the majority of the pneumonias of Madrid, are not pneumonias of the genuine inflammatory type described in our standard works, marked by their long duration, tending steadily toward hepatization and which, after great danger, terminate only in a lingering convalescence. This form which we are studying is more manageable, but is a pneumonia in the true sense of the term. What charac- terizes a pneumonia, if not this? We know how this disease was distinguished before the time of Laennec ; the general symptoms-the high fever, the difficulty of respiration, the cough, pains in the chest and the more or less sanguinolent expectoration suffice to diagnosticate the pulmonary inflammation. As a result of the labor of that famous French physician we have the pathognomonic signs obtained by auscultation and percussion. The rales dry, crepitating or sub-crepitating at first, with bronchial respir- ation and bronchophony afterward and finally the return of the bubbling, moist soundsand the resonance of the parietes of the chest, indicating clearly the course of the disease in this most important vital organ. This fibrinous exudation, which is generated in the cellular tissue, constitutes the principal organic phenomenon of the inflammation ; when it is still thin and liquid, the air passes with difficulty and in traversing and rudely bursting the walls of these vesicles gives rise to those fine rales which the ear detects in the form of sub-crepitating sounds ; when the product of the exudation is completely so- lidified, the pulmonary tissue is transformed into a hard, com- pact mass impermeable to air, which transmits, with the MILIARY PNEUMONIA. 327 eonductibility of solids, the sounds which are made in the bronchial tubes, whence we have bronchophony, the bronchial ronchus, etc. Hence it is that the pneumonic sputa formed, in part, of this inflammatory exudation, which occupies the ultimate bronchial ramifications and the pulmonary cells, are viscous, adherent to the vessel and may present all the colors intermediate betwen straw yellow and the darkest red, accord- ing to the quantity of blood mixed therein. And this expect- oration is of such importance that, as Jacoud says, a single sputum, thoroughly examined, enables us to affirm the existence of the disease, even when the lesion, by reason of its site, is beyond the reach of our exploration ; and by this same means, experienced physicians follow the pathological changes as accurately by the examination of the sputa alone, as if they daily percussed and auscultated their patients. Returning from this digression and recalling the numerous instances of miliary pneumonia which are to be found de- tailed in the annals and journal of the society, it will be seen that they are so complete as to leave no doubt of their being true pneumonias. Some cases are met with in which the symptoms of physical exploration are not marked, but there are very few in which the rusty, viscous, sanguinolent sputa, of which we have already spoken, as sufficient in itself to char- acterize pulmonary inflammation, are not constantly present. The only differences to be noted, however, occur in the sub- sequent progress of the disease, and we shall describe a speci- men case of the mild and benign form. It generally begins with a violent chill, followed by strong reaction, with an im- mediate increase of temperature which, according to the daily variations, corresponding to the type of the fever and which have been described by Thomas, Bserensprung, Wun- derlich and others, extends to 40, 41 or more degrees (C.) from the first to the fifth or seventh day; when,.suddenly, the heat diminishes 1° or 1£° and convalescence commences, the heat falling rapidly and steadily till it becomes normal, completing the pulmonary cycle. In the meantime, the other symptoms keep pace with this stage of the disease, the dyspnoea dimin- ishes, the sputa are no longer viscous or transparent or bloody, 328 world's iiomceopatiiio convention. but become opaque, heavy with globules of pus, of fat and a multitude of newly-formed cells, and lastly the urine becomes normal in quantity and in its physico-chemical conditions. The disease has terminated by resolution, without any notable phenomena and with only the ordinary changes. When this does not occur, when to hepatization succeeds infiltration, when instead of convalescing at the end of the first week, the disease is prolonged to the second or third, then the pneumonia becomes most threatening and may terminate fatally in several ways. It may assume the asthenic or nerv- ous form, which is the most common and depends upon the alterations which occur in these vital tissues from the elevation of their temperature; or it may terminate in pulmonary abscess, in gangrene, in caseous infiltration or otherwise. These and other terminations are most formidable and usually fatal. In the pneumonia which we are studying, two terminations may occur; the ordinary one benign, when on the third day -more commonly the fifth or even the seventh-the disease reaches its acme. Then, the temperature and the sphyg- mographic curve rapidly fall, at the same time the patient be- coming covered with a miliary eruption, generally confluent, rosy and smarting ; the dyspnoea disappears, the expectoration becomes yellow and mucous, the sleep is normal, the appetite returns; in a word, the disease has ended and convalescence begun. When the disease is not of this benign type, there will be observed on the fourth or fifth day an increase of the fever, with excessive heat (41° C. + ), agitation, sleeplessness, furious delirium, attempts to rise from bed ; in a word, symp- toms of ataxic nervous fever, which cease immediately on the appearance of the eruption, but, when this does not occur, death speedily follows with symptoms of serous cerebral suffusion, common to cases in which the circula- tion is profoundly affected and the vascular tonicity dimin- ished. In short, this miliary pneumonia in its simple, uncom- plicated form is neither the croupous nor the bronchial pneumonia of Niemeyer, from which it is distinguished by the following characteristics: MILIARY PNEUMONIA. 329 1st. Gastric and bilious symptoms in the beginning, marked by persistent nausea and vomiting ; 2d. Constant predominance of the general febrile symptoms over the local ones of the respiratory apparatus; 3d. Verification, in all cases, of the physical stethoscopic signs, and of the cough and expectoration which characterize true pulmonary inflammation; 4th. Complete crisis of the disease, when the miliary erup- tion presents itself before the seventh day, when resolution of the morbid process quietly follows in the more benign cases; 5th. When the miliary eruption comes out slowly after the ninth day, is incomplete and fades away quickly before its time ; then the disease advances slowly and terminates with many difficulties, such as abscesses, boils, diarrhoeas, etc., etc.; 6th. When the eruption does not recur, death ensues with cerebral ataxic symptoms, serous effusions and general pros- tration ; or a very lingering convalescence sets in, subject to frequent relapses. It may be asserted that the disease in question is only a miliary fever with pneumonic symptoms. In former times there has been much discussion whether miliary eruptions were idiopathic diseases or merely symptomatic of certain malignant epidemic fevers, of gangrenous forms of angina, of dangerous puerperal conditions etc. The opinions of Whyte, Dehaen, Lepeeq and others are well known and need not be repeated here ; but though the existence of a miliary eruptive fever is admitted by most nosologists and its treatment is perfectly understood in our school, we believe that the affec- tion of which we are now writing is a different disease. It remains for us, finally, to decide whether the miliary eruption is a crisis in these pneumonias as in malignant anginas and puerperal fevers. The idea of a crisis in disease, so largely studied and believed by ancient physicians, has fallen into disrepute among modern pathologists and materia- lists and without doubt, as Borduc says, questions like the doctrine of a crisis should be reserved for the legislators of the art, those physicians who elevate themselves from mere 330 world's IIOMCEOPATHIC CONVENTION. practitioners to grand observers. The doctrine of a crisis as being a phenomenon so marked and startling as to call the attention of the ordinary observer, and which enables him to definitely fix the day and hour for the end of the disease, though highly esteemed by the ancient humoralists and several other schools, is too antiquated for us, and does not suffice to explain this most important pathological problem in the eyes of modern science. See how M. Ilirtz {Mod. Diet, de Med. et Chir., t. X., p. 246] expresses himself: "In our day, patronized by the German Schools, studied in the light of the most careful thermometry, the crisis has been proven and observed with precision. AVe can measure the moment of its origin, its course, its duration as well as its termination, with the diverse modifications which characterize it, according to the morbific species and the type of the disease. " And in another place he adds " the crisis, clinically considered, is simply a rapid defervescence. " AI. Chauffard regards the crisis as " the end of the morbific evolution, the final conclusion of all the constituent steps of the disease. " This last evolu- tion is to be studied principally in the course of the fever which is, without doubt, the principal element in acute diseases, since it reflects the condition of the most important vital functions; so that the thermometer, the sphygmograph and chemical analysis are the most useful instruments which the physician has, wherewith to ascertain when the disease reaches its crisis, that is to say its rapid subsidence, when as Gourand {Des Crises} says: " He can study three distinct periods in the succession of the critical phenomena ; the im- pending crisis, the crisis proper and the sequel of the crisis. " The crisis is an act of vital spontaneity of organic agreement, ■modified by the re-active power of the patient and the treat- ment of the physician. Considering the crisis in this light, we must decide that the ^miliary eruption in pneumonia is a critical phenomenon, because its appearance coincides with the subsidence of the fever and the immediate conclusion of the disease. In concluding this first part of our memorial, we would say . a few words regarding the treatment most applicable in this MILIARY PNEUMONIA. 331 form of pneumonia. In addition to the general hygienic and therapeutic rules which obtain in all such cases and not forgeting to individualize each particular case of disease as regards the choice of a remedy, we should say that experience has shown the following to be specially indicated: Ipecacuanha at the beginning of the attack, indicated by all the symptoms which characterize it, not only the gastric disturbances but also by the febrile agitation, anxiety, dyspnoea, etc. ; It is in this stage that Aconite is so generally abused, to the great detriment, both of the patient and phy- sician. Bryonia is next indicated, especially if its peculiar symptoms are accompanied by a sharp and lancinating pain in the side. Pulsatilla, if the pain is in the back or shoulder- blades. Phosphorus and Sulphur in single doses of a high potency generally complete the cure of this disease. But when, from any cause, it does not follow the regular course and we have violent delirium with desire to throw oneself out of bed, Stramonium will almost always cure. Rhus, Belladonna, Arsenic, etc., will sometimes be of use according to the symptoms indicated. Observations upon the Action of tiie Tarantula.-During the twelve years which have elapsed since this remedy, thanks to the labors of the distinguished Dr. Marquez de Nunez, was added to the arsenal of our Materia Medica, its published clinical results have been so many and so interesting that we are constrained to show how many of its indications have been verified in practice, in accordance with the law of sim- ilars. Like all other poisonous substances, the Tarantula ex- erts so profound and complex an action upon the human or- ganism as to enable it to combat complicated and very diverse pathological conditions; like Lachesis, Apis, Crotalus, Dia- dema, Bufo, etc., its sphere of activity penetrates all the sources of organic life, and, therefore, it exerts a powerful effect in chronic diseases. In reviewing the pathogenesis of Tarantula, we find most conspicuous among its primitive symptoms the following: General chilliness, anguish, stupor, slight convulsions, feeble and plaintive moanings, oppression in the cardiac region. 332 world's nOMCEOPATHIC CONVENTION. vertigo and deathly faintings. After these primitive symp- toms, quickly follow alteration of the features, paleness of the face, great anxiety, constant change of posture, pain in the kidneys, hips and other parts of the body, quick and difficult respiration, broken speech, aphonia, oppression and pain about the heart, wiry irregular pulse; numbness of the locomotive apparatus, followed by convulsive twitchings more or less strong and intermittent; contraction and painful rigid- ity of some muscles, headache, vertigo, sleeplessness, agitation, hypersesthesia of the skin, exaltation of sensibility, integrity of the intellectual faculties with exaggeration of the emotional, profuse cold sweats, intense thirst, nausea and vomiting, tume- faction of the abdomen, difficulty of micturition with hot and thick urine; increase of the venereal appetite in both sexes; ex- cessive sensibility of the genital organs and increase of the symp- toms which accompany and follow coitus; pus in the uterus, with discharges abundant, acrid and corrosive ; great changes in menstruation, with aggravation of the conditions which pre- vail during and after the monthly periods; profound melan- choly, with despair of cure; eruptions on the skin ; tumors and excrescences of various kinds ; profound asthenia ; serous discharges ; general debility and cachexia. The symptoms of this remedy, as of many others, are alter- nating, and are aggravated or modified by noise, by the time of day, by moral influences, movement, pressure and music ; and it is particularly notable that they are periodic and are re- peated every day, every third day, monthly and even yearly, at which periods can be noted not only the febrile symptoms, but also many others which sometimes particularize the fever and at other times constitute the whole disorder. The Tarantula is a medicine which acts principally upon the cerebro-spinal system, and primarily upon the medulla spinalis. This is proved by the alternations which are perceived in the locomotive apparatus, torpor and difficulty of motion being followed by restless agitation, muscular contractions, clonic convulsions, etc. And as a consequence of this exaltation of the medulla spinalis come the aggravations from pressure, even of the hand, the cardiac oppression and pain and the MILIARY PNEUMONIA. 333 quick and labored respiration. Not only the medulla spinalis, but the cerebellum and the cerebrum also, show its effects by a multitude of phenomena. In a word, as Dr. Nunez says, the action of the Tarantula upon the human economy is characterized by an especial and primordial affection of the central nervous system, as is shown by the disorders of innervation, tremblings and painful twitchings of the muscles; these phenomena are alternating- or intermittent and by action sometimes direct, sometimes reflex or sympathetic, produce changes in the blood which eventuate in haemorrhages, ecchymosis, serous fluxes, etc., or in cedema- tous swellings of the skin, with eruptions of various kinds. [Estudio Med. del Veneno de la Tarantula, p. 189]. The characteristics of this drug are the disorders of motion under the convulsive form, in which there is a necessity for continual motion, fright, terror, fear of speedy death, with vertigo and pre-cordial anxiety, with intolerance of pressure or touch, and periodicity. From what has already been said, we can readily infer how many morbid states the Tarantula is able to modify and cure. In the numerous clinical cases already published there abound, singularly enough, many varied specimens of a disease which is the opprobrium of ancient medicine, which treated it with all known medicaments without any results ; wve refer to Chorea or St. Vitus' dance. Chronic or recent, in children or adults, with or without rheumatic complications - so many cases, after having suffered the allopathic treatment in vain, have been cured by the Tarantula as almost to entitle it to be considered a specific in this affection. Many intermittent forms, febrile as well as nervous or convulsive, have been immediately cured by the use of the Tarantula. Hysteria, in many of its Protean forms, falls within the scope of action ofthe Tarantula : a case of epileptiform hysteria, published by Dr. Garcia Lopez [Criteria Medico, 1865] is notable for more than one reason : a woman aged twenty- four years, unmarried, of nervo-lymphatic temperament, suf- fered for more than four years, every eight, fifteen or twenty days, an attack with the following characteristics. At first. 334 world's nOMCEOPATIIIC CONVENTION. she fell senseless to the ground, became rigid, ground her teeth, frequently bit her tongue and rolled up her eyes which remained open during the attack. In some three minutes the paroxysm passed off, leaving only confusion of mind and no recollection of the attack. This disease, which had resisted a thousand allopathic measures employed during its long course, was controlled by the Homoeopathic remedies indicated. But, afterward, the disease appeared in another form ; in place of convulsions, there appeared anguish and oppression of the chest amounting almost to suffocation, while the paroxysms became longer and more frequent. Five doses of Tarantula200, one every twenty four hours, completely cured this grave affection. Most noteworthy, also, is the case of paralysis agitans, narrated by Dr. Cramoisy {Bull, de la Sue. Med. Ilomoeop. de Trance, 1873) of a lady, aged sixty one. She was of good general health, subject only to mild rheumatic attacks. After great mental distress, she was seized with pains in the arms, a continuous trembling and an itching in the left leg, with inability to remain in bed which compelled her to walk the floor all night. These tremblings extended to the head and the tongue; her condition became most serious, her appetite was lost, her nights were sleepless, except for a few moments when she was held in the arms of her daughter. The remedies employed, Belladonna, Nux, lod., Secale, Crotalus, etc., gave not the slightest relief, when Dr. Cramoisy selected the Tar- antula which, in less than a month, effected a complete and radical cure. Dr. Farrington quotes a case of spinal irritation cured by Tarantula, of which the characteristic symptoms were as follows: excessive sensitiveness, the slightest touch upon the dorsal vertebra producing spasmodic pains in the chest and indescribable distress in the cardiac region ; sensation at times, as if the heart turned over; intense headache, which was relieved by gently rubbing the head against the pillow; general parching heat and trembling of the whole body and even of the tongue. The use of the Tarantula in cases of obstinate neuralgias which present its characteristic symptoms has been very com- MILIARY PNEUMONIA. 335 mon; and even in certain eruptions, like the ordinary prurigo, accompanied by acrid, yellow leucorrhoea. This remedy is frequently applicable to certain forms of uterine disease, such as uterine colic, menstrual difficulties and some organic lesions of the uterus, among which may be specially mentioned chronic engorgement, which have been either cured or surprisingly ameliorated. Among the notable cases on record we may mention that of a lady, aged 36, of a feeble, lymphatic temperament, who ever since the birth of her first and only child, sixteen years before, had been so irreg- ular in all her generative functions that, notwithstanding the most elaborate specific treatment, she became steadily worse and had lost all hope of cure. Frequent metrorrhagias lasting twelve or fifteen days, persistent leucorrhoea, pains in the legs and sacrum, emaciation and pallor of countenance, constant sense of fatigue, sighing, oppression and pain in the chest, fear of impending death, sleeplessness, nervous trembling, etc., all produced a state of complete anaemia. Physical exam- ination revealed such an increase in the size of the uterus that it extended to within two inches of the umbilicus ; while the uterine cavity was diminished, with anteversion, catarrh of the neck, and clear viscous leucorrhoea. Little benefit had been obtained from any of the remedies employed for three years previous, such as Platina, Sabina, Crocus, China, Arsen- icum, Secale, etc., but the continuous treatment for two or three months by Tarantula, the 200th and 12th triturations, so greatly modified the disease that the uterus lost more than half of its abnormal size, menstruation became regular, a light form of eczema appeared on the internal aspect of both thighs and the general condition was notably improved. The patient is not yet completely well, but the results so far warrant us in predicting a speedy and surprising cure. It is the duty of the homoeopathic profession to study the Tarantula and fully complete its pathogenetic indications. Thus far it has been employed in little more than nervous dis- orders ; but its action is much more extensive and far reach- ing. The functions of nutrition, the cellular tissue, the lym- phatic vessels, are all included in its domain. 336 world's homoeopathic convention. We now close this imperfect sketch ; we have only had in view to call the attention of the Congress to the possibi- lities of progress in Medical Science, based upon the doctrines of Hahnemann. The two points which we have selected, one in clinical medicine, the other in therapeutics, both from the archives of the Ilahncmannian Society of Madrid, clearly prove that it is possible to accomodate the new and powerful means of inves- tigation and of pathological analysis to our doctrines of dis- ease, which they indeed strengthen and confirm ; and, more- over, that when new provings and the purification of those which we already possess come to enrich our Materica Medica with all the aids which chemical and microscopic analysis, the thermometer, the sphygmograph, etc., will supply, then our therapeutics will be as potent and complete as even modern science has a right to demand. May those Homoeo- paths, who live in countries where the intellect is more serene and the mind more disposed toward such investigations, than they can be in this poor Spain, take up these labors and com- plete so important a work. For this do we, Spanish Homoeo- paths, ever fervently pray. LATENT PNEUMONIA IN THE AGED: DIGITALIS. By P. Jousset M. D., Paris. Physician to the Hopital Saint-Jacques. Octogenarians and those who, without having reached the age of eighty, are prematurely decrepit, frequently die of pneumonia. In particular cases the disease is the more dan- gerous from the fact that it generally makes its appearance without appreciable cause, and is not accompanied by any of the ordinary symptoms; during the first four days, at least, it is scarcely distinguishable except by the high temperature which always accompanies pneumonia. The onset is sudden and is marked by a chill with vomiting; the fever continues with redness of one of the cheeks; dry tongue, dark red urine without deposit. The patient neither coughs nor expectorates, and the stitch in the side is either absent or very obscure; the dyspnoea is in proportion to the height of the temperature. Auscultation doubtless furnishes valuable indications but they have not the clearness of those which we observe in the pneumonia of adults ; but let us add that very often old people object to a careful and minute examination of the lungs. The comparative dulness and obscurity of the respiratory sounds and some moist rales are often the only palpable signs during the first days. The disease thus instituted progresses according to the usual type. Sometimes we observe an abatement of the fever on the 337 338 world's homceopathic convention. fourth day, but it is from that time that the patient sutlers frequent attacks of coughing with viscous and more or less bloody expectoration; we rarely fail to hear also a blowing sound and crepitant rales. After the fifth day, the nights become more disturbed, the patient has hallucinations and delirium which disappear when his attention is occupied. AVe have never noticed in this variety of pneumonia the continued delirium, which characterizes the metastatic meningitis of adults. The temperature and dyspnoea increase during the last days and death generally conies quite peacefully at the end of the first or in the course of the. second week. Almost always with these patients, we notice toward the end of the first week an irregularity of the pulse which, in my estimation, is very significant as influencing the prognosis and treatment. But here it is necessary to make an explanation : in a certain num- ber of old people the pulse is habitually irregular, and this irregularity which most physicians erroneously consider as normal in old people is always the sign of a lesion of the heart or of the aorta, and in these patients the habitual irregularity of pulse disappears during the febrile stage of pneumonia and it reappears when the temperature diminishes. In other words, the return of the habitual irregularity of pulse is a favorable sign in certain cases, except in those of which we shall now speak. If the irregularity of the pulse, after having disappeared at the beginning of the disease, reap- pears, without an amelioration of all the symptoms, and is greater than is habitual, this irregularity is a very unfavorable sign. With the exception of such cases as are enumerated above, the irregularity of the pulse in the course of pneumonia is an exceedingly unfavorable sign and announces a speedy dissolu- tion ; the disappearance of this irregularity is, on the contrary, an excellent sign, and an almost certain presage of recovery. The therapeutic indication which we have deduced from several cases of irregularity of the pulse in pneumonia is the necessity for the use of Digitalis. In a very recent case we have had the happiest effects from this drug. Madame C., aged 81 years, a lady unusually lively and ac- PNEUMONIA-DIGITALIS. 339 tive for her age, is subject to bronchitis and even to pneumo- nia. To avoid these diseases, she passes most of her winters in Italy. This patient does not present any symptoms of car- diac disease. Having returned to Paris in the beginning of May, she suffered from the cold weather which we had at that time, and neglected to observe the customary hygienic precau- tions which her great age demanded. The 27th of May she was attacked with violent fever, a chill and vomiting; the pulse was regular, under one hundred pulsations per minute; the respiration quickened, the left cheek red, the tongue coat- ed, and urine red; the patient was greatly disturbed and un- easy, complaining of headache, and with a vague pain in left side of chest. Cough and expectoration were absolutely want- ing. The respiratory murmur was obscure on the left side, and on deep inspiration tine rales were heard, which had the character of the crepitant rale. I prescribed Bryonia12, some soup, and a spoonful each of brandy and coffee in a glass of sweetened water, for drink. The patient remained in this state until the fifth day. Bry- onia and, a little later, Phosphorus12, were totally without ef- fect. From the fifth day the condition was more serious ; the fever increased, the pulse became irregular and unequal, the tongue dry ; the urine diminished in quantity and became very red and contained bile ; at the same time the white of the eyes became jaundiced. Hallucinations and incoherence as soon as the patient falls asleep. The patient now coughs from time to time, and expectorates very bloody, viscous sputa. Finally auscultation reveals a blowing sound in the apex, and some irregular crepitant rales in the middle of the left lung. The nights are very much disturbed, and toward morning the pa- tient has much difficulty in breathing, and is threatened with syncope. Arsenic6 caused no amelioration of this condition and, on the seventh day, in view of the danger from the con- tinuance of this state, and of the permanent irregularity of the pulse, I prescribed Digitalis6, two drops in two hundred grammes of water, a teaspoonful every two hours. The effect produced by this remedy was very rapid ; the syncope did not reappear, and at the end of twenty-four hours there were 340 world's homceopathio convention. scarcely any irregularities of the pulse, the intervals between them growing longer and longer. I alternated Digitalis by day, with Bryonia at night; sleep and appetite returned; the temperature diminished very much, the jaundice disappeared, and I discontinued the use of Digitalis on the tenth day. I still gave Bryonia, and the patient was completely convalescent on the fourteenth day of the disease. From this experience I deduce the conclusion that pneu- monia of old people is not entirely beyond the reach of art, even in the latent form; and that Digitalis, when it is indicated by the state of the heart and of the pulse, is much preferable to Bryonia and Phosphorus. Let me add that, in this particular form of the disease, Phos- phorus and Bryonia, which constitute the classic treatment of true pneumonia, seem to me very unreliable remedies; and it is to aid the practitioner in difficult cases that we publish the preceding observation. PRIMARY CONGESTION OF THE LUNGS. J. Meyhoffer, M. D., Nice. It would be vain to seek in many works on pathology and therapeutics, of recent date, for information on simple, pri- mary congestion of the lungs ; all that is found therein relating to secondary processes of that nature, consecutive either to other diseases of the respiratory organs, or of the heart, or to such as are termed zymotic maladies. Still there is, perhaps, no morbid manifestation which deserves more serious atten- tion, from its intrinsic importance and effect; and it cannot but be surprising that even the best authors of the present time should treat this affection so lightly. Some of them indeed give a fair description of the course and symptoms of acute pulmonary congestion; but as to its etiology and prognosis, we find statements evincing total absence of insight into the true nature of the disease and almost absolute silence as to its chronic form. We owe to the French school our earliest information on the subject. Andra], in his Anatomie Patholoyique, tome I, 1829, first described the general characteristics of hyper- aemia. Joly (1830), Hausmann and Dechene especially examined pulmonary congestion; and Devergie and Lebert published some cases of rapid and fatal issue determined by it. Fournet, Legendre and Bailly, de la Berge, Monneret and Fleury in France and Mendelssohn in Germany contributed their share to the better understanding of this affection. INTRODUCTION. 341 342 world's homceopatiitc convention. But notwithstanding all these special publications on the subject, pulmonary congestion remained still a debatable ground, occupying no proper place in pathology, until Woillez dispelled the mist by which it was enveloped, by setting forth the views on inflammation which now prevail. Already in 1851 this writer demonstrated, by mensuration of the chest, that congestion of the lungs as well as inflammation, produced an amplification of the thorax ; which subsided with the return of a normal circulation. Moreover he described certain signs by which simple hyperaemia can be recognized at the bed- side. In 1866 Woillez published, in the Archives de hhedecine a paper, the purport of which may be stated as follows: Pulmonary congestion is more easily studied on the living individual than has hitherto been considered possible ; and may be observed under the two following conditions : a. as a pri- mary acute affection with symptoms, course and lesions of its own, by which it may be distinguished from any other dis- ease, especially pneumonia. J. Asa sequel or epiphenomenon of other morbid processes. Finally, a pupil* of Woillez published in 1870 a pamphlet in which he reports twenty-eight cases of acute pulmonary congestion. Of these, the last seven relate to secondary pro- cesses, while of the twenty-one remaining, eight must be eli- minated, either on account of a doubtful diagnosis or of their secondary origin. Niemeyer and Jaccoud prove, by their more or less cautious expressions, that, in their opinion, pulmonary congestion is, in the majority of instances, a more serious affection than they had formerly considered it. They seem rather to have suspect- ed than have formed a definite idea of the intrinsic gravity of this malady; the serious influence of which on life lies, not in its immediate effect and course, (for in itself it is gener- ally harmless and easily controlled) but in its cause and repeti- tion. Though secondary congestion often becomes a prominent feature in the course of the various diseases to which the pec- * Dr. Ernest Bourgeois (De la Congestion Pulmonaire simple.) PRIMARY CONGESTION OF THE LUNGS. 343 toral organs are subject, we abstain from entering on its consi- deration, as that would lead us beyond the scope of this paper. Etiology and Pathogenesis.-The rich capillary network of the lungs, their irrigation by two systems of blood-vessels, the one destined to minister to the function, the other to the nu- trition ; the intimate and direct dependence of the pulmonary circulation on the healthy or morbid action of the heart; and, finally, the influence of external irritants on the vesicles by means of the air-tubes, predispose, in a high degree, the pul- monary tissue to vascular dilatation. Moreover the physiologi- cal importance of the lungs in the functions of life, suggests at once the danger to be apprehended from a sudden and general affluence of blood to these organs. The function of the lungs, like that of any other organ, is entirely dependent on the har- monious working of the arterial and venous circulation. Any disorder in one or the other of these two systems of blood ves- sels produces at once a rupture in the equilibrium of circula- tion. A too great affluence of blood to the arteries, while the emission from the veins remains the same, establishes the pathogenetic condition of what is called active congestion; whereas a diminished evacuation from the veins with a normal supply of arterial blood, constitutes passive or mechanical congestion, i. e., stagnation or engorgement. Pulmonary congestion is generated in divers ways: 1. By paralysis of the vaso-motor nerves. 2. By irritation of the respiratory,surface, according to the old but always true propo- sition, " Ubi irritatio ibi fluxus." 3. By collateral or compen- satory circulation. The latter is, in the majority of cases, sec- ondary to other morbid processes, or follows the suppression of habitual, normal or morbid excretions-menstruation, haem- orrhoidal haemorrhage, etc. Whether the congestion be produced by paralytic dilatation of the blood-vessels, or by direct or reflex irritation, it is under all circumstances a diminution of the vital properties of the tissues. On the other hand, hereditary or acquired debility of con- stitution creates of itself a predisposition to irregularity of cir- culation, i. e., plethora in one part and want of blood in an- other. 344 world's homceopatiiic convention. Therefore pulmonary congestion is not, as some authors de- clare, a common phenomenon among the strong and robust: these form, on the contrary, the exception, i. e., they are sub- ject to this affection only under certain positive injuries, or sudden changes of atmosphere and temperature, local fatigue, exhaustion, violent muscular effort, inhalation of irritating va- pors, gas or dust, or else abuse of alcoholic liquids. Congestion of the lungs is, in fact, most frequent among the delicate, the anaemic and especially the scrofulous. The slender-built youth, with a narrow, elongated chest, white transparent skin ; the children of old, delicate phthisical parents, and chlorotic girls, provide the physician with the largest number of observations on this complaint in its acute and, more especially, in its chronic form. Though individuals of this class often attribute congestion of the lungs to one of the before-mentioned exciting causes, yet no such cause can be discovered in the majority of instances; or else it is so slight as to be inadequate to the production of the supposed effect. Moreover, pulmonary congestion is not an isolated occurrence in the life of these persons. They exhibit, on the contrary, a great tendency to relapses, which, by their frequent recurrence, betray the importance, not of the congestion itself, but of its primary cause, namely, a predisposition transmitted by the parents or acquired by malnutrition. In the same category must be ranged the pulmonary hypersemia of rapidly growing youths; irregular circulation and deficient nutrition are here also the direct or mediate promoters of vascular dilatation. The irritability of the heart, so common at this age, preemi- nently favors all the exciting causes of this affection. It is impossible to explain why over-action of the heart should pro- duce congestion in the lungs; while in the systemic circula- tion such a result from the same cause, hardly ever occurs ; for with the increased tension of the arteries, the pressure in the veins diminishes. Nevertheless, as the fact exists it can for the present only be attributed to some condition of circulation in the lungs as little known as the normal pressure on the pul- monary artery in the healthy thorax. Pulmonary congestion, especially in the chronic state, is often PRIMARY CONGESTION OF THE LUNGS. 345 the sequel of measles, whooping-cough, influenza, bronchitis and pneumonia; hence its frequency among children. Intense action of cold on the cutaneous surface, and, some- times also, extensive burns produce reflex congestion. It is the indiscriminating fashion of the present day to place phthisical invalids under conditions of a diminished atmos- pheric pressure ; in other words, to send them to high Alpine regions. But the very rarefaction of the air in great altitudes is the most active generator of vascular turgescence in the lungs,* as is amply proved by the reports of all the scientific explorers of the Swiss Alps and the Andes, as also by those of aeronauts. Hence, also, the constant presence of congestion in the lungs, whenever, with a normal capacity of the thorax, the introduction of air is impeded by an obstacle in the larynx or trachea. The effect is the same as that produced by the cupping-glass. It is no less remarkable fact that chronic congestion shows a great preference for the apices of the lungs. This very selec- tion in itself suggests a priori that there must be other causes at work besides weakness of constitution or hereditary trans- 'mission; and that these lie chiefly in the anatomical disposi- tion of the lungs themselves. Indeed the upper lobes of these organs have to accomplish their functions under great disad- vantages. Not only is the ascending arrangement of the air- tubes, with their sudden and numerous divisions, an obstacle to the easy access of air to this section of the pulmonary tissue, but, also, the whole apparatus of the shoulders and arms acts as a compressor on the chest, and hinders the free expansion of the first ribs, in the ordinary superficial style of breathing. Deep inspirations alone, which necessitate elevation of the shoulders, incite the apices of the lungs to action. These, therefore, in persons of sedentary habits, are in a more or less permanent state of repose; and since, according to physiologi- cal laws, any organ or part of an organ which does not duly accomplish its functions, suffers deterioration, they lose their * Dr. Meyer-Abrens. Die Bergkrankheiten, Leipzig, 1854. Dr. H. C. Lom- bard, Les Climate des Montagnes, Geneve, 1858. 346 world's iiom®opatiiic convention. vital energy, and thus become liable to congestive and inflam- matory processes. This is, however, not the sole consequence of the deficient action of the lungs. The introduction and absorption of oxygen increase in direct proportion to the frequency and depth of the inspiration ; while the expulsion of carbonic acid augments in the same ratio. It is, therefore, easy to understand that in those parts of the lungs, which are the least ventilated, there must remain a stagnant atmosphere of carbonic acid. This, in its turn, not only prevents the absorption of the vivifying oxygen, but also a portion of this deleterious gas is retained in the organism and gradually undermines the vitality of the whole system. This view is not a mere hypothesis, but the result of clinical experiments which every physician can conduct and verify in the following manner: In any case of simple chronic conges- tion in the apices of the lungs, let the patient practice, meth- odically, several times a day, such formulae of respiratory gym- nastics as serve to expand the upper portions of the lungs; and in a relatively short time it will be found that parts formerly condensed have recovered their normal elasticity and function, without the interference of any medical agent. Collateral and compensatory congestion of the lungs is the product of compression or obliteration of the blood-vessels in some parts of these organs. The capillaries of the healthy parts become dilated, turgescent; and, before a certain equi- librium has time to be established, the congestive process often assumes a gravity superior to the disease which caused it. Pneumonia, pleurisy, emphysema, tuberculosis and ob- struction of the pulmonary artery are always accompanied by a collateral congestion. Usually confined to a limited surface, it may become general from the suppression of an habitual haemorrhage or congestion (menstruation, haemorrhoids, ar- thritis, gout), or it may be caused by the contraction of the peripheral capillaries in the cold stage of malaria. All these forms of congestion may lead to haemorrhage, es- pecially when tubercles exist in the lungs. There is, however, a class of young persons prone to haemoptysis, in whom the most careful examination fails to detect the slightest trace of -tubercular deposit. PRIMARY CONGESTION OF THE LUNGS. 347 Passive congestion or venous stagnation is the inevitable consequence of an incomplete evacuation of the pulmonary veins. The emission from them is less than the afflux of ar- terial blood, hence the higher degree of dilatation and engorge- ment of the capillaries than in active congestion. Valvular lesions are here the cause of the mischief, especially obstruction and regurgitation of the left auriculo-ventricular aperture; valvular insufficiency or narrowing of the aorta pro- duces the same effect, but in a minor degree. Less direct, but leading to a similar result, is the incomplete evacuation of the right ventricle. Inability of the vena cava to void its contents into the auricle produces in its system an extremely high pressure; which reacts, in its turn, on the ar- terial circulation, and prevents the complete evacuation of the left ventricle. As primary cause of this condition must, how- ever, be pre-supposed an obstruction in the circulation of the lungs (bronchitis, emphysema). The worst forms of passive congestion are those resulting from loss of propulsive power in the heart; either of the ven- tricles frees itself, with each systole, of its contents; hence their dilatation ; the blood accumulates in the lower lobes of the lungs, according to the law of gravitation, and soon gives rise to serous infiltration or oedema. This form of congestion is the habitual epi-phenomenon of adynamic processes; of adi- pose deposit on and in the substance of the heart, and, more especially, of fatty degeneration of its fibres. Pathological Anatomy.-According to Stokes and Niemey- er, the affected portion of the lung presents at the initiatory stage of congestion an aspect of intense arterial injection and dryness; this, however, soon changes with the progress of vas- cular turgescence to a deep-red color; a bloody, turbid, frothy liquid exudes from it when cut, which also partly fills the air- tubes ; its density is greater, retaining the impression of the finger; and it crepitates under pressure, though less than in the normal state, and still floats on water. A more advanced stage is characterized by a dark red or purplish color. The interstitial tissue and the walls of the vesicles arc so much swollen that it is hardly possible to recog- 348 world's homceopathic convention. nize traces of the areolated structure of the lung. Its density lias become like that of the spleen (hence the name of " splen- isation " given to this condition by the Germans) and frag- ments of this part of the lung will sink in water. In chronic congestion the pulmonary tissue has a purplish color and is indurated; its section presents a smooth, porous, sometimes grayish surface; yields, on pressure, a small quantity of a thick, reddish fluid, and its fragments sink in water. Mechanical congestion follows the law of gravitation, and occupies the lowest parts of the lungs. Symptoms.-Jaccoud affirms that unilateral limited conges- tion does not produce any functional disorder. This affirma- ation is not correct in all cases of acute congestion. No doubt, in the majority of instances, pulmonary congestion comes and goes without causing more than a slight and transitory discom- fort ; especially with individuals predisposed to pulmonary affections. On the other hand, it is no less true that the more sudden the congestion, and the healthier the individual, the greater are the disorders of the respiratory functions induced. A relatively limited congestion in one of the lungs, suffices sometimes to produce considerable febrile action and difficulty of breathing. In general, sudden congestion of both lungs is rapidly fatal. Paralytic dilatation of the whole capillary net- work of the lungs induces an almost complete stagnation, sus- pending the circulation in these organs ; hence, also, the oxi- dation of blood which necessarily leads to asphyxia. A fatal issue is, however, more the result of the incapacity of the heart to move the arrested mass of blood in the lungs. Sometimes an abundant haemorrhage is the immediate cause of death, but this is generally connected with tubercles or organic disease of the heart. Between acute and uncomplicated congestion and general vascular paralysis of the lungs, this morbid process appears under a great variety of objective and subjective symptoms. Among the first, sibilant rhonchi, or fine, moist or coarse rat- tles are frequent. No less common are cough and oppression; the latter are, however, not always the exact expression of the local condition of the lung. The congestion may be extensive PRIMARY CONGESTION OF THE LUNGS. 349 and yet cause no other inconvenience than moderate dyspnoea; while a more limited capillary dilatation, which involves the finer air-tubes, may be the generator of much pain, distressing cough and great difficulty of breathing. The same variation is observed relative to pain; intense pleurodynia often ac- companies a relatively-circumscribed vascular congestion; while, in other cases, almost the whole lung may be affected with little or no pain. As a rule, acute congestion begins suddenly and is initiated by a shiver. This varies from a creeping chilly sensation along the spine, to intense rigors. Commonly, however, the patients complain for days of chilliness, slight, fleeting shivers alternating with a sense of heat or simply of a feeling of dis- comfort, until pain in the side or cough reveals the situa- tion of the morbid process. Pain in the side is one of the most constant symptoms and is usually, the first which seriously arouses the attention of the sufferer. As its seat corresponds, in general, to that of the insertion of the diaphragm, it easily induces a belief in the existence of incipient pneumonia or pleurisy. The pain however is sometimes absent, is at others so slight as only to somewhat impede deep inspirations; while at times it affects in a greater or less degree all the muscles of the side of the chest implicated. What is the nature and where the seat of this pain ? In some it is rheumatic and the great pectoralis and intercostals are found to be especially affected ; in others, it assumes a neuralgic character, and fol- lows the intercostal nerve from its point of issue all round the side of the thorax, when the slightest pressure on this nerve increases the pain to an intolerable degree. This circumstance induced Woillez to distinguish two forms of congestion, the simple and the neuralgic. Such a distinction, based on a mere accidental symptom instead of on an intrinsic difference of the morbid process, is too arbitrary to be admitted. Moreover, congestion is often accompanied by pleurodynia ; which, like neuralgia, is exaggerated when the intercostal muscles are moved with the tips of the fingers in a direction from the front backwards; whereas pressure with the palm of the hand, at once brings relief. Whatever be the nature of the pain, it is always increased by respiratory action. 350 world's homceopathic convention. There can be no doubt that pleurodynia is often the result of the congestive process affecting the pulmonary pleura; in which hyperaemia cannot but produce considerable tension and, consequently, proportionate pain. This view is corroborated by the decrease of the pain in proportion as the pulmonary congestion subsides. Intercostal neuralgia docs not follow quite the same course. Though the violence of the suffering abates with the return of the vascular dilatation to its normal condition ; it continues sometimes for days together, after the lung has resumed its healthy function. It may, therefore, be presumed that there was also congestion at the origin of the affected intercostal nerve. Febrile action is a common phenomenon of acute pulmonary congestion. It is, nevertheless, sometimes so slight and tran- sitory as to escape the notice of the physician ; and rarely lasts beyond from twenty-four to thirty-six hours. Immedia- tely after the shiver, the pulse grows quicker and generally ranges between ninety to one hundred, seldom higher. A rise of the temperature coincides with the acceleration of the pulse and in some cases is the only symptom of fever; the variations are, however, but slight and seldom exceed 103° F. As a rule the febrile symptoms appear to be in direct relation to the constitution of the patient and the cause of the con- gestion ; the healthier the former, the more sudden and intense the latter and the more prominent the febrile action. Dyspnoea is one of the foremost symptoms of pulmonary congestion ; but it varies from a slight oppression to the highest degree of orthopnoea. It is not always correspondent, in in- tensity, to the extension of the vascular dilatation ; but depends on several concomitant conditions. The most important among these, is the propagation of the congestive process to the ter- minating ramifications of the air-tubes, followed by imperfect ventilation or superficial breathing, resulting from the pain which each inspiration exacerbates ; and finally, by fever. Under the combined action of these circumstances the respira- tory movements become frequent, ranging from twenty-four to forty per minute, and the patient complains accordingly of oppression and want of air. In accordance with the difficulty PRIMARY CONGESTION OF THE LUNGS. 351 of breathing is the appearance of the patient. In mild cases the countenance is placid or simply shows signs of suffering when he coughs, moves or takes a deep breath ; in more serious cases the face becomes red, purplish or bloated ; and anxious when the dyspnoea is great and distressing. Still there exists a great contrast between these formidable symptoms of im- paired respiration and the general febrile action ; the pulse and temperature do not correspond by their frequency and eleva- tion to the gravity of the local phenomena. This circum- stance has often led to a mistaking of pulmonary congestion for an attack of asthma. This error is the more easy as, with a well covered chest, it requires a delicate ear to seize the some- times very slight differences of resonance. Cough is more the effect of bronchial irritation than of pul- monary congestion. It is often entirely absent, but as the congestion is rarely limited to the pulmonary vesicles, and generally extends to the air passages, it induces in these parts functional disorder of which a cough is one of the most com- mon and troublesome forms. Nothing particular need be said here about the character of the cough : it is only to be re- membered that its absence implies little or no bronchial irrita- tion. Congestion may extend over a large surface of the lung tissue, unattended by the slightest cough. The same may be said of expectoration, as it is correlative to cough. Entirely absent in the beginning, or frothy after se- vere coughing, it soon becomes viscous and assumes the well known catarrhal character. Sometimes, however, it is tinged with blood ; or sputa of a pure, bright red, frothy blood are brought up ; even hemorrhage is no very uncommon occur- rence, especially when the congestion is sudden and general. There are, however, certain individuals particularly prone to pulmonary congestion and hemorrhage. These are generally persons of a nervous temperament, with a quick pulse and thin, transparent skin, who are commonly considered as victims of phthisis long before any tubercular deposit can be discovered. The error is here a serious one, as most of such patients might be perfectly restored by proper treatment, whereas, if regarded as consumptive, they run a great chance of becoming so in reality. 352 world's iiomceopatbic convention. Physical signs. These are of unequal value and acquire pathological importance only by their relation to each other. Thus, those obtained by yyercussion are neither constant nor reliable; the resonance may be either normal, tympanitic or slightly dull. This variation, of course, depends on the den- sity of the pulmonary tissue. Ilyperaemia, which does not very materially incapacitate the vesicles of the lung to hold air, will not present any appreciable diminution of sound. The tympanitic sound is produced, according to Wintrich, the best authority on the matter : 1. By the presence of cavi- ties in the lung ; 2. By diminished tension of the pulmonary tissue in the thoracic cavity; similar to that which it presents after death when the lungs are separated from the chest; 3. By the simultaneous presence of fluid and air in the ve- sicles. Vascular dilatation in the pulmonary tissue necessarily modi- fies the elasticity of the latter; its power of expansion decreases with its capacity for holding air. The tension of the lung is diminished; its vesicles still contain air but in a smaller pro- portion ; hence it is that the sound produced by percussion, on such parts, is of a higher key than that of the healthy part of the lung, where a larger volume of air is brought into vibra- tion. Thus, the tympanitic sound is one of the most valuable signs of congestion ; in connection with the corroborative ausculta- tory signs. With the increase of density in the lung, percus- sion elicits the various shades of sound comprised between the tympanitic and the absolutely dull one. In acute congestion, however, the dull sound is rarely to be remarked; we have found it only in two cases and in them it was transient. In chronic congestion, however, the dullness beneath one or both of the clavicles is often complete and persisting. The resistance of the thoracic walls is hardly ever modified by a circumscribed congestion in the lungs ; but if a whole lobe or lung is involved, the elasticity of the walls becomes impaired and their resistance greater. The signs of congestion furnished by auscultation acquire, then, their pathological significance only through their relation PRIMARY CONGESTION OF THE LUNGS. 353 to its other signs. There is no pathognomonic symptom of this affection. Thus cautioned, we may say that feebleness of the respiratory murmurs, combined with a tympanitic sound, con- stitute the most important sign of pulmonary congestion. The respiratory noise may be altogether absent, or harsh, the expi- ration prolonged and tubular; rhonchi and rattles of various kinds may be heard; but all these abnormal phenomena are too common in other diseases of the hmg and air tubes to possess any special diagnostic value. Such a complexity of signs of the morbid action in the ventilating organs is generally con- sidered, especially if there be dullness on percussion, to indicate a condition more serious than simple congestion; but it must be remembered that all of them may be nothing more than products of the latter. In acute cases the doubt will not be of long duration; for, within a few days, the congested lung will resume its healthy function. The presence of a feeble bruit on inspiration must always direct the attention to the cause of this insufficiency of action. This is either the consecpience of a feeble respiration ; of dimin- ished elasticity of the pulmonary tissue after acute congestive ; diseases, (or typhoid fever, diphtheria, etc.); of exudation and fluids incompletely obstructing the air-cells ; of emphysema; or finally, of para'ysis of the respiratory muscles. Proceeding by careful elimination, it will in most instances be possible, if noc always easy to diagnose uncomplicated con- gestion. The anomalous sounds in the lungs incident to congestion arise from the same cause as the feebleness of the vesicular murmur; that is, deficient dilatation of the air-cells. The lining of the terminal ramifications of the air passages is swollen ; and the latter are compressed by the relaxed and condensed pulmonary tissue; the air penetrates, therefore, with difficulty into the vesicles, and finds still greater impedi- ments to its exit in the loss of their elastic power. Hence the rough, prolonged, more or less distinctly tubular expira- tion, accomy anied by sibilant rhonchi. The moist, fine and coarse rattles, so common in this affec- tion, are the product of a sero-mucous exudation in the air- 354 WORLD'S HOMtEOPATHIC CONVENTION. cells and tubes impeding free inspiration. There is little to say on vocal resonance. An increase may be sometimes re- marked coinciding with an extremely feeble or totally absent respiratory bruit. Though rare in acute congestion, it will be found a frequent phenomenon in the chronic form. Finally, every acute congestion of the lungs of any extent increases the amplitude of the affected side of the chest. Woillez's cyrtometre or Sibson's chest-measurer will show exactly the difference between the sound and congested parts of the chest. This measuring is certainly of much interest from the symp- tomalogical point of view, but is of little value at the bedside. As a general rule, primary or active congestion is rarely bi- lateral ; exceptionally, however, it affects both lungs exten- sively and proves, then, rapidly fatal (Devergie, Lebert). But owing to a certain sympathy between the two lungs ; a careful examination will often find a degree of hyperaemia in the supposed healthy lung. Secondary and passive congestion, such as occurs in dis- ease of the heart, in eruptive and typhoid processes, is habit- ually bi-lateral. Idiopathic, acute congestion, accompanied or not by inter- costal neuralgia, or pleurodynia, is sudden in its evolution and rapid in its course. Left entirely to itself it will rarely leave a trace of its presence after the sixth day from its commence- ment. Under an appropriate treatment, the disease will seldom last more than two days: and often terminate in less than twenty-four hours. It would therefore appear, that pulmonary congestion is one of the mildest morbid processes to which the respiratory organs are subject, and rarely causes serious apprehension. Such is, in truth, the fact, as long as it is simply an accident happening to a healthy, robust person. But, among the large number of those suffering from this affection, the healthy and strong form but a small minority; the majority being represented by individuals of weakly constitution. With such, pulmonary congestion is not a mere accident but the evidence of a low vitality or of a morbid predisposition. Individuals of this class do not generally come under med- PRIMARY CONGESTION OF THE LUNGS. 355 ical observation, unless some troublesome or alarming symp- tom (such as beating of the heart, or spitting blood) deter- mines them to seek advice. Most of them are young overgrown people ; but some are the offspring of old or unhealthy parents, many of whom be- tray by the swollen and red borders of the eyelids, the thick nose and lips, the thin, transparent skin, a strumous taint. Ex- amination of the chest of such patients often reveals a dimin- ished resonance below one or both of the clavicles, generally under the left one, combined with a lessened, indistinct respi- ratory murmur, a slight inspiratory cough, with sometimes a rough prolonged expiration. These physical signs indicate various degrees of impaired contractility and condensation of the lung tissue from a slight change to absolute consolidation. This circumstance has often misled experienced physicians to regard as tuberculosis of the lungs in the first stage, cases which were in reality nothing else but chronic pulmonary con- gestion, and to treat them accordingly. It would be difficult to trace out a symptomatology of this form of pulmonary disease. The initiatory stage being so in- sidious and latent that usually the patients have no suspicion of there being anything wrong with their lungs unless a dry, hacking cough, or blood-spitting, calls their attention to the matter. Adolescents often complain of troublesome beating of the heart; their pulse is frequent, the least exertion pro- duces painful palpitation and breathlessness; while, on exami- nation, nothing can be found but slight consolidation in one of the lungs. This form of congestion is most frequent among children ; and then is, in most cases, the sequence of measles, whooping- cough, bronchitis, pneumonia, or even simple influenza. The convalescence from the acute disease makes but slow progress, the little patients remain languid, and sometimes febrile symp- toms appear toward evening; or a dry, short cough, the rem- iniscence of whooping cough continues, resisting every kind of treatment, and before long one or both of the apices of the luno-s will exhibit signs of congestion. o o o The congestive process often assumes an acute aspect under 356 world's iiomceopathic convention. the form of frequent repetitions in the same lung. In these instances, though the attacks are usually sudden, the conges- tion shows a great tendency to endure and to leave a nucleus of condensation, which each successive affluence of blood in- creases. I have, at this moment, a clergyman under my care, who, for the last six years has, every winter, suffered from congestion of the right lung. As long as he remained in the North, he was hardly ever quite free from it during the winter months; while during the last three winters which he spent in the South (one in Cannes and the last two in Nice), the con- gestive attack of each successive winter was shorter and mild- er than the preceding one. A recent attack was accompanied by febrile symptoms, much oppression and cough, while the w'hole of the right lung was affected; nevertheless, in less than a week, this lung resumed its normal function. It was the mildest attack he had experienced. The physical signs were here, as in most instances, those of the first stage of pneu- monia, i. e., diminished resonance, and fine crackling rales over the whole surface of the lung. Temperature, 102.5° Fahr.; pulse, 90. These last conditions, combined with the firm and bulky muscles of the patient and his otherwise good constitu- tion, excluded at once acute pneumonia or tuberculosis and affirmed the congestive nature of the disease. This form of congestion appears to us to be particularly fre- quent among youths and young men ; also among professional people accustomed to oratorical or vocal efforts. This or any other chronic congestion of the lungs runs often into chronic pneumonia and caseous exudation; and is, in most instances, the initiatory stage of phthisis puhnonalis. This issue is, how- ever, in many cases more the result of neglect or mismanage- ment than a necessary sequence of the congestive process. The latter may lead simply to an imperfect expansion of the pulmonary vesicles, and consequently to a sub-inflammatory condition or thickening of their walls; a kind of atelectasis (Bouchut); hence, reproducing all the phenomena of impaired elasticity and consolidation of the pulmonary tissue. More- over clinical experience teaches that the signs of the latter are mobile. Most members of the profession are aware that, in PRIMARY CONGESTION OF THE LUNGS. 357 chronic pneumonia, extensive dulness is often superseded by normal resonance; the signs of imperfect aeration give place to a vesicular murmur, and a morbid condition persists only on a small surface. They interpret it correctly as a chronic con- gestion round an inflammatory focus, which has given way to a healthy circulation. Now, the same chronic congestion, in- stead of being secondary, is frequently a primary process, which exhibits a particular tendency to settle in the apices of the lungs. It may exist for a considerable time, like conges- tion of the liver, the kidneys, the womb, etc., without produc- ing a permanent alteration of the tissue, which, under this con- dition, may at any time resume its physiological function. This very capacity of chronic congestion of the lungs to un- dergo a healthy transformation, has led many physicians into the error of believing they have cured pulmonary consump- tion. This error is, moreover, often unavoidable, because, as be- fore remarked, the seat and signs of these affections are iden- tical, the first being frequently the primary stage of the sec- ond. Herein lies the gravity of chronic pulmonary congestion. Under circumstances favorable to its development, such as hereditary predisposition, low vitality, unwholesome hygienic condition, the congestion may drift into tuberculosis of the lungs. The presence of consolidation in the lungs, therefore, obliges the physician to use great circumspection before giving his opinion on the nature of the disease; days and weeks of ob- servation may be necessary to determine whether it be the product of simple congestion, atelectasis or chronic inflamma- tion. The recoveries from phthisis pulmonalis reported from the various hydro-mineral stations may be counted by hundreds. Surely there can be no doubt that, amon? this larg-e number must have been many cases which presented all the physical signs of the first stage of tuberculous deposit; but which were neither more nor less than congestion. It is, on the other hand, not less certain that the great num- ber of invalids, laboring under incipient phthisis, sent to the 358 world's iiomceopatiiic convention. springs of Cauterets, Enghien, Eaux-Bonnes, Ems, Luclion, St. Ilonore, etc., return thence either improved in health, but still exhibiting the old signs of consolidation, or with the fatal result of softening of the caseous exudation. The min- eral waters either cause the calcareous transformation of the morbid product, which, if not too circumscribed or located in the centre of the lung, will always betray its presence, or else the latter falls into decay and produces ulceration. Moreover, every physician in good practice must have observed how fre- quently children or adolescents, recovering from an epidemic disease, remain languid and feverish, and, before long, exhibit signs of condensation in the lungs. The parents are warned of the serious turn of the malady, and justly so, according to the present teachings of science; but let these young invalids be sent into the country; prescribe open-air sports and respi- ratory gymnastics, and many of these will return home in blooming health, with no trace of mischief in the lungs. The diagnosis of chronic congestion presents, thus, great dif- Acuities; but before we examine how they may be vanquished, a few words need to be said on the course of the disease. Acute congestion in persons of good health rarely lasts long- er than six or, at the utmost, seven days ; and, not seldom, the lung resumes its physiological function in twenty-four hours. The mean of duration, without medical interference, is three to four days. The beginning is generally sudden ; shiverings, fever, pain, and the thoracic signs appear simultaneously. The fever is generally very moderate, sometimes quite absent, and the ele- vation of the temperature rarely exceeds 2° Fahr, above the normal. With the disappearance of the febrile symptoms, all other morbid signs and functional disorders vanish also, and the convalescence is almost as sudden as the attack. The course of pulmonary congestion in persons predisposed to delicacy of the chest is far less favorable. With such pa- tients there is usually vascular turgescence of the lungs, which, though sudden, shows a tendency to linger, sometimes continu- ing for weeks, while it exhibits, moreover, great inclination to relapse. PRIMARY CONGESTION OF THE LUNGS. 359 Usually these attacks are also attended by a greater frequen- cy of the pulse, and a slight elevation of the temperature ; and when these last two symptoms appear in the course of one of these subacute forms of congestion, it will be found that the latter has experienced a new extension, or that the healthy lung has become involved by the congestive process. It is thus that chronic congestion often begins. Its commence- ment is, however, frequently so obscure, that it is impossible to determine the moment of its formation. It may exist for months without causing any troublesome symptoms. An exception must be made here for children. With them, congestion of the lungs, whether it be the consequence of cap- illary bronchitis or not, is always accompanied by much cough- ing and great disposition to feverishness; its course is, there- fore, more rapid on account of its subacute character, and also on account of the greater predisposition of children to the for- mation of tubercles. As regards the latter, it is impossible to say how long chronic congestion may exist without leaving permanent trace of its presence. We have observed patients of this class, declared, from one to three years previously to our seeing them, to be affected with phthisis in the first stage, per- fectly recover under treatment from every trace of consolida- tion. The diagnosis of acute pulmonary congestion presents rarely any difficulty, and it is almost impossible to err, unless in mis- taking the case for the first stage of acute pneumonia. The physical signs of the latter differ little, if at all, from those of a high degree of congestion, though there is a great difference in the temperature between the two diseases. In congestion this rarely exceeds 101° to 102.5° Fahr.; whereas in pneumonia it reaches rapidly (within five or six hours) 103° to 105° Fahr. This sudden rise of temperature which marks the invasion of pneumonia; and which, with some exceptions, persists, with slight morning remissions and evening exacerbations, through- out its course until a crisis occurs, is almost sufficient to dis- tinguish it from other diseases. In congestion the elevation of the temperature is as transitory as the other febrile symp- toms. 360 world's iiomceopathic convention. The following comparative sketch will show at a glance the great difference between the two diseases : CONGESTION. Fever slight and not lasting longer than three or four days. Temperature does not ex- ceed 1U2.5° Fahr. None or but slight cough. No expectoration. Never bronchophony. Great variability of the tho- racic signs. PNEUMONIA. High fever persisting five days, at least; seven days in the mean, and nine at the most. Temperature rarely under 103° Fahr., except in old peo- ple ; it often exceeds 104° Fahr. Cough frequent. Characteristic sputa. Bronchophony. Great fixity of the same. Catarrhal pneumonia, with its troublesome, profuse expec- toration, coarse, moist rattles, and rhonchi of all kinds, dis- seminated over a large surface, is so different in its whole course and symptoms from congestion, that a mistake between them is scarcely possible. As before remarked, pulmonary congestion is not always limited to the lung tissue, but frequently extends to the lining of the air-passages, and leads, therefore, to a mixed character of morbid manifestations. More frequently still, congestion is induced by bronchitis. Under such circumstances, the diag- nosis is all the more difficult on account of the simultaneous presence of both affections. This is especially the case with children, where both these maladies are generally combined; and it is hardly possible to distinguish among the loud and various noises, those appertaining to bronchitis from those caused by the congestion. However, simple bronchitis, unless it be capillary, rarely begins in its pulmonary divisions, but proceeds from the trachea, or is even initiated by a coryza or a sore throat. Moreover, if the congestion be extensive, the resonance of the thorax will be somewhat modified, which is not the case in simple bronchitis; neither is the latter accom- panied by the pain in the affected side of the chest, so usual a symptom in congestion. PRIMARY CONGESTION OF THE LUNGS. 361 Simple bronchitis usually extends over the bronchial divi- sions of both lungs ; whereas, congestion is rarely bilateral, or at any rate, one lung is more seriously affected than the other. Congestion is characterized by the absence of the vesicular murmur; by weakness of the respiratory bruit; by fine crepi- tation, and sibilant rhonchi; bronchitis bv moist rattles at the posterior basis of the lungs. In connection with the difference of these physical signs, is the expectoration ; in congestion there is no discharge, except sometimes a small quantity of frothy, serous liquid; in bron- chitis there is always a more''or less profuse expectoration of a viscous yellow mucus, particularly toward the decline of the disease. The termination of the congestion is sudden, and its course much more rapid, than that of bronchitis. The violent pain in the side of the chest which so frequently accompanies pulmonary congestion, has sometimes led to its being mistaken for pleurisy. This error may be the more easily committed, should there be dulness of sound, and ab- sence of the respiratory murmur. However, the thoracic vi- brations and extremely mobile signs of congestion, must very soon dispel any hesitation as to the nature of the disease. If the diagnosis of acute congestion is, on the whole, easy, that of chronic congestion presents, on the contrary, the great- est difficulties. Its localities and the signs of consolidation are so identical with those of the first stage of pulmonary phthisis, that it is often impossible, at least for a certain time, to make a distinction between them; and the greatest caution is there- fore necessary in giving an opinion under circumstances so doubtful. There, as in many instances of questionable syph- ilis, the treatment alone determines the diagnosis. We have found the following prescriptions very efficacious: 1. Respiratory gymnastics, especially such as tend to bring into action the apices of the lungs; 2. Residence in the coun- try ; 3. Phosphorus; 4. Cold and warm sulphurous springs. One, or the combined action of these remedies restores the lung to its physiological function, if there existed only conges- tion ; tubercles may be transformed into a calcareous mass with its indelible mark, but they are never absorbed. The gray, 362 world's homoeopathic convention. miliary tubercles surrounded by a chronic congestion, chronic pneumonia, and old localized pleurisy, may, by their physical signs, be easily confounded with chronic congestion. But the course of the morbid incidents will soon permit us to exclude the localized pleurisy, and the gray tubercle. Chronic pneumonia has, for the most part, an acute begin- ning. Its bronchophony is such as to convey to the ear the impression of an induration of the pulmonary tissue, more in- tense and extensive than that in simple congestion. The difficulties increase, when, as sometimes happens, chron- ic bronchitis, with, profuse secretion, is complicated with signs of condensation in one or both apices of the lungs. In such, as in all other cases where a doubt exists between congestion and the first stage of tuberculosis, the elements of distinction may be found in the pathological history of the subject and in his constitution. If no hereditary scrofulosis or tuberculosis can be detected, no disposition to bronchial catarrh or haemorrhage; if the gen- eral state of health be satisfactory, and the muscles firm, a strong presumption may be entertained that the case in hand is one of simple chronic congestion. When, on the contrary, the individuals are sickly, thin, feverish, liable to inflammatory processes of the respiratory organs, to haemoptysis, and par- ticularly if their parents have been phthisical or scrofulous, the diagnosis acquires a much more serious aspect. Nevertheless, even in instances of this kind, it must be remembered that the signs of consolidation in the lungs may, as before said, be but the result of simple congestion. Prognosis.-After the description of the course and symp- toms of acute pulmonary congestion, need we say that its issue is one of the most favorable and rapid ? The instances reported in medical literature which terminated fatally, by general affluence of blood to the lungs, are extremely rare. More caution is to be observed as to the probable issue when frequent relapses betray a predisposition to vascular dilatation in the lungs ; much depends here on the age, constitution, and social position of the subject; childhood, adolescence, heredit- ary phthisis and poverty, render the future doubtful; conges- tion of the lungs is here often the precursor of tuberculosis. PRIMARY CONGESTION OF THE LUNGS. 363 These circumstances and the want of diagnostic certitude, O 7 impose on the physician a still greater reserve in chronic con- gestion. Families should not be made anxious without reason. The best course to be followed, in a doubtful case, is, in our judg- ment, to abstain from giving an opinion until after a certain time of observation, stating the reason of this reserve; to keep in view the possible course of the disease, and to procure by appropriate measures the most favorable issue. By proceed- ing thus we have often been able, before long, to show the true nature of the malady by the gradual disappearance of all the morbid signs and symptoms. Chronic congestion terminates in perfect resolution, in ate- lectasis or thickening of the pulmonary tissue, in chronic in- flammation and in tuberculosis. Recoveries from this vascular affection will become more numerous in proportion as its nature is more widely and cor- rectly understood; also pari passu, the number of victims to tuberculosis will diminish in a corresponding degree. Treatment.-Nothing is more simple than the medical man- agement of an acute attack of pulmonary congestion. The frequency of the pulse and the elevation of the tempera- ture as well as the vascular turgescence in the lungsail indicate the exhibition of Aconite. This remedy and rest will, in all simple cases, suffice to restore the suffering organ in a very short time to its normal condition; and relieve the pains in the walls of the chest. Sometimes, however, the pain, whether it be in the muscles or proceed from the pleura, yields most readily to Bryonia while, if it simulate pleurisy, we rely chiefly on Arnica. The myalgic and neuralgic pleurodynia which affects women more particularly, generally gives way to Actaea racemosa, whereas Ranunculus bulbosus answers better for men. Recurrent congestion is usually the result either of a local predisposition, disorders in the circulation, of mal nutrition, or, frequently, of all three combined. Scrofulous children, overgrown adolescents, or those of phthisical origin, are par- ticularly prone to congestive processes in the lungs. These 364 world's homceopathic convention. are moreover, nurtured and kept up, either by an irregular function of the heart, a weak capillary system or, especially, by Anaemia. These attacks of congestion are promptly removed by Phosphorus ; but the principal scope of the treatment lies in their prevention. The nutrition must be improved by appro- priate food, out of door life, muscular exercise within the capacity of the subject, and, if need'be, by change of climate. Among the medicines which act especially on nutrition, as reconstructives, are the various preparations of Lime, Iron, Iodine, Phosphorus, Arsenic, and Silicea. Functional irregu- larities of the heart and blood vessels fall under the dominion of Aconite, Arsenic, Cactus grand., Caffeine, Digitalin, Ferrum, Lachesis, Naja and Phosphorus. Great irritability of the heart with tendency to bronchial or pulmonary hemorrhage often demands an exclusive milk diet. Vascular congestion, considered in itself, is nothing but a paralytic condition of the capillaries; it follows that all the means which tend to restore their elasticity are its curatives. With regard to pulmonary congestion, we know no agent "which has a more promptly vitalizing effect on the pulmonary vesicles than respiratory gymnastics. AH the prescriptions, of this method, which act especially on the upper lobes of the lungs and solicit at the same time deep inspirations produce, in a given time, a more beneficial effect than any other remedy. Phosphorus alone may be con- sidered as a competitor, in recurrent as well as in chronic con- gestion ; it is matched by no other drug for its rapid restoration of a healthy circulation in the diseased lungs of weakly and amemic invalids. The combined use of both of these agents is therefore often productive of the most surprising and satisfactory results. Both have, moreover, the great advantage of being injurious under no circumstances; but, on the contrary, of proving equally beneficial should tubercles be the cause of consolidation, by dispelling the congestion surrounding the tuberculous deposit. The value of Phosphorus and gymnastics is certainly not PRIMARY CONGESTION OF THE LUNGS. 365 lessened by their being also diagnostical remedies. Under their influence the congestion will, in a relatively short time, entirely vanish; or the permanent induration will tell its own tale of the nature of the disease. The very gratifying results obtained in France by the hydro-mineral treatment in the malady under consideration, have induced the French physicians to send all their patients, who exhibit signs of condensation in the lungs, to some of the sulphurous springs of this country. Such a proceeding however is not devoid of danger. These mineral waters powerfully excite the circulation ; hence their salutary influence on con- gestion ; but should there exist a tuberculous deposit in the lungs, there is great risk of producing softening and subse- quent ulceration. Therefore, unless one can be perfectly certain that no other lesion exists in the lungs, these waters must be carefully avoided. However, should the physician's mind be free from doubt he may send his patient to one of the following stations : Cauterets, Eaux-Bonnes, Saint-IIonore, Saint-Sauveur, Ems, etc. As a matter of course the selection of one. or other of these springs must be adapted to the individuality of the patient. Still more efficacious than the mineral waters, and without their danger, is the residence on mountains in chronic con- gestion. Nothing tends more to stimulate a sluggish circulation in the lungs, and to induce capillary contraction, than dimin- ished atmospheric pressure. Neither need there be any fear of injurious effect, should there be chronic inflammation or tubercles in the lungs. These morbid conditions are on the contrary, a further indication for an excursion into the Alps. On the other hand, the very reasons which recommend Alpine air in chronic congestion, militate against its use when the patients betray a great tendency to bronchial or pulmonary hemorrhages. With the means just enumerated at hand, when judiciously employed, it will, in most instances, be possible to restore to health and vigor persons who seemed to be fatally condemned as victims to pulmonary consumption. Nice, France, February 12, 1876. 366 world's iiomceopatuic convention. LITTER ATURE. Joly, 1830, Dictionnaire medical et chirurgical pratique; article congestion, Housmann et Dechambre, Archives de medecine, 1835, 36. Devergie, Medecine legale, 1836. Andral, Rccherches pratiques sur 1'inspection et la mensura- tion de la poitrine, Paris 1838. Memoircs de la Societe d'observation, 1, 111. Fourney, Recherches cliniques sur l'auscultation. Dubois d'Amiens, Premieres legons de pathologie experi- mentale, 1841. Legendre et Bailly, Archives generales de medecine, 1841. Legendre, sur quelques maladies des enfants. Isambert et Robin, sur 1'induration pulmonaire, nominee carnification congestive (Memoire de la Societe de Biologie, 1855.) Rokitansky, Lehrbuch der path. anatomie, Wien, 1855. Wilson, Illustrations of the use of blood-letting in a form of oedema of the lung and pneumonia (Edin. Med. Journal, 1856.) Giinoberg, Klinik der Kreislauf und athmungs-organe, Breslau, 1856. Black, on sudden passive congestion of the broncho-pul- monary mucous membrane (Edin. Med. Journal, 1857). Delioux de Savignac, des Congestions puhnonaires (Bulletin therapeutique, 1859). Oppolzer Ueber Lungenoedem (Allg. Wiener Med. Zeitung, 1860). Zeutrer Beitraege zur normalen und path. Anatomie der Lunge, Dresden, 1862. Mandi, Gazette Medicale, Paris, 1862. Ziemssen, Pleuritis und Pneumonie im Kindesalter, Berlin, 1862. Ferrand, Archives generales de Medecine, 1862. Goudoin, These de Paris, 1866. Ferrand, Union medicale, 1866. Blancpain, De la congestion pulmonaire chronique (Presse Medicale beige, 1867). PRIMARY CONGESTION OF THE LUNGS. 367 Bouchut, Gaz. Hop., 1868. Lolliot, Congestion pulmonaire et cerebrale, suite d'effort (eod. loco., 1868). Bouchard, Bulletin thereapeutique, 1868. Fournier, Congestion pulmonaire developpee sous 1'influence d'une lesion des nerfs vaso-moteurs, etc. (Gaz. Hop., 1868). De la Berge, Monneret et Fleury, Compendium, de Med. Dr. Ernest Bourgeois, de la congestion pulmonaire simple, Paris, 1870. Jaccoud, Traite de pathologie interne, 1872. CIRRHOSIS OF THE LIVER. L. Salzer, M. D., Calcutta. The hepatic disorder which is to form the subject of the present paper essentially consists in inflammation and hyper- trophy of Glisson's capsule and of the connective tissue of the liver generally. In the early stage of the disease the organ is enlarged, and can hardly be distinguished from a liver in a state of active congestion. As the disease advances however, the liver is reduced in size, particularly the left lobe. This ultimate shrinking is owing to a proliferation of the connective tissue, in consequence of which both the branches of the portal vein and of the hepatic duct are ob- structed, thus leading to the destruction of the secreting cells of the liver. The disorders accompanying this pathological state are mani- fold. Owing to the obstruction of the portal circulation we find: enlargement of the spleen ; later, ascites; still later, oedema of the lower extremities, dilated abdominal veins, and sometimes vomiting of blood and bloody stools. Meanwhile there is more or less jaundice; digestion is greatly impaired, causing emaciation and loss of strength. Meteorism is almost a constant symptom, leading often to difficulty of breathing before ascites has set in. The chief cause of cirrhotic degeneration of the liver is the abuse of spirituous liquors. As other causes have been assigned: Malaria, or such climatic influences the prolonged exposure to which may lead either primarily, or through a preceding 369 370 world's HOMCEOPATIIIC CONVENTION. recurrence of febrile attacks, especially of the intermittent type, to a morbid state known as malarial cachexia; High temperature or a prolonged sojourn in hot climates, even when not infected with malaria; and finally- The immoderate use of irritant substances, particularly spices, such as Capsicum. Each of the above-mentioned agents is known to be capable of producing primarily a state of active, and, when allowed to act for a long time, secondarily a state of passive hyperaemia of the liver, with all signs of obstruction in the portal region. There is, however, as far as I know, no evidence to show that either high temperature or Capsicum alone, that is, un- aided by the pernicious habit of alcohol-drinking, has ever produced a genuine case of cirrhosis of the liver. Our prov- ings of Capsicum show no signs of ascites, of oedema or even of enlarged spleen. Otherwise is the case with malaria. Men under the influence of this agent may be found to exhibit all the symptoms pertaining to this hepatic disorder, and even fihe physical signs capable of demonstration by percussion. Yet, even under such circumstances, a reduced liver is rare, the rule being that liver and spleen preserve their enlarged form to the last. The diagnosis, although easy enough in the advanced stage, is difficult in the first stage of the disease. Professor Borelly, of Naples, has lately drawn attention to the fact, said to have been found by him in many cases, that the enlargement of the liver taking place during the first period of this disease does not produce, as in other swellings of the liver, the dull sound on percussion heard low down in the right hypochondrium and epigastrium, but the liver rather enlarges upwards so that the absolutely dull sound begins on the fourth or even third rib of the right side, whereas the lower edge of the liver hardly passes the arch of the ribs. As far, however, as my observations are concerned, I must say they do not corroborate Professor Borelly's statement. In the second stage it is true enough that the hepatic dullness decreases from below up- wards, owing no doubt to the almost constant meteorism and to the ascites often joining it. But, as to the pretended diagnostic CIRRHOSIS OF THE LIVER. 371 sign of the first stage, it is certainly not the rule in India. Dr. Morehead makes also in this respect statements which directly go against those of Professor Borelly. He says :* " The exudation in the early stages, before organization, con- traction and lobular atrophy have taken place, may cause en- larfjement of the liver and its extension below the margin of the ribs." I shall only add here that, in explanation of Profes- sor Borelly's observation, it has been said that the high stand of the enlarged liver is chiefly owing to the softening of the hepatic part of the diaphragm caused by the extension of the inflammation from the serous covering of the liver to the diaphragm. The prognosis in this hepatic disorder must necessarily depend upon the stage in which the disease comes under treatment. Favorable in the first stage, the prognosis is un- favorable in the second stage of the disease. " Much good might probably be effected," says Dr. Ward, "in the earlier stages of cirrhosis, if the disease could then be brought under continuous treatment, and the victims of it could be induced to exercise the self-denial necessary to the arrest of the mis- chief. Mercurial preparations, etc., might induce the absorp- tion of the lymph effused, while it is yet in an organized state. Or, supposing a portion of liver to be irreparably damaged, further extension of disease might be prevented by strict abstinence from spirituous drinks, by bland, nourishing food, and by remedies calculated to improve the tone of the stomach, and to keep up healthy action of the unim- paired secreting structure of the liver."f From these re- marks it will be seen that recovery, even when the second stage of granulation has set in, is by no means a physiological impossibility. Let us also remember that the liver, in its natural state, is in many men larger than is absolutely neces- sary. According to Frerichs, the relative weight of this organ in the adult may vary from 1-24 to 1-40 of the body; so that, could we only succeed in arresting early enough the * Researches on Diseases in India. London, 1870. p. 421. + On some Affections of the Liver and Intestinal Canal, by Stephen H. Ward, M. D., Physician to the Seamen's Hospital, etc. London, 1872. 372 world's HOMCEOPATHIC CONVENTION. progressive shrinking, there may yet be left sufficient liver for the requirements of a well regulated mode of life; and this even without the aid of remedies, as suggested by the just quoted author, " calculated to keep up healthy action of the unimpaired secreting structure of the liver." The treatment, when conducted on homoeopathic principles, might at first sight appear to labor under the disadvantage of being deficient in such therapeutic means as are calculated to promote the absorption of the effused lymph. Experience, however, has taught us that we need not be anxious about organized inflammatory products; that we may moreover fairly trust, for their ultimate removal, to the natural function of the absorbent vessels, provided we can manage to arrest the inflammatory process itself. As malarial fevers have been assigned as one of the causes of the hepatic disorder under discussion, it will not be out of place to state here briefly the practice I have pursued, during a stay of more than seven years in India, with regard to the treatment of intermittent fevers. I divide these cases into two great classes-the one, namely, purely intermittent; the other, complicated intermittent fevers. It is in the inter- mittent type, pure and simple, that Quinine is the remedy par excellence. No massive doses need be given in such cases; the sixth trituration has often proved sufficient. But I never had occasion to go beyond the first decimal trituration, of which I order two or three grains every two, four, six or eight hours during the intermission. In complicated cases, that is cases accompanied by distinctly congestive symptoms of other organs than liver or spleen, or cases where gastric or general catarrhal symptoms prevail during, and extend beyond, the pyrexia, such remedies as China, Arsenic, Ipecacuanha, Nux vom., etc., may either succeed in arresting the attack altogether, or they at least will pave the way for the suitable administration of Quinine. After these preliminary remarks, I shall now proceed to those remedies which have proved themselves to be useful in the hepatic disorder under discussion. The first remedy which suggests itself to the mind of a physician when called CIRRHOSIS OF THE LIVER. 373 to treat a case of malarial cirrhosis of the liver, is alcohol. The similarity of action between alcohol and malaria on the liver should, after what has been said on the subject, hardly need any further illustration. And if we choose to under- stand, as most pathological writers do, by a cirrhotic liver any shrunken, hob-nailed liver of yellowish-brown appearance when cut into, then there is in fact scarcely a difference be- tween the liver of a gin-drinker and that of a malarious fever- patient. We have seen above that the analogy holds good even to all the symptoms characteristic of this disease. Let us however examine, side by side, both the mode of action and the ultimate destructive results of the malarial poison on the one hand, and of the alcoholic poison on the other. As to the former, we know from the researches of Virchow, Frerichs and many others, that the blood undergoes a pigment degeneration, in consequence of which the minute tissue elements contain black coloring matter. Such pigment is seen to accumulate in the minute capillaries of the brain, attaching to the point of division of the small vessels, and sometimes associated with the comatose and apoplectic forms of intermittent fever. Such pigment is also seen in the minute hepatic vessels (Frerichs), where it ultimately gives rise to atrophy of the parenchyma of the liver (Aitken). And, with regard to the liver in particular: Pigmentary degeneration of the liver is only to be recognized at a post- mortem examination, as the result of melanaemia. It is seen in cases of severe or pernicious remittent, intermittent or malarious fevers. It is due to the accumulation of pigment matter in the vascular apparatus of the gland, especially in the capillary network of the portal and hepatic veins; and the minute branches of the hepatic artery also contain quan- tities of black coloring matter. In cases where the liver is so affected, similar melanic matter is generally found in the spleen, kidneys and brain; while the blood itself may be seen to contain dark granular masses or nucleated pigment-cells, with black granules in their interior. The spleen seems to be the seat of formation of melanotic matter (Frerichs). The effects upon the system of this degeneration are mainly due to 374 WORLD'S HOMXEOPATIHC convention. the destruction of blood corpuscles with which it is asso- ciated and tending to a condition like chlorosis. There is extensive capillary stagnation, which gives rise to obstruction of the circulation of the blood in the roots of the portal veins, and exhausting haemorrhages of an intermittent kind are apt to occur from the gastro-intestinal mucous mem- brane. Profuse diarrhoea, vomiting and serous effusions are also common occurrences (Aitken). While, then, the malarial poison is essentially a blood poison and causes structural dis- ease in, and eventually ultimate reduction of, the liver by a deposition of melanotic pigment; the alcoholic poison effects similar destructive results in the hepatic organ, by its local inflammatory action, with subsequent cellular proliferation. I have just before me the German edition of Ziemssen's Special Pathology and Therapeutics. Dr. Herz, in his de- scription of the pathological anatomy of malarious fevers and malarial cachexia (Vol. II., p. 574), says : " Besides the antemic coloration of skin, the oedema, the dropsical effusions in serous cavities, the atrophy of the muscular and adipose tissues, etc., it is the change of the liver, spleen, kidneys and the heart which deserves mention." And, after describing the hypertro- phy and the occasionally following atrophy of the spleen, he con- tinues : " In the liver similar changes are to be found. Here also we find large and massive indurations, which by the presence of pigment assume a chocolate color. In rare cases the liver is reduced and has a certain similarity with a cirrhotic liver." When we come, therefore, to read in standard works of medicine, even so lately published as 1872, that cirrhosis of the liver may be caused by malarial fevers (Aitken), we shall do well to keep in mind that, histologically, and even anatom- ically, malarial cirrhosis essentially differs from the granulated liver of the gin-drinker, and that their relation to each other does not go beyond a certain similarity. Little can therefore be expected, on homoeopathic grounds, from the therapeutic effects of alcohol, in any case of advanced malarial cachexia, either with regard to the condition of the patient in general, or to the structural changes of the liver in particular. CIRRHOSIS OR THE LIVER. 375 But in the incipient stages of malarial cachexia, alcohol deserves a fair place as a remedy. When we have succeeded in arresting the periodic febrile attacks, and yet the enlarged state of the spleen and liver distinctly tells us that our patient is yet far from being cured; then alcohol will often do in a comparatively short time what no other remedy can do. The drug need not be given in large doses. Ten drops of rectified alcohol mixed with a proportionate quantity of distilled water, taken two or three times daily, half an hour before each meal, are quite sufficient. In the case of children, three to five drops used in the same manner will often be found to meet the case. I need hardly say that this method of treat- ment is only adapted to individuals not habitually addicted to the use of alcoholic liquors. Oue remark more about the habits of the alcohol-drinker. Amongst the three prominent causes which (besides malarial fevers) are liable to produce active congestion of the liver are, as we have seen before, high temperature, alcohol and spices. Now, if we look to the general habits of the gin-drinkers, we find amongst others [Allen's Encyclopedia ; article Alcohol] : " Desire for pepper, mustard and other heating articles." It would then appear that the gin-drinker instinctively craves after what is tho best homoeopathic antidote to the alcoholic poison. On the other hand, wo find here in India a popula- tion of about 250,000,000 consuming all sorts of spices to such an extent that, when I first tried their national dish-curry and rice-I felt a burning of my lips for hours afterwards. Being, in consequence of climatic influence (high temperature and malaria), naturally liable to the same hepatic congestion as the gin-drinker, we find them, as a matter of custom, resort- ing to the same homoeopathic antidote. From what has been said about the nature of hepatic degen- eration in some cases of advanced malarial infection, it will be seen that any therapeutic attempt solely directed towards the restoration of the diseased liver must be of no avail so long as we neglect the fundamental disorder out of which the hepatic degeneration arose. Our hope can only lie in the administration of such remedies as have proved themselves to 376 would'S HOMCEOPATHIC CONVENTION. be useful in malarial cachexia. Arsenic however, our sweat remedy in chronic cachexia of malarial origin, will fail us in such of the cases as are seriously complicated with hepatic disorders. Dr. Baehr in his Therapeutics has already remarked that, suitable as Arsenic is in all forms of dropsy, its curative results are most doubtful if we have only ascites to contend with. China is another remedy of great promise, but unfor- tunately impotent in these cases, most likely because the patients had been overdrugged long before by this valuable therapeutic agent. There is only one drug which has done me valuable service in this grave pathological complication, and this is Argentum nit. We owe an intimate knowledge of the range of action of this salt to Dr. v. Grauvogel. For the present purpose I shall, however, content myself with quoting a short resume from Dr. Hughes' Pharmacodynamics; " Dr. Bogo- lowsky, of Moscow, has recently experimented with it largely in rabbits to ascertain its deeper and more chronic effects. From these it appears that the salt has a direct and primary influence on the red corpuscles of the blood, causing their coloring matter to escape into the plasma, and so leading at first to ecchymosis and effusions, and later to interference with oxidation and ultimate chlorosis. As a result of the deficient nutrition (so he thinks) there occurs catarrh of the mucous membranes generally, and degeneration-rather of a granular than a fatty kind-of the renal and hepatic cells, and of the muscles, including the heart. There is also found universal venous blood-stasis." This description of the drug's action compared with what has been said before about the pathological changes occurring under the influence of malaria, will convince every one of the great toxicological analogy between these two agents. It would be out of place here to ■enter into their respective symptomatology; I shall, however, mention one symptom here as especially relating to our sub- ject. It is amongst the generalities of Argentum nit. and runs as follows: " Cachexia, emaciation, affection of the liver, dropsy" [Allen's Encyclopaedia}. Argentum nit. is no antiperiodic like Quinine or Arsenic, its great remedial function lies within the sphere of confirmed CIRRHOSIS OF THE LIVER. 377 malarial cachexia. So long as there are distinct periodic acces- sions, its administration would simply be waste of time. But when we have to deal, more with the progressive ravages left by the periodic febrile attacks than with the latter themselves, then Argentum nit. will take a worthy place near Arsenicum alb., or, better yet, after Arsenicum alb.; for in the measure as the last-mentioned drug loses its therapeutic hold, the nitrate of silver will be found to be so much the more homoe- opathically indicated. Returning to the genuine cirrhosis of the liver as caused by alcohol, I would give the first rank to Phosphorus as its appropriate remedy. From Dr. Wegner's experiments on rabbits [ Virchow, Archiv., V., p. 4] we know that, amongst the chronic influences of Phosphorus on the organism, when administered in suitable doses, is its prominent effect on the digestive apparatus. " The interstitial connective tissue of the liver and of the stomach becomes irritated, there arise chronic indurative gastritis and chronic interstitial hepatitis, with icterus and atrophy of the hepatic substance; the last link of the chain is atrophy of the liver, either the smooth or the lobulated variety, or else the classical granular atrophy- the so-called cirrhosis." Phosphorus has besides, like Nux vom. our famous alcoholic antidote, that peculiar nervous irritability or, moreover, irritable weakness, so common in people while addicted to ardent drinks and even long after they have given up the pernicious habit. I am almost in- clined here to give some cases of undoubted cirrhosis, in order to show the great curative power of Phosphorus in this other- wise most unmanageable disorder; but then I were in duty bound to give also, side by side, some other cases where it did not arrest the progress of the granular degeneration. We must remember that a specific, in the true meaning of the word, for this hepatic disorder is, at the present stage of our knowledge at least, out of the question. In the first stage, when all the pathological preparations are silently made for the subsequent degeneration, our present diagnostics are in- sufficient to give us the proper warning at the proper time. On the other hand, when the diagnosis is clear enough, a cer- 378 world's homceopathic convention. tain amount of organic destruction has already taken place which may often render all prospects of a tolerable recovery a matter of physiological impossibility. The value of our specifics in such cases, even when most properly selected, will therefore always be far from absolute. True, so it is in all cases and under all circumstances; for our law of cure, however great its claim to universality may be, is, after all, necessarily limited and subordinate to the great, governing law inorganic Nature-which is ultimate death. But nowhere as in organic diseases, are the causes which are at work to defeat our cura- tive law, so palpable to our human eyes. Taking the very disorder under discussion as an example, we can clearly see the great difficulty physiology opposes to our curative attempt. With the reduction of the hepatic volume, more blood must proportionally pass, within a given time, through the impaired portion of liver than was the case in the individual concerned, when in good health. But this very increase of flow of blood predisposes to inflammation, and has, in fact, brought the patient to what he now is. It is therefore erroneous to think that, by stopping his alcohol and feeding him with bland food, we have entirely removed all causes of further disturbance. These causes, far from being entirely removed, are, as we have seen, continually at work. When, then, we see that a man, in spite of all his moderation, has been for months going from bad to worse, and that after he began to take Phosphorus he began gradually to rally, we may fairly ascribe the im- provement to the curative action of the drug administered. And such is what I have seen in a fewr cases. In some of them, cirrhosis of the liver had been diagnosed not only by myself, but by other medical men attending before me. The decided action Mercury exerts on the liver makes it necessary to mention this drug in connection with the disorder under consideration. In the stage of enlargement, Mercury is no doubt one of the most important remedies. But then this is just the stage about which we are not certain whether it is the first stage of granular degeneration at all. In order to be able to speak of the usefulness of a drug in cirrhosis of the liver, we must know what the drug can do in the second, un- CIRRHOSIS OF TIIE LIVER. 379 mistakable stage of the disease. And here my experience with regard to Mercury is totally negative; nor is it after all to be wondered at that a drug, so eminently endowed with the power of destroying the fibrin of the blood, should have so little homoeopathic relation to the morbid state, essentially fibrinous in its inflammatory character. It is generally stated that cirrhosis of the liver and hepatic abscesses do not occur together. " This is," says Dr. Morehead, " doubtless correct of European countries, but it is not so of India, where the co-existence of the affections is not very unusual." If ever Mercury should find a place in the treatment of the cirrhosis of the liver, it would, no doubt, be in complicated cases of the nature just described. I can, however, not say that this drug has done much good in the few cases which came under my observation. Nor has any other remedy done more. I would say here a few words, in passing, about the fibrin- destroying quality of Mercury in the human body, which has so long been a puzzling fact. Dr. Headland ascribes it to "some inscrutable chemical power, whose agency we know nothing of." Viewed, however, in the light of recent physi- ological researches, I believe that the influence of Mercury upon the diminution of fibrin is merely a consequence of the hepatic irritation the drug is known to produce. Lehmann and Bernhard have shown that, while portal blood contains much fibrin, blood from the hepatic vein contains little or or none. Brown-Sequard [Journal de Physiology, Vol. I., p. 304] has calculated that no less a quantity than 2,690 grammes or about 86-^ ounces of fibrin is daily lost to the blood in its passage through the digestive organs and the liver. It is then most likely that the fibrin-destroying quality of Mercury is owing, not to its direct chemical effect upon the blood, but to its effect upon the liver, the natural destroyer of fibrin. In speaking of Mercury as a liver-irritant, I have not forgotten Professor Bennet's experiments with this drug on do£S, which resulted in a diminution of the bile-secretinc; faculty of the liver. I believe, however, that due attention has not been paid to the dose-question in the experiments alluded to. In moderate doses, Mercury no doubt stimulates the function of the liver. 380 world's homoeopathic convention. More related to the inflammatory process prevailing in genuine cirrhosis of the liver is the physiological action of Hepar snlph. Our provings show moreover that the portal system is deeply affected by this drag. Dr. Bayes, of Eng- land, speaks highly in its favor in cases of chronic engorge- ment of the liver ; and this is just what necessarily happens in a cirrhotic liver. I have, as a rule, found this drug the more useful, the more there was reasonable ground to suspect that the case is one of incipient cirrhosis. In the second stage, Ilepar snlph. will go a long way in the symptomatic treatment which is often so urgently called for in this dis- order ; but it has under my hands just as little arrested the fatal progress of the disease as Nux vom., China, Lycopodium, Calcarea carb., Arsenic and many others. I close with a drug of which, I am sorry to say, we have no provings, or almost none, but which I consider should not be left unmentioned in connection with interstitial inflammation and cellular proliferation, no matter where such a morbid state may make its appearance. I allude here to Ilydrocotyle asiat., a remedy, the great curative power of which I have long since learned to appreciate in such disorders. Ilydro- cotyle asiat. has for a long time, and deservedly, enjoyed a high reputation in elephantiasis. Now if we enquire into the pathology of this disease, we learn (Morehead, op. eit.) that an exudation of liquor sanguinis takes place into the interstices of the affected structure and the lymph becomes formed into fibrous tissue of low organization ; the subcutaneous areolar tissue is either hypertrophied or it has a semi-liquid glutin- ous matter deposited in its areolrn. Now, the first of the two above-mentioned pathological alternatives is just the exact counterpart of what happens in cirrhotic degeneration of the liver. If we further enquire about the causes of elephantiasis, we learn from the same author that " it would seem to be re- lated to particular localities ; to be most common in damp, low situations, near to the sea, in warm climates. It has also been supposed that the use of fermented toddy (an intoxicating native beverage) is favorable to its production, just as wine and beer are to that of gout " (Morehead), and, it may be added with CIRRHOSIS OF THE LIVER. 381 much more appropriateness, just as alcohol to cirrhotic degen- eration of the liver or to acne rosacea, an affection which, not unlike elephantiasis and cirrhosis of the liver, consists in hypertrophy and induration of the connective tissue in the region of the nose and the face in general. In fact, hypertrophy and induration of the connective tissue, in organs varying according to constitutional and climatic con- ditions, seem to be one of the specialities of alcoholic liquors; and it is in this speciality that Ilydrocotyle asiat. shows its great curative power. When we remember the importance of the areolar tissue in the animal economy; that nutrition by imbibition is to a large extent carried on through the medium of its cells; that it is intimately interwoven with almost every part of our body ; that it is, in fact, the house we live in-then shall we be able to realize to ourselves the value of a drug which has so decided an action on this tissue. I wish I could close these remarks with a thorough-going proving of Ilydrocotyle asiat. ; this is a task, however, which I must, under the present circumstances, leave to others. I have used this drug in dilutions from first to sixth decimal. INTERMITTENT FEVERS. By A. Charge, M. D., Tamaris pres la Seyne, S. M., France, Honorary President of the Societe Hahnemannienne Federative ; officer of the Legion of Honor, etc., etc. Motto.-" After he has found all the existing and appreciable symptoms of the dis- ease, the physician has found the disease itself-he has a complete idea of it, and knows all he need know to cure it."-Hahnemann's Medicine of Experience. By the generic name of intermittent fever, we designate fevers characterized by paroxysms, generally composed of three stages: cold, heat and sweat, appearing periodically and sepa- rated by a complete apyrexia. We consider the complete apyrexia between the paroxysms to be the essential feature of intermittent fever. It is of long- er or shorter duration ; quotodian, tertian and quartan fevers are the commonest types. The paroxysms whose duration differs from these commence and complete their evolution with a regular or irregular course of temperature ; hence regular or irregular intermittent fevers. The most frequent form is that caused by the effluvia of marshes, called paludal. • Cinchona has been so much misused for all intermittents that we have at last confounded them all under the name of Cinchona fevers. This is an error. There is certainly a primi- tive intermittent fever, depending on paludal poisoning, to which Cinchona has shown itself specific, but it cures only the fever analogous to that which it can produce, and this fever is distinguished from all others by some salient features which 383 384 world's iiomceopathic convention. are exact periodicity instead of simple intermittence, and regu- lar course of the three stages. But there are other forms of intermittent fever, and therefore Cinchona does not suffice for the needs of practice. To confound together intermittent fever and Cinchona fevers is very dangerous, there can be no synony- my between different terms which have not the same signiffca- tion. Every case of intermittent fever is an individual case, distin- guished from all analogous cases by more or less definite shades, and these shades of difference, whatever they may he, provided they are strongly marked, ought to be seriously considered, because they are the characteristics of the case, and the remedy which best corresponds to these characteristics is the most sure- ly curative. Therapeutics has too long wandered in the easier but too broad road of generalities. In order to facilitate his studies, and to render his expositions clear, the pathologist has the right to confound, up to a certain point, under the same de- nomination, the morbid cases which have characteristics in common, like anatomical characteristics, for example; but the practitioner finds more profit in studying the differences rather than the resemblances between his patient and others ill of the same disease. If we take the plainly marked analogy of one case to an- other as our guide in selecting the remedy, we grope in the midst of- approximations which can lead only to uncertain re- sults ; while if we case our choice on the differential and char- acteristic features of the case, we better follow the law of sim- ilitude ; we apply to the morbid individuality the correspond- ing medicinal individuality, and, as a necessary consequence, our cure is prompter and surer. Among the great number of intermittent fevers there is a formidable pyrexia called pernicious, because it may carry off the patient, in the second or third paroxysm; he dies probably from excess of poisoning. This extremely violent pyrexia forms no exception to the rule, and, like all other pyrexias, finds its most prompt and certain remedy in the drug which is most homoeopathic to it; INTERMITTENT FEVERS. 385 but here a delicate question arises, which should be solved at once. What shall we do in the presence of a pernicious fever in which we have reason to fear sudden death, in the second or third paroxysm ? Find the homoeopathic remedy. Without doubt principles are inflexible, and I know no means more powerful to combat the radicalism of the false than to oppose to it the radicalism of the true. We have a law of cure which has always shown itself triumphant when rigorously applied ; why should we be unfaithful to it ? I see no reason. The violence of the disease ? But the more ur- gent the haste, the more highly ought we to value the shortest road. Now the most prompt and certain means of curing any disease whatever, however pernicious we may suppose it, con- sists in opposing to it the homoeopathic remedy. Then, in- stead of renouncing in this emergency the application of our law, it is best to conform to its requirements. The greater the danger, the greater this obligation. Science cannot and ought not to speak otherwise; but, be- sides the inflexibility of the principles which govern science, and which, therefore cannot allow themselves to be encroached upon, we must consider the difficulties of the strife and pro- tect the delicacy of the physician's conscience. All practition- ers, even the most skilful, may be embarrassed in presence of a pyrexia rapid in its progress, alarming in its symptoms and badly defined in its differential features. The choice of a drug really homoeopathic to the case may be rendered excessively difficult by the confusion or the multiplicity of symptoms, by uncertainty or complete ignorance of the ground on which to base the principal and essential indications. In this excep- tional and happily rare case, what shall we do ? What advice give? Administer a drug almost homoeopathic to the case ? No; I have a horror of almost• it leads to chance, and chance is unworthy of us and is injurious to the patient. Stand with folded arms ? Impossible ! The danger is too real and too pressing for us to wait for some lucky and unforeseen event. 386 world's homoeopathic convention. We ought not to rest in expectation ; we must absolutely act, and act with a view to cut short the fever and also to save the patient from the imminent peril. Cinchona or Quinine, by their anti periodic property, approach near enough to all intermittent fevers, to satisfy these indications. No doubt, therefor, we must give Cinchona or Quinine, according to the precepts of the Old School. It will generally fail to really cure the patient, but we shall have gained time and averted death. Let us be content. This is not a concession; our principles remain intact; we have no breach to repair, none has been made ; it is a conde- scension to our weakness ; it is a necessity to which we submit in the present state of our knowledge, in order to keep our con- science clean. When our pathogeneses shall have been con- firmed, purified, enriched, our successors will be able to meet all cases with a more direct and certain, because more com- pletely homoeopathic, medication ; but, till then, let us beware of disdaining the relative benefits of Cinchona or Quinine. While there is still time let us see nothing but the combat against death; we can take up afterward the combat against the disease; and let us prove to our colleagues that if we con- secrate our lives to rendering the work of Hahnemann faithful, we are not the less penetrated .with a profound respect for the true science of the past. The lessons of Sydenham, Torti, Lancisi, and other masters who have left us such valuable works on intermittent fevers and on Cinchona, and practical observations of such deep interest, are ours as well as theirs; and, as much as anyone, we hold that these lessons should not be neglected. Etiology.-Wherever there are marshes, or stagnant waters containing animal and vegetable substances in decomposition, whether these waters be fresh or a mixture of fresh and salt, there are, or have been, intermittent fevers. Between marsh effluvia and intermittent fever there is a necessary relation; it is a fact resting on observation, and no one will think of de- nying it; but in what consists marsh effluvium and what is its intimate nature ? It is impossible to answer with precision ; a new proof of the futility of our efforts to pursue theinvesti- INTERMITTENT FEVERS. 387 gation of the intimate nature of anything whatever; our poor humanity always encounters something unknown. Chemistry, justly proud of her success in tne positive deter- mination of the constituent parts of bodies, but quite wrong in often raising her pretensions too high, will tell us indeed that the mud of marshes gives out azote, carbonic acid, sulphu- retted and carburetted hydrogen, etc.; but, marsh effluvium which causes fever, where is it ? Where does it reside ? Ad- huc sub judlce lis est. This toxic agent acts with more or less intensity according to certain conditions of season, climate, and especial predispo- sition ; but this is all that observation enables us to state. Besides marsh miasm, a recognized cause of intermittent fever is the clearing of land where quantities of earth are turned over. Thus, since the establishment of railroads, in- termittent fever has epidemically prevailed in localities where, until that time, it was unknown ; at Paris, for example, in 1811, when the St. Martin canal was dug; in 1840, when the fortifications were constructed. Prolonged moisture, extremely high temperature, suppres- sion of chronic exanthema, or of sweat of the feet; stricture of the urethra, introduction of the catheter, etc., are efficient causes of intermittent fevers, different, no doubt, in their nature from those produced by paludal poisoning, but showing a great symptomatic resemblance to them ; and whether due to reflex action or not, equally inexplicable in their intimate nature. Symptoms.-With or without premonitory symptoms; in the majority of cases the premonitory symptoms are very slight. Paroxysms composed of three stages or periods: shivering or cold; heat; and sweat. 1. Cold stage.-This may show itself in all degrees, from goose-flesh, which consists, of a simple horripilation, up to trembling with chattering of the teeth, discoloration of the skin and icy coldness of the extremities, particularly of the nose, ears and fingers which become cyanotic. It is only superficial; for according to the most recent observers the ther- mometer shows increased temperature in the deeper parts up to 388 world's homoeopathic convention. 40° or 41° C. To the coldness, vague pains are added, in various parts of the body; general malaise, anxiety, oppression ; the pulse small but frequent, the urine scanty and clear. The withdrawal of blood from the surface-to the centre may cause congestions and haemorrhages, as epistaxis and haemoptysis. The cold stage varies in duration and intensity; sometimes it is completely wanting. Thirst may be present. 2. Hot stage.-Duration and intensity variable. Heat of the surface increases, and may become burning. The pulse is full, large, resisting ; urine red. The heat may be more intense sometimes in the head and face; sometimes in the chest; in one person in the stom- ach ; in another in the feet and hands ; with or without thirst; indifference, stupor or agitation, anxiety and delirium. 3. Stage of sweat, which terminates the paroxysm ; here a simple moisture; there profuse sweat which by its abundance and duration debilitates the patient; the urine deposits a quantity of uric acid and urates; there appears to be a con- stant relation between the degree of heat and the quantity of uric acid excreted. Every intermittent fever is susceptible of assuming a certain number of types; quotidian, tertian, quartan, etc. In the tertian type there is one day of rest ; in the quartan, two, etc. The type may undergo many transformations; the fever may last an indefinite time, and induce an especial cachexy called paludal, a consequence of the persistent poisoning of which the paroxysms were the first manifestation. This cachexy is characterized by impoverishment of the blood shown by a diminution of the red globules and of the albu- men, by an increase of the serum and finally by a diminution of the fibrin ; hence follows discoloration of the skin and of the mucous membranes. Bruit de souffle, especially in the course of the great arteries, the carotids for example; these sounds are single, intermittent or continuous, or are double. Bruit de diable, general weakness and nervous disorders (absence of red globules). Ecchymoses of the skin, epistaxis, scorbutic gums with bleeding and gangrenous spots on the ■walls of the mouth (absence of fibrin); serous infiltration, INTERMITTENT EEVERS. 389 ascites, oedema of the lower extremities; general anasarca, hydrothorax ; oedema of the lungs ; effusion in the ventricles of the brain (increase of serum, diminution of albumen). This is perhaps the time to speak of leucocythemia, which consists in considerable increase of the white globules of the blood with diminution of the red globules. The blood changes color; it is the color of the lees of wine, or grayish, and we ■find there is hypertrophy of the spleen, frequently of the liver, and distension of the great venous trunks. This leucocythemia called splenetic differs from the lymph- atic leucocythemia in this, that in the latter the alteration of the blood is constituted not altogether by the increase of the white globules properly so called, or colorless cells, but by that of the globulin. In this form, we no longer find hypertrophy of the spleen or of the liver, but we discover lymphatic tumors in the armpits, on the neck, in the abdomen, either in Peyer's patches or in the solitary glands of the intestines. Whether splenetic or lymphatic, the leucocythemia is not the cause of the pathological phenomena; it is, on the contrary, dependent on them, occasioned by them ; its lesion, that is to say result and we find its remedy in the drug which is homoeo- pathic to its symptomatic manifestations. Other considerations are necessary to complete the history of the cachexy of intermittent fevers ; the skin is earthy yellow, which must not be confounded with the colorations of jaundice, chlorosis, or the cancerous cachexy. The spleen is hypertro- phied ; this hypertrophy has been called the proximate cause of intermittent fever. Error ! effect and not cause; the hyper- trophy disappears with the suppression of the fever. When it exists we should certainly include it in the picture of the symptoms, but we must see in it only one feature of the pict- ure and not make it the whole picture. The liver may also be congested; but more rarely and less profoundly than the spleen. In the highest degree of cachexy, the paroxysms of fever appear from time to time, but in an irregular manner, the periodicity is broken, which is an unfavorable augury. To cure an intermittent fever we must; 1. Study the pa- 390 world's homceopathic convention. tient during the apyrexia, to form an exact idea of the func- tional action, regular or otherwise, of all the organs. 2. Observe all the symptoms of the pyrexia in its three stages of cold, heat, and sweat. 3. Particularly note if a stage is absent, and which among them is the most marked. 4. Expressly depend on the bizarre, singular, exceptional phenomena, because these, above all, are characteristic, and figure in the first rank of the symptoms to which the drug must correspond in order to cure. TREATMENT. Aconitum nap.-In plethoric subjects, in cases where the fever proceeds by irregular paroxysms or the almost impercep- tible chill is accompanied by internal heat, or the heat lasts a long time without sweat, with loss of appetite, burning thirst, red and burning cheeks, headache, tendency to throw off the clothes, pulse full, hard and frequent; agitation, fear of death. If the intermittent fever turns into synochus, or if it becomes complicated with inflammatory symptoms, with congestion of the head or chest, Aconite, given immediately, will lead to the happiest results. AEwul'US hip.-Periodic paroxysms of fever especially marked by general cold and heat followed by sweat, with soft, slow pulse and general feebleness; burning in the mouth, afflux of saliva ; burning dryness and constriction of the throat with frequent spitting of mucus and constant need to swallow; in hemorrhoidal and constipated subjects. A woman of 44 years presented herself at my office in the following condition : for fourteen months, every day at 4 p.m. paroxysm of cold without shivering, followed by heat and sweat ; the paroxysm lasted altogether from 4 to 5 hours. During the paroxysm she suffered cruelly in the throat and could swallow nothing; it seemed to her as if the inside of her throat were rubbed with a live coal; she was thirsty and the difficulty of swallowing was so great that she could not drink; moreover, saliva flowed abundantly and her whole mouth was lined with mucus. Being interrogated, she told me that, in the interval of the paroxysms, her throat always hurt her, but in a less degree; she was constipated and sometimes INTERMITTENT FEVERS. 391 suffered from hemorrhoids. The numerous physicians pre- viously consulted were unanimous in attacking the intermit- tence with the antiperiodic, par excellence. Quinine, and always without effect. In consideration of the periodicity of the symptoms, the sore throat, the constipation, the hsemor- rhoidal affection, all pathogenetic effects of LEsculus hip., I gave this remedy 30th and two doses, of three globules each, sufficed to relieve the patient of all her sufferings. The febrifuge properties of this drug have been long known. Sabarot de la Varniere, quoted by Murray, had published his success in tertian and quartan fevers, slight and severe (Et graviores, tome iv., p. 70) maxime inclaruit hie cortex febrifuga pia virtute (Eod. loc, p. 02). The need of a succedaneum to Cinchona the supply of which failed during the continental wars of the Empire, suggested to several physicians the thought of experimenting, and the Bul- letin des sciences medicales of the Societe d'Emulation, in 1808, tome ii., p. 560, published a large number of cures obtained by the bark of the horsechestnut (43 cures, Dr. Ranque d'Or- leans). Cazin (p. 615) reports two cures obtained by him in tertian fever and in a double autumnal tertian, and besides, he quotes Lacroix who in an epidemic of intermittent fevers in the departement of Loire et Cher administered this febrifuge with success, to more than 220 patients. Angustura ver., Galipea cusparia.-The paroxysm takes place only in the afternoon; violent shiverings every day at three o'clock; the shiverings are followed by slight heat without sweat. Very timid dyspeptics who are frightened at everything, show themselves very susceptible and will not bear the slightest joke. It has been recommended as a fe- brifuge in the intermittent and remittent fevers of warm countries (Dr. Iliraud, Dictionnaire des plantes medicales, 1875). Antim crud.-Paroxysm afternoon ; no thirst ; tongue covered with milky white coat, with bitter taste, loss of ap- petite ; gastric troubles ; nausea, vomitings, colics, diarrhoea, or constipation, similar to Pulsatilla, but constipation which is not found under Pulsatilla is present here, and moreover, there 392 world's homoeopathic convention. is this peculiarity ; that the sweat stands in beads on the skin at the same time that the stage of heat commences, but disappears almost immediately, leaving the skin hot and dry. Pulse irregular. Apyrexia : No appetite, sensation of fulness in the stomach; abdomen inflated with gas; urine dark, depositing an almost blackish sediment. Pulse variable every moment, slow or rapid, rarely in normal state. Apis mel.-Tertian fever; paroxysm in the afternoon or evening; usually the paroxysm commences from three to four o'clock. The initial chill, without chattering of the teeth, is felt on the front of the chest, and along the spine; it is aggra- vated by the warmth of the apartment and is accompanied by headache, toothache, nausea and diarrhoea. Hot stage : dryness of the skin, drowsiness; thirst more intense than at any other time in the paroxysm. Hoarse cough, redness of the skin ; heat greatest in the chest, in the abdomen, in the cheeks and hands. Sweat: slight with frequent alternations of dry- ness of skin. Apyrexia ; violent squeezing, bruised pains in the two hy- pochondria, under the edge of the false ribs, especially the left one. Sensibility at the pit of the stomach. Noisy borboryg- mi as if diarrhoea would set in; heat in the intestines. Sen- sibility of the abdominal walls to the slightest pressure. Infla- tion of the abdomen. Urine scanty; feet swollen. Great uneasiness in all the limbs and joints. Itching over all the body, with a sensation of pricking and burning heat. Nettle- rash ; nervous excitement, agitation. Aranea diad.-A remarkable anti-periodic. All the most diverse affections, headaches, colic, etc., when they assume a regular type and reappear at stated times, come within its sphere of action. We have seen it succeed in quotidian inter- mittent fevers returning exactly at the same hour. The cold stage much exceeds the hot stage and the sweat. The chills are accompanied by colic. Pains in the bones, as in Arnica and Eupat. perf. Apyrexia ; Enormous swelling of the spleen. Paleness of the face. Cold extremities. Abundant lachry- mation. Frequent desire to urinate; priapism with or with- out swelling of the penis. INTERMITTENT FEVERS. 393 Empiricism had long preceded us as regards this drug. Ett- mueller learned to successfully administerpoudre d'araignee for intermittent fevers. James, in his Medical Dictionary, states that boluses of cobweb cured with marvellous rapidity a very severe intermittent fever which even Cinchona had failed to cure. In our day, we see the common people, espe- cially in the country, try to stop the course of quartan fever by crushing a great spider on the wrist, or by inclosing the animal alive in a nut-shell and hanging this around the neck (Faune des med., II. Cloquet, Vol. II., pp. 76-77). Fausch gives spider's web internally (Allg. Med., 1808). Cases of quartan fever cured by spider's-web, after having resisted all kinds of treatment for eight months (Gaz. Med, Jan., 1863). Arnica mont.-The paroxysm occurs usually in the morning, sometimes toward noon, and rarely in the evening. Before the paroxysm, gaping and intense thirst for large quantities of drink. Cold stage, bruised pains in the limbs, the head is hot, the face red. The thirst continues; pressure at the stomach ; vomitings. Hot stage, the thirst continues, but is more moderate than in the cold stage. Osteocopic pains (Eupat. perf.); moreover, the parts on which the body reposes always seem to him too hard. Sweat, moderate. Apyrexia: bitter taste in the mouth, want of appetite, tongue coated yellowish ; repugnance to meat, prostration, sleepiness. Arnica cures the disorders caused by Cinchona, when the face is puffed, the complexion yellowish ; the respiration diffi- cult, very painful, with short, dry, hacking cough. Diarrhoea preceded by straining ; abdomen hard and inflated; feet swol- len and erysipelatous up to the ankles; tearing pains in the joints of the feet; head confused. Stoll (Bat. Med.) extols Arnica flowers as a febrifuge; he calls them the Cinchona of the poor. Jn. Frank (Path. Med.) in autumnal tertian fever, quartan fevers, those which are sub- ject to relapse without known cause, with disposition to visceral obstructions, to oedema, without any inflammatory tendency. Alibert, in his Elements of Therapeutics, mentions very re- markable success in the employment of Arnica in an epidemic of intermittent fevers, which changed into adynamic fevers ■when treated with Cinchona and its preparations. 394 world's homceopathic convention. Arsenic. alb.-The stages have lost their integrity and theii' rhythm. Intermittence incomplete. No free apyrexia. The paroxysm comes indifferently at all hours, in the morning, toward noon, or later. Before the paroxysm, general uneasiness, gastric troubles, especially after eating. Headache, vertigo, yawning. Cutting pains at the pit of the stomach and in the intestines. During the paroxysm, cold, shaking chills, sensation in the back as if cold water were poured on it. The cold felt inter- nally is mixed with a sensation of external warmth which be- trays itself by flushes of heat on the skin. Skin wrinkled. Oppression and spasms in the breast, with short cough. The hot stage does not, any more than the cold, follow a regular course ; both are marked by alternations of cold and of heat. The hot stage may sometimes limit itself to these alternations and then it is almost wanting; but also it may be very severe, dry, burning, and with it we notice dryness of the mouth and lips, thirst, but can drink only a little at a time. Nausea or violent pain in the stomach. Delirium, headache and loss of consciousness, anxiety, extreme agitation which excites to change of place every moment; precordial anguish, palpitation ; throbbing throughout the body. Pressure and tension in the left hypochondrium. Short breath, oppression causing fear of death. Pains in the limbs ; prostration. Sweat: remarkable for its absence ; when entirely wanting, the case is well suited to Arsen., or when it appears, it is sticky, has a strong odor, and, as long as it lasts, is accompanied by a burning thirst which is not the ordinary thirst of Arsen., since it can only be satisfied by drinking abundantly at a time, always provided that the beverage is not too cold. After the paroxysm, great weakness, stretching; bitter and sour eructation: cough, with continual tickling; hiccough, apparently caused by strong and sudden contractions of the diaphragm. Urine highly colored, green, with acid reaction. Violent, pressive pains in the frontal region. Apyrexiat Face pale, puffed ; complexion earthy, yellow- ish ; features depressed; lips thick, cracked, and covered with crusts; tongue dry, white, or covered with a yellow coat; ap- INTERMITTENT FEVERS. 395 petite sometimes increased, but, after having eaten, heat and nausea; or small appetite, and, after having eaten, taste of the food, pressure at the pit of the stomach. Disagreeable sensa- tion moving toward the stomach and the breast; impossibility of lying, except on the back; stools diarrhoeic, fetid; urine cloudy and scanty; oedema of the feet, or general infiltration. Scorbutic spots scattered over the body. Palpitation of the heart on the least movement. The skin is often covered with cold sweat all day,.in the night profuse sweat; insomnolence, principally the night preceding the paroxysm. Arsenic, suits all types, not excepting the quartan, but most of all the adynamic form. Why does Arsen, cure certain forms of intermittent fever? Because it possesses the faculty to periodically produce, in the healthy, groups of symptoms analogous to veritable paroxysms of periodic fevers. Where it has triumphed over the disease, it has done so by virtue of its homoeopathicity. To establish the truth of this proposition, it would suffice to refer to our Materia Medica Pura; but, as our dissenting confreres affect a superb, an inexplicable disdain for the labors of our school, we will for an instant yield the floor to the therapeutists of the Old School. Sauzet, of Montpellier, in treating an intermit- tent acute ophthalmia by Arsenic., observed a paroxysm of fever after a single dose. Biett remarked a sort of periodicity in the changes of pulse produced by Arsenic. Boudin thus expresses himself on p. 264 of his treatise on Intermittent Fevers: " I have seen an-intermittent quotidian fever set in, which I was obliged to combat with Quinine (he would have done just as well to wait for the action of the drug to exhaust itself) in one of my patients who, on account of icthyosis, had taken of a grain of Arsenious acid in twelve days." Again, p. 267, Boudin says: "I must congratulate myself on the employment of this drug (Arsenious acid) in the treatment of certain pains with clearly periodic exacerba- tions^ and appearing to result from marsh poisoning." The poisoning is taken for granted ; nothing has been demonstrated here except the disappearance of the pains with clearly periodic 396 world's HOMCEOPATHIC CONVENTION. exacerbation, a clinical verification of the pathogenetic effects of the drug. We can then reduce to nothing the pretended contro-stimu- lation resulting from the absorption of the Arsenic, and the stimulation supposed to be produced by its direct application. Arsenic, is the specific for certain forms of intermittent fever, on the express condition that the morbid phenomena to which it is applied are similar to the phenomena which it may pro- duce in the healthy. The use of Arsenic, and its compounds dates from a very an- cient period, and its therapeutic history is too extended for us to pretend to give it fully here; we will simply touch upon points bearing on its use in intermittent fevers. In China, the yellow Sulphide of arsenic (orpiment), red Sulphide (Realgar in its native state), have been employed from immemorial times against obstinate and pernicious fevers (Debeaux, Essay on the Phar. and Mat. Med. of the Chinese, Paris, I860). And, by the way, it is curious to observe how the Chinese have found a means of handling the latter of these two poisons with impunity and even with advantage by combining with its specif- ic action as a remedy, the indispensable advantages of the small dose. They make little cups of red Sulphide of arsenic., which is an excellent remedy for obstinate intermittent fever. They fill one of them with an infusion of tea, and after it has stood bwenty-four hours the patient drinks this infusion. These cups may be used for an indefinite length of time (Eod. loc., p. 58). Hegewisch wrote in 1829 (Bibi. for. Leger) that he had em- ployed orpiment for several years in the apyrexia as a febri- fuge specific with great success. Jn. Frank tells us that the Jews and peasants of Lithuania have long used it to break up fever. In Germany, in 1693, Fusch wrote: "Experientianos doce- bat arsenicum in febre intermittente adhibitum omnes eas dotes possedere quibus optima remedia praedita esse debent." Winkler, in 1811 (Annal. Allg. Med.), Ebers, in 1813 (Huf. Jour.), Burger, in 1814 (Arch.), have affirmed the efficacy of Arsenic. INTERMITTENT FEVERS. 397 In America, Barton, 1804 (Collect, for an essay) Philadel- phia ; in Italy, 1806, Brera (Clin. Med. de Pavia); in Eng- land, Fowler, Pearson, Stokes, etc., have been ardent partisans of arsenical preparations. In? France, at different times, laud- able efforts have been made to give Arsenic an honorable place in the treatment of intermittent fevers, and in the first rank we will cite Fodere, who, before occupying the chair of legal medicine in the medical faculty of Strasburg, had prac- tised in the south of France. October 8,1809, when Fodere was about to leave, the Mayor of Martigne wrote to the Prefect of the Bouche du Rhone: "The hospitals especially will have cause to long regret him; the population has never been so large, nor the mortality less; his -medical method has worked a considerable economy in these establishments.1' Several hundred cases of intermittent fever were cured by Fodere, some with Pearson's solution, some with Barton's pills {wide Diet, de Med. et de Chir. prat.). Kiel, Physician-in-chief of the Marseilles Hospital, in 1807, expresses himself thus: " I ought to say that there is no febri- fuge like the Arsen, of soda, and whose effects are so prompt." All these multiplied facts, all these solemn declarations ought to definitively convince us of the value of Arsenic, in intermittent fevers, and yet they have not done so. Though the harvest was abundant, the tares have devoured the good grain, and from the highest exaltation, Arsenic, has sunk into neglect; nay more, it has been dishonored and abandoned. This neglect has been accounted for on the ground of the name; a mere cpiibble! the name can always be disguised; witness Trousseau with his Dioscorides pills; facts have wrought the reaction and changed the songs of victory into recrimination. Although it cured sometimes, even often, it did not always cure, because it is only specific to groups of symptoms, and because there was lacking the individualization for precisely defining an Arsenic, case, and then, the infinitisimal dose being unknown, the drug was abused; the end desired was over- stepped, and arsenical poisoning was induced, before which wise practitioners recoiled affrighted. This explains Jn. 398 world's HOMCEOPATHIO CONVENTION. Frank's remark, who, after having been himself misled, ends by declaring, " if we cure fever with this poison, it is only by killing the patients." Nowadays, Arsenic is rehabilitated. Even in France it holds a perhaps too prominent place in the treatment of intermittent fevers. How has this rehabilitation been made? It is not generally known; I propose to make some statements worthy of interest, and which are the more agreeable to me inasmuch as some among them redound to the honor of our School. For their exactness I will answer. In 1810, my friend Dr. Boudin, then chief physician to the Military Hospital of Marseilles, lamented, in my presence, his want of success in the intermittent fevers of Africa, which at that time crowded his hospital. I acted on his avowal and advised him to use Arsenic prepared according to our method. I followed up my proposition by taking from my pocket a tube of Arsenic.30, and conjured him to try it. His friendship for me and his confidence in my word happily overcame his natu- ral hesitation, and he accepted my globules and promised to try them. He kept his word; he took some patients promis- cuously, and gave them three or four globules of Arsenic.30 dry on the tongue, and these patients were all cured. Here is the point of departure. Assuredly it could have been wished that we might date from this moment Dr. Bou- din's studies of the master's teachings and of the lessons of his first disciples. We should have received him with acclama- tion, because, in talent and character, he wras well fitted to honor our School, and his labors which would not have been restricted within narrow limits, would have borne other fruits; but a grain of sand stopped him. He looked out for his fu- ture; and, fearing, not without reason, that he would bear- rested in his career, he did not dare to face the disapproval of the official world. The position of a homoeopathic physician was, at that time, a formidable novelty in the presence of an all-powerful superior board of health; to sustain himself be- fore which, Dr. Boudin used all manoeuvres consistent with honor ; but let us hasten to say for tbe sake of his memory, that if he did not do enough to be honestly counted one of us, INTERMITTENT FEVERS. 399 at least lie never spoke of Hahnemann and his School, except with the greatest respect. We put this to his credit. lie was content to labor to regulate the therapeutic employ- ment of Arsenic ; this single object satisfied his ambition. Comprehending at last, from the study of the Organon, that Arsenic was both a medicament and a poison, and that his pre- decessors had erred by giving too large doses, he undertook to exclude the poison and conserve the medicament. To accom- plish this what did he do ? He pushed the division of a grain of Arsenious acid farther than had been done before him. After effecting this division, ke suitably prepared it; he tritu- rated it a long time, and, by this means, he succeeded ; for this was precisely the best means to expel the poison and preserve the medicament. "Arsenious acid, suitably prepared, preserves in the some- what microscopic dose of of a grain (a demi-milligramme) all its medicinal energy, not only in the treatment of marsh fever, but of a multitude of other diseases. Moreover, I have often, with a single dose of of a j?rain, effected the radical disappearance of fevers contracted in Algeria or in Senegal, which had, up to that moment, resisted the most varied reme- dies, including Sulphate of quinine, as well as change of cli- mate" (Boudin, p. 277). This statement is positive; a demi-milligramme of Arseni- ous acid, suitably prepared, suffices for the needs of practice, and yet, from the demi-milligramme of Boudin, we range to- day in the official School, up to four milligrammes a day. For example: Trousseau's pills, Arsenious acid, twenty centi- grammes for one hundred pills, one or two at the commence- ment of the treatment, each pill contains two milligrammes of Arsenious acid. Asiatic pills, Arsenious acid, five centi- grammes for twelve pills, the dose is one or two a day. Why this progression ? It cannot be a matter of indiffer- ence to use such disproportioned doses, mathematically speak- ing, of so energetic a medicament; either the demi-milligramme is inert, and we have seen the contrary, or the four milli- grammes are too much. If, then, there is parity of success in these doses, which we are forced to believe from the obstinacy 400 world's iiomceopatiiic convention. with which these latter formulas are defended, there is another difference between these doses besides that conveyed by the figures. More and less can never keep step in marching. Yes, this difference exists, and it is this: in toe official for- mulas there is division of the material sufficient to prevent poi- soning ; in Boudin's there is dynamization of the medicament, which explains that, in the somewhat microscopic dose, all the medicinal energy is conserved. How is this dynamization produced? By the same method as under the hand of Hahnemann. Boudin's formula: Arsenious acid, a centigramme (one-fifth of a grain); add successively, and in very small portions, pulv- erized sugar of milk, a gramme (twenty grains); triturate in a glass mortar for a good while, and divide into twenty packages, each one of which represents a demi-milligramme, or of a grain of Arsenious acid. " Add successively in small portions, and triturate it for a good while;" this is the solution of the enigma; this is the accomplishment of the dynamization. What occurred to the mind of Boudin is neither more nor less than what occurred to the mind of Hahnemann ; when he thought he could attenuate by dividing, he doubtless divided the material, but, by prolonged trituration, he exalted its medi- cinal virtue; the same process led to the same consequences. To divide a substance by prolonged trituration is to break the cohesion of the molecules which compose it; it is the surest way to disengage the active principle, sui generis, which re- sides among these molecules; it is to dynamize the medica- ment with certainty. Let who will protest against this dynamization ; it is a fact established by experiment, and this reduces to nothing all ar- guments and pretentious dissertations ; human reason finds it difficult to comprehend ; light will be thrown upon it in time, but while awaiting this, the comprehension of the fact is not of the first importance; the interest of the sick consists above all in the verification of the fact, as experience does verify it every day. There is no reasonable course left to take save to accept the fact and profit by it. Facts established by experi- INTERMITTENT FEVERS. 401 ment impose more respect than all theories; they act accord- ing to natural laws which are not the work of man, and man can do nothing against these laws; his obstinate denial of them does not impede their progress, and cannot diminish their effects. Boudin could say with entire truth, " I have often, with a single dose of of a grain obtained the radical disappear- ance of fevers," etc. Yes, but this of a grain was " suita- bly prepared, triturated a good while; " that is to say dynam- ized ; and from the day that this trituration failed him, he per- ceived the necessity of increasing the dose. This trituration failed him one day; and this is the way we know it. Trichon, a pharmaceutist of Marseilles, who, be- fore 1840, rendered us the service of adding to his old phar- macy a special homoeopathic pharmacy, was the first who was called on to prepare Boudin's arsenical powders; now Tri- chon, devoted to the interests and honor of homoeopathy, fol- lowed Hahnemann's precepts in making these preparations; he " triturated a good while." Afterward, at Paris, the ordi- nary pharmaceutists made up Boudin's formulas, but, whether from indifference or ignorance, they did not "triturate a good while," and then Boudin was able to say to Trichon: "make my powders for me, yours are the only ones that succeed mir- aculously." Mons. Tri chon is still there to give evidence. In 1841, I was general Secretary of the Medical Society of Marseilles, and in my report on Boudin's book, I rendered justice to my friend's merits in these words, which I find to- day still irrefutable: " Harmless as to the dose, a prompter curative action, a surer preventive action against relapses." I paused there ; to-day I complete the expression of my thought. Boudin borrowed from us the idea of combating intermit- tent fevers with Arsenic. Ue obtained his first success with globules of Arsenic.30 From this fact, Boudin deduced the possibility of taking away from Arsenic its toxic, action while entirely conserving its curative action, and he succeeded in doing this by attenuat- ing the dose; but he could not foresee that by the process which he thought was only susceptible of aiding the attenua- 402 world's iiomceopathic convention. tion, he dynamized the medicament, and it was becanse it was dynamized that the hundredth of a grain was sufficient to obtain for him the most remarkable cures. Such were, and such are still the acquisitions which science owed to Boudin, but our friend lacked exact knowledge of the law of specific relation, and the study of the means which prepare the benefits of its application. Ue did not know how to individualize either the malady or the medicament, and this explains the avowal which escaped him on p. 2S1. "I have not succeeded in all cases. . . . It would now be difficult to precisely designate the circum stances in which it is suitable to prefer Quinine." These difficulties, of which he caught a glimpse, could only be surmounted by the Ilalmemannian individualization. Ah! if Boudin had been more independent and had worked more seriously in the new path which Providence opened to him, he would have been spared many disappointments and his fame would have increased by the services he would have rendered. Instead of leaving a name honored for regulating the therapeutic employment of Arsenic in the treatment of intermittent fevers, a wider horizon would have opened before him; instead of a partial truth he would have embraced the whole truth, and we should have counted him to-day in the first rank of the benefactors of humanity. Arsenic is not only a curative remedy of certain forms of intermittent fevers, it is also an excellent preventive incases whose symptoms bear a homoeopathic relation to the patho- genetic effects of the remedy. We have seen these fevers disappear under the influence of arsenical emanations in localities where, up to that time, they had endemically prevailed. Stokes of Dublin has recorded in his Therapeutics this interesting remark : that paroxysmal fevers which formerly made great ravages in the district of Cornwall had entirely disappeared since the establishment of a copper foundry in that district. Every one knows that Ar- senic is disengaged during the fusion of copper. In Algeria, in the province of Constantine, there are baths called the mi- neral baths of Ilammammeskutia, containing an atom of Ar- senic (Tripier). The Arabs and the colonists attribute a INTERMITTENT FEVERS. 403 salutary influence to these waters, and not without reason ; the presence of Arsenic is well calculated to give confidence. Traces of Roman baths are still to be seen near these waters. Asarum europ.-"I have given it several times with success to persons whom Quinine had failed to cure of intermittent fevers." (Garidet, Ilistoire des plantes de la Provence.) Tour- nefort has already designated it as excellent- for the cure of inveterate intermittent fevers, as well as for obstructions of the viscera and principally of the spleen ; very useful in the ancient quartan fever, with disposition to infiltration, con- gestion of the liver and of the spleen (Desbois de Rochefort.) Mathiole, Kanning, Pedtzole have written that the adminis- tration of Asaret was advantageous in the treatment of quoti- dian intermittent fevers. (Dictionnaire de medecine; 2me edi- tion, vol. vi., p. 191). It may be given in small doses in intermittent fevers (Dictionnaire universel de matieres me- dicales, vol. ii., p. 180). Elsewhere it is recommended as a specific for intermittent fevers. There are few remedies about whose value tradition is so unanimous, and there is none more neglected, But facts are everything in medicine. Ars tota in observationibus. Wherever we find them we ought to revive them with care, for our science is interested to know them. Tradition is subject to corruption and apt to mix many errors with its truths ; but tradition is not, for this reason, to be despised ; it is our mission as physicians to reject the errors but preserve the truths; for otherwise, therapeutics has always to be begun over again ; and it is unseemly to extol experience in words and make no account of it in reality. We have in our School an infallible criterion for distin- guishinff the true from the false ; let us avail ourselves of it. Does the remedy, in its pathogenetic effects, produce the ana- logue of the disease, whose cure we attribute to it ? Certainly, since the cure is homoeopathic ; whereas, where the Materia Medica Pura is silent, we must place an interrogation point. Asar. europ. has been tested, and we may affirm that it has cured intermittent fevers because, it has the property of producing the faithful image of them. 404 world's homoeopathic convention. We read in the pathogensis of Asar. europ : "fever which announces itself by gooseflesh and cold feet and hands,, face azure blue; shiverings leading to general trembling. Cold, exasperated by the least movement, by slightly uncovering and by drinking. Cold followed by extraordinary heat of the forehead and whole scalp; temperature of the rest of the body not too high. Chills in the midst of the hot stage, pulsestrong and accelerated. Absence of thirst; no sweat. After sleep, sensation of external heat with internal shiverings. Apyrexia: sensation of painful pressure in the left hypochondrium, aggravated by movement; in the same region, painful pinchings which extend into the back ; momentary pains in the left side of the abdomen, radiating obliquely under the umbilicus; soreness in the region of the spleen; pressure in the abdomen, fulness, flatulence ; sensation of constriction in the region of attachments of the diaphragm." How can we fail to recognise, in these distinctly marked features, the physiognomy of certain intermittent and inveter- ate, obstinate fevers, since hypertrophy of the spleen figures in the picture of the symptoms? It is more than would be absolutely necessary to determine the certainty of cures effected by the ancients. Now let us precisely state the indications. Predominance of cold ; heat without thirst, absence of sweat; alternations of cold and heat, even during the hot stage ; concomitance of external heat and internal shiverings. Cho- leraic form with abundant evacutions up and down. The pathogenesis of Asar. eur., has violent vomitings and abundant evacuations, as has been long known ; for Desbois de Rochefort treats of it as purgative and emetic, sometimes to a dangerous degree. Subjects physically and morally feeble. Avoidance of all sorts of work; if he fixes his attention on any point whatever, he is seized with headache and vomitings. Bebertne.-This active principle of Bebeern (NectandraRo- diee) has been introduced in the homoeopathic Materia Me- dica without any valuable experiments to reveal to us its pa- thogenetic effects; we are therefore powerless to assign it a suitable place. Yet it has been sufficiently recommended to us to make us feel obliged to say what we know about it. INTERMITTENT FEVERS 405 Tlie inhabitants of the British Guiana employ Beberine in the treatment of intermittent fevers, and have made it a suc- cedaneum to Quinine. Dr. Bodie was the first who experi- mented on Beberine and its sulphate, and who declared its efficacy in intermittent fevers. After him, Dr. Douglas Ma- clagan of Edinburgh, AV. Pepper of Philadelphia, Dayley of Smyrna, Becquerel of Paris have also experimented with this febrifuge and have obtained good effects from it; and all recognise that it has this advantage over the sulphate of Qui- nine, that it does not produce any sensible physiological phe- nomena. Dr. Becquerel has found it less efficacious than the sulphate of Quinine, although succesful sometimes where the latter has failed ; which proves that there is no way to guage the comparative value of Beberine and the other antiperiodics but by determining its characteristics. Belladonna.-Intermittent fever is susceptible of assuming an inflammatory and congestive form, affecting the brain, cha- racterised by violent headache, delirium or drowsiness, photo- phobia, vertigo, heat and redness of the face, visible beating of arteries of the neck ; shiverings in one part of the body and heat in another. The shiverings are violent and the heat moderate, or the heat is excessively intense with insignificant shiverings. Thirst is absent or very intense. At the climax of the pains especially, the patient is in tears, very irritable or morally depressed ; calling on death with loud cries. The paroxysm never begins in the afternoon. Bryonia.-Burning thirst in the three stages. The parox- ysm may set in at any hour of the day or night, but it oftenest commences in the evening. The initial chill appears in the lips, the ends of the fingers and toes. Often in the begin- ning only one side of the body is affected, the right side by preference. Rheumatic pains mingle with the paroxysms. Hot stage: heat general, with thirst. Violent stitches in the sides of the chest, especially in the right side and under the sternum; with dry, hard cough, oppression; the cough and shootings in the chest diminish with the fever and even disap- pear in the sweat. Painful stitches in the abdomen and limbs, all aggravated by the slightest movement. Sweat: abundant 406 world's iiomceopatihc convention. at night and toward morning; Before the paroxysm headache, vertigo, dry heat of the skin. Apyrexia: tongue thick, exces- sive thirst, bitter taste in the mouth; disgust to the degree that he cannot bear the sight of food; nausea or vomitings; constipation. Cactus grand.-Quotidian fever. Paroxysm always begins either at 11 a. m., or 11 p. m. The cold stage is excessively severe, and lasts almost three hours. Hot stage: burning, with great difficulty of breathing; thirst, pain in the head, dizziness, and, finally, sweat very abundant, with inextinguish- able thirst. During the sweat, in women, sharp uterine pains. Apyrexia: organic affection of the heart. Pains in the heart, sometimes very violent; general feebleness ; prostration. In individual cases where Cactus has succeeded, experience has proved that Quinine fails. Calcarea carb.-Chronicity ; hopeless persistency. The only effect of Quinine has been to produce deafness. Lym- phatic subjects, with dermatoses, ganglions, congestions and swellings of the joints. In women with too early, too abund- ant and too prolonged menses. Tertian type : Paroxysm tow- ard 3 p m. The cold and the heat alternate rapidly or exist simultaneously; the cold makes itself felt internally; thirst during the cold. Hot stage : during which the hands remain cold. Drowsiness, face congested. Lies down on the left side. On waking, eyes haggard, dizziness, cries, alarms, tremb- ling of the hands. Persistent disposition to sweat; nocturnal sweat, principally on the chest. Tongue red, clean, pointed; stools diarrhoeic, grayish. Loss of power, emaciation ; hyper- trophy of the spleen. Camphora.-Its pathogenesis authorizes its choice in in- termittent fevers with predominance of cold and of extreme cold (pernicious algid fever); general indefinable illness; anxi- ety, agitation with trembling of the limbs; twitching of the tendons; necessity to move, which obliged him to leave the bed; cramps, convulsions. Barthez and other practitioners of the Old School, have obtained excellent effects from the ad- ministration of Camphor in intermittent fevers characterized by a predominance of nervous symptoms. INTERMITTENT FEVERS. 407 Canchdlagua.-One of the names of Chironia chiliensis; Erythroea chiliensis, Pers.; Gentiana peruviana, Lamk ; Chi- ronia of Chili, the root of which is employed in Chili as a fe- brifuge. The American Journal of Materia Medica recommends it especially in vernal intermittent fevers. Symptoms: nausea, vomitings of mucus, colored with bile ; very violent chills with chattering of the teeth; extreme paleness of the face, bands, and lips. Apyrexia: almost always excellent appetite. Capsicum ann.-Fever, with predominance of cold; chills on the least movement, first chill in the back ; this lasts a long time, increases little by little, and ends by bringing on cold- ness of the whole body. Thirst in the cold stage, but drink- ing is not borne well, the patient says he feels worse after hav- ing drunk, and vomitings follow after much gaping and stretching. During the cold stage, pains in the back, in the shoulders, in the calves. Hot stage, none; that is to say, the sweat immediately succeeds the chill; or, intense and burning, and, during the heat, thirst, which, however, stops after one swallow ; will not have a drop more. The mouth and throat are full of mucus. The irritability is so great that the least noise is intolerable. Sweat without thirst. Apyrexia: chronic diarrhoea, acrid corrosive, with great coldness. The patient complains alternately of being too warm or too cold; at the same time has viscous sweat over the whole body. Painful swelling of the spleen and pains in the limbs. Capsicum has been successful after the abuse of Quinine. Carbo veg.-Corresponds to the ataxic, which is one of the most pernicious forms. Its different points do not come in regular succession; they are often inverted. The paroxysm begins in the afternoon, evening or night. It is announced by coldness of the feet. The initial chill begins by affecting only one side, the left by preference; while Bryonia has more pre- dilection for the right. Cold stage : eager thirst, which ceases immediately after the chill, and does not again appear at any period, as in Ignatia. Hot stage: redness of the face, vertigo, great depression, sudden prostration ; you would say the nerv- ous system had received a shock; in the middle of the hot 408 world's homceopatiiic convention. stage there is a very sudden glacial coldness of the whole body; the tongue is cold, the features are distorted, and assume a cadaverous aspect, the voice fails, the pulse is effaced; coma- tose state. Sweat: often profuse. Apyrexia : the spleen is hypertrophied and painful; frequent nausea. Epigastrium swollen and painful after eating. Rheumatic pains in various parts of the body; there is no part, even to the teeth, which is not painful. More especially indicated when cold and damp weather prevails. Cedron, has often been recommended as an anti-periodic, when Cinchona and Quinine have failed. It is an antidote to Quinine, since it notably removes roaring in the ears which the other too often causes; but, alone and on the first admin- istration, it is sufficient to cure an intermittent fever in the following cases: Regular paroxysm of fever, coming at the same hour, com- mencing every day at 6 p. m., by chills in the back and limbs. Tearing and twitching pains in the limbs. At first there is a sensation of cold in the feet and hands. Mouth dry, great thirst for cold water. The chill is severe enough, to shake the whole body. It is renewed by every movement; its duration is from one to two hours; the hands, the feet and the nose are cold; palpitations of the heart, hurried respiration; pulse feeble and depressed. Hot stage: dryness, accompanied by heaviness of the head, redness of the face, burning heat in the hands, pulse full and accelerated, thirst with desire for warm drinks. Sweat profuse. Apyrexia : frontal headache, heavi- ness of head, nervous; general illness with weakness. The body is heavy, the mind depressed ; transient pains are felt in the joints and principally in the right elbow, which seems, be- tween whiles, to perspire. Roaring in the ears, deafness at night. Chamomilla.-The paroxysm comes in the afternoon, runs regularly through its three periods, usually anticipating two hours each day. Chill slight, lasts pretty long without thirst. Hot stage: with little thirst, intense fever, one cheek red, the other pale; great agitation, anxiety; the tongue is red on the edges; bitter taste. Bitter vomitings; diarrhoea, preceded by INTERMITTENT FEVERS. 409 colics. Sweat abundant and at night, as the end of the parox- ysm. In subjects who are a prey to painful and sharp dis- quiet ; nervous, and inclined to bad digestion. Cinchona.-Paludal fevers are its especial domain. Type variable, quotidian, tertian, etc.; stages regular. Before the attack there is usually a certain feeling of illness, headache, an- guish with beatings of the heart, sneezing, canine hunger, nau- sea, thirst. The attack may begin at any hour of the day, rarely at night, and usually toward mid-day. Cold stage : thirst ceases as soon as this begins; paleness of the face, vertigo, paleness and icy coldness of the feet and hands; flow of thick saliva into the mouth; complete absence of thirst, and the chill is much increased if a cold drink is taken at this moment. Hot stage: burning heat in the whole body with burning lips and agitation; this stage is of long duration; headache, con- gestion, delirium, external veins swollen, bright redness of the face; twitching pain in the right temple and around the right eye, which is red, hot, painful, sensitive to light; pulse full and accelerated. Cough dry, spasmodic, fatiguing, with pain- fulness of the two hypochondria, and, above all, at the pit of the stomach. The limbs seem bruised and are painful. Sweat: the first sign of it is the return of the thirst which preceded the chill and which was absent during the cold and hot stages ; an intense thirst during the chill, and, above all, during the hot stage, is a positive contraindication for China. The sweat is sometimes slow in establishing itself, but when it exists it is of long duration and profuse, most frequently out of propor- tion to the intensity of the cold and hot stages. This sweat is more abundant at night and noticeably on the parts upon which the body rests; it debilitates the patient considerably. Apyrexia: tongue coated with a thick and yellowish-brown coat, bitterness in the mouth; little appetite, or canine hun- ger, with pain and epigastric swelling; pressure at the pit of the stomach, eructations and vomitings ; hypertrophy of the spleen and of the liver, with shooting pains. Complexion earthy, yellowish-black; eyes without brilliancy, great feeble- ness, anxiety, prostration, unquiet sleep, full of agitating dreams. 410 would'S HOMOEOPATHIC CONVENTION. Chininum arsen. - This composition, of two principal agents which experience has demonstrated to be the most useful against intermittent fevers, is marvelously efficacious in all cases where the paroxysms are followed by extreme prostra- tion. During the paroxysm the pains are burning, the patient is oppressed ; pain in the heart; the paroxysms usually come in the morning, and last till midnight. The pains are relieved by warm applications. Chininum sulph.-A perfect regularity in the periodicity of the invasion and in the progress of the paroxysm is the first condition of its success. Acute cases, similar to China. Vio- lent chills, intense heat, profuse sweat, are in its domain; whether the fever assumes the type of tertian, quotidian, etc., the first indication is regularity. Delirium during the attack, and the spinous apophyses of the dorsal vertebrae are sensitive to pressure ; this should be remembered, for the Sulphate of quinine acts especially upon the spinal marrow and the nerves which come from it. Before the chill, thirst; which, as in China, ceases as soon as the chill commences; the thirst reap- pears during the sweat. Apyrexia: canine hunger more marked than in China, even when the subject is feeble and nervous ; even light exercise exhausts him and causes palpita- tions. The urine deposits a coarse sediment or brick-red pel- licle and contains crystals of urates ; ringing in the ears, with burning in the ears accompanied by vertigo and feeling as if the head increased in size. Visceral obstructions and particu- larly swelling of the spleen. It is because it produces this swell- ing in the healthy that it is the more specific against it. The Sulphate of quinine recommends itself by its anti-periodic ■virtue, par excellence, every time that w'e have to fear a perni- cious fever, without having at our command the truly hom- oeopathic remedy ; let us never lose sight of the fact, however, •that the Sulphate of quinine, in such cases reaches only one of the elements of the fever, the periodicity. Also useful in the last -stages of the paludal cachexia, the leucocythcmia, in sub- jects enfeebled by loss of blood or by any other cause. Chininum val.-The combination of Valerianic acid and Quinine gives a compound useful on account of its antiperiodic INTERMITTENT FEVERS. 411 and nervo-stlienic properties. Administered simple and pnre, it is equivalent to China and nervines combined. It is said to render great service in nervous, hysterical subjects. Periodic fevers of an atonic and malignant form. Cimex.-Tertian or quartan fever with pains in the liver; haemorrhoidal trouble, tension in the bowels and constipation. Cold stage: pains in the lumbar region and in all the joints. The action of the flexor muscles exceeds that of the extensors; pains in the chest, which inconvenience respiration and often provoke a long inspiration. Hot stage: without thirst, but with desire to vomit and sensation of constriction in the oesophagus, which sometimes makes swallowing difficult. Sweat: most evident on the head and chest. Cina.-Vomiting and diarrhoea before, during and after the fever, with clean tongue; this distinguishes it from Antimon, crud., which requires for its application a tongue covered with a whitish coat, and from Ipecacuanha, in that, for the latter, if the tongue is sometimes clean, there is always a predomin- ance of the vomiting over the diarrhoea. Thirst in both cold and hot stages, but the especial characteristic is rubbing of the nose. Intestinal worms. Vomiting of food immediately suc- ceeded by canine hunger. Cocculus.-Independently of the ordinary symptoms of in- termittent fever, the patient complains exceptionally of feeble- ness in the kidneys, of colics mixed with burning, of constric- tion and tearing in the epigastrium and lower abdomen. The paroxysm consists of cold exclusively, without heat or sweat. When the fever threatens to assume a slow and nervous form, whose apyrexia consists of vertigo, dull pains in the head, physical depression, general weakness, anorexia, with cleanness of the tongue. Marked tendency to nausea, as if the stomach was always ready to rise. Drosera.-When desire to vomit exists, and tickling in the throat, with a short cough, so sudden that the patient loses his breath; the cough induces vomiting. Intense fever begins with a cold face, icy coldness of the feet and hands, with bil- ious vomiting. Hot stage: accompanied by violent pressive and pulsating pains in the head, with spasmodic cough. Apy- rexia: marked by gastric symptoms. 412 world's HOMCEOPATHIC CONVENTION. Eucalyptus glob.-A popular remedy in Australia, Spain and Italy, it promises to be so in Africa and in Provence, both as a preventive and curative agent. Preventive action: we know that Ilelianthus (Hely. aim.) has the property of puri- fying the atmosphere by absorbing a great quantity of damp and injurious gas and by exhaling oxygen mixed with ozone. Why should not the Eucalyptus, whose leaves diffuse to a great distance so penetrating an odor, possess the power of antidoting miasms and exercise a preservative action ? There is no longer any doubt that the Eucalyptus has this, power. Here is an instance of it: the abbe Felix Charmetant, priest to the African missions, writes: " I will give you some facts about our plantations of the Eucalyptus at Maison-carree, which is now become our Mother-House. This estate was, six years ago, an immense territory covered with brush, dwarf palms, and rendered very unhealthy by the neighborhood of the stagnant waters of Harach. In 18G9 and 1870, as fast as the brush was destroyed, we planted a considerable quantity of Eucalyptus in groups or beside paths the whole length of our fields and gardens, and the result was most marvellous ; for the intermittent fever, which often stopped our orphans in their agricultural labor, has gradually disappeared, so that to- day this domain is one of the most healthy suburbs of Algiers, after having been the most subject to fevers." Curative action : the same sketch continues thus : " We have completely given up the use of the sulphate of Quinine in intermittent fever which still persists in showing itself from time to time in some of our children. . . . for several years we have used only a tea made from the leaves of the Eucalyp- tus glob, taken from the young plants, and we have remarked, as moreover many physicians in Algeria have stated, that this remedy is efficacious in certain cases where the Sulphate of Quinine is powerless, and especially that it has not, like the latter, the disadvantage of injuring the stomach and of some- times, while curing the paludal fever, leaving behind it what our colonists call Quinine fever, so common in Algeria." Its antiperiodic virtue being once admitted, as it must be, the Eucalyptus deserves to occupy a distinguished place in the INTERMITTENT FEVERS. 413 treatment of prolonged intermittents ; for, under its influence, the volume of the spleen diminshes, but it becomes more re- sistant, harder and bunchy on its surface, which is the case in obstinate fevers. As to individual indications for this remedy, we are not far advanced; we do not know its characteristics; the pathogenesis alone can give them to us. As, however, we already know that the Eucalyptus is called on to play an im- portant part in anti-catarrhal medication, we may assume, without fear of error, that cough and exaggerated mucous se- cretions will be among its indications. Eupatorium perfThis plant, popularly fever-herb, was always employed in the United States in infusion, as a febri- fuge. We owe the knowledge of its definite indications to our transatlantic colleagues. The attack usually commences from 7 to 9 a. m. ; but this is not absolutely necessary; all types may be cured by Eupatorium perf. Before the chill, and even a long time before it, great thirst appears, which is prolonged, and after drinking there is vomiting. Cold stage: chill begins in the lumbar region; chills of long duration ; between the two first stages acute osteocopic pains and bilious vomitings. Hot stage: slight and of short duration, accompanied by weakness and syncope. Much shivering even during the heat. Sweat rare and insignificant. Apyrexia : bitter taste in the mouth, yellow tongue, thirst, cracks at the commissures of the lips ; uneasiness of the stomach the night preceding the day on which the attack is to set in. The pains of Eupatorium perf. are not only osteocopic; they affect the back, the limbs, the head, the chest, more particularly the wrists as if these were out of joint, the eyeballs. They are accompanied, like the pains of Bryonia, by headache, pain in the hepatic region, constipation; but while for Bryonia the perspiration is abun- dant and the pains force one to lie still; the sweat is wanting in Eupatorium perf. and the pains cause restlessness without being relieved by motion. Eupatorium purp.-Great affinity with Eupatorium perf., and besides, it has been praised as a preservative. The same characteristics: violent pains in the bones during the attack and, above all, during the cold and hot stages. The chill 414 world's nOMGEOPATHIC CONVENTION. begins at the back, as in Capsicum; the chills are not of extreme violence as they have been observed to be in other forms of fever, and yet the whole body is briskly shaken by them. Thirst in both cold and hot stages. Finally the sweats cover particularly the upper part of the body. Ferrum met.-Before the attack, congestive frontal head- ache manifesting itself by violent pressure, and then violent chills with more intense headache, burning thirst, red face. Hot stage and sweat moderate, tendency to vomiting, great weakness. Besides these clearly defined conditions, the prin- cipal indications for Ferrum are all drawn from the totality of the general condition, of which I will give the principal fea- tures : constant shivering even in bed, pulse habitually feeble, small, soft, excited by the least movement; paleness of the face, the skin is transparent when it is not earthy. Panting on the least movement ; various neuralgias: con- gestive headache, want of appetite, feeling of fulness in the stomach after having eaten. Constipation or chronic diarrhoea with lientery; vomitings of food. Complete decoloration of the mucous membrane of the mouth; swelling of the hypo- chondria, with hardness of the spleen and liver; oedema of the extremities, difficult respiration. Iron is evidently one of the most precious remedies against the cachectic condition; but I admit neither the chemical rea- sons which have been imagined and which have been current even on the lips of our School, nor the massive doses which naturally flow from these considerations ; it is by its dynamic virtues that Ferrum acts and confers all its benefits. Ferrum phos. and sulph. may be substituted for Ferrum met. in the majority of cases and replace it advantageously Gelsemin.-Periodicity being attributed to it by its patho- genesis, it could not fail to be useful in fevers of a regular type, but characterized by the disorders of innervation which this drug controls. Delirium, vertigo, feelings of vacuity, of fainting, in the female patient especially, for Gelsemium is above all a remedy for women ; does not wish to speak ; nor have any one near her to keep her company, even if the per- son is silent. The attack begins in the evening, the first chill INTERMITTENT FEVEKS. 415 begins in the extremities ; remittent type of fever with marked exacerbation toward evening, and diminution of heat with perspiration toward morning. IL lleborus nig.-Considerable oedema ; abdomen tender and inflated on the left side, stools hard, urine normal. llepar sulph.-Exercises a like curative action to Sulph. in psoric individuals when, at the beginning of the fever, skin-symptoms show themselves, but it is especially indicated after mercurial treatment sufficiently prolonged to awaken fear of poisoning. Hydrastis.-Recommended in America by practitioners worthy of entire credence both on account of the integrity of their character and the extent of their experience; but, notwith- standing this, the silence of the pathogenesis of this remedy with regard to the phenomena which characterize true inter- mittent fever, forbids us to count upon it in any pyrexia what- ever, if it be periodic. At the most, we could but conceive of its appropriateness in conditions of profound cachexy with jaundice, considerable gastric trouble and extreme prostra- tion. Ilyoscyamus.-Ilas shown itself specific in fevers of various types, which have resisted several strong doses of Cinchona. The indications consist in a dry nocturnal cough, which dis- turbs sleep, in an extreme nervous excitement sometimes accompanied by epileptic attacks or by other spasmodic affec- tions. Hot stage: without much sweat; after each paroxysm pressure in the head, vertigo. Apyrexia: extreme weakness, luminous spots before the eyes, dryness in the mouth and frequent hiccough. Pulse small. Ignatia.-In nervous persons exhausted by long concen- trated grief. The attacks are not regular either in periodi- city or in the evolution of their stages. They are complicated by nervous symptoms, cramps, convulsions, attack of suffo- cation. Cold stage: offers this peculiarity, that it is moderated by hot applications. Thirst during the cold stage, and the thirst is burning in this first period but only then; for in the hot stage and in the sweat it is entirely absent, or if it appears it 416 world's homceopatiiic convention. is only at wide intervals and always for a short time. With the cold stage colics appear and gastric troubles characterized by a pressing pain at the pit of the stomach, and by vomit- ings. Heat especially appreciable externally and partially; much emphasized in certain portions of the body, and coldness elsewhere. Sweat with sensation of internal heat, slightly marked and accompanied by somnolence. Ipecacuanha.-I have known practitioners, highly com- mendable in other respects, who always began with Ipec., under the pretence that, after it, the case was better outlined and the choice of the true specific was consequently easier. This is simply an encouragement to indolence. Ipecacuanha presents itself to us with so clearly defined features that it is impossible with a little attention not to recognise at once the cases which call for it. Before and during the paroxysm, the scene is laid by preference in the digestive organs; afflux of saliva in the mouth, taste often bitter, eructations, nausea, vomitings with clean or slightly coated tongue; dryness of the mouth without thirst, difficulty in breathing on account of oppression in the front of the chest. Many chills and little heat, or much heat afterlight chills, are two cases equally fa- vorable. The chill is without, or with very little, thirst; it is exacerbated under the influence of heat applied externally, the contrary of Ignatia whose chills are moderated by hot appli- cations. In the cold stage the feet and hands are very cold and covered with cold sweat. Hot stage: great thirst, nausea, vomiting; diarrhoea; convulsive cough, sweat irregular. Apy- rexia : bilious complexion ; spleen swollen ; total loss of appe- tite. This last characteristic feature of Ipecacuanha had not escaped the perspicacity of Jn. Frank, since the intermittent fevers for which he extolled this remedy especially, were accompanied by an unusual aversion to food. (Path, med.) Kali carb.-The stage of sweat is entirely absent. The pa- roxysms are characterized by headache, pricking pains in the forehead and eyes ; deep pains in the eyes with photophobia and weeping; the pain at first pressive, then sharp, making him. cry out. Sparks before the eyes ; gaze fixed. Mist and black spots before the eyes; swelling of the upper eyelids, face red and INTERMITTENT FEVERS. 417 hot; headache wakes him in the morning ; it is increased by the cough and sneezing ; urine red ; stools dry. During the cold and hot stages, dyspnoea, constriction in the chest and pain in the region of the liver. During the cold stage the hands are warm. The attack begins in the evening. Thirst oftenest during the cold stage. Lachesis.-The paroxysm begins at 2 p. m., soon after eating, and lasts all the afternoon and all night. Tertian fever. Cold stage : pains in the limbs and in the back. Hot stage: head- ache, delirium, oppression. Burning thirst, agitation. Sweat, nothing remarkable except a great weakness. Apyrexia: complexion' livid, but complete remission of all symptoms. More especially useful in subjects in whom paroxysms of fever surely return after taking acids. It is confidently stated that spring and the beginning of summer are the most favorable seasons for the action of Lachesis. Ledum palu^e.-The chills offer this peculiarity that dur- ing the whole time they last the patient complains of a sensa- tion as if cold water were poured over his body. Hahnemann gives as characteristic of this remedy : violent chills and hor- ripilation with cold limbs. Tradition has transmitted this in- struction : " Ledum possesses a heating and roborant virtue. It is an excellent remedy in all diseases which arise from cold and debility; " evident proof that it has been seen to cure af- fections in which cold and horripilation were the salient feat- ures (curative effect corresponding to the pathogenetic effect). Its distilled oil, given in a dose of from four to six drops be- fore the paroxysm, sweeps away the tertian fever" (Diet. rais. et univ. de Mat. Med., Paris, 1773). Lycopodium.-The hour.of aggravation of Lycopodium is of the first importance in its therapeutic application. Every fever, whose initial chills appear at 4 p. m., is surely within its sphere. The first chills are usually felt only on one side of the body, most often on the left (Bryonia and Phus on the right). Hot stage: almost none, but with burning thirst and frequently with incontinence of urine. Profuse sweat; after the sweat, thirst. Persons of delicate chests, affected at least with chronic bronchitis, with thick, yellow and salt expectora- 418 world's HOMCEOPATHIC CONVENTION. tion; the cheeks colored. Inflated abdomen with abundant eructations and obstinate constipation. Menyantlies.-Irregularities in the periodicity. The parox- ysm is almost entirely made up of the cold stage, which, how- ever, is incompletely developed, for the cold is partial. The hands or the ends of the fingers, the toes, or the feet, or the end of the nose are frequently the only parts really cold. Mercurius.-Tertian fever, with paroxysm anticipating two hours each time. Cold stage : with thirst, which appears with the first chilliness. Hot stage : burning, with insatiable thirst, palpitation of the heart, excessive anguish. Sweat excessively abundant, fetid. During the entire paroxysm offensive odor from the mouth. Apyrexia: great feebleness, vertigo when sitting down on the bed; sore throat felt when swallowing; gums inflamed and painful; thick, salt mucus in the mouth. Mezereum.-Fever consisting of severe cold throughout the body for several hours; icy coldness of the hands and feet. Extreme thirst during the whole of the cold stage. Hot stage: excessive, but of short duration. Sweat, with drowsiness. Apyrexia: swelling and hardness of the spleen, pressive pain in this region, general feebleness, great paleness of the face, headache, want of appetite, sensitiveness to cold air. ^Lomordica elat.-Enormous hyper-secretion from all the mucous membranes is the most certain effect of this remedy on the healthy. Quotidian intermittent fever of the choleraic type. Cold stage preceded by gaping and sneezing, accom- panied by nausea, vomitings, watery stools, colics, and pains in the limbs. Hot stage : intense fever, pulse hard and fre- quent, respiration accelerated, frontal headache, burning thirst. Sweat abundant. Apyrexia : tongue white, bitter taste in the mouth; burning itching throughout the body; general jaun- dice, more marked in the conjunctiva; urine black: stools very frequent and watery, accompanied by violent colics. Sweats, which stain the linen yellow. Natrum mur. is one of our most important remedies ; every type of fever belongs to it. Autumnal and vernal fevers. Chronic cases especially, perverted, aggravated, made more in- sidious by the use of Quinine, which had temporarily sup- INTERMITTENT FEVERS. 419 pressed the regular paroxysms. A superficial relief, indeed ! The genius of the malady has veiled itself under the effects of Quinine; but, it has not disappeared. In these cases, the skin is earthy, dirty, flabby and torpid; the liver is always more or less affected, its hypertrophy is only too easy to verify. The paroxysms appear at various times. During the whole parox- ysm, violent headache, with a sensation as if the head was go- ing to fly into fragments. The patient is stupefied to the point of no longer knowing where he is. Oppression, thirst, tearings in the hands, feet and kidneys. Cold stage: severe general coldness felt in the bones during several hours, with blue nails and chattering of the teeth; paleness of the face and lips. During this stage, independently of the violent headache, troubles of vision appear. The first chills begin at the back, or are felt in the feet; and, in both cases, they most frequently affect only half the body, and the right side by preference. Thirst in cold stage. Coldness, as in Ignat., is relieved by warm applications. Hot stage: general burning heat, but of short duration, with thirst and excessive headache, jerking from the occiput to the forehead, as far as the eyes; the headache persists after the hot stage; shootings and smart- ing in the eyes ; cough. After the cold and hot stages, great thirst. Sweat abundant, of a disagreeable odor, with persist- ence of the thirst and drowsiness after it. Apyrexia : loss of appetite, all food repugnant except bread ; bitter taste in the mouth, tongue coated, white; all food bitter to him. Sensi- bility at the pit of the stomach; eructations, pressure in the liver alternating with pains in the spleen ; constipation, bilious urine, incisive pains in the urethra after micturition. Yellow- ish complexion. Venereal appetite diminishes, almost disap- pears. Herpes labialis : little ulcerations at the commissures of the lips; crusts on the lips ; exanthema in the mouth; lit- tle sleep at night and sleepiness during the day. Depression to the point of wishing to always stay in bed. Suppression of menses. After Natrum mur. one would do well to take Nux vom. for the persistence of vertigo or headache, or when the pros- tration is too prolonged. 420 world's homeopathic convention. Nux mosch.-Fever, not paludal, purely nervous ; its peri- odicity places it here. At seven o'clock every morning the chills set in and increase, but, in the midst of this progression of chills, the patient becomes drowsy, and, when the chills cease, is fast asleep. The hot stage is very slightly pronounced, the patient continues to sleep; on awaking, great dryness of the throat; fever, with colliquative diarrhoea. Nax vom.-The same practitioners who affected a marked predilection for Ipecacuanha, had also the habit of intercalat- ing a dose of Nux vom. between the repeated doses of Ipecacu- anha and this practice, at least so they tell us, almost certainly retarded the paroxysm, especially in the vernal tertian fever. But such proceedings too much resemble the unreflecting em- piricism which still leads, the Old School to the abusive em- ployment of Quinine. Nux vom. well deserves to be studied by itself, in order to be solely and exclusively used in cases to which it is suitable. Temperament bilious ; dyspeptic subjects, habitually constipated, sad disposition, easily irritated. Before the paroxysm, prostration and paralytic feebleness. Fevers of every type; paroxysm may come at any hour of the day, re- curring at the same hour, in advance of it, or later ; but it is better indicated in tertian fever, in which the paroxysm comes in the morning. Before the cold stage, thirst; severe cold- ness in the whole body, with chattering of the teeth, icy cold- ness of the feet and hands. The nails become blue, the Angers seem to him dead, the extremities as if paralyzed. Twitching pains in the thighs, legs and kidneys. Thirst; sleep during the chills. General heat, with headache; pressive pain, espe- cially in the sinciput; redness of the face ; roaring in the ears; burning thirst. Necessity of lying down and keeping well covered; immobility in bed, because the slightest movement which uncovers him causes very unpleasant chills. Sweat, which offers nothing particular except a diminished persistence of the various symptoms which accompanied the two earlier stages. Apropos of the previous stages, it is well to note that for Nux vom. the hot stage may precede the cold or be mixed withit. Apyrexia: vertigo, head heavy and affected; frontal headache more severe in the morning; twitching, pressive, INTERMITTENT FEVERS. 421 pulsating pains, especially in the sinciput and temples; face pale, waxy, as in chlorosis. Toothache. Tongue clean or covered with yellowish-brown mucus; the taste is lost, no ap- petite. Vomiting of food; bitter vomiting. Epigastrium painful and sensitive to touch. Swelling and shooting in the region of the liver. Swelling and aching in the left hypochon- drium, which will not bear the least pressure. Constipation, with unsuccessful inclination to stool. Great weakness in the whole body; chills on the least movement, with heat and full and frequent pulse. Dry cough at night; emaciation ; anxie- ty, irritability. It is needless to add that some of these symp- toms appear with greater or less intensity before and during the paroxysm. Opium. - Soporous intermittent fever, the paroxysm of which comes especially in the afternoon. Immediately after the chills, sleepiness, lethargic sleep. Respiration snoring, stertorous, with mouth open ; pulse full and slow. Hot stage: burning heat, with hot, swelled face, of a violet red; on awaking, headache and general prostration. Twitching of the muscles of the extremities; spasmodic contraction of the mus- cles of the face; sardonic smile, loss of consciousness. All the evacuations are suppressed. Insusceptibility of the whole nervous system ; complete indifference; the patient makes no audible complaint. Great feebleness, great thirst, no appetite. Intermittent fevers in old persons and children. Epileptiform fever. Petroselinum.-Quotidian fevers, by preference, free, regu- lar in their evolution, the three stages invariably succeeding each other; fevers of recent date, which appear to depend solely on perverted innervation. Indicated in men, when the pyrexia is accompanied by flatulent dyspepsia, with heat and twitching in the epigastric region, eructations, nausea, vomit- ing and colics; in women of strong plethoric constitution, whose menses are painful and slight or even absent, with lum- bar and inguinal pains. A slight cerebral excitement resem- bling that from coffee, finding its analogue in apiolic drunken- ness, would be an express indication for Petroselin. The pathogenesis of the remedy shows its elective action on 422 world's HOMEOPATHIC CONVENTION. the canal of the urethra by continual need to urinate; fre- quent desire to urinate, with retention, etc. The homoeop- athic clinic has recorded a great number of cures of acute and chronic urethritis; even the old therapeutics has cured, in the hands of Lallemand, of Montpellier, with two or three drops daily of Sue de persil, 1 Jennorrhagias which had resisted Copaiva and Terebinth. I recall these facts in order to give an idea of the especial specificity of Petroselinum in intermittent fevers, complicating traumatic or chronic inflammations of the canal of the urethra, and even stricture. The consensus of the multiple actions of the drug, being here in perfect harmony with the local and general morbid processes, ought to be fruit- ful in practical results. The discovery of the anti-periodic properties of Petroselin has been attributed to Joret and Ilomolle, authors of a memoir which took the prize of the Soc. de Phar. of Paris, and of which the Union Medicale spoke in January and February, 1855. This is not so, and I may say so without offending Messrs. Joret and Ilomelle, for their dissertation is so remarka- ble they need not borrow from any one. Empiricism long ago revealed to us the efficacy of Petros, in periodic affections, and when one of the authors of the memoir cured, in 1847, a case of intermittent fever with a decoction of the seeds of Petros., he made no discovery ; he applied a lesson of traditional expe- rience which he had remembered. In 1630, Ilorstius, in his herbarium, offered this axiom : "Aqua petroselini prodest in febribus pituitosis, scilicet quo- tidianis et tertianis." In 1779, Ferrein (Mat. Med.) declared that Tournefort had seen the Sue de persil administered in Provence as an anti-periodic. Tournefort had already ob- served that the seed is gifted with much better febrifuge prop- erties than the other parts of the plant. In August, 1836, Dr. Potot communicated to the Paris Acad, de Med. some obser- vations on the cure of intermittent fever by the Sue de persil. Peyraire published in the Bordeaux Bull. Med. and in the Jour, de Chimie Med., second series, vol. viii., p. 588, several essays on the treatment of periodic affections with prepara- tions of Petroselin, and, finally, to be just even toward an au- INTERMITTENT FEVERS. 423 thor who, in his books, has the bad taste to sometimes amuse himself unjustly, at the expense of homoeopathy and the hom- oeopaths, Dr. Cazin has reported, in a work presented to the Soci- ety of Medicine of Marseilles, that, in his hands, the Sue de per- sil, given to six patients, had caused three cures and produced two remarkable ameliorations. If we may honor tradition with our full confidence, the serous infiltrations, which follow inter- mittent fevers, should sometimes find their specific in Petro- selinum. Phellandri. aquat.-Lymphatic, feeble and very irritable persons without reaction. Concomitant symptoms : catarrhal or pulmonary affections; cough and muco-purulent expectora- tions; difficulty of respiration; nervous trembling; anxiety; want of appetite, emaciation, diarrhoea, night-sweats, sleepless- ness. Jn. Frank reports (Path. Med. Trans., Paris, 1835, vol. i., p. 1G1) that he cured, witbout a failure, the intermittent fevers which prevailed during the spring and summer of 1801, with Phellandri. aquat. But, he adds, immediately after that, in the following years, the same means employed in the same disease failed. What more evident proof of the necessity of absolutely and always individualizing in pathology and thera- peutics? The law of cure is immutable; there is no caprice about it; caprice is the appanage of physicians ! Phell. aquat. cured the fever of 1801; with the testimony of Jn. Frank no one has a right to doubt it; and, if it failed in the following epidemics, it was because the medical constitution was no longer the same, the disease was no longer the same ; and, not know- ing how to individualize, Jn. Frank has left us a memento, O 7 J but a sterile one. If, however, he had left us the minutely exact portraiture of the fever of 1801, he would have left us the characteristics of Phellandri. aquat. and the success which he obtained, instead of being lost to us, might have been re- peated. Podophyll. pelt.-The attack comes at 7 p. m., with com- pressing pains in both hypochondria, the knees, the ankles, the elbows and the -wrists. Before the chill, pain in the back. The sensation of cold does not leave the patient in the hot 424 world's iiomceopathic convention. stage. During the cold stage, the patient is conscious, but he cannot speak, failing to find words to express his thought. Thirst in the middle of the chill, and more intense thirst dur- ing the hot stage ; in which latter there is delirium and loqua- city ; incoherent remarks which the patient does not remem- ber. Sweat: sleep. Apyrexia: loss of appetite, constipa- tion. P ulsatilla.-Every type. Paroxysm which begins at sun- set and lasts all night. Lymphatic persons of mild character, patient and timid. Cold stage : predominant, with pale face, pain and heaviness of the head. The chills are aggravated when the patient uncovers himself. Soon after the initial chill, mucus vomitings, diarrhoeic, glairy, watery stools, espe- cially at night; anxiety and oppression. Hot stage: slightly marked, partial, often on one side only; repeated chills alter- nating with flushes of heat; redness and swelling of the face or only redness of the cheeks. Sweat: especially on the face and principally at night. Absence of thirst during the whole paroxysm. Apyrexia: paleness of face, tongue watery and coated ; taste bitter, nausea, gastric trouble without thirst; ex- treme and constant chilliness. Mood grieved and plaintive; weeps easily and abundantly. Chlorotic condition in women : change of mood, from being mild the patient has become irri- table and tearful. Rhus tox.-Intermittent fevers appearing after exposure to rain, without taking the precaution to change the wet clothes; in gouty and rheumatic subjects. The paroxysm begins in the evening and lasts all night. Cold stage: the first chills affect only one side of the body, the right by preference (Bryonia). The arm and leg of this side feel the cold first. Pains of lassi- tude, of tearing in the limbs. Headache, throbbings in the head, in the temples; toothache. The cold is severe and ren- dered more painful by a dry cough and by pains in the back. Thirst during the chill. Hot stage : roaring in the ears, hard- ness of hearing; stage painful on account of a constant rest- lessness, which does not permit the patient to keep quiet a single moment. This restlessness resembles that of Arsenic.; but in Rhus tox. there is relief in constant movement, and INTERMITTENT FEVEBS. 425 this is why the patient keeps changing his position. Shootings and tearings in the thighs and legs. Colic and diarrhoeic stools. Nettle-rash; no resemblance to Apis. The eruption appears at the moment of febrile reaction, and disappears some hours after the paroxysm, leaving only a sensation of burning. Sweat profuse with sour smell. A salient feature of Bhus is irregularity in the progress of the first two stages with thirst and hard cough before the initial chill. Sabadilla.-Tertian and quartan types, with regular parox- ysms, always at the same hour. Predominance of gastric symptoms, without thirst or with very moderate thirst. Dur- ing the chill, discomfort, vomiting and a dry, spasmodic cough. Hot stage: thirst none or very moderate, with headache, drowsiness and delirium. Sweat: moderate without thirst. Apyrexia: cold and confusion of the head; weakness in the limbs. Sambucus.-The paroxysms of fever are remarkable : 1. For the intensity of the heat which does not prevent the patient from being very much afraid of uncovering himself and, 2. For excessively abundant sweat which continues even in the apyrexia, and which is often out of proportion with the cold and heat. (Edematous swellings in various parts of the body, notably in the feet, instep and lower part of the legs. Sedum acre.-Quartan fever with predominance of abun- dant evacuations provoked by inflammation of the mucous membrane of the intestinal canal. Scorbutic subjects. "In febribus intermittentibus, potens esse medicina fertur." (Murray). "Hsus quartana." (Linne. Mat. Med., p. 135). Boerhaave had already made known the efficacy of the infusion of this plant in quartan fever. Sepia.-Chronic cases: several types. Quotidian fever; paroxysm in the afternoon ; hot head with redness and shootings in the sides of head ; pressure in the occiput; horripilation in the back for an hour and a half, with thirst, dry cough, shootings in the hypochondria, swelling of the right sub-maxillary glands. Tertian fever; paroxysm now in the morning, now in the evening, horripilation, heat and sweat; sweat especially on the 426 world's IIOMCEOPATIIIC CONVENTION. face. Tliirst in the three stages and even in the apyrexia. Vertigo so that he inclines to fall backward; bitter taste ; shootings in the region of the spleen ; spasmodic cough espe- cially morning and evening, with glairy sputa streaked with blood; bleeding at the nose; shootings in the kidneys when turning over in bed; oppression, insomnia and, if he falls asleep, warm sweat over the body. Quartan fever: paroxysm 5 A. m. ; sensation of moist cold, constantly on the front of the chest. In all forms, the following symptoms serve as indica- tions : yellow spots on the face, black pores on the skin of the face; yellowish tint around the mouth. Eruption, especially annular, or chapped skin. In the evening in bed, palpitations of the heart and throbbing of all the arteries. Profuse sweat in the night; cold sweat on the chest; sweat during the day on the slightest exercise; lassitude and sprained sensation in the lumbar region; violent cramps in the calves, at night. Burning of the feet at night; fetid sweat of the feet; callosi- ties in the breasts, painful to the touch. Flushes of heat in the face, frequent during the day ; paralysis of the upper eyelids; jaundiced tint of the conjunctivae ; disgust for meat and milk; the milk is not digested, it always causes diarrhoea. Thirst in the three stages and even in the apyrexia ; cough, particularly at night, with salt sputa ; extreme lassitude ; great oppression, especially at changes of weather; headache, ill- humor, weakness of memory, deafness. Silicea.-If the fever lias followed the suppression of sweat of the feet, no other remedy ought to be chosen. In scrofu- lous persons with indurated and ulcerated glands; inveterate disposition to cold in the head. Furuncles, panaris; suppura- tions of all sorts; headache relieved by warm covers; pale, earthy complexion; pimples and ulcers in the nose ; ulcera- tions on the red part of the lips ; distaste for meat and warm food ; hurried pulse; chilliness provoked by every motion. Staphysagr.-Much affinity with Sedum acre. Their fea- tures in common are the scorbutic cachexy and the property demonstrated by Orfila of producing inflammation of the stomach in the neighborhood of the pylorus and hence vomit- ing. Before and after the paroxysm, canine hunger. Paroxysm INTERMITTENT FEVERS. 427 is almost exclusively confined to a chill at evening without heat. During tne cold stage bleeding of the gums; hot stage slight, with thirst; sweat, abundant and fetid; sometimes cold on the forehead and feet. Stramonium.-In hysterical persons, violent chills followed by cold throughout the bodv, but the face is red. Hot stage with anxiety, oppressed respiration, sighing, gesticulations, subsultus, agitating dreams; violent thirst during several hours with violent throbbing and tingling in the head, without loss of consciousness. Roaring in the ears; hardness of hearing ; delirium at night, rapid pulse. Apyrexia : attacks of oppres- sion at night; liquid stools. Sulphur.-Delirium during the cold stage would seem to be the first indication for Sulphur. Fever consisting of an alter- nation of cold and heat. Continued and remittent fever with aggravation at evening when a chill of two hours occurs, followed by great heat succeeded towards morning by a sour smelling sweat. The fever of Sulphur is distinguished by the predominance of cold ; slight sweat, particularly characterized by being greatest in the morning; by " morning " is meant " after midnight.'' Cold stage intense ; the initial chill begins at the toes. Hot stage: pulse much accelerated, prostration ; thirst, dryness of the mouth, tongue dry with or without yellowish brown coat; frequent delirium, jaundice. The ant'periodic virtue of Sulphur does not apply simply to pyrexial intermittents, but it also comprehends intermittent neuralgias ; these neuralgias consist of attacks of pain on the right side of the face and head, which begins at the maxillaries and finally extends along the orbital nerves and thence invol- ves the whole side of the head, there being no dental caries. The pains begin toward evening, last three to four hours, then cease, reappear later, and again cease up to the hour of attack in the evening. Psoric subjects ; after the suppression of an exanthem ; after the abuse of Quinine. Taraxacum.-Its whole value is expressed in these words of its pathogenesis: "abundant nocturnal perspiration." Intermittent fevers distinguished from all others by this pathognomonic character are not rare, and this is why Taraxa- 428 world's homoeopathic convention. cum (pissenlit) has so long held a distinguished place in their treatment. Ettmiiller had already asserted its specificity in intermittent and inveterate fevers, and Garidel tells us he has used it with success where Cinchona had only slightly delayed the paroxysms, and where the disease degenerated into a slow fever, especially in dry and bilious subjects. Tartar emet.-During the whole paroxysm, the patient wants to gape and stretch, and, at the same time, intense su- pra-orbital headache lasting even after the paroxysm. The paroxysm comes during the night. No thirst in the first two stages. Pretty acute pains in the lower limbs, but especially a very distressing nausea. The chills are mixed with flushes of heat; constant alternations of heat and cold ; profuse sweat. Agitation, nausea, vomiting and diarrhoea. Excessive vomit- ing ; difficult respiration, with rales and rhonchus relieved by expectoration. Tartar emet. resembles Veratrum alb. in the chilliness, vom- iting and diarrhoea, but it ouffiit to be reserved for cases where the nervous system seems to be more affected, and where the affection shows itself by drowsiness, insensibility, and rigidity of the whole body; by sudden twitchings in the muscles of the face and limbs; pulse thready, trembling. A chronic in- flammation of the mucous membrane of the intestines is one more reason for selecting Tartar emet. Thuja occid.-The paroxysm usually appears at G p. m., con- sists of a chill w'ith violent trembling and internal and exter- nal cold, after which comes a general sweat without previous heat; or, if there is heat it is confined to the face. Mouth dry. Perspiration on the skin of the uncovered parts of tho body, while the covered parts are warm and dry. Sycotic subjects. Valerian.-Absence of cold; violent heat with thirst, and head greatly affected. Veratrum alb.-Choleraic algid fever. Coldness of the whole body and viscous cold sweat particularly on the fore- head, with internal heat and desire for cold drinks. The cold becomes general, but without shaking chills. The chills begin with a sensation of great cold in the abdomen, alternating INTERMITTENT FEVERS. 429 with heat and perspiration. Continued thirst in the cold and hot stages; with the peculiarity, that the beverages are never cold enough. Concomitant symptoms : excessive prostration, face red or pale ; drowsiness or delirium; pulse slow, inter- mittent. Vertigo. Pain in the back and kidneys. Nausea, vomiting of food or serum and diarrhoea, with frequent, ser- ous, watery or bloody stools, or sometimes of pure blood, which is clear and red, or thick and black. There are certain resemblances to notice between Veratrum and Momordica el., which is likewise remarkable for the abund- ance of evacuations which it produces; but, in grave cases, Veratrum alb. ought always to be preferred on account of the predominance of cold which is its characteristic. Zincum.-Its pathogenesis puts us on the track of an inter- mittent fever characterized by repeated chills, a very short, hot stage, and profuse sweat. During the chills there is uneasi- ness, nausea and a painful sensation of constriction in the chest. Concomitant symptoms: want of vitality, physical and moral depression, cerebral weakness, irregular spasms of the heart; sharp, persistent, violent pain about the last lum- bar vertebra; almost all the joints of the upper and lower ex- tremities are the seat of twitching or tearing pains with paraly- sis of movement and trembling; motion aggravates the pain ; constrictions and contractions in various muscles, with jerk- ings of the body during sleep, and frequent wakings and starts. Modus faciendi.-I do not admit any other preparations except triturated and diluted, that is to say dynamized, drugs. Administer the remedy as soon after the paroxysm as pos- sible, and if the apyrexia may be assumed to be of short dura- tion, do not wait beyond the decline of the paroxysm. In sporadic cases, vary the remedy according to the totality of the symptoms, and in epidemic 'cases study the medical constitution, to discover the characteristic of the prevailing disease, and insist upon the remedy which, more than all others, satisfies this imperative indication. INTERMITTENT FEVER IN IT ARY. Dr. Cay. Francesco Panelli, Naples. Much has been written on intermittent fever in general, and eminent authors have endeavored to examine the subject from all sides; to determine its cause in different localities, and to exhibit its various forms. Now, without entering into a minute detailed analysis, I shall restrict myself to a general epitome of its character, at least of the various pathological phenomena which accompany it, always intending to give especial attention to the practical side-that is, to its cure. The Italian peninsula, with its numerous marshes and pools of shallow water, is more subject to intermittent fever than any other country ; and more especially in localities where there are stagnant waters, or in those subject to periodic inundations. With the approach of summer and a burning sun, evapora- tion of these waters takes place, producing the miasms which are the cause of so many diseases, but especially of intermit- tent fever. There are regions, like the banks of the Po in Upper Italy, or the neighborhood of certain lakes, like that of Agnano (recently drained by government), Fucine (likewise in process of drainage, a commendable work initiated by Prince Torlonia at Pome), as well as the Boman campagna and other places, where the greater part of the population bear the imprint of marsh miasms. In these districts, inter- mittent fever prevails epidemically in the summer months, and gastric, rheumatic, and even nervous diseases, often pres- ent an intermittent type. Moreover, the infection attacks the 431 432 world's iiomceopathic convention. majority of the inhabitants, bnt especially the working classes and country people, among whom, more than among those in easy circumstances, there is a deficiency of nutritious food. The stranger travelling through these districts is, for the most part, guaranteed against the fever by observing a nutritious and rather stimulating diet, carefully avoiding night air. It may be said in general, that, in these districts, all carry within themselves the germs of intermittent fever. A person of robust temperament, and also leading a regular life, resists the infection, so that even if attacked by the fever he recovers easily, while the field-laborer, condemned to exhausting toil as well as to privations of every kind, suffers horribly from this disease. Much has recently been said and written of the introduc- tion of a tree-the Eucalyptus globulus -by means of which the air of marshy regions may be improved. According to the observations of competent men, it appears that the plant absorbs much humidity and thus removes the primary cause of the production of malaria ; it is, therefore, the better adapted to purify the air of these regions. In various situations where this plant has been introduced for some other object, it has been observed that, although previously intermittent fever prevailed almost permanently, after a few years it entirely disappeared. In this relation I recall the many learned observations of the celebrated Professor Pettenkofer, in Munich (Bavaria), where epidemics of typhus fever are very frequent. lie found a strict relation between the rise and fall of the water in shallow pools and the augmentation and diminution of the epidemic. The consequences to health of the culture of rice on a large scale are universally known. Intermittent fever permanently prevails. I wish here to mention still another cause, namely, the maceration of hemp. If we must really admit that the evaporation of stagnant water is the primary cause of a species of fermentation of all the vegetable and animal substances which come in contact there, this is more fully illustrated in the maceration of hemp; and this operation is consequently a much more pernicious INTERMITTENT FEVER IN ITALY. 433 source of febrile emanations and usually produces a true epidemic. When, in the times of great military manoeuvres, the troops encamped on soil damp by nature or full of moisture from prolonged rains, disease and intermittent fever prevailed. As the manoeuvres always took place in the summer, all the con- ditions were naturally favorable to its development. With this short preface on the cause of intermittent fever, I pass to the practical side-that is, to the cure. Here I will first speak of the allopathic method, since the Homoeopathic School, notwithstanding its recent rapid progress, is still in the minority. Afterwards I will add my own cures and ob- servations. The panacea against intermittent fever is always Quinine, which is administered in large quantities and in different forms, whether sulphate, bi-sulphate, citrate, arsenite, etc., accompanied by a strengthening diet. In many cases this treatment succeeds well, especially when the patient is in con- dition to leave the infected country and to place himself in another locality. But when the patient, remaining in the country, continues to be exposed to the same infection, after a short interval the relapse appears, and the attacks, at first mild and infrequent, increase in intensity and frequency. The doses of Quinine are then doubled, trebled, so that many patients consume twenty or thirty grains of this drug to free themselves from the fever. If the cure is accompanied by a nutritious dietetic regimen it is frequently crowned with com- plete success; in other cases the drug, taken in such quantities and after having neutralized all the morbid symptoms, begins little by little to display its own symptoms-that is to say, physiological and no longer dynamic-to form, by slow steps, a true medicinal disease.. In a locality on the shore of the Adriatic, whither I was called by an illustrious gentleman, I saw the peasants consume extraordinary quantities of Quinine, either as a curative or a preservative. Every inhabitant was provided with this drug, and every drink of' water was accompanied by some small bits (each bit equal to about four and a half centigrammes) of 434 WORLD'S HOMCEOPATniC CONVENTION. it. Symptoms of intermittent fever appeared in the faces of most of the people, or perhaps of abuse of Quinine. When a physician is called to a case of intermittent fever his pre- scription of Quinine is so stereotyped that even the laity take it without any difference, except in the dose and the form. If I may rely upon the statement made to me by an honest merchant, who was representative of a first-class Quinine factory, I may calculate that Italy consumes not less than 10 or 12,000 kilogrammes of Quinine a year. Certain substitutes for Quinine have recently come into use. Among these I mention only the tincture of Eucalyptus globu- lus, which is said to possess great febrifuge qualities. Never- theless, in general, it has not yielded great results, and I cannot speak of it from the homoeopathic point of view, in- asmuch as there exists up to the present moment no well- elaborated pathogenesis. As to my own observations, I may say that during my long medical practice I have had charge of numerous cases of intermittent fever of different forms. Although the climate of Naples may be considered among the best, yet in recent years an increase of typhoid and intermittent fevers has been observed. Several learned professors, guardians of the public health, have labored to cliscovei' the cause of these miasms, but it cannot yet be said that their efforts have led to a definitive result. Some attribute the principal cause to the neighborhood (about three or four kilometres) of lake Agnano, where, more- ever, in the summer months it is the custom to macerate hemp. That this idea may have had, in times past, some show of reason is demonstrated by the unexpected circumstance that the epidemic of intermittent fever which was habitual in the neighborhood of the lake during the summer months, always redoubled its vigor when a large quantity of hemp was in process of maceration. But now that this lake is being drained, these miasms, in case they still develop themselves, may have an influence on villagers in the vicinity, but hardly on the city of Naples. Others attribute the cause to the bad arrange- ments for the sewerage of water closets. I agree with this last opinion and believe that the emanations from subterranean INTERMITTENT FEVER IN ITALY. 435 sewers in which many putrifying substances accumulate and remain, whether from lack of water or from the too slight fall of the pipes, produce many infectious miasms. But these miasms, according to my observation, are rather a cause of typhus infection, while intermittent fever is produced by preference where moisture is directly subjected to the solar rays. Cases of intermittent fever, as they generally appear, man- ifest themselves with headache, sometimes insufferable, severe chills followed by warmth, general weakness, face yellow, gastric disturbance. The sulphate of Quinine in the first trituration, which I generally use in these cases, has given most satisfactory results. I administer this drug in doses of from five to twenty-five centigrammes, from two to six times a day, according to the severity of the disease. After twenty- four hours the paroxysms almost always delay one or more hours; in some light cases they entirely cease. In rare cases, I have been obliged to increase the remedy until it reached fifteen centigrammes every hour and, even in these severe cases, the result was always happy. I have used crude Quinine only a few times, but, instead of better results, I have several times had occasion to observe a decided aggravation with diarrhoea and roaring in the ears ; all symptoms of the physiological action of Quinine, which I was obliged to promptly combat with alternate doses of Arsenic and Carbo, veg'. When the predominating symptoms are sweat, great thirst, excessive debility, emaciation ; especially when the patient, having had intermittent fever several times, had been treated with large doses of sulphate of Quinine, I use Ars. sixth dilution in drop- doses two to four times a day. If I see a person in this last condition (no rare thing), who clearly manifests symptoms of poverty of blood, whether from too frequent blood-letting or from having suffered from some debilitating disease, I alter- nate Arsenic with Carbo, veg. In some cases Phosphoric acid3 has proved of great service. The Quinine diarrhoea almost always yields to Ipecacuanha when Arsenic has produced no result. A few months since, a Frenchman, about 35 years old, 436 world's homceopatiiic convention. presented himself at my clinic ; he had been Jiving for some time in one of our provinces infested by intermittent fever and after having been attacked by it, was treated with large doses of sulphate of Quinine. His condition was really deplorable ; face yellow with dull eyes, extreme emaciation, so great weak- ness that he was scarcely able to stand on his feet, moreover an insatiable thirst; such were the predominant symptoms of this walking corpse. Arsenic sixth dilution, three doses a day, worked the usual miracle of restoring him in less than fifteen days to perfect health. In all cases of intermittent fever, I prescribe for my patients a nutritious strengthening diet with small doses of strong wine in the interval. The frequency of the dose and the dose itself are regulated by the disease; the more frequently and vehe- mently the paroxysms show themselves the stronger and more frequent should be the doses of medicine. Change of air in very obstinate cases is a sovereign remedy so that, where it is practicable, we should have recourse to it in the beginning. Besides the above remedies, I have sometimes used Helianthus annuus, Cedron, Arnica, Linum, etc., with doubtful results. I ought also to add that a great number of diseases, like gastric fever, rheumatism, even diseases of a nervous character take on, not infrequently, an intermittent type, so that, after having vainly exhausted the remedies directly indicated, the disease yields as by enchantment to a few doses of a febrifuge remedy. It seems finally that in many localities, and in predisposed individuals, the germs of intermittent fever form a kind of latent infection ready to manifest itself on the first occasion. If, bursting forth, it shows itself in its proper form, we know at least what enemy we have to combat, but if, complicated with other diseases, it works under other forms, it follows that the physician, even the most skillful, treats it in ignorance and often mistakes the cure, to the damage of the patient. I come now to the following conclu- sions : 1. Intermittent fever having its sources in emanations from stagnant waters and marshes in the summer season, may be effectively combatted; either by draining the water and drying INTERMITTENT FEVER IN ITALY. 437 up shallow lakesand marches, where practicable, as has already been done with lake Fucine and lake Agnano, and as the Italian Government, under the initiative of the most illustrious General Garibaldi, is about to do in the Roman campagna ; or by making plantations on an immense scale, of the Eucalyptus globulus. Under the new impulse felt by both private citizens and the government of Italy, it is to be hoped that the problem of drainage may be solved within a few years, 2. Although it may be truly acknowledged that among all febrifuge remedies Quinine occupies the first position, never- theless its prudent and moderate use ought to be recommended. When we consider the terrible effects of the immoderate use of this drug, besides the great number of invalids who suffer from these effects and not from intermittent fever properly speaking, we comprehend the truth of this assertion. I readily understand that allopathic physicians who shall read this sketch will call me a charlatan, but my homoeopathic colleagues will confirm what I have said on this subject, and my own observations made during more than twenty years of laborious and extended practice strengthen me in my conclu- sions. THE ROMAN FEVER. A Hygienic and Therapeutic Study. G. Pompili, M.D., Bomb, Italy. This is the great bugbear of the foreigners who come to Rome. Almost all hasten to question the resident physicians about the " fievre romaine," "Roman fever," " roemisches Fieber," its dangers and the means of avoiding them. At the outset, we ought to say that there is no " Roman fever" properly so called; just as there is no Roman menin- gitis, Roman pneumonia, or Roman cystitis, in the sense that these affections are in a special and exclusive manner peculiar to our soil and climate. There are periodic intermittents at Rome as in many other places; fewer perhaps than in other places exposed to marsh air. What is improperly denominated Roman fever is simply peri- odic intermittent fever, which is much less devastating with us than in Algeria, Australia, Cuba, and in some localities of young and prosperous America. Physicians are to blame that the threatenings and dangers of this fever are exaggerated here; for there is no disease in which they do not see or suspect its existence, either complicated or disguised, in order that they may administer their panacea, Quinine, to the incalculable injury of human health; for it is a question whether there are not more lives ruined than saved by it. If, in an inflammation or other affection of any viscus what- ever, or if, in any manifestation of a neurosis, there appear a slight hint of rhythm or of recurring phenomena, this is enough to form a pretext for tormenting the poor patient with inter- minable doses of the Peruvian alkaloid. Nearly the whole allopathic body in Italy is suffering under a decided Quinine monomania. Moreover, the allopaths here, with an inconceivable blindness, attributed to malaria the severity of the numerous acute dis- eases of the respiratory organs which, in the beginning of 1875, 440 world's homceopathic convention. appeared in the United States and at Paris, as well as at Pome, in consequence of the extraordinarily cold and icy winter. It would be impossible to say how great was the consequent con- sumption of Quinine and its various preparations. And the great mortality from pneumonia, instead of being attributed to their foolish mode of cure, was placed (by some adept who dig- nified this dream of malaria with the name of theory) to the account of marsh miasm; because he would rather do that than recognize some efficient primary cause of disease, and because he wished his vaunted panacea to be copiously used. Allo- pathic sophism and delirium cannot go farther. Incredibilia, sed vera I Thus allopathic doctors, very few excepted, with their illogi- cal idealism have awakened in the mind of the vulgar high and low, the most extraordinary fears, fruitful of incalculable harm, perverting the good sense of the public and bringing the climate of Rome into great disrepute. lam asked: "Does not malaria then exist at Rome ?" We must make a great distinction between Rome and the Roman Campagna. Of the latter we do not propose to speak, as it is quite a different matter. It stretches over an immensely ex- tended tract, reaching from the point where the river Nera flows into the Tiber to the sea and the Pontine Marshes, which are the regions most intensely infected by the miasmatic principle. In this vast open country, intersected here and there by more or less healthy mountains and hills, intermittent fever prevails everywhere, although in different degrees ; and frequently as- sumes, according to the locality, a more or less pernicious char- acter. To reclaim this tract would be a humane, but a difficult, long, and exceedingly expensive work. The popes did much toward it. The Italian government has promised much, but its achievements are and will be nothing. The city of Rome, with which alone we propose to occupy ourselves, being situated in the same atmosphere, in the midst of uninhabited fields, which are little cultivated and little pro- tected by trees, naturally feels some bad influences from its sur- roundings, especially since the greedy avidity of speculators has been permitted to destroy many groves which the ancient Romans called "sacred," and which were therefore protected from in- jury; like those which formed a defence against the emanations from the Pontine Marshes and against the south winds (plum- beus auster of Horace). Moreover, the most marshy and un- healthy districts are those which are farthest from Rome, at the extreme southern confines of the Campagna; while those which THE ROMAN FEVER. 441 immediately surround the city are in a considerably better con- dition, for they are separated by a long tract from the centre of the worst emanations and have been somewhat cultivated. Hence the air of the interior of Rome may V>e called compara- tively good, but it is not equally so in all parts. That of the centre and most populous portions is the best. Toward the periphery, where the houses are fewer and the open ground spreads out into gardens and vineyards, unhealthy effluvia grad- ually appear. We would also make a distinction in the seasons of the year. In winter there is good air everywhere in Rome, and in the most populous centres it is even salubrious and quite beneficial to deli- cate persons, or those of bad constitutions; so that valetudina- rians and those suffering from chronic complaints find this an excellent place of residence not only then but even in the spring, which season, although inferior to the winter in salubrity, is well adapted to sickly and overtaxed constitutions. In summer and autumn, especially in September, the air in Rome becomes "less good;" we cannot induce ourselves to call it absolutely "bad," since we are persuaded that he who knows how to order his life need not fear the Roman climate. Our periodic intermittents we believe to be the inheritance principally of the poor, who do not know how and have not the means even to guard against them. Of those who live in greater comfort, thousands and thousands of persons spend their lives in Rome even in the months called the worst, and attain to eighty or even ninety years of age without once having intermittent fever. I recall, in this connection, the years of my youth, when, in the month of August, after a heavy supper offish, with a dessert of melons and other fruits, taken at midnight in lively company, near the banks of the Tiber, we reached home with the thoughtlessness of youth at about 2 o'clock in the morning, running through many streets in the delicious and deceitful coolness. We were persons of all ages, and, except some indigestions, no harm from fever or other illness was ever experienced by us. It seems apropos to cite here the excellent testimony of Count P , who, in the hottest season, in the very heart of Rome, was in the habit of sleeping at night with open windows without ever being attacked by the dreaded fever. Such conduct, to speak the .truth, would never be approved by any good hygienist. It appears, then, that the periodic intermittent fevers in Rome may be incurred by those who wish them, and that hygiene will be a sure safeguard against them. Hoc opus. All preservative rules may, I think, be summed up in one: 442 WORLD'S HOMOEOPATHIC CONVENTION'. Avoid alternations of temperature; that is to say, protect your- self in such a way that the superficies of the body may always be in an equable state of natural heat; and see that you are not subjected, especially when heated and perspiring, to a strong and protracted draft of cold air, particularly at evening and morn- ing, "AEstate sudore madere et auram frigidam captare, pestis est," wrote Baglivi; without neglecting good nutrition and an appropriate and salubrious regimen, and avoiding in all re- spects a disorderly course of life. This does not prohibit going about at night and at all hours through the city, as everybody does in civilized society. I call attention to this because I have seen Americans and others shut themselves up in their own apartments during the evenings and nights of winter, the most healthy season, for fear of intermittent fever, - a fear engen- dered in them either by the prejudiced counsels of distant and ill-informed physicians, or by some fancy taken from the illiterate classes of society. Coming now to the therapeutics of the intermittent fevers of Rome, we must premise that they are cured by the same method that cures them in any other place, since the application of the Ilahnemannian law does bear exceptions, the law itself being im- mutable and universal. While latitudes and zones, climates and soils vary, man is always the same, however great the varieties of his constitution. Moreover, similar or identical cosmo-tel- luric conditions necessarily produce similar effects; and, what is of most consequence, in the same maladies the phenomenal mani- festations and the morbid modifications are almost always the same, while the ground of the intimate predisposing causes is various. These monotonous symptoms, which combine in a thousand different ways,-these symptoms despised by the allo- paths are always generally the same; and, as they constitute the one single genuine characteristic expression of diseases, so they are the one true characteristic and trustworthy guide for the selection of suitable remedies. Therefore the very nature of things prevents me from imparting anything new to our col- leagues, for the general and special pathology of the intermit- tent fevers of Rome, whether due to the miasmatic principle or not (I must repeat it), do not at all differ from those of the inter- mittent fevers of America and other regions. This periodic rhythm, monotonous in the parts which fundamentally compose it, but exceedingly various in the modality of successions of con- comitants, of deficiencies, of predominant symptoms, of alterna- tions, of times, etc,, now more, now less, grave and dangerous, always offers the same problem, more or less difficult to solve, THE ROMAN FEVER. 443 and everywhere in the same manner, because everywhere the truth of the laws of nature is one and unchangeable. With all the principal remedies already known to our school we have cured intermittent fevers of every kind, including the most obstinate and inveterate, even of several years' standing, except with China and its sulphate, particularly at the time when an abusive use was made of them. Ars., Arn., Bell., Bry., Calc, c., Carb, v., Ign., Ipec., Merc., Natr. m., Nux v., Puls., Nhus., Sulph., Veratr., Zingib., etc., were the remedies which we used most, and which yieided the best results. Among these I have not enumerated Eupator perf., because its introduction among us is so recent. But the case to which it is applicable will soon be ascertained, and, I believe, to our advantage. Sometimes a single remedy is sufficient to cut short the par- oxysms in recent and in inveterate cases. Most frequently, how- ever, recourse is had to the successive administration of several remedies. In some cases the paroxysms have ceased after five to twenty days at most of treatment. Once only thirty days were necessary for the cure of a quartan fever which had lasted thirty months; and the last remedy, under which the cure was made permanent, was Calc. carb. 200th. I am not accustomed ordinarily to persist with a remedy, as some allopaths and ho- moeopaths do. The cases are very rare in which it seems to me suitable to repeat a drug which did not on a first trial prove advantageous. And even if it works a useful change, the varied state of things demands another and different remedy; but we must return to the previous remedy, if required. I have not disdained any dose whatever in the treatment of intermittent fevers, but have ordinarily used the 200th dynami- zations. These have always obeyed me well, provided the remedy was well selected; that is, plainly homoeopathic. I record with especial pleasure a case in the Polish convent here of a young monk who for seven months was tormented by inter- mittent fever and by the Sulphate of quinine. He bad a par- oxysm so violent that the allopathic doctor called it pernicious (congestive); and, being alarmed, prescribed twenty-four pow- ders of Sulphate of quinine,-I do not know of how many grains each,-to be given at once and every hour. Being called in, I arrived in time to prevent the beginning of the administration. Ars., Zingib., Natr. m., and Rhus, all 200th, all given in the successive intervals of the apyrexia, choked off the fever so that it did not return. Among the remedies I employ I have mentioned Zingiber, which I do not see noticed even in the rich Therapeutics- of 444 world's homoeopathic convention. Intermittent Fevers, by the illustrious Bonninghausen, made still richer in the English version by Dr. Korndoerfer. This remedy, of which our Dadea will give us a pathogenesis, gath- ered from all the fragmentary experiments scattered here and there must, we believe, take a foremost rank in the cure of peri- odic fevers. Dr. Migneco was the first in Italy to employ and describe it in his little manual of maxims, crammed full of allo- pathic generalities, considering it the one remedy for all inter- mittent fevers, whose nature has not been altered by Quinine, as well as for many other diseases. Cautiously attempting em- pirical verifications of its action, I obtained some cures; in most cases, however, it failed me; but how can one use a remedy, which has no pathogenesis? For, according to the most essen- tial law of the Hahnemannian doctrine, to pathogenesis alone belongs the right to define the sphere of action, a law, which can- not be limited at least by a physician who makes it a matter of conscience to be logical. The excellent and lamented Dr. IMat- toli, a priest, worthy by erudition and conscientious skill to bean authority, employed it largely in intermittent feversand in other intermittent diseases, and spoke to me very highly of its power, believing it to be a great polychrest. The celebrated Orientalist, Professor Lanci, a great lover of homoeopathy, also assured me that he had cured with Zingiber 12th, empirically administered, more than one hundred cases of periodic fever. I shall, how- ever, wait until the pathogenesis has uttered the final word which shall fix its features and indications. But in the selection of a remedy we should never follow predilections or sympathies. Al- most every remedy in its proper place may cure intermittent fevers, that is, provided it be chosen in exact correspondence to the morbid expression, according to the great law established by Hahnemann, or rather founded by nature, who revealed it to him. By this method happy results are obtained, and thus, as our il- lustrious master Bonninghausen declared, intermittent fever and ;all its attendant sufferings disappear permanently as if by magic after the smallest dose of a well-selected homoeopathic remedy. In this way I overcame in a few days, with a single dose of five globules of Arnica 200th, a tertian intermittent fever in a ser- vant of Baron Hoffmann, who had suffered therefrom for six months. Nevertheless, allopathy will continue to be self-satisfied and "deceived (when not skeptical) by empiricism and panaceas, and ■will torment for years, and finally ruin its patients, with a " uni- versal febrifuge?' To compensate tor the damage, which the Ignorant either do not discern or else resign themselves to, al- THE ROMAN FEVER. 445 lopathy will be able to offer now and then some prompt and happy cure which will cover it up, or cause it to be forgotten. This will be, probably, in cases whose resemblance to Sulphate of quinine is fully characteristic and complete (without their knowl- edge, be it understood), and in persons of good temperament, who enjoy immunity from the miasms, detected and described by Hahnemann. But when these miasms are present, as they are in most cases, Sulphate of quinine in enormous allopathic doses will only aggravate the patient's condition; the fever will recur for months and years, with either exact periodicity, or in- tervals of cessation, but always with imperturbable persistence, until at last the panacea, instead of destroying the disease, shall have produced cachexia, infarctions, and at last dropsy and death, which ends the credulous patient's-sufferings, and draws a veil over the blind work of the doctor. This is an every-day story. In such a case Homoeopathy, guided by the torch of medical philosophy lighted by Hahnemann, will know it to be a true chronic disease, whose periodicity is only its most general and visible manifestation ; it will know that the combating of this in its fundamental substratum, and in the totality of its symp- toms, is not always the work of a moment, or of one remedy alone, and that, if more time is required to remove such a com- plexity of symptoms, more ample compensation will be obtained in the restored organic condition, which prevents the recurrence of the intermittent fever, and establishes a permanent state of health. Young beginners, in their apprenticeship to homoeopathy, whose words some indolent and doubting homoeopaths echo, may ask: "But, in cases of pernicious intermittents, in which one paroxysm not controlled in time may be followed by another which may prove fatal, shall we renounce the Sulphate of qui- nine and search for a homoeopathic remedy whose success, when selected, may be uncertain?" We respond at once that, here in Rome, some pernicious intermittents occur, as already observed, though their number and frequency are greatly exaggerated. This is convenient for the doctors of the old school, because it relieves them from thought and authorizes them to prescribe strong doses of Sulphate of quinine. Besides, to what other remedy could they betake themselves in their incredulity and blindness? This good fortune of sparing brains and fatigue is naturally envied by the indolent, faithless homoeopaths above mentioned. And, just as we might agree to a badly-selected remedy, which does not correspond to the symptoms, so we may agree, in the gravest cases only, to have recourse to a remedy, 446 world's homoeopathic convention; which, however injurious, may sometimes avert a danger. Let us come to an understanding, then, viz., that the blame of this proceeding is not to be laid to homoeopathy, but it is to be con- sidered only a " testimonium paupertatis" as Bonninghausen said. From this brief exposition the following corollaries may be deduced : 1st, the climate of Rome is excellent in winter; in other seasons it may prove unhealthy to those who do not know how to practice a good hygiene, or who cannot do so. 2d. The in- termittent fevers of Rome are cured by homoeopathy with the same remedies with which it cures them in other countries. 3d. Homoeopathy, with the wise and infallible laws which govern her, not inflicting the injuries which the allopathic school does by the universal use of Quinine, shows the importance and dan- gers of the old school, even where it counts itself strongest and safest; and, in the cure of this kind of disease as of all others, far excels her old rival. ERUPTIVE FEVERS. P. P. Wells, M. D., Brooklyn, N. Y. The science whose object is the deliverance of men from disease, presents itself in two divisions: prophylaxis and thera- peutics, prevention and cure. Prevention is proverbially the better of the two. But physicians have not hitherto fully recognized the fact that the prevention of disease is their high- est function and most important duty. Nor when this duty has been performed by them, have their services always been adequately appreciated; for men are slow to estimate aright a danger which has been averted. Less study has therefore been hitherto given to the prevention than to the cure of diseases. The means of prophylaxis may be considered in two divi- sions : 1. Those of a general character, constituting what is known as hygiene. 2. Those of a specific character, or medicine. Much earnest attention has been given to the prevention of disease by general or hygienic measures, and so much has been accomplished in this direction, that the development of hy- giene or preventive medicine is justly regarded with pride by the Old School, as one of the chief attainments of modern medicine. It is almost wholly a modern science. The idea of preventing disease by medicines taken inter- nally by persons still in a state of health is also modern. It has not received the attention which its importance deserves. 447 448 world's iiomceopathic convention. It is one of the honors which gather around the name of Hahnemann, that he first suggested this idea and demonstrat- ed its value by its successful application in most important epidemic diseases, viz: scarlet fever and Asiatic cholera. And it is a marvel that his followers so greatly neglected his suggestion. The value of the specific prophylactic medication advised by Hahnemann on the first appearance of cholera in Europe was clearly proved. He predicted the successful ac- tion of medicines before the disease had come under his own observation. His selection of these medicines must have been in accordance with some law and not a result of accident. As a matter of fact, he recognized the law of prophylaxis in the law of similars. That agent which produced on the living or- ganism effects most like the phenomena of the natural disease, was its surest preventive. This was the law. The discovery of the preventive must therefore be made in the same way as that of the curative agent, viz., by a comparison of the phe- nomena of the natural and the artificial or drug-disease. This law of specific prophylaxis can be practically available only in diseases which occur in groups or epidemics. The re- quisite similarity can be known only after the examination of numbers of cases of the disease; for no epidemic disease dis- closes all its phenomena in any one case. For this reason it is obvious that, even if we could foresee sporadic attacks of disease, we could not apply specific agents to prevent them, according to this law ; because we could not know in just what combinations and proportions the morbid phenomena might occur. These might not be similar enough in any two successive cases to constitute the requisite specific likeness of both drug and disease. And even in epidemics this rela- tionship may be limited to the single one in which the great- est similarity has been observed. For epidemics, as they oc- cur in successive years, are not identically the same. They require different curative remedies, and for the same reason must require different preventive agents. We may not assume, then, an identity of prophylactics in successive epidemics bearing the same name. ERUPTIVE FEVEKS. 449 In looking at variola and its relations to prophylactic agents, attention is first arrested by the claim of vaccine virus to be regarded as the first in importance, by its almost universal use, and the confidence given to it by the medical profession and the general public. It is not now our object to examine the grounds of this confidence, or the results of vaccination, but rather to place it in a light where its protecting power may be more rightly estimated than it generally is. In the first place, it will be readily conceded that it, to some extent, protects those susceptible to the action of the variolous poison. In the second place, it is equally certain that this protection is but partial; and, in the third place, that it is very uncertain. That vaccination protects, is proved by the fact that, many who have been successfully vaccinated receive no damage from exposure to air charged with variolous poison, or from contact with those who have the disease. The writer was successfully vaccinated 45 years ago, and the operation has been repeated many times since, without result. He has, in this time, treat- ed many cases of small pox, and has, of course, been often in its presence; has handled patients in all states of the eruption, and never received the slightest injury. That the protection is partial, is proved by the numbers of those who, notwith- standing successful vaccination, have contracted the disease, and passed through all its stages and sufferings (in some cases with fatal termination), apparently unmodified by the sup- posed protector. That it is uncertain, is proved by the fact that those who have been vaccinated with success, and on whom the operation has been many times repeated after- ward, and always without result, have yet contracted the dis- ease in its severest form. The uncertainty is further proved by the case of one who was vaccinated in infancy, and many times afterward, without result, and who treated numerous cases of variola, sometimes four or five in one room, and con- sequently was fully exposed to infection, without taking the disease, till he wafe called to the last of a series of 25 cases, which was contracted from the 24th. This was a very mild VARIOLA : ITS PROPHYLAXIS. 450 world's jiomceopathic convention. case, there were not more than half a dozen pustules in all, and yet he took the disease from this case, and in him it came in its utmost violence. Why was this ? The attendance on the 25 cases was continuous, the succeeding cases being contracted from those which preceded them, in an uninterrupted scries. This violent example of the disease resulting from contact with the last and mildest of the series, where there had been immunity while attending the preceding members, all of which were more severe, goes far to illustrate and prove the uncer- tain character of this prophylactic, even after there had seemed to be an immunity secured to the person so constantly and so thoroughly exposed to infection. It would be easy to multi- ply such examples, and thus to show that the proper place of the vaccine virus as a protection against attacks of variola, is far below that assigned it by professional and popular estimate. Indeed, in view of this admitted partiality of the success which has attended its use, the uncertainty of the protection it af- fords, and the accidents which sometimes follow vaccination, there are those who, on the whole, seriously question its value, as a preventive of variola. After vaccination, medicines which stand in specific relation to epidemics of the disease may deserve a careful consideration. There are a number of those from which it is claimed protec- tion has been realized, where given internally; e. g., Varioline, Vaccinine, Sulphur, Thuja, Tart. Antimon., etc. That either or any one of them will protect the exposed, in all cases, is not to be admitted. It is claimed for each that it has been suc- cessful in some cases. But in order to insure a uniform suc- cess from any one of them, it would be necessary that each recurring epidemic should be a specific repetition of those which had preceded it, and each should be, in its specific char- acteristics, like the characteristics of the effects of the drug on the organism. This identity of elements at each succeeding epidemic is just what the disease will not present to us. And in resorting to the internal administration of medicines for pro- tection, we must select for each epidemic that which, in its effect, is most like the characteristics of that epidemic. If each epidemic be carefully scrutinized as to its specific charac- ERUPTIVE FEVERS. 451 ter, and the right agent be selected afterward, according to the law of similars, there is, no doubt, much promise of good in its use as a protector of those who may be exposed to the dread infection. Treatment.-When, notwithstanding all endeavors for pro- tection, the disease is developed and becomes a subject of treat- ment, it is found exhibiting very various phenomena in the different periods of its progress, as, for example, in that of its invasion, eruption, suppuration, and desiccation; and there are two methods of dealing with the problem of cure, as presented by them. One, to find a single remedy which, in its patho- genesis, has produced symptoms like those of each of these periods, and which thus answers the requirements of the law of cure for the whole case, and for all cases. The other seeks a remedy for the peculiar phenomena of each period, as the case progresses. No doubt, if the remedy can be found which more than all others, has a pathogenesis like the different ele- ments of the succeeding periods of the disease, the difficulty of its treatment is reduced to a minimum. The cure will be speedy and safe. But it is quite another question whether such a remedy has been found. The claim of Thuja to this high distinction, set up by Wolf, of Berlin, has hardly been sustained by clinical success. Many cases have certainly been cured by it, with singular promptness and completeness, but in other cases it has seemed to fail. This want of success, it is true, may have been the consequence of the unskilful use of the remedy, as may happen in any other disease, and with any other remedy. Or it may have resulted from an imper- fect knowledge of what should have been reasonably expected; and the change of remedy, and the conclusion of failure, may both have been hasty and unwarranted. But it would seem to be quite as reasonable, in view of the ever-varying phenom- ena of successive cases, and the light of experience in dealing with other forms of disease, that the absolute specific for va- riola, in all cases, has not yet been found, and is not likely to be. Thuja may be of great value. That it is a specific for all cases, in all circumstances, and in all combinations of symp- toms, may be held as something more than doubtful. In all 452 world's iiomceopathic convention. the range of our knowledge of other diseases and other reme- dies, nothing like a universal specific for any form of disease, has been found. It was once supposed that Cinchona was such a specific for intermittent fever, Sulphur for psora, and Belladonna for scarlet fever. But experience has proved that these suppositions are not well founded. The more recent suggestion of Tartar emet. as such a specific for variola is no better sustained by reason or practice. The remedy has its place with others in the list of those which have cured the disease, and. may be regarded as of value. The same may be said of Vaccinine and Varioline. Both have been regarded by a limited number of practitioners, as specifics; both are said to have cured cases of the disease with singular prompt- ness, and both, in other instances, have as signally failed to do any good. There is no reason to suppose that the true homoeopathic treatment of variola will be found any exception to the gen- eral rule, which requires the adaptation of the remedy, which is to accomplish the cure, to the specific elements of the case to be cured. In order to find the one appropriate to a given case, reference must be had to the period of its development, and the phenomena present at the time of the first prescrip- tion. If it be at the beginning of the invasion, and the attack of average severity, there will be successive chilly shudderings, alternating with sensations of heat, great bodily restlessness, pain and throbbing in the head, with congestion of head, face and eyes, these last being watery and suffused ; great pain in the back, which is sometimes accompanied by stiffness, hardly admitting of motion, or this sense of rigidity may be accompanied by a sensation as if the back were paralyzed, pain in the epigastrium, often severe, with nausea, retching and vomiting. If the case be a severe one, there will be early delirium, which will increase in violence as this period pro- gresses to that of eruption. The skin becomes hot and con- gested. The disposition of mind is desponding. In children especially, the brain affection, besides the pain, may show it- self by coma, frightened starts in sleep, grinding the teeth, and convulsions, and these symptoms are present, especially in ERUPTIVE FEVERS. 453 the evening and at night. The above is a fair picture of a case of variola, in the period of invasion. It is for this, of- tener than otherwise, that the physician is first called to prescribe. lie may say "variola," and give a supposed uni- versal specific for the malady, and so save himself all trouble; or, he may, from these elements, seek the remedy best adapted to them, as a curative, according to the law of similars, which we may suppose he professes to obey. This may be more dif- ficult, but, it is submitted, if the responsibility of the treat- ment be on him, the physician has no choice but to overcome this difficulty. lie has all the elements of the case, with which he has to work, when he has mastered those of this period, lie cannot look forward to the periods beyond, not yet devel- oped, and therefore, with these, at this time he has nothing to do. Taking the symptoms of this period, as we have given them, we have a very complete picture of them in the pathogenesis of Belladonna, Bryonia, Rhus, Arsenic, and Antimon, tart. If the symptoms of cerebral affection predominate in the case, and are of a marked character, as given above, there can be no doubt of the similarity of Belladadonna, in its effects, to the symptoms of the case. If, on the other hand, the gastric ele- ments prevail, Bryonia will have the preference. Or, if the vomiting be very violent, with great prostration of strength, and cool or cold, damp skin, great anxiety and restlessness, Antimon, tart, will be called for. But, if with the nausea or retching and vomiting, there be severe pain in the epigastrium, of a burning character, with diarrhoea, Arsenic, will be better. This remedy will also be especially called for if in this period there be indications of the case assuming an adynamic charac- ter. Rhus may be called for by this last indication, in the ab- sence of other signs calling for Arsenic. It will have the preference if the restlessness and pain in the back predomi- nate. AVe may reasonably expect from either of these reme- dies a mitigation of the violence of the attack, provided it is rightly selected and given, and is not' alternated with either of the others, or with any other, and, as a general result, the case will come to its second period in a condition more amen- able to the action of remedies appropriate to its phenomena. 454 world's iiomceopathic convention. The eruption is generally characterized by a cessation of the violent symptoms of the preceding period, and by no new sufferings peculiar to itself, calling for especial interference on their own account. It is inaugurated, usually, on the evening of the third day, and continues from two to three days. Its especial features are, the absence of the preceding train of symptoms, the appearance of small, circumscribed, round red spots, which afterwards are slightly raised by a small hard nodule which is formed beneath them, from the apex of which appears a small umbilicated vessicle, filled with a transparent fluid. Stramonium has been recommended in this period, with the object of effecting its more complete and speedy de- velopment. If, notwithstanding, the usual subsidence of the violent symptoms of the first period, they should be continued into the second, by reason of accident, constitutional feebleness, or cachetic condition of the patient, or an especial malignancy of the epidemic prevailing, they are to be met by the remedy most appropriate, before. It will probably be found to be either Bell., Bry., Antim. tart., Antim. crud., Ivhus., Thuja or Sulphur. As this continuance of the violent symptoms of the initiatory period is only found in cases of the gravest character, it will be of the utmost importance that the selection be made after careful examination of the symptoms, and in strictest accordance with the requirements of the law of cure. In the common experience of average cases of this disease, the period of eruption is of importance, so far as their treat- ment is concerned, chiefly for this. It is the time when efforts are best made to secure patients from future evils, only too likely to follow, in the varied cachexias which the variolous process may itself produce or call up, by exciting to activity those which were latent in the patient when attacked. To guard against variolous cachexia, Thuja, given at this period, may be all that is required. There should be care not to over close with this remedy, at this time, or the patient may fail of the benefit he might receive from it, and the doctor lose confi- dence in a most valuable medicine from a fault wholly his own. To protect against latent cachexias, so likely to be brought into action by this disease, there should be the utmost care in ERUPTIVE FEVERS. 455 selecting the appropriate anti-psoric remedy. The cine to this will not unfrequently be found in a history of previous diseases in the person of the patient or his family, or, it may be, even in his ancestors. There is no more important duty in the treatment of small pox than this, of securing the patient against these destructive sequelae so often left to follow the loathsome sufferings of this dreaded plague. When the re- medy is found, there should be the same care to avoid over- dosing, as with Thuja. The period of eruption will pass into that of suppuration about the evening of the third day of the eruption. At this time there is a slight red halo round each pustule. Each for- mer little umbilicated vesicle is enlarged and continues to grow to the size of half a pea, loses its indentation and transparency, becomes pearl colored, or yellowish opaque. The centre of the apex finally becomes amber colored, then brownish, and the contents of the pustule, if not discharged by its bursting, be- come solidified and incorporated into the crust which charac- terizes the period of dessication. The red halo becomes en- larged till it occupies most of the interspaces between the pustules. When these are somewhat numerous, the skin is swollen, especially that of the face, till, when the eruption is abundant on this part, all likeness to the human face is lost. In cases of average severity, and in those of milder character, there is little call for active medication in this stage. If there is injury from accident, carelessness, or improper interference, either of these may convert such cases into those of utmost danger. It happened in a case, under the care of the writer, which had reached near to the limit of this period, with the most satis- factory progress, that on his visit, the third day of the suppu- rative process, he found the patient insensible to all external impressions, delirious, dry tongue, sordes on the teeth, pulse quick, small and weak, urine bloody. The pustule had be- come flattened, flabby, dark colored, and apparently but half filled. The whole aspect of the case appeared of the most threatening character. The whole was, at first, a mystery, which was only solved by the restoration of the patient to consciousness, when he said his nurse, a powerful old woman, 456 world's homceopathic convention. who did nothing but nurse small pox patients, and who there- fore knew all about it, when she learned " the bowels had not been moved" took the case into her own hands, and having procured an ounce or two of castor oil, proceeded to pry open the mouth of the resisting patient with an iron spoon, and to pour this dose down his throat. The result was as we have stated. . The patient was saved by Rhus tox. It is also true that where the right antipsoric has been given in the period of eruption, that of supuration and that of dessication may be aborted, and the whole case ended in a few days. In these fortunate cases, the pustules leave no cica- trices, the thick, dark colored offensive crusts are wanting and are replaced by thin, slightly adherent scaly crusts. This was the result in a case of extreme severity, where the vesicles, which followed the most violent pains and fever I have seen in any case of the disease, were so thickly set over the whole surface, as to make it certain that before they would reach half the size of the fully developed^pustule, they would all become one suppurative surface. The whole process was arrested by a single dose of Sulphur. No vesicles enlarged, no more appeared after the dose, but in two or three days they passed through what is usually extended over ten, the phenomena usual in this period, except the secondary fever, being repre- sented in par vo. If the ulcerative fever be set up in this suppurative period, and if the eyes, mouth, throat, etc., become seriously affected, it may be necessary to give Mercurius sol. If it take a typhoid character, then we must give Rhus, Ars., China, or Secale, according as eithei' may be called for by the symptoms of the case. In the period of desiccation, the treatment is, for the most part, limited to the proper regulation of diet and regimen, and this by the application of general rules, rather than especially imposed by the specific nature of the disease. Simple, nutri- tious diet, proper protection by warmth and clothing, and strict cleanliness, will embrace most of the needed requirements at this time. One of the causes of the great dread with which this dis- EBUPTIVE FEVERS. 457 ease is regarded is the fearful scars and seams it so often leaves on the face of those who have been attacked by it. It is of no little importance that this be prevented, if it be possi- ble. Much may be done to effect this by the use of the proper remedy, in the period of eruption, as has already been said. But there are other means, which it may be well not to neglect, which seem to aid in protecting from this great evil, the fundamental idea in the use of which is, the exclusion of light and air from the pustule during its period of develop- ment and decline. Various appliances have been resorted to for th's purpose, which are said to have been more or less succesful in preventing this misfortune. Covering the face with gold leaf was early recommended as a mean of this exclusion, and it was claimed that the resort was successful in many cases. It could hardly fail to prevent the access of both air and light if perfect contact of the leaf to the whole surface of the face could be certainly secured. Another and more convenient method is, to make an application of Collodion to the whole face, with a camel hair brush, being very careful to see that every part is perfectly covered by the application. This is to be repeated till the evaporation of' the fluid constituent has left a solid mask over the whole face. It may be well after this to repeat the application occasionally, to seal up any cracks in the mask which movement or accident may have effected. This is often quite effectual in preventing scarring, and it seems to promise all that can be secured by the exclusion of light and air. SCAELET FEVEE. Prophylaxis.-In attempting to prevent new attacks of this fever, when it is prevailing as an epidemic, we have two objectives before us, quite different in their nature and which are to be attained, if at all, by very different means. 1st. The destruction of the morbid poison which produces the disease. 2d. That of the susceptibility of the human organism to that poison. The means by which the first is accomplished, if at all, are of the general character which relegates them to the province of Hygiene. Those adapted to secure the second, 458 world's iiomceopatiiic convention. are of a specific character, and consist in the exact application of specific agents to the organism, which have the power to suspend, for the time, its susceptibility to the action of the morbid poison. These can be discovered only after a careful examination of the effects of the poison on the organism, in the given epidemic. The specific protector for any epidemic will be found in that agent, the effects of the action of which on the living body are most like those of the morbid poison. This is the keynote to the whole system of specific prophy- laxis. The agent may be the same in successive epidemics or it may be different, just as the poison producing each is iden- tical in its specific action on the organism, or not. Hence it follows, that the once supposed specific prophylactic for scarlet fever, Belladonna, is such only when in its pathogenesis are found specific phenomena like those of the prevailing disease; and/br this reason, and never because the disease prevailing is called scarlet fever. As this disease was met, in this country, forty years ago, it was found in a form so corresponding to the pathogenesis of this drug, that, it was very generally relied on as a protector, and with reason. -Now, as we meet the disease in practice, we find it, almost always, so changed, that we are oftener than otherwise, disappointed if we trust it as a prophylactic. In an epidemic characterized by the smooth form of the eruption, the scarlet fever described by Sydenham, it will probably still be the best protector. But if, as we find now, almost uniformly, the eruption be in patches of red with interspaces of dull, parchment-like, opaque color, there is little ground for trusting to this drug to prevent attaccks in those exposed to infection. The reason is, Belladonna protects, not because the epidemic is scarlet fever, but, if at all, because the specific elements of the epidemic are like the characteristic symptoms of the drug. And, for the same reason, in cases marked by the miliarly form of eruption, as above described, we must look elsewhere for our prophylactic, as Belladonna has not this form of eruption nor a train of symptoms like those which we are often called to combat, in connection with it, we shall be more likely to find the agent sought for in Ailanthus, Ammon, carb., Lachesis or Rhus. ERUPTIVE FEVERS. 459 Whether we select the one or the othor of these remedies or some other, must depend solely on whether it presents in its pathogenesis, chracteristics more like the phenomena which declare the specific nature of the genius epidemicus than any other. There is, and can be, no such thing as too much care in this selection. Prevention being better than cure, and securing this being the highest office of the physician, there should be no want of faithfulness in this duty, and no acting from mere example or habit. Treatment.-In the simpler forms of this fever there is small need of much medical interference; and this solely, al- most, with reference to preventing the development of the ca- chectic conditions, so liable to result even from the mildest cases. It should never be forgotten, that mildness of the at- tack is no assurance of safety from these, even in their gravest character. The most important duty of the physician, in such cases, is to find the antipsoric which will protect the patient from these different forms of cachexia, so often the sad results of this dreaded disease. lie can be guided in this by a care- fully considered history of the patient, or his parents or ances- tors, if he has inherited psoric taint in any of its forms ; or, in the absence of this, by a careful consideration of the genius of the epidemic prevailing. Whis duty may be neglected be- cause of the consideration that the patient may escape those evils without all this trouble. The physician does not know that his patient will be one of the escaping ones, and he is bound to secure for him the greatest possible safety, without regard to the consideration of trouble. For the acute symp- toms of such cases, Belladonna will probably do all that will be required to bring them through the first slight emergency, if there be not too much of it given. But these mild cases are the exception and not the rule in practice, as we have met the disease of late years. It is often- er than otherwise now, one of the most formidable and rap- idly destructive maladies with which we have to deal. To such an extent is this true, that not infrequently every thing of success in its treatment is in the first effort, or it is not at all. There is no time given to the prescriber to remedy the 460 world's homoeopathic convention. consequence, if his first prescription be an error. Here, as in almost no other practical duty, an error once is an error for- ever. First, because the rapid progress of the disease toward a fatal termination will give him no time in which to retrieve his mistake. Second, if the first prescription be wrong, then its effects are added to those of the morbid poison, intensify- ing them, and so greatly adding to the difficulty of the cure, where it was already only too great. It should never be for- gotten, that the effects of a wrongly selected remedy are a positive factor in the case to be afterward treated, and never merely negative. Especially is this true in the treatment of diseases of so grave a character, and so rapidly destructive as are malignant examples of scarlet fever. Third, it is a sine qua non in the successful treatment of these examples, that the right remedy be put into the case early, otherwise the life- forces will be so far exhausted by the action of the morbid poison, as to render them wholly unimpressible by remedies, even by that which, earlier in the case, might have been right and successful. Every possible effort then should be made to secure the accuracy of the first prescription. No other which may follow can have an equal importance. To make sure of this, no labor is too great. Time: the time of the prescriber is not to be counted, wdien it is a question of taking more of it in the interest of greater certainty of the prescription. Nor is it to be reckoned even when regarded as containing in itself the measure of the progress of the disease, in its destructive processes, if the question be one of time or an uncertain rem- edy. Because here, as everywhere else, it is better to do noth- ing than to do wrong. It is not meant by this to undervalue the early giving of the right remedy, nor to intimate in the least, that its results will not be all the more valuable because given early, but only to insist oh the duty of taking time enough to do right, rather than by haste to increase the risk of doing wrong. In the remainder of this paper we shall be mainly engaged with these more grave forms of the disease, and in endeavors to present considerations which will facili- tate the the early finding of the right remedy, in any given case we may have the responsibility of treating. ERUPTIVE FEVERS. 461 With this object in view, and for its more ready and perfect attainment, scarlet fever, in its more grave examples, may be considered as manifesting itself in two forms of a nature the opposites of each other. One of torpor, with deficient and vanishing power in the life forces; the other, of excessive ac- tion of these forces, simulating attacks of acute inflammation. It is obvious, that by whatever name we may call such attacks of disease, so varying in their character, they cannot properly be the subjects of the same treatment, under any system of practice founded on law. Examples of cases characterized by torpor are met in those which sicken suddenly, and speedily die, if not rescued from this state promptly, by rightly selected remedies. They com- mence with vomiting, great pain in the head, anxiety, rest- lessness, delirium, which soon passes into unconsciousness, con- vulsions, paralysis and death. The eruption may be wholly wanting, the life-force not being equal to bringing it to the surface, or it may appear slightly for a time, and then vanish; or it may be general, but of a dark, livid color; which, when pressed with the finger till the blood is expelled, is slow in re- gaining its lost color. When it does appeal1, it is generally in patches, with raised points visible to the naked eye, and per- ceptible to touch. The interspaces between the patches are of a dull, parchment-like aspect. The pulse is small, rap- id, and without force. To treat a case like this with remedies which have proved curative in the inflammatory form of the disease, simply because the one and the other are called scarlet fever, is to consign it to the grave from the first, without rea- son, help or hope. In a former treatise on this subject,* the almost uniform failure to cure such cases, was noted. They had died in spite of the routine remedies of our School, as well as of the best endeavors of the old, with few exceptions. The hopelessness of both, before these cases led to inquiry as to other and un- tried remedies, with the suggestion that their use might bo followed by better results. Worse could not be, where all else * See American Hom Review, vol. iv , p. 289. etseq., and North American Jour- nal of Homoeopathy, for February, 1876, p. 349. et seq. 462 world's homceopathic convention. was fatal. Among others so noticed was the Ailanthus. It was the remembered poisoning, by the juice of the young shoots of this tree, and the likeness of the symptoms which followed to those of these fatal cases, that led to its mention as a possible remedy for these hitherto hopeless cases. This was in 1864. Since that time, the hint has been acted on in this country, in Europe, and in Africa, with results so gratify- ing, that it may be safely claimed that the remedy merits a very high place in the list of remedies for this variety of the fever, if not, indeed, the highest. The symptoms given above as an example of the torpid variety of scarlet fever, are not from the, imagination, but from life, and are so complete a picture of the symptoms of the poisoning, that these were, without hesitation, accepted as an instance of the natural dis- ease. It has been in just such cases as this that the Ailanthus has been used successfully many times, and in which all other remedies have failed. Its true place will be recognized in cases which show the extreme of torpor. In the same paper, the serpent poisons were also named as possible remedies for this fatal form of disease, especially Lachesis and Crotalus. Since then there have been repeated opportunities to test the value of the former, and to learn its far more extended relation to other forms in which scarlet fever is met. In its relations to the adynamic variety, its place may be confidently assumed to be in the treatment of those cases wdiere the torpor is somewhat less pronounced than in those which call for Ailanthus. The difference is rather one of degree than kind. Rhus may be in place when the torpor is still less than in cases which call for Lachesis, but it should be given early, and before dissolution of fluids and solids have made much progress, otherwise it will be of no use. The example given above of the adynamic form of this fever, it will be perceived, is of that variety characterized by predominant brain affection, and of this variety, one most rap- idly progressing to a fatal termination. In practice we not infrequently meet cases of strongly marked adynamic charac- ter, when the throat and parts adjacent are more especially ERUPTIVE FEVERS. 463 the centre of the localized effects of the poison. These cases, as a rule, are not as rapid in their progress, but very many of them are found wholly beyond the power of the remedies or- dinarily given in the treatment of this fever to control. If less rapid, they are hardly less fatal, and we are but little bet- ter furnished with remedies with which to resist their down- ward progress than in the more rapid cerebral variety. Be- fore a case of this kind, what, if anything, have we to hope from Ailanthus? In the case of poisoning which suggested it a possible remedy, in cases like the example given, there were no throat symptoms developed, and we should be unable to answer the question, if it were not for some cases admirably reported by Dr. Chalmers, of Thornhill, Dumfrieshire, Scot- land, in the " British Monthly Homoeopathic Review, for De- cember, 18G8. lie gives seven cases which were treated by Ailanthus, in an epidemic of strongly marked adynamic char- acter, and which was fatal far beyond ordinary experience, even in epidemics of scarlet fever. Of those six were charac- terized by serious affections of the throat, glands and cellular tissue adjacent They' all made good recoveries under the remedy, though the doctor says they were like cases he and his neighbors lost uniformly, when treated by other remedies. Some of his cases were examples of ugly sloughings of the in- ner surface of the throat, some of swollen glands, six of them, I think, of which only one suppurated, and that healed speed- ily and kindly. From this experience of Dr. Chalmers, we must conclude the drug has powers not yet disclosed by prov- ings, which is very likely true, or that its curative relations to the disease are rather in its general adynamic character, than in its special localized effects in particular parts or organs, which is also very likely true. Lachesis is also a remedy of the first importance in adynamic cases with grave affections of the throat. There are three forms of these in which this remedy may be found the best of all. Those in which there are deposits on the mucous surface of the throat, or in which there are slomrhino's of this surface, or in which the external areolar tissue is involved, with large, hard swelling. In the first and third of these there is no rem- 464 world's homceopathic convention. edy which we can so often trust to bring the patient safely through his trouble. In the last variety Rhus may often be useful, if given at the very beginning of the swelling, and if the torpor be but moderate. If the swelling and its sensitive- ness to touch be not promptly moderated by this remedy, there should be no time lost before giving Lachesis. In the second variety, that with sloughing, the ground is divided between this remedy and Ailanthus, the division between the claims of the two being determined by the greeter or less degree of tor- por in the given case. The greater gives the preference to Ailanthus. Wo have not named Belladonna as a remedy for this adyn- amic variety of scarlet fever, because, if the relationship of the curative to the disease it cures, be expressed in the similarity of the symptoms of tlie one to those of the other, then it has no place in the list of agents in which we are to look for the remedy in such cases. Instead of similarity to the symp- toms of the disease in those of the drug, we find these the op- posites of the elements of the fever. In the fever there is tor- por, or deficient action. In the pathogenesis of the drug the action is excessive. Therefore its action would be the oppo- site of that required by the law' of cure, and consequently hurtful. This is why it has never done good in this class of cases. Ind this is why it illustrates fully the absurdity and mischief of prescribing for the names of diseases, and being controlled by these in the choice of the remedy, rather than by the characteristic elements of the case under treatment. It is no excuse for giving this medicine, in this form of scarlet fever, that for years it almost uniformly cured the cases for which it was prescribed, and was held to be, in all this time, no less than a specific for it, whenever and wherever met. The truth is, the form of the disease we have been considering is not like that so cured, though we still call it by the same name. That form which wras so successful}7 treated years ago, by this remedy, is now a rarity in this community, only occasionly met, and then as readily and certainly cured by it as it was formerly. The disease, as we meet it now, is an in- teresting example of the change which has taken place in the ERUPTIVE FEVERS. 465 nature, symptoms and curative relationships of diseases even in the experience of the present generation. This change is not limited to scarlet fever, but has a wide range through those which are the subjects of every-day practice, and hence the absurdity of calling that practice homoeopathic which has reference to names in selecting remedies rather than to a care- ful consideration of the characteristic elements of the cases to be prescribed for, as required by the genius of homoeopathy, and the law on which its practice is founded. But there is another class of cases, and in practice more nu- merous than this we have been considering, which are charac- terized by symptoms more like those of an acute inflammation, the action of the forces being excessive rather than depressed. These cases are less rapid in their progress, and not so uni- formly fatal, as those of the adynamic variety. Their initia- tion is less sudden and violent. There are slight chills (rarely severe), followed by a disproportioned heat of the skin, and frequency of pulse; the pain in the head is violent, often ac- companied by vomiting; intolerance of light and sounds; great redness, heat and turgid appearance of the face; the eyes are injected and suffused; the patient soon becomes drowsy, is very restless, and intolerant of all disturbances; the skin is generally covered with the characteristic eruption, or this is in patches, as has been already described ; the color is a brighter red than is found in the adynamic variety, and the eruption is less evanescent; if it be in patches, the inter- spaces are less opaque and parchment-like in appearance than in that variety; delirium is early developed and becomes in- creasingly violent; or, if at the outset, only occasional, in the progress of the case it becomes more constant; it is oftener demonstrative in its character than mild and muttering*, amounting, in its later period, to terrors and screamings, and these may be followed by coma, convulsions and death. The above is a picture of the very common form of the fever, with prominent cerebral affection so often met in practice in this variety. It is obvious, at first glance, that if the law of cure which is to control our selection of remedies, is that of simi- lars, then for the cure of such cases as these, a different class 466 world's homoeopathic convention. of remedies from that most beneficial in the adynamic form, is to be here interrogated for the discovery of that one which is most similar to the case of this variety to be treated.* But there is another element in these cases, always more or less present, and often of great importance in determining the treatment of the case and its final issue. The different affec- tions of the throat, which are quite various in their character and influence in the case, are always to be carefully considered in determining prescription and prognosis. In a given case it may be there is only slight redness and swelling, with but little difficulty of swallowing. Or the redness may be more intense, bright or dark colored, and the swelling and soreness so great as to render swallowing difficult or even impossible. Or there may be deposits on the inner surface of the throat, of various color and consistency. Or there may be sloughings of this surface of various extent. Or the glands of the throat may be swollen so as to become an important element in the case. These swellings may suppurate and form ill-conditioned ab- scesses which may embarrass treatment and recovery. Or the external areolar tissue of the neck may become greatly swollen hard, sensitive to touch, and painful, adding much to the suf- ferings and danger of the patient. It is hardly necessary to remark that elements so various in their character, will not be likely to be always met successfully by the same remedy. It will sometimes be found, however, that more than one of these varieties is in relation to one remedy, by virtue of its power to produce phenomena like those of each of the differ- ent cases. In the milder form of what, for convenience, we may call the inflammatory variety of the fever, the treatment is most simple, and but for the danger of unpleasant sequelae result- ing, would be a matter of no great moment. In these cases * There are remedies, and those of the greatest value, which produce symptoms the oppos'tes of each other, and winch t'.iercfore have the widest range of applica- tion in the treatment of diseases An interesting example of this is found in Lach., which, by its symptoms, is related to both the torpid and inflammatory varieties of this fever, and will be found, on a careful study of its pathogenesis, npp'icable to the treatment of a greater number of cases in practice, as the disease is at present met, than any other remedy. ERUPTIVE FEVERS. 467 there should he the most absolute repose, the patient kept in a warm bed, and wholly withdrawn from confusion of what- ever sort, the diet should be most plain and simple. In the way of medicines there will be little required, but that little should be selected with care, or by a blunder, either in this or in the observance of the proper regimen, the mild case may become severe. Better do nothing than to do wrong, is a practical maxim, the wisdom of which has been illustrated and confirmed many times in the history of these very mild and apparently unimportant cases. In the outset what is the char- acter of the eruption and of the febrile reaction ? If the rash be bright red, smooth, and the heat of the skin but moderately increased, the throat but little swollen, and the swallowing but slightly painful, the "whole case will require but a few doses of Belladonna, and in their administration there needs hardly more than this caution, don't give too much or too often. But even here the cachexia is always possible, and it should always be anticipated and prevented, if possible, by the proper antipsoric, given at the beginning of the decline of the erup- tion, and if the process of exfoliation be delayed or tardy in its progress, it should be occasionally repeated till this is com- pleted. But, unfortunately, this variety of the disease is not al- ways so mild in its initiation and progress. It may be ushered in with vomiting, violent headache, intolerance of light and sound, great redness and heat of face, delirium, thirst for cold drinks, which, early in the case, are swallowed with difficulty, pulse quick, and, at first, "with slight hardness. There may be, with these symptoms, and they increasing in violence, as yet no appearance of the characteristic eruption on the sur- face, while the general physiognomy of the case, and the ap- pearance of the mouth, tongue and throat, will assure it to be scarlet fever, to one who is experienced in observing it. The first problem here is the best means of bringing the eruption to the surface and keeping it there. We say keeping it there, because sometimes the above picture is modified by the ap- pearance of the eruption here and there, usually on parts which are covered, but it remains but a short time, and disap- 468 world's nOMCEOPATHIC CONVENTION. pears leaving the surface as before. These slight and tran- sient appearances of the rash are always to be regarded as in- dicative of danger, and if not promptly met by the appropri- ate remedy, are only too likely to be very troublesome. Still another modification, and an important one, is the sudden dis- appearance of the eruption, which has been out in a more or less satisfactory condition, with aggravation of all the other symptoms, and evident increase of danger to the patient. There should be the utmost care in selecting the remedy in these cases, that the right one be found and given first, for failing this, it may be of very little consequence what is given afterward, all may be alike useless. In cases of violence, where the symptoms seemed to call plainly for Belladonna, which, notwithstanding, gave no relief, the eruption being wholly wanting', Lachesis lias not only brought the rash to the surface, but wrought a prompt and radical cure of the whole case, cutting it short, in a very few hours, no other remedy being called for afterward, and no trace of cachexia followed. The symptoms of these cases of failing eruption may call for other remedies, such as Bry., Bellad., Ilepar., Ipecac., Sepia, Strain., or Sulph. In the selection of either of these, we re- peat there cannot be too much care. I have seen a most un- promising case of this kind, characterized by coldness of the surface, great bodily restlessness, the little patient throwing himself violently in all directions, over all parts of the bed, complete sleeplessness, frequent distressing outcries, relieved by a single dose of Ipecac, in a very few minutes. All the violent symptoms disappeared, the patient in a few minutes became tranquil and warm, slept quietly, and waked to a pros- perous convalescence. The sudden disappearance of the rash when it has been out, is a fact of the first importance, and requires the promptest attention. It may be brought to the surface again by either Bryonia, Ilepar, Lachesis, Ipecauanha (especially if the rash has been of milliary variety) Rhus, Sepia, Stramonium, or Sulphur. There should be great care in selecting either of these remedies, to see that the one chosen is most like the other symptoms of the case, the mere fact that the eruption ERUPTIVE FEVERS. 469 has disappeared is not sufficient to warrant the choice of either. In treating cases with active febrile reaction and marked cerebral excitment, as opposed to those of an adymanic cha- racter, we shall often be called to choose between Belladonna, Bryonia, Hyoscyamus, Lachesis, Stramonium and Sulphur.* In relation to Belladonna, it may be observed that nearly all the symptoms which relate it to this fever are of a demonstra- tive character and violent in their manifestations, as are also those of this form of the fever. This is true of the convul- sions, restlessness, heat of skin and eruption, this being bright colored and generally diffused; the affections of the glands, the manifestations during sleep, the character of pulse. The symptoms of the head, disposition and intelligence, eyes, ears, face, mouth and throat. The same remark will hold true as to Hyoscyamus, Stramonium and Sulphur. But the three varieties differ as to the degree of violence which charact- erizes the manifestations of each, in those symptoms which are similar in them. Belladonna being most, and Hyoscyamus least violent, Stram. holding its place between the two others. Besides this, each has symptoms peculiar to it elf, by a careful comparaison of which all difficulty in the choice will disappear. If the case fall into coma, there may be a temptation still to give Belladonna. This will probably be a mistake, unless the eruption be smooth, the pulse hard and strong, and the febrile reaction vigorous. A better rem- edy will usually be found in either Sram. or Opium. The latter is preferable if the coma be profound, with loud and slow respiration. Any remedy which is to control this state must be given at its earliest manifestation, for it soon and rap- idly progresses to a condition where all remedies are alike useless, if not promptly arrested by the right one. Apis has also been successful in relieving such cases. Besides its importance in preventing post scarlatina cachexias, Sulphur has often a very important place in the treatment of * For a translation of the symptoms of these remedies, by which they are related to the form of scarlet fever, see North American Journal, for February 1S76, p. 371 et seq. The limits prescribed to this paper prevent its reproduction here. 470 world's IIOMCEOPATniC CONVENTION. those cases with marked cerebral affection. The form in which it is most effective is characterized by the milliary rash, with high febrile reaction and peculiar condition of the brain, of which the following case is a fair example. A little girl, five years old, was attacked with chills, vomit- ing, violent headache, prostration, peevishness, flushed face, injected eyes, which symptoms were followed in a few hours by a miliary eruption, which was patchy and evanescent. At times it was bright and full, then it faded and partially disap- peared. The intellect soon became wandering, and then delirous, the delirium beinc; active rather than muttering. The skin was hot, dry, hard, and somewhat roughened. The throat was moderately swollen internally and externally, impeding somewhat both speech and deglutition. The patient had Bel- ladonna till the evening of the fourth day, growing rather worse than better, at which time, in addition to her previous symptoms, she was apparently wide awake, but quite asleep so far as perception of her surrounding relations was concerned. She no lono;er knew her attendants or heeded in the least what was said to her. She was in great agitation and anxiety, with loud outcries, not screams, calling out that she wished " to go to bed," though she was on the bed at the time. Immediately on being laid on her pillow she would spring up and call out that she wanted " to go to bed;" and this was repeated as often as she was replaced with the assurance that she was on the bed. She seemed to have no apprehension of what was said to her. The eyes were injected and staring. The aspect dull and heavy, though apparently apprehensive and anxious. At six o'clock in the evening she got a dose of Sulph. She soon became more quiet, fell asleep, had a good night, and in the morning was convalescent. It will be seen that the pecu- liarity of the case was in the likeness of her mental condition to that of sleep walking. Sulphur has like symptoms, and by these was brought into the relation to it of its curative. The indications for this remedy are often found in the moral and intellectual manifestations of the patient. In looking back on this case from the stand point of present experience, it is doubtful whether the patient would have fallen into this pe- ERUPTIVE FEVERS. 471 culiar state if she had had Lachesis instead of Belladonna in the early treatment of the case. I regard the giving of that remedy, and continuing it so long, with a continued progress downwards, a mistake. Lach, would have been better. In this variety of scarlet fever as it is oftenest met here, Lachesis has a wide range. We have spoken of it in the adynamic form, and in the examples of the inflammatory, when the eruption fails to come to the surface, or is evanes- cent. But its range of relationship to the varied manifesta- tions of this fever is much wider than this. Where the erup- tion is of the miliary variety, it will be found applicable to the other symptoms oftener than any other remedy. It is in relation to many of the most important affections of the throat, as to those with varied exudations on its inner surface, and still it is in place if these deposits are followed by ulceration beneath them. It is of the first importance in sloughing of this surface. In affection of the glands it is often of great value. In cases of swelling of the external areolar tissue of the throat and neck, it is the one remedy more important than any other. It may give place to Rhus, in the very earliest stage of the swelling, if this be but small as yet, and there be but moderate sensibility of the swelling to touch, and there be no signs of the case becoming adynamic. In treating these swellings, as in all else belonging to this fever, it is incumbent on us to put in the right remedy first and early. If this has not been done, and the case goes on to suppuration and sloughing, Lachesis is almost our only hope.* It is a mistake some have made to regard this remedy as only applicable to the last stage of the fever. Where it is in place it cannot be given too early. MEASLES. Prophylaxis.-It has not been generally thought practicable to prevent by medicines, the development of this disease, in persons who are susceptible to impression from the action of its morbid poison, and who have been exposed to its influence. This may have been, in part, the result of the light importance * See Am.. Hom. Review, vol. iv., p. 362. 472 world's HOMEOPATHIC convention. of the disease, as compared with other forms of eruptive fever, which generally prevails. And then there is an inherent difficulty in the nature of the case, which may render prophy- laxis by medicines often impossible. It is this. Though the disease occurs chiefly in epidemic form, it varies so much in the different periods of its progress, in each individual case, that several medicines are recognized to meet these changes, and no one has yet been found sufficiently like them all in its pathogenesis, to warrant expectation of its success as a prophy- lactic. And then, the epidemics of measles are subject to changes in their successive visitations, like other epidemics, and there would be added to this difficulty of changes in the progress of individual cases through their successive periods, this more general one pertaining to the epidemic character. Still, if such a remedy can be found, it may be no more than reasonable to expect protection from the effects of the morbid poison from its proper use. In the case of poisoning by Ailanthus, which suggested it as a remedy in the adynamic form of scarlet fever ; after the eruption which was so perfect an imitation of the miliary scarlet rash, then followed one which resembled that of meas- les so closely, that no difference could be detected. Though the catarrhal symptoms of this disease did not accompany the rash, the gastric disturbances were of a marked character and quite like those often conspicuous in measles. The character of the fever which accompanied this rash was strikingly like that found in the more violent form of measles. There can be no doubt of the duty to study carefully this remedy in its relations to this disease ; and certainly there is enough known of its effects on the organism, to warrant the hope that it will be found of great importance in the treatment of the adynamic form of it, so often in the highest degree embarrassing, and not unfrequently fatal. In malignant epidemics it may prove a prophylactic. Treatment.-The homoeopathic treatment of measles, as the disease is commonly met in practice in its milder forms, is not a matter of much difficulty. At the outset of cases of average severity in epidemics of a benignant character, there will be ERUPTIVE FEVERS. 473 found a catarrhal condition of the mucous membrane of the nose, eyes, mouth, throat and bronchi, with sneezing, fluent coryza, lachrymation, pain in swallowing, hoarseness, cough, which is dry, with loud, rough sound, quick respiration, dry heat of the skin, thirst, restlessness, anxiety, peevishness of temper, headache, quick, hard pulse. In this state, and especi- ally if there be disposition to loud complaining of the suffer- ings, with outcries, as is likely to be the case with children, who are the most common sufferers from this plague, a few doses of Aconite, at short intervals, in the beginning, will soon moderate the violence of the fever, and quiet the restlessness. The doses, if continued, will be given at longer intervals as the relief progress, till the appearance of the eruption. Then in ordinary cases, Pulsatilla will effect all that will be required of medicine. But the disease does not always run this even course. It is subject to many variations and complications which may be- come sources of danger to the patient, and anxiety to the phy- sician. It may be that at the time when the eruption should appear, instead of this the thoracic and cerebral symptoms are all intensified. The respiration becomes shorter and more rapid, the cough more frequent and violent, the pain in the head is followed by delirium, and this by coma, and this by insensibility. The fever becomes adynamic, and unless relief comes speedily, the case will soon reach the fatal termination to which it is so rapidly tending. The embarrassment of the internal organs will only be relieved by the appearance of the eruption on the surfaco. Or the gastro-intestinal irritation may be intensified to a degree that it becomes a source of dan- ger, especially in cases where the fever has become adynamic. The catarrhal condition of the throat may be attended with diphtheritic exudations, and these may add seriously to the difficulties of the case. There may also be inflammation of the eyes of so grave a character as to call for the most prompt efforts for their relief, failing which they may suffer irrepara- ble injury. By the above brief sketch it will be seen that the effects of the morbid poison are localized chiefly in the brain, lungs and 474 world's homceopathic convention. mucous membranes. When the eruption fails to appear, or, having been out, has suddenly disappeared before its period was fulfilled, either of these may become the centre of impor- tant and dangerous congestion or inflammation, which will call for prompt administration of rightly selected remedies. There must be no failure in this, for such cases will not ac- commodate us with the time which guessing requires. It is to be the right thing first. Neither time nor the great suffer- ings of the patient will tolerate a succession of wrongly selected drugs, giving B, if A fails, and C if this brings no relief, and so on through the series of those of which somebody has said of each of its members, that it has done good to other cases, supposed to be more or less similar to the one under treat- ment. Certainly they were called by the same name, and there, it may be, the similarity ends. In order to a more ready finding of the right remedy, let the above-named centres of localization ke kept in mind. It will be most likely that danger is threatened by a more grave affection of some one of them than by an equal invasion of all. If the chest be the scat of the chief localized affection, or the danger from inflammation of the lungs or bronchi is more immediately threatening than from attacks of other or- gans ; then, if there be great heat and dryness of skin ; hard cough, with bruised soreness through the chest, or sharp, stick- ing pains from cough, attempt to take a deep inspiration, or from motion of any kind ; respiration short, with great op- pression of the chest, as from pressure on the sternum ; great thirst for cold drink; pulse hard and quick; there need be no hesitation in giving Bryonia. If the soreness of the chest be like as if it were excoriated, when coughing, the pains dull and the oppressed respiration short and quick, and if there be a sense of sinking and anguish at the epigastrium, the rem- edy is Phosphorus. It will be an additional reason for this selection if, with the above symptoms, there is a painless diar- rhoea, which is exhausting the strength of the patient. If the patient be of a scrofulous constitution, or has been subject to cutaneous eruptions, and if the chest symptoms have not yield- ed to Bryonia or Phosphorus, and if there be with these marked ERUPTIVE FEVERS. 475 gastric complications, there should be no hesitation in giving Sulphur. If the head be tire seat of the chief localization, and the pains be violent, with intolerance of light and noise; great heat and redness of face and head, injected eyes, violent de- lirium, with outcries ; and if these symptoms are followed by violent convulsions, Bellad. should be given. Strain, here, as in other diseases, often is indicated by a difference in intensity of symptoms as compared with those of Bellad. rather than by difference in kind ; those of Strain, being less violent It will be an additional reason for giving Strain, if the secre- tion of urine be very scanty or suppressed. If the pain in the head be of a sticking character, the thirst for cold drinks great, redness and heat of face and head, with little disturbance of the intellect, and peevish or agonizing humor, and quick, hard pulse, Bryonia should be given. It will be an additional rea- son for Bryonia, if there be at the same time much bronchial irritation, with hard cough. If the disposition to coma has resisted Bellad., Strain, and Opium should be given, at short intervals, till this symptom is removed. If the gastric symptoms prevail over those of the chest and head, and there be nausea, vomiting, diarrhoea, burning pain in the epigastrium, later, the medicines from which we may select a remedy, are Arsenic., China, Phos. and Sulph. If the vomiting be with burning pain in the epigastrium, great rest- lessness, colic, great prostration, and the alvine evacuations are watery and brown or yellow, Arsenic, will have the preference. If the diarrhoea be painless, and the burning pain be absent, China will be the better remedy. If there be with the diarrhoea, sinking at epigastrium, with great weakness after the stool, Phos. may be the remedy, and especially if there be pulmonary symptoms present, which call for this remedy. Like other eruptive fevers, measles is liable to be followed by cachexia, in various forms, and this fact should always be borne in mind wdien the disease is under treatment. It should always be forestalled, if possible, by the appropriate anti-psoric, and this, when found, should be given at the beginning of the 476 world's homeopathic convention. decline of the eruption. This cachectic condition is liable to affect injuriously, and permanently, if not prevented by ap- propriate remedies, the organs of sight and hearing, the func- tions of digestion and assimilation, and the bronchial and pul- monary tissues. The most important fact in this relation of measles to practice, is its frequent bringing into activity that form of psoric taint which, latent at the time of the attack, results in pulmonary tuberculosis. The damage to organs of sense is also important, as is also that done to digestion and assimilative functions. Now what we wish to say in this con- nection is, that the ordinary remedies given in the treatment of this disease are wholly inadequate to the prevention of these evils. Aeon., Puls., etc., are of no value for this purpose. The remedy for these is to be sought in a much broader field of inquiry than the surface symptoms of the case, which have suggested these remedies so appropriate in the initial and ter- minationary developments of the attack. The inquiry must go beyond those into the life condition of the patient, as mani- fested in his previous history, or it may be even in that of his progenitors, as well as in whatever there may be in his present sick condition, till the totality of the deviations from a state of perfect health is brought to light. This will disclose to the intelligent practitioner the true anti-psoric, and, therefore, the true preventive of the sad disasters which, when not thus fore- stalled, are attended with so much of suffering and danger. It is not in the limits of possibility to say, beforehand, what this remedy will be in any given case. It can only be known after the thorough investigation suggested above. Nor will it do here to say, because in the last half-dozen cases a given remedy, Tiepar, for example, has been found to be the remedy that, therefore, we may assume that it will be found to be so in the seventh, and proceed to give it without investigation. There would be no more propriety in this than in giving any other remedy for any other unwarrantable reason. In this last case, that which was related to the six, and cured them, may be as far removed from this relationship as the farthest. This relation is in the vital condition of the seventh sick man, and the similarity of this to the characteristic symptoms of ERUPTIVE FEVERS. 477 some one drug, irrespective of all other cases and their cura- tives. This relationship can only be ascertained when this condition has been clearly brought to light by thorough in- quiry. Taking it for granted, because of what was known, and what happened in other casos, is only a resort of the ig- norant or the lazy, and is nothing less than high treason to a most important duty. CERTAIN DISEASES OF CHILDREN. B. F. Joslin, M. D., New York. DIPHTHERIA. Diphtheria has prevailed as an epidemic in the United States about sixteen or seventeen years. It has been sup- posed by some that the disease was always endemic in this country; but my own impression is, that it is, with us, a new rather than an old disease. A similar difference of opinion existed when cholera visited this country in 1S32 ; it was then affirmed by many that the disease was merely an aggravation of the cholera morbus, but it was, I think, soon decided by the profession generally that the epidemic cholera was a new disease, of Eastern origin. Since its first visit to this country it has become acclimated here and has become endemic. So with diphtheria. Starting from the South of France, where it had been known for many years, it visited England, where the physicians carefully watched the disease and described its characteristics. I am willing to state that, as I read these re- ports of the English physicians, which I saw mainly in Braith- waite, I did not recognize a disease with which I was familiar, though I then had been actively engaged in a general practice for a number of years. Again, when the disease finally reached New York, I clearly saw the correctness of the descriptions of the English physicians, and followed their instructions regard- ing the necessity of a recumbent position and a stimulating diet. I had certainly never witnessed such peculiar nervous prostra- tion following any sore throat, previous to the visit of diphtheria. 479 480 world's HOMCEOPATHIC CONVENTION. As is well known, the disease prevailed in Albany before it did in New York City, taking a course quite different from that of cholera in its visitations. An eminent colleague of ours, then practising in Albany, informs me that the physicians were much surprised at the disease, and, in at least one instance, mistook a large patch of false membrane for an abscess, and, attempting to open it, found it of cartilaginous hardness. It is evident that these intelligent physicians had not been previ- ously familiar with the disease. I think it may reasonably be inferred from these statements, that diphtheria, for all practi- cal purposes, on its visit of sixteen or seventeen years since, was a new disease. I need hardly describe a disease so familiar to the profes- sion. The onset is usually sudden, the patient being attacked with severe splitting headache and high fever, which symp- toms are usually of short duration, passing off in twenty-four or thirty-six hours. The throat is frequently not complained of as the seat of trouble, for a day or more. In many in- stances the throat, when inquired after, is stated by the patient not to be affected; but is, notwithstanding, found on investi- gation to be swollen, red and with commencing patches. A very characteristic symptom is a swelling of a lymphatic gland near the angle of the jaw, evidently arising from irrita- tion by matter taken up by the lymphatics from diphtheritic exudation. The patches may be small, and so situated behind the tonsils as to be easily overlooked; or the whole surface of tonsils, uvula and pharynx may be covered so as to present a uniform white or greyish appearance, and the false mem- brane may extend to the nares or to the larynx and trachea ; in the latter case, constituting the rapidly fatal diphthe- ritic croup. The membrane may continue only a day, or it may remain two or three weeks. When it extends to larynx and trachea, hoarseness is common, and a husky cough. The symptoms to watch most closely are those connected with the respiratory function. The disease is so rapid in its progress, yet so passive in its character, that the patient may be in im- minent danger before the serious nature of the disease is sus- pected. The peculiar effect of the subtile poison of diphtheria DIPHTHERIA. 481 on the nervous system is the most important, as well as the most characteristic, of its results. The febrile symptoms rap- idly pass off ; the pulse going down from, perhaps, 120 or 140 to 70 or GO, or lower ; I have known it as low as 40. The pulse becomes irregular as well as slow, and it is evident that scarcely sufficient nervous force is supplied to the heart to keep it in motion. The great danger is from paralysis of the heart. It is for this class of symptoms that the English phy- sicians strongly urged the employment of stimulants, and in- sisted upon the recumbent posture as the only safe one. I have followed their advice and have never had cause to regret it. I must acknowledge that my professional influence has been taxed to the utmost to enforce these requirements, and much anxiety caused when patients could not be induced to take the advice. If is obvious that, with great irregularity and hesitation in the heart's action, any exertion which puts addi- tional stress upon that organ may overpower it, and produce fatal syncope. This has repeatedly occurred; and the very common statement of a fatal case is that the child was doino' pretty well, but was taken up, or sat up, and shortly died. Stimulants given frequently and in considerable quantities are necessary in such cases; the most nicely adjusted prescriptions will fail without their use. I usually give milk punch and beef tea alternately, a gill each, every alternate hour or two. Of the medicines usually administered, Kali bich. is, in the large proportion of cases, the most specifically indicated. I have used the first, second and third triturations, usually dis- solved in water, a dose every two hours. Under this remedy the patches usually clear off the throat in two or three days. Obstinate cases occasionally occur which last longer. Mere, protiod. has had a high reputation, and in many cases, especi- ally those y^ith considerable glandular swellings in the neck, serves us well. Of Merc, deutiod. also I have a favorable opinion. At the onset, I usually give Belladonna until severe headache and febrile symptoms abate. Lachesis is relied upon by many in our school, and no doubt is useful in some cases. 482 world's homceopathic convention. Chlorate of potash, which seems to be much thought of by our old school friends, I have used only m certain cases at- tended with offensive effluvia. When this symptom is relieved, I discontinue its use, believing it to be much less specific than the Bichromate of potash, Protiodide of mercury and some other medicines. The application of warmth is said to relieve the severe pains in the back and other parts which often introduce the diphthe- ria. 'Carbolic acid in attenuation has been used with alleged success. It cannot be too fully impressed on the minds of physicians attending cases of diphtheria, to carefully note, at each visit, the state of the pulse; its frequency and, more particularly, its force and regularity. I am well satisfied that valuable lives have been lost by inattention in thi§ matter. Be pre- pared to advise the use or an increase of stimulants when any lack of force or any irregularity is observed. And above all, insist upon the recumbent posture, for reasons already given. Although I supposed these points in treatment were largely, if not almost universally, conceded, I do not find them in- sisted upon with as much emphasis as I would desire. Paralysis is said by Meigs and Pepper to exist in at least a fourth of the cases. It may come on suddenly, though a gradual advent is more usual. A peculiar tone of voice is left in many instances, occasioned by a paralysis of the vocal organs. It lias seemed to me that a paralysis of the pneumogastric nerve might account for the irregularity in the heart's action ; the loss of all desire for, and even excessive repugnance to, food; as well as the paralysis of the throat observed in some cases. GANGRENE OF THE MOUTH. Amon" the formidable diseases which a connection with o institutions has made familiar to me, is gangrene of the mouth. It is a disease almost unknown to the practitioners of families GANGRENE OF THE MOUTH. 483 in comfortable circumstances, and is liable to be overlooked by them on account of its rarity, and from the fact of its first symptoms not being prominent. I would advise all physicians in charge of institutions for the care of children, as well as those who practise largely among the poor, to acquaint them- selves carefully with the symptoms of this disease, so as to be prepared to treat it correctly from the start; and thus save life and, in all cases, prevent the deformity arising from the extensive destruction of tissue. This disease is most frequently a sequence of measles ; sometimes following typhoid fever or hooping cough. In one instance in my experience it was the termination of phthisis pulmonalis. It may follow any dis- ease, or even appear without being proceeded by any other malady, in poor, badly nourrished constitutions. The first symp- tom usually noticed is a hard swelling in one cheek accom- panied by a circumscribed redness not unlike the hectic flush. The touch reveals an indurated mass not sensitive to touch ; nor is any pain or inconvenience complained of by the patient. The above symptoms should lead to a careful examination of the interior of the mouth, when a greyish slough will be found in the cheek near one or other maxilla. It may be small in extent. In one case, which recovered, it involved the interior of both cheeks, both corners of the mouth and the superior maxillary bone. The recovery of this patient was remarkable. The destruction of tissue at first threatened to produce permanent disfigurement; but it was less subsequently than would have been supposed possible. Portions of bone came away, but the patient left the institution before this process was completed, although, apparently, in fair general health. When this case was first observed it was in the con- dition described, the whole extent of both cheeks was in a gangrenous condition; and a very considerable portion of tissue involved, so that perforation of both cheeks, and their complete destruction seemed inevitable. A child was brought to me, at the Central Homoeopathic Dispensary, a number of years ago, with one cheek black from gangrene. The cheek was destroyed and the interior of the mouth exposed; the child died. It resided in a low basement; 484 world's iiomceopathic convention the mother was a tolerably intelligent woman ; yet her atten- tion was not drawn to the child's mouth, until the whole cheek was destroyed. It is therefore apparent that those so situated as to be likely to meet with this disease, should be watchful in the extreme, as their success will depend on their early appreciation of its nature. Bear in mind that pain is not one of the symptoms. Ulcer in the mouth (the ordinary ulcerative stomatitis) is a painful disease, and the smallest ulcer is accompanied by great inconvenience, as most of us can testify. The ulcerative and gangrenous forms of stomatitis need never be confounded. In regard to the treatment of this disease I can in few words say all that need be said. Until I used Chlorate of potash I saw no case cured. I have known cases commence in a small slough, and extend till complete destruction of tissues of cheeks and death supervened ; in spite of the most careful attention from experienced and skilful physicians. Since I have used the remedy named I have seen few cases prove fatal; and a large majority have been cured. I have usually dissolved two or three grains of the salt in three ounces of water, giving two teaspoonfuls each hour. A somewhat stronger solution, say -two grains to an ounce of water has been used by the nurse in washing the mouth with a linen swab. I have also used the solid points of nitrate of silver, as a local application ; but candidly acknowledge that my success is not attributable to this means ; as, in cases of extensive gangrene, it was impos- sible to sufficiently touch the healthy structure through the gangrenous, to make the application available. In all, twenty-eight cases of gangrene of the mouth occured in Five Points House of Industry, from January 1861 to February 1876. Of these but five died; only one from un- complicated gangrene of the mouth. In one of the other fatal cases, the gangrene was apparently improving, when death took place. A post-morten was made by Dr. Houghton and myself; when extensive tubercular disease of the lungs was found. Phthisis should be credited with this death. Of the three other fatal cases, two of which occured during the past year, the patients were already dying of phthisis, when gan- CROUP. 485 grene supervened; and, in the opinion of Dr. St. Clair Smith who saw one, and of Dr. D. B. Hunt who saw the other two patients, the gangrene did not materially hasten the approaching death. Thus, excluding the four patients having phthisis pulmonalis in an advanced stage, we can with justice claim to have cured twenty-three out of twenty-four cases. In the same institution (Five Points House of Industry) gangrene of the throat in one case, and gangrene of vulva in another, followed typhoid fever and proved fatal.* The late Dr. B. F. Bowers was called in consultation to a case of this disease in Brooklyn, in a family in comfortable circumstances ; he made use of the Chlorate of potash and re- covery took place. CROUP. Of the diseases of childhood none is more dreaded by mothers and, I may add, by physicians than croup. And in none is the comparative success of our system of treatment more satisfactory than in this. It is certain that more deaths annually take place from cholera infantum, scarlatina, broncho- pneumonia and other forms of this disease, than from croup. But croup is in some instances so sudden in its approach ; so rapid in its progress and so little amenable to treatment ; that those who have once witnessed a rapidly fatal case, never recover from the shock ; and are seriously alarmed at symptoms which, by those unacquainted with this disease, would be considered of little moment. In private practice for a period of years my success has been so great as to surprise me; attributable in part to the care used in providing medicines for prompt domestic use, as soon as the patient should be attacked. This is a special point with me when called to treat an attack of this disease, in a new patient ; I endeavor to ascer- *A case of gangrene of vulva recently treated at this institution by Dr. D. B. Ilunt, and which I also saw on several occasions, recovered. Chlorate of potash was used both internally and externally. 486 world's homceopathic convention. tain which remedies are best indicated for this particular patient and family, and leave such medicines to be given promptly and persistently when the disease recurs. The per- sistence is a most important point. It is not unfrequent with me when called in, to simply continue the prescription which, according to the nurse, was not producing any marked effect; being fully persuaded in my own mind that nothing was needed but persistence. When called in consultation, in this or other diseases, my common experience is that too many re- medies, rather than too few, have been given ; and the marked difference between domestic and professional practice lies in this. The physician who carefully studies his case, and decides upon the particular remedy in full faith in the law of cure, expects success and patiently waits for it. Much difference exists among writers in regard to the cer- tain nomenclature of croup. We frequently hear of spasmodic, of catarrhal, of inflammatory, of membranous and of diphthe- ritic croup. True and false croup are also terms used. Locality has much to do with this difference of description, each writer describing the forms of disease with which he is most familiar ; and it is well known that the form and sever- ity of the disease vary much in different places. Of spas- modic croup properly so called, I must confess my ignorance. I presume no one intends by this term the laryngismus strid- ulus of young infants, for which Dr. Dunham used Chlorine with success.* The only very severe case of this affection I ever witnessed I cured with the same remedy. I believe that inflammation is the basis of all cases of croup. In certain sensitive subjects a little inflammation gives rise to spasm of the glottis, and a ringing cough and stridulous respiration are the symptoms produced. At the same time the alteration in the natural secretions of parts, tends to a varnishing over of the mucous membrane with a thin albuminous secretion ; which, as it becomes thicker, gives rise to a dry, wheezing res- piration and a hoarse and husky sound of the voice and cough. These changes in tissue and symptoms exist in varia- ble proportions. And, as one or other class of symptoms pre- * American Homoeopathic Review, Vol. II., p. 18, 1860. CROUP 487 dominates, the cases are denominated by some physicians as spasmodic or membranous. Tliis classification is not justified by my experience nor by that of some others. In the American Journal of ^Jedlcal Sciences, for January, 1856, is a dissertation by Albert Newman, M. D., who takes this rational ground : " We clo not think that the presence of false membrane has any claim to be considered either the pathognomic symptom of the disease or the characteristic of a distinct variety.* Nor can w'e see any practical benefit to be derived from such distinction ; the nature and pathology of the disease being, as we shall endeavor hereafter to prove, essentially the same in cases in which false membrane is found, as in those in which it is not." Ilis views are, to my mind, ex- ceedingly clear and correct, and accord with my observations of the disease in New York City. Vogel [Am. Ed.\, a recent writer on diseases of children, and of repute in Germany, con- siders croup as a necessarily fatal disease. All of his cases died ; but he cured three cases of diphtheritic croup. All cases of apparent croup, not proving fatal, were, according to him, laryngitis, a disease which, lie states, may in a few days be- come true croup. I think it is more rational to consider these as different grades or stages of the same disease. Vogel ridi- cules the idea of a patient having several attacks of eroup. Of course if the disease be, as he represents, necessarily fatal, one attack would suffice. Meigs and Pepper (" Diseases of Children," Phila., 1870) consider the ordinary attacks of croup as divisible into mild and severe laryngitis ; but pseudo-mem- branous croup as a distinct disease. According to them the severe form of laryngitis is sometimes with difficulty distin- guished from true croup. Inflammation is acknowledged by them to be the cause of all croup, from the simplest spasmodic to the most severe membranous. Takino; into consideration the above statements of Mems o o and Pepper and that of Vogel, that laryngitis may become true croup, is it not reasonable to consider the simple and * " Croup : Its History, Nature ami Treatment,'' by Albert Newman, M. D. The dissertation to which the Fiske Fund Prize was awarded, June, 1855. 488 world's iiomceopathic convention. severe laryngitis and the membranous croup, as different grades of the same disease ? In mild cases of croup the inflammation terminates in reso- lution ; in others, in a secretion of mucus; in the more severe form, in the production of false membrane. I regard the cases of croup, denominated by different writ- ers as spasmodic, catarrhal, inflammatory and membranous, as essentially the same disease; varied in degree of severity by constitutional predisposition and local influence. Damp situ- ations will afford more severe cases of this disease than dry ones. New York City probably furnishes a much greater proportion of severe cases than interior country districts. No greater difference exists between mild and severe attacks of croup than between different grades of scarlatina. A nomen- clature, founded on the severity of a disease, is obviously in- correct. I have not been so fortunate as some in finding deposits of false membrane on the tonsils, even in severe and fatal cases of croup. In diphtheritic croup, which I consider as a distinct disease, I have usually found the membrane on the tonsils and fauces. So far as danger is considered, the patient may be in more immediate danger from the spasms closing the glottis and producing suffocation, than from the formation of membrane. It has been stated by some authors that the membrane never completely closes the larynx and trachea. The formation of membrane causes death gradually, partly by apnoea but also from asthenia. The patient is ex- hausted by the enormous muscular efforts required to force the air through the diminished calibre of the air tubes. Strong children have the popular reputation of being peculi- arly subject to fatal attacks of croup. I think otherwise; their muscular strength enables, them to keep up respiration W'hen the more delicate ones would succumb. My ordinary method of ascertaining the amount of obstruction to the intro- duction of air into the larynx, is to place my hand upon the abdomen and observe the play of the abdominal muscles. The increased action measures the degree of effort made by the patient. The lungs being supplied with too little air, the change of the blood, from venous to arterial, is not fully CROUP 489 affected ; and, as a consequence, the skin becomes dusky and bluish. Such appearances betoken an unfavorable result. The homoeopathic treatment of croup is remarkably success- ful. The medicines which I have found most generally effica- cious are Hepar sulph.8 and Iodine8, usually in powder of the trituration. A very large proportion of the cases occurring in my practice are cured by these drugs. Sometimes Hepar sulph.3 alone suffices; in other cases, Iodine3 alone ; and in many cases they are given alternately. As before intimated, I am quite in the habit of supplying families, subject to croup, with medicines, so that they may be given promptly on the occurrence of the first symptoms. I believe that lives have been saved by this method. A single dose of Hepar sulph.3 frequently breaks up a threatened attack. The dose is re- peated in from one to three hours. Much valuable time is saved to the patient by having the medicine on hand, and the doctor is spared many a " night call." I am satisfied that my success has been better with the above attenuations than with the higher, formerly used by me in treating croup ; nor do I think that less attenuated medicines would do as well. I have used Iodine in doses of a couple of drops of the tincture in three or four ounces of water, a teaspoonful of the solution administered each hour. I can recall cases in which this proved successful. In several instances I used the vapor of Iodine with benefit to patients. For the exhibition of the vapor of Iodine, I would suggest the following method re- cently used by me with good effect: Place in a vial a few grains of metallic Iodine. To this vial is attached an ordin- ary hand-ball atomizer. The vial being heated over a lamp (inserting the vial into a vessel of warm water would answer), the vapor of Iodine fills the vial and is projected by the atomizing apparatus into the patient's mouth and larynx. I had previously used the Iodine vapor by having the patient inhale it as it came from an evaporating dish, heated by a spirit lamp, but found the above method much more com- plete and efficient, and less annoying to the patient. The vapor goes only where it is needed and does not irritate the eyes or nose, as it may in the other manner of using it. My 490 world's homoeopathic convention. friend, Dr. St. Clair Smith, on hearing of this method, sug- gested its application to the use of the vapor from slacked lime by a slightly modified apparatus ; using a large jar for lime and water, with a cover so contrived as to be removed to take out refuse material and renew the lime. The vapor could be readily projected into the patient's throat. Should the vapor of Bromine be used, a portion of water should be put into the vial and a few drops of Bromine added. The space above the water would be filled with vapor of Bromine on account of its exceeding volatility. Bromine has considerable reputation in our school, having been given in solution internally, and by inhalation. I believe the above method of administration would be found a useful one. Of other remedies. Aconite is most frequently needed. Spongia* is, in my opinion, very nearly the same as Iodine ; Lachesis is a valuable remedy; Carbonate of Ammon, is cer- tainly of great value in some cases, and at least one very severe case, in which an unfavorable prognosis had been given by an eminent member of our school, recovered under its use. The case presented persistent, dry, wheezing respiration, with husky voice and cough, which, having lasted several days, certainly justified a very doubtful prognosis. The same pati- ent has since had severe attacks, yielding to the persistent use of Iodine2. In addition to the above remedies, Kali bich.1 ', and Mercurius protiod.1 have been useful in my experience. Tart. emet. I have used less frequently than some of our school. It seems to be homoeopathic to a loose rather than a dry cough. In a few instances I have seen benefit arise from a few doses of this drug, given at short intervals, say fifteen or twenty minutes ; then returning to Ilepar, Iodine, etc. In two cases, false membrane was thrown off under its use, but the patient subsequently died from the reformation of the mem- brane. Belladonna will relieve many a loud barking cough which might make us suspect croup, but is not included by me among the remedies for the disease proper. In treating croup, the selection of the correct remedy is necessary, but at the same time certain other matters must be attended to. * Spongia is stated to contain both Bromine and Iodine (Holcombe, etc.) .CROUP. 491 The patient must studiously be kept from any currents of air, which always tend to aggravate the laryngeal spasms. If in a large open room, screens had better be constructed and put around the patient. I prefer a temperature of 80° Fahr, to a lower, and 88° is not objectionable. An open-grate fire is the most efficient ventilator known, and is particularly useful in this disease. Cannel coal or hickory wood is the best fuel. The dry, hot air of furnace heat is quite objectionable. I rarely use any steaming apparatus. It is a serious objection, in my opinion, to such an appliance that the air of* the room is ren- dered too humid, and thus becomes too good a conductor of heat, and the patient's vitality is lessened by carrying off the heat of the body. In a few cases I have seen good results from such apparatus. I have, in a number of instances, seen benefit arise from flannels wrung out of warm water and placed around the neck of the patient. The windpipe is thus kept warm; the atmosphere inspired by the patient is rendered sufficiently moist and warm to be grateful to the interior of the larynx and trachea; yet the general air of the room is not too much affected. Rapidly fatal cases of croup are not com- mon ; forty-eight hours is about the minimum duration of the disease in my experience. I have known severe cases last more than two weeks and then recover. The membrane, when thrown off, may again form and prove fatal, as is shown by the first of two cases narrated at the close of this paper. Some writers have doubted that the membrane if thrown off is ever reformed on the same surface. In the case referred to, there seemed no reasonable doubt, from the similarity of the size of the casts, that this process took place. Previous to the mass of false membrane being thrown off, the patient's symptoms had improved at times, from (I believe) the membrane being expectorated in inappreciable particles. This, I believe, in far the largest proportion of cases, is the manner in which false membrane is disposed of under the action of our remedies. This case is of interest in considering the propriety of tracheotomy. Certainly, no operation could more completely remove the products of disease and temporarily relieve the patient, than did the medicines which threw off this false 492 world's IIOMCEOPATniC CONVENTION. A membrane. The probability of reforming, after medicine had expelled them, must be conceived to be much less than after an operation. For certain cases of laryngitis in the adult it must always be thought of, though I have never found it necessary. It must be acknowledged that of late years the profession have regarded this operation with increased favor. My per- sonal experience with it is very slight, being confined to one successful case at the Five Points House of Industry. In this case the patient was a boy about 9 years of age, extremely emaciated, having just recovered from a severe attack of typhoid fever. I saw him about twenty-four hours after he was attacked with croup. Dr. T. V. Smith, the resi- dent physician, had used IIepar3 and Iodine3 quite persistently. Iodine in solution had also been given. I used vapor of the metallic Iodine, atomized into the mouth and throat, as previously described in this article. Undoubt- edly some effect was produced, and the patient seemed slightly improved, after the hour and a half that I stood by his bedside. Still his prospects were not promising; his pulse was 140 and small, respiration difficult. Considerable effort of abdominal muscles was required to force air through the windpipe ; voice hoarse. From his previous illness, he was notin condition to maintain along conflict with the disease. Carb, of amm. had been given ; that and the vapor of Iodine seemed to me to be the best remedial agents in the case. On my return up town I called upon Dr. Doughty and suggested his seeing the patient in the evening with reference to tracheotomy. Dr. Doughty found the patient worse and, after careful examination, operated. The relief afforded to respiration was prompt, and he became more comfortable. lie remained in a critical posi- tion for several days, but eventually recovered. The discharge from the trachea and bronchia coated the tracheal tube ; but no patches were seen in throat. I do not believe this to have been diphtheritic, although a case of diphtheria existed in the institution at the same time. I think there can be very little question that this boy's life was saved by tracheotomy. As is well known, the French CROUP. 493 have favored the operation while the English had, a few years ago, almost totally abandoned it. The Americans have occupied a medium position, at present decidedly tending towards a favorable judgment under certain circumstances. Almost all authorities condemn tracheotomy in diphtheritic croup. Pro- fessor Jacobi, exceptionally, favors it; asserting that, should we meet with a man hanging by a rope, we should cut him down without first stopping to inquire whether he were the subject of a fatal disease. Two points seem to be generally conceded : that tracheo- tomy is not a dangerous operation; and that it almost always affords temporary relief to a patient's sufferings, even if it does not cure. Still, the question as to the actual proportion of lives saved which would otherwise have been lost is an exceedingly difficult one. In such a case as that already alluded to, which died after the expulsion of seven different tube casts of the windpipe, ap- parently from extension of disease to bronchia, no operation could'have saved the patient. In another instance, following scarlatina, the membrane was thrown off under Tartar emet., after the case had been pro- nounced hopeless by two physicians of our school. Complete relief was afforded, but the membrane reformed and was thrown off several times; the patient finally dying from the occlusion of bronchial tubes. In my private practice, no operation has ever been performed. For a considerable period I have lost no patient, not distinctly diphtheritic. I conse- quently have no regrets on the score of avoidance of tracheo- tomy. But I am so far influenced by the experience of others that I consider the operation admissible, and should no doubt favor it under some circumstances-; as for instance in a case of croup in which remedies persistently used had produced no effect, and the patient's strength was failing, pulse becoming small and rapid. No doubt, croup patients have been operated upon when all chance for benefit had ceased, and in this way the operation has lost credit; and, on the other hand, those who most freely operate will always show the best percentage of cases. The 494 world's HOMCEOPATniC CONVENTION. question of the propriety of an operation will always be a nice point for mature judgment and experience to decide. I am disposed to concede that lives have been thus saved; and would refer the reader to Meigs and Pepper [Diseases of Children, 1872j for statistics, and an able consideration of this subject. It is a matter of interest to note that croup is more frequent and more fatal with boys than with girls. The two cases enumerated, in which I had charge of patients during only a portion of their sickness, and two others, are the only fatal cases in girls that have occurred in a practice of twenty-five years. In only one instance had I full charge of the patient. Of boys, I can recall probably six or eight fatal cases, during the same period. None of such deaths have occurred for a number of years past. Of course I am not including cases of a strictly diphtheritic character. Nor do I see any greater necessity of confounding diphtheria and membranous croup than scarlatina and diphtheria. Diphtheritic exudation on the fauces had been a symptom observed in scarlatina before*diph- theria visited this country in an epidemic form ; yet the two diseases are distinct affections. A disease consists of a number of symptoms occurring in a certain order, representing path- ological changes not always easily understood, but on which we are fond of theorizing. I have not alluded to the great negative advantage possessed by our treatment, in its not producing nausea and prostration, as do most of the rem- edies considered valuable by our old school friends in this dis- ease. Many cas$s are prolonged ; and, if the system is reduced and muscular strength diminished, so much less chance is there of patients recovering. I have been sent for to treat cases of croup in families who had not before employed our system, on account of the very great annoyance they had experienced from the action of the drugs previously employed. The di- gestive organs would be disordered for several weeks after an attack, and along train of sequences supervene. With us no such unpleasant consequences occur. It is not uncommon for the patient to have bronchitis following an attack of croup ; this is usually treated by Phosphorus, Bryonia or Belladonna. CROUP. 495 Case 1-This case is alluded to in the preceding section as one in which seven complete tube casts and other portions of membrane were thrown off. On October 20th, 1859,1 was called to Maria C., aged five; had been sick a week with croup, but had become worse, in the opinion of friends, since last evening. At two o'clock, the family physician had been sent for, as I understood, for the first time. Ue had prescribed emetic and cathartic medicines, and had given a decidedly unfavorable prognosis. The case was a severe one, and had been neglected, owing to its insidi- ous character. At 11 a. m., I found her with a pulse of 120 ; husky cough and rattling respiration ; voice very hoarse and indistinct. Gave Hepar sulph.' every half hour. At my second visit, at 1:30 p. m., gave Spongia3. At 5:30 p. m., found her worse. Respiration much impeded; cough short, husky and suppressed. During the afternoon she had slept, having, during sleep, no apparent difficulty of respiration ; had frequent yawning and perspiration on head. 1 gave Aconite13 and Spongia3, alternating every half hour. 10 p. m., worse, respiration labored, face flushed and perspir- ing, pulse more rapid and smaller, inspiration accompanied by husky, brass-tube, sound ; some rattling still accompanies res- piration. Gave Tartar emet.1 every twenty minutes. 21st, 8:30 p. m. After second dose of Tartar emet.1 com- menced to improve. Respiration became more moist and, after a time quite easy, as at present; but she has, once in a while, a croupy whistle; cough still husky. Continued Tartar emet.1 each hour. 8:30 p. m., has improved all day ; is now easier than at any previous time ; respiration quite easy ; has occasional cough. Continued Tartar emet.1 22d. Pulse 112 ; respiration now perfectly easy ; has had no bad spell, in fact has steadily improved. Coughs occasion- ally, a rather dry hacking cough. Gave Phosphorus12, Tartar emet. to be given if worse. 9 p. m., pulse, daring sleep, 94; woke in a paroxysm of suffocative cough, long continued and severe ; has had several such paroxysms this evening. Gave Lachesis39. 23d, 11 a. m. Pulse 104. Had three severe paroxysms 496 world's homceopathic convention. of suffocative cough during night; no difficulty of respira- tion; voice quite indistinct; thirst during night and this morning. Took three powders of Tartar emet.1 in addition to Lachesis30. Gave first Aeon.30, then Lachesis30, every three hours. 9 p. m., has had only two severe paroxysms of cough during day; sneezes to-night; bowels normal. Had taken Tartar emet.1; gave Lachesis30 three hours. 24th, 10 a. m. Pulse 108; coughed frequently during night, but had no severe paroxysm ; heard her cough ; it still had some of the husky character, but was loose at the end of paroxysm. Had taken Tartar emet. in night, gave Phos.12 every two hours. 4:45 p. m., pulse 108. Coughs more fre- quently this afternoon ; a brassy sounding cough, not very dry but with rattling of mucus, wheezing sound of respiration. Gave Tartar emet.1, one hour. At 8 p. m., called in haste. Cough and respiration worse ; wheezing respiration and dry husky cough. Gave three doses of Tartar emet.1 within an hour. At 9 p. m., she seemed slightly better. Continued Tart. emet.1 pro re nata. 25th, inst. Pulse 110. Continued to be severely affected until one or two p.m.; since then, somewhat better. Not so well as yesterday morning; coughs frequently with a ringing sound, as yesterday afternoon; has, after cough, vomited frothy matter, with a little blood and shreds of false membrane ; one loose evacuation; seems weaker. Gave Hepar sulph.8 and Tartar emet.1 9 p. m., pulse 110. No change till evening, since then has improved. Cough rather loose; respiration rattling and wheezing; has vomited a quantity of mucus sev- eral times after coughing; had one loose evacuation. Pre- scribed Kali bich.2, a dose each hour; but Tartar cmet.1 to be given if she became worse. 26th, 10 a.m. Had an easier night than at any time since I have been attending her. Since 7 a. m. not quite so well. Has had several severe coughing spells, one attended with choking, which very much alarmed her friends, after which she coughed up a large piece of tough white membrane, so tough that the point of a pair of scissors was not readily forced through it. Its size was one and a half inch long by three- CROUP. 497 fourths of an inch broad. The expectoration contains small shreds of membrane. Took Tartar emet? since 7 a. m. ; continued Kali bich?; Tartar emet? to be given if worse. 9 p. m. very severe paroxysm of coughing this afternoon ; expectorated a complete tube-cast of membrane, about one- third of an inch in diameter; appeared oppressed before, better since; pulse 104; respiration easy. Took Tartar emet? during day; continued Kali bich? every two hours. 27th. Pulse 136. Expectorated two large portions of mem- brane, rather larger than previous ones, one being a tube; skin warm; respiration dry and husky ; tongue heavily coated ; cough dry. Ilas taken two dose^ of Tartar emet? Continued Kali bich? 5:30 p. m., sent for in haste. -In the morning had coughed up, with severe straining, a tube two and half inches long and more than one-third of an inch in diameter; has since coughed up large shreds. This afternoon much oppressed. Tartar emet. was given every fifteen minutes for two hours until relief. Pulse 120. Continued Kali bich? ; Tartar emet? to be given if worse. 28th, 10 to 11 a. m. Pulse 120. Two tubes expectorated since last record, each about three inches long and one-third of an inch in diameter. Expectorated much thick tenacious mucus. Appears better this morning than she did yesterday ; had one loose evacuation. Took Tartar emet? every fifteen minutes for three hours. 9 p. m., has taken only two powders of the Tartar emet? Ilas been rather easy during day. To night, sleeping with loose rattling respiration. This afternoon ap- peared quite well, except as to voice. At noon had nausea with vomiting of greenish matter and mucus, and shortly after a loose evacuation. Continued Kali bich? one hour. 29th. Pulse 128. Had an easy night; had one evacuation not very loose. Vomited after cough this morning; had one paroxysm of cough about 9 a. m. ; took four powders of the Tartar emet? Expectorated a complete tube (same length as before) last night and an incomplete one this morning. Con- tinued Kali bich? 9:30 p. m., pulse 112. 7 p. m., had a par- oxysm of cough and husky respiration. Took Tartar emet? and was relieved. Continued Kali bich? 498 world's homceopathic convention. 30tIi. morning. Pnlse 140. Rather easy night but, since 1 a. m., respiration dry. A normal evacuation to-day. Evening. Pulse 140. Gave Kali bich.1 Respiration dry and much oppressed. More prostrated ; has appeared rather better since 6 p. m., but undoubtedly is much Worse than usual. Gave Tartar emet. A, then Kali bich? 31st. Ilas been getting worse. Respiration quite rapid and labored ; is pale and seems quite low ; has not slept; wants to be carried about constantly. Two loose evacuations this morning ; expectorated during night, thick tough mucus and pus with some blood. Pulse 156, feeble, almost imperceptible. Rattling respiration; has not coughed this morning, apparently from difficulty in inspiring sufficient air with which to cough. Tartar emet. in solution every ten minutes. 4 p. m. No cough; extremities are cool; wants to go to the open door and asks her father to run with lier in his arms. Green slimy evacuation. Gave Carbo veg.30 every half hour. 9 p. m. Same condition; frequent desire for evacuation. Mercurius viv." Death soon occurred. Remarks.-This case was of that inveterate character which in all human probability nothing would have cured. Yet it is fair to remark that this family have been under my profes- sional care ever since (a period of sixteen years) and that several of the children have had exceedingly severe attacks of croup which I have had the advantage of treating from an early period of the disease. I recall at least one case where the child appeared bluish and where I feared a fatal result, yet all re- covered. I had previously been the physician of relatives of this family among whom many severe cases of croup had been by me successfully treated. No fatal case of croup has occurred among this circle, a large one in my practice, and where I am now treating the fourth generation. This I attribute to the confidence placed in me, so that my medicines are given promptly and my directions followed implicitly. It is to my mind an illustration of the effect of faith ; the absence of which, in other instances, has been attended with very unpleasant and even fatal results. This case seems to have been under domestic treatment for CROUP, 499 six or seven days ; showing the insidious character of some of the worst forms of croup. The improvement under several remedies (Tart.1, Lachesis'11 and Kali bichrom.9) was marked ; and gave a reasonable hope of recovery. Tart.1 certainly seemed at first to produce very satisfactory results. I had at that time greater confidence in this remedy than I now have. The membrane was repeatedly thrown off; but again and again was formed and the patient eventually died, apparently from the extension of inflammation to minute bronchia. In a number of instances in former years, I found Tartar emet.1 to be of temporary use. But I incline to the belief, from enlarged experience, that its effect is to increase secretion of parts and thus aid in throwing off the 2}r°dUGts of the dis- ease rather than having a specific effect in reaching inflamma- tory action at the basis and sd preventing the formation of such products. In my present judgment no remedy possesses the character of a specific for croup more nearly than Ilepar sulph.; where the case is characterized by a dry wheezing, or husky respira- tion, hoarseness or aphonia it is well indicated. Next in order stands Iodine. I should give this in cases where the loss of voice is more marked than the dry wheezing respiration. Aconite is regarded by Hartmann as by far the most valuable remedy for croup. I always use it when there is a full and rapid pulse and heat of surface; but a large propor- tion of the serious cases of croup in New York City are of an asthenic character and do not present the appearance of inflammatory fever. Lachesis, which I used on October 22d and 23d with some benefit, has always proved a useful remedy in laryngitis, in children a little over the croup age, and in adults. Its symptoms, such as cough on touching the larynx and after speaking are characteristic; in many instances it has cured croup. Bromine I have used in a few bad cases and can not in my own experience point to any cures. Others seem to have used it to some advantage. 500 world's homoeopathic convention. Case 2.-A. Fletcher, an unusually large and hearty infant, aged one year, was attacked -with croup on the morning of April 1st, 1860. I was called on the afternoon of the second inst. lie had rough, hollow cough, respiration wheezing, more apparent during sleep. Ipecac, had been given and had caused vomiting. The night previous he had rather high fever, but had none at the time of my visit. I prescribed Aconite12 and liepar sulph.*, to be given alternately every two hours ; and if he got worse to take Spongia3. I was called up the following night at 1:15 a. m. ; found that he had been growing steadily worse since 9 p. m. One oi1 two doses of the Spongia3 had been given without apparent effect. Respiration stridulous, with dry wheezing, heard be- tween the noisy inspirations. I gave Lachesis6 every six or seven minutes till 2 a. m., when, not observing any improve- ment, I gave him Iodine tincture, two or three drops in a gill of water, a teaspoonful at a dose. A few minutes after tak- ing this, the wheezing sound became more moist; no other change took place while 1 stayed, which was till 3:30 a. m. The remedy was repeated every twenty minutes. 9:30 A; m. Found him rather worse ; towards morning his mother had given him a powder of Tartar emet.1, which I had left conditionally; this was followed by slight amendment. The Iodine solution had been given subsequently, I gave him another powder of Tartar einct.1, with temporary relief. As there was still stridulous respiration, I gave him Chlorine solution, which I had observed to produce very marked effects in a case of laryngismus stridulosus; a dose was given every fifteen minutes till 3:30 p. m. Respiration had then none of the stridulous sound, but the dry wheezing sound remained; cough had been looser; during sleep he had breathed quite easily. Prescribed Bichromate of potassa1, a powder every half hour. At 10 p. m. had no return of the stridulous respiration (nor had he any subsequently). Breathing much easier; the wheezing sound is less dry. Continued Bichromate of potash, every half hour. On the morning of the 4th, found he had been better till CROUP. 501 2:00 a. m., then had increase of wheezing respiration; is hoarser than he was; thirsty ; drinks quite frequently ; when he coughs seems to raise something; has coryza. I gave Iodine every half hour. At 5 p. m. had not changed much ; had rather more difficulty in respiration ; was quite hoarse ; could scarcely cry at all ; cough drier. Gave Bichromate of potassa every twenty minutes. At 10 p. m. was no better. Respiration seemed quite dry, very difficult and somewhat irregular; thirst. Gave him three doses of Aconite, fifteen minutes apart; then two doses of Tartar emet. without effect; pulse 120, not quite regu- lar. Left Mercurius protiod.1 and Potassa bich.1, to be given alternately every half hour. Continued the prescription till 5:30 p. m. of the next afternoon ; he remained about the same. Prescribed Phosphorus3 every half hour. At 10:00 p. m., no change; had constant dry, wheezing respiration. I was at this time much discouraged in regard to the result. The dan- ger of suffocation was not so imminent as I have often wit- nessed, but the symptoms resisted treatment more obstinately than is usual. After thinking over the whole case I concluded to give Ilepar sulph.3 and Spongia8. alternately every half hour. On the morning of the 6th, found him sitting up in his bed, appearing quite comfortable. No change had taken place during night, but this morning his respiration is easier. When he coughs it seems to loosen the secretion in the trachea. Same treatment, a dose every hour. In the evening his res- piration was still easier. Same treatment. 7th. Gradually improving; cough loose. Continued treat- ment. 8th. During night had much dry wheezing respiration ; at present quite easy ; scarcely any sound perceptible; remains hoarse. Gave one dose of Phosphorus13 and continued Ilepar sulph.3 and Spongia', alternately every hour. 9th. Improving; cough loose, but slightly hacking. Con- tinued treatment. 10th. Slight croupy cough and coryza; no wheezing. Con- tinued same treatment. 502 world's homceopathic convention. 12th. Seems quite well. I directed the Ilepar sulph. and Spongia to be given occasionally for two days, then Phos.12 for a day or two. To those not familiar with membranous croup, this case may not appear very interesting nor extremely successful. But those who have watched the fully developed cases of this dis- ease will consider that I was fortunate in saving my patient. Probably I should have done better by giving the Spongia a more thorough trial in the commencement. This boy had, each following year, a severe attack of croup till he was nearly seven years of age. I was able partially to relieve attacks in thirty-six hours, subsequent to the first de- scribed above. I find by my records that Ilepar sulph., Iodine, Tartar emet. and Lachesis proved useful at different times. BIBLIOGRAPHY OF CROUP. Bromic acid.-In the Philadelphia, Journal of Homoeop- athy^ Vol. II., p. 76, Dr. McKnight, of Providence, R. I., reports the cure of a case of membranous croup in a girl of four years of age, whose sister, two years younger, had previ- ously died of the same disease. lie saw the little patient forty- eight hours after the attack, and gave IIepar and Spongia. The next day she was worse, but he continued the remedies. The day following was told the child was dying, andon reach- ing the bedside found the statement apparently correct. lie gave Bromic acid every fifteen minutes, and in one hour she began to improve. lie then gave Ilepar sulph. in alternation with Bromic acid, and under this treatment the child recov- ered in a week. Chloride of Iron.-In N. E. Hedical Gazette, Vol. IV., p. 246, is recorded a case of membranous croup, treated by II. E. Spalding, M. D., Hingham, Mass.: Annie O., sixteen months old, was seen after two days' domestic treatment. " At 5 p. m. I found my patient with flushed cheeks, dry hot skin, pulse quick and high, respiration laborious; inspiration slow, with a deep sonorous, grating sound, while the expiration was short and quick. Cough ringing, but not frequent." He gave Aeon, and Spongia, and applied wet compresses to throat and chest. At 9 p. m. the patient being worse " I placed a steam atom- CROUP 503 izer about three feet from the child, as she lay in her mother's lap, and directed a spray of tincture Ferri cldoridi towards the child's face. She had hardly taken the third breath of the vapor when she raised herself in her mother's lap and looked curiously at the instrument, while breathing with comparative freedom and ease." The spray was continued " all night, di- luting the tincture with from one to two parts of water, accord- ing as the breathing seemed easy or oppressed. Spongia3 and Sulphur300 were given. During the night she threw up some pieces of membrane. The treatment was continued, and on the third day after the doctor's first visit the child was well." Kaolin-The following case is reported in the Medical In- vestigator, of Chicago, 1870, Vol. VIL, p. 257-"Kaolin in Croup (membranous laryngitis)," by S. Lilienthal, M. D., New York: " E. B., sixteen months old, of strong and healthy parentage, was never sick a day in his life and even passed through dentition without suffering. Tuesday, Febru- ary 8th, was as lively as ever, only his mother thought his voice a little husky. During the night he became very fever- ish and, in the morning of the ninth, he wanted to be carried about; his skin felt rather dry and he did not take his food with his usual appetite. Very little cough, but huskiness and, by auscultation, a metallic rasping sound could be detected, increasing as the evening wore on. Lie had already taken the usual remedies without benefit, and was therefore put on Kali bich. in order to produce vomiting ; this took place freely on the tenth, but without any marked relief. The cough and suffocative spells rather increased; and the three days' suffering began to tell on that child formerly so bright. Called in consultation at that time, I proposed Kaolin, which was given in the sixth dilution, a dessert spoonful every hour. It did not produce any vomiting; it rather seemed to dissolve the fibrinous false membrane; for after a few doses .the child breathed easier; slept on and off during the night and, on the eleventh, in the forenoon, he could be declared convalescent, although we kept on with the same remedy at lengthened intervals." In the Ilahnemannian Monthly, Vol. VIL, p. 291, Kaolin, 504 world's IIOMCEOPATIIIC CONVENTION. third dec. trituration is given the credit of curing a case of croup, in the hand of Geo. N. Parker, M. D. See also report of a fatal case by T. C. Hunter, M. D., of Dunkirk, N. Y. in American Homoeopathic Observer, Vol. X., p. 469. In the Journal of Homoeopathic Clinics, Vol. III., p. 80, Dr. J. Landermann, of Geneva, Switzerland, reports the cure of a case of croup with Kaolin0. The patient, a boy five years of age, had been under allopathic treatment for five days, steadily growing worse; until at last it was proposed to resort to tra- cheotomy, as the only hope of saving the child's life. Dr. Landermann was then called in, gave Bromine31 and after six hours use, finding that it did no good, he gave Kaolin". The second dose relieved, and the next day convalescence followed. Lachesis.-Dr. J. II. P. Frost [American Homoeopathic Review, May, 1865] cured a desperate case with Lachesis8; the principal symptom being " aggravation after sleep." In Hahnemannian Monthly, Vol. VIII., p. 549 a record appears of three cases treated by Dr. II. V. Miller, in which Lachesis was given on the same indication with equal success. See also same Journal, Vol. IX, p., 196. Lime.-The Hahnemannian Monthly, Vol III., p. 90, notices "Lime in membranous croup," by V. IL Tindall, M. D. The case had been given up by an old school physician. The author agreed with the other Doctor, in prognosis; but, as a last resort, put about three ounces of Lime in a mug, poured water upon it, and had the child inhale the vapor. In an hour the child was easier; rejected false membrane and recovered. See also case reported by Dr. W. W. Parker of Richmond, Va. in American Homoeopathic Observer, Vol. X., p. G14. lie says : " The most dense vapor is not at all unpleasant, and can be born as well as the ordinary atmosphere of a heated room.3' In the Transactions of the Central N. Y. Homoeopathic Medical Society, reported in the above Journal, Vol. IX., p. 196, Dr. II. V. Miller adduces a severe case of croup cured by Calcarea carb.200 and Lachesis200. Domestic prescriptions had been previously given without effect. " A large fleshy boy with large head, blue eyes, light hair and complexion, of leuco- CROUP 505 phlegmatic constitution, during dentition had an attack of croup which had continued all night. There was profuse scalp sweat, particularly of the occiput and nape of neck. Each inspiration was hoarse, rough, loud enough to be heard in the street, and difficult, causing the child to cry out with pain. During inhalation, the cheeks and supra-sternal fossa were each time forcibly drawn inward, indicating spasm of the glottis ; the face wore a purplish hue. There was an aggrava- tion of the croupous symptoms invariably after sleeping; hence Calcarea carb, and Lachesis were plainly indicated. But the former remedy was selected to commence the treatment, on account of the strongly marked Calcarea constitution, and the fact that 1 had previously cured the child of dentitional diarrhoea with that remedy." Lactic acid.-The U. S. Medical and Surgical Journal, 1871, Vol. VI., p. 263, says : " The Physician and Pharmaceutist quoting the Medical and Surgical Journal of June 7th., says that A. Weber, of Vienna, has drawn attention to the use of Lactic acid in the treat- ment of croup; as it has the power of dissolving fibrinous exuda- tion. By the use of this remedy, he has not lost a single case. Even in very extreme cases relief was manifest in seven hours after the application of the remedy. Twenty drops of the acid in a drachm of water were administered by inhalation; repeated every two or three hours." Cubebs.-The following appears in the Hahmmannian Monthly, Vol. IL, p. 363, on " Cubebs in croup" by Emil Tietze, M. D. The case detailed was that of a girl aged 5, who had had several previous attacks of croup, one of which was severe, and had been relieved by Iodine and Kali bichrom. The present attack was treated with Iodine, Ilepar and Kali bichrom, but gradually become worse. The symptoms threatened suffoca- tion. Tincture of Cubebs, about 5 dropsin half a teaspoonful of water, was given. " In less than fifteen minntes she became more quiet, breathing less laborious wheezing and sawing." The patient rapidly recovered. The author remarks: " The fact that Cubebs was given so soon after Kali bichrom, may 506 world's .IIOMCEOPATniC CONVENTION. make it doubtful whether to the last given remedy alone belongs the praise." lie himself inclines to the belief that it was the Cubebs that cured the patient. Sempervivum tectorum.-In the U. S. Medical and Sur- gical Journal 1866, Vol. III., p. 200, is found the following: " Treatment of croup with Sempervivum tectorum. Dr Ga- rin, having observed that the peasants arrested epidemics of pseudo-membranous stomatitis, angina and laryngitis, by ma- cerating this herb in their drinks, experimented with it, at first in pseudo-membranous stomatitis; and observed that, under its influence, the false membranes disappeared rapidly, returned again if the use of the drug were prematurely suspended, and finally yielded entirely under its continued exhibition. Dr. G. has applied this treatment to croup, and no other treatment furnished as many cures, i, e. three-fourths of the cases. (Bul- letin General de Therapeutigue, LXXI, p. 328.) Flowers of sulphur.-At page 200, Vol. XI. of the same Journal mention is made of ''Treatment of croup by the flowers of sulphur" : " Dr. Laganterie thinks that he has found a new specific (?) against this fearful disease, in the flowers of sulphur, suspended in water, and given by the teaspoonful every hour. He was led to the use of this remedy, thus: An epidemic of croup broke ont in his vicinity ; twelve children were taken ; twelve died. Then, thinking that the diphtheritic production pre- sented a striking resemblance to the parasite which develops itself upon the grape ; he resolved to try Sulphur for croup, as it acted so well against the oidium. After that, his cases were all cured. The remedy is not new, however, since MM. Duche and Senechall had used the same remedy before, by insufflation, and had given it internally, mixed with honey, as often as possible." (Bulletin General de Therapeutiquei) Sanguinaria-Thos. Nicholl, M. D., of Montreal, Canada, contributes an article in the American Homoeopathic Observer, Vol. VII, pp. 128, 209, on " Pseudo-membranous Croup," in which he says : " Many years ago I encountered a very fatal epidemic of pseudo-membranous croup, against which our usual remedies were not so successful as one could wish; CROUP. 507 while I noted that allopathic remedies were worse than use- less. In my extremity, I. applied myself to the study of Homoeopathic Materia Medica-that monument of unwearied industry-and decided that Sanguinaria can. was an appropri- ate remedy, as it presented the following symptoms : ' Chronic dryness of the throat and sensation of swelling in the larynx, with expectoration of thick mucus. Aphonia, with swelling in the throat; continual severe cough, without expectoration ; pain in the head and circumscribed redness of the cheeks. Tormenting cough with exhaustion and circumscribed redness of the cheeks; croup.' Soon afterwards I was called to an undoubted case of pseudo-membranous croup, and as I had no tincture of Sanguinaria in my office, I gave minute doses of Sanguinaria in water, and the result was a rapid cure. In the course of my studies I read Prof. Paine's 1 Epitome of Eclec- tic Practice,' in which he gives the following testimony to the efficacy of Sanguinaria in this disease : ' The Sanguinaria is one of the most valuable remedies known in the treatment of pseudo-membranous croup. It has proved as much a speci- fic for that disease as Quinine has for ague. I have seen it used in a great number of cases, and have never known a sin- gle failure. It should be made into an acetic syrup, by adding twenty grains of Sanguinaria to four ounces of vinegar, steep, and add one ounce of sugar to form a syrup; dose a teaspoon- ful as often as indicated.' I frequently gave the remedy as Prof. Paine directs, but, finding that the large dose caused an unnecessary aggravation, I reduced the quantity, and for a number of years have used the following formula: Dissolve tw.o grains of the first decimal trituration of Sanguinaria in four teaspoonfuls of good vinegar and two teaspoonfuls of white sugar, adding a little water; of this acetous syrup I give a teaspoonful every hour. I have given the Sanguinaria in trit- urations, but have found better results from the acetous pre- paration. I have also used the tincture successfully, but have had no experience with the dilutions. On page 3>S, of Vol. IV., of the Observer, Prof. Helmuth, of St. Louis, reports a fine cure effected by the tincture; and, on the whole, the blood-root seems destined to take a good position amongst the remedies with which we combat this disease." 508 world's homoeopathic convention. An article headed " Sanguinaria and Kali bich. in Pseudo- membranous Croup," appears in the American Homoeopathic Observer, Vol. VIIL, p. 235. The writer, Dr. E. C. Price, of Baltimore, Md., used the acetous syrup of Sanguinaria with some success, and also had success with Kali bich. The same writer recommends Causticum.-As a specific in catarrhal croup (American Homoeopathic Observer, Vol. X., p. 271) considering the sen- sation of rawness in the throat during cough, a characteristic symptom. Veratrum viride.-In an article in the U. S. Medical and Surgical Journal, Vol. VIIL, p. 295, Dr. W. II. Holcombe says: " In membranous croup, fever generally precedes the local manifestations, and continues all through the disease." Aconite, he thinks, which may be safely used in the beginning, should soon give place to Veratrum vir., which is better adapted to high fevers with accompanying or impending or- ganic lesions. " I use mother tincture, five drops to half a glass of water in teaspoonful doses." Spongia, Ilepar sulph. and Tartar emet.; then Iodine, Bromine or Kali bich, may be given alone or in alternation with Veratrum vir." Iodine he thinks better adapted to croup and Bromine to laryngitis. See also American Homoeopathic Observer, Vol. VIL, p. 413, for a case treated by Dr. C. D. Clawson, Canoga, N. Y. Phytolacca dec..-In American Homoeopathic Observer, Vol. VIL, p. 413, a case of " Croup" is given, treated by Dr. C. D. Clawson, of Canoga, N. Y., in which this remedy was administered. The symptoms were " sore throat, diphtheritic patches covered both tonsils, croup symptoms again present; great oppression of respiration, tight, shrill, ringing cough." Reports of cases in which remedies more commonly used have been employed, will be found in the following jour- nals : Aconitum nap.-Dr. Belcher, North American Journal of Homoeopathy, vol. v., p. 379. Dr. C. Dunham, American Hom. Review, vol. ii., p. 494. CROUP, 509 Dr. P. P. "Wells, American ITom. Review, vol. ii., p. 494. Dr. Small, U. S. Medical and Surgical Journal, vol. vii., p. 14. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii. p. 295. Dr. J. E. Morrison, IT. S. Medical and Surgical Journal, vol. vii., p. 2S2. Dr. II N Guernsey, Halm. Monthly, vol. vii., p. 432. Dr. S. M. Cate, U. S. Journal of Homoeopathy, vol. i., p. 523. Dr. T1ios. Nicolls, American Ilom. Observer, vol. vi., p. 52G. " Anonymous," Philadelphia Journal of Homoeopathy, vol. iii., p. GOO. Dr. Routh, Medical Investigator, vol. viii., p. 269. Dr. O. D. Childs, Medical Investigator, vol. viii., p. 440. Clinical Reports, British Journal of Homoeopathy, vol. v., p. 291. Dr. Ozanne, Monthly 11 om. Review, vol. i., 3G4. Arsenicum alb.-Dr. Belcher, North American Journal of Homoeopathy, vol. v., 379. Dr. Thos. Nicholls, American Hom. Observer, vol. vi., p. 52G. Bromine.-Dr. Ball, North American Journal of Homoeop- athy, vol. ii., p. 388. ' Dr. S. S. Guy, N. American. Journal of Homoeopathy, vol. iii., p. 355. Dr. S. S. Guy, Phila. Journal of Homoeopathy, vol. iijp. 275. Dr. Belcher, N. American Journal of Homoeopathy, vol. v., p. 379. Dr. E. II. Drake, N. American Journal of Homoeopathy, vol. x., p. 296. Dr. C. Dunham, American Hom. Review, vol. ii., p. 494. Dr. J. E. Morrison, U. S. Medical and Surgical Journal, vol. vii., p. 2S2. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii., 295. Dr. II. N. Guernsey, Hahnemann. Monthly, vol. vii., p. 432. Dr. II. C. Preston, Philadelphia Journal of Homoeopathy, vol. i., p. 529. Dr. McKnight, Philadelphia Journal of Homoeopathy, vol. i., p. 529. 510 world's homoeopathic convention. Dr. Routh, Medical Investigator, vol. viii., p. 269. Dr. Henderson, British Journal of Homoeopathy, vol. viii., p. 348. Clinical Reports, British Journal of Homoeopathy, vol. viii., p. 424. Dr. Ozanam, Monthly Hom. Review, vol. i., p. 95. Provings on Animals and Men, Monthly Hom. Review, vol. i., p. 95, et seq. Dr. Patin, Monthly Hom. Review, vol. i., p. 129. Dr. Ozanne, Monthly Hom. Review, vol. i., p. 364. Dr. Ozanne, Monthly Horn. Review, vol. ii., p. 16. Dr. Wyld, Ann. and Trans., British Hom. Society, vol. ii., p. 42. Bromide of Potash.-Dr. Ozanne, Monthly Horn. Review, vol. i., p. 364. B Madonna.-Dr. S. S. Guy, N. American Journal of Hom- oeopathy, vol. iii., p. 355. Dr. O. D. Childs, Medical Investigator, vol. viii., p. 440. Dr. Ozanne, Monthly Ilona. Review, vol. i. p. 364. Bryonia.-Clinical Reports, British Journal of Homoeop- athy, vol. v., p. 291. Baroo veg.-Dr. S. S. Guy, N. American Journal of Hom- oeopathy, vol. iii., p. 355. Cantharldes.-Dr. Belcher, N. American Journal of Hom- oeopathy, vol. v., p. 379. llepar sidph.-Dr. Ball, N. American Journal of Homoeop- athy, vol. ii., p. 388. Dr. S. S. Guy, N. American Journal of Homoeopathy, vol. iii., p. 355. Dr. Belcher, N. American Journal of Homoeopathy, vol. v., p. 379. Dr. Lewis Hallock, N. American Journal of Homoeopathy, vol. v., p. 532. Dr. C. Dunham, American Hom. Review, vol. ii., p. 494. Dr. P. P. Wells, American Hom. Review, vol. ii., p. 494. Dr. J. E. Morrison, U. S. Medical and Surgical Journal, vol. vii., p. 2S2. Dr. Holcombe, IT. S. Medical and Surgical Journal, vol. viii., p. 295. CROUP, 511 Dr. II. N. Guernsey, Hahn. Monthly, vol. vii., p. 432. Dr. S. M. Cate, U. S. Journal of Homoeopathy, vol. i., p. 523. Dr. Thos. Nichols, American Horn. Observer, vol. vi., p. 526, Dr. McKnight, Philadelphia Journal of Homoeopathy, vol. i., p. 529. Anonymous, Philadelphia Journal of Homoeopathy, vol. iii., p. 600. Dr. O. D. Childs, Medical Investigator, vol. viii., p. 440. Clinical Observer, British Journal of Homoeopathy, vol. v., p. 291. Mr. Sharp, British Journal of Homoeopathy, vol. ix., p. 579. Dr. Elbe, British Journal of Homoeopathy, vol. x., p. 393. Dr. Moore, British Journal of Homoeopathy, vol., viii., p. 540. Mr. J. II. Nankivell, British Journal of Homoeopathy, vol. xxi., p. 651. Dr. Ozanne, Monthly Horn. Review, vol. i., p. 95. Ipecacuanha.-Dr. S. M. Cate, U. S. Journal of Homoeop- athy, vol. i., p. 523. lodium.-Dr. L. Hallock, N. American Journal of Hom- oeopathy, vol. v., p. 532. Dr. E. II. Drake, N. American Journal of Homoeopathy, vol. x., p. 296. Dr. Small, U. S. Medical and Surgical Journal, vol. vii., p. 14. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii., p. 295. Dr. Routh, Medical Investigator, vol. viii., p. 269. Clinical Observations, British Journal of Homoeopathy, vol. x., p. 393. Kali bich.-Dr. Belcher, N. American Journal of Hom- oeopathy, vol. v., p. 379. Dr. E. II. Drake, N. American Journal of Homoeopathy, vol. x., p. 296. Dr. Small, IT. S. Medical and Surgical Journal, vol. vi., p. 330. Ibid., vol. vii., p. 14. Dr. J. E. Morrison, U. S. Medical and Surgical Journal, vol. vii., p. 282. 512 world's homoeopathic coxvention. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii., p. 295. Dr. S. M. Cate, U. S. Journal of Homoeopathy, vol. i., p. 523. Dr. Routh, Medical Investigator, vol. viii., p. 269. M^rcur. prutiod.-Dr. Ball, North American Journal of Homoeopathy, vol. ii., p. 388. Dr. Belcher, N. American Journal of Homoeopathy, vol. v., p. 379. Dr. Clauson, American Hom. Observer, vol. viii., p. 413. Mercur sol.-Dr. S. S. Guy, N. American Journal of Hom- oeopathy, vol. iii., p. 355. Dr. Ozanne, Monthly Hom. Review, vol. i., p. 364. Jdho.phorus.-Dr. Ball, N. American Journal of Homoeop- athy, vol. ii., p. 388. Dr. S. S. Guy, N. American Journal of Homoeopathy, vol. iii., p. 355. Dr. Lewis Hallock, N. American Journal of Homoeopathy, vol. v., p. 532. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii., p. 295. Dr. Thos. Nicholls, American Hom. Observer, vol. vi., p. 526. " Anonymous," Philadelphia Journal of Homoeopathy, vol. iii., p. 600. Clinical Reports, British Journal of Homoeopathy, vol. v., p. 291. Svonqia.-Dr. Ball, N. American Journal of Homoeopathy, vol. ii., p. 388. Dr. Belcher, N. American Journal of Homoeopathy, vol. v., p. 379. Dr. C. Dunham, American Ilom. Review, vol. ii., p. 494. Dr. P. P. Wells, American Hom. Review, vol. ii., p. 494. Dr. J. E. Morrison, U. S. Medical and Surgical Journal, vol. vii., p. 282. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii., p. 295. Dr. S. M. Cate, U. S. Journal of Homoeopathy, vol. i., p. 523. CROUP. 513 Dr. Thos. Nichols, American Horn. Observer, vol. vi., p. 526, Dr. II. C. Preston, Philadelphia Journal of Homoeopathy, vol. i., p. 529. Dr. S. S. Guy, Phila. Journal of Homoeopathy, vol. ii.,p. 275. Clinical Observ., British Journal of Homoeopathy, vol. v., p. 291. Dr. Ozanne, Monthly Hom. Review, vol. i., p. 364. Mr. Sharp, British Journal of Homoeopathy, vol. ix., p. 579. Dr. Elbe, British Journal of Homoeopathy, vol. x., p. 393. Dr. McKnight, Philadelphia Journal of Homoeopathy, vol. i., p. 529. Sambucus n.-Dr. S. S. Guy, N. American Journal of Hom- oeopathy, vol. iii., p. 355. Dr. Tlios. Nicolls, American Hom. Observer, vol. vi., p. 526. Tartar, emet.-Dr. Belcher, N. American Journal of Hom- oeopathy, vol. v., p. 379. Dr. Holcombe, U. S. Medical and Surgical Journal, vol. viii. p. 295. Anonymous, Philadelphia Journal of Homoeopathy, vol. iii., p. 600. Clinical Reports, British Journal of Homoeopathy, vol. v., p. 271. Dr. Ozanne, Monthly Hom. Review, vol. i., p. 364. Dr. Moore, Monthly Hom. Review, vol. viii., p. 540. Dr. S. M. Cate, U. S. Journal of Homoeopathy, vol. i., p. 523. DIPHTHERIA. Ad. Lippe, M. D., Philadelphia. History.-Bretonneau was tlie first modern writer to give, in 1821, this form of Angina the name " Diphtheritis," because of its essential characteristic-the exudation. He thought to prove that the disease was known to Homer and Hippocrates under the name of Malum yEgyptiacum ; and Aretaeus, at the beginning of the second century after Christ, gives a most characteristic description of the Malum yEgyptiacum. Forest wrote an account of the breaking out of the disease in Hol- land, in 1557, spreading thence over the whole continent of Europe, and also appearing in England. According to the various descriptions of the different writers, the disease at times appeared as an epidemic by itself, and again in combina- tion with other diseases; as, for instance, scarlet fever. Virchow tried to show that diphtheria and croup were entirely heterogeneous processes; Buhl was of opinion that the disease in the throat and air-passages was not an originally localized affection, but was only the indication of a general infection. Later, Hueter and Oertel simultaneously discovered that the diphtheritic membranes, the adjacent diseased parts and even the blood, contained in great numbers vegetable organisms or bacteria, by Oertel called Micrococci. Etiology.-Diphtheria is a general infectious disease which secondarily makes its first local appearance upon the mucous membranes of the throat and the air-passages. The opinion has been held, and is still held by many eminent men, that the disease begins by an infection, as a local disease, and at an 515 516 world's homoeopathic convention. indefinite time becomes general. If this opinion were correct, the effort to conquer the disease by destroying the diphtheritic product on the mucous membranes, by means of thorough cauterizations, would have been followed by good results. The positive failure, however, to eradicate the disease by this means is ample proof that such an opinion is erroneous. The local appearance of the disease, consisting in the characteristic diphtheritic deposits upon the mucous membrane of the throat and air-passages, is only a manifestation of the general disease. Its origin is due to a miasm; its occurrence is sporadic and epidemic; in certain localities and under favorable conditions it becomes an endemic disease. It is induced by contact with objects and persons infected with diphtheria. Hence, diphtheria is to be considered a miasmatic, contagious disease. The contagion of diphtheria may be carried through the air, or by solid matters to which it has attached itself. The viru- lence with which the disease attacks various individuals ex- posed to the contagion depends entirely on the susceptibility of the individual. The disease is most frequently developed in children up to the tenth year of life, seldom attacking prior to the first year; infants, up to the sixth month, are almost free from the sus- ceptibility to the disease. The greatest mortality occurs in the second, third and fourth years. Adults acquire the disease easily, but it does not commonly appear in so severe a form with them as with children. The vegetable parasites which penetrate the tissues or appear in the false membranes in the mouth and fauces or in those of the nose and deeper air-passages, have been divided into four genera with one or more species: 1. Sphrnrobacteria (spherical bacteria), i. e., micrococcus ; 2. Microbacteria (rod-like bacteria), bacterium termo: less frequently and only in the mouth and fauces, bacterium lineola; 3. Spirobacteria (corkscrew-shaped bacteria), spirillum tenue, spirillum undula; 4. Unclassified forms: a. Larger cocci with sprouting cells; DIPHTHERIA. 517 b. Cocci with tube-shaped processes, sprouting conidia ; c. Cocci with one or two small waving processes. There can be no diphtheria without micrococci. Period of Incubation.-This is somewhat limited by the amount of the poisonous infecting material itself, and the sus- ceptibility of the individual. The action of this matter begins as soon as it comes in con- tact with the tissues. The stage of incubation is generally very short, being from two to three days, seldom lasting as long as the eighth day and rarely ever till the twelfth day. Pathology.-The first symptoms are great debility, fever, and the characteristic diphtheritic deposits. These deposits may first show themselves on either of the tonsils, or on the posterior wall of the pharynx, or on the arches of the palate. Sometimes swelling of the cervical and submaxillary glands occurs. The progress of the disease is manifested by an increased fetor of the breath; by an extension of the diph- theritic deposits over the buccal cavity, or downwards into the larynx, trachea and bronchi; by an extension upwards through the posterior nares into the nose, or into the eustachian tube and middle 'ear. The swelling of the cervical and submaxil- lary glands increases with the development of the disease. Unfavorable symptoms, which may appear while the diphthe- ritic deposits are spreading, are: Diminution of (albuminous) urine or an entire suppression of urinary secretion ; great rest- lessness and the wildest tossing about, followed by heavy stupor, out of which the patient (child) awakens with suffoca- tive attacks. Temperature of the body rises to 103° to 104° Fahr. The fever all the while increases, the pulse becomes smaller and harder, or intermittent, or becomes slower. If the disease has resulted from severe infection, the patient dies, usually from the fifth to the seventh day, with symptoms of rapid poisoning of the system, from oedema of the lungs from paralysis of the heart, or from haemorrhages. Termination in Recovery.-There is a cessation of further formation of diphtheritic deposits, the different false mem- branes become gradually more sharply bounded, and their edges stand more prominent above the surface of the mucous 518 world's iiomieopatiiic convention. membrane. At the same time, the swelling of the mucous membrane diminishes ; the false membrane separates in small portions from its base, or peels off in large patches and the loosened membranes are thrown off by the patient's efforts to cough or to clear the throat. The flow of fluids from the mouth ceases, there is diminution of the glandular swellings, the diminished temperature of the body rises again, the expression of the patient's countenance improves, and the eyes become brighter. Diagnosis.-As every form of disease must have some few characteristic symptoms, by which we may discern it from all other forms of disease, in diphtheria we find, as characteristics, the great weakness, the small, hard and frequent pulse and the diphtheritic effusions with their peculiar fetid odor. The accompanying symptoms and variations are just as many as there are various constitutions and various peculiari- ties of various persons. It is to these characteristic individual symptoms we must look in determining the Treatment.-The knowledge that a person is attacked by diphtheria, and that the disease is really present, at once requires us to give directions, concerning the general regime to be observed in the case. AVe should remember the peculiar characteristic condition of the patient, in directing the regimen, the proper application of which will, in some cases, require all our ingenuity. It is well to observe the following rules. The patient must be kept in bed with some covering, but no more than is agreeable to him or than the season may require; he must be kept as tranquil and quiet as possible. lie may have as much water or milk to drink as he desires, and if he can take nourishment it is well for him to have all he wishes. Never force a patient to take food. Food taken against the inclination will not be digested, and is only a hindrance to the recovery. The vital forces, so necessary to combat the disease, become employed in disposing of the substances forced upon the stomach and which are really lying there, a foreign body, undigested. The most important, and at times quite a difficult, task is the ventilation of the sick room. All so-called disinfecting agents, with the exception of DIPHTHERIA. 519 charcoal, must be banished from the apartment. The patient requires the freshest obtainable air, and all disinfecting agents, charcoal excepted, communicate their qualities to the air to be inhaled by the sick; the most dangerous of these agents is Carbolic acid. After the patient has been properly cared for, our first duty is to find and collect all his symptoms, both mental and physical, local and concomitant. As Ilomoeopa- thicians we never treat a disease as a disease only, but we treat the patient; and we regard as leading symptoms such as peculiarly belong to the case in hand. If it be a case of diph- theria, we begin with the mental symptoms, then take up the local affection of this or the other part of the throat, find out the quality and quantity of the secretions and the excretions, especially the urine,-in fact there can be no better advice given how to examine the sick than we find in Hahnemann! s Organon §84-99. Having obtained, a full record of the patient's symptoms, we must endeavour to find a remedy that not merely corresponds with the characteristic symptoms of diphtheria, but that corresponds with the symptoms of the individual patient as we find them. The same range of re- medies which were useful one year may not be of any use another year, during a similar epidemic. This is so because the epidemics continually change their character ; are different in different localities and at different seasons, as well as in different individuals. Recurring combinations of symptoms frequently occur, and when they do reappear, the same remedy may be given. Nor can we forget that, in the .course of our observation, cases will occur unlike any previous cases. When we thus meet with a combination of symptoms, not known to have appeared before in an epidemic or in an attack of diphtheria, there is no precedent to guide us. We must in such circumstances look to our Hateria Medica for aid, and faithfully search for the similar. It is now my intention to give such groups of symptoms as clinical observation in the treatment of this dreaded disease has repeatedly confirmed. Apis met.-The first diphtheritic patches generally appear on the arches of the palate and on the uvula. The uvula is oedematous and elongated; the urinary secretions are entirely 520 world's homceopathic convention. suppressed, or there is excessive albuminous urine; degluti- tion is very painful; heat is very unpleasant to the patient. Great restlessness with an uncontrolable tossing about and trying to get off the bed. This form is frequently found in combination with scarlet fever. Arum triph.-The discharges from the nose and mouth are very acrid and excoriate the skin wherever they come in contact with it. The lips become ve?y sore and swollen and the skin peels off; the patient continually picks at these peel- ings, trying to pull them off, and thereby makes the lips bleed. Drink is refused on account of the great soreness of the mouth ; the breath is very fetid and the cavity of the mouth is covered with diphtheritic deposits and ulcers. There is very great restlessness, the patient crying and throwing himself into all sorts of positions. Arsenicum alb.-When the advanced septic form appears. Great fetor from the diphtheritic deposits and oozing of blood from under the elevated portions of the thickened deposits. Great thirst; inclination to be warmly covered. Restlessness; although very weak, the patient desires to have his position, and even the bed or room, frequently changed. Belladonna.-The patient complains, from the onset, of much dryness in the throat and great pain on swallowing. The glands of the neck swell at once, the throat looks red, the neck becomes stiff. The patient is very drowsy, his head is hot and painful. Under such circumstances the disease may be entirely prevented from further development, even though there be diphtheritic cases in the same house. Capsicum.- Throat smarts as from cayenne pepper; diph- theritic deposits cov,er a considerable portion of the fauces. There is a sensation of constriction accompanied by soreness on swallowing. Kali bich.-The patient is in an almost unconscious condi- tion ; when aroused from it or when awaking from apparent sleep he complains most, or feels worse (same as Lachesis). Ue often awakens with a desire to cough, or to hawk up de- tached portions of the diphtheritic depos t ; whi'e making this attempt he throws off tough, ropy, yellow, discolored mucus. DIPHTHERIA. 521 The fetor is very great; the deposits cover the throat, uvula, tonsils and even roof of the mouth, and are of yellow-greyish color. The patient becomes hoarse, indicating the extension of the disease into the larynx and air-passages. The tongue is either quite red, or is covered with a thick, yellow substance. The (right) parotid gland is much smaller and, upon degluti- tion, the pain shoots up to the ear and down the neck of the affected side. Kali bich. will correspond to the form of disease in which the vegetable parasite found in the diphtheritic deposit resem- bles the Spirobacteria. Lachesis.-The diphtheritic deposits first show themselves on the left tonsil, from there extending to the right side, and then spreading further. The neck is stiff, or the external throat sore and quite tender to the touch. The patient coughs, and feels worse, when awakening from sleep; expectoration very difficult and scanty. Great loquacity is only kept in check by the hoarseness. Lycopodium.-The diphtheritic deposits begin on the riylit tonsil and from there extend further. Swelling of all the glands of the neck ; perfect stupor; diminished secretion of urine. Grinding of teeth f s well during the heavy stupor, as when fully awake. Nercurius iod.-The diphtheritic deposits begin on the arches of the palate; glands of the neck swell very rapidly; there is a general condition of oedema of the throat and neck. Nitric acid.-Much pain when swallowing; stoppage of the nose with discharge of acrid fluid and hoarseness. There may be cases in which Phytolacca or Mercurius cyan, or Lac caninum or Sulphur or Hepgr or Bromine or Natrum mur., or Carbolic acid, or almost any remedy may be indicated. After finding the similar remedy, the question arises of how to apply it properly, in a way to insure success ? If we are governed by the well established principles belonging to our school, we shall of course administer but one remedy at a time; and this remedy, the most similar, in a dose just sufficient to cure, in the minimum dose. Never repeat the dose or give 522 world's homceopathic convention. another remedy, till the effect of the dose administered has been exhausted. It must be left to the individual judgment and opinion of the practitioner what dose is best suited for each individual case, whether it is best to give but a single dose, or to dissolve the dose in w'ater and administer it comparatively often. So must it be left to the individual judgment of the practitioner whether to give a low or a high or the highest potencies in a given case; and his judgments and opinions must be based on the known principles belonging to our School, and on his own experience. ANGINA PECTORIS-A SYMPTOM. E. B. de Gersdorff, M. D., Boston, Mass. The development of " cellular pathology" has supplanted the ontological view of disease. According to the modern theory, each case of disease represents simply the presence of one or more cells at a wrong time in a wrong part of the organism. From this change of theory we might reasonably have expected a new classification and a better nomenclature of diseases. Most of the old names however are retained ; and with but few exceptions a single symptom, not always the leading one, gives name to a collection of only partially understood phe- nomena. The master mind which, 80 years ago, cut the gordian knot of confusing names and arbitrary diagnoses by laying down the practical rule: " consider the totality of the symp- toms as identical with the pathological case in hand," would find at the present day the same work of reform to be done. We have still in pathology excessive generalization and a vain groping in the dark for an impossible diagnosis. Humoral and solid, neuro-and cellular pathology have succeeded each other; but neither morbid anatomy nor microscopy nor chemical analysis of the products of disease has brought to light disease itself; the only result has been new symptoms expressed in a new language. Every practitioner of experience can recall cases, the main symptom of which, somewhat differently described in each case, has been what is called angina pectoris. He will also 523 524 world's homceopathic convention. remember that the co-existing symptoms were very different in the different cases. " Angina pectoris," an anomalons spasmodic affection of the chest, involving respiration as well as circulation, means anguish as well as oppression and is a symptom of neurosis as well as of organic lesion. The many names proposed for it show how different are the clinical history and the anatomical lesions of different cases. It has been called " asthma convul- sivum or doloriferum " or " cardiodynia; " gout of the dia- phragm or arthritic asthma; syncope anginosa; sternalgia; neuralgia cordis; sterno-cardia, pneumo-gastralgia. Some class it among the neuroses of the heart and chest, others affirm that it never occurs except when organic lesions are present, such as valvular disease, fatty degeneration of the heart, hypertrophy, atheroma or ossification of the coronary artery. Its origin is variously assumed to be the phrenic nerve, the vagus and sympathetic or the vaso-motor ganglia. But under all these various theories it remains a symptom only, very distressing but rarely fatal. The neuro-pathologists, deducing their views from physiolo- gical experiments such as vivisections, assume the following types: 1. Angina pectoris cardio-centralis or gangliosa, with either quickened pulse or completely paralyzed action of the heart. 2. Angina pectoris regulatorica as a disease of the vagus with disturbed rhythm of the heart's action and of respiration. 3. Angina pectoris sympathetica as a lesion of the sympathetic. 4. Angina pectoris vaso-motoria caused by an affection of the vaso-motor nerves; a type acknowledged by some and denied by others. These four types of angina pectoris, or rather these four affections each of which has angina pectoris as a symptom, represent different neuroses. It is evident that pathological anatomy cannot contribute much to our knowledge of neu- roses ; for which we must depend chiefly upon physiological experiments. We willingly admit that angina pectoris is a frequent symptom of neurosis of the chest ; but we cannot ignore the great number of facts furnished by pathological anatomists and which show that this affection coincides with ANGINA PECTORIS. 525 various organic diseases of the heart, aorta and their surround- ings, although not confined to any one form of lesion. We have nothing new to add to the description of angina pectoris. It is a paroxysmal, irregular pain or di tress extend- ing from the sternum toward the left side and arm. The heart's action is disturbed but not in proportion to the severity of the pain, the pulsations are irregular, violent, tremulous or feeble. Dyspnoea is sometimes present but not always ; some- times the patients groan and move about, at others they are afraid to speak or move ; sometimes there is a sense of numb- ness in the parts affected, at others the pain is so sharp that the patient is afraid to make the slightest movement even for the purpose of breathing. The patients are generally apprehensive with, sometimes, " a sense of impending death; " but in some cases this is not observed. Cases differ greatly as regards the severity, duration and fatality of the attack and its frequency of recurrence. The attacks may last from a few moments to several hours. When of a neurotic origin they are rarely fatal. The more cases we read of and observe, the more satisfied shall we become that angina pectoris is a rather infrequent symptom attending a variety of affections of the heart, organic as well as neurotic. Moreover it is a symptom which may be produced by violent emotion, such as grief, fear, anger, and is sometimes a concomitant of what is called " broken heart," in which no lesion can be found after death. During a practice of thirty years, many cases have come under my observation, which deserved more or less justly, the name of " Angina pectoris," whether this name be held to designate a definite disease or merely a symptom of some dis- ease or other. Some of these cases yielded to treatment, the patient remaining exempt from paroxysms for years ; of others I lost sight; in some fatal cases, no autopsy was made; but three fatal cases presented, during life, striking symptoms of angina pectoris, and the autopsy proved that death was due to very different lesions in the three cases. The first case was that of a boy, aged eight years, who was said to have had rheumatic fever two years before I was 526 world's homoeopathic convention. called to him, and to have been, since that illness, feeble and pale if not cyanotic, quiet, not disposed to exercise or active play. When first called to him, I found him feverish, with intercurrent chills. The fever abated within a day or two, but an occasional sudden pain in the region of the heart, streaming towards the left side and arm, with increased frequency (though not strength) of pulse, came in paroxysms, preventing speech, and ceasing as suddenly as it came, These attacks of pain were repeated several times a day during four or five days; meanwhile another, more steady, pleuritic pain on the left side near the seventh rib, had appeared ; and symptoms of pleuritic effusion wrere soon recognised, the level of the effusion being about the apex of the heart. The heart's sounds, though w*eak, were about normal. The episode of angina pectoris passed over without further manifestations. The effusion de- creased for a few days, but a dull percussion sound above the diaphragm remained ; and I perceived symptoms of dyspnoea, denoting an oedematous state of the left lung; the fever be- came remittent or hectic ; pyaemic symptoms were evident; the urine was scanty and concentrated. General restlessness and inability to lie on the back or sides were the main symp- toms, with absence of pain. There was no abnormal elevation of the chest or protrusion of the cardiac region, to justify the suspicion of pericarditis or hydropericardium. The patient sank rapidly and died on the twenty-fourth day from the first chill, having coughed up some blood and pus the night before his death. The autopsy revealed an abscess on the left pleura, resulting from the effusion near the heart, between the diaphragm and lower surface of left lung, which had just begun to perforate the lunfj and to create some local inflammation. On examining the heart, I found I could not separate the pericardium at any point from the heart itself. It was firmly adherent, or rather seemed to be obsolete; for the heart showed no organic changes except a more than usually dense outer covering and an un- common absence of fat. I ascribed this adhesion of the peri- cardium to the rheumatic fever which had occurred two years before I was called, and which probably, left this adhesion and ANGINA PECTOKIS. 527 a weakened heart. I am inclined to believe that, even in this young subject, this pathological condition of the heart pro- duced the temporary symptom of angina pectoris. The second case occurred in a sea captain, aged 50 years, of originally strong constitution, who had had various "fevers" in different parts of the world. The most severe of these was of a rheumatic character, in Sumatra. lie could give no more exact account of it, than that his greatest suffering had been in the region of the heart. This man was sometimes a hard drinker, sometimes very temperate; he was an irregular and often an immoderate eater. Ever since the violent fever above mentioned, he had had, two or three times a year, generally after an excess in eating or drinking, great distress in the re- gion of the heart, causing him to moan and to wish that he could " tear his chest open." It lasted twenty to thirty mi- nutes, and ceased suddenly; his pulse meanwhile was quick and small; the heart's action not irregular, sounds not ab- normal. During one such attack, while on a voyage, he had a sudden cataleptic fit, during which he fell ten feet into the hold of his vessel. Though stunned by the fall he seemed to have re- ceived no definite injury. The attacks of angina pectoris continued to recur, implicating however the respiratory organs, and resembling a severe and painful asthma. In this way he lived several years under various courses of treatment and regimen, sometimes using much stimulant daily, and at other times strictly abstaining. Two years after the fit above described, while at sea, he had another, and then I was first called to see him. It was evident that he was suffer- ing from apoplexia cerebri sanguinea. He had rallied some- what from the deepest stupor, but was slightly paralyzed ; had lost the use of his right arm, and had difficulty in speech and deglutition. These symptoms yielded, but he did not gain strength; I soon found there was much pus and albumen in his urine. After a few months, anasarca occurred first in the lower extremities, then general dropsy set in, finally the thor- acic cavity began to fill. It seemed remarkable, until the post mortem explained it, that the heart's sounds were not muffled, 528 world's iiomceopathic convention. and that the dropsy seemed to avoid the pericardium. About every six weeks he had an attack of angina pectoris less severe than formerly, and not followed by apoplectic symptoms. I ought to say that, when the dropsical symptoms had become severe, the friends caused an allopathic physician to be called, without consulting me, who, in concurrence with other col- leagues, diagnosticating "Bright's disease," instituted a corre- sponding mode of treatment. This, however, did not satisfy the patient, who called me in again, during one of his "heart- spasms." To my satisfaction and astonishment, after six months of treatment, the dropsy disappeared, the urine became normal, appetite and power to sleep returned ; the patient could lie down at times, but continued very feeble. lie enjoyed his food so much that he was led to his old habit of over-eating, which proved fatal. After a large sup- per he had another attack of apoplexy, from which he never rallied into consciousness, but died in three or four days. I made the autopsy in the presence of my allopathic colleague. The kidneys were entirely normal, only somewhat pale and flabby. The brain was much congested, showing three dis- tinct traces of former clots and a large, fresh, dark coagulum in the left hemisphere. On examining the heart, no peri- cardium could be found ; at least, if there had ever been one, it had become adherent to the heart, which was slightly hyper- trophied, but without valvular lesions. But little water in the thoracic cavity. Lungs normal. I concluded that the angina resulted from a severe pericar- ditis, which had caused entire adhesion of the pericardium, during the rheumatic fever in Sumatra. The apoplexy was probably a secondary result of the crippled state of the heart, aided by the patient's intemperate habits. The kidney-disease was temporary and functional, resulting from pressure on the brain, and therefore the dropsy disap- peared and the urine became normal as soon as the kidneys resumed their function. The third case, a lady, aged 45 years, was thrown from a carriage and injured in the left leg, necessitating amputation ANGINA PECTORIS. 529 below the knee. She received, also, a violent blow across the forehead and nose, which stunned her, but she apparently re- covered from the effect of it. Since this accident, she had, from time to time, severe attacks of pain, varying in charac- ter and locality, but generally concentrated in the region of the heart, with inability to speak and great dyspnoea, lasting twen- ty to thirty minutes, and leaving great prostration. For several years she suffered much and often from these attacks of angina pectoris and from too much treatment. I was called to her during a violent attack. Here I thought I should have a chance to trace this phantom disease to its source, but I was disappointed. The attacks were violent, character- istic and very distressing, sometimes alternating with violent headache, which always yielded to Glonoine, while the heart- symptoms were controlled by Spigelia more than by any other remedy. At this juncture, she was suddenly seized with bleed- ing from the lungs ; not the slightest cough ; pulse quick and small. The bleeding lasted three days, yielding to Phosphorus, and during this time there was neither head- nor heartache. From that time there was no angina pectoris, only occasional palpitation. In her fiftieth year she had an apoplectic seizure, followed by paralysis of the left arm, and preceded by violent headache. She rallied, retaining slight symptoms of aphasia. In her fif- ty-first year, she had another attack of haemoptysis, lasting four days, and leaving her weak but free from pain ; and, about three months later, violent headache with stupor, ending in apoplexy, from which she did not rally. The autopsy showed the lungs to be entirely sound ; heart not hypertrophied, valves normal, coronary artery slightly ossified in one small spot ; no trace of fatty degeneration. In the brain was one clot, partially absorbed and changed into pus or fatty substance and one large fresh coagulum ; both in the right hemisphere, mostly in the grey substance. Queries.-Did the angina here indicate a tendency to apo- plexia cerebri ? Why did it never appear again after the first apoplexy ? Were all the various affections and lesions produced by the shock of the fall and the subsequent amputation of a large 530 world's homoeopathic convention. limb? Finally, what caused the hemoptysis and what the apo- plectic attack ? Might a common cause be assumed in the pre- sence of emboli ? The treatment, in these cases, was not based on a precon- ceived diagnosis ; but was expectant, symptomatic, palliative and always homoeopathic. I think I may count on the sup- port and approval of my hommopathic readers, when I affirm that not only angina pectoris, but, in a practical sense, all dis- eases, are to us nothing but symptoms or collections of symp- toms ; but I trust I have also the assent of the diagnostician and pathologist when I also assert that angina pectoris is not a disease per 8e forming a centre around which many symp- toms gather; but that it is to be regarded as a symptom com- mon to many heterogeneous affections of the organism. MODIFYING INFLUENCE OF EPIDEMICS ON THERAPEUTICS. PART I., By A. W. Woodward, M. D., Chicago. With our present imperfect facilities for studying the Ma- teria Medica, few practising physicians have time to find the similimum for fifty patients per diem. If this be so, then some aid is wanting to facilitate the practical use of our doctrine. The ponderous size of our Materia Medica, if no other reason, causes it to be neglected save in some great extremity even by men of talent, industry and enthusiasm.. They feel unequal to the mental effort requisite to read its provings un- derstandingly, and from its necessarily encyclopaedic character, it becomes to many a work of reference rather than a chart for daily use. To meet this urgent demand for some quick method of choosing the remedy, many planshave been tried. The Materia Medica lias been condensed and epitomized until the provings are much distorted ; " the characteristics " have been labo- riously collected, but are nearly useless. Various Repertories and Guides to practice exist, all of which fail to adapt the remedy to the entire case. If these means fail how is the busy physician to apply the law of Similia in the majority of cases at the bedside? Is the difficulty insurmountable, and must we abandon the attempt save in few chronic cases ? Surely not! The remarkable results we sometimes attain, are a promise of greater and more fre- 531 532 world's homceopathic convention. quent victories in the future, if we can once discover a ready rule of practice ; so that the unabridged Materia Medica may be needful only for reference. If we can find a law by which an occasional search for a typical remedy will suffice for more than one half of our cases, then we shall feel more courage to study the Materia Medica; our difficulties will diminish, and we shall enter upon a new era of success. Now, is it not possible that, by studying more closely the prevailing disease forms, their peculiarities and variations from season to season, we may be better able to choose the remedy than by the endeavor to find the similimum in every individual case ? If we should analyze the prevailing diseases in the same manner that we make a diagnosis, i. e. by a process of exclusion, we should find that, though differing in their symp- toms, they would require a very limited number of re- medies, and that exceptional treatment would be required in exceptional cases only. If we all resided under as constant and powerful a toxic cause as is malaria in some sections within the tropics, we might find the practice of medicine an easier task, because the fevers and phlegmasiae in those situations show little variation from year to year; the treatment, once proved successful, needs little variation either on account of subject or season ; the remedies called for years ago are still actively in demand; and, in extremely malarial regions, all schools of practice, our own included, find themselves obliged, sooner or later to resort to Cinchona. In pronouncing this drug to be a specific for swamp ague, Hahnemann recognised an overwhelming telluric cause. This cause, operating upon and modifying other dis- eases in the same locality, produces a condition that may be labelled Cinchona, whatever name be given to the disease. As we approach Northern latitudes, malaria loses its intensity, and we find proportionately greater variations in disease forms. Intermittents, remittents and typhoids no longer present changeless characteristics ; but vary, from season to season, so as to oblige us to make corresponding changes of remedies. As we pass outside of malarial influences, if we do not run into another poison centre, we may find that the aerial or INFLUENCE OF EPIDEMICS. 533 epidemic influences become equally potent in shaping the forms of disease. The master-mind which recognised the invariable conditions calling for Cinchona also perceived that the cause of cholera was equally overpowering and controlling, and that the conditions thence arising would as surely demand Ar- senicum, Veratrum, Cuprum and Camphor. Now if we are correct in assuming that Quinine (Cinchona) is specific against marsh malaria, in all seasons and conditions of atmosphere ; and that the remedies indicated by Hahne- mann are still the nearest specifics for cholera; two conclu- sions would seem inevitable, viz: 1. That telluric influences, if controlling^ are invariable; and demand a very limited class of remedies grouped around the one remedy which the con- trolling influence calls for. 2. That aerial influences, powerful enough to produce a world-wide epidemic, also demand a very limited class of remedies to meet every form of disease occur- ring during their prevalence. In either case there is but one cause, variously manifested. These conclusions appear to me of wide significance; and I even venture to think that they furnish the key note for practice, at all times and under all circumstances. I think it is provable, that when the mass of people do not live under the controlling influence of malaria, they are subject to atmospheric (epidemic) influence; and that these influences or forces, recip rocally modify the forms of disease. During the past winter (1875-6) I was called to attend two children in one family, ill with scarlet fever. They were of scrofulous habit and bore a remarkable physical resemblance. The eldest sickened first; and although the effects of an epi- demic remedy (Ammon, carb.) had been quite satisfactory in all forms of disease, I decided in this case to give Mercurius. After a seeming improvement, there occurred Bright's disease, by which 1 nearly lost my patient: and as this was the only case so endangered that I saw during the season, I attribute the result to tJie Mercury. The sister, presenting, apparently, the same symptoms, was treated throughout with the "epi- demic" remedy, and recovered in five days. The idea of an epidemic remedy is not new ; but that of an 534 world's homceopathic convention. epidemic influence constantly prevailing, was presented, I think, for the first time by v. Grauvogl in his Text book of Homoeopathy. But even v. Grauvogl doesnot emphasize the fact that an epidemic may modify different diseases, without specially showing itself in a distinct form. As illustrating the value of the true epidemic remedy (page 296 et seq^ he cites an epidemic of pneumonia, treated altogether by venesection and Saltpetre. When the physician was summoned within the first two days, the cure was effected in from 5 to 7 days; when treatment was delayed for a week, the patients took 14 days to recover. In 58 serious cases, but two deaths occurred. In a similar epidemic in 1847-8, every patient being treated with Acetate of Iron, two deaths in 37 (all serious) occurred: duration of illness, 5 to 7 days. Again, from 1848-1850, out of 93 cases of pneumonia, many with typhoid complications, treated with Cuprum, but four deaths occurred; duration of illness, 3 to 4 in most, 9 days in the worst cases. An epidemic of measles is next cited (p. 324 et seq^ in which Aconite proved specific even for dropsical sequelae. At page 288, Argent nitr., it is said, was for two years the remedy for all cases of typhus ; of which v. Granvogl lost but three out of thirty-nine severe cases. In explaining this singular treatment and its surprising results, v. Grauvogl advances views similar to those of Rade- macher ; maintaining the influence of epidemic conditions in so modifying the bodily states of enfeebled subjects that the symptoms at one season shall be hydrogenoid, at another carbo-nitrogenoid; the normal bodily constitution being res- tored after a longer or shorter season. As bearing favorably on this doctrine, I may mention that about ten years ago there prevailed in some of the Western States an intractable form of herpes palmaris and facialis, which demanded the most active carbo-nitrogenoid remedies, such as Sulphur and Mer- curius. Since that time the same patients have exhibited a radically changed constitution, and have become strongly hy- drogenoid, requiring that class of remedies whatever be their ailments. Admitting this radical physiological change, the proof of which is in the fact that we no longer see destructive INFLUENCE OF EPIDEMICS. 535 effects by ulceration ; it follows that the symptoms, in their entirety, must call for entirely different remedies. In December, 1874, in an aggravated case of phlegmasia alba dolens, that was not improving, my patient asked leave to use common Hartshorn liniment. Permission, with due cau- tion, was given, and, much to my surprise, the pains were re- lieved as by magic, and a cure speedily followed. No symp- toms of poisoning appeared. On studying the drug anew, I found many Ammonia symptoms, not only in the present con- dition of the case, but in its history before and after confine- ment. About this time I had an unusual number of cases of lumbago, with acute wandering pains, or very aggravating ca- tarrhal symptoms. Other remedies failing, Ammonia in some form was given, with prompt recovery from all complaints. Encouraged by this success, either the Carbonate or Muriate of ammonia was given in every acute disease that presented itself, and in more than half of them prompt cures followed. Cases usually requiring from five to seven days' treatment, now occupied but three to five days. For more than twelve months past Ammon, mur. has proved the noblest of polychrests. By its use, wfinter colds have yielded to twenty-four hours of treatment; and tonsillitis, laryn- gitis and pneumonia have been speedily cnred. Delayed erup- tions of scarlet fever and measles have promptly appeared, and convalescence rapidly followed. It has also proved useful in pleurodynia, gastralgia and en- teralgia; and catarrhs, not only of the air-passages, but also of the stomach and bowels have been subdued. It has served me wTell in controlling sudden venous congestions, however severe, whether of the brain, simulating typhus, or of the lungs and heart, promising speedy death. One characteristic in every case was a disposition to an unusual change of symp- toms, somewhat as in wandering rheumatism; another w'as a moderate fever often alternating with slight chills, or perspi- ration that relieved the pains. This remedy has worked bet- ter than Aconite in relieving fever and producing diaphoresis. It has removed dangerous congestions, soothed pain and brought sleep, better than Bellad. or Opium. It has served 536 world's homceopathic convention. better in dysmenorrhoea than any other remedy during this time, and in parturition it lias promoted labor pains and con- trolled haemorrhage better than Pulsatilla or Secale. As a rule, Ammon, mur. proved itself a function remedy, par ex- cellence^ and, if used in the commencement of morbid pro- cesses, it was all controlling; when these had advanced to structural changes, some form of Kali or Natrum seemed to work better than such remedies as Mercurius or Sulphur. Few other remedies have been found needful. Arsenic., Apis, Calc., Hyos., Ignat., Lach., Rhus rad., Podoph., Puls, and Verat. alb., have been sufficient to control nearly every morbid condition. It is noteworthy that such remedies as Bryon., Canth., Cham., Mercur., Mux vom., Rhus tox. and Sulphur, have sig- nally failed. Why they should not have worked as well as formerly, I can only explain by the theory of an epidemic constitution, to which they are not adapted. I should mention, also, that my experience did not embrace any low, putrid or septic forms of disease. Such cases did arise in certain limited localities throughout the city, but they could generally be traced to exceptional filthy surroundings, or sewer gases. I am persuaded that there was a decided intermittency in the remedies required. During the months of December, January and February, Ammon, was most frequently the rem- edy ; but when the damp atmosphere of spring came, Rhus rad. quite superceded it. But Ammon, was again the remedy late in the spring, yielding, as summer advanced, to Apis; this remedy served well for about a month, when Ammon, mur. was again required. Through the autumn, Kali, in some form, seemed sufficient, but we had to return to our main rem- edy again late in November. Since the new year, other drugs seemed to be more called for. Stibium is occasionally necessary ; and Ilepar sulph. may perhaps prove to be the next remedy. We seem to be at pres- ent in a transition state, with new conditions establishing them- selves ; this also has been alluded to by von Grauvogl. Finally, while I feel justified in affirming that, during the INFLUENCE OF EPIDEMICS. 537 year 1875, no special form of disease in epidemic frequency prevailed in Chicago; yet the results of my experience, which I have cited, convince me that an epidemic condition existed, calling for a limited class of remedies, of which one was typi- cal. Moreover that typical remedy worked as surely in all forms of disease as Bellad. once did in scarlet fever. PART II., by T. C. Duncan, M. D., Chicago. THE INFLUENCE OF THE GREATER EPIDEMICS. " Coming events cast their shadows before.". "Epidemics give distinct and unmistakable warnings of their approach. These warnings consist of two events: first, the sudden outbreak and general spread of some milder epi- demic ; and secondly, the transformation of ordinary diseases into diseases of a new type, more or less resembling the char- acter of the extraordinary disease at hand " (Dr. S. Smith, Nature of Epidemics, p. 5). Sydenham gives a graphic description of such a transforma- tion of the fevers and inflammatory diseases prevailing in London, some months before the outbreak of the great plague in 1665. Dr. Southwood Smith observed a similar change in the general type of the fevers in the London Fever Hospital, six months before the first visitation of cholera in 1831 (Ibid, p. 6). Dr. G. E. Shipman reports that, eight months before the appearance of cholera in Chicago, in 1853, nearly every case of disease was complicated by a diarrhoea which called for a cholera remedy {Nedical Investigator, vol. x., p. 292). An interesting question arises : How long may the warning precede the epidemic proper? We have just seen that it ex- tends for a few months, but Dr. Hennen informs us that "for four or five years preceding that (1813) in which the plague raged (in Malta) sudden deaths (apoplexies, etc.) were more frequent than ordinary, and during the twelve months imme- diately preceding and especially for the last month of the pe- 538 WOELD's HOMCEOEATIIIC CONVENTION. riod the increase was still more, insomuch as to excite public observation " (Cyclopedia of Practical Medicine, vol. ii., p. 68). Some years before the cholera epidemic of 1848, Boenning- hausen reported a malignant whooping-cough prevalent among the children in his neighborhood (Munster). "In its origin the indications for the employment of Drosera (the epidemic whooping-cough remedy in Hahnemann's day) were only ex- ceptional, and none of those were developed which call for other remedies ordinarily employed. However, in all affected, swelling and puffiness were remarked above the eyes between the eyelids and eyebrows, where it frequently formed a thick little bag-a symptom which had never been observed among those of any other medicine except Kali carb. (.219), and in fact this medicine was the only one that, at the commencement of the epidemy, effected a quick and lasting cure. In the last stage, this malady took another form, characterized by cold per- spiration on the forehead and vomiting during the fit, symp- toms which required the use of Veratrum alb." (Manual of Therapeutics, p. 18). The modifying influence, indicated by the change in the treatment, was no doubt the coming cholera epidemic. The greater epidemic influences the lesser. "Anterior to 1831, fever in London, for a long series of years, had been essentially an acute inflammatory disease. Six months before the cholera epidemic, fever ceased to be inflam- matory, and became a disease of debility. Up to 1855, this character of the fever had never disappeared (Nature of Epi- demics, p. 7). The same is, without doubt, true to-day. This explains why Aconite is not so frequently indicated now as it was in Hahnemann's time. Buchner says: " Fibrinosis of the blood has disappeared more and more since 1827, and this is the reason why cholera has travelled repeatedly so easily all through Europe; as soon as fibrinous d'seases- regain the ascendency, the albuminous cholera will disappear" (North American Journal of Hom- oeopathy, February, 1874, p. 291). In the light of the above we can understand why such remedies as Gelseminum, Bap- tisia, Arsenicum, Veratrum, etc., are so frequently indicated year after year. INFLUENCE OF EPIDEMICS. 539 But cholera is not the only epidemic that is modifying therapeutics. The widespread influence of the yellow-fever epidemic in 1872-'73, was manifested by the character of the cholera epidemic of 1873, by the prevalence of the dengue in India and in the South, and by the great demand for " bilious remedies." . Many physicians would not believe that this coun- try was visited by cholera in 1873, because the stools were chiefly bilious rather than of a rice-water character. The re- ports from the various cities and towns (chiefly in the southern section of this country) published by order of Congress make a large octavo volume. The epidemic reached Memphis in May, and was followed in July by an epidemic of inflamma- matory dysentery. In August yellow fever appeared and raged as never before. Throughout the South, this epidemic was followed by dengue, which is defined by Dr. AV. II. Hol- combe, of New Orleans, as "a compound of yellow fever, rheu- matism, scarlet fever and influenza." In 1872, the dengue raged in India. In the winter of the same year an epidemic of jaundice prevailed in Paris. In the early summer of 1873 many cases of jaundice were met in Chicago, and Nux vom. was the epidemic remedy. Bryonia alb., another " bilious remedy," was the one chiefly indicated in the dengue in Gal- veston, Texas ^ledicaL Investigator, vol. x.). MODIFYING INFLUENCE OF THE LESSER EPIDEMICS. " It is a very singular fact that both in the middle ages and in modern times, the lesser epidemic which has generally pre- ceded and preannounced the coming of the greater, is influen- za" (Dr. Southwood Smith, Member of the General Board of Health, 1848-1854, London). In the fall of 1858, Dr. W. Eggert, of Indianapolis, Ind., reported an epidemic of scarlet fever prevailing, and that Rhus tox. and Apis were the chief remedies. " Belladonna," says Dr. Eggert " has been of no use whatever." In March, 1869, he reported a change in the character, of the epidemic. Bel- ladonna, five or six weeks ago, was hardly ever indicated on account of the rash being papulous, but now it has to be called 540 would'S HOMCEOPATHIC CONVENTION. on more frequently, for the rash has assumed a smooth form (Medical Investigator, vol. vi., pp. 116, 236) What had changed the type of this disease ? An epidemic of influenza had passed over the country, and the atmosphere, surcharged by a large amount of ozone, had become more highly inflammatory (Ozone and Antozone, p. 136). Hahnemann, in January, 1798, records the prevalence of a mild epidemic fever of a remittent type that was promptly curable by Ignatia. In March, this fever assumed a different form, and now Opium was the indicated remedy in the ma- jority of cases. In April, a severe epidemic of influenza ap- peared, different from that which had been observed five years previously. The attacks of fever were now changed, and Cam- phor was indicated, and only failed in about one case in a hun- dred. The point of interest in the report is that now the fever assumed more of an intermittent and inflammatory type, and was promptly relieved by Ledum and finally Aconite (Lesser Writings, p. 329). The influenza had modified both disease and treatment. Influenza and therapeutics are likewise modified by other epidemics. "In 1860, diphtheria reappeared and, since then," says Dr. O. P. Baer, of Richmond, Ind., "all our catarrhal af- fections, for several years, have presented more or less diph- theroid symptoms " (Medical Investigator, vol. ix., p. 530.) "In 1863, meningitis cerebro-spinalis, or more properly typhus stupidus, made its appearance, complicating all our dis- eases. In the fall months of 1870, typhoid fever prevailed in Richmond, Ind., and called for Arsenic. In December, the weather changed suddenly from warm to cold and the charac- ter of disease changed as suddenly. Catarrhal fever set in, complicated by meningitis ; and Aconite, Nux vom., or Bella- donna were indicated at first, but finally the epidemic remedy, Arsen, alb., was again needed" (Dr. Baer, Medical Investiga- tor, vol. ix., p. 531). In 1872-'73, a severe epidemic of influenza spread all over the United States froni east to west, affecting both animals and man. " In New York, Bryonia was first required, and later Lycopodium ; while in Philadelphia Nux vom., and later Phos- INFLUENCE OF EPIDEMICS. 541 phorus cured the majority of cases" (Dr. Lippe, Medical Inves- tigator, vol. x., p. 169). Dr. Paulson, of Council Bluffs, who studied the epidemic very closely, decided Sulphur to be the similimum. His success confirmed his selection. In February, 1873, a mild epidemic of influenza again pre- vailed in the region of Chicago. Now, Arsenic, was the rem- edy. Cholera was coming a few months subsequently, and we detect its modifying influence (in the Mississippi Valley at least). Sulphur is a cholera prophylactic, and Arsenic, is rec- ognized as one of its most valuable remedies. As the charac- ter of the lesser epidemics is modified by the greater, so also is the therapeutics. ENDEMIC INFLUENCE. The epidemic may be modified to a certain extent by en- demic influence. "When the plague first broke out in the Indian army in Egypt, the cases sent from the crowded hospitals of the 61st and 88th Regiments were, from the commencement attended with the typhoid or low symptoms. Those which were sent from the Bengal battalion, when the army was encamped near the marsh El Hammed, were all of the intermittent or remit- tent type. The cases which occurred in the cold, rainy months of December and January had much of the inflammatory dia- thesis ; and in the end of the season, at Cairo, Rhiza, Boulac and in crossing the isthmus of Suez, the disease wore the form of a mild continued fever" (Sir J. M'Gregor, Cyclopaedia of Practical Medicine, vol. ii., p. 69). Dr. Rush tells us that in Philadelphia, when the yellow fever appeared in 1793, "the frequent absence of a yellow color led to mistakes which cost the city several hundred lives" (Ibid). "We must carefully distinguish what may depend upon endemic influence ; e. g., Nux vom. was, at a certain time, indicated for all toothache cases in Leipzig, while Puls, was indicated in the cases in Lausitz and Cocculus in Basle, and that in more than ninety per cent, of the patients " (N. A. Journal of Homoeopathy, vol. iv., p. 302). In 1874, whooping-cough prevailed severely in San Fran- 542 world's homoeopathic convention. cisco, Cal., and Veratrum was the epidemic remedy; while at Chattanooga, Tenn., at the same time, it was promptly arrest- ed by Ipecac. (Drs. G. M. Pease and D. G. Curtis, Medical Investigator, vol. xi., pp. 516-517). In 1873, when Memphis was being visited by Cholera, then inflammatory dysentery, then yellow fever and malarial fever. Philadelphia's chief diseases were cholera infantum and morbus (severe), then dysentery, and then typhus fever, intermittent. New York reported Veratrum diarrhoeas and Carbo veg. colics, closing the season with Baptisia typhoids; while Chicago re- ported severe Veratrum cholera morbus and infantum cases, then dysentery, and then typhoid (Medical Investigator, vol. x.). The type of the remedies indicated was, however, about the same. THE CHANGING NATURE OE EPIDEMICS. The fact that has impressed careful observers more than any other is the varying character of all the epidemic diseases. Sydenham, who lived during the frequent epidemics of plague, says : "I am convinced that epidemic diseases differ from one another like the North and South and that the remedy which would cure a patient at the beginning of a year, will kill him, perhaps, at the close. Again, that when, onoe, by good for- tune, I have hit upon the true and proper line of practice that this or that fever requires, I can (with the assistance of the Almighty) by taking aim in the same direction, generally succeed in my results. This lasts until the form of the fever epidemic becomes extinct and until afresh one sets in. Then I am again in a quandary and am puzzled to think how I can give relief." (Sharp's Essays on Medicine, p. 23.) The same changing character has been observed in the dif- ferent epidemics of cholera. In one epidemic, one class of symptoms have been prominent while, in another, they have been less prominent. Hahnemann, who lived during the vacillating period between the plague and cholera epidemic, noticed this chang- ing nature in the lesser epidemics of remittent, intermittent, typhus fevers, etc. But he soon found he had remedies by INFLUENCS OF EPIDEMICS. 543 which to name and to cure them. " When JEgidi visited Hahnemann in March 1813 in Kothen, Hahnemann remarked to him : 'You will have to treat a number of cases of inter- mittent fever on the Bhine; please observe whether there, also, as it does here, Natrum mur. corresponds to the epidemic constitution, and let me know it. If we regard the genius epidemicus we accomplish more quickly and with less trouble the desired end even in acute diseases, which usually are only efflorentia of the three chronic ailments.' yEgidi found it so. In one case, however, the paroxysms came back again, although Natrum had relieved for a while. Hahnemann, being con- sulted, advised Carbo veg.'0, because this remedy had corres- ponded to the last year's epidemic constitution, and the relapse in the case might be considered merely as a continuation of the same. It cured at once. In another case, where the in- termittent paroxysms, one every eight days, had continued for two and a half years, with swelling of the spleen and liver and cedema of the lower extremities, Hahnemann advised Cantharis30, because, two and half years ago, this remedy had been very efficient against the epidemic constitution which prevailed then, and also because Cantharis has the eight day type of the paroxysms. Cantharis broke the paroxysms; the remaining difficulties were cured by other remedies. Dr. Staler, in Berlin, collected likewise observations on the effects of Sepia and Spigelia as epidemic remedies, and all this was done ten years before Bademacher's ' Erfahrungs Ileillehre' was published." (Internationale Hom. Bresse, vol. ii., p. 195.) liering says: " Intermittents appear nearly every year in a somewhat different form. One year Arsenicum, another Bel- ladonna, or Antimonium crud., or Spigelia, Aeon, in alternation with Ipecac., Nux vom., Ammon, mur., Natrum mur., Opium, Cina alone or in alternation with Capsicum, or Capsicum alone, Menyanthes, Calcarea, Pulsatilla, Carbo animalis or veg. Arnica alone or in alternation with Ipecacuanha, etc., curing the fever in a few days." (North American Journal of Hom., vol. iii., p. 308.) In 1870 Mr. G. Hawkes, in Delaware, found Natrum mur. indicated in three fourths of the cases, while next year it was called for only a very few times. In Jan. 1871, 544 WORLD'S IIOMCEOPATniC CONVENTION. Dr. C. Lippe of New York, writes : " The epidemic (intermit- tent fever) was cured this year in the most of the cases by Arnica." (North American Journal of Hom., Feb., 1872.) In no disease perhaps is this change in the genius epidemi- cus more apparent, from year to year, than in whooping- cough. Hartmann truly says : " Every epidemic of whooping- cough is more or less distinguished from those which preceded it and has, therefore, to be treated in accordance with its own characteristic symptoms. This is, probably, the reason why Hahnemann's specific Drosera has not produced equally fine effects in all cases" (Diseases of Children, p. 357.) In .1859 Corallium rub. was the whooping-cough remedy in Detroit, Indianapolis, etc., (Drs, T. F. Pomeroy, W. Eggert, etc. in Me- dical Invest.) In 1874 Drosera was the epidemic remedy in Lewiston, Ill. (Dr. Stillman Med. Ivest., vol. xi., p. 59) and in Oregon (Dr. W. E. Jones, U. S. Med. Invest., New series, vol. ii., p. 102.) In April 1875, Kali carb., in powder, was the whooping-cough remedy in Hackensack, N. J. ( Dr. A. P. Macomber. U. S., Med. Invest., vol. i., p. 375.) The same changing character is also noticed in epidemics of influenza. But-as these are forerunners of the lesser and greater epidemics they must necessarily be varied. In no dis- ease perhaps has this changing nature been more confusing than in scarlet fever epidemics. Repeated failures have de- monstrated that Belladonna is not always the specific. Dr. Lippe says : " The older practitioners will well remember what an important remedy Ammon, carb, was in the scarlet fever epidemic of 1840. Later, the same disease often yielded to Capsicum and in turn to Nitric acid or Lycopodium, and m later years to Arum tri. or Apis meh, etc." (Med. Invest, vol. x., p. 171.) In the winter of 1874 and 1875 Belladonna was the epidemic remedy in Tidioute Pa., and especially in an epidemic of influenza in March. In April, a severe epidemic of scarlet fever broke out in which Belladonna proved a valuable prophylactic, but not so satisfactory as a remedy, as dropsical sequel® fol- lowed some of the cases. (U. S. Med. Invest., vol. i, p. 374.) About the same time, this disease prevailed at Utica, N. Y INFLUENCE OF EPIDEMICS. 545 complicated W'ith cerebro-spinal meningitis and diphtheria. Dr. L. B. Wells, who proved Apis in 1850, detected its appli- cation to certain of the cases attended with a sense of suffocation " as if they could never breath again," and he adds: " Apis has been a better remedy in scarlet fever than Belladonna." From the reports from various places, where the disease has been prevalent, it is noteworthy that, when Belladonna has been given, Rhus, Mercurius or Apis had also been needed to complete the cure. In September, Dr, C. C. Smith of Phil, reported great success with Apis, having no sequelae and no deaths. In New Albany, and in the fall months, intermittents were complicated with the angina and subsequently Dr. McNiel reported Apis to be the chief remedy. The fall and wunter of 1875 and 187G being a hydrogenoid wret one, Apis was also found to be the chief remedy in the scarlet fever epidemic in Louisville, Ky. The physicians then avoided cold water and did not loose a case. (U. S. Med. Invest, vols. i., ii. and iii.) A CONSTANT GENIUS EPIDEMICUS. The changing character of all the epidemics has led many physicians to doubt the possibility of there being a constant epidemic influence. The very fact of constant change has led others to inquire: why the changes? There must be a more potent influence back of the most severe epidemics to thus change their type. And if it influences them it must also in- fluence all the disease expressions met in a given year. Hahne- mann, we have seen, recognized it and styled it the "genius epidemicus." Rademacher called it the " stationary epidemic constitution;" while Dr. Lawson, of London, named it "a pandemic wave " (Aiken's Practice of Medicine). All close observers, however, have come to recognize its presence as con- stant and all pervading. Rademacher found that at certain times the most different diseases were cured by one and the same medicine in the shortest time without any crises what- ever. He thus practically solved the problem why, in the Ma- teria Medica, nearly all forms of disease are mentioned, and why for one form of disease nearly all remedies are recorded. 546 world's homoeopathic convention. Prof. Rapp says: After studying the provings, I learned tlfat similia gives the key for the selection of the stationary epidemic remedy." The stationary constitution (genius epi- demicus) occupies at certain times large portions of a country. Meningitis cerebro-spinalis, which appeared in 1865 all over Europe, may serve as a proof that the stationary disease char- acter is always a very extensive one (N. A. Journal of Homoe- opathy, vol. iii., p. 313). We have seen that a study of the meningeal eases by Dr. Wells led him to select Apis as the remedy for the genius epidemicus or stationary constitution. Dr. A. W. Woodward, of Chicago, believes that the rem- edy for the genins epidemicus of the past year, 1875, was Am- mon. mur. (LT. S. Medical Investigator, vol. iii., p. 278). In April, 1869, Dr. Lilienthal, of New York, reported that dis- eases take on an intermittent form, and that even in whooping- cough the epidemic remedy, Arsenic., was indicated. The weather was wet and very changeable (Medical Investigator, vol. vi., p. 174). Rademacher found, by careful observation, that even the so- called stationary epidemic constitution changed so that now Cuprum, then Iron, and Natrum nit. were the universal reme- dies, as he termed them. The question arises how is the gen- ius epidemicus modified? It will be seen that Hahnemann attributed the acute disease to the action of the epidemic con- stitution upon the three chronic ailments. GrauvogI found that Rademacher's three remedies correspond very closely to Hahnemann's three chronic diseases or bodily constitutions. These GrauvogI renamed the oxygenoid, hydrogenoid and carbo-nitrogenoid constitutions, and found that now those of one class were most affected during one epidemic condition, and another during another, etc. O / I Hering, Gross, Rapp and others have applied Grauvogl's con- stitutions to the genius epidemicus, giving us a hydrogenoid epidemic constitution, carbo-nitrogenoid epidemic constitution, and an oxygenoid epidemic constitution. As the bodily consti- tutions change, from infancy to old age, and from year to year, so it must have been with the atmospheric constitutions. Now INFLUENCE OF EPIDEMICS. 547 applying these to the weather recorded before and during a severe epidemic we may get at the order of the changes in the genius epidemicus and the causes thereof. Preceding severe epidemics have been recorded " long-continued drought (oxy- genoid weather), succeeded by torrents of rain forming exces- sive dampness (hydrogenoid weather), under the influence of which spring up inordinate growths, producing mouldiness and the blood spots and other colored vegetation that adhere to houses, furniture, clothing, person, etc., fostered by a steady elevated temperature, etc.-carbo-nitrogenoid condition-(Na- ture of Epidemics, p. 16.) The carbo-nitrogenoid constitution seems to be the severe epidemic year, although Lord Bacon's aphorism has been con- firmed that the " lesser infections of small pox, puerperal fever, agues, etc., in the preceding summer, and hovering all winter (hydrogenoid), do portend a great pestilence the following summer, for the putrefaction rises not to its height at once " (Cyclopaedia of Practical Medicine, vol. ii., p. 68). From Hahnemann's experience and that of others, we infer that the epidemic constitution changes every year, perhaps giving us the carbo-nitrogenoid epidemic constitution about every fourth year. Starting with 1860, the diphtheritic year, it will be seen that we had in 1863 the epidemic of meningitis cerebro-spinalis; in the fall of 1866 cholera; in the winter of 1869'-70 relapsing fever; and in 1873 cholera and yellow fever. This year, 1876, according to this calculation, is a carbo-nitro- genoid epidemic year. Just when the epidemic year begins we do not know, but from June, 1875, at least, it has been hy- drogenoid. Whether this rule of three extends to days, weeks and months, as well as to years, decades and centuries, is an interesting and very appropriate question for centennial inves- tigation by the whole homoeopathic profession. In conclusion, I think these inferences may be drawn: 1. That the greater epidemics exert a profound and long- lasting influence upon disease and therapeutics. 2. That the lesser epidemics are modified so as to exert a modifying influence. 3. That influenza is an erratic epidemic, modifying the pre- 548 world's homoeopathic convention. vailing diseases, and pre-announcing the type of the coming epidemic. 4. That all the foregoing may be called " intercurrent epi- demics," while, behind all, there is a genius epidemicus or sta- tionary epidemic influence. 5. That although this may not change decidedly for a long sweep of years; still it is modified from year to year as the change in the indicated remedy for the genius epidemicus proves. G. That the changes from year to year correspond to those of the bodily constitution. 7. That the lesser epidemics prevail during an hydrogenoid year, while the greater epidemics occur during an excessively carbo-nitrogenoid one. 8. That the upper and northern air being oxygenoid, this epidemic constitution is duo to the projection of this air tow- ard the tropical surface ; the hydrogenoid is the reverse, while the carbo-nitrogenoid epidemic constitution is due to the rapid oscillation of both. 9. The epidemic years are ushered in gradually and succes- sively like "waves" over the earth. 10. The only name we have for the genius epidemicus from year to year, is tliat of the indicated remedy. Many other inferences might be drawn, but the limits of this paper will not allow. DISCUSSION. THIRD SESSION. Wednesday, June 28th, 1876. The Third Session of the World's Homoeopathic Convention was called to order by the President, Dr. Dunham, at 9.30 o'clock. The Secretary announced that in accordance with the resolu- tion passed on Monday, 5000 copies of the President's address had been printed, and asked that those members who desired to procure it, hand in their orders. On motion of Dr. J. J. Youlin it was voted that the session of the Convention commence daily, immediately on the adjourn- ment of the American Institute. On motion of Dr. S. Lilienthal, Dr. Henry Detwiller, the first homoeopathic physician in Pennsylvania,* was elected an honorary Vice-President of the Convention, and was conducted to a seat on the platform. The President, Dr. Dunham, announced that the order of business for the day would be the discussion on Clinical Medi- cine, and that it would commence "On the Modifying Influence of Epidemics." A. W. Woodward, M.D.: Concerning the doctrine that there is at all times an epidemic influence which modifies every form of acute disease during its prevalence, and that each epi- demic diathesis requires but a very limited class of remedies for the cure of all forms of disease then prevailing, I cannot offer a better argument in support than is found in the works of Thomas Sydenham, first published in 1680. Sydenham's observations extended over a period of thirty years, from 1661 to 1690, during which time he recorded care- fully as they came, the distinguishing features of eight distinct types of continued fever, coming singly and alone, and ap- parently without order or relation to each other. They some- times prevailed extensively, and at other times were almost lost sight of in the greater prevalence of other diseases. Yet these * The first dose of homoeopathic medicine in Pennsylvania was adminis- tered by Dr. Detwiller, Pulsatilla30, July 24th, 1828.-Ed. 550 world's homceopathic convention. cases of continued fever, he considered, represented the genus epidemicus. For he found the main characteristics of this fever at any particular time were also prominent in every form of acute disease that prevailed at the time. It stamped its features upon all intercurrent epidemics, such as small-pox and measles, and could be seen in the phlegmasise, intermittents and dysen- teries. From 1661 to 1665, gastric intermittents were the prevailing type, at which time variola presented the umbilicated vesicle, and the best treatment for all diseases was Antimony. In 1665, preceding the plague (the other type of fever having gradually disappeared), there came a highly inflammatory form of fever, which brought also a new form of variola, in which the skin looked as if burned to a crisp, leaving the flesh blackened and gangrenous beneath. The only successful treatment at this time, whether for the fever, the plague, the variola, or whatever was the name of the disease, was frequent and copious venesections to the point of syncope; under this treatment for the first three days, most cases recovered ; without it nearly every one died. In 1669 under a new epidemic influence variola was more benign. There was, however, no vesicular stage, neither did the pustule umbilicate. In 1672 dysenteric symptoms accompanied every form of disease, while the disease itself was extensively fatal; at this time Hartshorn was the specific remedy. In 1678 com- plete intermittents were the fundamental type and Peruvian bark was specific. In 1680 spasmodic coughs accompanied all disease process and free venesection was again the measure bringing relief. From 1681 to 1685 intermittents again pre- vailed as the fundamental type, but Peruvian bark was no longer effective; and so far as I can learn the remedy was not discovered. This record leads us to three conclusions: 1st. That the idea of a fixed and established treatment for any disease was aban- doned 200 years ago, experience having taught that adherence to old methods was likely to prove fatal or result in a tedious convalescence. 2d. That the epidemic remedy once found was applicable in nearly all cases of acute disease, and produced the most speedy and happiest results. 3d. That not only were the objective symptoms of the various diseases changed from time to time under the influence of the epidemic diathesis, but so far as can be learned from the records, the pathology itself was also changed. The small-pox never presented the same disorganiza- tion in any two epidemic periods; neither were the concomi- tants of measles ever the same; pneumonias were frequently DISCUSSION ON CLINICAL MEDICINE. 551 termed bastard, owing to their departure from an established and recognized type. The point that I wish to make is this: that while in theory we have abandoned the idea of a fixed treatment for any disease, many of us still cling to the error that the pathology of a disease is always the same. So we continu- ally incline to return to our old favorite remedies. If we have a case of pleuritis we instinctively think of Bryonia, though the fever may be only subacute, and the effusion non-plastic; if we have a clear case of pneumonitis, we continue to give Phosphorus, though the sputa is not rust-colored, and the effusion is of serum rather than of albumen; if we have a case of typhoid we cling to our old loves and give Bryonia, Rhus, or Baptisia, though the tongue continue throughout to be moist and clean. Now I venture to assert that 1 have not seen a non-medicinal dry tongue in two years, neither have I found marked symp- toms of ileo-coecal ulceration during this time. Therefore, I believe that our treatment of all disease forms at the present time must be changed, not only because symptomatology de- mands it, but pathology also; else we must face defeat and see our patients die or linger in a tedious convalescence. It is time we had anew Organon which shall tell us what constitutes good practice under given circumstances. For, though we have made a great advance upon the results attained by old physic, there yet remains great room for improvement. When not only the intelligent laity but many of our own number come to believe that a continued fever must necessarily run its course like a prairie fire which we may neither hasten nor avert, it is cer- tainly time we had some method by which we can measure not only our remedies but our results. It should be a shame to any one calling himself a homoeopath (and it is to myself among the number) to have a fever patient linger four, five, or six weeks before recovery. Such cases would not and could not occur under the use of the true similimum, which will always be found to be demanded alike by the symptoms, pathology, and phys- iology of the case. Such a remedy will not only remove the symptoms, but it will also speedily cure the case, and quite lively we may find the similimum for one case will prove to be an epidemic remedy also for* the time being; for a common atmos- pheric or telluric cause operating upon large numbers of people is as likely to produce similar results, in different parts of the human organism of different people, as is seen in the provings of any toxical or therapeutic agent. Dr. P. P. Wells, Brooklyn, N. Y.: Diphtheria has been thoroughly written upon and talked about within the last decade, 552 world's homceopathic convention. but is by no means exhausted, and some of its phases have not been much noticed. Among these, which I have seen within a few years, are the peculiar attacks showing the constitutional symptoms of diph- theria, with very little and sometimes not any local manifesta- tions, and which are followed by a characteristic paralysis, espe- cially of the lower extremities, which is often very troublesome, and is not at all in a ratio with the severity of the initiatory at- tack. Perhaps that has been characteristic of the locality where I reside, or it may be more general. I trust to be excused if I mention a singular case which I had, and of which, though I have seen but one case, I have heard frequent mention. In this case the constitutional symptoms were apparently cured, but the patient had not yet recovered physical strength, when, without warning, there was an utter suspension of all ordinary intellect- ual manifestations, the patient going from idiocy into insanity, from that to insensibility, and thence to death. As to the termination of diphtheria, I wish to say that there is no such thing as that termination which separates it from any disease affecting humanity. In order to treat diphtheria intelligently and successfully, the proper similimum must be found according to its own manifesta- tions, and any other mode is not homoeopathic practice, whether it be a pellet or a bolus. Permit me to illustrate this with a case which I had a few years ago, the patient being now in this room. I cannot give the symptoms in detail, but remember that the patient was exceed- ingly exhausted, much prostrated, and inclined to sleep, awak- ing from short spells of sleep, and saying : " Oh, I am so much better !" immediately falling asleep again, and again waking with " Oh, 1 am so much better!" and again going to sleep. I gave that patient a remedy that I have never given before, or since, in a case of diphtheria, and which, I think, is not mentioned in the treatises on this disease ; I gave him one dose of Nux vom- ica, and that was all he needed ; the patient, gentlemen, was your President! Regarding the diet and regimen of diphtheria, my friend, Dr. Joslin, recommends stimulants, and I cordially indorse him in that, bearing in mind, however, that it is not simply because the pa- tient has diphtheria, that feeding and stimulation is proper, be- cause cases will constantly occur, where the patient will die even if ted and stimulated, but that the same nice discrimination, in regard to food, is required as in the selection of the similimum. I use milk punch as a stimulant in diphtheria. My friend, Dr. DISCUSSION ON CLINICAL MEDICINE. 553 Lippe, gives as an invariable rule that food should not be forced upon a patient, arguing that if food is refused, it is because the stomach is too weak to digest it, and that the undigested food remains in the stomach, as a foreign body, taxing the stomach to retain it. In some cases, no doubt, this rule is valuable; but in diphtheria, where the unwillingness to take food results from the condition of the throat and the difficulty in swallowing, and is not due to any aversion to the food, the case is quite different; and I affirm that if we adhere to this rule in diphtheria, we do it at the cost of the lives of our patients. I have been regarded as a purist; now here is where an idea made so plain in the Presi- dent's address appears: the pathology of this symptom of unwill- ingness to take food is the keynote,-they will understand that in Philadelphia,-it is the keynote, on which the whole prescription turns. Diet in Diphtheria*-The proper attention to the diet of the sick and convalescing is one of the important duties of the phy- sician in his endeavors to restore these to health. If it be more important in any one disease than another, it is so in the treat- ment of diphtheria. In grave cases success will often turn on this one point,-the right diet rightly administered. The principle is the patient must be sustained by proper nourishment, and this wholly independent of his willingness to take it. For this rea- son we take exception to the rule in the paper under discussion : il Never force a patient to take foody Ina majority of cases in practice, perhaps in most, the rule may be a sound one, and cer- tainly in those cases where the unwillingness to take nourish- ment issues from a suspension of the digesting power. It may be readily admitted that food undigested is no aid to sustaining: the life forces of the patient, and remaining in the stomach as a foreign body subject to chemical rather than digestive changes, is likely to be a cause of mischief. What we object to in this rule is, making the unwillingness of the patient to eat the crite- rion by which to judge of digestive powers. This, of itself, can hardly be a safe rule, especially in cases where the unwilling- ness may reasonably be referred to the condition of the mouth and throat, which resolves the difficulty into an aversion to swal- lowing rather than to food. This is often the true state of things in grave cases of diphtheria, and we have no hesitation in re- garding a yielding to it by physician or nurse as wholly unwise, and, if persisted in, as likely to be an active factor in contribut- ing to a fatal result. I wish to say a word concerning one form of intermittent fever mentioned by Dr. Charge, of Paris, with his remedy, 554 world's homoeopathic convention. Menyanthes trifoliata^ which is very valuable; but the descrip- tion given by him of the Menyanthes intermittent does not cover the whole field; nor is it entirely correct in its statement that the "paroxysm is almost entirely made up of the cold stage" in all cases, if we may be warranted in supplementing the rather scanty proving of the drug, as we have it in our materia medica, from our clinical experience of its use. He is quite correct in stating the partial extent of the coldness, and limiting this to the ends of the extremities. But that this makes up the whole or the most important part of the paroxysm in all cases may be fairly questioned, and perhaps fairly negatived by the following case. A child, 22 months old, had paroxysms of fever daily at 9 o'clock a.m. The heat, thirst, restlessness, and redness of the face and eyes were great, and lasted till about 3 o'clock p.m. There had been no chill detected for several* days, when the nurse was directed to watch carefully for this through the morning hours. At about 8.30 a.m. she found the extreme ends of the fingers and toes, of the nose and tips of the ears cold. This lasted about ten minutes, and was followed by a paroxysm of heat, which was severe, lasting six hours. There was slight perspira- tion. The case was cured promptly and permanently by Meny- anthes200, Jenichen's preparation. There were only two slight paroxysms after the first dose. The following case confirms the fact of partial coldness, and seems to indicate curative power in the drug beyond what is very clearly expressed in our materia medica. A man, about fifty years of age, consulted me for a trouble in his chest. He had great oppression of his breathing, with vio- lent and irregular action of the heart, both greatly increased by even slight exertion. He came to me when I was confined to my bed by illness, which made auscultation impracticable, so that just what was the physical condition of the heart and lungs was not known. A detailed examination of his symptoms brought out the fact that his feet and legs, below the knees, were habitually cold, and this was increased about 8 o'clock a.m., and the exacer- bation lasted for an hour or two, during 'which time his chest symptoms were aggravated. He was cured, not only of his coldness of legs, but of his respiratory and heart troubles by Menyanthes200. A single powder, containing half a dozen pel- lets, was dissolved in half a goblet of water, of which a teaspoon- ful was taken every four hours. The relief of the whole case was prompt and decided. H. D. Paine, M.D., New York: I am impressed with Dr. DISCUSSION ON CLINICAL MEDICINE. 555 Joslin's remarks on croup, wherein he differs from what I un- derstand to be the usually received popular and professional idea of the relations of spasmodic and membranous croup to each other. The general idea is that they are two distinct diseases, and I am very happy to see he takes a different view of it, and advocates the opinion which I have long entertained, that there is radically no difference between these two forms of so-called croup ; but that the two conditions are different stages, or differ in severity only, and are essentially the same affection. But my purpose in rising was to speak briefly on that impor- tant subject, Diphtheria, which is the principal topic in the paper of Dr. Wells, and embraces the entire scope of Dr. Lippe's short paper. The first point to which I wish to refer is not of an im- mediate and practical importance to us, but one exceedingly interesting and deserving of attention ; and that is, whether what we now call diphtheria is a new disease,-whether it is a new form of morbid action, or an old disease, long dormant and un- noticed, but now revived; or whether it has always been a more or less active agent in the destruction of human life, but now with our improved methods of classification has been distinguished and separated from those diseases that were supposed to be its prototypes. Bretonneau, to whom we are indebted for the name of this disease as it now exists, and who furnished the first intel- ligent description of it, as he saw it in an epidemic that prevailed in his native city of Tours during the early part of this century, inclines to the opinion that diphtheria is only another form of membranous croup ; and that those forms of disease, so vividly described by many, such as malum jacticum, morbus suffocativus, and angina gangrenosa, etc., all differ, and present different forms of real diphtheria. That he was mistaken in its identity with croup, I think every physician who has seen much of it will agree. It seems that there are radical differences between this and any form of croup, except diphtheritic croup, which is really one of the stages of diphtheria. There is a very great discrepancy between the two forms of morbid action ; and any one who will read attentively these various descriptions, and study the exact theory of this disease, as it is supposed to appear in all its cases, I think must come to the conclusion that there is no disease or single form of morbid process, by whatever name known, that was recognized by the ancients, or indeed in modern times, like diphtheria, until its outbreak within very nearly the present century. It is possible that it may have been confused with other dis- eases, as we see how easy that was in the case of Dr. Bretonneau, 556 world's homoeopathic convention. who confounded it, perhaps through negligence, with true mem- branous croup, which, I understand, is not a very frequent dis- ease in the part of France where he lived. It may be that sporadic cases of diphtheria have been scattered along through the history of medicine that have been confounded with other forms of angina; but, so far as the records of medicine go,-and I have examined them with the greatest interest,-I am satisfied that no clear and well-defined description of diphtheria can be found until within the last hundred years. We may, therefore, assume that it is practically a modern dis- ease. This is not unique, for we find among ancient medical writings many instances that correspond with what we now term small-pox and cerebro-spinal meningitis, which, so far as I know, are modern developments of morbid action. In this country writers are in the habit of considering diph- theria as only another form of that disease which prevailed just after the Revolutionary war, and which was so exactly described under the name of "angina suffocatoria;" but, I think, there is no danger of those, who have witnessed diphtheria to any extent, confounding the two diseases, as they have many irreconcilable and distinctive marks, especially if diphtheria is a recent devel- opment of morbid action. The next question is, how, from its origin, and from what causes, can we foretell its termination? I do not now refer to the attention that has been called in this discussion to the micro- scopic fungi, bacteria, and echinococci, which, by experiments, have demonstrated to be a frequent, if not a constant, attendant upon diphtheria. I cannot deny the correctness of these ob- servations; but, for all that, it has not been clearly demonstrated to my mind, although these parasites are constantly present in connection with diphtheritic deposit, that they therefore cause the disease; and I cannot, therefore, unhesitatingly accept Dr. Lippe's assertion coming from Oertel, that where there was no micrococci there was no diphtheria; for the converse of that proposition is full as likely to be true, that where there is no diphtheria there are no micrococci, a fact which should be estab- lished, if the fungoid theory be true. We are still at a loss to account for the origin of the micrococci, and may fail in advance in our etiology. The next, and a very practical difficulty, is as remote as ever, remaining a subject of controversy not in the least diminished, as to the circumstance of the first appearance in this country of the disease, or by the manner in which it has spread throughout our borders, as to what are the sanitary or unsanitary conditions which predispose to the development of DISCUSSION ON CLINICAL MEDICINE. 557 diphtheria, and what are the essential existing causes of its propa- gation. It is usual to classify this affection among those of an infec- tious or contagious character; and I am not prepared to deny the possibility of its propagation either from inoculation or per- sonal contact, the emanations proceeding from the person of the sick and infecting others; but, while this is possible, I am convinced, from abundant opportunities of observation during the epidemic in Albany, where it first began its ravages in this country, that such is not its usual mode of propagation. C. Pierson, M.D., Washington, D.C.: What I say may con- flict with Dr. Joslin, Dr. Wells, and others, but I can only give the result of my experience, which is worth more to me than the experience of any other person. I am unable to see what practical advantage this Convention is likely to derive from such papers as that of Dr. Joslin's. Of the two cases he reports as having been treated by himself, one died and the other came very near it. The first nine medicines were given in eleven days, all low, in alternation or rotation, then the child dies; just the result I would have anticipated from the treat- ment ; I have seen dozens of cases go the same way when I used to prescribe as he advises. In the second case twelve medicines were given in ten days all of them low, some in the tincture, and the dose repeated every " six or seven minutes," then the doctor tells us the child got well. But what cured it, no mortal will ever know. Stimulants are highly recom- mended, and physicians are advised to pay particular attention to the pulse. My own observation is, that of all diseases, in diphtheria the pulseis of the least practical importance; and stimulants are worse than nothing. I have treated the disease in the most malignant form it ever assumes, have seen nearly everything tried, from the crude tincture and inhaling the fumes of Iodine up to the 200th attenuation, and I am fully satisfied that the higher I have gone in the scale of remedies and the more scrupulous I have been to prohibit all stimulants, washes, gargles, etc., the better my success has been; and I am now fully determined to treat the next severe case of diphtheria or croup I meet with, with the C. M. attenuation of the appro- priate medicine. If there be such a thing as a blood disease, it is most emphatically diphtheria; and as a very similar condi- tion of the system obtains in membranous croup, Sulphur is as nearly a specific as a medicine can ever be for any disease. This is no idle fancy of mine. Physicians who wish can easily test its truth. I would rather take this medicine with Lachesis, 558 world's homoeopathic convention. Lycopodium, Apis, and perhaps one or two others mentioned in Dr. Lippe's paper, all at the 200th attenuation or upwards, than the whole materia medica below I The treatment recommended by Dr. Paine in his practice, tincture of Sanguin. and vinegar, corresponds very well with the balance of the paper; and if it had not been presented to a homoeopathic Convention, it would have been difficult to tell to what school of medicine it belonged. For my own part I dissent from all such papers and such treatment. In regard to the paper on "Pneumonia," there is one thing on the fifth page of the paper from Madrid, on "Pneumonia," that so perfectly coincides with my experience that I desire to call the attention of the Convention to it. The writer says, speaking of the sputa : " And this expecto- ration is of such importance that, as Jacoud says, a single spu- tum thoroughly examined, enables us to affirm the existence of the disease, even when the lesion, by reason of its site, is beyond the reach of our explorations; and by this same means experienced physicians follow the pathological changes as accurately by the examination of the sputa alone, as if they daily percussed and auscultated their patients." Some years ago I published in one of our journals an article on the " Characteristic Indications of the Sputa in Pneumonia as an Indication for the Selection of the Remedy." For this I was severely criticised by ray friend, Professor Jones, who seemed to think that I ignored all other symptoms. He stated that any physician who neglected to percuss and auscultate his patient on every visit to a case of pneumonia, was guilty of criminal care- lessness ; but so sure am I that the sputum is the most important guide to the selection of the remedy, both as it. regards color, quantity, and consistency, that where I can see this daily I will agree to cure nine cases out of every ten of pneumonia, without once seeing the patient. In the other paper the statement is made that in the form of pneumonia there referred to, Bry. and Phos. 12th were found to be unreliable. At this I am not at all surprised, for I have no confidence in any medicine in pneumonia below the 30th, while the 200th potency is a great deal better. This is the re- sult of my experience. The paper by Dr. Charge appears to be a well-written article, but not at all practical, as the writer says nothing about the at- tenuations he would recommend, or the repetition of the dose, both of which I have found to be as essential in the treatment of an intermittent as the selection of the remedy itself. The other DISCUSSION ON CLINICAL, MEDICINE. 559 paper presents nothing new. It is, in fact, the same old thing over again. No indications are given for the administration of Quinine, except by chills and fever. If this be homoeopathic, then homoeopathy is practiced more extensively by other schools of medicine than by ours. Some physicians declare that if they only adhere to the law of the similars, they are rigidly homoeopathic, even if they give a "cartload of medicine." Is this law the all of homoeopathy? If so, what did Hahnemann ever do, that we should regard him as a discoverer or reformer in medicine in any way? This principle was known to others a thousand years before he was born ; he only borrowed it from the ancients and used it as a bed-rock, upon which to build a system of medicine. But there is one thing he did not borrow, and that is potentiation I This I regard as one of the greatest discoveries ever made in medi- cine. It is the keystone of the arch of homoeopathy, without which the whole superstructure falls. Hahnemann so regarded it, for he says: "Medicines do not accomplish their object by quantity, but by potentiality and quality, dynamic fitness, homoe- opathy." If we are homoeopathists let us practice what we pro- fess at the bedside of the sick and defend our faith in open con- vention. Our opponents of the opposite school are not slow to denounce and disown any physician who tampers or fraternizes with homoeopathy in any way, and I respect them for it. If we have a medical faith, let us be true to it; if we have none, let us call ourselves eclectic, allopathic, or anything but homoeo- pathic; for one irregular practitioner can do more injury to ho- moeopathy in one year than ten allopathic physicians can do in a lifetime. J. J. Mitchell, M.D., Newburgh, N. Y.: It is my purpose to discuss the germ theory of diphtheria in antagonism to the views advanced by a physician at the present time, and more especially as promulgated by Professor Oertel in the lately pub- lished volume of Ziemssen's Practice of Medicine. A belief concerning the nature of a disease will inevitably have much to do with influencing its treatment. It will be a sad thing if a false etiology and pathology shall be fastened upon so fatal a disease as diphtheria for even a few years. And it is to the cause and nature of this disease that I shall prin- cipally confine my attention in the discussion of the papers before us. The questions arise, whether this disease is primarily and purely a local one, or is the result of blood-poisoning inducing a general disease with a local manifestation ? Or, is there a 560 world's homoeopathic convention. combination of both these elements in its etiology, the one mod- ifying the other, intensifying or ameliorating it, as the case may be. If the disease is a local one, what is the germ by which it is induced, and how may we destroy it? If it is the result of blood-poisoning, how may the poison be counteracted and eliminated? We take the position that the germ theory of Professor Oertel cannot sustain such a critical examination. If we were to base an argument upon our success in treating the disease, certainly its rates of mortality are sufficiently great to lead us to question whether the present theory, upon which our treatment is based, is the true one. When it made its first inroad in modern times, upon England, 20,000 lives were sacrificed to it in the years 1858 and 1859. But now a score of years have nearly elapsed and we find that, even when not epidemic, New York city has from sixty to seventy deaths a week, for a long series of months, from this disease. Shall w7e be satisfied with such success? I am not prepared to give the actual statistics of our school, but I think that a mortality of seven per cent, would be a low one. With our allopathic brethren twenty percent, is considered unusually favorable. If diphtheria be a local disease, as the profession so univer- sally declares, then it is to be met by local measures, and we have only to find the right cudgel with which to kill bacteria, and the cure of our patients is assured. But if this is an error, and the poisoned blood is that which gives the disease its local manifestation and virulence, then what a responsibility is taken by the physician who, in adherence to the germ theory, intently fixes his attention upon the local disease, and loses sight of the septic poison that is destroying his patient I Or, if there be a measure of truth in both the septic and inoculatory theories of the disease, as we are rather inclined to believe, then with what care should we endeavor to prevent the secondary poison- ing of the system by the exudations upon the mucous membranes, and at the same time understanding^ meet the general disease by the weapons homoeopathy has given us, and in the method Hahnemann has prescribed. It will render my arguments more debatable if I throw them into the form of propositions, all of which I think will be pronounced probable, even if they cannot be fully demonstrated. 1st. Diphtheria is an infectious disease, capable of being com- municated by inoculation. 2d. The substance for the inocula- tion of the disease must be fragments of the false membrane, or DISCUSSION ON CLINICAL MEDICINE. 561 that which, having been in contact with it, may serve as a vehicle. Vegetable organisms, bacteria, and the like, will not convey it. 3d. Diphtheria is not caused by the presence or action of bacteria, either in the rodlike form most commonly observed nor in the round berry-shaped monads called micrococci. 4th. Diphtheria is probably not due to primary blood-poisoning in all cases. 5th. Diphtheria is a septic contagious disease, char- acterized by a deposition of fibrinous membrane upon the pharynx and the mucous membranes of the air-passages. It is the result of a systemic infection by a specific poison, either through inoculation upon one of the integumentary surfaces or by inspiration with the lungs. The nature of this poison is at present unknown. As regards the first proposition, Diphtheria is an infectious dis- ease, capable of being communicated by inoculation, we would remark that while there has been no difference of opinion among the profession as to the contagiousness of this disease, there has been a strong party denying that it could be induced by inoculation. Trousseau, Michel Peter, and Raynel all failed in their attempts at inoculation. Dr. Harley, in his ex- periments upon animals, was no more successful, and, indeed, the Encyclopedic Dictionary of Medical Science states that it is impossible. Dr. Squire, the author of the article upon diph- theria in Reynolds's Practice of Medicine, seems to coincide with this statement. But this negative testimony does not invalidate the positive assertion of other experimenters. The success of inoculation cannot be assured in any case, as they seem to be influenced at times by conditions that are unknown to us. We have all failed in first vaccinations with the same lymph that had been successful in other cases, and yet upon subsequent efforts have been entirely successful. Trendelenburgh and Oertel, in their experiments upon rabbits, were both successful in transmitting the disease. Ilueter, To- massi, Nassiloff, of St. Petersburg, Ebert, Gabriel Duchamp, and others, were all more or less successful. At this point we may observe that this inoculation must be of true diphtheritic membrane, and not the membrane of true croup. We must remember, however, that the words are used interchangeably by some of the European writers. The efforts to induce the disease by inoculating the membrane of true croup have as yet been unsuccessful, and this may, perhaps, present one diagnostic mark between the two diseases; diphtheria being both contagious and communicable. It is rather remarkable that so learned a man as Professor 562 world's homoeopathic convention. Johnson, of London, should insist, as he does in a late number of the Lancet, that there is no distinction between the two dis- eases. I think most American practitioners consider it as strongly marked. It is to be observed also that the elements for this inoculation are not vegetable organisms, but parts of the false membranes themselves. Duchamp formulates the results of his experiments as fol- lows : 1st. The false membrane of diphtheria transferred from the larynx of a man into the larynx and trachea of the rabbit, can give origin to the diphtheritic process. 2d. In the absence of false membranes, the products (bacteria, vibriones, etc.) collected in the larynx of a man suffering from croup, and transferred to the rabbit, appear to lose that peculiarity, whilst they are very noxious. 3d. False membranes injected into the jugular vein or cellular tissue of the rabbit, rarely produce diphtheria, but more generally phlebitis or septicaemia. 4th. These products put under the epidermis and inoculated cutaneously gave negative results. Thus it appears, that if the false membranes are placed in contact with or under the epithelial covering of the mucous membranes of animals, diphtheria will be induced, but that the substance inoculated must be portions of the mem- branes themselves, and not the bacteria, vibriones, etc. As an argument in favor of this position it may be stated that Pasteur has lately changed his views in regard to fermentation and putrefaction, contending now that these processes are not due to organisms. One of his later experiments was suspending grapes in an atmosphere of carbonic acid, when they were found to undergo fermentation so as to generate alcohol and other prod- ucts even without the presence of torulseand other organisms.* Hiller, also, in an experiment with eggs, discovered that bacteria injected into fresh eggs did not change them, while contact with rotten eggs did. After inoculating animals with bacteria obtained from various kinds of decomposing substances, they exhibited no septic symptoms, though on the second day the temperature rose about 2° F. On the third day, when the points inoculated were opened and examined, some bacteria were found, but on the eighth day there were none. When bacteria were intro- duced into the blood-currents, they gradually disappeared, and could not be found at all, though in blood exposed to the air they multiplied rapidly. Panum, of Copenhagen,f boiled the * Vide Bastian in London Lancet, April, 1875. f Vide Virchow's Archiv, lx, 1874. DISCUSSION ON CLINICAL MEDICINE. 563 putrid matter that bad produced infection in rabbits and main- tained the boiling temperature for hours. Having thus de- stroyed all bacteria he subjected the virus to other conditions, but the liquid was still virulent. It will thus be seen that in diphtheria the false membranes must be employed, and that even in septic poisoning, the virulent matter is not the bacteria, but the septic material, whatever that may be. A point that will be of importance to us practically, and that will be hereafter spoken of, may be alluded to here. Disinfect- ants that destroy bacteria do not destroy the virulence of contagious products. Dr. Edward Curtis* found that Salicylic acid in the proportion of 1 to 100 with a little Phosphate of soda as a solvent, and Carbolic acid of the same strength, have each of them the power of preventing the formation of bacteria for a period of two months at least. The acid solution was thus used to determine if it would destroy theinfective power of tongue scrap- ings. But it was found not to have any effect upon the poisonous quality of the matter; and the lesions, though without bacteria, appeared as usual. Dr. Dougall, of Scotland,f found that Car- bolic acid in concentrated solution prevented the development of ordinary bacteria. Under certain conditions it suspended but failed to destroy the virulent properties of vaccine virus. Dr. Sa tterth waite, of New York, was cognizant of the experiments of Dr. Curtis, and substantiates their accuracy. The conclusions to which he arrives as reported in the Medical Record of De- cember, 1875, are highly interesting. I have time to quote but one of his positions. He remaks that the granules (micrococci) have not been produced from bacteria in a number of instances, when placed in a suitable condition to do so. 3d. Diphtheria is not caused by the presence or action of bacteria, either in the rodlike form most commonly observed, nor in the round berry-shaped monads called micrococci. The position of Oertel is directly to the contrary. He says : " There can no longer be a doubt after the statement of such facts, that these vegetable organisms are not of accidental occurrence, but are inseparable from the diphtheritic process, just as the bacteria of decomposition are necessarily connected with decay and act as a ferment of it. Without micrococci there can be no diph- theria.^ We have already seen that according to Pasteur, bac- teria are not necessary to fermentation, and possibly some of Oertel's other positions are equally untenable. The story of the * Medical Record, vol. x, p. 854. f Glasgow Medical Journal, July, 1875; Sanitarian, September, 1875. J Ziemssen's Cyclopaedia of Practical Medicine, vol. i, p. 592. 564 world's homceopathic convention. chase after vegetable organisms as a cause of disease is a very pleasing, almost an exciting one. But as yet it would seem it has been almost bootless. And diphtheria has been no excep- tion in its ability to hide its origin in the arcana of the unknown. Letzerich was sure he had found it, and even proceeded to name his discovery " Tilletia Diphtheria," pronouncing its presence pathognomonic of the disease.* But Duchamp was never able to recognize this parasite. Trendelenburgh denies the existence of the micrococci, and Wagner, Senator, Robin, Peter, Cham- beau, and Laboulbene deny the discovery of Letzerich. Du- champ found some granulations of a yellow color and high refractive power, which he thought might be the " Tilletia Diph- theria," but by inoculation they did not cause diphtheria, but symptoms of septic infection. Chouveau asserts that they could be found in the blood of persons who have died of variola or erysipelas. Dr. Charlton Bastianf states, " That the virus or contagion of these zymotic diseases, whatever it may be, does not exhibit the properties of living matter." Sir William Jenner is certain that vegetable growths were not present in several cases of diphtheria that he examined. These bodies, or what is supposed to be them, are among the minutest revealed to us by the highest powers of our microscopes. They have been found in almost every part of the body. In the mouth and about the teeth they are abundant. And they have been found in the blood in health as well as in disease. Beale says of bacteria generally: "It is difficult to say where bacteria germs do not exist. In the air, in water, in the soil, adhering to tiny particles of every kind, in every region of the earth, from the poles to the equator, they are to be found. At all periods of the year they retain their vitality. Extreme dryness does not de- stroy them and they withstand a temperature far below the freezing-point. Under adverse circumstances they remain dor- mant, and are not destroyed by a,degree of heat which is fatal to every other organism. Dr. Bastian tells us that living germs of bacteria are destroyed at a temperature of 160° F.; but others are of opinion that at least under certain circumstances, bacteria germs do not die at 212° F., and may increase and multiply after having been exposed to this high degree of heat. In the substance of the tissues, nay in the cells of almost all plants, and in the interstices of the tissue of many animals, bacteria germs exist. Upon the skin and the surface of the mucous membranes they exist in profusion, they abound in the mouth, and in the * Medical Record, vol. x, p. 22. f Address before the London Pathological Society, April, 1875. DISCUSSION ON CLINICAL MEDICINE. 565 follicles and the glands. And I have adduced evidence to show that bacteria germs exist even in healthy blood; passive as long as the higher life is maintained in its integrity, but ready to grow and multiply the instant a change favorable to them and adverse to us shall occur."* With regard to that peculiar form of bacteria called micrococci, the evidence of investigators proves their presence in many con- ditions not diphtheritic, and that, contrary to Professor Oertel, that are not pathognomonic of the disease. Dr. J. L. Smith, working in conjunction with Dr. Heitzman, of Vienna, found micrococci in abundance in the inflammatory product of pharyn- gitis, both diphtheritic and non-diphtheritic.f Cohn found them in vaccine lymph in 1868. They were found in the early stage of the disease before the eruption, and hence were thought to have some causal relation to it.J Wladimir Lukowsky, in a paper to Virchow's Archiv, states that in an examination of nine patients who had died of erysipelas, he found that in those cases in which the disease was recent, or still in progress, micrococci were found in great abundance in the lymphatics and serous vessels. But, when the process was retro- gressive, none were met with. Phlegmonous inflammation of the skin could be produced by the subcutaneous injection of the fluid containing micrococci, which, however, differed in some points from erysipelas. But if a wound was painted over with the fluid containing this form of bacteria erysipelas was produced.§ Bill- roth found micrococci in putrid blood.|| They have also been found in one instance in the exudation on the cardiac valve of a puerperal woman, who died by septicaemia, having no diphther- itic symptoms.^ We think our position is sufficiently sustained, and forbear further authorities upon this point, and that it must be conceded that micrococci are not special parasites of diphtheria, and pathog- nomonic of it, and that there is no relation of cause and effect between them. There seems to be a tendency in these monads to form and multiply wherever diseases of a low and putrid type are present. The conditions of moisture, heat, and nutrition, then, seem most favorable for them; and hence they exist because of these dis- * London Lancet, June, 1875. f Vide Virginia Medical Monthly, February, 1875. j Virclyw Archiv, 41, 42, 1867-68. $ Medical and Surgical Reporter, vol. xxxii,p. 332. || Medical Record, vol. x, p. 267. Ibid., vol. x, p. 41. 566 world's homoeopathic convention. eases, but do not cause them. As a practical inference we would deduce the conclusion that those measures having' for their ob- ject merely the elimination of bacteria have no necessary influ- ence in aborting or modifying the disease. 4th. Diphtheria is probably not due to primary blood-poison- ing in all cases. The fearful examples of this disease caused by inoculation, the death of those eminent physicians whose names are familiar to us, the many illustrations given in our textbooks, and the more vivid ones with which the mind of almost every member of our profession is stored, all seem to indicate that the local infection may so modify the blood as to induce the general disease in its most malignant form. The subsequent deposition of membrane being, however, not by continuity with the primary inoculation of necessity, but may be upon any part of the mucous membrane. 5th. Diphtheria is a septic contagious disease, characterized by a deposition of fibrinous membrane upon the pharynx and the mucous membrane of the air-passages. It is the result of a sys- temic infection by a specific poison, either through inoculation upon one of the integumentary surfaces, or by inspiration with the lungs. The nature of this poison is at present unknown. It is probably rather premature to discuss this last proposition at the present time. I may be allowed to indicate a few of the various theories that have been advanced as to the character of this un- known cause. Professor Johnson, of London, says it is the sewer gas, and the effect of drains not properly emptied and ven- tilated. Dr. Salter, of Toileshunt D'Arey, in Essex, believes it to be sewage poison, either gaseous or liquid.* Dr. Shrady, of the Medical Record, in an editorial, adduces arguments to prove that it is filth. Professor H. R. Nash, in a paper before the American Public Health Association, contends that it is sewer gas, and gives instances in support of his proposition. Professor Richardson, F.R.S., eliminated from the peritoneal fluid from the abdomen of a woman, who died of pyaemia after ovariotomy, a substance which he designated " septine." This substance has all the virulent powers of the poisonous blood itself. Its action, according to Dr. Richardson, is, that it exerts its deleterious powers through the property it possesses of setting at liberty the oxygen of the blood in undue quantities in the extreme circu- lation. His experiments, which are very interesting, may be found noted in detail in the June number of the London Lancet for 1875. * London Lancet, 1875, p. 133. DISCUSSION ON CLINICAL MEDICINE. 567 Respecting the treatment of this disease, the few thoughts I shall give will be but supplemental to those advanced by Drs. Lippe and Joslin. As to local appliances, we are to remember that there is a poison present at the seat of the local manifesta- tion of the disease, and that if reabsorbed it will intensify it. Hence the local applications must be such as will counteract and destroy septic poison, and not merely be anti-microphytics. Carbolic and Salicylic acid being thus of very doubtful utility, Sulphurous acid, Chlorine, Bromine, and Chlorine water may be of service. The latter has been given very successfully by allo- pathic physicians, in drachm doses, every three hours, as an anti- septic. Gargles of brewers' yeast are also highly useful in cleansing the parts. It being a disease of an adynamic type, alcohol in solution, 1 to 3 drachms, every four hours, has much to recommend it in malignant cases. But, above all ex- traneous measures, the remedy selected according to our law of the similars must be most earnestly persevered in; feeding the patient at the same time constantly and persistently. In the ordinary catarrhal forms of the disease we must remember that its course is downward towards the larynx and bronchia, and as much as possible we must guard by our remedies the track of mucous membrane below the disease. If diphtheritic croup sets in, with its hoarse cough and suffocative breathing, the case is a desperate one, though by no means hopeless. The room should be kept saturated with steam, and at a temperature of 90° F. The medicines, if not otherwise efficient, especially if Bromine is indicated, had better be administered by the aid of the atomizer, a funnel being provided to protect the face, through which the air loaded with the spray may pass. It is thus brought into direct contact with the most dangerously diseased surfaces. A solution of the Bromide of potassium may be a convenient form for the administration of Bromine. The Liquor calcis chlorin- ake, as recommended by one of the honored physicians of our own school in this our Centennial city, will, of course, not be for- gotten. But if these passages seem closing up, and air can scarcely be introduced into the lungs, we still have appliances for aid in the various emetics. The new drug Apomorphia is valuable; but that which in my opinion is the best, because of its not producing any depressive effect, is the yellow Sulphate of mercury, which, I am sure, has saved a number of lives for me, both in membranous croup and diphtheria. But if all these measures fail, and our patient should be slowly sinking into stupor and death, our friends the surgeons must come to our aid. 568 world's homceopathic convention. Dr. G. H. Wilson, Conn.: We know that regarding the ancient history of diphtheria there has been very much uncer- tainty. Since 1850 we have been examining it more carefully in this country, as its first appearance dates within that time, as also within that time dates the introduction of the use of petro- leum in its various degrees of purity, and which is used as an illuminator in our domestic circles ; I see and smell as I have heretofore seen and smelled it, but I wish to bring this to a mathematical test, and to show why I have adopted the hypothesis that it certainly aggravates if it does not actually produce diph- theria. My attention was first called to it when we used petro- leum, in a very impure form, about the years 1853 or 1854, when in this country, according to the statement just made, 20,000 lives were sacrificed to this disease; and while it has not since that prevailed to such an extent, it yet frequently appears in dif- ferent localities, extending from the first case and easily traceable according to its contact with other families during its ulcerative and other severe forms. Now in order to subject this theory to a mathematical test in the town of 15,000 inhabitants where I live, and in which 78 deaths from diphtheria occurred in 1875, I made a map of every case, so far as possible, but certainly of every death, locating it on the street map of the town, and I traced these cases from one to another, connecting their histories ; after observing all the proper conditions I found that not one death occurred in a house where gas was used, and 78 deaths oc- curred in houses where kerosene oil, or naphtha, or other forms of petroleum were used. I present this not as an original idea, but because in Brooklyn the same idea has lately been advanced, and because I wish those who live in the neighborhood of oil refineries to observe this point more carefully. In Cleveland, Brooklyn, and Cincin- nati, where the trade in kerosene is very extensive, there are abun- dant chances for such observation. It may not be owing to the trade in kerosene, because where lamps are left on the mantel- piece the effects of the kerosene become very apparent, as there is a deleterious gas given off from the lamp. T. L. Brown, M.D.: Dr. Lippe says that "All so-called disinfecting agents, with the exception of charcoal, must be ban- ished from the apartment, as the patient requires the freshest obtainable air, and all disinfecting agents, charcoal excepted, communicate their qualities to the air to be inhaled by the sick, and the most dangerous of these agents is Carbolic acid." Are disinfecting agents harmful when homoeopathically selected, and must all but one of them be banished ? DISCUSSION ON CLINICAL MEDICINE. 569 We think that the same rule which persuades us to retain one disinfectant as the right remedy should retain any other in like circumstances. If charcoal should be used, and all other tested rem- edies, because they are called " disinfecting agents " that are capa- ble of affecting the patient through the medium of the air, should be discarded, it proclaims a kind of favoritism for charcoal, both, unsafe and unwise, if not wholly empirical. Carbolic acid should be used only when indicated by the light of the homoeopathic law, and it can be diluted until its curative action is manifested independent of any power to harm the patient. The parasites are the real danger to the patient; and what shall we do? They are in the air, and enter the blood through the lungs as well as by means of the fluids taken into the mouth or stomach, and why should they not be destroyed in the air and in the patient by using one of the many disinfecting remedies, and thus treat the patient successfully? Did Hahnemann object to inhaling the remedy in a sufficient quantity to cure? Can there be a genuine case of diphtheria without the presence of the vegetable parasite, the real miasmatic contagion which produces and continues this disease? Will experience and ob- servation in our present state of medical knowledge compel us to exclude the single well-selected disinfecting agent as dangerous or useless because we diffuse it through the air of the apartment? I can see but very little if any difference in the effect of remedies when taken in curative doses, either through the lungs or stom- ach ; the known object in the successful treatment of this and all zymotic diseases is to prevent the formation of vegetable para- sites, and to destroy those already formed; and if good air, nutri- tious food, cleanliness, sleep, rest, and pure water are sufficient to remove and destroy these parasites, why give any remedy? Alcohol, Permanganate of potash, Chloride of lime, Iodine, Bromine, Sulphur, Carbolic acid, Brown's Chloralum have been known to kill these parasites in the air or in the patient, and these remedies also cure diphtheria. Destroy the miasmatic contagion, the parasite, and the spread of the disease is prevented and the cases are cured. In most localities, where diphtheria prevails in its worst forms, some sink-hole of filth can be found where Carbolic acid, Lime, or some other disinfectant will do more than any other means to prevent disease and cure our cases; and a wise law is in force in some cities compelling the physician to use some disinfectant or suffer the penalty of a fine. Now is it not better to use these agents under the light of our law of cure than to discard them, as Dr. Lippe advises? I apply Lime, or some one of the other disinfecting agents in all the localities near o o 570 world's homceopathic convention. the patient, where the parasites or miasmatic agents could possi- bly be generated, and use only one remedy in each individual case, considering this the safest and most intelligent method of practicing our noble and useful art. Lime is oftener needed in children, alcohol in full-grown and mature men, Permanganate of potash in older children and women ; these are the three most efficient remedies we have to destroy the diphtheritic parasites, and we prescribe the remedies of Hahnemann to restore the pa- tient to health. T. 0. Duncan, M.D, Chicago, Ill.: I wish to speak on Dr. Joslin's paper. In 1807 Napoleon the First, after the death of his nephew, the Crown Prince of Holland, offered a prize for the best essay on croup; and although eighty-three essays were writ- ten, in none of them was any remedy given for this fearful dis- ease. With us it is different, for in no disease has homoeopathy gained more triumphs than in the treatment of croup; and as to the identity of croup, it was settled years ago by Drs. Bretonneau and Brezon that there are distinct diseases included under the term croup, namely, stridulous laryngismus, and pseudo and membranous laryngitis. I find this position accepted by such Continental physicians as Binche, Herman, Vogel, Verdi, and it is disputed by English authorities as West, Benner, etc., but is again reaffirmed by American writers as Condie, Meigs, Pepper, Smith, H. N. Guernsey, etc. In Chicago we meet with two dis- tinct diseases under the head of croup; in one the child is well during the day, but at night has a low croupy cough; it may be hoarse at night and croupy at other times, especially in the day; the throat is slightly congested, and the first attack is usually the worst one. The second disease is membranous laryngitis, and is preceded by a catarrhal fever, the child grows more hoarse towards night, and continues to have during the day a harsh cough, which continues until the voice becomes gradually hoarse, then whispering, indistinct, and finally the throat becomes much congested; the character of the first disease is abrupt, spasmodic, while the latter is insidious and persistent; the former never runs into the latter, but is present more often in fair, nervous children, while the latter is met with in fleshy, phlegmatic, hy- drogenoid constitutions, and this is why in healthy England so much of the pseudo-membranous disease has existed that the spasmodic form of the disease has been ignored. I have seen stridulous laryngitis in fleshy children, and membranous croup in spare, nervous children, however. I have taught my pa- tients to recognize the abrupt, frightful, spasmodic laryngitis, so that I now seldom see a case, as a warm or cold wet pack applied DISCUSSION ON CLINICAL MEDICINE. 571 to the throat is usually all the treatment needed. I caution my patients against the use of Syrup of ipecac, thus avoiding a severe case of capillary bronchitis, which that drug is almost sure to induce; I also warn them not to neglect an insidious croupal cough, and to notify me at once if the children are lymphatic. An emetic given in the first stage of membranous croup simply hastens its development and adds to its severity, and this is one reason why this disease is so very fatal under the old-school treatment. In membranous laryngitis we have not so much to combat tracheal or laryngeal inflammation as an ob- struction of the absorbents, and Carbo veg. is the first remedy. Aconite rarely follows Hepar; but if the diseased condition prog- ress I know of no remedies so often indicated as Kali carb., Kali bichrom., and Kali permangan. Other remedies may be indicated in other cases. The mortality in both these diseases is very small; I have never lost a case of either. The diphtheritic croup is not a distinct disease, but is simply the extension of the diphtheritic inflammation throughout the respiratory tract, and this condition foretells the approaching paralysis of the pneumo- gastric, and a more severe paralysis of the glosso-pharyngeal tract, which is said to occur in one-fourth of the cases. Diph- theria affects most severely electro-negative persons, and is most amenable to electro-negative remedies. I now desire to call your attention to the relation between obstruction of the liver, hypertrophy of the liver, and follicular deposits; dry, clear weather seems to stimulate the liver; damp weather obstructs it, and also tends to induce follicular derange- ments. I wish to refer to spasm of the glottis, which, I think, is not a local disease, but a neurotic, and seems to prevail as an epidemic; during the past winter I met many cases, but had not seen a case before that since 1873; and Cuprum was the remedy for the epidemic of 1873, and also for that occurring in 1876. Albert Haupt, M.D., of Saxony: The fact that very often articles on diphtheria appear in homoeopathic publications, and among the writings of members to our Convention, shows clearly that not only the old school, but ours also, has not yet reached the surety in the pathology and therapeutics of this disease which would make superfluous any discussion, and, I think, we ought to be very thankful to Dr. Joslin, of New York, and Dr. Lippe, of Philadelphia, for presenting to us their very interesting pam- phlets on diphtheria. In no other epidemic sickness has the theory of microscop- ical mushrooms, as causa morbi, made so many proselytes as in 572 world's homoeopathic convention. diphtheria; and I see with pleasure that also amongst the American homoeopathists I have companions in professing this doctrine. I now wish to enter upon the discussion of the two monographs laid before us. You know that, according to this theory, diphtheria is pro- duced by a parasite of the family of Schizogmyutes-the lowest step of vegetation-called micrococcus diphtheriticus. I always found it in preparations made of fresh, and not externally treated diphtheritical membranes, under the microscope, magnifying 650 times; an egg-shaped, or round yellow-brownish corpuscle of nearly T$fa millimeter diameter. The different species mentioned by Dr. Lippe are partly different accumulations of the micro- coccus, which appear single, or partly strung together, or united into stripes or balls, partly different bacteria, which does not produce diphtheria, but putrefaction, and can be seen only when the pathological membranes occur in this state. The parasite brought by the air, or other medium, upon a permeable mucosa, introduces itself and multiplies rapidly, destroying the ground on which it lives. I do not doubt that for a short time the dis- ease is local, and that in this period cauterization may be suc- cessful, as we really see sometimes in the practice of allopathy; but very soon the micrococcus penetrates into the lymphatics and bloodvessels, and then the disease becomes general. The appli- cation of caustics is then not only unreasonable, but also dan- gerous for the patient, exhausting his strength, and favoring the rapid entrance of the parasite into the blood. When diph- theria has become general the micrococcus is to be found in the blood (between and upon the red corpuscles, which are com- passed considerably by the parasites in number), the muscles, the glands, the nervous system, the liver, the heart, the kidneys, and even in the bones. Its presence explains all the symptoms of the disease for which the adversaries of the mushroom theory have only more or less spiritful hypotheses. Dr. Joslin says : " A very characteristic symptom is a swelling of a lymphatic gland near the angle of the jaw, evidently arising from irritation by matter taken up by the lymphatics from diph- theritic exudation." Well, gentlemen, this matter is the micrococcus, which you will find in incredible numbers in the glands when you make the section of a diphtheritical dead body and the microscopical examination. The febrile symptoms to which the author calls our particular attention depend upon the power of reaction which the patient's organism may develop against the hostile agent, and from the DISCUSSION ON CLINICAL MEDICINE. 573 quantity of the parasites existing in the blood, whose oxygen and nitrogen it generates, poisoning the liquor vitae with carbonate, and impoverishing it of fibrinum. From my point I can, therefore, not agree with Dr. Lippe when he declares: " Never force a patient to take food. Food taken against the inclination will not be digested, and is only a hinderance to the recovery." This advice, so excellent for other diseases, cannot have good results in diphtheria, when the sick want a quick restitution of the nutritive elements diminished by the parasites. In fact I have seen in the practice of one of my friends some cases in which the diphtheria, although passed entirely, had a fatal result only because it was impossible to make the patients eat. Dr. Joslin, though he seems not to be a friend of the mush- room theory, is in this respect of my opinion ; he says: "I usually give milk punch and beef tea alternately; a gill each, every alternate hour or two." A very strong argument for my dogma I find in the words of Dr. Lippe: ''Unfavorable symptoms, which may appear while the diph- theritic deposits are spreading, are: Diminution of (albuminous) urine, or an entire suppression of urinary secretion;" and I will tell you why 1 The kidneys are the organs which purify the organism of the parasites ; therefore they are crowded with micrococci, which irritate and obstruct the urinal canals and cause albuminuria. Letzerich took out of the urine, which in severe cases of diph- theria is filled with the parasites, by means of a very careful filtration, the micrococcus; put it into milk, and made with this inoculation on rabbits, which produced without a single failure diphtheria. You see that when the expulsion of the parasites by the urine is interrupted the disease must take a dangerous turn. Coming now to the treatment of diphtheria, it is in my opinion a mistake to look only for remedies with disinfecting power, or only for those which show symptoms similar to the disease. The most satisfactory results will certainly be ob- tained by those which unite both these qualities; and I am very glad to state that all the remedies used by homoeopathists in the two hemispheres with the best results satisfy this con- clusion. There is to me no doubt that the homoeopathic physician who makes use of the well-known parasiticides, Acid carbolic, muri- atic, nitric., sulph.; Apis, Arsen., Brom., China, Sulph., lod.; 574 world's homceopathic convention. Kali bichrom., chlor., phosph.; Creasote, Mercurios in its differ- ent preparations, and Sulphur, chosen with the greatest care after our similia similibus, will certainly be as happy in the treatment of diphtheria as man can be. Gentlemen : It was not at all my pretension to bring before you new or undoubted truths, but only to give an impulse to those of you who are so useful in cultivating our wonderful homoeopathy in colleges or universities. This is the place for social discussions of which we are deprived in Germany, and for experiments with insulations on animals and microscopical examinations. You have amongst your professors such a great many very learned, ingenious, and indefatigable men, that I am fully convinced the American homoeopathic school will be able to solve the problem whether the mushroom theory is a truth, or only one of the medical fancies which come and go without any real practical use. E. B. De Gersdorff, M.D., Boston, Mass. : In the treat- ment of diphtheria, no allusion has been made to the importance of rest; I wish to acknowledge my indebtedness to two phy- sicians of England, where diphtheria prevailed extensively, just before it reached here, for their instruction upon that point, and also in the use of stimulants. Even with the use of stimu- lants, which I very strongly advocate, but without rest, very many persons would not recover even under the very best ho- moeopathic treatment; and I must say that, had I to choose be- tween giving the appropriate remedies, and making use of rest with a stimulating diet, I should decide in favor of rest and stim- ulation. Paralysis is the keynote to diphtheria, and compara- tively few cases die from diphtheritic croup; but far too many die from paralysis of the pneumogastric nerve and the consequent cessation of the heart's action. If a patient is kept in a reclin- ing position, and the pulse becomes a little irregular, stimulation for a few days will overcome the difficulty. I think we may be satisfied with our discussion on " Materia Medica " of yesterday, and "Clinical Medicine" to-day, for we find that, if the expounders of the modus operandio^ the homoeo- pathic drug are not all alike in their way of thinking, they do agree to the therapeutic method, to which we all, more or less, exclusively adhere. It is always more useful to invent a method than to discover a fact; for a method, while being followed, al- lows the analysis of a long series of facts, previously misunder- stood, or not seen at all. So in homoeopathy. Hahnemann in- vented a method, for such he called it, and his disciples formed a school, with dogmas, principles, and theories; and this method DISCUSSION ON CLINICAL MEDICINE. 575 makes us all homoeopaths wherever we use it, as the way to cure. But neither the various theories on life and disease, on force, ex- citability, or dynamics, nor theories on the modus operandi of the drug, and its dynamization and dilution, as entertained by the followers of Hahnemann, can have much significance one way or another, nor need they bring discord into our ranks. Yet I claim that the study of pathology has an influence upon ho- moeopathy. How do physicians become homoeopathists? I do not refer to those who learn the system from their alma mater, nor to those led by their enthusiasm, nor to those who take it up as a mere business; but I mean those men who have learned the use of drugs, and the habit of diagnosing by pathological re- search in other schools. Very many of the last-named come to us by perceiving that their search for the therapeutic agent by diagnosis is futile; but their pathology is behind their physiology and their therapeutics are behind their pathology too. They per- ceive that each case should be considered in accordance with the totality of its symptoms, which, indeed, is the one great Hahne- mannian proposition. I say, as many come to homoeopathy by that door as by any other, namely, those who despair of finding a direct remedy, after having stumbled among overestimated spe- cifics, and groped for anaesthetics, until the effects of these be- come worse than the disease. I think that Hahnemann himself was led to the promulgation of his method, which has made the tour of the world, more by this than by any other mode of reasoning. His distrust in the diagnosis of the learned men of his time proves to me that he stood in advance of them, and not that he ignored pathology! His rules for acquiring the symptoms of a given case are a masterpiece of clinical examination to this day, and need but little addition. Now, what I aim at by these remarks, is merely to speak for fairness and justice between the various expounders of the Hahnemannian principles towards each other. I know that some may never have reached a full stature in acquiring faith in a law of cure or a doctrine more or less connected with our method, such as dynamization of drugs by infinitesimal dilution, and yet they are men otherwise physicians; some there may be, who cannot perceive the necessity or the importance of certain subjective symptoms, which allow no pathological explanation ; they may even watch the pathological progress to a fault and thus overlook the most important business before them, namely, that of hunting after the best indicated remedy; others there are who never get rid of hindering and intervening 576 world's homoeopathic convention. doubts on the proving of our materia medica, and thus run into alternation or backsliding; while again on the other hand there are those, who with a happy and therefore self-confident facility execute like virtuosos that difficult art of ours, namely, the hitting of the right remedy. Who can say, which class leads the whole medical science more to progress, the doubter or the believer in any theory ? I think you do wrong in driving away the honest thinkers, certainly the faithful and honest meth- odists of our school, who, I trust, may be found on either side; these do the most good to the human race. It is with great pleasure that I have heard the papers on clinical medicine, especially the two or three on diphtheria; for I perceive that none of the writers have omitted to treat of the etiol- ogy and the pathology of this disease. These studies may per- haps never help us much in the performance of infallible cures of this scourge of the human family by homoeopathic remedies; but by tracing its sources among the zymotic diseases, or by studying the natural history of the bacteria or micrococci, or other animalcules, much good can be done for prophylaxis, which, next to curing, is the other great duty of the physician. The President, Dr. Dunham, declared the discussion on diph- theria closed and that upon intermittent fever opened. D. H. Beckwith, M.D., Cleveland, O.: The papers on in- termittent fever, prepared and forwarded to you by eminent physicians in Europe, I can only speak well of. They are above criticism, and will be read by those of us who practice medicine in malarial districts with great interest. The malarial poison that causes intermittent fever in this country will pro- duce the same train of symptoms in foreign lands, namely, the symptoms described in these papers. A remedy that will cure intermittent fever in Italy will cure a case anywhere if the symptoms correspond with the medicine to be administered. Travel all over the Centennial grounds, and of the 50,000 people that can be seen there, each will have his thousand pecu- liarities of constitution ; and thus it is with disease. For if these 50,000 people all had intermittent fever the physician would find in every case some peculiar type and some distinct and peculiar characteristic symptom which should be taken into account in prescribing. I find that in Dr. Charge's paper some fifty or sixty medicines are recommended and the symptoms enumerated; one of these remedies should be homoeopathic to almost every case of intermittent fever. Dr. Fanelli remarks in his pamphlet that Quinine is considered a panacea by the Italian allopaths, but that terrible effects are produced by its DISCUSSION ON CLINICAL MEDICINE. 577 indiscriminate use, and the same holds true in this country where Quinine is largely abused. I wish to call attention to a case with diarrhoea coming under my observation, where the patient had taken Quinine in. massive doses for nearly two weeks, at intervals of a few days, and had had twelve to fifteen stools daily; astringentsand opiates had been freely given without benefit, simply perpetuating the disease; there were a great many stools in the first part of the day, great thirst, slight cough, great prostration, great anxiety, fear of death, slow fever followed by a chill at the same time, the extremities being cold and the pulse but slightly accelerated. Iy. Arsenicum6, with a diet of boiled milk and flour, which cured the diarrhoea and in- termittent fever in forty-eight hours. In the papers under discussion reference is made to Eucalyptus globulus being planted on the banks of streams for the purpose of preventing intermittent, as the leaves contain a certain volatile oil which is said to absorb miasmatic poison, or it may be a specific; this oil has been known and used for years in Assyria and other foreign countries in the treatment of intermittent fever. The greater proportion of fevers that have prevailed in Ohio have been of malarial origin. The State of Ohio has on the north the Cuyahoga and Black rivers; on the east and south, the Ohio River; on the west the Maumee River, as well as the Maumee Swamp; through the interior of the State the Licking, Scioto, and Muskingum rivers. Small tributaries flow into the above-named rivers,-all of them passing through a flat and level country,-liable to have their banks over- flowed during the spring months, covering the lowlands with animal and vegetable matter, which being exposed to the rays of the sun, decomposition takes place, producing miasm. I apply the term miasm to an influence which is produced by a morbid principle existing in the atmosphere of a certain locality. For the past twenty years in Ohio the drainage of swamps and the lowlands have decreased the causes that produce intermittent fevers. And it is only within a few years that Italy has com- menced a thorough system of drainage; when it is completed the intermittent fevers that are so much dreaded will be greatly lessened, as they have been in Ohio. Italy is many thousand miles from us, yet we have the same train of symptoms in our patients that the Italian physicians have. Both locations have intermittent headaches, neuralgias, gastralgia, rheumatism, each disease often assuming an inter- mittent character. We know that along the banks of the Ohio, Muskingum, and Cuyahoga rivers, malaria has induced obscure 578 world's homceopathic convention. and anomalous forms of disease, which often impart new char- acteristic tendencies to every disease that may come within the sphere of its influence. Malarial poison undoubtedly affects the cerebro-spinal system, and the nerves distributed to various organs will develop its evidence by some functional derange- ment. So that diseases of the brain, heart, stomach, and liver, in females the uterus and such diseases, are complicated and of an intermittent type. Italy, besides its drainage, has planted in the low and marshy lands a tree called the " Eucalyptus globulus," which writers claim have very much lessened the number of cases of intermittent fevers in certain localities where the tree has been planted. The tree has a large healthy leaf which contains a large amount of volatile oil. The leaves have long been used in Australia to cure intermittent fevers, being prepared as an in- fusion. I have never heard any theory advanced why the tree should prevent intermittent fever. I would ask may it not be that the volatile oil which the leaves contain impregnates the atmosphere and acts as almost a specific antidote to malarial poison? The climate of Italy is considered the most genial of any in the world, and yet the mortality is greater in Italy than that in any other European country. No doubt that seven-eighths of all the diseases in Italy are produced by malaria. To produce this poison it has its lagoons and marshes, its rice and hemp fields, the overflowing of the Campagna, and its marshes around many of the small lakes and rivers. The inhabitants in many districts are poorly clad and subsist on a scanty, low diet, which renders their systems peculiarly sensitive to a poisoned atmos- phere. As soon as Italy adopts a system of drainage so that the uncultivated country can be settled, and adopts better sani- tary laws, it will be the home of many an American invalid. The Roman fever (which is nothing but an intermittent fever) will not be the dread of most travellers as it now is. Italy may be considered a healthy resort from the middle of October to the middle of June, much less intermittent fever being prevalent during that time. Mr. President, I would recommend every practitioner of medi- cine to study well the essays that we have heard on intermittent fevers from Europe, as they will make a valuable acquisition to our homoeopathic medical literature. Dr. Dunham : I am greatly interested in the papers on in- termittent fever and think they will be very valuable in our medical literature. L. E. Ober, M.D., La Crosse, Wis.: What I say is not by way of criticism, or in opposition to the doctrines advocated DISCUSSION ON CLINICAL MEDICINE. 579 in the papers presented, but to give my views concerning the origin of the malarious poison and the management of those afflicted with the disease. Dr. Fanelli, after referring to the prevalence of intermittent fever in the Italian peninsula, espe- cially in localities where there are stagnant waters, or in those subject to inundations, thus remarks: " With the approach of summer and a burning sun evaporation of these waters takes place, producing the miasms which are the cause of so many diseases, but especially of intermittent fever." Many years' ex- perience in malarious districts has taught me to suppose that marsh miasma which produces principally intermittent fever, is generated by the action of light and heat upon decaying animal and vegetable matter, which takes place upon the drying up of the water in marshes and its falling away in lakes and ponds, thereby exposing the debris there deposited to the direct action of the sun's rays during the summer months-this deposit being in a more favorable condition for decomposition on account of having been so thoroughly macerated while remaining under water. The same result follows upon turning to the surface alluvial soil, which has long been covered, thus exposing the decaying matter to the action of light and heat. Therefore when the marshes and low grounds remain covered with water during the hot part of the season, intermittent fevers are much less fre- quent; but when the water recedes during the early part of summer, exposing this decaying matter to the action of light and heat, this disease is much more prevalent. It appears that this miasm floats freely in the air, and that by the movement of atmospheric currents it may be carried to a greater or less distance from the place where it is generated, so that, as a rule, localities near and to the leeward of these places, during a malarious season, will be more exposed to intermittent fever than are those at the windward ; therefore, we can easily deduce from the above facts the sanitary rules which should be observed in all miasmatic districts. We have always noticed that the culti- vation of these alluvial soils destroys the malarious tendency in localities previously infected. The same rule applies in cultivat- ing swampy lands, which have been drained, unless they are subject to an annual overflowing, which causes a new deposit of animal and vegetable matter in a state of decomposition, which shall produce an annual crop of marsh miasm. I suspect the fa- vorable results following the cultivation of the Eucalyptus glob- ulus to be due, not only to the fact that it absorbs a large amount of humidity from the atmosphere, but more especially that it extracts a large amount of decomposing animal and vegetable 580 world's homoeopathic convention. matter and moisture from the soil, thereby converting what would otherwise be a prolific source of malarial poison to harm- less vegetable life. If, as has been intimated, the strong efflu- via exhaled from the Eucalyptus does, by its medicinal power, neutralize or destroy this poison, may we not suspect that such a poisonous agent in the atmosphere will also become a disease-producing power? My experience in treating inter- mittent fever has convinced me that, when this miasm is abundant in the atmosphere, a drug must be given which is capa- ble of destroying the action of this poison in the system, and break the paroxysm as soon as possible; and that if the patient continues within the infected district, the disease will be quite likely to recur, requiring a repetition of the same treatment, which, if long continued, will surely produce a drug disease, which must be met by the proper remedy. Or a combined drug and malarious cachexia will remain which is liable to ap- pear whenever from any cause the vital forces become impaired, thereby producing what is termed a masked intermittent, or of influencing any other disease which may chance to appear. I am of the opinion that the most safe and successful manner of treating intermittent fever is to select the drug most homoeo- pathic to the case, and the one best adapted to meet all the indi- cations of the epidemic constitution, then give a dose sufficient to break the paroxysm ; next, if possible, remove the patient from the infected district; at the same time continue the action of the remedy until seven days have passed, during which time the pa- tient must avoid exposure and violent exercise, take light, nour- ishing, and easily digestible food, being careful not to overload the stomach, and remain within the house during the dampness of the morning and evening; also, give the remedy every seventh day until twenty-one days are passed. In spring intermittents the remedies should be given in the higher or highest attenuation, and must be selected according to the totality of the symptoms during both the pyrexia and apy- rexia, providing the case shoqld be complicated by an existing cachexia. If not, the symptom of the pyrexia may be a sufficient guide for the selection of the proper remedy, always taking into consideration the prevailing epidemic constitution in deciding the choice of the remedy. Dr. Dunham : I would state that applications for member- ship in the American Institute of Homoeopathy should be handed in at once, that the names may be reported for election at 9 o'clock to-morrow morning. I also wish to say that the Treas- urer will receive the dues at any time the members choose to DISCUSSION ON CLINICAL MEDICINE. 581 visit him, and also would give notice that there will be a meet- ing of the professors of the various homoeopathic colleges on Thursday morning, the 29th instant, at 8.30 o'clock, for the purpose of discussing college affairs. All interested in that sub- ject are requested to be present. J. C. Morgan, M.D., Ann Arbor, Mich.: I think the etiology of intermittents is assumed to be due to some poisonous agent, and I wish to protest against so unscientific a position, and to declare we assume that which has never been demonstrated, as many are thus led to entertain the idea that we must give a medi- cine that is an antidote to this supposed poison. I remember an old allopathic doctor in Illinois, who explained the action of Quinine in intermittent fever as follows: "I think the Quinine goes in there and finds the malarial poison, and having a nat- ural affinity for it they attack each other, like two Kilkenny cats, and destroy each other." Now that is about as scientific an explanation of the action of .Quinine as the supposition that malarial poison must be antidoted. If I am in a malarial district I am satisfied if I keep my skin in a comfortable condition ; and, were it not too boastful, I would say that I should not be afraid to travel the continent of Africa as I traversed the Gulf States during the war, provided I could keep my skin comfortable, and avoid disturbing my digestive organs, and in case of any exciting or depressing cause take a dose of Gelsemium. If any one fears the approach of malaria let him take Gelsemium 6X, taking at the same time rest and avoid- ing all irritating conditions of body, and in a few hours the mor- bid symptomswill disappear; this I have proven many times when I have been exposed to malarial influences. Let a person go out with a fortified system, properly nourished, protecting himself against the morning or evening chill, which is vaporized in the atmosphere, and he will not need prophylactic remedies. I think I may say a word from experience. During the war I travelled throughout the whole Confederacy, taking the needful precautions against this disease, and I was always well; the only instance in which I contracted fever was under circumstances where I could not properly protect myself, but was for three weeks exposed daily and nightly to vapors, wet roads, and wet clothing; then my skin not being in a good condition I contracted a severe fever. I traced the causation of many attacks occurring in the army to similar conditions, and the day that I was placed in the hospital about three thousand men were disabled and placed in hospitals ill with the same fever. Many diseases, such as diarrhoea, dysentery, pneumonia, etc., 582 world's homoeopathic convention. may depend on or be associated with a malarial condition, and this is an important factor in its treatment; for if there is a rheu- matism, or a dysentery, or diarrhoea, or pneumonia of an inter- mittent character, with chill, fever, and sweat more or less com- pletely marked, and if the local disease can be cured with the appropriate remedy, then the intermittent condition is also re- moved. But there are many cases where those clear therapeutic signs are absent, and there is but little by which to distinguish the case beyond the fact of a chill, fever, and sweat now and then. Gelsemium will cure ninety-nine cases out of a hundred of simple and uncomplicated cases, whether it be given in the 1st, 3d, or 6th potency, according to the locality. In North Carolina and Mississippi I gave the 1st, while in Louisiana I gave the 6th, but I do not know the reason for the necessity of different strength to the medicines in different localities. Gel- semium could in many cases be superseded by Capsicum; and where neither remedy will answer Bryonia is most important, as in complicated cases that will not yield to the two former remedies Bryonia 2° will cure. Dr. Pierson advises giving only one or two doses daily; but my experience teaches that Bryonia should be given every two hours during the pyrexia, even when there is but little fever, only premising that the medicine is to be suspended if a high and dry fever supervenes, and after twenty-four to forty-eight hours of this kind of treatment use Natrum muriaticum. I have suc- ceeded admirably with Quinine in the 200th potency when there were present bilious symptoms, not so marked in bilious vomiting as under Eupatorium, with pain in the body; if suffering most intense pain in the head, the head pain being the most severe. These bilious symptoms have been considered in the West to belong to Eupatorium more especially. Dr. Dunham: This closes the debate on intermittent fever; the next subject for discussion is pneumonia. G. H. Hayward, M.D., Liverpool, England: Pneumonia is, perhaps, of all diseases the one that most perfectly demonstrates itself, its course and progress, and its termination, by physical signs; as Sir Thomas Watson says, in his Practice of Physic, "All the symptoms that give us the most sure information respecting the nature of the disease, the event to which it tends and the remedial treatment it requires, spring out of the actual changes wrought in the pulmonary substance itself; and these changes are disclosed to us by auscultation." The pathological state, then, being pretty uniform, the physical signs pretty generally the same, and the objective symptoms not deviating much from what DISCUSSION ON CLINICAL MEDICINE. 583 is usual, nor even the subjective symptoms being very greatly different in one case from another, it is reasonable to conclude- as in truth is the fact-that the treatment is pretty well settled and nearly uniform for all cases of simple uncomplicated pneu- monia in healthy persons. Indeed, the editors of the British Journal of Homoeopathy remark that, "We may say that our knowledge of the treatment of pneumonia is as perfect as is our diagnosis of the disease." This is, perhaps, saying a great deal. It is, however, fully justified by the facts of the case; that is, by the knowledge that we have substances which produce not only the subjective symptoms and the objective symptoms, but also the absolute pathological states manifested by pneumonia in almost all its stages and almost all its varieties. We have, for exam- ple, Aconitum, Baptisia, and Gelsemium, which produce the vascular excitement and irritation, and the general congestion of the pulmonary tissue; we have Phosphorus, Bryonia, and Tar- tarus emeticus, which produce inflammation of, with exudation into the pulmonary substance, the air-cells, and minute bronchial tubes, and on the investing pleuritic membrane,-the spleniza- tion and red hepatization, with the pain and dyspnoea; and we have Mercurius, Hepar, Sulphur, Lycopodium, Sanguinaria, etc., which produce conditions resembling the chronic pathological states of this disease. We may, indeed, say that with the means at our disposal every case of simple uncomplicated pneumonia in healthy persons ought to be cured, if only the treatment be begun before the commencement of gray hepatization. No such case ought to die. In undertaking the treatment of a case of pneumonia there are many modifying points to be considered. For instance, Is the constitution of the patient ordinarily healthy? Is it phthisical, strumous, syphilitic, rheumatic, mercurial, or alcoholic? Has it been reduced by fever or other exhausting disease? Is the heart healthy ? The liver, and the kidneys ? As to age, is the patient an adult, an aged person, or an infant ? How is the body built up? Does the bony system predominate? The muscular or the nervous? The vascular or the respiratory ? Is the in- dividual dark, fair, florid, wiry, or flabby? As to the organ in- flamed, is the inflammation confined to the air-cells or to a lob- ule, or does it involve a whole lobe? Is it parenchymal, or principally bronchopneumonia, or pleuropneumonia? As to the stage of the disease, is it the initial chill stage, in which there is not much fever, but principally harsh puerile respiration in the part, or is it the first stage of the reactive fever, with vascu- lar commotion, and fever out of all proportion to the local mis- 584 world's homceopathic convention. chief? Or, is it the stage of splenization, red hepatization, or gray hepatization, of suppuration or of mortification ? Hav- ing mentally answered these questions, the next inquiry is as to the medicine. Now, in this respect, we have reason to be ex- tremely well satisfied, for we have medicines that present the similiato the disease in almost all its stages, and almost all its varieties, to bespeak the exact sphere of their usefulness in pretty distinct tones. And fortunately we are not much embar- rassed with their number, for about twenty will, I think, provide for at least 999 out of 1000 cases. These are Aur., Bap., Gels., Phos., Bry., Tart., Scilla, Chelid., Cactus, Ipec., Mer., Hep., Lyc., Sul., Sang., Sil., Crotal., Ammon, c., Rhus, Arsen., Carb, v., Chin., Seneg., and what is perhaps more fortunate still, most of these are medicines whose pathogenesy and sphere of action are so completely known as to enable us to assign to each one its proper place in the treatment of this disease. In the further study of this question we might begin with the medicines, taking each one separately and enlarging on its special applicability in this disease; or, we might begin with the disease, taking it as it manifests itself in the different aspects, to which I have referred,-• in the different temperaments, ages, stages, etc.,-and grouparound each the medicines most frequently indicated, with their charac- teristic symptoms and keynotes. But time would fail me, and I must only further add that in all attacks of simple uncompli- cated pneumonia in healthy adults, in either the initiatory chill stage, or in the early reactive fever, or the stage of simple vas- cular engorgement, there is, in my opinion, no remedy equal to Aconitum, nor is any other required; a few doses of Aconite in one of the low potencies every two hours will almost always ar- rest the morbid process within twenty-four hours. If the mor- bid process has already run-on to actual inflammation, the sphere of Aconite has been superseded by that of Phos., or Bry., or Tart. Phosphorus is the remedy in almostall cases of simple pneumonia, bronchopneumonia, and pneumonia of children and aged persons. We all remember that Dr. Fleishman, of Vienna, has satisfactorily established this as the specific remedy for almost all such cases. In like manner Dr. Tessier, in Paris, has established the reputation of Bryonia in almost all cases of pleuropneumonia. In all such cases a few drops of one of the low potencies, given at intervals of two hours, will, as a rule, break up the disease by the end of the first week, or at any rate during the second. It may be thought that this is routine practice. We must, however, re- member that pneumonia is a routine disease, running a definite course, and depending on certain simple and constant structural DISCUSSION ON CLINICAL MEDICINE. 585 changes. It is not, therefore, unphilosophical to expect to have a specific for all cases of simple uncomplicated pneumonia in healthy persons. I need not particularize the cases for which the other medi- cines, to which I have referred, are appropriate. The symptoms very well and definitely indicate these, and we need only remem- ber their pathogeneses to be enabled to select the proper medicine for each case. Such instances as those referred to in the memoir from Spain form, I think, only a variety of mild attacks of simple pneumonia, and do not call for any very serious consid- eration, as they have a natural tendency to terminate within the first week. They seem to me, however, to present well the indi- cations for Tart. emet. or Ipecac. Such cases as those referred to in the paper from France present well the indications for Tart, emet., Phosph., Digitalis, or Cactus, but mainly, I think, for Alcohol. In them it is the heart and circulation and the innervation that fail, and we should not lose sight of this remedy, ■whose main characteristic symptoms are really similar to those presented in these cases. In such cases a dessertspoonful of brandy every four hours will do wonders, but it must be given unmixed with coffee. Finally, Mr. President, in severe cases of bronchopneumonia we should never forget the great benefit of moist, warm air to breathe, and in pleuropneumonia, of moist, hot applications to the exterior of the chest. These are not at all incompatible with true and pure homoeopathic treatment, and they are of immense comfort to the patient, and real assistance to the medicinal spe- cific, and, sir, I hold that we are bound to give our patients the advantage of every possible means of help. E. U. Jones, M.D., Taunton, Mass. : The pneumonia of aged people presents symptoms differing markedly from that of the adult, being more characteristic in the first stage of the disease than after it has become fully developed. It is not usually the result of any exposure to cold, or to the thousand causes to which it is assigned in the adult, but appears to be governed generally by atmospherical and malarial causes. In asylums for aged people it often appears as an epidemic, during which one or many of the inmates will succumb to the disease, while the others will slowly and more or less completely recover. All of these cases present one characteristic,-that of diffused congestion. Unlike the pneumonia of adults, in which the sphere of congestion and inflammation most perfectly coincide, in the aged the congestive act extends in a much lengthened radius from the centre of actual inflammation. Nor is it unusual to find, on close examination, 586 world's homoeopathic convention. separate centres of congestion, which have not yet passed into the stage of inflammation, in the very long in which we find the threatened or existing pneumonia. Hence, with perhaps less acute pain than with younger cases, we find a greater dyspnoea, not referrable by the patient to any one spot, and oftentimes to. neither lung to the exclusion of the other. This is not the case in ordinary pneumonia. I have been wont to divide those suffering from this disease into two classes, one consisting of those whose whole life has been a normal and comparatively healthy one, and the other of those who have inherited a predisposition to tubercular disease, but in whom it has not been fully developed. This latter class are often found in asylums, for the disease, which was not developed in themselves, has been transmitted to their offspring, and in them has done its sad work and left the aged parent alone in the world. But in both classes the primary conditions above noted are the same. Both are liable to the same diffused congestion; both to the same asthenic condition, and both to the same prognosis ; only that the prognosis, so far as my experience goes, seems to be more favorable to the tuberculous class. When first .called to a case the real disease is often apt to be overlooked, and the secondary and accompanying symptoms to be considered the primary. The « congestive tendency is not confined to the lungs, but may be found in any part of the body. The liver is apt to partake of it; diges- tion is disarranged, and symptoms of gastrodynia are prominent. These will be the first to strike the physician's eye, and are those most thought of by the patient. The distress of the gastralgia, the nausea which often accompanies the vomiting of bile succeed- ing the headache, which is nearly always present; the dull pain in the hepatic region; the more marked of the pulmonary con- gestions being in the lower lobe of the right lung, all greatly tend to mislead. There is yet no dyspnoea but which can be accounted for by the gastric distress; no cough, no sputa, and the patient is almost angry if you ask such foolish questions. The urine is high-colored and scanty ; but there is usually, and for several days has been, a constipated state of the system. The pulse is no more disturbed than might be expected with such symptoms; and, if the clinical thermometer be not used, you would have no reason to suspect that you had to deal with other than an ordinary case of indigestion, or a common " bilious attack." Another form of development in this first class is more slow and insidious. There are no sudden symptoms, but the appetite languishes, the tongue becomes coated; there is some, but not DISCUSSION ON CLINICAL MEDICINE. 587 usually, marked headache; the bowels are constipated; the last two or three nights have been more wakeful than usual; and there is a desire to sleep during the day ; there is dyspnoea only on movement; but, as there is also much languor, there is not much motion indulged in, and consequently the dyspnoea is not prominent or thought of; the pulse is from 75 to 80. There is no cough only on attempting a full breath ; and, as this is not willingly done, the patient tells you there is no cough. If now, again, the thermometer be uot applied, the case may not be understood. A third form is the catarrhal, and is not as likely to mislead as the others, for usually one notes the respiration; the peculiarity of the mucous secretion; the little cough, which is always pres- ent; the slight dyspnoea, which manifests itself just after the cough, or after laughing, and the little fever which may be pres- ent. And yet the magnitude of what may come will not be revealed unless the thermometer be tried. The thermometer has been my diagnostician in these doubtful cases. If there be a true relation between it and the pulse there is usually nothing to fear ; but if the pulse not being over 80, the thermometer stands at 100°-and 1 have seen it at 104°-a very serious mischief has already begun ; and, unless the measures used are successful, the seventh or ninth day thereafter will see the patient's earthly labors closed. Here permit me to commend to your attention the remarks of Dr. Jousset on the variations of the pulse in old people, especially in sickness. The class of phthisical pneumonias presents rather different phenomena. Auscultation seems to reveal the perfect hepatiza- tion of the portion of lung diseased ; but there is a truer relation between the pulse and thermometer ; the course of the disease is more rapid, usually ending in circumscribed suppuration, which suppuration seems almost fully to relieve the remaining hepati- zation. The recovery is rapid, but never complete, and the last sickness is usually of but few days. These cases of senile pneu- monia seldom call for the standard remedies, Bryonia and Phos- phorus, but are better handled with Antimony, and especially its Tartrate, with Arsenic, Hepar Sulphur, and whiskey. From the very first they need stimulation, and that alcoholic. The stomach often refuses beef tea, and indeed almost all food, unless it be milk. Nor does it seem best to urge food. After the safety of the case is assured there will be time fortheadministration of food and the withdrawal of all stimulants. Injury, sometimes irreparable, is done by forcing food into the stomach when it can- not welcome it, quite as much so in the aged as in the infant. But 588 world's homoeopathic convention. the remedy for the symptoms and the stage of disease which has been described will be frequently found in Cactus grandiflorus. Nor should it be chosen for its heart symptoms, for the irregu- larity of the pulse mentioned by Dr. Jousset is by no means a necessary concomitant of age; nor, so far as my observation extends, frequent in those suffering under pneumonia. In the cases which have been most benefited by the Cactus there has been no irregularity, nor could close auscultation make manifest any cardiac abnormality. The range of action of the Cactus is large, certainly affecting, functionally at least, the liver and digestive organs, and causing decided congestions of the lungs even to the extent of severe pneumorrhagia. Its peculiar and keynote symptom is that of constriction, a symptom which is very common in the pneumonias of the aged. Its sputa are also characteristic of the first stages of this disease. Its cough, its exhaustion also are characteristic, and in'many cases it will be found to be the similimum needed. If you will permit it, I will mention the last case in which I used the Cactus, as being in a certain sense typical. Mrs. S., aged eighty-two, was taken with anorexia, nausea, tongue heavily coated, a little cough, but with the marked trouble of the dyspnoea aggravated at 12 midnight, preventing sleep after that. The pulse was 80; thermometer, 101°; respiration, 30. Auscultation showed congestion of the middle and lower lobes of right lung; left lung perfectly normal; heart's action normal. Various remedies were given, but she steadily grew worse. She did not mention till four days had passed that there was a feeling of tightness around the lower portion of the chest. Cactus grandi- florus was given at noon. That night she was not so much troubled ; the second night she rested well, and soon was entirely well. Dr. Samuel Lilienthal : I disagree with my friend, Dr. Hayward, when he says that the choice of a remedy is easy in pneumonia, for I consider it very hard. I do not understand how any one can give Phosphorus and Bryonia in alternation, for they are as opposite as day and night. I say to those who despise physiology and pathology that the indications of Phos- phorus are very plain to me; experiments have shown that the antidote to Phosphorus poisoning is Terebinth., which has succeeded in every case. There is no stage of pneumonia, unless red hepatization has taken place, where Phosphorus may not be indicated; as we go on it is still indicated, acting well in gray hepatization and saving life, and why? Because Phosphorus produces fatty degeneration; and we learn this not from symp- DISCUSSION ON CLINICAL MEDICINE. 589 toms, but from the physiology of the symptoms. The action of this remedy is clear, and its symptoms have been verified by men celebrated all over Europe. Dr. Hughes says that Phos- phorus is not indicated only in the last stage of pneumonia, and that it acts well as a narcotic and as a strengthener. Phosphorus acts best on the apex of the lower lobe of the left lung, which is the most dangerous part, so far as my experience of forty years can teach, and even now I feel that I know very little about it. When I see the lower lobe affected with a weak heart there is danger; in these cases a little whiskey is useful. Kali bichromicum has been mentioned, but as yet I am not decided as to its action; it is certainly not indicated in the be- ginning of the disease but rather in those cases where only a part of the lung is attacked. Now where the heart's action is to be considered I disagree with Dr. Jones about the action of Cactus, which I consider a remedy for real carditis but not for partial stagnation such as we find in simple pneumonia. In such cases I prefer the Carbonate of ammonia. The primary congestion of the lungs is relieved and it shows more clearly that careful differentiation must be made between active and passive lesions. In most cases of so-called latent pneumonia there is not so much pneumonia as a passive con- gestion from weakness, and in cases where this congestion termi- nates in this disease then the medicine must be used to strengthen the constitution and keep up the failing strength of the old person, who dies, just as the infant dies, and who is in his second infancy, and should be treated as an infant; if this is done the patient will recover. Dr. Clotar Muller, of Germany, was then introduced by Dr. Dunham, and discussed the paper on u Angina Pectoris," as follows: Permit me to say a few words on the influence, which physical diagnosis, with its great progress, together with the results of physiological and pathological investigations of our time have exercised on our homoeopathic therapeutics in general, and especially in the case of disease of heart and lungs and of angina pectoris. And if I formerly with great zeal endeavored to direct the attention of my colleagues to the then nascent phys- iological school, and if my youthful ardor perhaps betrayed me into too great confidence in the advantages arising thence to our homoeopathic principles, I hope I shall for that very reason be permitted now for once to show the dangers and disadvantages which have arisen or at least may easily arise to homoeopathic therapeutics through an indiscreet adoption of the physical diag- 590 world's homoeopathic convention. nosis. For, fully persuaded as I am that homoeopathy has to take notice of every discovery in any department of medical science, yet I would by no means be blind to certain errors and their consequences; and some of these I wish here to touch upon. The various aids which we now possess in examining patients, enable us in most cases easily and with certainty to discover which of the organs suffers and has undergone a change. For instance in hydrops we find mostly a defect of the heart or a nephritic disorder, in asthma emphysema of the lungs, in cough- ing blood, tubercles, etc. Of course we then call the case a disease of the heart, or lungs, or kidneys, mostly with an ac- curate distinction of the organic derangement; and we are quite right in so doing. But if we do not here restrict ourselves to certain limits, we shall very soon change our axiom "similia similibus" into that of " local ia localibus," or we shall indeed sink down to the level of those sham-homoeopathists, who choose the remedies only by the name of the disease, and for every dis- ease of the heart immediately prescribe Arsenic, for every dis- order of the stomach Nux vom., for affections of the lungs Phos- phor, etc. Surely in this manner it may easily happen that undue attention is paid to the objective, at the expense of the subjective symptoms, while it is undoubted, that the real homoe- opathist must scrupulously attend to all discernible symptoms, the subjective as well as the objective, and the individuality of the patient. But besides this influence on the choice of remedies we are generally too easily induced to see in such a case nothing but a destruction of the heart or of the liver, or at least we con- sider all the other symptoms only as secondary and accessory. Yet it is by no means always true that the discovered insuffi- ciency of the valves or the tumor of the liver are the causal and primary idiopathic disorders; not uncommonly, even these are secondary symptoms, and only the result of another metamor- phosis, or of deranged functions. In all such cases consequently the extensive regard of the local disorder is wrong, and may even prove noxious. But even where such is not the case, danger may ensue. Who in any case sees nothing but a defective heart- valve or a scirrhous liver, will very soon, although he is a homce- opathist, arrive at the same disconsolate conclusion to which the physicians of the physiological school already have come; that is, he will abandon the idea of administering direct essential relief, and will therefore sit down and do nothing. And in that he would be quite right; for indeed he cannot make a new DISCUSSION ON CLINICAL MEDICINE. 591 heart-valve or a new liver, whether he uses very high or strong low dilutions. Happily that is by no means the question. For many a man has recovered (at least temporarily and rela- tively) in spite of a defective valve, and many a man enjoys his life with a morbid liver, though he formerly secreted albu- men or expectorated blood. This is a fact well known to life insurance companies, who have only prospered since they no longer refuse invalids. In general the restriction of diseases to a mere organic dis- order must be limited by main strength; for really local diseases are very rare, and when they do occur, they do not long continue local. Especially we homoeopathists have full reason to banish every kind of local pathology and therapeutics. Hahne- mann positively declared this, when he said : "Disease is dis- turbance of the vital force." Surely this doctrine of the inner and dynamic nature of the disease is one of the fundamental doc- trines of homoeopathy, and especially our law of similitude can- not be utilized without it. And it is on this very law that homoeopathy is based. But however great the value of this law of similitude, I must agree with those who affirm, that in a strict sense it is not a real principle of cure, nor a natural law, but only an empirical maxim, a therapeutical rule. Of course, we cannot say a homoeo- pathic remedy cures, because it produces in a healthy body similar symptoms, but the similitude of the symptoms is only the indication to find out the right remedy; it is not the cause of the effected cure, but only the guide to it. And because it is no natural law, but simply a formula, Hahnemann and his dis- ciples were not able to give a satisfactory explanation of the process of the homoeopathic cure. Between-the homoeopathic similitude and the cure there is doubtless still a third link in the chain, at present unknown to us, but by our future knowl- edge of it the present void will be filled and the homoeopathic cure clearly accounted for. To make this plainer, allow me here to draw a comparison, which seems appropriate to the purpose, although rather trivial. In Germany we say : " We shall very soon have rain, for the swallows fly low." That happens indeed very regularly, more regularly almost than the homoeopathic cure. Now it will be asked, what connection is there between the flight of swallows and rain? where is here the causality? Indeed there seems to be no such, and yet the inference is right. Where is then the key ? The thought is quite plain. Here too a third link is want- ing, which clears up the matter. It is, that the humidity of the 592 world's homoeopathic convention. air drives down the insects; of course the swallows must like- wise fly low in order to catch them. Consequently just as we don't say : "It will rain, because the swallows fly low," we also cannot say, a homoeopathic remedy cures, because it produces similar symptoms. It is a great pity, that I can tell you only the middle link about the swallows, but not about the homoeo- pathic similitude. Perhaps some day, another will come who can do so. The President here announced that four hundred and fifty-five members had registered their names, and been in attendance during the day. T. Dwight Stow, M.D., Fall River, Mass.: I wish to speak on congestion of the lungs, and oedema of the lungs. O O' O (Edema of the lungs is really a dropsy, and it is produced by anything which overtaxes or overexercises these organs; it is also produced by other miasmatic influences, by the action of Quinine and various other drugs. Its principal signs are dysp- noea, accelerated and shortened respiration, cough ; with oedema pulmonarum, as with oedema with congestion of the lungs, there is usually little or no fever; the pulse is generally depressed, with very slight cough and slight dyspnoea, increasing with the ad- vance of the disease. At first the patient only notices the ac- celerated respiration upon any unusual exercise; but as the disease advances he is obliged to take a different position, and to be slightly bolstered up in bed, then gradually he has to be raised higher until he is erect in bed, and in that position there is generally haemoptysis. When the thorax is filled with fluid we find that the lungs do not collapse; there is a darkish-red or bluish look ; they crepitate upon pressure, and on making a sec- tion we find large quantities of serum. If there is any expecto- ration connected with oedema of the lungs it is of a thin, fluid nature; if it continues of that character, now simply febrile, and with a diminution of the volume of the pulse, without any very great increase in its frequency, and with steady dyspnoea and an increase of orthopnoea, then, provided auscultation and percus- sion verify it, we have a case of actual oedema of the lungs. The sounds on percussion are generally clear, but are sometimes rather dull; but it must be borne in mind that in this condition there is a certain dulness on percussion on the right side, in the region of the liver, and on the left side in the centre of the thorax, in the region of the heart, in the lower part of the left lung, and in the region of the spine. This oedema may pass on to resolution, it may be connected with congestion. Now we come to the sputa, which is indicative, DISCUSSION ON CLINICAL MEDICINE. 593 when there is a blood streak, of the pressure of congestion; but when the sputa is wholly blood-streaked, then we have an ap- proach to if not the presence of an active congestion, to which the patient may be constitutionally predisposed, or to which there may be an hereditary tendency, as where there is hydroma, or where it follows "Bright's disease of the kidneys," or disease of the heart. These things seem to run in that channel occasion- ally; the exciting causes, as I have mentioned, are active exer- cise, overdrinking, overheating, blowing wind instruments, the abuse of Quinine and other drugs. In the simple form of venous congestion there is also arterial congestion and obstruction; in oedema and congestion of the lungs there is also valvular disease of the heart. If connected with embarrassment of the respi- ration and the thin liquid sputa, there is oedema of the extremi- ties, then the right side of the heart is affected. In these condi- tions the patient feels more or less difficulty of with a sensation of shortness during respiration, which is increased during mod- erate or active exercise. We can discriminate between congestion and oedema by the difference in the sputa, the blood-streaked sputa indicating con- gestion, and the thin liquid sputa oedema; but there is a con- gestion called pulmonary pleurisy, or capillary bronchitis, in which the percussion-sounds are ePar, auscultation revealing more plainly the delicate, physical, capillary, and bronchial rales; in oedema pulmonum, or in congestion, these peculiar rales rarely exist, but there is crepitation simply. It is easy to diagnose in- flammation of the lungs, as the disease, always preceded with a chill, has a high fever,an increased temperature, cough, peculiar rusty expectoration ; percussion reveals a peculiar du loess of the part affected, indicating approaching consolidation. The President then announced that the regular debate was closed, according to the printed order of business, and that the subjects were open to general discussion. N. R. Morse, M.D., Salem, Mass.: I wish to mention a fact re- lating to the treatment of diphtheria, which has not yet been men- tioned, and which I regard of the highest importance. The princi- pal idea of every member of the profession present I have no doubt is, that diphtheria is a blood disease, localized,contagious, and this, I think, can be proven. I think that ninety-nine cases out of every hundred, if taken in time, can be cured; but when there is com- plete blood-poisoning, and the case has gone on to diphtheritic croup, ninety-nine cases out of every hundred will die. Now, re- garding the management of children ill with this disease. I re- member, in a town where I practiced a few years ago, that almost 594 world's homceopathic convention. every case in allopathic hands died, while I treated upwards of a hundred cases with the loss of only two. I returned to my native village, where ten out of eleven died of diphtheria, and was called to see a case at 2 o'clock in the morning. As every case but one had proven fatal in the town, I was careful in giving a progno- sis ; I finally gave them some hope, as, 1 think, if the disease can be checked for twenty-four hours, there is a chance of success; the patient recovered. I prescribed for three other cases, which also recovered, while two others, employing the allopathic phy- sician of the town, died in four days. After this a homoeopathic physician from a neighboring town was called in, and under his care cases rapidly recovered. Now, early in the disease, when the patient is restless, afraid that something terrible is going to happen, give Aconite and Baptisia. Baptisia is the remedy par excellence for the cure of the disease. There is one more point that 1 think of as much value as the remedial treatment: let the light of hope beam from your countenance, and your voice be cheerful ; tor if there is in the sick-room the slightest doubt as to the result, it will exercise a very depressing effect, especially in young children, and will be as fatal as a dose of poison. For food I should recommend beef tea and whiskey, and in some cases, if necessary, would use alcohol and other stimulants, to- gether with Chlorate of po'tassa and ice. Keep the patients in bed, and watch them carefully ; the fatal cases are those that are neglected, and not seen in season. If these directions are fol- lowed, it will increase your success tenfold. On motion, the Convention then adjourned for the day. DEPARTMENT OF SURGERY. CONTENTS. Inflammation of the Conjunctiva,.... George S. Norton, M.D., New York. Ophthalmic Therapeutics W. H. Woodyatt, M.D., Chicago. Acute Diseases of the Ear; their Homoeopathic Treatment, ........ T. P. Wilson, M.D., Cincinnati. Homoeopathic Therapeutics of Aural Surgery, . H. C. Houghton, M.D., New York. Influence of Homoeopathy upon Surgery, . . Wm. Tod Helmuth, M.D., New York, Uro-lithiasis in Russia, C. Bojanus, M.D., Moscow. Therapeutics of Benign Tumors, .... Albert G. Beebe, M D., Chicago. Homoeopathic Therapeutics in Gunshot Wounds, and the Sequelae of Operations, Homoeopathic Treatment of Syphilis, . . . J. H. McClelland, M.D., Pittsburgh, • E. C. Franklin, M.D., St. Louis. Medical Treatment of Varicose Veins and Haem- orrhoids, John C. Minor, M.D., New York. Gunshot Wound; Case of Ball in the Skull, . W. H. Jenney, M.D., Kansas City. Discussion. INFLAMMATION OF THE CONJUNCTIVA. Geo. S. Norton, M. D.. New York. It is not within the province of this article to discuss the symptomatology, etiology, etc., of diseases of the conjunctiva. These points have been well described by various authors. The treatment, by the so-called " Regular School," has also received sufficient attention, but nowhere in our literature do we iind given the strictly homoeopathic treatment of these important affections; except, perhaps, in those excellent pa- pers by Dr. Dudgeon, published years ago in the British Journal of Ilomosopathy^ where the subject, however, was only incompletely considered, owing chiefly to the want of knowledge at that time of the efficiency of our drugs in these affections. This void in our literature we shall endeavor to fill, at this time, by giving the remedies which have been found useful in these disorders and their indications as con- firmed by clinical experience. In order not to occupy too much space by repetition, and at the same time render this paper practically useful, our divisions of the subject will be general; while the special form of disease to which each drug is adapted will be mentioned when giving the indications for its use. The forms of conjunctivitis which we shall consider are the catarrhal, purulent, granular and phlyctenular. Conjunctivitis Catarrhalis, Acuta kt Chronica.-The first point in the treatment will be the removal of any excit- ing causes. To accomplish this, the lids should first be everted and examined for the presence of a foreign body, 597 598 WOBLD's IIOMCEOPATIIIC CONVENTION. which, if detected, should be removed. If the conjunctivitis depend upon any anomaly of refraction, this should be cor- rected. If due to straining of the eyes in reading, writing etc. (especially in the evening), or to exposure to wind dust, or any bright light, as working over a fire, directions to abstain from overuse, or to protect the eyes from the injurious causes, should be given. If the case be very severe, the patient may be confined to his room, though this is rarely required in pleasant weather. As direct remedies, cold applications are especially recommended. But care should be taken that they are not employed too constantly, particularly if there is oedema of the lids, for they often prove harmful in these cases. Great reliance should be placed upon the sensations experienced by the patient, regarding the use of warm or cold applications, as the beneficial results obtained vary in different cases. Sometimes the same remedy that we employ internally is used with benefit externally. Cleanliness should be espe- cially required. To prevent the formation of crusts on the lids, the edges may be smeared at night with a little Vaseline, simple cerate, cream or the like. Astringents, such as sulphate of zinc or copper, or nitrate of silver are chiefly relied upon by the Old School, though not advised until after the acute symptoms have subsided. Atropine should not be used unless there be iritic complication. The attendants should be warned that the discharge is contagious, and that the sponges, towels, etc., used upon the patient, should not be employed for any other purpose. Aconite.-Is especially indicated in the first stage of catarrhal inflammation prior to exudation, when the conjunc- tiva is intensely hyperaemic and chemosed, with severe pain in the eye, often so terrible that one wishes to die; or, as is fre- quently the case, there is only a feeling of burning and general heat in the eye, with great dryness; there may also be an aching or bruised pain, or a feeling as if the ball were enlarged and protruding, making the lids tense. The eye is generally very sensitive, especially to air. This is the first remedy to be thought of for conjunctivitis dependent upon exposure to cold, dry air. INFLAMMATION OF THE CONJUNCTIVA. 599 In inflammatory conditions of the conjunctiva, resultingfrom the irritant action of foreign bodies in that tissue there is no better remedy. Allium cepa.-Of use in acute catarrhal conjunctivitis, associated with a similar condition of the air passages; the lachrymation is scalding, profuse and not excoriating, though the nasal discharge is so (reverse of Euphrasia). Apis mel.-Especially called for in the acute form of con- junctivitis, when the conjunctiva is bright red and puffy, lachry- mation hot and moderately profuse, and pains in the eyes of a burning, biting, stinging character ; sometimes the pains are very severe and darting through the eye, or may possibly be around the eye and the brows. Photophobia may be present. The oedematous condition of the lids, especially the upper, which is usually present in these cases when Apis is indicated, is an important symptom. There is, generally, aggravation in the evening and fore part of the night. Although the lachrymation is hot aud burning, yet it does not excoriate the lids, as in cases in which Arseni- cum is indicated. The general symptoms of dropsy, absence of thirst, etc., would suggest this remedy to our minds. Argentum nit.-Should be employed if the discharge becomes profuse, apparently taking the character of purulent ophthal- mia. It may also be indicated in the chronic form of conjunc- tivitis, when the conjunctiva is of a scarlet redness and the papillae are hypertrophied. The inflammatory symptoms usually subside in the open air, and are aggravated in a warm room. Arnica.-In conjunctivitis resulting from blows and various injuries Arnica is often beneficial. Arsenicum.-Occasionally useful in acute conjunctivitis marked by chemosis of the conjunctiva, much hot, scalding lachrymation, burning pains, especially at night, and oedematous condition of the lids, particularly the lower lid. It is also indicated in the chronic form when the lachrymation and discharge from the eyes are acrid, excoriating the lids and cheek, the balls burn as if on fire, especially at night; and when the inflammation is especially marked on the internal surface of the lids. 600 world's homeopathic convention. Warm applications generally relieve. The attacks of in- flammation are frequently periodic in occurrence and often alternate from one eye to the other. Belladonna.-This is the remedy in the early stages of catarrhal con junctivitis, when there is great dryness of the eyes, with a sense of dryness and stiffness in the thickened red lids, and smarting, burning pains in the eyes. Photophobia is often marked. Much dependence should be placed, however, upon the concomitant symptoms of headache, red face, etc., etc. It will be seen that Bell, is similar to Aconite and that both correspond to the early stages of the disease. The dryness of the eyes exists equally under both drugs ; but under Aeon, we have much more heat and burning in and around the eve than under Bell., therefore, the latter is not nearly so often useful as the former (Aconite). Calcarea carb.-Occasionally useful in catarrhal conjunc- tivitis caused by getting wet, especially when occurring in a person having a calcareous temperament. Chamomilla.-Catarrhal conjunctivitis, occurring in peevish children during dentition. Conjunctiva so congested, that blood oozes out. Cinndbaris.-May be called for in conjunctivitis, especially when that characteristic symptom of pain above the eye, extending from the internal to the external canthus, or around the eye (usually above, though sometimes below) is present. Euphrasia.-In this drug, we have a very valuable remedy for both acute and chronic catarrhal conjunctivitis, especially the acute. It is especially useful in catarrhal inflammation of the eye, caused by exposure to the cold and also in that of the eyes and nose found in the first stage of measles. In the selection of this drug, we are guided chiefly by the objective symptoms as the subjective are not very definite, there being a variety of different sensations. The conjunctiva is intensely red, even to chemosis. The lachymation is profuse, acrid, burning, while the discharge from the eye, which is also quite profuse, is thick, yellow, muco-purulent and acrid, making the lidsand cheek sore and excoriated. (The secretion is also excoriating under Arsenic and Mercurius, but is thinner.) Blurring of the vision, relieved INFLAMMATION OF THE CONJUNCTIVA. 601 by winking, being dependent upon the secretion covering the cornea temporarily, is especially characteristic of this remedy. Graphites.-Is sometimes indicated, especially in the chronic form of catarrhal conjunctivitis, though it is more particularly the remedy for phlyctenular ophthalmia. The redness, pho- tophobia and lachrymation are usually well marked, but may vary to a great extent. The discharges from the eye, if present are thin and acrid, while the nose is sore, excoriated and often surrounded by thick, moist scabs. Dry scurfs are frequently found on the lids, while the external canthi crack and bleed easily. Ilepar sulph.- This is another remedy more useful in strumous ophthalmia ; though it is sometimes employed with benefit in the catarrhal form, as when the conjunctiva is much congested even to chemosis, with considerable photophobia and lachrymation, while the lids are much swollen and very sensitive to touch. The discharge is of a muco-purulent character and often well marked. The pains are throbbing, aching or lancinating and relieved by warmth, so that he wishes to keep the eye covered most of the time. Icjnatia.-Ilas been successfully used in catarrhal ophthal- mia, especially when found in nervous hysterical subjects, consequent upon traumatic or even upon other causes, when there is a sensation as if a grain of sand were rolling around under the lid, with great dryness, and lachrymation only when exposed to the sunlight. Merc. sol.-In Mercury, we possess an important remedy for catarrhal conjunctivitis, and this preparation is most com- monly required, though some other form may be employed, if the concomitant symptoms so indicate. The redness and dread of light are usually well marked, especially in the evening, by artificial light. The lachrymation is profuse, burning and excoriating and the muco-purulent discharges thin and acrid, making the lids and cheek red and sore. The pains vary in character and are not confined to the eye but extend into the forehead and temples and are always worse at night, especially before midnight, in extreme heat or cold and in damp weather, and are often temporarily ameliorated by cold water. It. is 602 world's homceopatiiic convention. especially indicated in syphilitic subjects, and when the concomitant symptoms of soreness of the head, excoriation of the nose, nocturnal pains, etc., etc., are present. Nux vomica.-Is not very often called for in this variety of conjunctivitis. It would be suggested to our minds if there were much dread of light, marked morning aggravation and accompanying gastric symptoms. Hartmann and Altschul highly recommend its use in conjunctivitis, when there isgreat tendency to hemorrhage. Pulsatilla.-This is another of our standard remedies for catarrhal conjunctivitis, especially the acute form, though it is also useful in the chronic. It is particularly to be thought of in conjunctivitis occurring in the colored race, as well as when found in the mild, tearful female. Catarrhal inflammations resulting from a cold, an attack of measles, traumatic and various other causes, have been benefited. The redness is variable and may even amount to chemosis. The pains are burning, itching or lancinating in the eye, usually worse in the evening, when out in the wind, and after reading, but relieved by the cool open air. The lachrymation is often profuse by day with a purulent discharge at night; though, generally, a moderately profuse muco-purulent discharge of a white color and bland character, which agglutinates the lids in the morning, is to be found. Gastric, bilious and other concomitant symptoms if present will influence our choice. Phus. tox.-Is the chief remedy for conjunctivitis caused by exposure to the wet (Calc.', especially when the conjunctiva is much chemosed, and some photophobia, profuse lachryma- tion and oedematous swelling of the lids arc present. A rheu- matic diathesis would especially suggest this remedy. Sanguinaria.-Benefit has been derived from its use in catarrhal conditions of the conjunctiva with burning in the •edges of the lids, worse in the afternoon, and when the affec- tion is dependent upon stricture of the lachrymal duct. Sepia.-Acute catarrhal conjunctivitis with drawing sensa- tion in the external canthi and smarting in the eyes, amelio- rated by bathing in cold water and aggravated morning and ■ evening ; and conjunctivitis with muco-purulent discharge INFLAMMATION OF THE CONJUNCTIVA. 603 from the eyes in the morning and great dryness in the evening, have been speedily relieved by Sepia. It is frequently found useful in inflammatory affections of the conjunctiva of an asthenic character, the conjunctiva exhibiting a dull, red color with some photophobia and swelling of the lids, especially in the morning. Spigelia.-Rarely useful, though, according to Lippe, it has benefited a case occurring in the left eye with severe lan- cinating pains in the eye and left temple, worse at night, preventing sleep. Sulphur.-This is one of our chief remedies in both the acute and chronic forms of catarrhal conjunctivitis. The degree of redness may vary greatly. It may be confined to one eye or involve both. The lids may be swollen or remain unaffected. The sharp, darting pains, like pins piercing the eye, occur- ring at any time of the day or night, will furnish our chief indication. A severe pain darting through the eye back into the head, from 1 to 3 a. m., waking the patient from sleep, is also an important indication. A variety of other sensa- tions may be present ; as pressing, tensive, cutting or burn- ing pains, a feeling of sand in the eyes, etc. The patients are usually feverish and restless at night. Zincum,.-Ilas been useful in conjunctivitis especially when confined to the inner half of the eye, (usually without photophobia) and much discharge; worse towards evening, and in the cool air. Generally there is itching, and perhaps pain, in the internal canthus. The following remedies have also been used with benefit, or may be indicated in occasional cases: Alumina, Chelido- nium, Chloral., Crocus, Cuprum al., Cuprum sulph., Digitalis, Euphorbium, Eupatorium perf., Kali bichr., Natrum mur., Senega, Silicea and Thuja. Conjunctivitis Purulenta.- Under this head we shall include gonorrhoeal ophthalmia and ophthalmia neonatorum, which are only different forms of purulent conjunctivitis. If the attack is very severe, the patient may be confined to a darkened room, or even to bed; and if only one eye is affected, the other should be kept closed, in order to pre- 604 WOELd's IIOMGEOPATIHC CONVENTION. vent any of the matter coming in contact with this eye, for the discharge is very contagious, especially in the gon- orrhoeal variety and in that found in new-born children. On this account great care should be exercised, both by the nurse and physician, to protect their own eyes and those of others by providing that the sponges, towels, etc., are used only by the affected patient and also that their hands are thoroughly cleansed before touching another eye, for often the physician and other patients have been inoculated and vision destroyed through carelessness on this point. Fresh air and nour- ishing diet are important aids to treatment. But the special and primary point to be attended to in the treatment is cleanliness. To ensure this, the discharges should be often removed by dropping tepid warm water into the inner can- thus, until all the pus has been washed away or by cleans- ing with the palpebral syringe. This should be done at intervals of from fifteen minutes to an hour during the day and occasionally through the night, according to the severity of the case. The Old School rely chiefly upon the use of astrin- gents : sulphate of copper and zinc and the nitrate of silver ; the latter being the favorite remedy. When the cornea becomes ulcerated, some operative mea- sures or the use of Atropine, may be required; but as this is a complication, we will not dwell upon it. Canthoplasty might be necessary to relieve the pressure upon the eye-ball, if the lids were much swollen and very tense. Aconite.-May be indicated in the very first stage, accord- ing to the symptoms given under catarrhal conjunctivitis ; but it will be found of little or no avail after the purulent discharge has once appeared. Apis met.-Is useful in violent cases of purulent conjunc- tivitis and ophthalmia neonatorum when there is great swell- ing (oedematous) of the lids and adjacent cellular tissue. The conjunctiva is also congested, puffy, chemosed, and full of dark, red veins. The discharge is moderate, not profuse, though the lachrymation is well marked. The character of the pains, which are stinging and shooting, is an important indication. There is usually much photophobia accompany- INFLAMMATION OF THE CONJUNCTIVA. 605 ing the hot lachrymation (Rhus). The symptoms are aggra- vated in the evening. Objectively, the Rhus cases are similar to Apis, though the character of the pains will usually serve to distinguish between the two. Argentum nit.-This is the remedy, par excellence, for all forms of purulent ophthalmia. We have witnessed the most intense chemosis with strangulated vessels, most profuse puru- lent discharge and commencing haziness of cornea with a tendency to slough, subside gracefully under this remedy internally administered. We believe that there is no need of cauterization; but that all its beneficial results may be ob- tained by its use in the potencies. The subjective symptoms are almost none. Their very absence, with the profuse puru- lent discharge and the swollen lids, swollen from being dis- tended by a collection of pus in the eye or from swelling of the sub-conjunctival tissues and not from infiltration of the connective tissue of the lids themselves (as in Rhus or Apis) indicates the drug \Allens Ophth. Therapeutics}. By its employment as a cauterizating agent, as used by the Old School, there is no doubt that many cases of puru- lent conjunctivitis are cured, though at a risk to the cornea, as is attested by the results of this treatment. These sad results, viz.: perforation of cornea, dense leucoma, etc., we claim are, to a great extent, averted by the use of the remedy in the potencies, either internally alone or both inter- nally and externally. We are in the habit of using the thirtieth potency internally, and, at the same time, a solu- tion of five or ten grains to two drams of water of the first, third or thirtieth dilution as an external application, all the time taking great care to ensure cleanliness; and we have yet to see the first case go on to destruction of the cornea. Of course this remedy will not cure every case, though it will the majority, when simply purulent, gonorrhoeal or that form found in new-born children. Calcarea carl).-The discharges from the eye, under this drug, are often profuse and therefore it has been used with advantage in some cases of purulent or infantile ophthalmia, characterized by profuse, yellowish-white discharge, oedema of 606 world's homoeopathic convention. the lids and ulceration of the cornea. It is, however, espe- cially useful in the results of purulent ophthalmia, clearing up the opacities of the cornea, etc. It is specially indicated when the trouble arises from work- ing in the wet (Rhus). In the selection of this drug, great reliance should be placed upon the general condition (cachexia) of the patient, as the eye symptoms are not very characteristic. Chamomilla.-Is often of great service in ophthalmia neonatorum as an intercurrent remedy, even if it does not remove the whole trouble which it frequently does. It is in- dicated when the child is very fretful and wants to be carried all the time and when the usual symptoms of the disease are present even though the cornea has been invaded. Some- times the conjunctiva is so much congested that blood may ooze out, drop by drop, from between the swollen lids, especially upon any attempt to open them (Nux). Chelidonium.-Buchmann reports a case of severe inflam- mation of the eye, occurring in a man 62 years of age, caused by getting the feet wet, and which was cured with Chelido- nium0. The lids were thick, red, swollen and the lashes par- tially absent; conjunctiva swollen and dark red; thick, yellow discharge from the eyes; agglutinations in the mornings and great photophobia, with burning, darting pains in the eyes. But we doubt whether it will be often indicated in this disorder. Chlorine.-Aqua chlorinii, as an external application, has proved a very valuable remedy in the various forms of puru- lent ophthalmia. Cases have been relieved by it when used alone, as well as when the indicated remedy has been given at the same time internally (which has generally been the case). The strong solution is sometimes employed, though we usually dilute it to one-half, one-third or use a still weaker dilution. Euphrasia.-Is useful, especially in that form found in new- born children and more often in the later stages of the disease than at the beginning, as can well be understood by examining the symptoms already given under catarrhal conjunctivitis, where the indications have been stated. INFAMMATION OF THE CONJUNCTIVA. 607 Ilepar sulph.-Maybe indicated in any form of this dis- ease, particularly when the cornea has become implicated and ulceration has taken place. The lids may be swollen, spas- modically closed, bleeding easily upon any attempt to open them and very sensitive to touch. The conjunctiva is much reddened, chemosed and the discharge is considerable and of a yellowish-white color. The photophobia is intense, lachryma- tion profuse and pain severe, of a throbbing, aching character and relieved by warmth ; any draught of air aggravating the symptoms. When the ulceration is severe and hypopion has taken place, Ilepar is especially the remedy. Kreosote.- Blennorrhoea of the conjunctiva when the 'discharge is moderately profuse and marked by much smart- ing in the eyes. Mercurius.- Ilas been employed with benefit, particularly in ophthalmia neonatorum when the discharges are thin and excoriating and caused by syphilitic leucorrhoea. It is also one of our best remedies for gonorrhoeal ophthalmia and for purulent conjunctivitis found in syphilitic subjects, whether it be acquired or hereditary. The discharge, as has been said, is thin and excoriating, making the lids and cheek sore and raw. The lachrymation and photophobia are usually marked and the pains severe, though variable in character and always worse at night. Is more commonly called for in the later stage of the disease and especially if the cornea has become involved. The'concomitant symptoms are important aids in the selection. Mercurius corr., Mercurius sol. and Mercurius prec. ruber have all been successfully used, though the eye symptoms, we believe, vary little in these preparations, except perhaps being more intense under the corrosivus. Nitric acid.-Is especially advised for gonorrhoeal ophthal- mia. Much benefit has been derived from its employment in this affection. Lids much sw'ollen, red, hard and painful, conjunctiva hyperoemic and chemosed, cornea dim, great pho- tophobia and lachrymation and copious discharge of yellow pus, which flows down the cheek, pressing and burning pain in the eye worse at night. The cheeks are also usually much swollen and painful. 608 world's iiomceopathic convention. Pulsatilla.-This remedy stands high in the treatment of purulent conjunctivitis, when the discharge is profuse and bland, especially when occurring in negroes as well as in women. Benefit has been gained from its use in blennorrhcea of the conjunctiva, caused by the gonorrhoeal contagion. It is how- ever most frequently useful in ophthalmia neonatorum, cha- racterized by the usual well-marked symptoms. Many cases of this form of conjunctivitis have been cured by this drug alone, though we believe that it is particularly called for, as an intercurrent remedy, during the treatment by Argent, nit.; for, often when the improvement under the latter remedy is at a stand still, a few doses of Pulsatilla will materially hasten the progress of the cure. The symptoms are usually worse in the evening and ameliorated in the open air. Phus tox.-Ilas been employed with great benefit in this form of conjunctivitis, though it is particularly recommended by Hartmann, Garay and others for ophthalmia neonatorum. When the trouble arises from exposure to the wet this remedy suggests itself. The lids are red, cedematous and spasmodically closed. The palpebral conjunctiva is especially inflamed, so that when the lids are opened a thick, red swelling appears with a copious, thick, yellow, purulent discharge, or the discharge may be less and a profuse gush of tears take place. The child is usually, cachetic, restless and its head hot. It has been used both externally and internally. Sulphur.-Is not so useful in this variety of conjunctivitis, as in the pustular or even the catarrhal form, though it has been of service more frequently in that form found in new- born children, especially when the trouble has become chronic and when not dependent upon syphilis. The symptoms observed are not characteristic, with the exception, perhaps, of the sharp sticking pains, as if pins were sticking in the eye. We rely, to a great extent, in selecting this drug, upon the general condition (scrofulous cachexia) of the patient. Tartar emet.-Rosenberg reports a case of severe obstinate gonorrhoeal ophthalmia cured, though the urethral discharge was increased by the use of this remedy. Other remedies, as Con., Cup. ah, Cup. sulph., Dulc., Lye., INFLAMMATION OF THE CONJUNCTIVA. 609 Natrum mur., and Nux vomica have been successfully em- ployed. Conjunctivitis Trachomatosa Acuta et Chronica (with or without pannus).-As this form of conjunctivitis is usually found among the lower classes or those who are constantly exposed to wind and dust, care should be taken that these exciting causes be removed as far as possible, cleanliness and proper hygienic measures being very important aids in the treatment of this affection. It should be remembered that the discharges from granular lids are especially contagious and that whole families or a whole school may bo inoculated from one member, by an indiscriminate use of towels, etc.; therefore strict attention should bo paid to the prevention of its extension. Aconite.-In the first stage of granular conjunctivitis, when the eyes arc inflamed, hot, dry, burning and very painful, Aconite should bo given ; also in acute aggravation of granu- lated lids and pannus, with excessive hyperaemia, heat and dryness, especially if the aggravation be induced by over- heating from violent exercise or by exposure to dry, cold air. Alumen exsiccatum.-This remedy, first suggested, I believe by Dr. Liebold, is of great value in all forms of trachoma, whether complicated with pannus or not. It is employed by dusting the crude powder on the inner surface of the lids, allowing it to remain about a minute and then washing it off with pure water and, at the same time, giving the lower preparations internally. Alumina. -Cases of chronic granular lids frequently yield to this drug, when there is marked dryness of the lids and eye especially in the evening, with burning, itching and pressure in the eyes; agglutination mornings; the upper lids are weak, and seem to hang down as if paralyzed. The symp- toms of loss of power in the upper lids are often met with in old dry cases of granulation ; in these cases Alumina does good. Argentum nit.-Especially serviceable in the early stages of acute granular conjunctivitis, when the conjunctiva is intensely pink or scarlet red and the discharge is profuse and inclined to be muco-purulent. 610 world's homoeopathic convention. Arsenicum.-Indicated in chronic granulated lids, when the palpebral conjunctiva only is inflamed ; the lids are painful, dry and rub against the ball; they burn and can scarcely be opened. Chiefly called for, however, when the pains are intense, burning and the lachrymation very excoriating. A urum met.-Is the appropriate remedy for many cases of trachoma either with or without pannus (especially however, when pannus is present) and there is probably no other remedy, which has only been employed internally, that has cured more cases. We therefore highly recommend its use, though the symptoms which lead us to its selection have not yet been found peculiar or characteristic. The pains may be burning or dull in character, compelling the patient to close the lids. They are usually worse in the morning and ameliorated by the application of cold water. For the corneal ulcerations found in pannus Aurum is of great value. The Muriate of gold is frequently employed though the symptoms, as far as known, vary but slightly from those of the metal. Belladonna.-As a temporary remedy in acute aggravations of granular lids, may be beneficial; as when, after taking cold, the eyes become sensitive to air and light with dryness and a gritty feeling. Calcarea carb.-Conjunctivitis trachomatosa with pannus (caused by working in the wet) with much redness and lachry- mation has been relieved by this drug. The general condition of the patient will, to a great extent, lead to its selection. Calcarea caust.-Is recommended by Dr. Hills for this trouble, though we cannot see in what respects it differs from the carbonica. Cuprum al.-The Aluminate of copper has been successfully used to a great extent in trachoma, either with or without pannus. The results obtained are usually much more satis- factory than those from the Sulphate of copper, which is the main reliance of the Old School in the treatment of this disorder. It is employed locally by application of the crystals to the granulations, at the same time giving the remedy in the potencies internally. INFLAMMATION OF THE CONJUNCTIVA. 611 Kali Inch-Trachoma with pannus ; much discharge ; every- thing appears slightly red to him ; usually not much photo- phobia or redness of conjunctiva, though ulceration of the cornea may be present; eyes seem to feel better when lying on the face. Mercurius praec. rub.-In trachoma with pannus it is a valuable remedy ; rarely of much use in acute cases, but seems especially adapted to old chronic cases, when the cornea is covered with pannus of a high degree with considerable red- ness, discharge and photophobia. The granulations may be present or may have been already removed by caustics. Natrum mur.-Particularly useful in chronic cases and when the lids have been already treated by caustics (especially the Nitrate of silver). The pannus or the irritable condition of the eye resulting from, or kept up by the scarred palpebral conjunctiva found after cauterization, is often greatly relieved by this drug. The lachrymation is acrid and excoriating, as well as the discharges which are thin, watery and make the cheek raw and sore. The pains are variable, though some- times we have a sharp pain over the eye, upon looking down, which is very marked. The skin of the face round the eye is often glossy and shining. Katrum phos.-Granular conjunctivitis, where the granu- lations appear like small blisters, (Thuja.) Kux vom.-Of service in old cases of trachoma that have had much treatment, especially when complicated with pannus. Nux is frequently of great benefit in commencing the treat- ment of granular lids with or without pannus; also as an intercurrent remedy, for the morning aggravation is particu- larly marked under this drug and in the disease. It will rarely however, effect a cure, unassisted by any other remedy. Petrolewa.-Valuable in granular conjunctivitis with pan- nus, especially when occurring in a scrofulous habit with considerable white discharge from the eye, roughness of the cheek, occipital headache, etc. Pulsatilla.-Chiefly adapted to trachoma, uncomplicated with pannus occurring in anaemic amenorrhoeic females. The granulations are generally very fine (papillary trachoma) ; the 612 world's iiomceopatihc convention. eye is sometimes dry or there may be excessive secretion of bland mucus. There may also be soreness of the ball to touch and itching or pain in the eye, which is worse in the evening and better in the cool air or by cold applications. Thus tox.-Is frequently of use in relieving the intensity of the symptoms found in conjunctivitis granulosa with pannus. The eye is quite red, with much photophobia and profuse lachrymation. No remedy acts so powerfully as Rhus tox. in diminishing the profuse secretion of tears. Sulpdiur.-Trachoma, acute and chronic, with and without pannus, has been benefited by this drug and is often called for as an intercurrent remedy, even if it does not complete the cure alone. It is especially indicated when the pains arc sharp and lancinating in character and worse in the morning; and when the lids are glued together by the secretion during the night. The application of water is not agreeable to the patient and it often aggravates the disease. Thuja occid.-Favorable results have been gained by the use of this remedy in conjunctivitis trachomatosa, when the granulations were large, like warts or blisters, with burning in the lids and eyes, worse at night; photophobia by day, and suffusion of the eyes in tears. The following remedies- have also been employed with favorable results : Causticum, Cinnabaris, Conium, Cuprum sulph., Ilepar, Mercurius, Sepia, Tartar emet. and Zinc. Ophthalmia Phlyctenularis (Syn., Ophthalmia scrofu- losa, ophthalmia exanthem.^ Keratitisphlijct.^ Conjunctivitis phylct., etcj-We have thought best to include under this head the various forms of pustular inflammation of the eye, whether affecting the cornea or conjunctiva, as the etiology, symptomatology, course and treatment vary little in either case; in fact those remedies which have been found useful when the cornea is invaded, are also our chief reliance in this form of inflammation of the conjunctiva. The first points to be attended to are cleanliness and regu- lation of the diet. The eyes should be bathed often in luke- warm water, and any little scabs which have formed on the lids immediately removed, as they only prove a source of irri- INFAMMATION OF THE CONJUNCTIVA. 613 tation. If there is considerable photophobia and the child is rubbing the eye much of the time, a compress bandage will prevent this, and, at the same time, by keeping the lids closed will relieve the irritation to the eye-ball occasioned by their constant opening and closing; it also excludes the light, re- lieving the photophobia, and soaks up the tears and so prevents their running over the cheek, making it sore and ex- coriated. The bandage if used, though it is not commonly necessary, should be removed every four or five hours and the eyes cleansed. External applications should not, as a rule, be employed, as we can usually cure better and quicker with in- ternal remedies alone if we are careful in the selection of our drugs, although sometimes they may be useful and necessary; thus, occasionally a case will be found which has proved very obstinate to treatment, ciliary injection great, photophobia intense and pupil a little sluggish-where a weak solution of Atropine dropped into the eye, once or twice a day, will be of great benefit. Ajns md.-Pustular keratitis with dark chemosed conjunc- tiva and swollen lids (oedematous). This puffy condition of the conjunctiva and lids is very important, especially when accompanied by burning, stinging or shooting pains in the eyes. The discharges are slight, with the exception of the tears, which are usually profuse and burning, with photopho- bia (Rhus). The aggravation is usually in the evening, and often concomitant symptoms, such as drowsiness, absence of thirst, etc., are present. This remedy is not frequently called for, though useful when the above indications are present. Arsenicum.-Especially useful wdien the cornea has become affected and the pustules have broken, leaving superficial ulceration. The photophobia is usually intense at all times, though it may be so relieved in the open air so that the child will open its eyes easily. The lachrymation is profuse, burn- ing and excoriating, as are all the discharges from the eye, which are also thin in character. The conjunctival redness is variable; it may be very great, even to chemosis. The pains are generally of a burning character and may be very severe; the eye often feels very hot. The lids may be oedematous 614 world's iiomceopathic convention. and spasmodically closed or else red, inflamed and excoriated by the acrid discharges. The nostrils and upper lip are usual- ly excoriated by the acrid coryza. It is especially indicated in low, cachectic conditions and for the ill-nourished, scrofulous children of the poor. Great restlessness and thirst for small quantities of water are commonly noticed. Aurum met.-Scrofulous ophthalmia with ulceration and vascularity of the cornea. Photophobia severe, lachrymation profuse and scalding ; eyes very sensitive to the touch. The pains are from without inward and worse upon touch (reverse of Asafoetida). The cervical glands are usually swollen; patient very irritable and sensitive to noise. Baryta.-Both the carbonate and iodide have been em- ployed in scrofulous ophthalmia, especially when complicated with enlarged cervical glands. We have obtained better re- sults from the iodide than from the carbonate. Belladonna.-Barely useful except in acute aggravations where there is great photophobia. Calcarea carb.-Particularly indicated in phlyctenular keratitis, though it has also been successfully used in conjunc- tivitis. Is applicable to this form of inflammation occurring after the suppression of an eruption by Mercury, when there is also deafness ; also when the disease can be traced to expo- sure to the wet. We usually, though not always, find exces- sive photophobia and lachrymation (often acrid). The amount of redness is variable, as is also the character of the pain, though this is more commonly described as sticking than other- wise. The lids may be red, swollen and agglutinated in the morning. There is a general aggravation of the eye-symp- toms during damp weather or from the least cold, to which the patient is very susceptible. It is especially the remedy for pustular inflammation, occurring in fat, unhealthy, stru- mous children who have enlarged glands, distended abdomen, pale, flabby skin, eruptions on the head and body, which burn and itch, and cold sweat of the head. In fact, upon the con- comitant symptoms we place our chief reliance, as the eye symptoms are not characteristic. Calcarea iod.-The indications are nearly the same as for INFLAMMATION OF THE CONJUNCTIVA. 615 Calcarea carb., though it is preferable in cases where we have considerable swelling of the tonsils and cervical glands. Chamomilla.-Ilas proved very serviceable in scrofulous ophthalmia occurring in cross, peevish children during denti- tion and will often relieve the severity of the symptoms, even though it does not complete the cure. The cornea is usually invaded and we have great intolerance of light, considerable redness and lachrymation. Cinnabaris.-The cornea is generally implicated in the trouble and the symptoms of photophobia, lachrymation, etc., are severe. Pain from the inner canthus across the eyebrows or extending around the eye is a very marked indication for Cinnabaris. Clematis.-Conjunctivitis pust with tinea capitis over the greater part of the head and agglutination in the morning. Conium mac.-When the inflammation is chiefly confined to the cornea and we have intense photophobia and profuse lachrymation upon any attempt to open the spasmodically closed lids. The pains are various, but are generally worse at night. With all this intense photophobia, etc., there is, however, very slight or no redness of the conjunctiva, not suf- ficient to account for the severity of the symptoms. Croton tig.-In both phlyctenular keratitis and conjuncti- vitis is this drug useful. These are usually complicated by a corresponding characteristic eruption on the face and lids; the eyes and face feel hot and burning, especially at night; the photophobia is marked, ciliary injection like iritis often present, and considerable pain in and around the eye, usually worse at night. Euphrasia.-A valuable remedy in phlyctenular ophthal- mia when the lachrymation is excessive, acrid and burning or when there is a profuse, thick, acrid, muco-purulent discharge which excoriates the lids, making them red, inflamed and sore ; from this discharge the cheek may look as if varnished. In- tolerance of light is generally, though not always, present and the conjunctiva may be red even to chemosis. The pains are not marked, though usually of a smarting character from the nature of the discharges. Blurring of the eyes, relieved by 616 world's homceopatiiic convention. winking, dependent upon the secretions temporarily covering the cornea, especially indicates Euphrasia. Fluent coryza, acrid in character, often accompanies the above symptoms. Graphites.-This is one of the most important remedies we possess for this disease, and its sphere of action is not limited to any special variety, for excellent results have been gained from its use in both the acute and chronic form, whether the cornea is involved or not; it is, perhaps, more often called for in phlyctenular keratitis of the chronic recurrent form. Is especially indicated in scrofulous subjects, covered with ecze- matous eruptions, chiefly on the head and behind the ears, which eruptions are moist, fissured and bleed easily. The photophobia is usually intense and the lachrymation profuse, though, in some cases, nearly or entirely absent; generally worse by daylight than gaslight, and in the morning, so that often the child cannot open the eyes before 9 or 10 a. m. The redness of the eye is generally important (there may be pan- nus) and the discharges of a muco-purulent character, constant, thin and excoriating. The pains are not important and vary; may be of a sticking, burning, aching or itching character. The lids are red, sore and agglutinated in the morning or else covered with dry scabs, while the external canthi are cracked and bleed easily upon opening the eye. We often notice a thin, acrid discharge from the nose accompanying the eye affection. Ilepar sulph.-Is most useful in the severer forms of pus- tular inflammation, especially when upon the cornea and when ulceration has already commenced. The intensity of the symptoms suggests its use such as intense photophobia, lachry- mation and great redness of the eye, even to chemosis. The pains are severe, generally of a throbbing, stinging character, ameliorated by warmth, so that he wishes to keep the eye covered and aggravated by cold or uncovering the eye ; also usually worse at night or in the evening. The lids are often swollen, spasmodically closed and very sensitive to touch; also may be red, swollen and bleed easily upon opening. Particularly indicated in scrofulous, outrageously cross children who have eruptions and boils on various portions of the body. INFLAMMATION OF THE CONJUNCTIVA. 617 Kali bichrorn.-Is adapted to phlyctenules on the conjunc- tiva or to chronic cases of low grade. The chief characteristics are absence of photophobia and of redness, or much less of each than would be expected from the nature of the disease. The pains and lachrymation are also generally absent or nearly so. The eye is often quite sensitive to touch and its secretions are of a stringy character. This form of potash has been more often employed than any other, though the Iodide is also useful in similar cases. Mercurius.-Mercury, in some form, is a frequent remedy for strumous ophthalmia, especially when the cornea has be- come involved. As the symptoms are similar in all the preparations, we shall at first, under this general head, give those symptoms common to all forms and afterwards give the special indications for each. This is the first remedy to be thought of when this form of inflammation occurs in syphi- litic subjects -whether hereditary or acquired. Especially use- ful when the cornea is invaded and the vascularity is great, though sometimes there may be a well-marked grayish infiltration around the pustule or ulcer. The redness of the conjunctiva is usually great, even amounting to chemosis, the dread of light is generally great and often intense, so that the patients cannot open their eyes even in a darkened room, and it is more often aggravated by any artificial light, as gas- light, the glare of a fire, etc. The lachrymation is profuse, burning and excoriating, and the muco-purulent discharges thin and acrid. The pains are generally severe, vary in char- acter, though more often tearing, burning, shooting or lan- cinating and are not confined to the eye but extend up to the forehead and temples, seeming to lie deep in the bones; they are always aggravated at night, especially before midnight; by heat, extreme cold, and in damp weather and are tempor- arily relieved by cold water. The lids are often spasmodically closed, thick, red, swollen, excoriated from the acrid lachry- mation and sensitive to heat or cold and also to contact. The concomitant symptoms of excoriation of the nose, condition of the tongue, eruption on the face, pain in the bones, etc., etc., are of the first importance in selecting this drug. 618 world's homoeopathic convention. Mercurius corr.-Indicated in the erethistic form of inflam- mation, occurring in strumous subjects. The pustules are usually found upon the cornea, and hence the severity of the symptoms so marked under this preparation of Mercury, which is more useful than solubilis, especially in severe cases, as the pains are more severe, photophobia more marked, lachrymation more profuse and excoriating and all the symptoms more intense than under any preparation we have. Pustules on the cheek, enlarged cervical glands, coated tongue and excoriating coryza, etc., are usually present. ALercwrius dale.-Calomel dusted into the eye has been employed for many years by the Old School in scrofulous ophthalmia and even now is considered one of their chief remedies. We also have found this remedy, given internally in the potencies, very useful, especially in the severer forms of this inflammation, when occurring in pale, flabby, scrofulous subjects. ALercurius nit.-This remedy seems to be particularly adapted to this form of inflammation and has been used, especially by Dr. Liebold, with remarkable success, in a large number of cases. Severe as well as mild, chronic as well as acute cases, superficial as well as deep ulcers have yielded to its influence; in some cases there has been much photophobia, in others none at all, in some severe pain, in others none. We might thus go through a variety of symptoms differing as much as the above, where this drug has proved curative. It is commonly used both externally and internally at the same time ; and in the lower potencies, say about the first potency, ten grains to two drachms of water (or even stronger) as an external application, to be used in the eye, two, three or more times a day, and the second, or third potency to be taken internally. Atropine is sometimes used with it, especially when there is considerable photophobia present. ALercurius prec. rub.-This varies little from the general description given of Mercury, though it is often used in stru- mous ophthalmia with great benefit. ALercurius prot.-Not as often required as the other forms INFLAMMATION OF THE CONJUNCTIVA. 619 of Mercury, unless there be quite extensive superficial ulcera- tion of the cornea, with much photophobia and nocturnal ag- gravation. There is also usually swelling of the glands, and the tongue has a thick, yellow' coating at the base. Mercurius sol.-Is very often employed in scrofulous ophth- almia; the indications correspond very closely in all points to those found under the head of Mercurius. Mezereum.-Pustular conjunctivitis, accompanied by ecze- ma of the face and lids, especially when characterized by thick, hard scabs, from under which pus exudes on pressure. Natruoi mur-Especially useful in chronic cases and after the use of caustics (Nitrate of silver). The eye-symptoms are not particularly characteristic; we have itching, burning and feeling of sand in the eyes, worse in the morning and fore- noon ; the pains are various though not severe, except perhaps sharp pain over the eye upon looking dowm, a symptom which we have frequently verified. The lachrymation is acrid and excoriating, making the lids red and sore ; the discharges from the eye are also thin, watery and acrid. The photophobia is usually marked, and the lids spasmodically closed. The skin of the face, around the eyes, is often glossy and shining, while throbbing headache and other concomitant symptoms are generally present. Nux vom.-Favorable results have been gained in cases w'hich had been previously much medicated, both externally and internally. Rarely of service when the conjunctiva only is affected as the most characteristic indications are excessive photophobia and morning aggravation of all symptoms, w'hich are indications that the cornea is implicated. The lachryma- tion is usually profuse and the pains variable, as follow'S: sharp, darting pains in the eye and over it, in some cases ex- tending to the top of the head and always worse in the morn- ing, burning pains in the eyes and lids; a sense of tearing in the eye at night on awaking from sleep ; eye feels pressed out w'henever she combs her hair; sensation as of hot w'ater in the eye, pain in the lower lid as if something were cutting it, etc. Sometimes relief from the pain is obtained by bathing the eyes in cold w'ater. 620 world's homoeopathic convention. Psurinum.-Especially adapted to all chronic cases of re- current scrofulous ophthalmia. P ulsatilla.-This is one of our sheet anchors in the treat- ment of this disease, especially when the pustules are confined to the conjunctiva. It is particularly indicated in persons, especially amenorrhoeic females of a mild temperament and fair complexion, and is also very suitable to this class of ail- ments when occurring in the negro. When pain in the ear, otorrheea and other aural symptoms complicate the eye dis- order, this remedy would be suggested to our minds. The dread of light is often absent or quite moderate and the redness varies. The lachrymation is not acrid, but more abundant in the open air, while the other discharges are generally profuse, thick, white or yellow and bland. The pains vary greatly, but are more often of a pressing, stinging character. The lids may be swollen, though not excoriated, but are very subject to sties, for which Pulsatilla is one of our chief remedies. The eyes feel worse on getting warm from exercise or in a heated room and generally in the evening, but are ameliorated in the open air and by cold applications. The concomitant symptoms of stomach derangement, amenorrhoea, etc., must be taken into consideration. Phus tax.-Useful in pustular inflammation after it has gone on to superficial ulceration of the cornea; for then we have present the intense photophobia and profuse lachrymation so characteristic of this drug. The conjunctiva may be very red, even to chemosis, and the lids cedematous, particularly the upper, and spasmodically closed, so that we are compelled to open them by force when a profuse gush of tears takes place. The skin of the face, around the eyes, is often covered by a Phus eruption ; especially suitable in a rheumatic diathe- sis. The symptoms are usually worse at night, after midnight and in damp weather; therefore the patients are restless at night, and disturbed by bad dreams. Phus rad. has been em- ployed with excellent results in scrofulous ophthalmia when the above symptoms were present. In what respect it differs from Phus tox., remains to be proven. Sepia,-Especially of value in pustular inflammation found INFAMMATION OF THE CONJUNCTIVA. 621 in women, either occurring with or dependent upon uterine troubles, and these disorders should receive due consideration in selecting this drug. More often called for when the cornea is affected than when the inflammation is confined to the con- junctiva. The pains are usually of a drawing, aching, piercing character; and aggravated by rubbing, pressing the lids toge- ther or pressing upon the eye. The light of day dazzles and causes the head to ache. The conjunctiva may be swollen, with agglutination of the eyes morning and evening, consider- able purulent discharge, edges of the lids raw and sore, feeling as if the lids were too tight and did not cover the ball, eruption on the face, etc. All the symptoms are worse in the morning and evening and better in the middle of the day. Sulphur.-This is the remedy, par excellence, for pustular inflammation of the cornea or conjunctiva. Its sphere of action is very wide and adapts it to a great variety of cases, especially when chronic and occurring in scrofulous children covered with eruptions (and the majority of cases are found in this class), or when otorrheea and affection of the bones com- plicate the difficulty; also to those cases which have been caused by suppressing an eruption with external applications. The pains vary, though usually of a sharp, lancinating character, as if a needle or splinter were piercing the eye, and may occur at any time of the day or night; or we may have a sharp, shooting pain going through the eye back into the head, from 1 to 3, a. m., which disturbs the sleep of the patients ; although, besides these, there may be a variety of other sensa- tions as smarting, itching and burning in the eyes, feeling of pressure as from a foreign body; burning, as from lime; biting as if salt were in the eye; sensations as if there were a number of little burning sparks on the lids, which cause them to close spasmodically ; painfid dryness as if the lids rubbed the eye ball, bruised pain, etc., etc. The photophobia is generally very marked and the lachrymation profuse, though in some cases they may be almost or entirely absent. The red- ness varies greatly, but is usually considerable, especially at the angles; the secretions also vary both in quantity and quality, being often, however, acrid and corroding and sometimes 622 world's homoeopathic coxvention. tenacious. Agglutination in the morning is commonly present. The lids are often swollen, burn and smart as if bathed in some acrid fluid, or there is an itching sensation compelling the patient to rub them most of the time. They are frequent- ly covered with an eruption, as well as the surrounding integu- ment of the head and face. All the symptoms are, as a rule, aggravated by bathing the eyes, so that the child cannot bear to have any water touch them ; also usually worse in the open air. Tellurium.-Ilas proved successful in phlyctenular con- junctivitis with eczema impetiginodes on the lids and much purulent discharge from the eyes, especially when complicated with an offensive otorrhoea, smelling like fish brine. Zincum.-Favorable results have been obtained by its use for the persistent redness of the eye remaining after purulent keratitis without any discharge, especially when the redness is more marked at the inner angle and worse toward evening and in the open air. The following remedies have also proved serviceable in scrofulous ophthalmia, though not so commonly called for as the above: Antimon, tart., Argentum nit., Caust., China, Chloral, Cuprum al., Ferrum, Ferrum iod., Hyoscyamus, Kreasote, Lachesis, Magnet., Magnes, carb., Nitric acid, Petro- leum, Phosphorus, Sulphur iod., Thuja. OPHTHALMIC THEEAPEETICS. W. II. Woodyatt, M.D, Chicago. In. forming an estimate of Homoeopathic Therapeutics, it must be conceded that however perfect the law, or universal the principle, the ability to apply it in all cases is not to be found at the present time. The glory of a complete knowledge and a control co-extensive with disease, are reserved for the far future. Especially may the branch of the subject with which this paper has to deal-namely, Ophthalmic Therapeutics-be spoken of as in a partially developed condition. All are aware of this who have attempted to treat a great variety of eye diseases. Its very deficiencies, however, make the subject an interesting one ; for they are due to no inherent weakness in the system, but to the insufficiency of efforts made to elaborate it. To find ourselves confronted with an expression of dis- ease for the relief of which we have no specific guide to a rem- edy, is not an unusual occurrence. Our first recourse is to our symptomatology ; failing there we look to clinical experience. Finding no parallel amongst recorded cases, we call to our aid such pathological analogies as seem suggestive; and if still un- rewarded, try to interpret the modus operands of allopathic medication to find, if possible, an agent to be used on homoe- opathic principles. Sometimes, as a last resort, a broad gen- eralization may suggest a dozen remedies, out of which to choose one, it may be, hap-hazard. This is not the road travelled in ordinary prescriptions. As a rule the symptoma- tology suffices. But when interrogated for eye-symptoms the 623 624 world's HOMCEOPATHIC CONVENTION. response is always indefinite, often meaningless; and when the symptoms can be understood, we find them standing, in dif- ferent cases, for wholly different pathological conditions. When we attempt to translate into pathology the sensations of smarting, pricking, burning, pressure, tension, scraping, itching, etc., etc., we are simply lost. Yet these same vague words are probably rich with significance if we had the wis- dom to read them aright. Subjective sensations are essential; but the objective demaiid equal attention for a complete pic- ture of such gross disease as we can recognize. Ilad these, too, been noted by provers, the hieroglyph might have been accompanied by a key. A close study of some drugs enables us to collect scattered symptoms into groups and thus determine their relation. For example, in Argentum nit. we find : " Photophobia ; dilated pupils ; can only see by holding the book away from her." These symptoms indicate that this remedy will be useful in affections of the ciliary muscles ; as also in weakness of the recti muscles of the ball, which are supplied by the third nerve ; and clinical experience gives this drug a prominent place as a remedy in some forms of muscular asthenopia. If the proving were being made now, the aid of convex, cylindri- cal and prismatic glasses would give us the exact pathological values of these symptoms. When clinical records are conned for help the student does not get his wisdom unadulterated. The cases that attract his eye may present a correct diagnosis, but the recorded symp- toms will be few, and while the remedies given may be stated, the potencies, frequency of dose, rotation of remedies and time occupied are often omitted; or, the caseswill present evidence of incorrect diagnosis, such as those called "Cataract" in Peter's work on " Diseases of the Eye," many of which ap- pear rather to be cases of iritis and irido-choroiditis with opacity of the lens capsule. These records afford no help in the treatment of cataract, though they suggest the use of the remedies in the conditions named. More uncertain even than clinical records, is pathological analogy ; yet this is not to be despised as a prompter. Some OPHTHALMIC THERAPEUTICS. 625 successful treatments for inflammation of the lachrymal sac has been suggested to me by a comparison of the discharge with that from other mucous surfaces, and administering remedies indicated in the latter cases. In dealing with diseases of the choroid and retina, decided help has been obtained by studying the remedies used in affections of other serous tis- sues ; and the therapia of chronic meningitis has yielded its quota of help in diseases of the optic nerve. What is most wanting to supply thd deficiency in our ther- apeutics, is a reproving of the remedies, with a view to a care- ful record of objective as well as of subjective symptoms. The ophthalmoscope, the test-types and glasses-spherical, cylindrical and prismatic-in short, all appliances known to the profession for determining objective symptoms-should be employed ; and general symptoms should, as far as possible, be translated by the latest teachings of pathology. Meanwhile much instruction may be gained by a full and free publication of the cases daily demanding our attention; giving all the symptoms, whether necessary to a diagnosis or not, the name and potency of remedies, their mode and times of administra- tion and the results. By grouping and comparing symptoms thus derived, we may soon ascertain what sensations are pecu- liar to each disease, and thus supplement our present imper- fect symptomatology. The imperfection of the reports already published, and the large class of diseases which have received no mention at all, would require the fullest elucidation in the proposed publications; and the end in view would be best attained, if all contributions should appear in one journal. For this proposition I entreat the favorable consideration of the Convention. But there are practical points to be pre- sented, to which the writer would now draw attention. What is now known as the uveal tract consists of the choroid, ciliary body and iris. It is the middle one of the three tunics of the eye-ball. An inflammation arising in any of these and extending to the others, involving in time the scler- otic externally, and the retina and vitreous humor internally, was called by old writers " Internal Ophthalmia." Under this general term was included a variety of diseases which now re- 626 world's HOMCEOPATniC CONVENTION. ceive separate names. Choroiditis, cyclitis, hyalitis, and the compounds irido-choroiditis, irido-cyclitis, sclero-choroiditis, chorio-retinitis, and the term for general inflammation of the eye-ball, panophthalmitis, have supplanted the one old name. This new nomenclature is largely the outgrowth of modern ophthalmoscopic investigation, and has been found necessary for accurate description of pathological changes. Its value is obvious to all who understand that a correct appreciation of the value of our remedies depends upon the clearest possible statement of the conditions for which they are given. The division of internal ophthalmia into the parts named, is in no way fanciful. It is as essential to a proper understand- ing of the subject as are the divisions of the broad term con- junctivitis to a full and correct knowledge of changes in the con- junctiva. Thus, conjunctivitis includes hyperremia, catarrhal, purulent, granular, membranous and diphtheritic inflamma- tion ; each condition requiring distinct treatment although, in a certain sense, the boundary lines are quite arbitrary. There is a very intimate anatomical relation between the several parts of the uveal tract, and between this, as a whole, and the cornea, which explains the complications so frequently found. And the several parts are not only continuous, but so dependent for nourishment upon a common supply, that what- ever affects one affects all to a greater or less extent. The force of the disease may, in some cases, be spent upon any two of the parts without involving the others seriously ; or, the wfliole tract may be invaded. Thus in irido-choroiditis we some- times find the ciliary body unaffected, or so slightly disturbed as not to attract notice. In other cases, of choroido-iritis, where the inflammation has commenced in the choroid, the changes in the cornea may be so marked as to monopolise attention. The two practical questions which we have to propound to ourselves on meeting with these complicated cases are : What is to be the termination ? and wfliat can be done to make the end most favorable ? Each case will be individualized by peculiar features, while it presents typical ones, by wfliich it is recognized. Our prog- OPHTHALMIC THERAPEUTICS. 627 nosis will be influenced by these special features; but we must depend upon personal or recorded experience in regard to the general characteristics to aid our judgment. Information of this kind is only, at present, to be found in our current litera- ture ; and even there, the number of well reported, and there- fore instructive, cases is very small. The cause of this is not far to seek. In the first place, the classification of the diseases named is comparatively recent; and secondly, but a small number of practitioners have given them the study requisite to their diagnosis. But with accumulating experience we may reasonably look to overcome our present difficulties, reduce the list of cases now deemed incurable, and produce perfect restoration in others, where partial recovery is all that is now deemed possible for medicine to accomplish. With regard to treatment, our present knowledge of rem- edies applicable to these isolated diseases is so limited that I have been led, in complex cases, to use remedies indicated in morbid states of single parts of the structure. For instance, remedies useful in ulcerated cornea, as an isolated disease, have been used with benefit where such ulceration has been a prom- inent though secondary affection. This way of using remedies is of course open to objection ; yet it has often revealed the scope of action of a medicine of which previously we knew little. By way of illustration I subjoin some cases of a complex character, with their treatment, taken from my case book. Case 1. Choroido-Trltis.-Miss R. aged 20. After excessive fatigue and exposure to strong colored lights, left eye became inflamed nine weeks ago. Ilas grown worse under the treatment she underwent; she has, pain in the eye-ball and even the brow, photophobia, lachrymation, and occa- sional bright flashes just outside the visual axis. Examina- tion revealed slight pericorneal injection. Several small points of ulceration of cornea at the lower and outer segment; iris dim and reddish ; trabeculae indistinct ; pupil moderately dilated. Ophthalmoscope showed vitreous humor very hazy; some large patches of inflammation of choroid, with deposit of pigment along edges ; situation corresponding to points of ulceration in cornea. A few drops of a four grains solution of 628 world's homceopathic convention. Atropia dilated pupil fully in its upper half, and but partially in the lower; due probably to adhesions between iris and lens, or inliltration of iris stroma with lymph, or to both. V = /A' Patient exceedingly nervous; face pale, lips anaemic, tongue white and flabby, pulse rapid and irregular. Prescribed Merc, iod. 3 dec., every three hours. Sol. Atropine (-1 grains to 1 ounce) applied twice daily. To use blue glasses out of doors, and rest the sound eye. Four days later the vitreous was clear enough to reveal the details of the fundus ; arteries normal, veins somewhat enlarged ; edges of choroidal patches elevated and reddened, and well supplied with pigment. In the centre of the patches, atrophy of the choroid made the whitish color of the sclerotic apparent; retinal vessels could be traced over them. For a week further slow improvement; then a relapse from exposure of the eyes to strong sunlight ; the symptoms reappeared, with some ciliary neuralgia. Patient complains of weakness and want of appetite. Prescribed Chinin. arsen. 3 dec., every three hours. The prominence of the corneal symptoms suggested the remedy, which seemed also suitable to the general condition. The cornea improved under its use, and the constitutional symptoms disappeared. Silicea G dec. was then given, four times daily, to the end. Duration of treatment two months. Results: Vision improved from 2V0 to i cornea and iris restored to normal state; choroid partially restored, but, where atrophied, the marks remained. Case 2. Irido-Ckoroiditis.-Mr. C., aged 50. Six months ano had " chills," and was heavily drugged. Then came in- flammation of the eyes, which, when the acute symptoms subsided, left a case of irido-choroiditis. On examination: left eye, no external redness; cornea and anterior chamber normal; iris changed from a blue to a greenish tinge ; pupil slightly irregular from a posterior synechia at the lower middle third ; capsule of lens dotted 'with opaque spots, and markedly turbid in the lower segment; ophthalmoscope re- vealed haziness of vitreous ; fundus but indistinctly outlined; floating opacities in the partly liquid vitreons. Reads Snellen 3^- with + 24 glasses. Right eye: evidence of previous inflammation; lens capsule slightly dotted with pigment de- OPHTHALMIC THERAPEUTICS. 629 posit; vitreous slightly hazy ; fundus normal, V = K- Reads Snellen with + 24. Prescribed four grains Sol. Atropine to left eye twice daily to release synechia. Internally, Silicea 6 dec. four times a day. After a week's treatment, was attacked, while away from home, with diarrhoea for which he took all that many advisers recommended, and returned much prostrated. Vision had sunk to in the left eye, and ? £ in right. Prescribed Nux vom., every three hours for three days; right eye regained its previous vision ; the left unameliorated, but the synechia had been partially detached. Prescribed, Kali hyd. 3 dec. four times a day, continued for two months. Resume : Duration of treatment ten weeks. Result: Right eye, v. emmetropic j £ ; left eye, V = ; could read Snellen 1^- with + 21 with each eye. The Silicea was chosen from clinical experience in cases approximately similar ; the Kali hyd., because of its observed action in like cases under treat- ment at the time, Case 3. I Mo-Choroiditis.-Miss L., aged 26. Eight years ago noticed a drooping and heaviness of eyelids. After two years found sight of left eye imperfect, and when this dimness appeared the drooping of both eyelids ceased. No redness, pain, nor photophobia; but black spots and flashes of light were sometimes seen. A year later, the right eye was affected and rapidly grew worse than the left. Two years ago the sight failed entirely. Examination of right eye: no external red- ness ; anterior chamber shallow ; iris discolored, and crowded forward by a swollen opaque lens, to the capsule of which it was attached all around the margin of a contracted pupil. Not even quantitative sight existed. Left eye: anterior chamber shallow ; iris dimmed and discolored ; pupil moderately dilated and mobile. Ophthalmoscope revealed pigment spots on the lens capsule ; vitreous hazy throughout; lying in it, near the retina, three greenish blue spots a little larger than the optic nerve ; probably hemorrhagic effusions undergoing degenera- tion. V = |£. Snellen thread slowly at 3 in.; irregular dilata- tion of pupil under Atropine. Patient in fair health and only complains of black spots in the visual axis, inability to bear strong light and to use her eyes continuously. Prescribed Mer- 630 world's IIOMCEOPATUIC CONVENTION. curius iod. 3 dec., four times a day ; to use protective glasses and to abstain from " near work." Twenty days later V = ? Snellen 1^- read at 8 in. During the menses, two days after this record, there was hemorrhage into the vitreous. For one day sight was only quantitative, but it rapidly cleared. For ten days, V = jg emmetropic. Resume : Duration of treat- ment, sixty days; left eye from, V. = H to Case 4. Uyalitis or Opacities of Vitreous.-Mr. R., aged 39, had been treated for nine months, in different ways, for inflammation of left eye, and subsequent impaired vision. Patient robust, no syphilitic history ; no external signs of disease visible. Ophthalmoscope revealed a large floating opacity in the vitreous, close to the posterior surface of the lens ; vitreous hazy and partially fluid. Patient able to count fingers at G in. with eccentric fixation. Prescribed Kali mur. 6 dec. four times a day. In eleven days could count fingers at 11 in. Remedy continued for nearly a month without fur- ther improvement. Prescribed Mercurius iod. 3 dec. four times daily. One week after, fingers were counted at IS in. Three weeks later V = No further advance for a month. Prescribed Sulphur G dec., four times a day for three days, then recur to Mercurius iod. One month later V = | $ and some words of number 8 Jaeger were read. In two months following, under same remedy, V = | £ as before, but Snellen 1| could be read at G in. Resume : duration of treatment seven months. Result: improvement of vision from counting fingers at G in. or about to f", and ability to read Sneller 1-^ at Gin. This case illustrates the advantage of persistent treat- ment, for it had been considered hopeless by at least two educated and able oculists. Case 5. Chorio-Retinitis.-Mr. D., setat. 36. Noticed two years ago such dimness of right eye that he could not read a newspaper. Had observed no previous trouble. After a month's treatment he could read again ; but suffering a relapse the same treatment for a year proved ineffectual and the case was deemed hopeless. No history of syphilis. Examination showed cornea, iris and pupil normal. No external redness. By ophthalmoscope : vitreous rather hazy, with some black OPHTHALMIC THERAPEUTICS. 631 shreds suspended in it, having very limited motion on rotating the eye. This would indicate that the vitreous was not fluid. Optic nerve and blood vessels normal. Inside the disk, a large irregular, atrophic spot, involving the choroid and retina, sur- rounded by several small ones; edges irregular and pigmented ; the sclerotic seen white through their centres ; choroid adja- cent, congested and thickened ; some vessels lost in the infil- trated part to reappear on the other side ; a dull pain, occasi- onally, in the eye and over the brow, with an ill-defined feeling of contraction around the eye. V=^V»- Snellen 11, slowly deciphered. Prescribed Kali mur. 6 dec., four times daily. At the end of a month vision rose to and Snellen 3 was read at 5 in. A year afterwards the man could read Snellen 2|, distant vision but under Kali mur. for a week it was again The patient's business engagements prevented longer treatment. Case G. ChorioCRetinitis.-Mrs. S., (etat. 40. For twelve years has had " blurring of sight " during summer, if exposed to heat of stove, or otherwise overheated. Vision seemed un- impaired between these attacks; also in winter. But, for eighteen months a little use of the eyes for reading or sewing causes pain ; and if indulged in during an evening, she would wake from sleep with deep aching pain in the eyeballs, and tenderness to touch, especially in ciliary region. Fixed muscae very troublesome; eyes sensitive to light. Frontal headache is frequent and severe; scalp nearly always tender. Vertigo frequent, sometimes-with nausea or vomiting. Look- ing quickly at moving objects induces giddiness. Mood petu- lent, irritable especially on rising in the morning; easily worried; disposition to hurry things; time hangs heavily. Constant sense of weakness; perspires freely and is easily tired. Palpitation and occasional distress in region of the heart; op- pressive, suffocating feeling in sleep. Ophthalmoscope revealed a fixed opacity just behind the left lens, resembling a line about three lines long with a round dot in the centre. Optic nerve bluish white, somewhat irregular from a slight posterior staphyloma; vessels are attenuated but veins not tortuous. In the right the disc is the same, but external to it (inverted 632 world's homoeopathic convention. image) are atrophic spots through which the sclerotic can be seen. They resemble coalesced points of inflammation ; the edges are lined with pigment. Vision eccentric; right eye, AV left, AV She reads No. 7 Snellen, slowly. By black- board test field of vision seems complete ; but she sees only part of a large word at a time. Prescribed Argentum nit. G dec., four times daily. Three weeks after, the report reads : R. E. V = L. E. V = ; light as before. Deciphers Snellen 3 as clearly as No. 7 on first visit. Ophthalmoscope shows no change in left disc, but in the right the edge of the atrophic spots seems thinned and less pigmented. Case 7. Irido-Choroiditis.-Mrs. T., aetat 32 ; lives in a malarious district, and has taken large quantities of Quinine. Four years ago had cerebro-spinal meningitis. Two years ago had iritis of left eye, which recurred, after being cured, with greater violence. Last year had ulcer of cornea of same eye. Two weeks ago suffered as now. Examination : Pericorneal injection of a violet red color; especially marked at upper and outer segment. Cornea marked with opacity from former ulceration. Iris dull, thick and discolored. Pupil contracted and sluggish. Eyeball very tender to touch in the region of ciliary body, upwards and outwards. Photophobia intense ; lachrymation free ; ciliary neuralgia. Constant sensation of burning in conjunctiva. V = ; health generally good. Prescribed Arsenic 3 dec., every two hours ; Atropine lotion twice a day; to wear protective glasses. A week after, V = ^®, other symptoms modified. Under same remedy the neuralgia disappeared, the pericorneal injection grew faint; the iris assumed a more natural appearance. The ciliary body was the last point to yield. Patient suffered a relapse on re- turning home. Belladonna alternated with Arsenicum for a week gave little relief. Thuja 3 dec. was then given alone with good effect. Resume : Duration of treatment eight weeks. Result: Increase of vision from to ^®. Restora- tion of iris and ciliary body. The remaining impairment due to corneal opacity. Case 8. Irido-Cyclitis.-Master II., aged 9. Two weeks ago was struck in the left eye with a piece of glass, which OPHTHALMIC THERAPEUTICS. 633 ruptured the cornea, near the sclero-corneal margin. Severe inflammation supervened, involving the iris and ciliary body ; followed by sympathetic inflammation in the right eye. On examination: left eye virtually in a state of panophthalmitis, lids swollen, somewhat cedematous; conjunctiva bulbi intensely injected and distended (chemosis) with a sero-plastic deposit. Cornea opaque in the region of the wound, which embraced a portion of prolapsed iris. Iris thickened and discolored ; pupil contracted and filled with lymph ; ciliary region intensely sensitive; neuralgia severe, profuse lachrymation and photo- phobia very marked. Right eye: pericorneal injection, pinkish; iris inflamed, thickly infiltrated and discolored; pupil contracted ; neuralgia; photophobia ; lachrymation and ten- derness of ciliary body. The injured eye was at once removed, to get rid cf a direct and continuous irritant to the other. As regards the right eye, the prognosis was unfavorable. The condition was unfavorable to a hope of benefit from iridectomy. Prompted by the relief given by Belladonna and Silicia in cases of irido-choroiditis, where inflammation had supervened, the two medicines were prescribed, to be given alternately every two hours. The eye progressed favorably and rapidly, notwithstanding a relapse owing to a fall, in which the little fellow received a blow in the region of the left eye. Before leaving my care, he could count fingers at thirty feet; the external redness had disap- peared ; the iris had approached a healthy look ; but there was still some photophobia and decided impairment of vision. A month afterwards (the remedies having been continued) the eye was quiet and sufficiently clear sighted to permit reading. ACUTE DISEASES OF THE EAR-THEIR HOMEOPATHIC TREATMENT. T. P. Wilson, M. D., Cincinnati, Ohio. For one to take definitely this ground and discuss it, to the exclusion of collateral subjects, is to undertake a task of no small magnitude or trifling difficulty. The very nature of the terms employed in the statement commits us to the doubtful expedients and conveniences of the popular pathological sys- tem of the day. First as to nosology. We are obliged to recognize an artificial arrangement of pathological conditions into a catalogue of names. These names represent what are called diseases. It is needless to say they are essentially human creations. But, as though to give the lie to the accepted declaration, that a stream cannot rise higher than its source, these human creations, factitious and ideal though they are, rise into undue proportions and exer- cise autocratic powers; and we stand powerless before them. Two centuries ago, we might have found the American con- tinent stretching out from ocean to ocean, diversified in a thou- sand ways, but unbroken. To-day, we find its map curiously marked by dividing lines. From the original thirteen colo- nies, we have multiplied into nearly a half hundred states. Each state is a human device, as is evident from the absurd shape of its boundary lines. Nature seems never to be con- sulted in these artificial creations. But now we cannot fail to observe, that no state can be made so small, that it does not at once become autocratic. Each state, though a part of the 635 636 world's homceopatihc convention. general government, demands a maintenance of its individual autonomy. Suppose now, one were to write upon the subject of law, or the principles of government as applied to this country, he could hardly be expected to break away from this established order of things. Each state has its own special enactments; each administration and epoch its own peculiar legislation; but who does not know that there are principles of law and government that run deeper and more broadly than anything a lawyer or statesman would be likely to discuss ? Such a dis- cussion would be sadly hampered by conditions we have indi- cated. This simile is not lacking in force of application to the mat- ter we have under consideration. Our nosology presents us certain specified diseased states. These names are fanciful and notoriously unscientific. They demand of us recognition; and no one can enter the field of therapeutics, and successfully break away from these nosological entanglements. Yet nothing can be made plainer to the human understand- ing than, that a strict regard to the principles of homoeopathic therapeutics, demands that we wholly ignore much, if not all, that properly belongs to nosology. This statement is not, perhaps, more unfashionable than the words of Patrick Henry and his compatriots, in those memo- rable days, when it was sought to wrest this country from European domination. And we can say, as did he, " If this be treason, make the most of it." But may we not hope to see ourselves as a medical school, or what is more comprehen- sive, as medical men, in this memorable centennial, emanci- pated from the unjust demands of artificial systems of teach- ing and practice, that have been imposed upon us, partly by in- heritance and largely by custom ; for we are, as scientific men, as are scientific men everywhere, the veriest slaves of what is thought and taught to be the fashion in thinking and saving and doing. Equally absurd is the distinction sought to be maintained between certain diseased states which we designate as acute and chronic. To a thoroughly intelligent mind, it seems al- most childish to set up such a dividing line. ACUTE DISEASES OF THE EAR. 637 Secondly, our difficulty assumes no small proportion, when we come to select the homoeopathic remedy. Compared with the formation of our Materia Medica, our otology is modern. When many of our most important remedies were developed into their wonderful pathogeneses, so that we could ascertain under what well-defined conditions they were indicated, and to be applied, it was not known, if, in the provings made, the inner parts of the external ear, or the middle ear, or the in- ternal ear was the point affected. Amid the wealth of symp- toms found in our provings, we are left within a poverty of information as to the special pathological states which they are designed to meet. A third difficulty requires notice, namely, the assumed local character of the diseases we propose to treat. Specialism, by which the human body has been topographically divided into departments, and over these set special classes of practitioners, is not a child of the Homoeopathic School. The constitutional relations of each individual pathological state, should not only never be overlooked, but should always hold a foremost place in our considerations. And so, in a strictly scientific sense, there can be no special practice of medicine; and there can be no special classification of diseases; and no grouping of reme- dies with reference to one generally accepted nosology. It will, however, be the duty of your committee, to adopt the generally received mode of discussion, and enter with this protest upon the work assigned it. We shall not hesitate to assume in the first place, that, in every case, the practitioner, though he applies the strictly homoeopathic remedy, is yet to be not only able to investigate the case he has undertaken to treat, but that he does so inves- tigate it, physically as well as symptomatically. To this end, in needful cases, the fauces and nose are illuminated and ex- plored ; the meatus auditorius externus is carefully examined throughout its entire extent; the tympanic membrane is brought clearly into view whenever this is possible, and its condition carefully noted; the permeability of the Eusta- chian tube is ascertained ; and the condition of the labyrinth investigated, so far as to detect any existing modifications of the auditory nerve. 638 world's iiomceopathic convention. This may not be homoeopathic treatment, but it ia a most necessary antecedent to it. I mean by this that, while one may jump into the dark and land safely, he can only put it down to good luck. Science demands light, literally as well as me- tamorphically. No intelligent account of a case cured can be given, no matter what the remedy or the attenuation employed, unless the prescriber understands what he is dealing with. This point needs emphasis, because we, as a School, have unfortu- nately been always handicapped by a class of professed leaders, who have boastfully discarded these things, and taught us to rely upon symptomatology. It is some satisfaction to know that these misguided leaders have not touched upon this spe- cial field of otology, so as to prevent our students in entering upon it, from understanding the demands imperatively laid upon them, to master the whole subject, its anatomy and path- ology, as well as its symptomatology. The number of diseases of the ear that may properly be classed as acute, is certainly not numerous; but, whether this is due to their non-existence or their non-recognition by us, I am not prepared to say. I shall venture to designate but two, and those both of the middle ear : 1. Acute catarrhal inflammation. 2. Acute suppurative inflammation. It may be best to state, that this distinction is not deter- mined by very broad lines. They are interchangeable condi. tions, so far, that the former, by a simple increase in intensity, often becomes the latter. They do, however, present them- selves so frequently with such diverse symptoms, that we are authorized undoubtedly to maintain this classification. The symptoms of acute catarrhal inflammation of the mid- dle ear, as laid down by a late writer, are worthy of notice. Symptoms.-The symptoms of acute catarrh may be enum- erated in the following order: Subjective: 1. Pain referred to the depth of the ear. 2. A sense of fullness in the same part. 3. Noises in the ear. Objective: 1. Vascular injection (of the tympanic mem- brane). 2. Bulging outward of the the membrana tympani. 3. Impairment of hearing. 4. Catarrh of the pharynx and ACUTE DISEASES OF THE EAB. 639 Eustachian tube. 5. Fever (St. John Boosa, Diseases of the Ear, p. 239). Observe the writer does not say these are a part of the symp- toms, but he enumerates them as constituting the tout ensem- ble of the disease. But in the pages following, he makes a few additions to this picture; as " crawling along the Eusta- chian tube "a puffing sound like the puff of a miniature eno-ine; " " ringing or buzzing sensation." And these are in- cidentally introduced, so that we are impressed with the idea, that they are almost immaterial. And so they are, and must always be to the allopathic practitioner. What Boosa has here laid down is a sufficient guide to a physician of the he- roic or expectant or physiological school. To one who desires to employ the indicated homoeopathic remedy, such a picture of the disease, compared with the dis- ease as it presents itself to the more cultivated mind, is like the rude drawings of an Indian, compared with the master- pieces of the divine Baphael. That this is true, I will pres- ently show. Looking again at this picture, as drawn by Boosa, we are obliged in honesty to acknowledge, that a portion of the objective symptoms, .though of great value, are at present quite beyond our use. We have no pathogenesis of a remedy that corresponds with " vascular injection" ; " bulging outward of the membrana tympani," etc., simply because these condi- tions have not been observed by our pro vers. In good time, let us hope, objective symptoms in our provings, will hold equal rank with those that are subjective. Suppose now, in order that we may get a better definition of acute catarrhal inflammation of the middle ear, as expressed by the subjective conditions, we study this picture a moment: " Violent pressure on the mastoid process below the ear. Behind the left ear the muscles are painful as far as the throat as if they were violently pressed upon. Pressing tearing be- hind the right ear, drawing pain from the ears into the nape of the neck; sensation of heat with drumming in the ear. Earache accompanied by great headache; otalgia in the left ear ; a disagreeable pressure in the meatus; tearing in the right ear from before backward ; tearing in the internal and external 640 world's HOMCEOPATHIC CONVENTION. ear in a downward direction. A very disagreeable feeling in the right ear as if it would bo forcibly torn out of the head ; shootings in the internal ear with deafness on that side. Pul- sation in the ears with increased sharpness of hearing; very sensitive to loud tones. Deafness as if skin were drawn over the ears ; noises in the ears; roaring in the ears ; tingling and humming in the ears. First, a din of trumpets and kettle- drums in the ears and as of rushing wind; immediately afterwards a humming and buzzing, worse when sitting, better when standing and lying; still better when walking. (Allen's Encyclopaedia Materia Medica, vol. ii., p. 87.) Contrast this with the picture drawn by Eoosa, and remem- ber that his is as good as the best to be found in the Allo- pathic school. The ideas of his school are exhausted in his brief statement. Increase your knowledge and multiply your ideas of the condition under investigation, and then you must necessarily enlarge your description. Just as when you bring your object-lens to bear upon a given object, a remarkable increase of details comes into view and invites description ; so it is with diseases viewed in the light necessary for strictly homoeopathic treatment. But the picture drawn from Allen's Encyclopaedia is by no means perfect. It does not exhaust the details of the disease. It is in fact but a very small part of what comes under our observation. What we have quoted is from the provings of Belladonna. We have more than a score of remedies besides this, each one of which is rich in symptoms that are peculiar to acute catarrhal inflammation of the middle ear. We have chosen Belladonna because it is the leading and typical remedy to be employed. It is most frequently indicated and its use will, in a large proportion of such cases, be followed by suc- cess. I desire now to call attention to another aspect of this subject. And, while insisting upon its importance, I am pleased to be able to claim it, as essentially the product of that school of pathology which belongs, because it can belong only, to the homoeopathic school of therapeutics. I mean con- comitant conditions. Look again at Boosa's picture of acute catarrhal inflammation of the tympanic cavity. The fragmentary symptoms are, with one exception, all of the ear. ACUTE DISEASES OE THE EAR. 641 The pathology of his school is thoroughly localized. Beyond what the ear presents, 1st, subjectively, and 2nd objectively, he knows nothing and cares to know no more. More than that would not help his therapeutics. The homoeopathic investigator views the matter different- ly. To him, concomitant symptoms have an important value. To him, in connection with the local conditions spe- cified, vertigo, headache, nausea, diarrhoea, fever, delirium, lassitude, sleeplessness, etc., etc., and conditions of amelioration and aggravation all have their important relations to the case. In any given remedy you seek to apply, you cannot suppose the remedy is exhausted by what you find under that part of the rubric entitled ears. Were we to confine our view to this, by which to estimate the range and applicability of the drug, we should most likely miss its most important relations to this disease. Let us look now at another brief description, having the appearance of acute catarrh of the middle ear. " Tearing in the left ear; pressure in the ears; pains in the ear; pains in the right ear ; pains behind the left ear as from pressure of the thumb. Feeling as if a drop of water were in the left ear. Sensation as if something stopped up the left ear ; roaring in the ears; ringing in the ears; humming, hissing noise in the ears ; continual dull buzzing before the ears, then faintnes ." ( Ulen's Encyclopaedia, vol. i., p. 19.) This is from the pathogenesis of Aconite. But who would give this as a measure of its power as a remedy in this disease ? Certainly no one intelligently acquainted with either the dis- ease or the drug. The nose, the eyes, the head, the mouth, in short every part of the body, under varying conditions, con- tribute to complete the picture which the physician studies both in his pathology and his pathogenesis. Finally under this head, there are remedies other than those we have mentioned, applicable to this form of disease. Our failure to mention them, must not be taken as an indication of their want of value as therapeutic agents. Our second head is : Acute suppurative inflammation of the middle ear. 642 world's homceopathic convention. The writer begs to call attention to the fact, that he made, at the last meeting of the American Institute of Homoeopathy, an extended report upon this subject. The two reports are supplementary to each other. To the descriptions we have already given, we have but to add intensity of symptoms and the formation of pus in the tympanic cavity. It is proper, however, that mention should be made of the fact, that not infrequently purulent inflamma- tion of the middle ear occurs without noticeable subjective symptoms ; a discharge of pus from the meatus being the first indication of trouble. These cases are mostly confined to per- sons suffering from phthisis pulmonalis and but little amenable to treatment. We exclude them. " The usual origin ot acute suppuration is however a violent one. The severe pain of acute catarrh is unrelieved, pus is formed in the cavity of the tympanum, the lining of the mas- toid cells is very much distended, the outer surface of the process becomes red, tender and painful; the head throbs and the whole system becomes disturbed. In young persons, de- b'rium occurs; and in all subjects, there is general febrile excitement; and the condition of the patient is one of in- tense suffering. There is probably no more severe pain to which the human system is liable, than that due to the disten- tion of the little space called the tympanum, with mucus, serum or pus." (St. John Roosa, p. 357.) This author adds : " The membrana tympani has usually lost its naturally transparent appearance, in a case of acute suppuration. It has a boggy, sodden or swelled appearance and has none of its normal distinguishing marks in the way of light spot and handle of the malleus. Yet this is not always the case." And this completes his picture of a disease, that is second to few in the varied symptoms and complications which it presents. And here we stand facing a fact in pathology we cannot avoid accepting. It is this : No disease can be represented by less than an almost infinitude of symptoms. The physiolo- gical school may be easily satisfied with noting, in a general way, the modification of structure and function, caring only to correct these. f>ut our homoeopathic therapy demands much more. In outline and detail every existing feature of the ACUTE DISEASES 0E THE EAR. 643 case should stand revealed. Yet many of our writers on the- rapeutics, commit the folly of attaching to such descriptions of symptoms as they can copy from old school authors, our ho- moeopathic indications of remedies. The absurdity of this course seems never to strike them ; yet it can easily be seen that there is about as much likeness between the symptoms said to represent the disease, and the pathogenesis of the re- medy said to be indicated, as between a child in embryo and a full grown man. How is it possible for a disease to indicate a remedy except by its symptoms ? And how can a drug show its homoeopathic relations to a case, except as it presents symptoms corresponding to those of the disease ? Now what is the fact in regard to this? In every attempt to run a parallel between these two classes of symptoms, I mean in our text books on practice, the symptoms of the drug vastly outrun the symptoms of the disease. And the reason for this is evident. No disease (as understood in our accepted nomenclature) can be represented by less than an almost infi- nitude of symptoms. Add to this the fact already stated, that concomitant conditions rank in equal importance with local symptoms, and you have before you the problem of ho- moeopathic therapeutics. This is by no means a problem always easy to solve, but its solution is not only greatly enhanced by our possession of fixed principles of investigation and those of the correct kind, but it is a fact, that, without these, we can only plunge into the quagmire of empiricism. The incompleteness of our Materia Medica, when we come to apply it to diseases of the ear, as our modern otologists un- derstand them, is painfully apparent. But our Materia Me- diea is so much better than the best we can find of the symp- toms and pathology of the disease, as laid down by any of the writers of either school, that we have reason to be proud of wdiat we possess. An intelligent application of it, will give us very satisfactory results in the treatment of either of these forms of disease we have under consideration. In addition to Aconite and Belladonna already mentioned, we might name Bryonia, liepar sulphur., Mercurius, and 644 world's iiomceopatuic convention. Pulsatilla as of chief importance ; and a half score of others, each one being of more importance than all the rest when- ever specially indicated. To show their homoeopathic rela- tions to the disease, we would have only to quote their rich and varied pathogeneses. By way of conclusion, it may be best to add, that, while we aim to give to the strictly homoeopathic treatment of these dis- eases its true value, we do not ignore the value of such agen- cies as these : hot water, atropine and inflation. Our former report upon this subject, gives all needed emphasis to their use. But these agencies are adjuvants, and therefore secon- dary in importance, but never to be discarded because they do not fall ■within the province of our great unalterable law of cure, Similia Similibus Curantur. HOMEOPATHIC THERAPEUTICS OF AURAL SURGERY. Henry C. Houghton, M. D., New-York. Our first work in the consideration of any subject should be that of definition. Much time has been spent in fruit- less discussion, simply from neglect of this preparatory work, by those who were in perfect accord as to the subject matter. Therapeutics is that branch of the study of medi- cine which treats of the various means of cure. Hence we have no contest witli the advocates of mechanical, hygienic, or even allopathic curative methods. We recognize the great merits of mechanical expedients in the hands of scien- tific practitioners ; the same is true of hygiene. " Cleanli- ness is next to godliness," and physical purity would prove the greatest prophylactic agent ever introduced to the hu- man race. To our friends who advocate the principle of the " opposite " as acting in the cure of the sick, we accord the benefit of the doubt, and allow that it may be a law of cure, and we ask similar courtesy when we claim that the principle of "similar" is the foundation stone in a law of cure according to which we practice. By this definition we are therefore limited to the consid- eration of those means or agents which act according to the law first laid down by Samuel Hahnemann. Hence we shall endeavor to show that certain agents which cause deviations from physiological action and condition as regards the organ of hearing, will cure like morbid conditions of tis- sue or deviation of function where no change in tissue can be demonstrated. The ear offers a field of study of peculiar interest because its subdivisions present three kinds of surfaces, three classes of tissues. The surface of the external ear is a dermoid one, its features like those of the integument generally. 645 646 world's hojiceopathic convention. The middle ear, or tympanum, is lined by a mucous mem- brane, which is at the same time periosteum to the bone which it overlies, and is continuous with the pharynx via the Eustachian tube. The internal ear, or labyrinth, is lined by a serous membrane in immediate relation to and supporting the terminal fibers of a nerve of special sense. In discussing aural therapeutics as related to chronic dis- eases, which is the scope of this paper, we shall be obliged to assent to the following proposition : Symptoms cured by the administration of the homoeopathic remedy would have been caused by the proving of that remedy if it could have been pushed to its ultimate results, that is, the prover must desist from the extreme results on account of the lack of human endurance. If any one dissent from this proposition, he may be reminded that it is the converse of the fundamen- tal principle or law of his daily practice ; hence clinical proofs are as valuable as those developed in the course of a physiological proving, or shall we say pathological? We turn then to the consideration of a few remedies that act upon the external ear, and if I mistake not we shall have occasion to notice an interesting feature of this con- vention ; namely, the testimony regarding the similarity of the action of remedies upon like tissues in parts of the body remote from each other. We find that the remedies acting in the most marked manner upon the auricle, external audi- tory meatus and dermoid layer of the membrana tympani in the chronic forms of aural disease, are Alumina, Arsenicum, Antimonium crudum, Calcarea carbonica, Carbo-vegetabilis, ' 'O' Conium maculatum, Graphites, Hepar sulphuris calcarea, Mercurius virus, Oleander, Petroleum, Picric acid, Silicea, Sulphur, Tellurium. It may be well to preface this article with the statement that we shall give only those indications that have been con- firmed under our personal observation during the past eight years. The clinic of the New-York Ophthalmic Hospital has afforded ample material for study. About 3,000 ear cases have been treated from June, 1868, when the Institu.- THERAPEUTICS OF AURAL SURGERY. 647 tion came into our hands, until the close of the Hospital year, Sept. 30, 1875. Arsenicum album. In otitis externa diffusa. Objective symptoms: Tissues of meatus red, infiltrated, oozing clear watery fluid, in some cases vesicles, in others the tissues thin, dry and scurfy. Subjective symptoms : Burning and itching; itching is aggravated by scratching and amelio- O 7 O O O J <3 rated by heat. Antimonium crudum. In cases without onjective symp- toms, the subjective ones being heat and tension, aggra- vated by heat. Case.-Miss K., age 30. Diagnosis: Otitis media catarrhalis chronica, left; with the symptoms due to lesion of the middle ear. The heat of the auricle and meatus was increased by sunlight; heat from the stove, wrapping, or even turning upon that side in sleep, would increase the heat and waken the patient. An- timonium crudum caused transfer of the heat to the scalp. Glonoiu has since controlled the latter condition. Calcarea carbonica, one of the most valuable remedies in suppurative inflammation of the external ear, in scrofulous subjects The meatus filled with cheesy pus, the derma thickened and red Often the dermoid layer of the mem- brana tympani destroyed by ulceration and covered with exuberant granulations, which may fill the meatus, the structure of these polypi being of the simple cellular class. There is a lack of subjective symptoms ; in some a pulsa- tion is noticed. Carbo vegetabilis is indicated in otitis externa diffusa chron- ica. Objective symptoms being a dry furfuraceous erup- tion, a pityriasis, thin dry epithelial scales thrown off, unat- tended with marked inflammatory signs. In some cases the detritus is moist, yellow and fetid. Subjective symptoms: Itching and heat deep in the ear as well as in the meatus, causing an inclination to swallow. The ears feel stopped. These symptoms suggest the relation of the meatus to the tympanum and Eustachian tube. Carbo veg. is valuable in granular pharyngitis with the above symptoms, the expec- 648 world's homoeopathic convention. toration being small masses of mucus, easily raised. Under the use of Carbo veg. the secretion of wax is re-established in many cases. Conium Maculatum.-Valuable in hypersecretion from the ceruminous glands. Objective symptoms: Accumulation of soft cerumen, of normal color, and clinically, that which resembles mouldy paper, and is mixed with pus. The subjective symptoms are a sense of fulness, roaring, and humming; diminution of hearing, which is ameliorated, in many cases, by pulling the auricle, as this strengthens the canal, and makes a passage for the sound-waves beside the mass of cerumen. Graphites.-The characteristic symptoms of this remedy, as regards the integuments and nails, all also are noticeable in this locality. The objective symptoms are dryness and cracking of the tissues of the meatus and auricle, particularly behind the latter ; deep fissures in many cases. The pus, both in the meatus and about the auricle, is usually thick, and forms crusts very rapidly. The subjective symptoms are itching and soreness, not to the degree that may be called sensitive (see Hepar). Hepar Sulphurus Calcarea. - The appearances that suggest this remedy are those of an indolent ulcer, corroding and very sensitive to touch; the pus fetid and thin; or, if the membrana tympani be perforated, mingled with mucus. The subjective conditions are itching in the meatus, with soreness on attempting to bore with the finger. Mercurius Virus.-Although this remedy is specially indicated in diseases of the middle ear, yet it may be used as an intercur- rent remedy in disease of the meatus, with Conium and Carbo vegetabilis. In January, 1873, we treated Mrs. T., aged forty- eight, a thin, small woman, dark hair and eyes. Had discharge from R. since childhood. One month later took cold and lost the power in the L. Hears voice watch, r an(] L. M. E. scales and shreds. R. M. T. irregular, retracted, but movable. E. T. dilatable. Throat granular. The outermost dermoid layer of the membrana tympani was repeatedly thrown off during the course of treatment, the meatus filling with ceru- ,men and scales. Carbo veg. and Conium made remarkable THERAPEUTICS OF AURAL SURGERY. 649 change in one year, the hearing for voice becoming nearly nor- mal ; watch, R. 514°a ; L. The second year she was seen at intervals of about two months. During the third year, on one occasion, some of the shreds were accidentally carried very near the terminal filaments of the olfactory nerve, and the decided coppery odor was noticed. Merc, was given with most marked relief to the local as well as general condition of the patient. Petroleum.-Indicated in diffuse inflammation of the meatus, with moisture oozing; same condition behind the auricle; rather excoriation than deep fissures (Graphites). With the internal remedy we have used very largely the concentrated oil (Cosmo- line). It is far superior to olive, almond, and other oils so fre- quently used. Picric Acid.-This remedy is indicated by the recent proving in furuncular or circumscribed inflammation of the meatus ; yet, in the chronic or subacute forms, it has delighted patients and surgeons. In debilitated cases, with redness and localized ten- derness of the meatus, it acts like magic. Psorinum.-External ears, raw, red oozing; scabs form; sore pain behind ears. Otorrhoea very offensive, purulent, watery. Pustules on and behind concha. Scabby eczema behind right ear. Herpes from ears to cheeks. Scurfs form and scale off • yellow discharge from under scurfs; itching intolerable. This remedy has been repeatedly confirmed both in clinical and private practice. SiUcea corresponds to an ulceration of the tissues of the mem- brana tympani and inner extremity of the meatus, which is deep, slow to heal, covered with thick yellow pus; the pus tends to the formation of a firm scab, which adheres closely to the ulcer, and on removal reveals the above condition. The tenderness is marked on touching with probe and cotton, but not so extreme as Hepar sulph. calc. One subjective symptom that suggests this remedy is a hissing sound accompanying the purulent dis- charge. Sulphur.-This remedy applies to many and varied, some- times opposite, conditions. The appearance of ulceration, with perforation of the M. T., is usually thick edges, with thin pus, 650 world's homceopathic convention. fetid, tending to crusts. The ulcers show no disposition to heal. Subjective symptoms are burning and itching, or pricking; a sensation of tension or drawing deep in the meatus, or a pulsa- tion in the same, would suggest the remedy; but these objective and subjective symptoms are usually most marked in diseases of the middle ear. Tellurium is of great value in acute inflammation of auricle, meatus, and external surface of membrana tympani,-a condi- tion similar to phlycttenular conjunctivitis ; yet the remedy has proved curative in chronic suppurative inflammation, with the characteristic discharge, watery,. excoriating, and very fetid, smelling like fish-pickle. The condition of tissues in the prover, our honored President, Dr. Carroll Dunham, indicates that it should cure suppuration of the middle ear as well. We turn now to the study of those remedies that are curative in lesions of the middle ear. They may be divided into two classes, those homoeopathic to a chronic condition, characterized by perverted secretion, either of mucus or mucus with pus, and those indicated by the very opposite state, atrophy of the mucous membrane, and rigidity of the articular capsules or sheaths, evi- dence of idiopathic sclerosis, or the remote results of otorrhoea or suppurative inflammation of the tympanum. The functions of the tympanum depend upon, or are modified by, the integrity of the Eustachian tube and the mastoid cells ; hence the remedies studied must include those acting upon these. Aurum Metallicum.-This is indicated in consequence of sup- purative inflammation of the middle ear. The periosteum of the temporal bone being affected, the porous diploe yield, and finally the entire surfaces, external and internal, are denuded. The sub- jective symptoms, as far as the ear is concerned, are decidedly negative; but the general ones make the choice between this remedy and Fluoric ac., Nit. ac., or Silicea easy. Pain, like a bruise, or as if pulled, worse at night by uncovering and at rest; better by motion, by washing, and while sensitive to cold; yet relieved by going into the open air, even in bad weather. The tissues of the M. E. are bathed by a fetid pus, the odor being characteristic of necrosed bone. The M. T. is usually perforated, THERAPEUTICS OF AURAL SURGERY. 651 the ossicula more or less disintegrated and thrown off. Often the osseous meatus is denuded, sinuses connecting the canal with the fistulous openings upon the external surface of the mastoid process. Baryta Muriatica.-Baryta is one of our most valuable reme- dies, both in suppurative and non-suppurative inflammation of the middle ear. After frequent failures with the carbonate we find that the symptoms, as given in Allen's Encyclopedia, vol. ii, Baryta carbonica, symptom 122, "hardness of hearing;" 123, "severe buzzing in the ears;" 124, "cracking in both ears when swallowing;" 125, " cracking in one ear when swal- lowing, as if it were breaking;" 126, "cracking in one ear when swallowing, sneezing, etc.;" 129, "a reverberation in the ear on blowing the nose violently." All these have been repeatedly relieved by the muriate. What is the significance of these symptoms? Dr. Hinton, in his work entitled Questions °f Aural Surgery, writes: "Mr. Yule confirms the statements of Drs. Jago and Rumbold respecting the effect of an abnormally open Eustachian tube in intensifying any sounds produced in the patient's own throat; and 1 had the opportunity of demonstrat- ing that the cause is rightly assigned by introducing into his tube a vulcanite Eustachian catheter, in the curve of which an orifice was cut, so as to establish a continuous passage from the throat to within the tube, when the very same effects that result from his own muscular action were produced." Those specially interested in the details of this study are referred to the above- mentioned work.* These symptoms are, therefore, due to inter- ference with the action of those muscles which open and close the Eustachian tube. We shall have occasion to contrast an abnormally open tube with one closed by morbid conditions. Calcarea carbonica applies to the same class of patients as in general diseases. The fat, rapidly growing, large-headed, soft- boned children, or adults, who in youth were vigorous, but now fail from low power of assimilation, great weakness, dejection, sensitiveness to cold, damp air. The pains about the head are * James Hinton, The Questions of Aural Surgery, London, 1874, p. 102. 652 world's homceopathic convention. pressing or pulsating, often semilateral; coldness of the head; sweat on the head evenings. The pain in the head is also beat- ing, with knocking, buzzing, and roaring. Detonation in the ears. Meatus filled with whitish, pappy, fetid pus, or viscid dis- charge. Membrana tympani perforated, and often the edges are covered with granulations which extend to the walls of the meatus; occasionally these enlarge and form polypi, usually of the mucous (raspberry) variety. We have found these exuberant granulations to yield more promptly to the Calc. iod. than to the Calc. carb. If the growth is' large, and cause pressure by check- ing the escape of pus from the tympanum, it should be removed by mechanical means ; but this does not prevent its rapid re- newal. Silicea should follow the Calcarea after the ulceration assumes an indolent type. Capsicum.-For chronic suppuration, in adults especially. The pains in and around the ear are acute, shooting, pressing, with bursting headache; great thirst with chilliness and shiver- ing. In February, 1872, Dr. T. F. Allen called our attention to this special symptom : "On the petrous bone, behind the ear, a swelling painful to the touch." In April, 1873, we published in the Ophthalmic Hospital Reports, for the New York Journal of Homoeopathy, cases showing its value. Three years have added many cases to our list of cures ; the typical ones are those in which acute symptoms occur in chronic cases; the mastoid cells become involved and-their dense structure yields slowly; hence the danger of cerebral trouble as the diploe of the temporal bone above threatens to give way before the petrous portion below and behind. In children the mastoid cells are large and with their walls break down with comparative ease; Hepar sulph. calc, hastens the relief when the case has advanced far before Capsicum is used. In some cases the swelling behind the auricle has been very great, turning it almost to a right angle with the side of the head, the meatus being closed almost entirely, the pus is yellow, flowing quite freely, and not especially offensive. In every case the M.T. was perforated. Carbo animalis and Carbo vegetabilis are found in our reper- tories as curative for otorrhoea, and one writer states, "suppura- THERAPEUTICS OF AURAL SURGERY. 653 tion of the internal ear, and discharge from the same," meaning middle ear. Thus far all the cured eases seen at the clinic and in private practice were those where the lesion was external to the membrana tympani. A review of the yearbooks con- firms our view that the action of the remedy is curative in chronic, non-suppurative inflammation of the middle ear, the so-called, proliferous form. Objective symptoms: membrana tympani retracted, opaque in most cases, tympanum dry, the Eustachian tubes easily dilated, the pharynx granular. The sub- jective symptoms suggest a dry state of tissues, itching and tick- ling in the ear (similar to the throat symptoms), with cracking on moving the jaw, an inclination to swallow, which relieves the ear. Causticum.-There is an absence of objective symptoms in cases cured by Causticum, but the subjective ones are very pro- nounced. "Crawling as from an insect." " Itching in the ear, beginning in the throat, along the Eustachian tube." (Also under Nux vom.) The symptoms under the internal ear are noteworthy. China or Cinchona.-Indicated in suppurative inflammation. After repeated trial of the various remedies given in our reper- tories for haemorrhage from the ear, such as Cicuta, Lachesis, Mercurius, Pulsatilla, and failing of satisfactory results, we gave China to a little girl at the clinic of the New York Ophthalmic Hospital. The following were the objective symptoms : Meatus full of sanguineous, sanious discharge, the tissues infiltrated and suggestive of deepseated disease. M. T. not seen ; the patient was very anaemic, and the Cinchona was given upon general rather than local indications. To our surprise and delight, the case changed its features at once; the meatus became more open, the membrana tympani defined, the perforation clearly so, the flow of blood ceased, and the pus became more laudable. Since that date we have used Cinchona in every case of similar nature with a prompt response. The condition of tissue is not that of exuberant granulation but indolent ulceration, with passive haemorrhage. In one case there was mastoid disease, of long standing; a sinus opened upon carious bone. The action of 654 world's homoeopathic convention. Cinchona upon the middle ear in non-suppurative inflammation is a subject upon which we are not prepared to speak as we desire. That it causes hyperaemia of the tympanum has been shown by Hammond and others. Roosa* reports a case of otitis which illustrates the action of Quinine on the external ear, as well as the labyrinth. We have a case under treatment where the otitis was aggravated, if not caused by Quinine, the acute symptoms recurring every seventh day. In two cured cases, one in our own practice, the second reported by a colleague, the lesions were not of the external or middle ear, but clearly of the internal. Of these cases we will speak when considering the therapeutics of the internal ear. Cotyledon Umbilicus.-This remedy was first brought to our notice in Hale's New Remedies. The symptom as given in the "third edition," page 183, associate the ear symptoms with the cough. "During a cough, the Eustachian tube of the left side feels as if stuffed with mucus ; the sensation is extremely painful, with great deafness." " Eustachian tube feels constantly clogged up, and there is a most disagreeable singing noise in the ear, with deafness." The prover, Dr. Alfred Pope, after giving the symptoms of the respiratory tract, continues: "Eustachian tube of the left side feels as though it were stuffed with mucus; it was extremely painful and caused great deafness. Next day, 1 P.M., the Eusta- chian tube of the left side still feels clogged up, and there is a most disagreeable singing noise in the left ear ; still a little deaf." Evidently the pain, the clogged sensation, and the singing were not caused by expulsion of air in coughing, but due to accumula- tion of mucus in or about the tube. It would have been of advantage if the condition of the tympanum could have been ascertained; the symptoms suggest mucus collection in the middle ear. We have this day seen a gentleman with similar symptoms on the right side; the tympanum full of stringy mucus, which could be pulled out in strings through a perforation in the inferior posterior quadrant of the mem- brana tympani. In the case of a lady over seventy years * Eoosa on the Ear, New York city, 1873, p. 155. THERAPEUTICS OF AURAL SURGERY. 655 of age this remedy gave the most satisfactory results. On waking in the morning or at midday she was troubled by a low singing, hissing sound, which increased in intensity, soon be- coming more shrill and vibrating, like a policeman's whistle. The whole vicinity of the Eustachian tube seemed stuffed and pressing in every direction. Head felt tense. Seemed as if she must lose her senses, and referred all the symptoms of head and body to the noise in the ear. Cotyledon3 gave relief in twenty minutes, the sounds softened, the whistling died away, and at the end of two hours only a low hissing, or, as the patient termed it, "frying" remained. A similar attack, two weeks after, yielded to a higher potency, 200th. We have used the remedy in many cases but with no satisfaction, unless associated with the symptoms of the Eustachian tube. Elaps Corallinus.-Indicated in the chronic suppurative form of disease, complicated with naso-pharyngeal catarrh. The pos- terior wall of the pharynx covered with crusts or raucous mem- brane fissured, nasal mucous membrane in same condition. Ex- ternal meatus full of offensive yellowish-green discharge, which stains the linen green, membrana tympani usually perforated. Subjective symptoms : congestive lancinating frontal and occipital headache, < by motion and stooping. This remedy is of great value in the naso-pharyngeal catarrh which complicates aural disease in children. The patients are compelled to sleep with the mouth open on account of the obstruction of the nares; hence the term, snuffles, used by mothers and nurses. Graphites.-The relation of this remedy to the nutrition of the skin holds good in dry conditions of the mucous membrane, indeed we may infer very much of the condition of the tym- panum from study of the dermoid layer of the external auditory canal. Hence the condition is that of sclerosis or proliferous inflammation. The membrana tympani may be opaque and thick or transparent and very thin, adherent to ossicula or promontory, or perhaps mobile, Eustachian tube dilatable, but hearing not improved by inflation. There is one subjective symptom which is characteristic, " hearing improved in a noise." Writers upon aural surgery differ widely regarding this matter. 656 world's homoeopathic convention. Von Troltsch and Roosa treat the matter very lightly as if the patient's statements were faulty. Kramer and Wilde accept the fact, bnt fail to account for it. Dr. Peter Allen,* Aural Sur- geon to St. Mary's Hospital, London, England, gives an expla- nation which is satisfactory, one which we have been able to con- firm. Space will not suffice to go into the details of the physio- logical action of the muscles of the tympanum; we will simply state that any change in the tympanum which either presses the stapes into the fenestra ovalis or draws it out beyond normal re- lations, changes the tension of the serous fluids of the internal ear, and this causes subjective sounds. Such changes do occur in the dry atrophied condition we are considering, and the atrophied muscles cannot sustain the ossicula in their normal re- lations under ordinary sound-waves; when, however, the patient is subjected to extraordinary continuous sound-waves a reflex action stimulates the muscles; the sound ceases, and hearing im- proves. This can be done by galvanism, as we have shown in our article read before the Homoeopathic Medical Society of the State of New York, 1875. That which is done by the heavy sound-waves, or by galvanism, is accomplished by Graphites in a gradual manner; the function of the tympanic muscles is re- stored, when the nutrition is re-established. Hepar Sulphuris Calcarea.-In the suppurative forms. Mem- brana tympani perforated; ulceration angry; discharge small amount, sour, fetid odor; the tissues very sensitive, often covered with white shreds, which cling to the ulcer. Subjective symp- toms: soreness in small spots about the ear. Itching. Patient worse at night and by cold air. Hydrastis canadensis stands first among remedies for muco- purulent discharge from the middle ear. We should expect this from its action on mucous membranes elsewhere. In purulent inflammation of the middle ear with thick tenacious discharge, more mucus than pus, this remedy is invaluable. Compared with Kali bichromicum there is less tendency to granulations about the perforation of the membrana tympani, less cracking and crusting of mucous surfaces. * Lectures on Aural Catarrh, London, 1870, page 29. THERAPEUTICS OF AURAL SURGERY. 657 Iodine.-In chronic non-suppurative disease. Curative in atrophy of mucous membrane, probably by stimulating glandu- lar elements of structure (see Graphites). Kali Bichromicum.-In chronic suppuration : the membrana tympani perforated ; the cicatrization of the edges of the perfora- tion complete; the tissues have an appearance as if changed to mucous membrane, and the secretion is often more mucus than pus; the discharge yellow, thick, tenacious, so that it maybe drawn through the perforation in strings. The subjective symp- toms are lancinations, sticking sensations, that the patients are not able to locate with any degree of positiveness. Lachesis.-This remedy has been curative in some cases of the proliferous form. The objective symptoms being similar to those given under Graphites; the subjective symptoms of left- sided deafness and aggravation after sleeping led to its selection in lesions after typhoid or typhus fever and diphtheria. Lycopodium.-For scrofulous subjects, those who suffer from moist eruptions, abdominal troubles, sequela of scarlet fever, etc. Hence used in the suppurative form ; the membrana tympani is often destroyed with the exception of a small margin, the ulcera- tion showing no disposition to heal, but not sensitive to touch as under Hepar; the pus is offensive, not profuse, and inclined to crusts if not frequently cleansed. Mercurius Dulcis.-In the Homoeopathic Times, April, 1875, we gave the reason for employing this remedy in chronic catarrhal inflammation of the middle ear. Eighteen months have con- firmed the anticipations raised by its first trials. The objective symptoms are those of this form of inflammation,-the membrana tympani retracted, thickened, and immovable by inflation; a granular or hypertrophied condition of the pharyngeal mucous membrane. The subjective ones are those of a benumbed, dull feeling between the throat and ear, a pressure in the ear from without. With these the subjective symptoms of irritation of the auditory nerve from pressure or tension on the stapes and fenestra rotunda, humming, roaring, and singing. These fade as the audition increases. In many cases the more intelligent patients can give the moment when the air passes, for the first 658 world's homoeopathic convention. time in months or years, from the throat to the ear. Of this form of disease Toynbee writes thus: "This affection is less prevalent in the young than in adults, in whom it is liable to occur after repeated attacks of cold, whether with pain or not. It is, however, most frequent in persons advancing in life, and may, in fact, be considered as the disease which causes deafness in advancing years. The generally received opinion, that in this kind of deafness the nervous system is at fault, is manifestly in- correct, as proved by the symptoms, and by the mode of relief found beneficial." It is to this condition that Mercurius dulcis is proven to be homoeopathic. Mercurius Virus.-In chronic suppuration, with enlarged and sensitive cervical glands, resulting from sudden colds. The membrana tympani is not broken down to a very great degree, and often repairs very promptly, even in cases where the perfora- tion has existed for months; the discharge is pus, fetid, whitish, or mingled with blood. Subjective symptoms: tearing pains with the discharge, these aggravated by any cold which checks the free flow of pus; also worse by lying on the ear in bed. Mezereum is valuable in some cases of sensitiveness of the mu- cous membrane of the middle ear. " The ears feel as if too open, as if the tympanum were exposed to the cold.air and it blew into the ear." This has been repeatedly confirmed. Nitric Acid.-In ulceration, caries of the ossicula or mastoid process, the remote results of syphilis or abuse of Mercury. Subjective symptoms : shooting pains; sensitiveness of the bones; aggravated by every change of temperature, also at night, on waking, or rising from a seat, and by touch (see Aurum); better while riding in a carriage. Fluoric acid has inclination to un- cover and to wash with cold water (see Silicea). Nux Vomica.-In irritation of the mucous membrane of the middle ear: "itching in the Eustachian tube, provoking swal- lowing." Similar to Causticum symptom. Phosphorus corresponds to a dry condition of the tympanum. One objective symptom, deafness, is interesting in this respect, that the failure is especially for the human voice; noises and musical tones are recognized much more readily than the modu- THERAPEUTICS OF AURAL SURGERY. 659 lations of voice. It is undoubtedly true that we must look for an explanation of this fact in the functions of the tympanum, and hope that a more complete knowledge of its physiology will reveal the reason. Psorinum.-A remedy closely allied to Sulphur. Bell* writes: " Whether derived from purest gold or purest filth, our gratitude for its excellent services forbids us to inquire or care." In chronic suppuration, where the symptoms remain unchanged after Sulphur, the ulcers scab over rapidly, the pus very fetid, with the ulceration of the membrana tympani, scabby ulcers on the vertex and behind the ears. Subjective symptoms: excessive itching in the ears, so' that children can hardly be kept from picking or boring in the meatus. Silicea.-In chronic suppuration : ulceration in cachectic sub- jects, or those who have been dosed with Mercury; in caries or necrosis. Objective symptoms: membrana tympani perforated and irregular; secretion of pus scanty; ulcers deep and covered with scabs unless frequently cleansed. The theoretical relation of Silicea to the periosteum would lead us to expect curative action when the middle layer of the membrana tympani (sub- stantia propria) is involved, and clinical results do not disap- point us. It has been our view that more repairs of the mem- brane occur under the use of this remedy, in chronic disease, than under any other single remedy. Sulphur.-The indications for this remedy must be sought in general rather than in the special objective and subjective ones, as they are meagre compared with the last-mentioned remedy as well as others. Itching in the ears, drawing or shooting pains in the ears; discharge of pus, stinking, with crusts. Tellurium.-Curative in chronic suppuration when the symp- toms correspond to the following: a watery fluid smelling like fish-pickle, which excoriates the meatus and the skin wherever it flows. After the suppuration has ceased the membrane has been found cicatrized and corrugated, but not thickened. Thuja Oc.-The special indication for this remedy is the dis- * Bell on Diarrhoea and Dysentery, N. Y. C., 1869. 660 world's homoeopathic convention. charge "smelling like putrid meat." Clinically it has cured granulations in the meatus similar to condylomata. Teucrium Marum Verum.-This is the only remedy under which we are able to say we have seen mucus accumulations disappear from the tympanum, and then only in one case. In this the Politzer's method was used in connection with remedies; the accumulation persisted till Teucrium was used. " One swal- low does not make a summer." We are cautious in attributing to remedies that which belongs to mechanical means. The symptoms, as given by Dr. Dudgeon, certainly suggest the above condition: "Sometimes fine ringing in right ear on blowing the nose; a peculiar chirping sound as if air passed itself through mucus; thereafter the ear remained some time stopped up, and opened up again with a dull sound." The investigations of the past fifteen years liave shown that many symptoms which were referred to the nerve (auditory) are due to lesions of the middle ear; hence we find that the symp- toms arising from lesions of the internal ear are quite limited, and are similar to those occurring in the retina and optic nerve. Idiopathic disease of the internal ear is much more rare than middle ear disease, but we are able to determine its existence by exclusion, and to limit all symptoms that are marked by musical elements as due to abnormal conditions of the cochlea, and all those that are simply noises as due to similar states of the semi- circular canals. When we exclude all subjective symptoms of the hearing that are not due to some lesion of the middle or external ear we find ourselves narrowed to hypereesthesia of the terminal fibres of the auditory nerve, or to complete or partial paralysis of the same. If the lesion be limited to the cochlea it may give either sensitiveness as regards musical tones (or regular vibrations); if to the semicircular canals, the sensitiveness is noticed in regard to noises or irregular vibrations; with this there may be associated vertigo and confusion of sounds: these symptoms are explained when we understand that the recognition of the direc- tion of sound, as well as intensity, is the supposed function of those portions of the labyrinth. In contrast we may have all THERAPEUTICS OF AURAL SURGERY. 661 degrees of lack of perception of musical tones or a complete fail- ure for certain tones either high or low; that is, for short or lone; vibrations. The loss and recovery of the function of audition in these restricted senses is more frequently noticed in the acute form of disease, but sometimes in the chronic. To a few reme- dies for these conditions, as suggested by the symptomatology, we will now refer. Cinchona and Salicylate of soda, more than any other remedies, illustrate the relation of cause and effect: the first sustained by provings, the second by pathological examinations. Cinchona, and specially its alkaline proximate principle quinia, has been long recognized as having toxic effect on the ear. The symp- toms produced by the proving point to impressions upon the labyrinth, such as produced by sudden obstruction of blood, viz., vertigo, from loss of blood; giddiness, from anaemia; fainting, ringing in ears. In some subjects a fine ringing in the ears is caused, associated with a general nervous erethism. As a rem- edy Cinchona proves curative in these two opposite conditions, and acts upon both cochlea and semicircular canals. We have no exhaustive proving of Salicylate of soda, but ex- periments on lower animals show that toxic doses cause haemor- rhagic exudation in the labyrinth. It has proved curative in cases of sudden deafness, in which vertigo was a marked symptom. Gelsemium has proved of value in acute inflammation of the internal ear. In a case seen at the request of Professor F. E. Doughty, M.D., of this city, this remedy, in conjunction with Silicea, restored the hearing in forty-eight hours. The case was an interesting one in that it simulated cerebro-spinal meningitis on the one hand, and simple labyrinthine vertigo on the other. The subjective symptoms are vertigo, with confusion of the head, extending from the occiput upward and forward. Dulness and apathetic condition generally. Pulse slow and full. Fever, with little thirst or restlessness. Sudden loss of hearing, with rush- ing and roaring. Hydrobromic acid is a remedy which has lately come to notice 662 world's homceopathic convention. for auditory vertigo, but as no proving has been made the indi- cations for its use are not clear. It is given to antidote the toxic effects of Quinine, and Dr. Woakes* lays stress on the pulsating character of the subjective sounds as an indication for its use. We have used it in the first centesimal trituration with success in some cases, and failure in others. It is to be hoped that the drug may have a more complete study and testing. Many other drugs produce symptoms of disturbed function of the internal ear; in fact almost every remedy in the materia medica has roaring or humming in the ear; but we have con- fined our notice to those which stand foremost either on account of physiological or pathological research. * Edward Woakes, M.D. Deafness, Giddiness, and Noise in the Head. London, 1879. f THE INFLUENCE OF HOMEOPATHY UPON SUEGEEY. Wm. Tod Helmuth, M. D., New York. Of the names most distinguished in the records of surgery the majority are those of great chirurgical artists, rather than of scientists. Thus, when passing in review the illustrious names in surgical literature (with a few such exceptions as Paget and Billroth) we find, that it is the operating surgeon, the bold, fearless, dexterous and ready man, who acquires great reputation as a surgeon; and it is the records of these brilliant operations, that confer upon him enduring fame. Yet the surgeon who cures his cases, by the internal admin- istration of medicine, given according to fixed and definite scientific laws ; who, casting aside his instruments and mechan- ical appliances, can remove a cancer, or cure a hydrocele, or dissipate a fibroid, or cure a fistula by medicinal agencies, is actually a more scientific man, and a more thorough surgeon, than he who brilliantly operates, or dexterously manipulates. In order to limit the scope of this paper to its proper field of inquiry, it is proposed to avoid the discussion of operative surgery excepting when necessary for comparison, and all mention of recent surgical performances, no matter how successful or brilliant. The object, at present, is mainly to show, that, since Homoeopathy has been introduced to the medical profession, it has exerted a definite and controlling, and in some instances a very remarkable power over the so- called surgical diseases. 663 664 world's homoeopathic convention. Perhaps, the majority of the members of our school are not aware of the array of facts that might be cited to the credit of homoeopathic therapeutics; but to those who care to make the inquiry the factswill show, that since Hahnemann in 1796 published his essay " On a new principle for ascertaining the remedial powers of medicinal substances," to the present year (1876), cures of many surgical diseases have been effected, which, if collated and properly arranged, would fill volumes. In a paper of this kind, therefore, it cannot be expected, that mention should be made of all, or even a majority of the homoeopathic cures of surgical disorders. For this reason, the author has thought best to select but two of those affections generally considered incurable by allopathic authorities, and to ascertain if, in these diseases, there be any superiority of our own, over the older methods of treatment; to consider the facts as briefly as possible ; and finally to present for reference statistics of a few of those surgical affections, which have been reported from time to time, in our periodicals, as cured by homoeopathic medication. Having narrowed the limits of our investigation to the diseases in question ; having selected them as a test by which to demonstrate the beneficial effects of homoeopathic treatment in surgical diseases ; the matterat once becomes one for nicety of judgment and discrimination. The end to be attained is one of no mean import to our school; the vantage ground, if gained, gives a superiority so great, that its occupancy must not be pronounced, until the position is certain and secure. To this end therefore, the chief points to be ascertained are: That the diagnosis of each case, as far as can be learned has been correct ; that the record of treatment is reliable ; that the persons making such records have not had their judgment biassed by mistaken enthusiasm, too im- plicit reliance in the action of drugs, or desire to make an effective report; and finally to discover whether, in the old school literature, cures of equal iinportance can be adduced. Again, it must be born in mind, that many, even the most dangerous, surgical diseases, have spontaneously recovered. Aneurisms and ovarian tumors have been cured by the vis HOMOEOPATHY IN SURGERY. 665 medicatrix naturae; tremendous abscesses, opening into the intestines, have saved life ; dislocations and uterine displace- ments have been reduced by accidents. It is by giving to these points that consideration which justly belongs to them, that homoeopathy will receive its fair share of honor, and only that which legitimately belongs to it; for presumptuous assertion, not substantiated by facts, must result in discredit and downfall. In my own surgical practice, I have not effected very many cures of well developed surgical diseases, by the internal ad- ministration of homoeopathic medicines. Perhaps in the majority of cases, I have not given the medicines sufficient trial, because I have known that the knife, ligature, or other mechanical means, offered more speedy, if not more perma- nent relief; and perhaps I have not searched with sufficient care for the appropriate homoeopathic medicine. That I have, in many instances, tried to accomplish such favorable results, and after months of perseverance been obliged to resort to operative surgery, is a fact that I must proclaim at the outset. On the other hand, I have seen some remarkable cures of most severe surgical affections, which have convinced me that the properly applied medicines will act; and that many of the reports of such cures in our literature are worthy of attention and study. Without further delay therefore I shall direct attention to cancer. Professor Gross, speaking of the curability of this scourge, says : " All internal remedies of whatever kind and character, have proved unavailing. The vaunted specific of the empiric, and the enchanted draught of the honest but misguided enthusiast, have alike failed in performing a solitary cure ; and the science of the nineteenth century must confess with shame and confusion, its utter inability to offer even any rational suggestion for the relief of this class of affection." * Scarcely less strong are the words of Mr. Moore,f who writes : "No remedy is at present known to have a specific power of eradi- cating cancer, of neutralizing its taint, or altering the nature * System of Surgery, Vol. I , p. 257. f Holmes System of Surgery, Vol. I., p. 593. London, 1871. 666 world's ITOMCEOPATniC CONVENTION. of its growth. Scarcely less, in our present ignorance of the causes from which it springs, are we in a position to rely with confidence on any means for obviating its outbreak." Mr. Thomas Bryant says, in his late work :* " The general treatment of cancer resolves itself into the improvement of the general health, and the nutrition of the body by hygienic means ; good nutritious diet, and tonic medicines. No medi- cine has any special influence on the disease." It is not necessary to multiply quotations on this subject from the allopathic authorities of to-day; and I may remark, that the three that have been given, were not selected on account of any peculiar force of expression, but were those that first came to hand in consulting the works for the facts in the case. We may turn then with some feeling of satisfaction to our own literature ; although, at the outset, we must regret that while throughout our periodicals there are many cases of "cancer" reputed cured, in very many of these, the specific variety of the disease is not diagnosed. Cancer is, by the majority of surgeons, considered as a generic term, and has several important species. To group the scirrhus, medullary or encephaloid, melanotic, epithelial and osteoid, as "cancer," and in the report of a case to omit to diagnose the variety, is not sufficiently precise; leads us astray in our ideas; has a tendency to throw distrust upon our records, and gives us but little information for the treatment of subsequent cases. For instance, in a " Report of the Homoeopathic Institute of Leo- poldstadt,t there is a case of "cancer of the womb." The va- riety of the disease is not mentioned, whether epithelial, scirrhus, vegetating epithelioma, or other. Bryonia removed the severe pains and Belladonna was given for the uterine tenesmus; " the discharge diminished, and became less fetid, sleep and moderate appetite were established, and the patient felt so much stronger, that she was enabled to undertake a jour- ney." Such a record really counts for nothing in the establish- ment of the superiority of homoeopathic treatment. Many such * The Practice cf Surgery, p. 738, London, 1872. f British Journal of Homoeopathy, Vol. XIX., p. 144. HOMOEOPATHY IN SURGERY. 667 ulcerations are temporarily arrested by hygienic influences, and the tonic system of treatment, as it is called, of the Old School. This case is merely selected, as one from many, that are found in our literature, and can only be accepted as indi- ca.iig that relief fora cancerous ulcer was obtained. So again Dr. Bayes* speaks of a case of " cancer of the lip" (probably ulcerating epithelioma), which was arrested ; cancer of the left breast, in which the tumor had almost entirely disappeared ; and an " open cancer of the left breast," which from the size of a half crown diminished to that of a pea. These and many cases that might be cited prove conclu- sively that there are certain me Heines employed homoeopathic- ally that can arrest "cancerous" formations, but it is, as before stated, much to be lamented, that more precise diagnoses have not been given in each case. The chief among the medicines referred to in Dr. Bayes paper is Hydrastis can. I have used it frequently with excellent success; and from cases of my own, may affirm, that its efficacy in cancer is chiefly in the epithelial variety; also that its action in other forms of the disease is correctly indicated 1 y Dr. Bayes, who says : " My experience has thus led me to infer, that the remedial sphere of Hydrastis is confined to the arrest and removal of scirrhus in its early stage and chiefly when its situation is in a gland or in the immediate vicinity of a gland." We have other reports, however, which are more conclusive. The remarkable case of Field Marshal Radetsky f is one that it is fair to set down as a cure of encephaloid of the eye. So also we find that Dr. Hughes^: has a most excellent case, quoted from Petroz, in which a woman under the care of Dr. L. Herminier had a suspicions ulcer of the tongue, involving the parts deeply. The doctor distrusting his own diagnosis, sent her to Professor Mardolin, who returned the following: " Cancerous ulcer, no chance of cure but from operation ; and this is impossible, for the base of the tongue is involved." This case, which was probably one of epithelioma, was cured by * British Journal of Homoeopathy, Vol. XIX, p. 150. f British Journal of Homoeopathy, Vol I., p. 147. Being a series of letters which appeared in the Hom. Zeitung, July, 1811, by Dr. Hartung. J Therapeutics, p. 219. 668 world's iiomceopatiiic convention-. the Ilydrocyanate of potassa of a grain at a dose, repeated every fourth day. Eighteen years afterward there had been no relapse. Stapf * reports a most interesting case of fungus luematodes oculi, which was completely cured. Belladonna'0 removed the excessive photophobia and inflammation in six days : Calcarea carb., cleared the cloudiness of the cornea ; Lycopodium", Se- pia36 and Silicea", removed the fungous growth. The cure was complete. Muhlenbein f gives also a case of the same disease, so diag- nosed by several allopathic physicians and an experienced surgeon, in which Belladonna26, one drop at intervals of a week, for four weeks, together with Nux vomica, Euphrasia and Aconite, completed the cure. Dr. von Vietiunghoff^ among his cases, which will be found, in the annexed statistics, has recorded a case of encephaloid of the breast which is interesting. The pain was relieved by Bella- donna3 and Bryonia3 in alternation. Phosphorus30 and llepar30 also in alternation, materially improved the character of the discharge ; Arsenic30 caused separation and discharge of tumor. After persevering with the latter for several months, the cure was perfected. Other cases of this variety (encephaloid) of cancer are found throughout our literature.^ Dr. G. M. Pease, |l in a short and practical paper on "Can- cer," mentions three cases, in two of which operations had been performed; and these are merely noted here, inasmuch as beinir under the carbolic-acid treatment, one was alive five years, the other four years after operations had been performed. The third, however, a case of lic&matoid cancer, located on the right' cheek, and extending to the ala of the nose, was cured * Archiv fur die Homoeopathische Hilkunst, Vol. VII. f Lee cit ("both these cases are recorded in Dr. Jean's Homoeopathic Practice.) J British Journal of Homoeopathy, Vol. XVII., p. 53. British Journal of Homoeopathy, Vol. XXVI., p. 658. Dr. Quin's case in the Annals, Vol., I. p. 177, quoted by Hughes.-Fungus hsematodes, Dr. Hughes, British Journal of Homoeopathy, Vol. XXVIII, p. 795. || Transactions of the American Institute of Homoeopathy, 1872, p. 390. HOM(EOPATHY IN SURGERY. 669 by carbolic acid internally and externally with no return in three years. Dr. A. G. Beebe* gives a case of melanotic cancer, cured chiefly by Carbolic acid and Sanguinaria, the former for the specific disease, the latter for gastric disorders. During the first three weeks of treatment, the tumor was reduced to the size of a pin's head, and all suffering relieved. Ultimately there was complete recovery. Dr. Leon f relates a case of carcinoma uteri which had not recurred after three years. The medicines were : Arsenic., a dose night and morning for one week: Conium3 night and morning for one week. These medicines were continued four months in alternation, with an occasional dose of China as an intercurrent for haemorrhage. We must turn now to the consideration of Dr. Bayes' es- says,^: written especially with reference to the use of Hydras- tis can. in the treatment of cancer; and for brevity's sake will merely introduce his table appearing at the end of his second paper, lie also includes in these statistics, Dr. Bradshaw's § cases offering additional testimony to the beneficial effect of the " Golden seal." These papers certainly show (although the percentage of cures is small) that this medicine does possess more or less influence over the disease; but when the question arises as to the comparative efficacy of homoeopathic treatment com- bined with surgical operations, I think it may be shown that a better result is obtained with the knife, than without it. Of the following twenty-three cases, six are diagnosed as scir- rhus; thirteen as cancer (ulcerated or otherwise); one as fungus ha?matodes; and three as cancerous tumors. The results of the treatment are as follows : three were cured ; in six others there was " improvement; " in three " arrest of development; " and in six relief from pain was noticed; while again in five others "no effect " was produced. It would be interesting to * Medical Investigator, Vol. XL, p. 549. f United States Journal of Homoeopathy, Vol. I., p. 41. J Hydrastis can. in Cancer, B. J. II., Vol. XIX. ; also/occiY. Vol. XX., p. 1. g A Few Remarks on Hydrastis, B. J. H., 1861, Vol. XV11I., p, 598. 670 world's homoeopathic convention. the operating surgeon to ascertain Iioav long the three eases remained cured; and, if in any there was a recurrence of the Dr. Bayes' Table. Case. bl Sex. Disease. Location. Result. 1 41 Female. Scirrhus. Breast. Cured. 2 42 do. Tumor. Ovary, right. Relieved, 3 16 do. Cancer. Right breast. Much improved. 4 77 do. do do. Arrested. 5 .5 do. Scirrhus. Cervical glands. Much improved. 6 55 do. Hard nodulated turn. Do. sum of foot. A'most cured. 7 15 do. Sciri hus. Breast. Pain relieved. 8 50 do. Ulcerated cancer. Left breast. Great y improved. 9 37 do. Cancer. do. Cured. 10 4- do. do. Right breast. Pain relieved. 11 38 do. Tumors (cancerous). Both breasts. Much improved. 12 48 do. Scirrhus. Os uteri. N o effect. 13 56 do. Cancer-ulcerated. Os uteri, vagina and rectum. do. 14 12 do. Scirrhus. Uterus do. If 60 do. Fungus hsematodes. Right thigh. do. 16 22 do. Cancer. Left breast. Cured. 17 50 do. Ulcerated cancer. do. Relieved. 18 50 Male. do. Lip. Arrested and improved. 19 4( Female. Carcinoma. Left breast. Relieved. 2b 58 do. Scirrhus. do. Arrested. 21 40 do. Ulcerated cancer Os and cervix uteri. Slight and temporary i elief. 22 GO do. do do. No relief 22 37 do. do. do. Arrested disease, at what time the symptoms were developed. Until this point be clearly settled, the vexed question as to the ex- pediency of operative interference Avith the knife, cannot be satisfactorily determined. Few operations for cancer, espe- cially of the lip and mamma are not followed by a more or less complete exemption from the disease, from one, two, or even three years; but even then the conscientious surgeon would scarcely be justified in announcing a complete cure of the affection. This phase of our subject brings us directly to the consideration of the cases of Marsden and MacLimonts,* in which the " enucleation treatment " was adopted. In the ten cases they record the subsequent histories of the patients have not been given ; obviously from the many difficulties sur- rounding dispensary and hospital practice. In placing these * B. J. II., Vol. XXI. p. 616. HOMOEOPATHY IN SURGERY. 671 cases in this essay, they must be considered in a measure op- erative; as Nitric acid, Chloride of zinc, Hydrastis in powder and tincture, and Stramonium ointment would scarcely be called by the pure homceopathicians, homoeopathic medicines, especially when in combination and applied locally. Yet, the success of these applications may in a measure be attributed to constitutional treatment with medicines exhibited according to the law of Similia; and such being the case, does not the op- erator, whether with knife or caustic, who, throughout the en- tire duration of the case (before, during and after operative measures), prescribes homoeopathically for the presenting symp- toms, possess a most decided superiority over those who rely chiefly on hygienic and general constitutional treatment ? In other words, does not homoeopathy even here, exercise a ben- eficent influence upon operative surgery? The answer may be given in the affirmative. In June, 1873,* I reported to the New York Homoeopathic Medical Society, fifty cases of cancer, and since that period have operated with knife and the enucleating paste on fifteen others. I am glad now to give further results. It is needless to say that the patients have, always, while under my super- vision, been taking those homoeopathic medicines which ap- peared indicated. In order to be more accurate, I shall omit mentioning any of the lyore recent cases; because a sufficient time has not elapsed to convince me of their cure. I will merely state, that five of the fifteen have died between the date of my last report and the present. One of the cases was scirrhus of the breast; one advanced epithelioma of the penis; one scirrhus of the parotid, in which, I may say, that I think electrolysis did decided harm; and two, encephaloid of the mamma. Of the fifty cases I then placed upon record, five of the epithelioma cases are now alive; in one instance, eleven years having elapsed since the treatment; in another, eight years ; and both of these were locally treated by Marsden and MacLimont's paste. Another has lived four years, and is at present enjoying good health. Three years have elapsed since * New York Journal of Homoeopathy, Vol. I., p. 146. 672 world's iiomceopatiiic convention. another was operated upon, the patient being well; and the fifth also has survived five and a half years. A sixth case might also be reported as cured, as the patient died of gall- stones two years after the operation. Of the encephaloid of the mamma subjected to the knife, four survived; the longest time elapsing being four years. Two have died. Of the scir- rhus, of which twelve were operated upon with the knife, one is alive seven years after; one, six years; one, five years. The others I have been unable to hear from in time to report in this paper; although I have made many attempts, by letter and otherwise, to ascertain their condition. These reports have been made as concise as appears consist- ent with the importance of the subject. Many quotations of cures have been omitted, which may be found in the statistics at the end of this paper; but it is to be hoped that sufficient facts have been given to prove, that in a disease, considered beyond the reach of medicine by the Old School, well directed hom- oeopathic medicine can and has effected cures; and that when operative interference becomes necessary, the beneficial influ- ence of homoeopathic medication cannot be denied. It may entirely eradicate the cachexia, or postpone the recurrence of the disease. It would be ridiculous, however, even with this knowledge, to make the broad assertion, that all cases of can- cer may be cured; or, that return after extirpation is never to be expected. The facts remain, that cases are and have been cured, and such facts encourage every surgeon, in his endeavor to select the proper homoeopathic medicine, and avoid, if pos- sible, the performance of operations ; and still further, if the knife is deemed necessary, or the caustic treatment seems ad- visable, ne has certainly in the homoeopathic Materia Medica, agents which will assist him to prevent recurrence and allevi- ate suffering. Looking at the matter with these proofs before us; endeav- oring to view the testimony as impartially as we are able, and referring to the written opinions of the best allopathic authori- ties of to-day ; it may safely be claimed that homoeopathy has exerted a most beneficial influence over this department of surgery, whether the knife be employed or internal medicines exhibited. HOMCEOPATIIY IN SURGERY. 673 OVARIAN TUMORS. In the treatment of non-malignant tumors, homoeopathy can show a decided improvement over the methods of cure which are generally adopted by Old School practitioners ; indeed the majority of these formations have to be submitted to the knife in allopathic hands. When the members of our school shall have become better acquainted with the physiological action of drugs, and with the histological conditions, which call for the exhibition of cer- tain medicines, as lately pointed out by Dr. von Grauvogl; when " organopathy," as Dr. Sharp has it, has been more care- fully studied; there can be no doubt that much greater suc- cess will be obtained than heretofore. But here the question arises as to the most rational method. Is the knife, when em- ployed for the removal of smaller non-malignant tumors, locat- ed in parts not especially dangerous, to be preferred to the use of internal medication ? In considering this question, it must be remembered that in operative surgery, even in the minor operations, there are always certain risks to be encountered from anesthesia and tetanus, which can not be adequately counterbalanced by the length of time, and slight inconveni- ence to the patient, required for internal medication. More- over, should the latter fail, recourse may then be had to opera- tive surgery. Therefore, even in the non-malignant, innocent, bland, or benign growths, preference should be given to med- ical treatment. I am convinced of this fact the longer I live, and am very willing to plead guilty to having, on many occa- sions, " cut out" a tumor immediately, without giving inter- nal medication any trial whatsoever; although, in many, very many instances, with the most satisfactory results. In passing to the consideration of those tumors in the treatment of which the least satisfactory results are acknowledged by the allopathic school, viz., cystic tumors of the ovaries ; it may be remarked that adeoma of the breast, fibroids of the uterus and other parts, bony tumors, and even aneurisms are reported cured by hom- oeopathic medicines tvlde statistics). In speaking of the latter, I exclude those cases treated with Bromide of potash, Gallic 674 world's iiomceopathio convention. acid and Iron, winch have been reported from time to time, be- cause I believe these may be better understood, when the true physiological action of medicines is more accurately ascertained, and refer only to cases which are reported by those who cer- tainly have, or ought to have, sufficient skill to make a correct diagnosis. The cystic tumor of the ovary, is acknowledged to be be- yond the reach of allopathic medicines, and such acknowledge- ment conies from the highest gynaecologists at home and abroad. Professor Simpson* thus speaks to his students: "For my own part, let me state at once, I have no belief that any drugs or medicines ever removed a cystic multilocular growth or dropsy of the ovary ■ I would almost as soon expect to remove by them, a foot or a hand, or any integral part of the normal body. In any exceptional cases, where internal medicineshave appeared to diminish ovarian tumors, you may rest assured that a primary error in diagnosis has been committed; and, that the supposed ovarian growth was a meteorismic tumor of the abdomen or ascites, or a specimen of some of those other maladies of a curable type, that are often enough mistaken for ovarian disease." Thomas f writes, " After a careful search through the rec- ords of the subject, one is forced to the conclusion that an ex- tremely small number of cases exists, substantiating the possi- bility of the accomplishment of absorption by these means." Peaslee,j: whose scholarly work is without doubt the most carefully and exhaustively prepared of any on this subject after collecting eleven cases, speaks thus: "Admitting, in- deed, that they were actually cures by medication (as I do not think them to be), we must then offset these eleven, against the many thousands of cases in which all medical treatment has utterly failed. . . . There is no known remedy which can be at all relied upon for the cure of ovarian cysts? It is unne- cessary to go further-space forbids-but attention may be * Clinical Lectures on Diseases of Women, p. 237. f A Practical Treatise on the Diseases of Women, p. 667. J Ovarian Tumors ; their Pathology, Diagnosis and Treatment, p. 193. HOMCEOPA.THY IN SURGERY. 675 called for a moment to the expression " no known remedy," in the latter quotation. It will be observed that the singular number is used, and it is a " key-note " to the reasoning of the allopathic physician. To designate a disease as an " ovarian cyst," and set down opposite thereto a remedy for it, would be ridiculous indeed. Herein lies the advantage of the hom- oeopathic physician, that he prescribes for the totality of the presenting symptoms in each particular ease, changing his medicines as the symptoms vary, and thus is enabled to effect a cure. In 1855, I reported a case of ovarian cyst which was cured chiefly by Apis mel.; other medicines being given from time to time, as the symptoms indicated. In those days compara- tively little was known regarding these tumors, but I believe this to have been a genuine case and a genuine cure. I have lately known of another case, in which I was consulted, and which is really so interesting that it gives me pleasure to give it in full. This, for several reasons: 1. Because it has never been published ; 2. Because I know there was no mistake in the diagnosis; 3. Because the pressure of the foetus did not cure it, as is suggested in other somewhat similar cases; 4. Because several tappings were resorted to at different times. The case occurred in the practice of Dr. Baldwin, of Engle- wood, who has furnished me the following letter, at my re- quest : " Dear Doctor : I first saw Mrs. IT. J. D., aged 28, during confinement, September 18, 1872. Delivered of a healthy child, without any difficulty. When I came to bandage her, found her still as large as at full term, from dropsical effusion. This was the first intimation to herself or her physician that there was anything abnormal, whatever pain or discomfort she had suffered being attributed to the pregnancy. In consulta- tion with Dr. McVickar, of New York, and Dr. Banks, of Englewood, the case was diagnosed 'ovarian dropsy.' " On October 20th following, with Dr. Banks, I removed, by ordinary paracentesis, with trocar in median line, five and a half gallons of fluid, thicker and darker than I have com- 676 world's homceopathic convention. monly seen in ascites. So highly albuminous that heat and acid rendered it semi-gelatinous. Prescribed Apis, and in a short time she recovered her usual health, without immediate return of dropsy. " About August 1, 1873, the patient again complained of stinging, burning pains in region of right ovary, with tender- ness on pressure and motion, with cessation of menses. Re- sumed Apis and afterward, for varying symptoms, Arsenicum, Conium and Platina (also Phytol.). The abdomen again en- larging, examination revealed both pregnancy and dropsical effusion; which last accumulated very rapidly till the size of the patient was enormous. For fear of possible miscarriage, I delayed operation till after the seventh month of gestation; and on March 10, 1874, drew off, by the aspirator, four and a half gallons of fluid. Six weeks later, she was delivered of a large, healthy boy, with an entirely normal labor. In the in- terval between the last operation and her confinement, the fluid had again accumulated more rapidly than ever, and con- tinued to do so with constant stinging, burning, sore pains, until the 21st of August, when nearly four gallons of fluid were again removed by the aspirator. The effusion, however, continued, and, in consecpience of a severe cold, a general peri- tonitis developed with great severity, and for two or three weeks the patient was in a very critical condition. Recover- ing from this (Belladonna, Bryonia and Mercur., were the principal remedies used), her condition, about the 1st of Janu- ary, was as follows: An accumulation of fluid about the same as when I withdrew three and a half gallons; the abdomen being fully as large as in pregnancy at the sixth month. A rapid, irritable pulse, thirst, general prostration, able to sit up only part of the day, loss of appetite, pain and tenderness in right ovarian region, and the water rapidly accumulating. At this time I consulted with yourself with reference to ovari- otomy, believing it her only chance. While awaiting your visit, I made one further prescription, ' viz., Iodine3 dec., given three or four times a day. Decided improvement was manifested within a week. Pain much relieved, appetite and strength improved, and no increase of fluid, as shown by meas- HOMCEOPATHY IN SURGERY. 677 urement. Under the continued use of Iodine alone, the im- provement was rapid and continuous. Absorption of the fluid took place, and within a few weeks not a trace of it remained. All treatment was discontinued, and on the 1st of May the patient for the first time in a year, was able to resume house- keeping, and has, to this day, remained in perfect health. " You will have noticed that Hempel quotes a case of cure of an ovarian cyst with Iodine water containing one forty- eighth part of Iodine. One marked peculiarity of my case is its complication with pregnancy, the safety of operation with aspirator during advanced pregnancy (you will remember it was by your desire I used it), and the perfectly normal deliv- erance. " Synopsis. September 18, 1812.-Confinement and discov- ery of dropsy. " October 20, 1872.-Operation and withdrawal of five and a half gallons of fluid. "August 1, 1873.-Renewal of disease with commencement of pregnancy. "March 10, 1874.-Operation and removal of four and a half gallons of fluid. "April 22, 1874.-Confinement. "August 21, 1874.-Removal by aspirator of nearly four gallons. Renewal of disease, which continued till about the 1st of January, when Iodine was prescribed; and entire recovery by May 1st. " Very truly, your friend, " D. A. Baldwin." In recording this case I may refer to one in my own prac- tice. It was one of simple cyst. There was some obscurity in diagnosis, and I sent her to Dr. Atlee, of Philadelphia, to verify the case. This he did. The lady was pregnant; I tapped her and drew off about two gallons of fluid with the aspirator. She was delivered of a healthy child. The tumor refilled. She was pit upon strict diet, and Staphysagria, Iodine, Apis, Bryonia, Caulophyll., were used as the symp- toms indicated. I examined her on the 18th of March last, and found but the slightest trace of the tumor. 678 world's homoeopathic convention. For further very interesting records of cures, the reader is referred to the remarkable cases of Drs. Black, Hughes, Bayes, Wesselhoeft, Miller and others, in the statistics. It was my intention to select some other cases for examina- tion from diseases of the bones, and especially in enchondro- matous affections, showing the action of homoeopathic medi- cine on these tissues; but I find that too much space would be occupied by the recital of individual cases, which can be found properly arranged in the statistics at the end of the paper. Merely, then, as examples of the beneficial influence that the law of similia has exerted in surgical science, two grave diseases have been selected for comment and comparison. These affections are at the present time acknowledged to be the least amenable to internal medication, by the best allo- pathic authorities; and yet have been, without doubt, cured in a radical and satisfactory manner by homoeopathic treat- ment. These cures beiim established, further comment in other individual cases is unnecessary. Reference to the sub- joined statistics will give, at least an idea of what has really been effected by homoeopathy for surgery, and may serve as an incentive to further trial with homoeopathic medicines be- fore the knife is resorted to. This may be bad for the operat- ing surgeon, but good for suffering humanity; it may allow "the art" to languish, but it will elevate "the science." In conclusion I would say that, though for a number of years I have made surgery a specialty, and have been a lecturer, teach- er and writer thereon ; yet, until I actually commenced look- ing into the subject of this paper, I was unaware of the great good homoeopathy has accomplished. The result has done me service in many ways. It has inspired me with new hopes for the future of homoeopathic surgery; it has strengthened my faith in the action of dynamized medicines, and has opened to me a wider field of research and inquiry.. And I hope that it may stimulate others in a similar direction. Aneurism, abdominal; Secale2'0; cured.-IT. S. Med. Inves- tigator, vol. i., p. 48, Dr. Pease. ANEURISM. HOMCEOPATIIY TN SURGERY. 679 Aneurism of right common carotid, near innominata ; Bella- donna300 ; cured.-U. S. Med. Investigator, vol. i., p. 124, Dr. J. C. Morgan. Aneurism carotid ; Lycopodium13 dil., one drop three times a day ; tumor almost disappeared ; both legs normal size; en- tire recovery.-British Journal of Homoeopathy, vol. xxviii., p. 787, Dr. Hughes. Aneurism popliteal; Secale1 internally twice or thrice per day, lotion of Chlorate potassa, afterward Belladonna and Arsenicum'; entirely cured of aneurism but subsequently taken by his friends and put under allopathic physicians for subsequent ailments of which he died.-British Journal of Homoeopathy, vol. xxviii., p. 787, Dr. Hughes. Ani prolapsus, intestine blackish and painful to touch ; Mer- curius ; cured.-Jeane's Practice of Medicine, p. 25. Ani prolapsus ; Eliza Thomas, aged four; fomentation in solution of alum; Nux vom. every two hours; relief and improvement; incomplete report.-Helmuth's Clinic, p. 46, Dr. Helmuth. Anus, fissure of; prescribed Hamamelis3, one drop three times a day, then Cocculus' in the same dose, lastly Arseni- cum6 twice a day; a permanent cure; no indication whatever of a return.-Dr. Hughe's Therapeutics, p. 284. Anus, mucous tubercles of; Thuja tinct.; complete cure.- U. S. Journal of Homoeopathy, vol. i., p. 57, Dr. Kellogg. ANUS, DISEASES OE. Caries of femur and hyperostosis radii; Sepia" and, after six weeks, Nitric acid"; cured in nine weeks.-Jeane's Prac- tice of Medicine, p. 56. Caries of maxillary bones ; Mercurius sol.", Nitric acid", Si- licea", Causticum", Calcarea", Sulphur", Belladonna" and Sepia"; Mercurius sol. and Causticum proved the most useful; complete cure; dead bone came away.-U. S. Journal of Homoeopathy, vol. i., p. 718. Caries of Maxilla ; Silicea", four globules night and morning for fifteen days ; after this Silicea" and Silicea3 in alternation, BONE, DISEASE OE. 680 world's homoeopathic convention. one globule night and morning; complete cure; dead bone expelled without the aid of instruments.-U. S. Journal of Homoeopathy, vol. i., p. 720. Caries of maxilla; Mercurius sol.30, four globules in tea- spoonful of water, one night and morning; toward the close, Mercurius sol.300 ; complete cure;-U. S. Journal of Homoeo- pathy, p. 720. Caries of inf. maxilla ; IL L., aged 23 ; Mercur. sol.' ter die., Mercurius sol.13 bis die, Sulphur3* one dose bed time, Arsenic.13 ter die; pain lessened by Mercurius sol.; burning feeling relieved by Arsenicum. After discharge of abcess Phos- phorus8 ter die causes ulcer to heal; continued well for five months then returned with cheek much indurated and very painful, administered Silicea13 and 13 bis die, subsequently Sac. lactis for six days, Silicea3' every altern'ate night; thorough cure, no symptom of return of disease.-British Journal of Homoeopathy, vol. xix, 523, p. Dr. Markwick. Caries inferior maxillary; 1. Aurum mur.8 pulv. xx., 2. Calcarea carb.8 pulv. xx. powder every night for one week of No 1.; then, after one week's intermission, every night from No 2 in same way ; in three months perfect cure effected. -- American Homoeopathic Review, vol. iii., p. 112, Professor W. T. Helmuth. Caries ossium digitorum ; Silex ; cured.-Jeane's Practice of Medicine, ]. 57. Caries of temporal bone, a sequel of scarlet fever; boy affed 6, left side of cranium arrested in its growth and consid- erably smaller than the right; Fluoric acid, administered. After the employment of Fluoric acid attack came on in an aggravated form but never returned ; left side of cranium grad- ually increased in size until the inequality was too insignificant to be perceptible.-Dr. Hughes' Therapeutics, p. 480. Caries tibiae from an insect bite six years before with large ulcer; Asafoetida8 in one drop doses ; caries removed and ulcer healed in thirty-six days.-Jeane's Practice of Medicine, p. 51. Caries of supra-orbital arch; Mercurius sol.'0, Silicea'0, Au- rum30, Mercurius sol.30" and Sulphur; speedy cure.- U. S. Journal of Homoeopathy, vol. i., p. 720. HOMOEOPATHY IN SURGERY. 681 Caries tibiae ; Silex, Asaf., Calcarca carb., Mezereum, Silex repeated, Spirit sulph. and Nitric acid ; cured.-Jeane's Prac- tice of Medicine, p. 57. Caries of maxilla upper, from Nitrate of silver; Mercurius corrosives' ; slow but perfect recovery.-IT. S. Journal of Homoeopathy, p. 313, Dr. Mitchell. Caries of dorsal vertebrae; child aged 5; tried Phus, Coc- culus, Sulphur, Bryonia, Ipecacuanha, Arsenic., and Mercurius viv., without perceptible effect; prescribed Lachesis30 dil., two doses; marked improvement immediately after Lachesis was administered ; dyspnoea and thirst nearly removed after four days treatment with Lachesis ; restored to normal condition except muscular weakness.-British Journal of Homoeopathy 1864, p. 480, Dr. C. Wesselhoeft. Distortio spinalis with great protuberance of the abdomen, pain in head and eyes, strabismus, etc. ; Belladonna16 in one drop doses ; entirely cured in two weeks.-Jeane's Practice of Medicine, p. 54. Distortio spinalis, with chronic hydrocephalus; Calcarea carb., Ipecacuanha, Silicea; complete cure.-Jeane's Practice of Medicine, p. 55. Distortio spinalis with tetanic symptoms and dysuria; Cicuta, Staphysagria and Sulph. ; the Cicuta removed tendency to tetanus, Staphysagria stopped dysuria and Sulph. cured deform- ity in eight weeks.-Jeane's Practice of Medicine, p. 57. Exostosis on frontal, parietal and occipital bones ; Phos- phorus36 gtt. j, frequently repeated; cured.-Jeane's Practice of Medicine, p. 56. Exostosis from Mercury ; Belladonna"; much better.- Jeane's Practice of Medicine, p. 54. Exostosis syphilitica and caries with other symptoms of tertiary syphilis; Aurum' dec. trit, in scruple doses; two doses per day for ten days, then one dose every six days for three weeks; completely cured in less than five weeks; no return at the end of three years.-Jeane's Practice of Medicine, p. 54. Fracture of cranium, depression of both plates of skull; applied Calendula externally and internally; cured.-Trans- 682 world's IIOMCEORATniC CONVENTION. actions American Institute of Homoeopathy, 1874, p. 17, Dr. E. C. Franklin. Fracture of sup. maxillary ; Calendula locally ; Aconite for fever; Silicea and Ilepar during suppurative process ; entire restoration.-Transactions American Institute of Homoeopathy, 1871, p. 17, Dr. E. C. Franklin. Depression of both tables of skull with fracture of occipital bone; wound dressed with Calendula; Aconite given during febrile reaction, Ilepar, Silicea and China for general purposes ; rapid recovery.-Transactions American Institute of Homoeo- pathy, 1874, p. 18, Dr. E. C. Franklin. Fracture of cranium and protrusion of brain ; cold applica- tion of Hypericum to injured parts, Arnica internally every hour, followed subsequently by Aconite and China; reac- tion in eight hours; entire recovery in two months after injury.-Trans. Amer. Inst, of Horn., p. 19, Dr. E. C. Franklin. Fracture of femur with non-union of bone; Calcarea phos.30 dose morning and night; cured in three weeks.-Western Homoeopathic Observer, vol. iv., p. 225, Dr. Willard. Hyperostoses femoris; Arnica, Lycopodium30 and Silex; cured.-Jeane's Practice of Medicine, p. 56. Hyperostosis of foot; Lycopodium80, Silicer24, Mezereum24, and Ledum ; cured.-Ibid, p. 55. Hyperostosis of humerus throughout its entire length; Dulcamara20, Staphysagria20, Phosphorus30, Sulph.'; cured in eight weeks.-Ibid, p. 55. Hyperostosis of radius; Asafcetida in largo doses; then Pulsatilla12; to counteract this, Mezereum6, Silex18 and Calcarea -carb.30; finally Lycopodium30; bone reganied natural size ; joint became perfectly movable. General health improved ; scurfiness of skin removed by Lycopodium.-Ibid, p. 53, Hyperostosis tibiae; Cinchona18, two pellets at a dose, Asa- foetida', Mezereum6, Silex21, Sulph.6; improvement for seven- teen days under Cinchona; Asafcetida diminished the swell- ing and softened the skin ; after 51 days a slight thickening of the skin alone remained which the Sulph. removed.-Jeane's Practice of Medicine, p. 52. HOMEOPATHY IN SURGERY. 683 Necrosis following periostitis : complete atrophy ; Calcarea carb.8, one dose a day for a few days, then at longer intervals; subsequently Silicea, Sulph., Phos., Phos. acid, Mercur., Mer. hyd. and Rhus; cloths kept constantly wet in cold water; im- provement prompt; no pain after three days; foot assumed healthy appearance in a few weeks ; discharge of healthy pus and fragments of bone for several months; limb now of natu- ral size and perfectly well.-Philadelphia Journal of Homoeop- athy, vol. iii., p. 482, Dr. Williams. Necrosis, acute, of inferior maxillary; J. Walsh, aged nine; Mercur. prot. iod.s°, two grains night and morning for one week; parts syringed bis. die, with Lister's solution Carbolic acid; considerable improvement; treatment continued ; cured. -Helmuth's Clinics, p. 171, Dr. Helmuth. Necrosis, three cases; Silicea30; quantity of pus diminished in less than three days; pus, which was before very offensive, became entirely inodorous.-U. S. Medical Investigator, vol. i., p. 228, Dr. Win. P. Armstrong. Necrosis of bones of arm and forearm from a blow four months before ; Arnica, Silex, Calcarea carb., Spirits of sulph. and Colocynth ; Arnica relieved the pain; Silex, Calcarea carb, and Sulph. effected a cure; Colocynth removed stiffness of joint.-Jeane's Practice of Medicine, p. 57. Necrosis of metatarsal bone with ulcer; limb resembles case of elephantiasis ; Arnica16 dec., three^globules internally every morning, fasting; Arnica tincture, ten drops in a pint of rain- water as a lotion; considerable relief as to pain and ability to use the limb; ulcer remained unaffected. Prescribed Mercur. cor.8 dec. trit., one grain in eight ounces of clarified rain water; oedema of limb arrested by Bellad.30 dec., three pellets, fasting; for fetor Carb, veg.16 dec., three globules every morning fast- ing; Phos. acid3, same dose, Sepia30 dec., one grain, Sulph30 dec., one grain ; entire cure and rescue of limb from amputa- tion.-American Horn. Review, vol. iii., p. 233, Dr. Hornby. Necrosis of tarsus; Calcarea carb.; separation and painless discharge of dead bone.-Jeane's Practice of Medicine, p. 55. Necrosis of tibia; Silicea6 300, taken every other night alter- nately ; change for the better in less than a -week; spiculse of 684 world's homoeopathic convention. bone thrown off every few days ; complete cure in six months. -U. S. Medical Investigator, vol. i., p. 228, Dr. William P. Armstrong. Periostitis; B. W., aged 36, never had syphilis; no fever; all functions of body healthy, but unable to walk ; right limb much swollen ; prescribed Veratrum album3, every three hours; limb to be packed in cotton wadding; in seven days limb restored to normal condition not a trace of swelling or pain.-British Journal of Ilomceopathy, 1864, p. 645, Dr. W. Huber. CANCER. Cancer of right breast; woman aged 46; cancer treated with Hydrastis, mother tincture, and Nos. 3, 6 and 12; indi- gestion and other constitutional ailments treated with Arsenic., Conium, Spongia, China, Nux vom., etc.; cured; tumor very much decreased, though still adherent to the skin.-British Journal of Homoeopathy, 1862, p. 5, Dr. Bayes. Cancer of right breast; woman aged 77; tumor unattached to either skin or ribs; a small, hard tumor (movable) just above the clavicle; Hydrastis from 30th dil. to mother tincture in- ternally ; lotion of tinct. Hydrastis gtt. x, aq. dis. § xvi, twice per day ; tumors have not increased, pain much diminished, health excellent.-Ibid, 1862, p. 5, Dr. Bayes. Cancer of left breast; woman aged 22; Hydrastis can.; tu- mor entirely disappeared.-Ibid, 1861, p. 150, Dr. Bayes. Cancer, open, of the left breast; woman aged 50 ; Hydrastis can.; tumor reduced to size of small pea.-Ibid, 1861, p. 150, Dr. Bayes. Cancer. 1. Malignant tumor of right breast, size of duck's egg; Hydrastis6 in drop-doses; thorough cure in about six weeks; pain at once relieved.-Ibid, 1863, p. 639, Drs. Mac- Limont and Marston. 2. Tumor in left breast; Hydrastis both externally and in- ternally for two months; immediate cessation of pain and ultimate dispersion of tumor, with no indication of return.- Ibid. 3. Cancer in left breast, and neck of womb, ulcerated and HOMCEOPATHY IN SURGERY. 685 nodulated ; Hydrastis internally as a lotion to the breast and an injection to the womb; swelling disappeared from breast, discharge ceased, pains gone, and ulcers cleansed and cicatriz- ing.-British Journal of Homoeopathy, p. 642, Dr. Bayes. 4. Large hard tumor in left breast; Hydrastis; ten days afterward a plaster of one-third paste and Stramonium oint- ment ; improvement; inflammatory action having set up, de- sisted from local treatment for twenty-four hours, and substi- tuted Aeon, and Bellad. with a lotion around circumscribed parts; removed 17 ounces of diseased tissue by application of acid ; patient fully recovered in less than three weeks.-Ibid., p. 643. 5. Similar ease and treatment with exception of substituting Arsenic, for Bellad.; tumor size of a large orange; thorough cure effected in two months; entire restoration to health and spirits; freedom from pain.-Ibid , p. 645. 6. Cancer of left breast, movable tumor; Hydrastis1 dec.; complete cure in two months.-Ibid., p. 647. Cancer of right breast; woman aged 48; tumor stony- hard and adherent to subjacent tissues; Hydrastis, commenc- ing with 30th running down to mother tincture in five-drop doses; Hydrastis had marked influence in relieving pain ; size of tumor stationary, but patient subsequently died from pleu- rodynia and neuralgia.-Ibid., 1862, p. 8, Dr. Bayes. Carcinoma of left breast; married wemm aged 41; Arnica', pilule twice a day ; indurated scirrhus; perfect cure ; inflam- mation subsided ; Hydrastis3 gtt. iv, Sacch. lac. gr. xx. dissolved in half a pint of water; Arnica and Hydrastis alternately ad- ministered in increased quantities; tumor disappeared; to take away slight pain remaining, Conium30 gtt. iii., Sacch. lac. gr. i. every third night.-Ibid., 1862, p. 2, Dr. Bayes. Carcinoma uteri; Arsenicum3 dose night and morning for one week, Conium3 night and morning, one drop for one week; these two remedies were rotated thus for four months with an occasional dose of China for haemorrhage; perfect cure; no return three years afterward.-U. S. Journal of Homoeopathy, vol. i., p. 41, Dr. Leon. Carcinoma uteri, chlorosis and menstrual derangements; 686 world's homoeopathic convention. medicines used, Cocculus, Crocus, Ferrum met., Pulsatilla and Secale; chlorosis yielded to Pulsatilla; only two cases re- quired Ferrum met., and one Natrum mur.; in cancer of womb Secale of most service.-British Journal of Homoeopathy, 1864, p. 402, Leopoldstadt Hom. Hospital, 1861. Cancer of digestive organs; Madam , aged 48, had at- tacks of abdominal pains and cramps which finally became fixed in the pit of the stomach ; on first attack prescribed Aconite, Arsenic., China, Lycopodium, Nux vom. and Sulph.; on second attack, Ipecacuanha, which relieved her; on third attack, Ars.2 dec.; on fourth attack, Ars.2 dec., gtt. vi in aqua 3 iv, tablespoonful every quarter of an hour; on this last at- tack vomited up pieces of colloid cancer; Arsenic, was con- tinued in higher potencies for two months ; has had no attack since.-Ibid., vol. xvii., p. 65, Dr. von Viettinghoff. Cancer, encephaloid (subacute); Mrs. E. B., aged 30 ; Bella. donna3, Bryonia3, Phos. IIepar ; under these remedies there was little improvement, Arsenic. ; under Arsenic, tu- mor separated into many pieces, one piece size of hazel-nut was removed ; cured.-Ibid., p. 66. Cancer of face; Arsenic.31' dil.; the lower dilutions of the same drug were afterward used ; cure in four months ; no re- turn.-U. S. Journal of Homoeopathy, vol. 1., p. 717, Dr. Ley- det. Cancer of face; Kali chlor, applied with compresses every two or three hours, dissolved in distilled water in the propor- tion of one to six, and afterward one to twelve; in eight days the corroded parts were almost healed; in fourteen days a clear demarcation formed between the ulcerous and healthy skin ; in three weeks the base of the ulcer sloughed off, and in five weeks a fair, smooth, white cicatrix formed ; permanent cure.-British Journal of Homoeopathy, vol. xxv., p. 518, Dr. Boscher. Cancer, haematoid, on right cheek, extending to ala of nose; Carbolic acid externally and internally ; entirely removed with- out operation ; all traces removed within two months.-Tran- sactions American Institute of Homoeopathy, 1872, p. 389, Dr. G. M. Pease. IIOMCEOPATUY IN SURGERY. 687 Cancer, melanotic; Carbolic acid and Sanguinaria for three weeks, the former for the cancer, the latter for the gastric dis- order merely, at intervals; during the first three weeks tuber- cle reduced to size of a pin-head, and all pain stopped ; ulti- mately complete recovery.-Medical Investigator, vol. xi., p. 549, Dr. Albert G. Beebe. Cancer, open, of left breast; woman aged 50; Hydrastis; Hydrastis occasionally suspended when depression of heart's action present; when brought under treatment, bed-ridden and believed to be in articulo-mortis ; so far recovered as to be able to pursue her daily employment in housework.-British Journal of Homoeopathy, 18G2, p. G. Cancer, scirrhus of the breast; treated with lotion Hydras- tis, and Arsenic.6 pilule twice a day ; suffering from phthisis, for which Bryonia, Phos., etc., were prescribed ; pain in breast removed; patient still under treatment.-Ibid. Cancer, scirrhus in the antrum highmorianmn; Mrs. Eliza- beth B., aged 53; the remedies were first Arsenic., Silicea and Sulph., next Nux vom., Carbo ligni, Lycopodium, Calcar, carb., third series, Ipecacuanha, Pulsatilla and Aurum ; the intercurrents were Asafoetida, Lachesis and lodium : the scir- rhus never gave way till Aurum12 was given, two globules for a dose, night and morning for three weeks; perfect cure.- Ibid., vol. xvii., p. 59, Dr. von Viettinghoff. Cancer, scirrhus ; Arsenic.3 repeated every eight days; cured. -Jeane's Practice of Medicine, p. 348. Cancer, scirrhus ; Belladonna12, one dose repeated at the end of fourteen days with smaller dose ; cured.-Ibid. Cancer, scirrhus of breast; Conium, Chamomilla and Coni- um locally; improvement under both Conium and Chamo- milla, finally cured by the Conium locally.-Ibid. Cancer, scirrhus of the uterus ; Magnesia mur.; cured.- Jeane's Practice of Medicine, p. 348. Cancer, scirrhus of lip ; Nux vomica18 gtt. j, Conium12 gtt. j ; Nux was followed by great improvement, Conium completed cure by tenth day.-Ibid., p. 350. Scirrhus, induration of cheek ; Sil.80, six pellets in two ounces of water, tablespoonful every other day; completely removed. -Ibid.,p. 351. 688 world's iiomceopathic convention. Scirrhus, induration of left breast; Mrs B., aged 21, Pul- satilla 3%, Belladonna3 Bry.3 alternating, Mercurius sol., Ar- senic. Conium cured.-British Journal of Homoeopathy, vol. xvii., p. 70, .Dr. von Viettinghoff. Scirrhus, induration of the breast; Mrs. II. J., aged 50. Gave Arnica to antidote the camphorated oil which had been used; prescribed Conium ^0-; gave Puls. 3'n, Belladonna | for shooting pains under arm; improved.-Ibid,p. 71. Scirrhus of mammae; Mrs. S. Everit, aged 53 ; Arsenic, Belladonna ; much improved, the tumor lessened ; patient considered herself well enough to cease treatment; camo again claming to be as bad as ever, having brought it on bv drinking. Improvement this time slow.-Ibid, vol. xvii, p. OS, Dr. von Viettingoff. Cancer of the stomach ; nurse, aged 52 ; Arsenic., Kreasote; subjective symptoms much relieved by Arsenic.; vomiting diminished by Kreasote but never entirely disappeared,-Ibid, 1861, p. 134, report of Homoeopathic Institute of Leopold- stadt. Cancer in the uterus; Mrs. D. aged 56 ; Nux vom., Sepia, Pulsatilla, Bryonia, Kreasotum, Sulphur, Carbo anim., Thuja and Arsenicum; disease was of too long standing and too deeply ramified to be cured, but under the action of Sepia, Thuja, Carbo anim. and Arsenicum, pieces of decomposed cancerous tumor came away from rectum and vagina.-British Journal of Homoeopathy, vol. xvii., p. 64, Dr. von Viettinghoff. Cancer, uterine ; Mrs. F. B. M., aged 70 ; the ground work medicines were Sepia and Silicia, next Magnes, carb., Sulph., Caust., Lycopodium; in third place, Pulsatilla, Arsenicum, Belladonna. Other medicines were given to rectify accidental occurrences ; so much improved as to be able to walk for two hours as exercise.-Ibid, vol. xvii., p. 57, Dr. von Viettinghoff. Cancer of womb; menstruation ceased five months since ; in its place a continuous foetid discharge with labor-like pains; profuse urination ; Bryonia removed the severe pains within six days. Belladonna reduced these pains to mere trace of irritation ; diminished quantity and foetor of discharge and abated urgency of stool and urine; headache entirely gave HOMEOPATHY IN SURGERY. 689 way, sleep and moderate appetite established; cure nearly established.-British Journal of Homoeopathy, 1861, p. 144, Homoeopathic Institute of Leopoldstadt. 1. Condylomata, specific ; warty excrescence behind the glands, Tartar, emet.; complete cure in five weeks. British Journal of Homoeopathy, 1861, p. 428. 2. Urethritis ; Tartar, emet.; complete cure. Ibid. Cancerous tumor of breast; Conium, one pill a day, after- ward increased to four ; complete cure. Philadelphia Journal of Homoeopathy, vol. iv., p. 377, Dr. Cade. Tumor in cervical gland, left side of neck; Calcarea carb.30 gl. iij, Sacch. lac. gr j every third night, Calcarea carb." pilule every night on which powder not taken ; great improvement Calcarea earb.12 pilule every other night. Hardness remaining with occasional shooting pain, Hydrastis can., three pilules every night; swelling much reduced and generally better. Suffers from indigestion ; repeat pill Hydrastis and Nux vom.8 pilule twice per day ; pain ceased and no increase of tumor. British Journal of Homoeopathy, 1862, p. 6, Dr. Bayes. Tumor on dorsum of foot, size of walnut ; woman aged 55 ; Hydrastis can.3 pilule bis die.; tinct. Hydrastis can. 3 ij, aqua dis, 3 jss, to be rubbed in every night. After six months treatment, reduced to size of a pea. No indication of return.- Ibid., 1862, p. 6, Dr. Bayes. Stony tumor in the left breast; woman aged 37; tumor movable, size of a large filbert, somewhat nodulated ; lancin- ating pains ; Hydrastis12 pilule twice per day, afterward Hy- dras. tinct., a third of drop three times per day. Intcrcurrently a few doses of Nux vom. for dyspeptic symptoms; tumor became painless, and gradually diminished ; thorough cure ; neither pain or induration remaining.-Ibid., p. 8, Dr. Bayes. Two knotty tumors in right breast, size of hen's egg, and one in left breast; Hydrastis in increasing doses, and Hydrastis lotion ; great and rapid improvement. Tumor reduced to size of walnut. Steadily gaining health and strength ; still under treatment.-Ibid., Dr. Bayes. Stony enlargement of os uteri ; Miss II., aged 48 ; Hy- 690 world's homoeopathic convention. drastis" 12 ; lotion 3 ij, mother tincture, to 3 viij water; lotion gave much pain and was discontinued. Hydrastis produced no effect; Arsenic, iod.3 substituted with rapid change for better in all symptoms. Cold infusion of Hydrastis as an injection to relieve pain ; still under treatment. Ibid., 1862, p. 8, Dr. Bayes. Fungus luematodes oculi; Belladonna31', Cal. carb.12, Lycopo- dium12, Sepia30, Silex12, Calcarea carb.18; Belladonna removed the excessive photofolia and inflammation in six days; Calc, carb, at first aggravated, but afterwards removed cloudiness of cornea; Lycop. lessened size of fungus, as did also the remain- ing remedies ; the cure was complete.-Jeane's Practice of Medicine, p. 187. Fungus luematodes oculi; Belladonna28 gtt j, at intervals of a week for four weeks, Nux vom., Euphrasia and Aconite ; com- plete cure. Idid., p. 190. Cauliflower excrescence of uterus, about six inches in cir- cumference ; internal administration of Hydrastis subsequently using paste to reduce the fungoid growths ; general health greatly improved; marked diminution of vegetations growths, and at close of six weeks almost level with surrounding healthy structures.-British Journal of Homoeopathy, 1863, p. 648, Drs. MacLimont and Marston. CALCULUS. Calculi, renal; citrated borate of Magnesia, a knifepointful ter in die; temporarily relieved by Nux vom., soda water and Wildung water; renal calculi passed readily away; all traces of disease passed away within seven days; no relapse within five subsequent weeks.-Ibid., vol. xxiv., p. 688, Dr. Becher. Calculus, renal and gravel; citrated borate of Magnesia, about as much as would stand on the point of a knife, every two hours; pain and urgency of micturition completely disap- peared; quiet sleep; brown cylindrical stone passed out with urine, one line long by half a line broad ; complete cure.- Ibid., p. 687. Cephalalgia from pressure on brain ; Arnica3 dil. three times a day; cured in three days without trephining or other instru- HOMOEOPATHY IN SURGERY. 691 mental interference.-IT. S. Journal of Homoeopathy, vol. ii., p. 124, Dr. Bloede. DROPSY. Dropsy ; Arsenic.13 cent., six drops in a wineglass of water, two drops every three hours, afterward changed to 30th cent.; the lower dilutions made not the slightest impression on the disease; rapid improvement, however, resulted on the admin- istration of the higher potency ; entire cure resulted within eight weeks.-British Journal of Homoeopathy, vol. xxv., p. 511, Dr. D. Whitney. Dropsy, general ; woman aged 27 ; face, abdomen and limbs all involved ; unable to lie down for fear of strangulation; death imminent; administered Arsenic." one drop every six hours, subsequently every night and morning ; after first few doses general improvement apparent; in four weeks a com- plete cure.-Ibid., vol., xxiv., p. 671, Dr. Haustein. Dropsy, pericardial; X., X. aged 40; first prescribed Ar- senic.3 dec. and Ipecacuanha3 alternated every two hours; sub- sequently Apocynum can. 6 one drop, Mercur." dec. trit, one grain every three hours, increased to two drops every two hours; but slight relief from first prescription; Apocynum can. so improved all symptoms that he is enabled to do light work and sleep comfortably, which he had not done for many years.-Ibid., vol. xxiv., p. 329, Dr. J. D. Craig. Hydrothorax and anasarca; prescribed Apocynum can.; pa- tient aged 80 ; marked improvement, and arrest of symptoms in forty-eight hours.-Ibid., p. 325. GANGRENE. Gangrene, traumatic; Lachesis6 one dose; process arrested in a few hours; cure complete.-U. S. Journal of Homoeop- athy, vol. i., p. 57, Dr. Dake. Gangrene, traumatic; Lachesis200 one dose; stopped and healthy action set up in two days, after Arnica, Arsenic, and Secale had failed to give relief.-Ilahnemannian Monthly, vol. ii., p. 29, Dr. Gilchrist. Gangrene, traumatic, from burn; Lachesis6 one dose; pro- 692 world's iiomceopathic convention. cess stopped, and cure effected without delay.-U. S. Journal of Homoeopathy, vol. i., p. Gl, Dr. Dake. Gangrene, traumatic, from compound fracture; Lachesis" one dose ; process stopped in six hours; all traces disappeared in two days.-Ibid., p. GO. Goitre; congestion of thyroid gland; first gave lodium, Calcarea carb, and Dims, afterward Apis mel.16 3", swelling as large as a goose-egg; lodium and Calcarea carb, alleviated but did not cure; Apis mel. reduced the gland to its normal size within two weeks.-British Journal of Homoeopathy, 1SG5, p. 674, Dr. Poulson. 1. Simple goitre; lodium1 dec.; cured in two months.- Ibid., vol. xxv., p. 180, Dr. J. Kidd. 2. Goitre, simple and hard; Iodine, mother tincture ; cured in six weeks.-Ibid. 3. Goitre in girl aged 12, of weak constitution, lod.1 dec. six drops ter in die; cured in six months completely.-Ibid. 4. Cyst in thyroid; after using Iodine internally and exter- nally, for two months, and Spongia tost, for six months; cured by injection of Iodine; entire disappearance of tumor and perfect cure.-Ibid. 5. Goitre, exophthalmic; Belladonna1 dec., five drops ter in die, after failure of both Iodine and Iron ; permanent cure in five or six weeks. Ibid. Goitre; under allopathic treatment at first without improve- ment ; began with Sulph., afterward Calcarea, then pil. lod., externally lod.1 dec., Bellad. for headache, Mercur. sol. for purulent discharge ; all symptoms gradually vanished ; goitre entirely gone, not to return.-British Journal of Homoeop- athy, vol. xxviii., p. 390, London Hom. Hospital. Goitre ; Calcarea carb.' trit., one dose daily for ten days; Calcarea carb." gtt. vi, in acpia, tablespoonful morning and night; after one month appetite had improved, but swelling remained; in nine months was entirely cured.-Western Hom. Observer, vol. iv., p. 178, Dr. Bourgeoise. Goitre, size of hen's-egg; Calcarea carb.3 trit., dose every morning for twelve days ; three months after Calcarea carb.30, later Calcarea carb.200; at the time the last medicine was given the tumor was so small as not to be noticeable.-Ibid., p. 179. HOMEOPATHY IN SURGERY. 693 Goitre of size of hen's-egg, which interfered with respira- tion ; Mercur. prot.12, one powder every night for two weeks; Mercur. prot.8 during day, with 12th at night; Mercur oint- ment grs. j to adepis locally; very marked improvement during first two weeks; results from this time unknown.- Hahnemannian Monthly, vol. xi., p. 164, Dr. Blakely. Goitre ; Staphysagria and Lycopodium in alternation, with frequent intercurrent remedies; complete cure.-Ibid., p. 404, Dr. Kicket. HEMATOCELE. Haematocele, pelvic; Camphor and stimulants; nonfluctuat- ing tumor displacing posterior 'wall of vagina ; applied ice and cold Arnica lotions externally, gave Arnica internally, and subsequently substituted Hamamelis, five drops mother tinct- ure inwardly, and Hamamelis 3 ss to 3 xxj as a lotion for the abdomen ; peritonitis treated by Mercur. corr.3 dec. and Bella- donna3; first remedies had little or no effect; Hamamelis caused an instant improvement, though only partial in its op- eration ; Hamamelis1 dec. and Sacch. lac. absorbed fluid part of the blood, contracted the luematocele, and the uterus par- tially righted itself; eventually after subsequent miscarriage all symptoms with tumor entirely disappeared.-British Jour- nal of Homoeopathy, vol. xxviii., p. 250, Dr. J. L Newton. HEMORRHAGE. Haemorrhage from bowels; Lachesis", two doses, afterward Lachesis3 and subsequently Lachesis10000, Nit. acid", afterward 200th, lastly Natrum mur.SM ; Lachesis and Nitric acid had but temporary effect, the attacks continually returning; Nat- rum entirely subdued and eventually eradicated the disease.- Transactions American Institute of Homoeopathy, 1873, p. 416, Dr. W. Gallupe. Haemorrhage from stomach and bowels ; two cases: 1. Ar- nica1 dec, Ipecac.8 dec., Nux vom.3 dec. and China3 dec; 2. China in drop doses every three hours ; Arnica -was given for vomiting of blood; China in both cases for the anaemic condi- tion ; Nux vom. for the constipation ; and Ipecac, for removal 694 world's HOMOEOPATHIC CONVENTION. of nausea and tendency to vomit; the drugs answered all ex- pectation, affording prompt relief and ultimate cure in each case.-British Journal of Homoeopathy, vol. xxviii., p. 555, Dr. Shuldham. Haemorrhage of uterus; Mrs. G. aged 35; recurred every eight days; Puls., Phos., Mill., Ham. and Lycop.; Natrum mur." and Calcarea carb.16 in alternation, one drop every morn- ing, and finally Apis mel.3 80 in No. 1 globule; first-named remedies had only temporary effect, bleeding from womb re- turning worse than before ; Natrum mur., Calcarea carb., etc., arrested haemorrhage and reduced tumor ; Apis mel.8 80 in No. 1 globule effected a permanent and entire cure in about four weeks.-Ibid., 1865, p. 674, Dr. Pouson. Haemorrhage, uterine post partum; 1. Secale every half hour; Ipecac.80 to arrest haemorrhage ; excellent recovery.- Transactions American Institute of Homoeopathy, 1874, p. 12, Dr. M. Fi■iese. 2. Haemorrhage, uterine post partum; no external haemor- rhage ; Secale, Pulsatilla and Belladonna; complete recovery. -Ibid. 3. Haemorrhage, uterine post partum; Glycerine and Car- bolic-acid ointment once a day ; Caulophyllin thrice internally ; immediate relief, cure anticipated in about three months.- Ibid., p. 28, Dr. E. L. Cook. Haemorrhage, uterine ; two cases ; Bellad.200 in water, a dose every half hour; labor at sixth month; cured without band- age, tampon, cold water, or any other appliances; first case, complete recovery in three days ; second case, thorough resto- ration in twelve hours.-Ibid., 1872, p. 230, Dr. M. P. Jack- son. Haemorrhage, uterine ; Crocus200 given at increasing inter- vals for forty-eight hours; retained placenta, spontaneously discharged; thorough cure.-Ibid., p. 203, Dr. J. II. Wood- bury. Haemorrhoids, acute: 1. IL S. aged 20; nine drops Hlscm lus in three ounces of water, dessertspoonful three times per day; 2. Mrs. F. aged 60 ; one drop 2E sc ulus8 every four hours; HEMORRHOIDS. HOMOEOPATHY IN SURGERY. 695 both cases completely cured.-British Journal Homoeopathy 1865, p. 485, Dr. Hughes. Haemorrhoids; two cases, existing in first case for twelve years, in second case for whole period of adult life ; JEsculus hip.3 three drops in water twice per day; first case cured by one small bottle ; second case cured in two weeks.-Ibid., p. 347, Dr. F. A. Bailey. Haemorrhoids ani coecae ; Sepia A- 3; entire and permanent disappearance of symptoms.-American Hom. Review, vol. iii., p. 88, Dr. B. Fincke. Haemorrhoids following parturition ; Nux vom. in repeated doses; cured.-Jeane's Practice of Medicine, p. 261. Haemorrhoids of several months' standing ; Phosphorus for some time, then Ammon, carb.30, one pellet dissolved in four ounces of water, teaspoonful daily; Phosphorus did no good ; Ammon, carb, cured in five weeks.-Ibid., p. 260. Haemorrhoids, with fissure of anus ; Muriatic acid3 gtt. ij ; cured.-Ibid. Haemorrhoids, fifteen months ; Graphites and Petroleum ; after Graphites slight relief of brief duration ; Petroleum cured in four weeks.-Ibid., p. 262. , Haemorrhoids; Sulphur, gr. A; homoeopathic aggravation at first, then complete cure.-Ibid. Haemorrhoids; Aconite13 gtt. j, Sulphur3 gr. j ; cured.- Ibid., p. 263. Haemorrhoids, with painful fissure in anus ; cured by Peeonia3 5 drops, bathing the parts every two hours. At same time administered on alternate days Sulph.30, Nux vom.13 to remove the haemorrhoids; Haemorrhoids disappeared on the fifth day and cicatrization complete. In fourteen days all trace had disappeared.-British Journal of Homoeopathy, vol. xxv., p. 54, Dr. Ozanam. HERNIA. Hernia incarcerata; Nux vom. ; cured.-Western Homoeo- pathic Observer, vol., iv., p. 226, Dr. Cscrno. Hernia incarcerata; Nux vom.; cured.-Ibid. Hernia, incarcerata; Nux. vom.; cured.-Ibid. Dr. Syon- tagh. 696 world's homceopathic convention. Hernia, strangulated, which had resisted every effort at taxis; Nux vom.', a powder every fifteen minutes afterward Nux vom.30; Nux* promptly relieved ; Nux3' relieved subse- quent constipation, no relapse yet (five months after).-U. S. Medical Investigator, vol. i., p. 393, Dr. Cranch. Hernia, umbilical, congenital; Nux vom/5000, Calc, carb.,85"', Fincke, one dose; slight relief at first from Nux, but soon aggravation ; Calc. carb, cured the child completely.-Ilahne- mannian Monthly, vol. ii., p. 546, Dr. C. C. Smith. HIP DISEASE. Hip disease; Miss II. M., aged 24; prescribed four powders of Nux voin.3' (equivalent to four pellets), then five powders of Sulph., each A as above, Rhus tox.30 Nos 1, 3, 5, 7 ; Sacch., lac, Nos. 2, 4, 6, 8 ; immediate relief in stomach and bowels, pain and irritation about chest and left side and general health much improved, could walk with ease at last report.-British Journal of Homoeopathy, vol. xxiv., p. 308, Dr. AV. Gallupe. HYDROCELE. • Hydrocele; M. Grouard, aged 49 ; injection of Iodine water; size of tumor, 26 by 15 centim.; cure within fifteen days.- Ibid., 1860, p. 450-457, Dr. Helot of Rouen. Hydrocele ;-aged seven years ; treatment internally three globules 12th dil. of Rhodod. chrys., night and morning every alternate three days. Externally: R. Rhodod. chrys. 3 ij, Aquse font., 3 vi; appl. mane, nocteque, after fomenting the scrotum; complete cure.- Ibid., 1860, p. 351, Dr. Hastings, Cheltenham, England. Hydrocele; injection of Iodine water; P. Fountain, aged 32, size of tumor, 20 by 15 centim. ; diminution in tumor at end of ten days to one third its size; entire disappearance at close of mouth. -Ibid., p. 450-457, Dr. Helot of Rouen Hydrocele; Lecointra, aged 62, transparent tumor as large as ostrich egg, same treatment, entire cure ; in fifteen days tumor reduced to one third. No inflammation; at the end of two months thorough cure, no indication of return.-Ibid. Dr. Helot of Rouen. HOMOEOPATHY IN SURGERY. 697 Hydrocele; P. Constantine, aged 63, tumor large, acute inflammation. Entirely cured by same treatment; in six weeks tumor reduced to one third ; two weeks later, cure complete. -Ibid., 1860, p. 450-457, Dr. Helot of Rouen. Hydrophobia, spontaneous; Hydrophobih'0 dose at close of every spasm ; Mercur. viv.'° for soreness and muscular rigidity; effectual and positive cure.-Transactions American Institute of Homoeopathy, 1874, p. 461, Dr. O. P. Baer. JOINT, DISEASES OF. Hydrarthroses of knee-joint; Rhus tox.* dose every three hours for rigidity of limb ; Bryonia' and bandage for reduction of swelling and pain, and pneumatic aspirator for extraction of dropsical accumulation ; thorough cure and no symptoms of return.-Ibid., 1874, p. 153, Dr. R. E. Caruthers. Ovarian enlargement; Kali bromid. trituration, a grain night and morning, subsequently Apocynum, Apis and Arse- nicum ; every trace of enlargement gone, abdomen normal in size and appearance.-Ibid., vol. xviii., p. 787, Dr. Dudgeon. [?] POLYPUS. Polypi, "nasal," twenty cases; thorough cure from absorp- tion with Bichromate of potash; inflammatory action sets in within three or four days of application which subsides in about forty-eight hours, and results in the partial or total disappear- ance of the polypi; relapse very infrequent.-British Journal of Homoeopathy, 1863, p. 170, Dr. Fredericq. Polypi "nasal," Kali bich*, three times per day in pilules; for itching eruption Sulph.', Kali bich. 1 dec. trit., to be used as snuff once a day. Attack of coryza treated with Merc, sol.6; polypi considerably reduced by use of Kali bich.; nasal symp- toms entirely cured ; could breath freely through both nos- trils; eight months treament.-Ibid., vol. xxviii., p 356, Dr. R. D. Hall. Polpus nasi, treated with Calc.'0 ter die ; syringed with Liq. calcis; complete cure.-Ibid., vol. xxviii., p. 356, Dr. R. D. Hall. Polypus, nasal; Calc. carb. 2 dec. trit., 1 grain daily lime 698 world's homoeopathic convention. water; after three months treatment polypus entirely disap- peared, nose in normal condition.-Ibid., vol. iv., p. 545, Dr. R. D. Hall. Polypus, nasal; Calc, carb.", Staph.1 in alternation a half hour before each meal and at bed time. No improvement, Teucrium1 three times a day caused the polypus to disappear; complete and permanent cure.-U. S. Journal of Homoeopa- thy, vol. ii., p. 491, Dr. Richards. PYELITIS Pyelitis; treated first with Bryonia, and afterward with Bellad? twice or thrice per day, which effected a cure; Bry- onia gave but slight relief; the improvement under the use of Belladonna was striking, every symptom being gradually but permanently subdued ; health, strength and physical functions entirely restored.-British Journal of Homoeopathy, vol. xxv., p. 384, Dr. Watzke. RANULA. Ranula; large number of tumors of size of walnuts; had been frequently incised with but temporary relief; Thuja, Nitric acid in alternation twice, Ambra and Calcarea carb.; Thuja and Nitric acid did but little good ; Ambra diminished tumors considerably, and Calcarea carb, completed the cure.- Jeane's Practice of Medicine, p. 335. Ranula of two years' duration, growing; Lycop., Staph, and Mercur., Mezereum30; first three remedies did no good, but Mezereum removed tumor in eight days; frequent return ,each time removed by Mezereum; finally completely cured.-Ibid., p. 335. Ranula of large size; Mercur.; speedily cured.-Ibid., p. 335. Surgery, plastic; amputation averted by use of calendula, wounds ragged, torn and bleeding profusely; middle finger which was nearly severed, placed in apposition and bandaged in cotton saturated with Calendula; Calendula3 internally every two hours, six pellets; pain eased, united completely and hand entirely restored to normal condition in four months. -British Journal of Homoeopathy, 1864, p. 511. HOMEOPATHY IN SURGERY. 699 Synovitis, acute, and pulmonary haemorrhage; administered Arnica liniment first, then 40 drops American tincture Verat. vir. several times per day outwardly, at same time grain-doses Calomel1 dec. trit, every four hours ; no relief from Arnica ; immediate and marked relief to pain and swelling on applica- tion of Verat. vir.; an excellent recovery.-Ibid., vol. xxv., p. 256, Dr. George Moore. Extensive ovarian cyst; , aged 50; prescribed China' three times per day, a small portion of a drop in a powder of Sacch. lac.; for asthmatic affection Cannabis sat.1 dih, one drop in a teaspoonful of water every four hours; constipation treated by Sulph." at intervals of two days; Hall's Iodine water constituent parts; chloride of Sodium, Calcarea carb., Magnesia, Iodine and Bromine; 16 ounces contains chloride of Sodium 112.0412 grs.; chloride of Potassium, .0499 grs.; chloride of Ammonium, .0330 grs.; chloride of Calcium, 2. 9330 grs.; chloride of Magnesium, 2.6220 grs.; iodide of So- dium, .0607 grs.; iodide of Magnesium, .2849 grs.; bromide of Magnesium, .5176 grs.; eight days continuance of the China produced a very advantageous change in the digestive system, spontaneous action of bowels and normal pulse ; difficulty of breathing and cough considerably diminished by Cannabis; much greater activity in stools and increase of urine; size of abdomen diminished more than two inches in circumference under use of Cannabis, therefore prescribed three tablespoons- ful of Hall's Iodine water (about of a grain) at each dose; eight days' treatment produced livelier action in kidneys and outer skin ; the abdomen gradually and perceptibly slackened, becoming of a doughy consistency; after four weeks' treat- ment abdomen reduced to normal condition and size, urine in- creased to natural quantity.-British Journal of Homoeopathy, 1862, p. 588, Dr. Hirsch, of Prague. Ovarian tumor; married, aged 42 ; Hydrastis can.30, glob, iii., Sacch. lac. gr. j, two powders on every third night; Acon- ite tinct., gtt. viii, Sacch. lac. gr. xxiv., dissolve in half a pint of water, tablespoonful twice per day ; Phus tox.3, gtt. vi, lod.3, gtt. vi, Sacch. lac., gr. xx, in half a pint of water; Mer- cur. sol.6, Mercur. iod.1, grs. ii, nightly; cured in two months. -Ibid., p. 5. 700 world's homoeopathic convention. Tumor, ovarian; Apis mel.; entirely removed in a short time.-Philadelphia Journal of Homoeopathy, vol. iv., p. 103. Tumor, ovarian; Pulsatilla30, Arsenic.30, Lachesis30, Sulph.30, Calcarea carb.30, Aurum30, Mercur. viv.30 and Sepia30, one at a time in accordance with the totality of the symptoms; cured in two years; tumor entirely removed within three years from beginning- of treatment.-Hahnemannian Monthly, vol. ii., p. 50, Dr. J. IL Payne. Tumor, ovarian, of large size ; case pronounced hopeless by allopathic physician ; Bellad.30, Mercur. viv.30, Arsenic.36, Apo- cynum30, Pulsatilla30, Lachesis30 and Sulph.3', in aqua, dose every four hours at first; cured in five months; tumor gradu- ally disappeared.-Ibid., p. 51. Tumor, ovarian; case pronounced beyond the help of sur- gery even by several consulting allopathic physicians; Can- nabis30 20°, Pulsatilla200, Mercur. viv.100, Arsenic.200, Apis mel.30 20°, Lachesis 30 20°, Apoc.30 and Sulph.200 ; amelioration of gen- eral symptoms in four weeks, but tumor at first seemed to grow larger; complete removal in nine months; Apocynum had the most decided effect of any one remedy in removing tumor, Arsenic, and Apis mel. next.-Ibid., p. 53. Tumor, ovarian ; Bry., Lach., Sulph., Apis mel.20 two doses, with subsequent repetition ; Bryonia, Lachesis and Sulph. did no good ; Apis mel. removed tumor in three months.-Ilahne- mannian Monthly, vol. ii., p. 184, Dr. C. Wesselhoeft. Tumor ovarian ; Arnica200, Colocynth200, Cham.201', Lach.200, and Lach.400"; very small and may be inflammatory, perfect cure.-Ibid., vol. vii., p. 406, Dr. Miller. Fungus on gums ; Staphysagria, two doses; cured.-Jeane's Practice of Medicine, p. 239. Ulcer of coccyx, infundibuliform; six months duration; cured by Paeonia3 three times a day, both internally and as a lotion ; in eight days cicatrization was complete.-British Journal of Homoeopathy, vol. xxv., p. 54, Dr. Ozanam. Ulcer of great toe, five month's duration; cured by Paeo- nia3 internally and externally ; complete cure.-Ibid. Ulcer of back of foot, from tight boots; Paeonia3 internally and externally; patient unable to rest sufficiently, therefore cure delayed ; took ten days.-Ibid. HOMCEOPATHY IN SURGERY. 701 Ulcer of anterior surface of tibia; cured by Paeonia3 31 tinct. internally ; cicatrization complete at end of month, no bandage or other appliances used.-British Journal of Homoeopathy, vol. xxv., p. 54, Dr. Ozanam. Ulcer of breast, four months standing; Paeonia3 externally and internally ; complete cure.-Ibid., p. 59. Ulcer on left side of neck, embracing shoulders and both axillae ; cured by Chelidonium majus, sixty drops ter in die ; found that, while the freshly-expressed juice could be obtained, the healing and cicatrization was satisfactorily rapid, but when not procurable a corresponding delay in progress occurred; entire cure.-British Journal of Homoeopathy, vol. xxv., p. 229, Dr. Buchmann. Ulcer, chronic, of right leg, ten years' standing; serpiginous character; prescribed Paeonia3 to mother tincture; curedin two months ; ten months elapsed and no return of disease. -Ibid., vol. xxvi., p. 57. Dr. Ozanam. Ulcer, fistulous, of breast; suspended by long strips of adhe- sive plaster ; prescribed internally ten drops of Phytolacca1 four times a. day; externally half an ounce of tincture to eight ounces of water to be syringed into fistulous canal; in one week all the ulcers except one had closed, though the gland will never return to its normal condition ; the ulceration per- manently arrested.-Ibid., vol. xxi., p. 203, Dr. E. M. Hale. Ulcer, fungus of lower arm; Silicea8; healed in less than three weeks.-Philadelphia Journal of Homoeopathy, vol. iii., p. 271, Dr. Williams. Ulcer, irritable, on shoulder, two inches in diameter ; Sulph.3 and Vaseline as an emollient; complete cure in eight days.- U. S. Medical Investigator, vol. i., p. 393, Dr. Cranch. Ulcer, perforating, of the stomach; man aged 60 ; great emaciation, luematemesis and dyspepsia present; administered Arsenic, and Nux vom.; recovered his health completely; strength and appetite nearly restored ; has attained 78 years of age, with only slight relapse.-British Journal of Homoeop- athy, vol. xxiv., p. 657, Dr. Watzke. Ulceration, malignant, of the nose; cured by Kali Inch.; Arsenic, previously administered, but failed to arrest ulcera- 702 world's IIOMCEOPATHIC CONVENTION. tive process; prescribed Kali bich.3 externally and inter- nally, which instantaneously produced a marked change from ulceration to healthy granulation which continued and in- creased to entire recovery.-Ibid., p. 304, Dr. C. Hansford. Ulcerated leg, varicose veins ; Pulsatilla tinct., live drops in a pint of water externally and internally; Pulsatilla16 dec. three globules every night at bedtime; limb restored to its natural condition ; health robust and perfect.-American Hom. Review, vol. iii., p. 233, Dr. J. Hornby. Ulceration of seat, from decubitus; cured by Paeonia3; cica- trization and cure complete in ten days.-British Journal of Homoeopathy, vol. xxv., p. 54, Dr. Ozanam. URETHRA, DISEASES OE. Urethra, stricture of; Berberis, after many medicines had been given without effect; speedy cure.-Hahnemannian Monthly, vol. vii., p. 402, Dr. Miller. WARTS. Warts, more than seventy on the hands; prescribed Natrum muriat.21, in sixteen powders of sugar of milk, one each day; entirely cured within ten days.-American Homoeopathic lie- view", vol. iv., p. 549, Dr. Bojanus. Warts, malignant; Arsenicum6, six globules dry on tongue ; only one dose given; complete cure in ten days; no return one year afterward.-U. S. Journal of Homoeopathy, vol. i., p. 43, Dr. Leon. Warts on face, fourteen in number; Thuja20 20°, with tinct. externally, Calc, carb.200, six globules every morning for one wreek, Calc, carb.30 6 ; under Thuja a few warts disappeared; but more made their appearance; Calc, carb.200 improved general health, Calc, carb.30, six warts disappeared ; Calc, carb.6, all re- maining warts disappeared within month.-Western Homoeo pathic Observer, vol. iv., p. 181, Dr. Bourgeois. Warts on the face, large number; Calcarea carb.; warts all dried up and dropped oil.-Ibid., p. 161, Dr. Bourgeois. Warts on the hands; Thuja30 18 for two months and Thuja tinct. locally, Calcarea carb.; no result from Thuja; w'arts HOMCEOPATIIY IN SURGERY. 703 began to drop off after first dose of Calcarea and after two months treatment all disappeared.-Ibid., vol. iv., p. 181, Dr. Bourgeois. Warts on hands, of many years standing; had been removed several times by caustic; treatment, Thuja8 dec. every morning internally, and Thuja tinct. applied morning and evening with Nux vom.8 twice or three times a week for two weeks. Next two weeks Nux as before ; continue Causticum12 dec. internally and Causticum' dec. externally in place of Thuja and so con- tinuing, alternating as above ; no diminution in size of warts for six months, but general health began to improve. Between six and seven months warts began decreasing in size and grow- ing white and shriveled. By the end of the ninth month the hands were perfectly smooth and all signs of warts gone.-U. S. Medical Investigator, vol. i., p. 234, Dr. John F. Wage. Warts on hands and face ; treatment same as in last case; at the end of four months all traces of warts had disappeared.- Ibid. WHITLOW. Whitlow (or panaris); lady aged 30, right fore-finger; con- centrated Nitric acid applied for about two minutes; im- mediate relief and gradual and entire subsidence of both swelling and pain ; entire cure within four days.-British Journal of Homoeopathy, 1863, p. 218, Dr. J. Hirsch, of Prague. Whitlow (or panaris) of middle finger; young man similar remedy and result.-Ibid. Whitlow (or panaris), aggravated case; girl aged 11; Silic.24 and Hepar2 trit. ; in eight days entire cure.-Ibid. Wounds, gun shot, near os pubis and femoral artery; pre- scribed Urtica urens, six globules in half tumbler of water and four globules Sulph.20; complete and permanent relief to pain. Temporary loss of power in limb alone remaining.-American Homoeopathic Review, vol. iii., p. 462, Dr. D. F. Wells. Wound on surface of tibia down to calf ; Lachesis200 in 3 of water, dose every half hour; cured.-Ibid., vol. iv., p. 556, Dr. T. F. Allen. Poisoned hands; Lachesis200 every hour; complete cure in ten days.-Ibid. URO-LITHIASIS IN RUSSIA, ( Nizhny-Novgorod) A Contribution to Operative Surgery, Etiology, Statistics and Therapeutics. By Dr. C. Bojanus, Moscow, 1876. [This Essay is illustrated by 72 Vesical Calculi (the "second series" of which the author speaks) sent by the author to the World's Homceopathic Convention of 1876.J TO HIS HONORED FRIEND, THE EMINENT PROMOTER OF SCIENCE, DR. E. VON SRAUVOGI, THIS ESSAY IS DEDICATED AS A FEEBLE TOKEN OF RESPECT AND LOVE BY THE AUTHOR. Preface.-It is in the nature of mankind to seek to explain what is obscure, by searching for the causes of phenomena. And where could such investigations be more in place than in the natural sciences, the advancement of which redounds at once to the personal advantage of man himself? These two lines of work, however, observation and explanation, converging to one result, never advance at equal rates; observation outstrips explanation. An attempt has been made in the following pages to explain phenomena, the causes of which have not hitherto been fully recognized ; how successfully, let competent but impartial judges determine. The observations which are the basis of this treatise were confined to a single province of the Russian Empire, the other provinces offering too few and indefinite data for positive conclusions. May this effort tend to the advancement and general recognition of the truth-the sole object which has animated and guided Moscow, February, 1876. The Author. 705 706 world's homoeopathic convention. The period during which the Hospital of Nishny-Nov- gorod was under my charge embraces about nine years (from September, 1854, to July 1, 1S63). During this time the operation of Lithotomy was performed in the hos- pital 143 times. The report of a portion of this period was published at Dorpat in 1863, and this report was translated and pub- lished under the following title: Application de la Medecine Homoeopath! que aux Traitements Chirurgicaux. Bruxelles, 1864. We refer to this work for that portion of the service. During the second period (subsequent to the preparation of the above report) there were 72 lithotomy cases, one of which was in a female; an evidence that males are much more liable to this disease than females. Of at least 200 cases that have come under my observation, only three were in women, one of whom was operated upon. All of these three women had passed their fortieth year. I have never seen unmarried women, young or old, afflicted with stone in the bladder. The rate of mortality for the second period (1859 to 1S63) was more favorable, than for the previous period ; of the 72 cases, one in GfVo died, about 15.27 per cent. The mortality in the 143 cases, comprising both periods of operations, with homoeopathic treatment, was one in 5TV, or 19.58 per cent., which is at least not worse than the ex- perience of other surgeons. If the report serve no other purpose, it will at least prove the fruitlessness of the treat- ment hitherto employed after the surgical operation ; and, if it did nothing more, Homoeopathy would, for this, merit a favorable recognition. The duration of treatment during the second period was, on an average, 2T7o1o days shorter than during the previous, period, being an average of 42T6o7o instead of 45t308q days for each patient. The total of 143 lithot- omy cases gives us, therefore, 115 cured; the average UROLITHIASIS IN RUSSIA. 707 treatment lasting 43T%7o days. If we deduct from the 72 cases five in which the recto-vesical operation was per- formed, and one in which the horizontal was resorted to, the rate of mortality for the 67 cases of bilateral operation is 14.92 per cent., or as one to 6T7o ; the average duration of treatment, 41 days. Whatever may be the bearing on the question of the preference previously, and now again, expressed by us for the bilateral over the lateral operation, more numerous observations are necessary for a positive settlement of the question. Certainly, the results hitherto obtained are not unfavorable to the views we have expressed. The sequelae of the operations and the mortality in re- lation to the age of the patients are given in the accom- panying tables. [See Appendix ^L] The variety of the sequelae is less than that of the pre- vious period. We do not find cysto-renitis, haemorrhage, abscess and fistulae, phlebitis, pyaemia, tetanus and eclamp- sia. On the other hand, we find among the sequelae of the second period, intermittens and pneumonia; in how direct a relation to the operation these diseases stand, we cannot with certainty determine. Of 61 cases which recovered, 19 had no sequelae and 23 had simple traumatic fever; while, in the previous period, only eight were exempt from sequelae, and 28 had traumatic fever. Whether, and to what extent these favorable results are due to the mode of operation we cannot determine, but think the question deserves investigation ; for we think that the bilateral operation, a method which presents no special technical difficulties, has been unjustly neglected by many surgeons. The accompanying table [See Appendix Bi], embracing all the cases (143) of both periods, shows the frequency of the various sequelae, and their relation to age and mortality. The accompanying table [See Appendix C.] shows the relative frequency and mortality. The number of these observations is too small to justify a conclusion respecting the frequency of sequelae, especially 708 world's homceopathic convention-. if we take into acccunt the fact that these sequelae result not simply from the operation, but likewise from many local endemic, epidemic, climatic and nosocomial influences to which the individual palients have been subjected; and that, moreover, the more or less favorable results may depend in part on the individual luck of the surgeon,* and in part upon the fact that, as already stated,! I operated under most unfavorable circumstances, which many surgeons will not do. It appears that traumatic fever and cysto-peritonitis were the most frequent sequelae ; the former occurring once in 2.8 of the 143 cases, and the latter once in 6.5 ; while cys- titis occurred once in 13 cases. The prognosis can be numerically determined for only two forms of disease; for the others, which occurred less frequently, it depends on the pathological character of the disease. It is favorable for traumatic fever without local- ization; in cystitis it is as one to eleven; in peritonitis as one to four; in cysto-peritonitis as one to two; in cysto- peritonitis, with acute purulent oedema, as one to two; in acute purulent oedema, without complication, as one to 1.5. The relation of the mortality to the age of the patient is, for the second period, as follows: Age, 1£ to 5 years, 22 cases, no deaths. " 6 " 12 " 27 " .4 " = 14.81 per cent. " 12 " 17 " 13 "4 " = 30.76 " " " 21 " 58 " 10 " 3 " = 30 " " For both periods, embracing 143 cases: Age, 1£ to 5 years, 43 cases, 4 deaths, = 9.3 percent. " 6 " 12 " 54 ' 7 " = 12.96 " " " 12 " 19 " 24 "9 " - 37.5 " " " 21 " 58 " 22 "8 " = 36.36 " The important influence of the size-of the calculus upon the mortality is shown, for the second as well as for both periods together, by the following tables: *Piragoff: Clinical Surgery, page 22. \ Application du trait. Hom., etc., pp. 23, 24. URO-LITHIASTS IN RUSSIA. 709 Table I. Second period, 1859 to 1863. 72 cases. Stones weighing less than » di. Both periods together. 143 cases. Stones weighing less than 1 dr. V d Deaths. Cases. Deaths. Age, 3 years. Grains, a " 2^ " " 3 " 1^ " " 5 44 2 (i 23 " 4 " " 33 " 6,4,7" " 38 " 2 " " 46 " 2 " " 53 1 2 1 1 1 3 1 1 Age, 3 years. Grains, 2 4 4 J / ( ( 44 z» 2/2 3 " 1% " "5 " 4 " " 15 " 3 " " 18 " 2^, 3 " " 23 " 2 " " 29 " 4 " " 33 " 4 " " 35 " 6,4,7,8 " 38 " 7 " " 40 " 2 " " 46 " 1^ " " 48 " 6 " " 52 " 2 " " 53 I 2 I I I 2 I I I 4 1 1 1 1 1 I 11 - I 20 I Table II Stones weighing just I dr. Stones weighing just I dr. Age, 4 years. Cases. Deaths. Age, i^, 4, 8 years. | Cases. Deaths. I 0 3 o 710 world's homoeopathic convention. Table III. Stones weighing more than I dr. Stones weighing more than I dr. CZ) a <u Q 0 q Age, 40 yrs. 1 dr. 7 gr. I Age, 40 yrs. 1 dr. 7 gr. I " 8 " 1 " 21 " I " 4 " 1 " 8 " I 44 O J 44 J 44 22 I 44 44 j 44 44 I 1 " 5 " I " 30 " I " 4 " 1 " 15 " I 1 " 13 " i " 35 " I " 10 " 1 " 18 " I " 15 " 1 " 43 " I " IO " I " 20 " I " 8 " 1 " 46 " I " 8 " I " 21 " I " 2 " 1 " 48 " I 44 21 44 J 2^ I " 4 " 1 " 32 " I " 5 " 1 " 30 " I 44 0 44 I " JI 44 I 44 >7 44 1 It n 44 7 1 jj I " 13 " 1 " 35 " I " 15 " 1 " 43 " I " 2^ " 1 " 45 " I " 8 " 1 " 46 " I " 2% " 1 " 47 " I " 2 " 1 " 48 " I " 4 " 1 " 52 " 2 9 0 .9 2 Table IV. Stones weighing more than 2 drs. Stones weighing more than 2 drs. Cases. Deaths. Cases. Deaths. Age, 6 yrs. 2 dr. 0 gr. " 3, 9 " 2 " 12 " " ix " 2 " 13 " " 46 " 2 " 15 " " 5 " 2 " 18 " " 6 " 2 " 19 " " 13 " 2 " 40 " " 3,13 " 2 " 42 " " 4 " 2 " 46 " " 10,8" 2 " 50 " I 2 I I I I I 2 I 2 I I Age, 6 yrs. 2 dr. 0 gr. 5 " 2 " 11" " 3,7.9" 2 " 12 " " 11 " 2 " 13 " " 6 " 2 " 14 " " 46 a 2 « I5 « " 5 " 2 " 18 " " 6 " 2 " 19 " " 5- H " 2 " 35 " " 3 " 2 " 39 " " 3, 13 " 2 " 40 " " 3, 13 " 2 " 42 " " 4 " 2 " 46 " " 10,8 " 2 " 50 " " 25 " 2 " 51 " 2 I 3 1 1 1 1 1 2 1 2 2 1 2 1 I I I 2 22 3 UR0-LIT1IIASIS IN RUSSIA. 711 Table V. Stones weighing over 3 drs. Stones weighing over 3 drs. Age, 14 yrs. 3 dr. 2 gr. 44 O 44 44 j 7 44 " 6 " 3 " 26 " " 2 " • 3 " 29 " " 11 " 3 " 32 " " 3 " 3 " 37 " " 13 " 3 " 41 " " Io « 3 « 47 « " 5 " 3 " 5i " Cases. Deaths. Age, 14 yrs. 3 dr. 2 gr " 5 " 3 " 6 " " 30 " 3 " 7 " " 8 " 3 " 16 " " 3 " 3 " 17 " " 14 " 3 " 18 " " 5 « 3 " 27 " " 2 " 3 " 29 " "11 " 3 " 32 " " 10 " 3 " 33 " 44 3 44 37 "12 " 3 " 40 " " 13 " 3 " 41 " "10 " 3 " 47 " " 5 " 3 " 51 " " 5 " 3 " 53 " " 27 " 3 " 56 " " 17 " 3 " 59 « Deaths. I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 9 0 18 I Table VI. Stones weighing over 4 drs. Stones weighing over 4 drs. US Q d "d Q 0 p Age, 12 yrs. 4 dr. 14 gr. I Age, 12 yrs. 4 dr. 14 gr. I " 8 " 4 " 18 " I " 4 " 4 " 16 " I « 9 " 4 " 23 " I .... " 8 " 4 " 18 " I " 32 " 4 " 30 " I I « $ « 4 " 23 " I " 17 " 4 " 40 " I " 8 "4 " 24 " I " 14 " 4 " 42 " I I " 32 " 4 " 30 " 2 I " 3 " 4 " 50 " I " 17 " 4 " 40 " I " 6 "4 " 52 " I " 14 " 4 " 42 " I I " 3 "4 " 5° " I " 6 "4 " 52 " I 8 2 II 2 712 world's homceopathic convention. Table VII. Stones weighing 5 drs. Stones weighing 5 drs. CJ tn <u d rt 0 a u a Age, 8 yrs. 5 dr. 5 gr. I Age, 8 yrs. 5 dr. 5 gr. I " 6 " 5 " 12 " I " 6 " 5 " 12 " I " 58 " 5 " 28 " I " 22 " 5 " 17 " I " 9 " 5 " 48 " I 1 " 10 " 5 " 23 " I " 10 " 5 " 49 " I " 14,58" 5 " 28 " 2 " 12 " 5 " 53 " I " 9 " 5 " 48 " 2 1 " jo a « I " 11 " 5 " 50 " I 1 " 12 " 5 " 53 " I " 22 " 5 " 59 " I 1 6 1 12 3 Table VIII. Stones weighing 6-8 drs. Stones weighing 6-8 drs. tn d <v d u Q 0 « Age, io yrs. 6 dr. io gr. I Age, 6 yrs. 6 dr. 4 gr. I " 6 " 7 " ii " I " 10 " 6 " 10 " I " 12 " 7 " 24 " I " 15 " 6 " 13 " I CC I 7 Ct 7 CC OJ CC I " 9 " 6 " 22 " I " 3° " 7 " 43 " I " 14 " 6 " 40 " I I " 6 " 7 " I! " I " 12 " 7 " 24 " I \ " 17 " 7 " 25 " I CC 17 CC cc 21 u I " 3° " 7 " 43 " I " 25 " 7 " 50 " I I 5 0 II 2 URO-LITHIASIS IN RUSSIA. 713 Table IX. Stones weighing more than 1 c z. Stones weighing more than 1 oz. Age, 23 yrs. 1 oz. 1 dr. 46 gr. _ Cases. ; Deaths. Age,9,21 yrs. 1 oz. 0 dr. 9gr. M Cases , , Deaths. " 6 " 1 " 2 " 21 cc I " 25 " 1 " 0 " 27 " I "21 " 1 " 2 " 38 Cl I I " 28 " 1 " 0 " 38 " I " 47 " 1 " 2 " 40 ci I I " 10 " 1 " 0 " 45 " I " 28 1 " 3 " 37 n I " 19 " 1 " 0 " 47 " I " 10 " 1 " 4 " 42 (c I I " 8 " 1 " 1 " 4 " I " 14 " 1 " 7 " 12 cc I IC J £ CC J Cl J Cl 0 ■> cc I I 7 3 " 23 " I " I " 46 " << n « i " i " 47 " " 11 " 1 " 2 " 17 " " 6 " 1 " 2 " 21 " " 21 " 1 " 2 " 38 " " 24 « 1 " 2 " 40 " Cl J 7 CC J CC Cl j q cc " 28 " i " 3 " 37 " " 10 " 1 " 4 " 42 " "11" 1 " 5 " 36 " " 10 " i " 5 "48 " " 14 " 1 " " 12 " I I I I I 2 I I I I I I 21 I I I I I I 8 Table X. Stones weighing over 2 oz. Stones weighing over 2 oz. yj O yi yj d tn 0 </) tn d 0 q u q Age, 17 yrs. 2 oz. 0 dr. gr. I 1 Age, 17 yrs. 2 oz. 0 dr. 55 gr- I 1 " 13 " 2 " 7 " 37 " I 1 " 47 " 2 44 J It 10 I 1 " 13 " 4 " 0 " 10 " I 1 " 13 " 2 " 3 " 5 I 1 " 22 " 2 " 3 " 46 I 1 " 13 " 2 (I y IC 37 I 1 " 13 " 4 " 0 « IO It I 1 3 3 6 6 714 world's homoeopathic convention. Important as is the size of the stone in its bearing upon the mortality and the sequelae, and hence upon the prog- nosis, it bears no so direct relation to the age of the patient as to admit of any positive conclusions. On the contrary, we find the same class of stones in patients of the most diverse ages; consequently, the size of the stone must de- pend rather upon the duration of the case, upon the chem- ical composition of the stone (it is well known that calculi of the phosphate of ammonia and magnesia form rapidly and become very large), and also perhaps upon individual dia- thesis. If the conclusion that the size of the stone is directly in proportion to the age of the patient is theo- retically plausible, the conclusion that it is in direct relation to the duration of the disease is both theoretically and prac- tically true beyond question; and this is more important than all the other elements of the question. The condition of the entire urinary apparatus and of the whole organism, as well as the prognosis, depends upon it. The character and frequency of the sequelae, and therefore the results of the case, are governed by this element. It is to be regretted that I am not able to state more exactly the duration of the cases operated upon. They all belonged to the peasantry, who lacked intelligence necessary to give an accurate, or indeed any, history of their cases. This much is certain, that many of them came into the world with a stone already in the bladder, and that in many the duration of the disease was five to thirty years. From the preceding tables, based on the size of the stone, we see that in Table I. Stones less than 1 dr. Between 1 i and S years, 20 cases, 1 death, = 1:20 Table II. Just 1 dr. Between 1 £ and 8 years, 3 cases, 0 death, = Table III. Over 1 dr. Between 2 and 40 years, 19 cases, 2 deaths, = 1: 9.5 Table IV. Over 2 drs. Between 3 and 25 years, 22 cases, 3 deaths, = 1:7 URO-LITHIASIS IN RUSSIA. 715 Table V. Over 3 drs. Between 21 and 30 years, 18 cases, 1 death, = 1:17 Table VI. Over 4 drs. Between 2 and 32 years, 11 cases, 2 deaths, = 1:5 Table VII. Over 5 drs. Between 6 and 22 years, 12 cases, 3 deaths, = 1: 3.GO Table VIII. G to 8 drs. Between G and 30 years, 11 cases, 2 deaths, = 1: 5.5 Table IX. 1 to 2 oz. Between G and 28 years, 21 cases, 8 deaths, = 1:3 Table X. From 2 to over 4 oz. Between 13 and 58 years, G cases, G deaths, = Of the 143 cases, with a total mortality of one in 5.1, or 19.58 per cent., there were in Children, from l.jto 10 years, SG cases, 9 deaths. " " 11 " 15 " 28 " 11 " Adults, " 17 " 58 " 29 " 8 " The proportion of children from 1J to 15 years to adults is as 114 to 29, or as 3.09 to 1. The relative mortality of the former was as 1 to 5 or 17.54 per cent. ; of the latter as 1 to 3.G2 or 27.58 per cent. But if we consider the size of the stone without taking further account of the age of the patient, we find the mortality much more dependent on the former than on the latter; for we find in the first five tables (not over 4 drs. weight) 7 deaths in S2 cases, or 1 in 11.7 I, or 8.53 per cent.; while in the three following tables (VI., VII., VIII.) there are 7 deaths in 34 cases, or 1 in 4.85 or 29.58 per cent.-that is, more than twice as many. If, still disregarding the age, we consider the last two tables (IX., X.), the dependence of mortality on the size of the stone is evident: with a weight of from 1 to over 4 oz., we find 14 deaths in 27 cases-more than twice as many as in the three preceding tables, and six times as many as in the first five; that is, 1 in 1.92, or 51.85 per cent. In all discussions, therefore, respecting the mortality of the operation of lithotomy, the size of the stone must be 716 WORLD'S nOMCEOPATHIC CONVENTION. taken into account as one of the most important of the elements that determine the result of the operation. The accompanying table [See Appendix DJ\ shows the influence of the size of the stone on the mortality, with the cause of this influence, by showing the relation of the size of the stone to the sequelae. As regards the occurrence of sequelae, th's table shows that tables I., III., IV., V., VI., VII., VIII. give the best proportions, although the size of the stone is very different, varying from less than 1 to 8 drs. in weight. In these seven tables, of 113 cases there were sequelae in 85, or 1 in 1.32, or 75.2 per cent. In the remaining three tables (II., IX., X,), on the other hand, there were 30 sequelae in 30 cases, or 100 per cent. This apparent contradiction ceases to be such, as soon as we take into account the character of the sequelae in the respective cases. To make this more evident, we show in the following arrangement the relative frequency of the sequelae located in those organs which are directly involved in the operation: Table I. 20 cases, 15 sequelae, 1 cystitis, = 1 to 20 cases and 1 to 15 sequelae. " III. 19 cases, 15 sequelae, f T C" s^'s' 1 - 1 (I cysto-peritonitis, ) 1 to 6.33 cases and 1 to 5 sequelae. " IV. 22 cases, 14 sequelae, cystitis, ) _ 1 (3 cysto-peritonitis, ) 1 to 5.5 cases and 1 to 3.5 sequelae. " V. 18 cases, 17 sequelae. cystitis, ) - 1 (2 cysto-peritonitis, ) 1 to 2.57 cases and 1 to 2.42 sequelae. " VI. 11 cases, 9 sequelae, f I - 1 (2 cysto-peritonitis, ) 1 to 3.66 cases and 1 to 3 sequelae. " VII. 12 cases, 10 sequelae, 5 cysto-peritonitis, = 1 to 2.4 cases and 1 to 2 sequelae. "VIII. 11 cases, 5 sequelae, f ! cystitis, ) _ n (1 cysto-peritonitis, ) 1 to 5.5 cases and 1 to 2.5 sequelae. URO-LTTHIASIS IN RUSSIA. 717 Here the few cases embraced in Table VIII. seem to con- tradict our affirmations. Table IL 3 cases, 3 sequelae, none inflammatory. " IX. 21 cases, 21 sequelae, f s^'s' £ = n (7 cysto-peritomtis, j 1 to 2.1 cases and 1 to 2.1 sequelae. ** X. 6 cases, 6 sequelae, 4 cysto-peritonitis, = 1 to 1.5 cases and 1.5 sequelae. In these three tables, therefore, no case was free from sequelae, and in one-half of the 30 cases the sequelae were severe inflammations. Deductin<T the 3 cases of traumatic o fever of Table II., there remain 14 localized inflammations in 27 cases, or more than one-half. But, in Table IL, the stones weighed 1 dram, while in Tables IX. and X. they weighed from 1 to more than 4 oz. The cases without sequelae likewise confirm the statement that the size of the stone must be regarded as one of the most important elements of the prognosis. For we have in Table I. 20 cases, 15 with sequelae, 5 without, - 1 to 4 cases, 1 to 3 sequelae. " II. 3 cases, 3 with sequelae, 0 without. " III. 19 cases, 10 with sequelae, 3 without, = 1 to 0.33 cases, 1 to 5 sequelae. " IV. 22 cases, 14 with sequelae, 8 without, = 1 to 2.75 cases, 1 to 1.75 sequelae. " V. 18 cases, 17 with sequelae, 1 without, = 1 to 18 cases, 1 to 17 sequelae. " VI. 11 cases, 9 with sequelae, 2 without, = 1 to 1.55 cases, 1 to 4.5 sequelae. " VII. 12 cases, 10 with sequelae, 2 without, = 1 to 6 cases, 1 to 5 sequelae. " IX. 21 cases, 21 with sequelae, 0 without. " X. 0 cases, G with sequelae, 0 without. Here, in Table VIIL, comprising cases which seem to have been remarkably favorable, we observe a proportion similar to that of the inflammatory sequelae. Let us now 718 world's homoeopathic convention. consider the frequency of traumatic fever without local- ization : Table I. 20 cases, 15 with sequelm, 11 traumatic fever,= 1 to 1.81 cases, 1 to L.-35 sequelae. " IL 3 cases, 3 with sequelae, 3 traumatic fever, = 1 to 0 cases, 1 to 0 sequelae. " III. 19 cases, 15 with sequelae, 9 traumatic fever, = 1 to 2.11 cases, 1 to 1.66 sequelae. " IV. 22 cases, 14 with sequelae, 9 traumatic fever, = 1 to 2.41 cases, 1 to 1.55 sequelae. " V. 18 cases, 17 with sequelae, 5 traumatic fever, = 1 to 3.6 cas s, 1 to 3.4 sequelae. " VI. 11 cases, 9 with sequelae, 4 traumatic fever, - 1 to 2.75 cases, 1 to 2.25 sequelae. " VII. 12 cases, 10 with sequelae, 2 traumatic fever, = 1 to 6 cases, 1 to 5 sequelae. "VIII. 11 cases, 5 with sequelae, 2 traumatic fever, = 1 to 5.5 cases, 1 to 2.5 sequelae. " IX. 21 cases, 21 with sequelae, 6 traumatic fever, = 1 to 3.5 cases, 1 to 3.5 sequelae. " X. 6 cases, 6 with sequelae, 0 traumatic fever. The unprejudiced observer will notice, notwithstanding all variations in the tables, that the proportion of sequelae to cases increases much more directly with the size of the stone than with the age of the patient. He will remem- ber, also, that when the numerical method is employed to determine the relative advantages of any mode of treat- ment, we must take into account not merely the naked numbers, but likewise the individual and concomitant circumstances. The very history of the operation of Lithotomy demon- strates the important bearing of the size of the stone upon the prognosis and the results. What led surgeons to the discovery of the various operative methods ? Obviously, it was the desire to make as large a wound as possible, that the stone might pass out freely without causing contusions and lacerations, which, of course, when they occur, result URO-LITHIASIS IN RUSSIA. 719 from the size of the stone. In part, however, they depend also upon the duration of the disease ; for the more elastic the organic tissues through which the stone must pass when extracted, the less will be the laceration and contusion. But the longer these tissues have been exposed to chronic inflammatory irritation, the more they are histologically changed and hypertrophied. We may, therefore, assume that the greater the duration of the disease the less is the elasticity of the tissues; the greater the consequent proba- bility of contusion and laceration, and, therefore, ofsequelae, and the more unfavorable the prognosis. It is not, there- fore, the size of the wound (of course, within the limits of anatomical possibility), but it is contusion and laceration which constitute the danger of the operation ; but even the largest (possible) -wound will not completely obviate these dangers, if the requisite elasticity of the tissues be lacking. I have often seen with great astonishment the extent to which the bladder, the membranous portion of the urethra, and even the prostate, may become thickened ; and I have a specimen of a bladder the walls of which are almost one inch thick. To many of my readers the preceding tables and argu- ments may appear fruitless and unnecessary, inasmuch as all surgeons have recognized the size of the stone and the duration of the disease as the chief factors of the prognosis and result. I have given much space to the study of the mortality and frequency of the sequelae and their relations to the number of cases, in order that no question might be thrown upon my statement of results. The unprejudiced reader must judge of my success. Fully to master the question, however, we must compare our results with those of the old school ; although, in truth, our scanty material shrinks out of sight when placed beside the colossal statistics which our opponents have for centuries been gathering. Sir Astley Cooper says: "The proportion of deaths to cases operated upon, including all ages, is 1 to 8 (12.5 per 720 world's iiomceopathic convention. cent.")* Milhryt quotes a statement of Roux that, " the general mortality of Lithotomy cases maybe assumed to be 1 in 5 or 6 adults and 1 in 20 children." CivlaleJ laid be- fore the Academy of Sciences, Oct. 5th, 1S35, statistics of Lithotrity collected from the largest hospitals of Europe, in which he showed that of 5,713 cases of Lithotomy, 1,141 were fatal, that is, 1 in 5 or 19.97 per cent. In the Norfolk hospital, in the course of sixty years, there were 704 cases of Lithotomy, 35 of them in women; Oil recovered, 93 died ; a proportion of 1 to 7.56 or 13.21 per cent. Another calculation makes the yearly average of Lithotomy cases in London 47, and in the rest of England and Wales 64; both together 1 11. It is estimated that one-fifth of these cases are fatal, as in Paris.§ Gunther gives an extended state- ment of the results of Lithotomy according to the different methods of operating, and also without reference to the method. Here we see a variation of the relative mortality, from 1 in 1.2 to 1 in 100. Taking from this collection of statistics data covering a considerable number of cases for a somewhat extended time, we find that: 1. In the Austrian states, during a period of 10 years, there were 1,263 operations and 314 deaths, a proportion of 1 to 4.02 ; with me the proportion was 1 to 5.5. 2. In the Paris hospitals, for 10 years, according to Du- puytren, 97 boys from 3 to 15 years old were operated upon, with 9 deaths, a proportion of 1 to 10.77 ; with me it was 1 to 6.IS. 3. Wattman, during 35 years, shows a proportion in children of 1 to 11.3. 4. In the hospital for incurables in Naples, according to Renzi, during 13 years there were 401 Lithotomy cases and 60 deaths, a proportion of 1 to 6.58. * Sir Astley Cooper's Lectures on Surgery, edited by Lee, 1856, I. 343. tMiiliry: Darstellungen und Ansichten zur Vergleichung der Medizin in Frankreich, England und Deutschland, 1836, p. 172. t [bidem, page 173. § Miihry, loc. cit., page 405. H Gunther: Lehre von den blutigen Operationen am Menschlichen Korper, IV., 316. URO-LITHIASIS IN RUSSIA. 721 5. In the Norwich hospital, according to Morel, in 44 years there were 506 operations and 70 deaths, a proportion of 1 to 7.23. 6. According to Dupuytren, the general mortality is as 1 to 5 or 6. 7. According to Souberville, 1 to 6 or 8. 8. According to Oesterlin ^Handbuch der Medlcinsiclien Statistik^&ge 651"), the mortality after Lithotomy is "about 15 per cent., subject to great variations, according to indi- vidual and other conditions." In 15 London hospitals (1S54-57), it was 21.5 per cent.; in 29 English hospitals, only 12.1 per cent. ; in Glasgow, 14.4 per cent. The mor- tality also increases,in general, with the patient's age; but is greater in children under than over five years. In cases of phosphatic calculus the mortality is greater than in other cases; indeed, it is in general proportion to the size of the stone. Of 6,369 cases collected by Coulson from the records of many hospitals and countries, 958 died, a pro- portion of 1 to 6 or 15.4 per cent. (In England alone, the proportion was 1 to 7 or 14.3 per cent.) And while the mortality of patients from 1 to 10 years old was only 1 in 13, and of those from 11 to 20 years 1 in 10 ; in those from 41 to 50 years old, it was 1 in 4.6 ; in those from 51 to 70 years old, it was 1 in 3.4, and in those from 71 to SO years old, it was 1 in 2.7." Gunther says (1. c., page 317): "In the latter, appar- ently very favorable statistics, the unfavorable cases seemed to have been passed over," and I must myself raise this question, especially since Bassoff* states the mortality, after the bilateral operation, to be 1 in 4.68, and that, after the lateral operation, in a total of 2,893 cases, to be 1 in 10.71. The weight and size of the stones are given in 69 cases only, which were submitted to a chemical analysis ; it never exceeded 3 oz. and 20 grains. In all the other cases, the * De Uthiasi vesica urinaria in genere et in specie de extractions calculi per sec- tionem perinai, dissertatio medico-chirurgicu, 1<S41. 722 world's homceopatiiic convention. reporters failed to mention the size of the stone, and this makes the statistics of much less value. II. Thompson and Bryant* agree with the view which has been above expressed and, so far as the scanty material permitted, demonstrated. They say : " The duration of the disease determines the prognosis, which, moreover, is in direct relation to the size of the stone." Thompson col- lates 1,002 cases with 13G deaths, according to age. The mortality, without regard to age, is 1 in 7 ; in patients from 1 to 5 years old (225 cases) it was 1 in 11. With me under similar circumstances (20 cases) it was 1 in 20. In patients from G to 10 years old (179 cases) it was 1 in 30 ; with me in patients from G to 12 years old (2G cases) it was 1 in G.5. In all the other cases, his results are more favorable than mine, which is very natural, considering that his total num- ber was more than ten times mine. According to the reports of the University Kasan, there were in the course of 30 years 259 operations and IS deaths, a ratio of 1 to 5.39. It appears then from these citations, which, I must repeat, are imperfect, inasmuch as the weight of the stone is not taken into account, that the results of Lithotomy under homoeopathic treatment are at least no worse than those of the old school. The number of cases hitherto treated is too small and our clinical material too scanty, to justify positive conclusions. We confidently expect, however, as a result of further investigations in the unlimited field of our therapeutics, a favorable result for the subjects of this operation, similar to that which has been attained in other diseases, c. g. in pneumonia. The cause of the formation of vesical calculus has long interested physicians. Many excellent works have appeared on the subject, none of which, however, not even the most recent by Ultzmann, explains the zuherefore, though they do * Medicinische Neuigkeiten, redigirt von Prof. Wintrich in Erlangen. Jahr- gang XIII., No. 11, p. 83. URO-LITIIIASIS IN RUSSIA. 723 explain the how, of the formation of stone in the bladder. As an example of the views that have been put forth on this subject, I mention that Prof. Telatschitsch, in Kasan, has ascribed the formation of stone in the bladder to the use of sour-krout and quass* among the Russians, and he states that, in the course of his long practice, he has never seen a case of stone among the Tartars,t who use neither of the above named articles. Miihry says that, " We often seek the causes of peculiar endemic diseases in the soil, the drinking-water, the habits or the food of the people ; and yet the peculiar cause of most of these diseases remains unexplained."! Although this may not be disputed, yet it cannot be a matter of in- difference whether the chief nutrition of the organism consists of albuminates or albuminoids, and whether the atmosphere contain much or little ozone or be laden with paludal or other exhalations, etc. Moreover, in looking for the causes we should not confine ourselves to isolated circumstances, overlooking concomitant and modifying conditions ; for it is often these very conditions that reveal to us the cause, where it was not at first apparent. The conditions under which a phenomenon occurs may constitute it a cause, whereas, apart from these conditions, it could not be so re- garded. We have an analogy to this in our selection of remedies, where our choice is determined by the phenomena and conditions jointly. We propose, then, to investigate as far as possible the phenomena and their conditions by which the occurrence of Lithiasis may be explained. The Government Nishny-Novgorod (between 54.14° and 5G.0S° N. Lat., and G0.45° and G3.4° E. Long.) has an area *A beverage, quite palatable when well made, prepared by fermentation (sometimes effervescent) from rye malt, or sometimes from crusts of bread. t The Government Nishny-Novgorod, and all below it on the Volga, are thickly peopled with Tartars, " Tscheremishen Tschuwaschen" and "Mord- winen." JMiihry: Die Geographischen Verhaltnisse der Krankheiten, page 3. 724 world's HOMCEOPATHIC CONVENTION. of 923 square miles and a population of 1,202,913, or 1,307 to the square mile.* It lies about 500 English feet above the sea, and although the climate is very temperate, yet in consequence of ex- tensive forests and large bodies of water, consisting of lakes, rivers and swamps, the average temperature of Nishny- Novgorod is lower than that of many other places in the same latitude. The Volga, the largest river of Europe, rises in the district Astaschkow of the Government Trver, 840 to 1000 feet above the sea, about 57.1° N. Lat. Its source is in the midst of an almost inaccessible swamp, which was, proba- bly, once part of an immense inland sea, occupying the great Sarmatian plain. At first an inconsiderable stream, the Volga is soon swelled by tributaries from a number of lakes until, before it receives the outlet of the Selmer Sea, it has become a navigable and stately river, having run a course of 35 versts.t From this point, where it has a breadth of 20 Fadens,| it flows south-eastward over a wide plain through a formation of quartz and limestone. The shores are high and sandy. From its source to its entrance into the Caspian Sea, the Volga has a length of about 485 miles. The current is sluggish ; there are many sand-bars and islands in it. The water is turbid, of a dirty yellow- green color, charged with salts of lime and with organic matter, visible even to the naked eye. Without suitable purification it is not fit to drink, but, from the lack of better water, it is generally used. In the spring, the river overflows its banks for a distance of ten or twelve miles, filling all the hollows and converting the whole region into a colossal swamp which, in fact, never thoroughly dries up. A second large river of the Government Nishny Novgorod, a tributary of the Volga, with banks of sand and limestone, * Calendar of Academy of Sciences. St. Petersburgh, 1872. t Seven versts - one German mile, = about four English miles. JOne Faden = seven feet. UROLITHIASIS IX RUSSIA. 725 has a still more sluggish current than the Volga; and ita annual overflow likewise converts the plains and hollows into swamps and stagnant pools. Besides these and numer- ous smaller tributary rivers, there are many lakes which are shallow, not navigable, with swampy banks generally of wide extent. The total area of the lakes and rivers is about 175,000 acres, and that of the swamps about 400,000. According to monthly tables, the mean annual tempera- ture is + 5° R.; the mean state of the barometer 751. There are in the year 78 perfectly clear days, 84 partially clouded, 61 completely clouded, 86 variable, 56 of snow or rain. Spring begins in April; at the end of May and begin- ning of June every thing is in blossom ; the harvest begins in August. In September come cloudy, foggy days, with rain and snow. In November heavy frosts begin, and the winter is generally clearer, healthier, and more enjoyable than the other seasons. The prevailing wind is from the south-west ; gales are frequent in March, April, May, and October. The rain-fall is abundant in spring and autumn, scanty in summer; the fall of snow, which begins in Sep- tember, is very considerable, and continues at intervals until April and May. Hail storms, with thunder, come occasionally during the summer. Fog prevails from the beginning of August to the establishment of winter. With such a climate and soil, the atmosphere must be poor in ozone and rich in vapor of water and in the gases resulting from decomposition. There is no complete geological description of the Gov- ernment of Nishny-Novgorod. In the southern part there are coal formations, with limestone, gypsum and dolomite, belonging to the permian and triassic systems. These are covered with diluvial and alluvial formations, forming lay- ers of sand, sometimes 140 feet thick. There are also large turf deposits, and much bog iron ore in the southern part. Most of the inhabitants are Russians, of Slavic origin, gen- erally strongly built and robust, inured by their mode of life to hardships and exposure. There are also among the 726 world's homceopathic convention. inhabitants, Mordwinen and Tschuwaschen, Finns and Tar- tars, of Mongolian origin, and whose customs and mode of life differ much from those of the Russians. The dwellings of the Russians are log cabins, the crevices stopped with turf, in- closing a space of about 450 square feet and seven to eight feet high. An immense stove occupies much of the room, the floor of which consists of the mother earth, or boards ill-fitted and covered with a straw matting. This room is the dwelling-place of the entire family, which includes in winter the young domestic animals, e. g. sheep, calves, swine, fowls, etc. The fire in the large stove is kept up dav and nmht; the heat is often intense and the air of the cabin detestable, the small and infrequent windows being only exceptionally opened. The house has no chimney, the smoke escaping through the windows and door, which the residents open when compelled to do so. The upper por- tions of the room are therefore constantly full of smoke ; when airing it, therefore, they crouch upon the floor, and, in this position, after being in an intensely heated atmos- phere, are exposed to currents of cold air. The clothing of the Russian peasants is of their own manufacture, and generally insufficient. It consists of a coarse linen shirt, a woolen coat and a sheep-skin, which is often worn in summer as well as in winter. The feet and legs are covered in summer with linen, in winter with woolen cloths wound around them, and the feet protected by shoes of the Lindenbast-of course, not water-proof; they rarely wear boots. The women, at the most, have a woolen gown and sometimes a sheep-skin over a coarse chemise ; their feet are protected like those of the men. The children wear a shirt and go barefoot The exceedingly strict religious observances of the Rus- sians allow them animal food (meat, milk, eggs, butter) only 167 days in the year; on the remaining 19S days they live on a vegetable diet prepared with hemp or linseed oil, and occasionally have fish. The observance of these 198 fast days has been for centuries, and is still, strongly en- URO-LITHIASIS IN RUSSIA. 727 forced as the chief means of salvation by the priesthood, who are generally of a low culture; and is so ingrained in the mind of the Russian peasant, that there could be in his view no greater crime than to neglect a fast day. More- over, meat, being a luxury and not easily attainable, is sel- dom eaten even on feast days ; bad husbandry makes milk and butter scarce, and, in fact, the Russian peasant lives mostly on a vegetable diet, consisting of bad rye bread, bar- ley, buckwheat, millet, cabbage, red-beets, potatoes, and the oil of hemp, linseed, or sunflower. The commonest drink of the Russians, besides water and quass, is brandy, generally a bad fusel-corn-brandy. Every opportunity is taken to get drunk, and fatal poisonings with this abominable brandy are of almost daily occurrence. One must have lived in Russia to have an idea what an enormous quantity of brandy one man can consume. The results are, of course, very sad ; for besides the specific effects of the fusel-alcohol poison, it happens that every winter many hundreds are frozen to death, or so injured by the cold that they lose one or more extremities, not to speak of single fingers and toes. The effects of alcoholism upon the mental and moral nature are known to everybody; I need only say that this plague infests a people inferior in intelligence and capacity for culture to none in Europe. Another favorite beverage, used only on high festivals, and peculiar to Nishny-Nov- gorod, is a very palatable and highly intoxicating beer, pre- pared from rye or barley malt, with a large addition of hops, called " Braga." When taken to the excess which is char- acteristic of the Russian peasant, and during a debauch lasting often several weeks, it produces swelling, followed by stiffness of the extremities. I cannot explain this phe- nomenon, but have often observed it, and it is well known to the peasants. A third beverage consumed of late years in large quantities is tea. The Russians do not neglect the care of the skin ; they are in the habit of taking a vapor- bath at least once a week, the construction of which, how- ever, and the abrupt changes of temperature which it 728 world's HOMOEOPATHIC CONVENTION'. involves, make it rather a source of illness than a hygienic measure. The nurture of the children is worse than that of the adults. The peasant women, who, in every respect, share the life of the men, all nurse their children ; but as this takes time and is difficult, especially in summer, when they are at work in the fields, the "sucking-bag" is in constant use for nurslings. This sucking-bag, in its influence on nutrition, is the most abominable apparatus that human brutality has ever contrived for the misery of the race. Imagine a cow or ox-horn perforated at the end, to which is attached a nipple cut from the udder of a slaughtered cow ; used often for months, never washed, and finally becoming a disgusting, putrid, offensive mass. In this apparatus, which is rarely washed, a ferment forms, which at once makes the milk sour that is poured into it, even if it was not sour before. The unhappy child has this appar- atus continually in its mouth to keep it from crying, and sucks away at it whether it be full or empty ; taking in, in the former case, the sour milk ; in the latter, the septic poison of the decomposing nipple, and with it the seeds of an early and painful death. The following statistics, cover- ing a period of ten years, from 1838 to 1848, show that this is no exaggerated statement: Children born in Nishny-Novgorod, males, - 29,059 " " females - 28,303 Total - 57,362 Died, males, - - 22,778 " females - - 25,607 4S,3S5 Remained alive 8,977 That is only 15.65 per cent.; while the immense propor- tion of 84.35 per cent, perished. If the child survives the period of dentition, often even earlier, it shares its parents' fare, and must, nolens volcns, keep the fast days which are URO-LITHIASIS IN RUSSIA. 729 obligatory at the age of G to 7 years, although before that age milk is allowed. The results of such a physical (not to say bestial) educa- tion must be evident, as well as the impossibility of profes- sional help under such circumstances; and so, among the Russian peasants, diseases otherwise unimportant become serious, and easily surpass the resources of art. The most prevalent diseases in a ten years' experience in Nishny-Novgorod, arranged in percentage, are as follows: Arthritis and rheumatism, - S.G1 per cent. Catarrh of respiratory, digestive and urinary organs, ------ 6.89 " O 7 Chronic dermatoses, - 9.01 " Chronic ulcers, ----- 5.20 " Interrnittents, _____ 2.90 " Secondary syphilis and mercurialism, - 1.91 " Uro-lithiasis, ------ ],35 " Here the carbo-nitrogenoid constitution has a contingent o o of 30 percent, and the hydrogenoid only 4.81 percent.; for secondary syphilis belongs rather to the sycotic form. Considering, however, that, for so large an area and popula- tion, ten years is much too short a period of observation, and considering the dread which the peasants feel of a phy- sician, especially an official one, and which makes them only exceptionally seek his aid, when their condition is beyond the resources of the village quack, a fact which the small number of intermittent fevers in the above table clearly shows, it is plain that the above statistical ratio should be greatly increased. The intermittents of all types which prevail in Nishny- Novgorod are peculiarly obstinate ; and those which occur in the autumn are generally quartans, which, treated in the usual way (if treated at all), by being suppressed, favor the establishment of the carbo-nitrogenoid constitution. The mode of life of the Tartars is, in obedience likewise to the precepts of religion, very different from that of the 730 world's homceopatiiic convention. Russians. In their houses, built like those of the Russians, but much more carefully, the greatest cleanliness prevails. They all have floors ; the kitchen is separated from the dwelling by a vestibule ; domestic animals do not share the living-room with their owners. The food of the Tartars consists chiefly of meat; they have no fasts, in the sense in which the Russians observe them ; and, even though they do not strictly follow the precepts of the Koran, they consume much less brandy, and very rarely use braga. Their clothing is better and more carefully prepared. Their children do not live in the dirt, like those of the Russians, nor is their food so damag- 7 7 o ingly poor in protein. Having considered the external relations of climate and mode of life, of the regions in which Uro-lithiasis is so fre- quent, we must now, in order to come at our final results, turn our attention to chemistry, physiology, and the doctrine of the constitutions in v. Grauvogl's sense. On the first view of the chemical constituents of the nuclei, which must necessarily be regarded as the foundation of calculus, we see that, with few exceptions, all consist of the products of retrograde tissue changes : uric and oxalic acids and their combinations with lime, etc. We must, therefore, pay especial attention to the circumstances under which these substances occur in the organism and the changes they undergo, as well as to the organs to which they are related. Chemistry and physiology teach us that uric acid is a re- sult of the retrograde metamorphosis of nitrogenous tissues, and that, by a further oxidation, it is converted into urea; that it is, therefore, to be regarded as representing a less complete stage of oxidation than urea. Since, however, it is, for this reason, capable of further oxidation, it must be regarded as an intermediate stage in the retrograde meta- morphosis. It is, however, far from being established whether free uric acid in the organism is to be regarded as URO-LITHIASIS IN RUSSIA. 731 a normal or a pathological product or as a result of decom- position. Free uric acid is found in fresh urine just evacu- ated from the bladder, only when there is formation of stone or gravel; it is found also in the blood, in arthritis and leucaemia. By the action of a high temperature and ozone, uric acid is converted into urea : and we are justified in concluding that when these two conditions fail, the further oxidation of uric acid into urea does not take place. There is an excess of uric acid in the urine when respira- tion or pulmonary circulation is impeded, and when there is any disturbance of interchange of elements in the organ- ism, especially if it retard oxidation. The quantity of uric acid, then, is inversely proportioned to oxidation. Accord- in'? to Barthez, in febrile conditions there is decrease of urea and proportional increase of uric acid only when, with the fever, there is disturbance of respiration. According to Kanke, the spleen is to be regarded as the or^an in which uric acid is formed; and his observations show that in Leucaemia and enlargement of the spleen, the daily formation of uric acid is absolutely, and relatively, much increased. We knowthat, under normal conditions,the uric acid in the organism undergoes a change by which its nitrogen leaves the bofy as a constituent of urea, and a part of its carbon as carbonic oxide and carbonic acid. The experiments of Frerichs and Wohler show that uric acid, taken into the organism, is discharged as urea and oxalic acid, but not as uric acid ; and this is confirmed by another experiment, viz., that, in the blood of dogs poisoned with alcohol, oxalic acid is found toward the end of the intoxi- cation. Oxalic acid occurs in genetic connection with uric acid, as a result of retrograde tissue metamorphoses. Its genetic connection with uric acid consists in the fact that they oc- cur together in the urine, and in its concretions; and that the physiological conditions under which oxalate of lime (the only form in which oxalic acid appears in the organ- 732 world's HOMCEOPATHIC CONVENTION.: ism) appears in excess in the urine, are the same as those which induce an increase of the uric acid, viz., a disturb- ance of the material exchanges of the organism, and of the respiration. It may be assumed, then, that oxalic acid, like uric acid, appears in the urine because it has not been further oxidized. The experiments of Frerichs and Wohler (injections of urates into the veins of animals) have shown that an excess, not only of oxalate of lime, but also of urea, in the urine results ; from which we may assume that ox- alic acid is one of the by-products of the formation of urea from uric acid. Excess of carbonic acid in the blood increases the oxalate of lime in the urine, which proves the origin of formed ox- alic acid from diminished or impeded oxidation. If we are justified in assuming that, within the normal organism, the further oxidation of uric acid by its separation into urea, oxalic acid and allantoin (just as this takes place under the action of ozone and hydrogen di-oxide), it is by no means impossible that in abnormal conditions, this process may be imperfectly performed and the oxidation of the uric acid may not take place (Gorup Besanez). What has been said forbids a doubt that the origin of calculous concretions is to be sought within the organism, not in individual organs which simply co-operate in the process, but in the blood which, under the influence of internal and external conditions, undergoes a change of quality. This view is confirmed by the fact that uric acid is found not only in the blood, but also in many organs; that the kidneys, therefore, are not the only organs in which it is formed ; that, indeed, it is not proved that it is formed in the kidneys at all; for Strahl, Lieberkuhn, Zalesky and Garrod found that, after extirpation of the kidneys in snakes, abnormal urinary deposits took place; and, still more, after ligation of the urethra, which, however, is far from proving the exclusive formation of uric acid in the kidneys. Moreover, with a few exceptions, of which we shall speak URO-LITHIASIS TN RUSSIA. 733 hereafter, the primitive formation of stone must necessarily begin in the kidneys, which are the filters and organs of diffusion for the separation of the urine from the blood. This view is confirmed by the fact that, as is well known, in early childhood the urine is very rich in uric acid, and that the rasa recta of sucklings are often found full of urates, which explains the, prevalence of urinary calculus in chil- dren ; it likewise- explains why small concretions not larger than the lumen of the ureters are sometimes retained and sometimes evacuated, and why, in some cases, there is a formation of sand (gravel). It is not to be assumed that exchange of elements and the process of oxidation go on continually in the same di- rection in unchanged progression, but rather that the energy of these processes suffers oscillations of more or less, depend- ing on external and internal vital influences, which likewise experience various oscillations. An evidence of this is found in the fact that the analysis of the urine serves as a physio- logical criterion of relative nutrition and exchange of ele- ments, and, therefore, of increased or diminished oxidation ; and likewise in the fact that the concentric layers of a urinary calculus, while they may differ from each other in composition, nevertheless must constitute a record of the changes which have taken place within the organism. Supposing, now, that, with a given plus of depression of oxidation, and a similar plus of disturbance in exchange of elements, a concretion is formed, at first necessarily small; it is not impossible that, with a minus of the above-named disturbance of oxidation and exchange of elements, the con- cretion would be eliminated, or, at least, would not increase in volume. For, with such a minus, the tension and energy of the organism would increase; and the quality of the layers of the calculus proves to us that these minus periods may be very long. If, under the above circumstances (depression and disturb- ance of oxidation and element-exchange), a small renal con- cretion has formed, and if these circumstances continue in 734 world's homeopathic convention. the same direction, the concretion grows in the place where it was formed and becomes a renal calculus. If, on the contrary, oxidation increases, and the disturbance of element- exchange ceases (of course, within reasonable limits), as, e° g. in consequence of exchanging an atmosphere contain- ing but little ozone for one rich in ozone, or of adopting a diet rich in protein, the energy and tension of the organism increase, the concretion leaves the place in which it is formed,-the kidneys,-passes into the bladder, and, if there be no mechanical hindrance, leaves this organ or may be retained in it, or more rarely in the urethra, until, under a recurring depression of oxidation, it becomes larger in con- sequence of simple juxtaposition with the substances con- tained in the urine. In this way the presence of several stones in the bladder, or, what is often enough observed, of stones occurring simultaneously in the bladder and kidney, is explained. The current names of calculi, according to the place in which they are found, are, therefore, strictly, of no value; and although it is now generally believed that concre- tions may form in various parts of the body, yet, wherever formed, the process is, as we shall sec, essentially the same. We have hitherto considered the manner and locality of the formation of stone; let us now consider the cause. There are, says v. Grauvogl, diseases which are actually accompanied by diminished excretion of carbon and nitro- gen, such as pulmonary catarrh, exanthems, etc. We know that such sicknesses are sometimes inherited, sometimes occur as sequelae, and sometimes result directly from exter- nal causes, such as frequent use of alcoholic drinks, insuffi- cient diet, residence in bad air (poor in ozone), suppressed intermittent fevers, etc., etc. These causes retard the oxi- dation of the blood and produce an accumulation of carbon and nitrogen ; a result of this deficient oxidation is that the nitrogenous tissues are no longer oxidized so as to form urea, but are excreted as uric acid. The chronic diseases which make this constitution (the carbo-nitrogenoid) possi- ble are processes of retention. URO-LITHIASIS IN RUSSIA. 735 If we now recur to what has been said of the mode of life of the Russians and the Tartars, and of the substances which form the diet of these two races, we find no difficulty in understanding why the Tartars are free from Uro-lithiasis. We shall also see the correctness of the conditions which v. Grauvogl states to be the chief factors of the carbo-nitro- genoid constitution. Dr. R. Arnoldoff, of Simbirsk* on the Volara, who is not a Homoeopathist, and can therefore have no notion of v. Grauvogl's "text-book," speaking of diet as a cause of Lithiasis, says : " On the one side, we see a great accumu- lation of vegetable acids in the organism; on the other, in consequence of febrile conditions, of affections of the respi- ratory and digestive organs, of inhalation of bad air-a defi- cient oxidation of the blood ; that is, we see on the one hand every thing which would increase the quantity of vegetable acids in the organism, and on the other hand every thing that could favor the excretion of uric acid." When the observations of men unknown to each other, living in different quarters of the globe, lead them to the same conclusions, both observations and conclusions are of great value. It is hardly necessary to call attention to what is so clear : the agreement between the chemico-vital processes of the carbo-nitrogenoid constitution and those of the for- mation of stone ; we simply remind the reader that the reten- tion-processes involve retention-products. If acid fermen- tation of urine stands in causal relation to stone-genesis, and if, as Scherer has shown, the fermentation of urine (outside of the body) depends upon the formation of a fun- gus similar to that of yeast, it may not be too bold to assume that in this constitution a similar process within the organism-that is, in the blood-precedes the formation of urinary concretions, inducing a low form of pyelitis catarrhalis. The fact that, according to Ultzmann, of seve- * Journal of the Society of Homoeopathic Physicians, St. Petersburg!;, III., 6,. 171. 736 world's homceopathic convention. ral hundred urinary concretions, spontaneously discharged, not one consisted of earthy phosphates, leads to the neces- sary conclusion that only such concretions form in the kid- neys as are composed of the constituents of acid urine; and the views above expressed make this observation more than probable. Inasmuch, moreover, as uric acid must he regarded as an intermediate step in retrograde tissue metamorphosis, or as an arrested formation, we can understand that, under favor- able internal and external conditions, retention-processes, and consequently retention-products, may easily occur. Dr. Arnoldoff (/. c.) recognizes in the lime (especially the phos- phate) contained in the soil and drinking-water, and like- wise in the diet, overcharged with vegetable and lactic acids, of the Russian peasants, and particularly of their children, the chief conditions of the formation of stone. Without denying that these conditions may contribute to the forma- tion of stone, we can concede to them only a subordinate value as favoring elements. For, the mode of life of Rus- sian peasants, and especially of their children, is pretty much the same everywhere ; many provinces of Russia, as for example Orel and Kursk, have extensive deposits of phosphate of lime ; and yet, in these provinces, Lithiasis is very rare. We must, therefore, accept without doubt the view that the formation of stone begins only when, by vir- tue of all conditions depending upon diet, regimen, climate, and atmosphere, the carbo-nitro-hydrogenoid constitution has perverted the normal vital chemistry of the organism. It is known that Thein is converted, in the organism, into uric acid, and it would be equally reasonable to regard ex- cessive use of tea as one of the causes of the formation of stone. We must here mention a noteworthy circumstance, that the constitution of human urine, during Uro-lithiasis, most resembles that of birds and serpents. The latter is well- known to be rich in uric acid and urates; that of birds con- sisting chiefly of acid urate of ammonia, urate of lime and URO-LITHIASIS IX RUSSIA. 737 free uric acid. Human urine contains free uric acid only in Lithiasis. We have seen that uric acid is found, and is said by Ranke to be formed, in the spleen ; and we have observed that in Leucaemia, with enlargement of the spleen, the daily average of uric acid is absolutely and relatively increased. Whether this observation would justify the conclusion that the formation of uric acid is a physiological function of the spleen, or whether this is to be regarded as a pathological process, we shall not undertake to determine; the fact suf- fices for our purpose. We know that splenic as well as lymphatic Leucaemia belongs to that form of sycotic dis- eases which v. Grauvogl has included in the hydrogenoid constitution, characterized by hygroscopic blood, or by an undue proportion of water in the blood, and by mucous formations. When, says v. Grauvogl, we are seeking the causes of chronic diseases, we must not forget that these are not to be found in a something absolutely foreign to the organism, but rather in a plus or minus of those elements which furnish the material for building up the organism; that this material depends not only upon an inborn inherited dispo- sition, but also upon the mode of life, and especially upon the character of the atmosphere and its changes; and that a special consideration of these circumstances is of the greatest importance in the construction of a truly rational pathology and therapeutics. If we now go back a little and consider the circumstances -mode of life, climatic and atmospheric conditions and in- herited disposition-in which the patients of whom we are speaking live, we must confess that they favor the produc- tion of the hydrogenoid constitution; and we are justified in concluding that the origin of urinary concretions must be referred to a complex pathological condition such as v. Grauvogl has described as the carbo-nitrogenoid and the hydrogenoid constitutions. If, as is generally admitted, urinary concretions are formed 738 world's homceopathic convention. by the cohesion of their smaller particles, through some connective matter, the hydrogenoid constitution furnishes us this connective material in the mucus-like substance to which it gives rise; we might almost then say that urinary concretions-perhaps concretions in general-occur only when external and internal conditions have produced a combined carbo - nitrogenoid and hydrogenoid constitu- tion. If, on the other hand, the predisposing conditions- diet, mode of life, climate, and atmosphere-do not favor such a combination, we have a formation, not of stone,but of gravel; the latter being a purely carbo-nitrogenoid process, the former a carbo-nitro-hydrogenoid. The fact that, during a ten years' (in this direction) pretty active practice, in a region in which urinary calculus is very common, I saw, lit- erally, not a single patient suffering with gravel, may be re- garded as confirming these views. It is true, I operated on only 143 patients ; but I examined more than double that number, for not every one consents to the operation, and the Russian peasants have a great dread of the knife. Moreover, the chemical constituents of urinary calculi are essentially the same as those of the urinary deposits excreted in fever, inflammation, rheumatism, gout, etc.; and fevers, especially intermittents, in which there are always urinary deposits, occur in precisely those constitutions which are distinguished by enlargement of the spleen and hygroscopic blood. Intermittents, moreover, are particularly apt to occur under such climatic and atmospheric conditions as are characteristic of regions in which urinary calculi are common, viz., frequent sudden changes of temperature, prevailing cold weather, moist marsh-air poor in ozone, and, in con- sequence of all these, depressed activity of the skin. In consideration of all these facts, the co-operation of this constitution in Lithiasis is easily understood. The geo- graphical distribution of Lithiasis confirms what has been said. The localities which most abound in swamps have furnished us the greatest number of patients with stone; for example, the district Balachna, and in it the villages Maloje URO-LITIIIASIS IN RUSSIA. 739 and Bolschoje, (little and great) Kasino, both of which lie in and are surrounded by swamps; also the district Gorba- tow, and in it the village Pawlowo, close on the shore of the Oka, and surrounded by a marsh. The question now presents itself: Do these investigations bring us any nearer to our object, the prevention and cure of Lithiasis ? for we do not call an operation a cure. We reply, unhesitatingly, Yes ! The problem is simply to choose amom? the remedies, which, mutatis mutandis, corre- spond to the constitution in question, that which, according to the law of similarity, best suits the individual case ; and to remove injurious predisposing causes which play so im- portant a part in Lithiasis. We know therefore, positively, where to look for curative and prophylactic remedies, and we know what injurious elements must be avoided. Whether all this is attainable is another question ; for cli- mate and atmosphere cannot be changed by magic, nor a population of several millions removed nor improved in morals and culture. It is enough, for the present, to have indicated the way to attain our object, and to have proved its possibility. Whether a urinary calculus already formed can be removed from the organism by therapeutic means is a question which, for the present at least, must be postponed, but by no means regarded as beyond the hope and possibility of realization-a statement which, to those who are familiar with the present position of Homoeopathy, will not appear too sanguine. According to Ultzmann's researches, it appears, as he himself says, that the formation of stone begins in the kid- neys. For 93.8 per cent, of the 886 calculi examined by him belonged to this category ; and his classification of calculi according to their chief constituents must be re- garded as a very rational one. He assumes, and correctly (until the contrary be proved), that calculi resulting from alkaline fermentation of urine are formed in the bladder. According to his classification, all calculi are divided into two categories, viz., those composed of the constituents of 740 world's homoeopathic convention. acid urine, and those composed of the constituents of alka- line urine. There must, therefore, be calculi which are formed in the bladder, when, by some pathological process, the urine becomes decomposed and the alkaline fermenta- tion is established ; and we must regard as a subdivision of this category such stones as form upon a foreign body as a nucleus, such as a fragment of a catheter, a needle, or a mass of mucus or blood. These facts in no way contradict our proposed explana- tion, based on constitutional conditions. We often observe chronic catarrhal and inflammatory diseases of the bladder, as well as such as result from spinal affections, in which quantities of mucus are secreted, and there is long-continued retention, or scanty and difficult emission of urine, and con- sequent alkaline fermentation, as, for example, in stricture and enlarged prostate. Moreover, hemorrhages of the bladder and the kidneys are not infrequent. Now, if these affections were really a chief element in the formation of vesical calculus, then Uro-lithiasis ought to be a ubiquitous disease. It is not so, however; for Muhry says, in his Elements of Noso-Geography, "There are some special dys- crasias which occur in every zone, not distributed, however, over the whole area, but occurring in scattered groups, as, for example, Strumosis and Uro-lithiasis; the latter has nests here and there, and we are not able to explain the reason of this." (Pages 79 and 113.) It is more than probable that if we investigate all the circumstances and conditions of these "nests," we should come upon just such conditions as we have heretofore pointed out, and should thus attain the desired explanation. Touching the size of these "nests," it should be said that the region in Piussia where we know that Lithiasis abounds, covers a very considerable area, and could not properly be called a "nest." The provinces Nishny-Novgorod, Kostroma, Wladimir, Taraslow and Kazan, in all of which Lithiasis abounds, cover an area of at least G,000 square miles; and they are not the only ones in which it prevails. URO-LITHIASIS IN RUSSIA. 741 Without wishing to deny the prevailing view of the formation of stone in the bladder, we must say that it is evident that there must be something besides the hitherto recognized conditions necessary to the formation of stone; and this something we believe we have found in the "coiisti- tutions" described by v. Grauvogl, and in the conditions and circumstances which produce these constitutions. In this connection we must mention that Virchow has found urate of ammonia in the renal pyramids of new-born children, and that, in one class of calculi, the nucleus of which is urate of ammonia. 84 per cent, of the cases were children. Finally, according to our observations, the formation of concretions in the kidneys begins in foetal life, dependent, therefore, certainly upon the constitution of the mother. Experiments upon animals, such as are subject to Uro- lithiasis, might inform us how the formation-of stone occurs in the bladder after the introduction of foreign bodies, and whether it always occurs. It is a wonder that such experi- ments have not already been made. The female sex enjoys a relatively great immunity as re- gards Uro-lithiasis. Of 143 cases operated on by me, three were in females. One reason of this difference between the sexes may be the anatomical diversity of the urinary organs, but this is certainly not the only reason. This immunity, like Litbiasis itself, may depend on many conditions; menstrua- tion, pregnancy, lactation, and probably also upon a some- what modified vital chemistry. This is a field of research uncultivated, promising, and which belongs to the future. I need not say that what has here been offered to the reader does not claim to be an exhaustive treatise on the subject. Such a work would far surpass our object and our limits. It will suffice if we have given an outline of the subject, and we should rejoice if it furnish an impulse to continued and more thorough research. 742 world's iiomceopathic convention. Appendix A. 1% 2 3 4 5 6 7 8 9 IO 11 12 13 14 IS 17 21-23 28-32 40-5 8 Age. *to 4^ OJ 04 OJ mW O'W 10 In W Ln m 00W Ln ^4 O\ m Number of cases. to to to 10 . M^M^HtOMHtOHM Without reaction. to . With't reaction ; sub- sequent intermittent. to to M M M >-* HH tO to Uj Uj Traumatic fever. M : M Traumatic fever and erysipelas. - Traumatic fever and pneumonia. Os - - M to - : Cystitis. w w « w to Co >-, M Cysto-peritonitis. to to Cysto-perit. and oedema. - - Cysto-enterb-perit. Co - Peritonitis. M M - Acute purulent oedema. to ~ M Typhus. ^Mw^o^tOOO^^^OHHQOOOO Died. UROLITHIASIS IN RUSSIA. 743 Appendix B. to ~ HH 0 oc^o to UtGO tO'MLn-PxC^ K» -< O'O OC*-J O\Ln CO tQ fh OC tO ^4 t4-£jW Age. £ 3 IO 11 11 8 12 4 11 5 11 6 5 7 8 2 6 13 5 5 Number of cases. - NttGoWititOONNWt-it No reaction. to No reaction; intermittent. 0 to to to co N In Ct 41 Cl A ON Traumatic fever. - . . w Traumatic fever and erysipelas. . „ Traumatic fever and pneumonia. = It « to to It It - to Cystitis. It • It It - . . Peritonitis. N) to to Co hH to to too OJ ~ to ~ Cysto-peritor.itis. Cysto-perit. and acute purulent oedema. -t ■ Cysto-entero-peritonitis. 631 1 1 t It M It It Acute purulent cedema. Tophus. - • Cysto-reri.is. to . Abscess and fistute. - u_ Marasmus. to to Phlebitis and pyaemia - <-< Tetanus. - . - . Eclampsia. to Haemorrhage. co to « O1C.0 O Oo 00 0 to to « t 0 t >t to M 0 0 Died. 744 world's HOMOEOPATHIC CONVENTION. Appendix C. tJ O 0 a No reaction ; subsequent intermittent 2 2 Traumatic fever; no localization 51 51 I Traumatic fever ; subsequent erysipelas I Traumatic fever ; subsequent pneumonia I I Cystitis II 11 Peritonitis 4 3 1 Cysto-peritonitis 22 11 11 Cysto-peritonitis, with acute purulent oedema 4 2 2 Cysto-entero peritonitis 1 1 Acute purulent cedema 6 2 4 Typhus 3 3 Cystorchitis . 1 1 Abscess and fistulas 2 2 Marasmus 1 1 Ph'ebitis and pyaemia 2 2 Tetanus 1 1 Eclampsia 1 1 IT hemorrhage 2 1 1 116 88 28 URO-LITHIASIS IN RUSSIA. 745 Appendix D. I. II. III. IV. V. VI. VII. VIII. IX. X. Table. Under I dr. Just I " Over I " " 2 " " 3 " " 4 « " 5 " F rom 6 to 8 " Over i oz. 2 oz. and over. Weight cf stones. 2 3 19 22 2.S II 12 1 I 21 6 No. of cases. Ch to w « oe uj • No reaction. - | No sequelae; intermittent. 0 to to Ln NO N0 Go t-H Traumatic fever. Traumatic fever and erysipelas. ; | Traumatic fever and pneumonia. Go - • >-< Ln >-» to M | Cystitis wi h and without complications. ►-< Ln to tO Go •-< i 1 Cysto-peritonitis with and without complications. to • - i | Acute purulent oedema. M • M M • i | Typhus. - Abscess and fistulae. >-< • • . . . Marasmus. Phlebitis and pyaemia. • . • . • . ~ Tetanus. • • • • • Eclampsia. - . to * * Haemorrhage. Peritonitis. 16 i-i . 18 14 I-I-57 17 1-1.05 91-1.22 1 IO 1-1.02 5 1-2.2 21 1-1 6 1-1 1 No. of cases with sequelae. 7 7 0 « GJ Proportion. 746 WORLD'S HOMCECPATHIC CONVENTION. Age. Sex. No. of stones. Weight. Operation. Recovered. Died. Remarks. Male. Female. Ounces. Drams. Grains. Days. Sequelse. Days. Cause of Death, and Autopsy. I I I Lateral 27 Traum. fever; no localization. . iX IX I I I I s 43 Bilateral... . (C 18 21 No sequelae Traum. fever; no local 2 2 2 2 I I I I • I I I I 3 29 29 46 3 u (( 66 66 22 90 23 25 66 66 66 6. ( Cysto-peritonitis, superficial Z gangrene of wound, long ( suppuration, slow conval.. No sequelae Traum. fever; no local 2 2 2 I I I I I I I 3 48 53 66 66 66 38 31 29 €6 66 66 66 66 66 66 66 ( Trm. fever; erysipelas penis, ) scroti et pedis dextri.... $ Broken during extraction. 2X I I 23 66 24 Traum. fever; no local 2J^ 2X I I 5 i I I 47 45 Lateral u 45 3° 66 66 66 66 Haemorrhage, 6th day Tetanus 3 3 I I i i I 2 5 40 66 3i No sequelae % 3 3 I I i i I 31 18 66 Bilateral.... 39 28 ( Cysto-peritonitis and super- $ ficial gangrene of wound.. Traum. fever; no local 3 3 I I i i 4 5° 37 u 66 29 67 No sequelae Traum. fever and pneumonia. . 3 I 2 23 6i 44 " " no local Table of Operations, Arranged According to the Ages of Patients. UROLITHIASIS IN RUSSIA. 747 3 3 3 i i I I I I 2 2 2 12 2 42 Bilateral.... cc 36 47 38 No sequelae Traum. fever ; no local < Cysto-peritonitis and partial ( gangrene of the wound.... 3 I I 3 17 CC 36 Traum. fever; no local ( Stone flat, tabular, strongly £ adhering to bladder. 4 4 4 4 4 4 I i i i i I I I I I I 2 I 2 I 38 46 52 33 16 cc cc cc cc cc cc 56 32 28 21 29 No sequelae Traum. fever; no local CC cc cc cc CC CC CC cc cc cc cc cc 33 ( Cysto - perit. ( & marasmus. Crumbled during extraction. 4 I I 52 cc 60 ( Acute pur. cedema; partial < sphacelus of scrotum and 4 I I 38 Lateral CC 18 ( wound No sequelae ( Cystitis, abscess of scrotum, 4 4 5 I I I I I I I I I 8 15 30 cc cc Bilateral.... < Recto - ? .. /4 70 29 $ andfistulse J Cystitis, phimosis, and abscess of scrotum No ' equelae ( No sequelae; tertian inter- ? 2X Eclampsia.... ( Stone wedged fast in neck 5 5 I I J 2 51 18 } vesical J . . Bilateral.... 2o 34 / mittent during convales'ce $ Traum. fever; no local • ( of blaader. 5 5 5 5 5 6 .1 I I I I I I I I 2 I 3 2 2 2 3 2 6 39 11 35 53 Lateral (C CC Bilateral... CC 36 22 29 72 28 CC cc cc cc cc cc cc cc No sequelae Cystitis; erysipelas of scrotum. Traum. fever; no local 6 Cysto-perit... 'Complicated with stricture of urethra,which delayed recovery; treated with bougies and completely removed. 'Almost in agony tvhen 6 6 I I I I 6 4 54 cc Lateral 21 29 No sequelae Peritonitis < brought to hospital; op- erated only at urgent re- k quest of parents. 748 world's iiomceopathic convention. 0) bJO Sex. No. of stones. Weight. Operation. Recovered. Died. Remarks. Male. Female. Ounces. Drams. Grains. Days. Sequel®. Days. Cause of Death, and Autopsy. 6 6 6 6 6 6 6 6 6 7 7 7 7 8 8 I I I I I I I I I I I I I I I .1 I I I 3 i i i i i i i i i i I I 2 2 5 2 4 3 7 2 I I 14 21 12 19 S2 26 38 I I 38 12 40 33 4 38 Lateral.. . 32 76 39 57 66 14 23 36 38 27 32 3i 50 121 ■ Traum. fever ; no local ( Stone wedged in neck of bladder; crmbl'd on extrac. Bilateral.... 44 cc CC ( Recto- ) $ vesical J Bilateral.... cc Lateral cc cc Bilateral.... Lateral ' Cysto-peritonitis ; superficial gangrene of wound; long suppuration: slow conva- lescence; great debility. . . Traum. fever ; cysto-periloni- tis ; superficial gangrene of wound ... No sequelae Cysto-peritonitis; superficial gangrene of wound; slow convalescence No sequelae IO ( Acute pur. } oedema.... Traum. fever; no local CC CC CC Ci No sequelae Traum. fever; no local " " haem'ge 5th day. " " no local cc cc cc Abscess of scrotum, and fistulae. Table of Operations, Arranged According to the Ages of Patients-Continued. UROLITHIASIS IN RUSSIA. 749 8 8 8 8 8 8 8 8 8 9 9 9 9 9 IO IO IO IO IO IO IO IO IO IO IO I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 3 2 I I I I I I I I I I 4 I 3 5 2 5 i i 4 5 2 4 6 5 i 5 2 6 4 5 3 i 3 24 16 48 5° 5 46 21 18 48 12 23 20 9 23 20 45 48 50 10 42 49 33 18 47 Bilateral.... CC tc CC Ci Ci a Ci Ci a cc tc CC tc Lateral CC Bilateral.... cc Ct Lateral cc Bilateral... . 30 23 29 35 25 55 24 37 28 38 32 7i 28 29 34 44 30 27 45 23 90 Traum. fever; no local CC ic cc Cystitis and superficial gan- grene of wound Cysto-perilonitis Traum. fever, and light cysto- peritonitis Traum. fever; no local No sequelae Traum. fever; no local No sequelae Traum. fever; no local No sequelae Traum. fever; no local No sequelae Traum. fever; no local tC CC CC Traum. fever; no local No sequelae No sequelae Traum. fever; no local CC CC CC 'Traum. fever, cystitis, super- ficial gangrene of wound, long suppuration, very scrof- _ ulous subject 8 7 19 4 ( Cysto-perit.; gangrene of ? genitals to above sym- physis Cysto-perit.... Marasmus Perit. & gangr.. Stone crumbled on extract'n. f Almost in agony when brought; a small stone had closed the urethra ; urine retained four days; bladder distended above symphysis. To remove | stone enlarged orifice of urethra; much bloody urine. In one week a second stone removed by operation. No febrile re- V action; rapid marasmus. 750 world's HOMOEOPATHIC CONVENTION, <d bJO Sex. No. of stones. Weight. Operation. Recovered. Died. Remarks. Cause of Death, a d Autopsy. Male. Female. Ounces. Drams. Grains. Days. Sequelae. Days. II II 11 II II II 12 12 12 12 12 13 13 13 I I I I I I I I I I I I I I I I I I 2 I 2 I I I I I I I I I I 4 2 3 2 5 i 5 4 3 7 5 4 2 I .3 32 17 36 33 3° 3° 40 24 S3 14 42 35 IO Bilateral.... Lateral... . Bilateral.... cc 28 24 85 49 Stone crumbled. ( Autopsy.- Inflamed, en- larged liver; hypostatic pneumonia, with fluent tubercles very abundant; yellow serum in right ) pleural cavity ; much per- 1 itonitis; kidneys much hypertrophied and dilat- ed; Bright's disease; ure- ters as large as finger; bladder callous and car- tilaginous. Stone crumbled. f One-half the stone engaged | in the bladder and adher- I ent; at this spot two deep | furrows; the stone one- 4 third as thick. 13 3 2S Cysto-perit... ( Acute purul't £ oedema.... Cysto-perit. and en- teritis, ending in marasmus. Autopsy.- Exu- dation on serous coat of small in- testines, causing them to cohere ; walls of the blad- der thick as the finger and cartila- ginous ; kidneys dilated, saccu- lent; the cortical substance gone ; the calices disor- 1 ganized, full of l fine sand. a " " ...... cc ct Lateral Bilateral.... ct ct u 55 42 45 3° 44 35 29 No sequelae Peritonitis . • 1 Traum. fever; cysto-peritonitis / and superficial gangrene of / wound ( No sequelae; tertian intermit- ) tent In convalescence ( Acute pur. oedema; gangrene j of wound Cystitis; traum. fever No sequelae Table of Operations, Arranged According to the Ages of Patients Continued. URO-LITHIASIS IN RUSSIA. 751 13 13 13 13 14 14 14 14 14 14 14 14 15 15 17 17 i i i i i i i i i I I i I I i i I I I i I i i i i I i I I i I I 2 2 I I I 2 7 3 3 5 3 i 6 4 2 7 3 j 6 7 3 40 37 4 5 28 18 47 40 42 35 12 2 43 13 25 32 Bilateral.... cc 21 No sequelae 2 ( Acute pur. ) } oedema. $ Stone crumbled. t Stone wedged fast in neck ( of bladder; crumbled. {Autopsy.-Kidneys dilat- 1 ed and sacculated; Bright's disease; cortical substance much inflam- ed ; peritonitis and acute | purulent oedema in the V pelvis. 'Autopsy.-Sacculated, di- lated, softened kidneys ; bladder thickened ; acute pur. oedema in the pel- k vis. i Stone entangled in false } membrane andcrumbled. t Stone smooth and so im- bedded in the bladder- J though not adherent-as } to be more easily found through the rectum than t with the sound. Stone crumbled. Recto-ves... Lateral 61 Cystitis and traum. fever 3 2 2 2 t Cysto - perit. < and paraly- ( sis of lungs. ( Cystitis & ) < acute pur. > ( oedema... ) do. ( Cysto-perit ? } andgangr. $ cc CC cc 61 56 < Cysto-peritonitis and superfi- cial gangrene of the wound. Peritonitis Bilateral.... cc cc Recto-ves... Bilateral.... CC cc cc Lateral .... 55 142 48 37 90 32 Traum. fever; no local ( Cysto-peritonitis; acute pur- ) < ulent oedema; slow con- > ( valescence ) Traum. fever ; no local... cc cc cc cc cc *c 33 ( Cystitis, per- 2 itonitis, ma- ( rasmus No sequelae 752 world's homoeopathic convention. Age. Sex. No. of stones. Weight. Operation. Recovered. Died. Remarks. Male. Female. Ounces. Drams. Grains. Days. Sequelae. Days. Cause of Death, and Autopsy. Lateral ( Cystitis, per- 17 I I 3 59 42 < itonitis, ma- ( rasmus 17 I I 7 3 Bilateral.... 38 No sequelae t Cysto-perito- Stone crumbled. 17 I I 2 55 44 3 < nitisand 17 I I 4 4° 66 Lateral 35 Traum. fever; no local ( gangrene... ( Stone mulberry, but soft; { crumbled. 19 I I I 45 5° ( Gang., phle- 21 I I 9 66 8 < bitis, pya> ( mi a 21 I I 1 22 Bilateral... . 39 Traum. fever; no local f Cysto-perit.; | gangrene of 21 I I I 2 38 66 17 1 wound; pa- 1 tient reduc- j ed by long V suffering.... f Haemorr'ge, 46 | cystitis, per- 22 I I 2 3 7 •< itonitis, and I pulmonary b apoplexy. Table of Operations, Arranged According to the Ages of Patients-Continued. URO-LITIIIASIS IN RUSSIA. 753 22 22 23 1 1 1 2 I I I ■ 5 5 1 17 57 46 Bilateral... . cc 54 Traum. fever; no local 22 ( Typhus, with Z great pros- ( tration 'Anomaly of the Art- eries.-The transverse 64 ( Cystitis, gangrene of wound, long convalescence 24 25 I I I 2 40 5° Lateral 77 Traum. fever; no local perineal ran 6'" above the orifice of the anus, and the right external pudic a few lines from the raphe. Both were severed ; the pudic was tied; the transverse I I 7 CC 16 (. Gang., phle- z bitis, pyae- ( mia I I I I I I 2 S2 27 c6 cc 38 Traum. fever; no local 25 27 28 I I I 3 Bilateral... . Lateral .... 30 60 Haemorrhage and traum. fever.. Cystitis I I -8 Bilateral... . 120 Cystitis and orchitis could not be. No sec- 28 I 3 37 CC 69 ( Traum. fever, cystitis, and su- z perficial gangrene of the ( wound ondary haemorrhage. (Five years before had a stone weighing 1 oz. 27 grs. removed by lateral I operation. This time b stone crumbled. I I I 7 3 43 7 18 No sequelae 3° I Lateral.... 104 t Abscess; partial gangrene of z scrotum; five vesico-scrotal ( fistulae 32 40 I I 4 20 Bilateral... . 23 ( Typhus dur- ingconval.. f All four stones entangled I 4 7 Bilateral.... 64 t Cystitis; long suppuration ) z of wound, slow convales- > ( cence ) j close under the symphy- 1 sis pubis, making not j only the discovery but | the extraction very diffi- V cult. 46 I I 2 i5 Dbl.-horiz... 17 No sequelae fThe operation was per- formed with the double lithotome cache from the | urethra. Stone crum- V bled. 754 WORLD'S I1OMCEOPATHIC CONVENTION. Age. Sex. No. of stones. | W eight. Operation. Recovered. Died. Remarks. Male. Female. I Ounces. 1 Drams. Grains. Days. Sequelae. Days. Cause of Death, and Autopsy. 47 47 I I 16 2 I 2 2 I 40 IO Bilateral.... Lateral .... 48 4 ' Died of ty- phus, which set in long after the urine h a d begun to pass n 0 r - mally. ' Gangrene of scrot'm and acute puru- 1 e n t cede- ' Considerable fragments of a single large stone, the outer layers of which had peeled off, the sharp cor- ners not yet rounded. Several months before the operation the patient had been catheterized, the stone repeatedly struck, and small pieces discharged by the ure- _ thra. 58 I I 5 28 Bilateral.... 57 Traum. fever; no local L ma |'42 Total, I 142 '43 Total recovered, 115. Total died, 28. Table of Operations, Arranged According to the Ages of Patients-Continued. URO-LITIIIASIS IN RUSSIA. 755 No. of calculus. ' < Weight. Province. District. Village. Other constituents in small quantity. Ounces. Drams. Grains. 52 14 I I 7 Nishny-Novgorod. Nishny-Novgorod. CC Afonasjewo None. 71 47 2 I 10 << Tedjakowo CC 4 I 8 cc Balachna Bolschoje Kosino.. cc 20 5' 2 35 cc Szokowo cc 48 12 3 40 cc CC Maloje Kosino ... cc 2 3 cc Kujamnin Uwarowo cc IO I c 48 cc Balachna Tartenyewo Traces of urates of lime and soda; blood. 5 2 i I 47 Kostroma Makarjew Makarowo Phosphate of lime, and traces of magnesia. 37 10 5 2 ; CC Mogiljowo with blood. 10 3 18 CC Turjewetz Podwigai Traces of lime and magnesia. II.-Calculi, pure uric acid, and traces of oxalate and phosphate of lime. 4 2j 23 Nishny-Novgorod. Sonijonow Kononowo Traces of oxalate of lime. 19 5 2 11 CC Gubjouki CC 6 2 CC Gorbatow Soszuowka cc 8 2 4° cc CC Uschakowo Traces of oxalate and phosphate of lime. 18 5 2 39 Kostroma Makarjew Bolschije Gari... CC 45 11 I I 53 cc CC Semjouki cc 7« 3 4 5° cc Turjewetz Borishoglebsk .... Traces of oxalate of lime and magnesia. 29 8 I 1 4 Wladimir Gorochowetz Werchn. Laudicha. " iron and blood. Classification of the Calculi, According to their Chief Constituents. I.- Calculi chiefly of uric acid. 756 world's homceopathic convention. No of calculus. Age. Weight. Province. District. Village. Other constituents in small quantity. Ounces. Drams. Grains. 127 6 I 2 Nishny-N ovgorod. Nishny-Novgorod. Bakschewo None. I32 5 2 18 44 City N. Novgorod I 12 3 2 12 (( Gorbatow Tarjewskae Traces of phosphate of lime. 105 6 4 52 (( 44 Tawlowo " " ammonia and magnesia. 9 3 1 31 44 44 Wjasowka " " and magnesia. 137 2 53 Balachna. Ljachowo 44 44 125 3 2 42 a Gorbatovvka Traces of urate and phos. of lime and magnesia 44 *4 44 12 4 1 S2 44 Kujaschicha 131 6 7 11 44 Arsamas Wuijesduoje None. 1 '3 3 23 44 44 Risadejewo Traces of phosphate of lime. 134 13 3 41 44 44 Pomilicha " " and magnesia. 139 4 1 S2 44 Wasil-Tursk Semjau 44 44 39 IO I 45 44 Ardatow Rosmaslei " " and iron. 29 6 6 4 Wladimir Gorochowetz Gorochowka " " and magnesia. 99 8 1 21 44 Murom Leszuikowo Traces of oxalate of lime and urate of magnesia. Classification of the Calculi, According to their Chief Constituents-Continued. III.-Calculi, uric acid, acid urate of ammonia, with or without traces of phosphates of lime and magnesia. URO-LITHIASIS IN RUSSIA. 757 IV.- Calculi, uric acid, acid tiratc of ammonia, zuith phosphate and oxalate of lime, magnesia, iron, Hood, and, traces of urate of soda. i5 4 7 25 I 2 15 12 Nishny-Novgorod. Nishny-Novgorod. CC Tutino With oxalate and phosphate of lime. " " and iron. Szemeti 65 7 5° u cc Staroje Polje Oxal. and phos. lime, and ammonia and magnesia. 77 6 5 12 cc Kujaginin ( Woitschichins- ? ( kay Maidan. 5 Phosphate of lime. io6 2 3 CC Uwarowo Oxal. lime, traces of urate soda, lime and mag. 109 13 2 40 cc CC As in the title. 120 14 1 7 2 cc cc Pokrow Phos. magnesia and iron. 74 2 46 Semjonow Muchino 24 6 54 CC Gorbatow Pawlowo Phos. calc, and mag., iron. 123 8 4 18 t6 CC Kischkino As in title, except iron (blood), soda. 1'4 5 3 5i cc Isbuiletz Phos. ammonia and magnesia. IS6 4 33 cc Wasil-Sursck Ljwowo Urate and oxal. lime, and urate magnesia. 42 10 1 18 Kostroma Makarjew Troiza Oxal. and phosphate lime. 103 9 4 23 u 1 urjewetz Dolmatowo " and magnesia. 119 4 1 cc CC ( Maluija & Mar- ? £ itzui 5 Traces of urate of magnesia. 107 47 1 2 40 cc Kineschma Some urate of lime and magnesia. THERAPEUTICS OF BENIGN TUMORS. Albert G. Beebe, M. D., Chicago. Whether our remedies are able, generally, to remove tumors, even when benign in character, is a question not yet satisfac- torily answered. While a very large majority, even of homoeo- pathic practitioners, are probably skeptical as to such results; there are not a few who assert positively that such growths are curable by potentized drugs, and report cases in which they fully believe this has been done. In support of this belief, it has been asserted that tumors are not to be regarded as constituting the disease or as, in their nature, local, but merely as the symptoms or local manifestations of some constitutional dyscrasia, on the erad- ication of which, by appropriate medication, the effects will necessarily disappear. This assertion, like many others, can neither be positively proved nor disproved in the present state of our knowledge. It may, however, be accepted as probably true of certain growths, and probably false of certain others; though where the dividing line should be drawn it would be impossible to determine. Even if this theory be conceded as universally true it does not follow that, the cause being removed, the effects must cease. On the contrary, the fact is too well recognized to require illustration, that a train of events may continue its progression indefinitely, long after the initial force has ceased to be operative. If we suppose a morbid growth to be developing under the direct influence of some morbific force, w'e may reasonably expect to arrest its progress if we can remove the cause ; but it does not follow 759 760 world's iiomceopattiio convention. that this alone would produce that retrograde metamorphosis necessary for the removal of the growth already present. Neither are we warranted in assuming that the conservative forces of nature can, unaided, accomplish such removal. On the other hand there is reason to believe that morbid growths are not infrecpiently sustained and fed through a purely local stim- ulation, resulting from mechanical irritation by the growths themselves ; or from some accidental extraneous circumstance. 1. We will assume then that, of the entire number, a con- siderable proportion of the benign tumors we meet with arise from purely local or mechanical causes; and for these med- ication offers the least promise of success. 2. Of the remainder, or those which originated in some constitutional cachexia, a portion have already ceased to feel the influence of the original cause; are sustained in a kind of independent existence by local or mechanical causes ; and are therefore essentially in the same category as those of the pre- ceding class, and subject to the same principles of treatment. 3. Including all growths developing under the continued influence of a systemic dyscrasia. These should be most readily controlled by constitutional treatment. Supposing such treatment to be adopted as will eradicate the dyscrasia, we may expect one of two results. If the growth has pro- gressed sufficiently far to enable it to maintain an existence independent of the primary cause, we shall find it assuming the characteristic of class two ; while, if taken at an earlier period, the growth may disappear with the removal of the cause. Since the sole province of homoeopathic remedies is to secure the normal performance of the vital functions, we conclude that if the conservative forces of nature are not able to elimi- nate a morbid growth, when the constitutional disturbing cause has been removed, we can expect nothing further from medication. The reason is that a continued mechanical irri- tation or stimulation of a part or tissue would naturally be followed by increased activity or perversion of growth, the natural result of a perfectly normal performance of the organic functions. A mechanical cause should and must be mechan- ically removed. THERAPEUTICS OF BENIGN TUMORS. 761 We conclude, then, that only in a limited number of cases can we reasonably expect medicinal measures to accomplish the removal of tumors. The selection of remedies for this purpose is attended with considerable difficulty. The pathogenesis of very few, if any, of our drugs exhibit any well-defined tumors, resulting from our provings; and since there are generally no other constant or essential symptoms found in these cases, we have no guide in the selection of remedies but occasional concomitant, disas- sociated symptoms; and frequently there are none of any kind. These concomitant symptoms, being, for the most part, purely accidental or entirely independent of the disease we are seek- ing to cure, are evidently unreliable as a basis of treatment. The etiology of most tumors, of constitutional origin at least, is involved in such obscurity that we are left without even the clue which such knowledge would, perhaps, afford; so that, up to this time, it must be conceded our medical treatment of this class of affections has been generally empirical, and its suc- cesses can not be fairly claimed for Homoeopathy, even though they may have been accomplished by potentized drugs. Prescribing homceopathically is one thing ; using drugs em pirically, even when prepared in the form usually employed by homoeopathic physicians, is quite another : and if we would be honest, we have no right to claim for Homoeopathy the results of any prescription not based upon the similarity of the symptoms of the case to the pathogenesis of the remedy. Whatever of value our literature affords upon this subject is, therefore, of the character of clinical experience. Numer- ous cases have, no doubt, been reported from the time of Hahnemann down to the present; some of them of practical value. But as neither the time nor the facilities for making a complete digest of these reports have been available to the writer, we must content ourselves with a brief resume of what seem to be the most tangible results in the clinical experience of practitioners of our school. Undoubtedly tenfold more, and riper, experience lies buried in the memories or note- books of busy physicians throughout the world, than all that has as yet been published ; and if this paper shall fortunately 762 world's IIOYKEOPATHIC CONVENTION. provoke the divulgence of some of this knowledge, it will surely have subserved a useful purpose. In a considerable proportion of the cases reported as cured by remedies, the cure has been accomplished either through the elimination of the tumor en masse, as in the expulsion of uterine fibroids, or of polypi of the uterus, vagina or nares; or else through the rupture and discharge of the contents of cystic growths and subsequent obliteration of the cyst by sup- purative inflammation. It may well be doubted whether such cases can be fairly considered legitimate cures by remedies; whether the drugs given had any thing to do with the result. Probably a large majority of physicians and surgeons of both schools, whose credulity has not given them over entirely to the fallacy of post hoc, ergo propter hoc, will continue to con- sider such results as due solely to the spontaneous efforts of Nature, and their relation to the treatment as a simple coin- cidence, nothing more. Belladonna?* cured several cases of wens of the scalp.1 Kall brom.. " Great advantage from the internal adminis- tration, given in two grain doses three times a day." 2 " Calcarea carb, is recommended by Professor Dunham for encysted tumors of the head and neck, with fluid or semi-fluid contents." 3 Staphysagria has been successful in removing sebaceous tumors of upper eyelid (after styes), and Thuja, when arising from meibomian glands.4 Graphites™***, rapid cure of cystic tumors of eyelids.5 Silicea?*. Cystic tumor of lower eyelid, existing one year, was cured by one dose every night in fourteen days.6 SEBACEOUS CYSTS. Silicia. Chronic bursitis had generally yielded to it.7 Kali iod. " In my experience the Iodide of potash is more SYNOVIAL CYSTS BURSAE GANGLION. 1. New York State Transactions, 1864. John Hornby, M. D. 2. Helmuth's Surgery, p. 180. 3. Helmuth's Surgery, p. 180. 4. Prof. W. II. Woodyatt. 5. Amer. Hom. Ohs , 1874, p. 45. 6. Stens Sr. Allgem. Hom. Zeit., Vol. LXXXIX, p. 156. THERAPEUTICS OF BENIGN TUMORS. 763 effectual in chronic bursitis than any other medicine which I have employed."8 S'dicea, followed by Calcarea carb., cured ganglion of wrist, size of hazlenut, in four months.9 OVARIAN TUMORS (CYSTIC AND OTHERWISE)*. Colocynth™ cured (fibrous?) ovarian tumor.10 Colocyntl™ 1000 100000 cured cystic tumor of ovary.11 Podophyllum?™ twice cured a tumor of tbe right ovary in the same patient, with an intervening period of health of fourteen years. Lachesis™ also removed enlargement of left ovary in the same patient.12 Graphites™ cured tumors of both ovaries simultaneously.13 Platina. Ovarian tumors diminished.14 Kali brom, (crude) cured ovarian cyst.16 Apis mel. and Arsenic, cured one case.16 In allopathic practice, bromide and iodide of potassium, chlorate of potassa and oxide of gold have cured quite a num- ber of cases. The difficulty of arriving at a positive diagnosis in many cases of ovarian tumor leaves, naturally, some uncertainty as to the accuracy of many of the reported cures. LIPOMA (adipose OR FATTY TUMORS). Crocus™ cured fatty tumor of scalp with hemorrhage of dark stringy blood, with feeling as something were alive in the tumor.17 Baryta carb™ It has been my good fortune to treat quite a number of cases. I have uniformly used Baryta carb.200, and have not yet failed to cure a single case.18 7 Mr Pope, Discussion in British Hom. Congress, 1871, 8. Helmuth's Surgery, p. 506. 9. Hermann Welsch, A 11g. Hom. Zeit., No. 24. 1874. 10. Carroll Dunham, N. Eng Med. Gazette. 1869, p 211. 11. J G Gilchrist, Med. Investigator, 1873, p 632 12 Wm. Gallupe, American Institute Transactions, 1869, p 328. 13. Dudgeon, Brit. Jour. Hom., 1873, p. 183, 14. M. B Jackson, N. A. Jour. Hom., Vol. XXII, p. 93. 15. T. Black, Brit. Jour. Hom., January, 1869. 16. Helmuth's Surgery, p 1181. 17. J. C. Morgan-see Helmuth's Surgery, p. 183. 18. T. S. Hoy ne, U. S Med, and Surg. Jour, July, 1873, p. 425. 764 world's HOMCEOPATIHC CONVENTION. Prof. Chas. Adams reports having as uniformly failed with Baryta in several cases, upon which he has tried both the car- bonate and the iodide. FIBROUS TUMORS. This class, undoubtedly, includes a large number of cases diagnosed as scirrhus, especially of the breast, and reported cured by remedies, or operated upon as cancer. Probably few physicians of experience have failed to see several such cases. A smooth, rounded, dense tumor, from the size of an almond upward, is found in the breast. It is usually movable, not very sensitive, enlarges slowly, with some slight lancinating pain, often aggravated before the menses. Conium m* Hard, round, movable tumor of the breast cured.19 Conium™ cured, in two months, a tumor of the breast, size of a walnut, resulting from a bruise.90 Silice^. Hard, nodular tumor of breast ("scirrhus"?) cured in two month's.91 Conium* 30. Same kind of tumor as the preceding, size of hen's eu'2:. Silicea94 had no effect.99 Conium1™. Hard and painful lumps in the mammae re- duced.93 Conium* cured a small painless tumor in the breast, near the nipple.94 Belladonna (plaster) relieved a painful, indurated tumor of the breast.95 Silicea™1 600 cured a tumor of the breast (in a man) inches in diameter and % inch thick.96 Silicea™ 60°. Scirrhus (?) of breast improving.97 Coni am and Calc. carb. I have found the most efficient remedies for fibrous tumors.98 19. W T. Helmuth, New York State Transactions, 1870. 20. J. G. Gilchrist, Med. Inv., Vol. VIII., p. 8. 21. Zeit. f. II. KI., No. 12, p. 91. 22. Zeit. f. II. KI., No, 12, p. 91. 23. North Amer. Jour. Horn., Vol. XXI, p. 553. 24. J. II. Nankivell. Hom. World, Vol. VIII., p. 79. 25. New York State Transa- tions, 1S61, p. 112, Dr. B. F. Bowers. 26. J. B. Bell, New Eng Med. Gazette, 1869. 27. J. B. Bell, New Eng. Med Gazette, 1869. 28. Helmuth's Surgery, p. 189. THERAPEUTICS OF BENIGN TUMORS. 765 Conium? dec. To the above 1 can add my own testimony as to the efficacy of this remedy, having three times used it suc- cessfully for tumors of this class. The testimony seems abun- dant to prove the value of Conium in fibrous tumors of the breast and other glands, especially in lymphatic subjects, and connected with menstrual disorders. This simply corresponds to the pathogenesis of the remedy. UTERINE FIBROIDS. Ustilago madis. Sub-serous or interstitial fibroid much diminished under use of this remedy.29 Ustilago madis™ Similar case, similar result.30 Kali hyd.™ 200 cured several cases of intramural uterire fibroids.31 Kali hyd™ removed thickening of posterior wall of uterus.33 Calcar, iod. has, in at least one instance in my own hands, greatly reduced and relieved a large intra-mural fibroid of the uterus ; the influence of the remedy being most marked in re- lieving the severe menorrhagia, for which it was originally selected. In several other cases it has been used, in conjunc- tion with other remedies, with excellent results ; sufficient, at least, to warrant careful trial in similar cases. I have usually used Nichol's preparation, putting about five to ten grains of the crude into four ounces of hot water and giving a teaspoon- ful of the clear, supernatant fluid, three or four times a day. I have not used the medicine in triturations because it is very unstable; decomposing very readily on exposure to light and air. The reports of cases of various kinds of polypi have gener- ally been so vague as to make it impossible to determine the precise character of the growths-whether mucous, fibrous or fibro-cellular. Sanguinaria. A decoction used as an injection, per va- ginam, removed two uterine polypi by absorption.33 POLYPOID GROWTHS. 29. W. H. Burt on Ustilago madis. 30. E. M. Hale, American Institute Transactions, 1870, p 475. 31. Professor Charles Adams. 32. Professor Charles Adams. 33. H. C. Spaulding, New Eng. Med. Gazette, March, 1873, p. 126. 766 world's HOMCEOPATHIC CONVENTION. Conium0 15 30 was followed by expulsion of five polypi of va- rious sizes with uterine contractions and profuse hemorrhage.34 Calcarea carb2 was followed after fifteen days by the expulsion of two fibrous polypi of the upper portion of the vagina. Thuja1 had first been given to check profuse serous discharge.35 Thuja™. In a case mentioned by Dr. Petroz, caused in eleven days, the detachment of a large and very distressing fibroid-polypus.38 Calcarea carb 200. Eight doses cured a severe case of polypi of both nostrils, of two years duration, after the failure of Teucrium200 during six weeks.37 Calcarea plus2 cured large polypus of left nostril (in- ternally and topically) after it had first been considerably reduced by local use of Sanguinaria.38 Calcarc a carb2 dec. and Phosphorus* dec., alternately, pre- vented redevelopment of frequently recurring cysto-mucous polypi of nose.30 Phosphorus20, Sulphur20 and Calcarea20 at long intervals, cured nasal polypi.40 Calcarea carb0 had reduced polypus of the velum fully two thirds when last examined.41 Teucrium?0 dec. cured mucous polypi of both nares in about four months, boy aged eleven.42 Teucrium20 cured mucous polypi hanging out of the nose, a year or more, boy aged fifteen.43 " The best medicines are undoubtedly Calcarea carb., Teu- crium, Phosphorus and Sulphur." 44 " Dr. John E. James speaks highly of freshly powdered Sanguinaria canadensis root, blown through quill or other 34. North Amer Jour. Hom , Vol. XXII., p 62. 35. S. M Alvarez, N. A. J. II v XXII, page 62. 36. J. II. Woodbury, American Institute Transactions, 1870, p. 474. 37. W. P. Wesselhoeft, N. E. M G , Fe' ruary 1373, p. 49. 33. W. F. Hocking, O. M. and S. R., 1873. 39. Med. Advance, September 1373, p. 401. 40. S. M. Alvarez. N. A. Jour. Hom., Vol. XXII, p. 350. 41. Prof. J. S. Mitchell. 42. William Galiupe, American Institute Transactions, 1870, p. 451. 43. William Galiupe, American Institute Transactions, 1870, p. 452. 44. W. T. Helmuth-see Surgery, p. 864. THERAPEUTICS OF BENIGN TUMORS. 767 cylindrical tube over tlie whole polypus. In many, if not in most cases, three applications, at intervals of from three to seven days are sufficient, to effect a radical cure ; and should the polypus be so large as to necessitate forcible removal, the application once or twice will make a temporary relief a certain cure. Dr. Thos. Bryant, after an experience of three or four years, also speaks highly of the use of Tannin, in a similar manner." 45 " Dr John Pattison, has used successfully a snuff of powdered rad. Sanguinaria canadensis. Professor Dunham reports cases cured with Calcarea carb., Teucrium and Staphy- sagria." 46 Sanguinaria* dec. I can also testify to the efficacy of this remedy, having several times cured mucous polypi of the nares, one case being of a very obstinate character under other treatment, by the internal use of the 2d. dec. trituration of this drug, conjoined with the insuffiation of the 1 dec. trit- turation. Teucrium^ Sanguinaria and Calcarea iod. have been found useful in aural polypus.47 Lycopodium, has cured conjunctival polypus.48 Lycopodium and Calcarea for polypus of the conjunctiva. " The remedies have been given at long intervals and in high potencies, and the result is thus far very satisfactory.49 Nitric acic^ and Silicea™ cured a case (probably one form of epulis).60 TUMOR OF THE GUM. ADENOID TUMORS. Broncliocele is so generally amenable to our treatment that it seems hardly necessary to quote examples. Most practi- tioners could probably give reports from their own experience as to the efficacy of Iodine and the iodides; also of the prepara- tions of lime. From my own experience I should say, that 45 W. T. Helmuth-see Surgery, p. 8G4. 4G. W. T. Helmuth-see Surgery, p. 185. 47. Prof. W. H.Woodyatt. 48. Prof. W. II. Woodyatt. 49. T. F. Allen, American Institute Transactions, 1871, p. 412. 50. C. C. Slocomb. N. E. M. G., Vol. 5. No. 10. 768 world's iiomgeopathio convention. nearly all cases, if taken early, can be controlled by Iodine® to s°. Occasionally Spongia, Calcarea, Calcarea iod. or Mercurius iod. may prove more serviceable. Egg shell (Calcarea carb.) " A man who had been afflicted many years with a goitre and had taken Gastein water for five years, and also Iodine without success, had been advised by a neighbor to take the shell of an egg, cleanse it well of the skin within, and pulverize it. Then take of this powder every morning as much as there lies upon the point of a knife, during the decreasing moon for fourteen days. This he had done and the goitre was gone." 61 Iodine cured a case of very long standing in a man of 58, after the ineffectual use of Spongia30. 62 Calcarea carl)3 Goitre, sanguine temperament, etc.63 Salix niger. " I cured one case of goitre in October 1S74, of a Miss, twenty years old, in eight weeks with Salix niger. The goitre was large, standing out as far as the chin, was heavy and caused pain when swallowing. I gave in all sixteen ounces of the first decimal attenuation of Salix niger." 04 Siliced to 30 cured cystic goitre (right lobe) in about three months, girl aged seventeen.66 Helmuth credits Natrum carb., Calcarea carb., Staphysagria, Lycopodium and Spongia with curative powers; also the iodides of mercury, both internally and as an ointment; but says Iodine30 is the principal remedy in the treatment of this disease.66 Generally, we may feel confident of removing all recent cases of this kind, especially of the simple or adenoid variety. Pulsatilla^ and Conium^ cured a case of recent sarcocele.67 JIercurius Cniod3 of course removed syphilitic sarcocele.68 We have but little to add to these reports except to refer to the almost absolute control which our remedies exercise over 51. G. Proell A. H. Z. vol. 89, p. 176. 52. Dr. Schepens, Rev. Hom., 1874, p. 143. 53. A Elblein, Proc. H. M. S. Ta., 1873. 54 J. S. Wr ght, Med. lav., April, 1875, p. 326. 55. Dr. II. Welsch, A 11g. II. Z No 24, 1874. 56. See Surgery, p. 940. 57. Jno Hornby, N. Y. St. Trans., 1864, p. 122. 53 A. Cricca, W. H. Obs. Vol. VII, No 10. THERAPEUTICS OF BENIGN TUMORS. 769 vascular tumors of the rectum. Hemorrhoids should very seldom require surgical treatment with such remedies as JEsculus hip., Hamamelis and Nux vomica within our reach. There is no doubt, that with added experience and skill in the selection of remedies, conjoined with greater care in diagnosis and a more scientific pathology, the operating case will be more frequently put aside in favor of the medicine chest. However, it seems at least questionable, if science, humanity, or the true interests of our patients, will always be best sub- served by occupying weeks or months, and perhaps years, (subjecting the patient meanwhile to lingering suspense and inconvenience, if not pain) to accomplish by drugs what might be safely and painlessly accomplished by surgical measures in a few moments, and probably at much less expense. HOMEOPATHIC THERAPEUTICS IN G.UN SHOT-WOUNDS, AND THE SEQUELAE OF OPERATIONS. E. C. Franklin, M. D., St. Louis, Mo. This variety of traumatic lesions includes all injuries inflict- ed by missiles } rejected by the explosive force of gunpowder. Though comparatively rare in civil practice, yet in this coun- try, where the sports of the field are so common, they occur with sufficient frequency to render a knowledge of them and of their effects indispensable to the accomplished surgeon. Occurring in all portions of the body, and in various degrees of severity, they present a wide and interesting field of study and investigation. History.-From the earliest period of the employment of gunpowder in war alone, down to the present time, when it is also extensively and variously used for engineering purposes; the wounds inflicted by its means have excited the liveliest in- terest in the chirurgic mind, often appealed to by terrible in- juries produced by the bursting of shells or the blasting of rocks. That military surgery does not materially differ from the surgery of civil life is true only with some reservation. As a science, surgery is the same whether practised in the wide operating tent of the army-surgeon's quarters, or in the cozy amphitheatre of the city hospital. As an art, however, it varies according to the peculiar nature of the injuries to be treated and with the attending circumstances. If we compare 771 772 world's homceopathic convention. the almost superstitious dread with which the older surgeons regarded the effects of gunshot-wounds, and the erroneous views they entertained of inducing healthy action, with the accumulated experience and scientific treatment of to-day, we see at once the great advance that has been made in this de- partment of operative surgery. Formerly the wound was con- sidered a poisoned one, which could only be cured by a long and tedious process of suppuration that would prevent the absorp- tion of the poison into the patient's system. The irritative fever, the emaciation and other results'of the protracted cure of the injury, were thought to be so many evidences of the indi- rect effects of the poison permeating the physical structure; just as the shock or injury, the loss of vitality along the surface track of a small projectile, or of the tissues denuded by the passage of a cannon-ball, were considered evidences of its indi- rect effects. In obedience to this method of reasoning, the openings of entrance and exit of the ball were incised; the wound dilated by tents or other substances; terebinthinates, or even boiling oil poured into it; and irritating compounds and ointments applied, where superficial dressings were prac- ticable ; and it was only after the wound was considered to be fully purged of its venom and foul humors, by the extensive suppurative action thus kept up, that cicatrization was per- mitted to be established. It required many years of observation, many and severe hu- man conflicts, untold misery and death of thousands of the race, besides the exercise of much labor and moral courage, to stem the tide of professional custom and prejudice, and inau- gurate a simpler, better and more efficacious method of treat- ment. Not until the great, and last achievement of the cele- brated John Hunter, who wrote on the subject of the " Blood, Inflammation and Gunshot-wounds," in 1794, was the profes- sion thoroughly awakened from the ignorance and prejudice which up to that time had prevailed in all departments of sur- gical science and art. Having served as a surgeon on the staff of the army in the expedition against Bellcisle, in 1760, and subsequently in the same capacity in the campaign in Portu- gal, in 1763, Hunter had acquired a reputation that elevated GUNSHOT-WOUNDS. 773 him to the highest positions in the medical department of the British service. In 1776 he was appointed Surgeon Extraor- dinary to the army, in 1786 Deputy Surgeon-general, and in 1791 Surgeon-general; the highest medical position then known in England. It was John Hunter, also, who advocated with great force the delay of amputation, after severe gunshot-wounds, that "the patient's constitution might accommodate itself to the injury; " a proceeding which more extended observation and experience have demonstrated to be more dangerous than the primary or immediate operation. Mr. Guthrie writes, in his "Commentaries on the Surgery of the Peninsular War, between 1808 and 1815," that the prin- ciples and practice of surgery, which prevailed at the begin- ning of the war were almost entirely superseded at its conclu- sion ; and further adds that the art of surgery received greater impulse and improvement from the practical experience of that war than ever before. The still more recent military operations in Algeria, in Schleswig, in Holstein, in the Crimea and India, have fur- nished abundant opportunity of testing practically many great improvements that have been made in surgery by its distin- guished practitioners, both in civil and military life. Promi- nent among these may be cited the excision of joints, in lieu of amputation of limbs, that was so largely practised by the older surgeons; resections of injured portions in the continui- ty of bones; amputations limited to the removal of terminal portions of the extremities destroyed by the original injury ; and other methods of what has been styled conservative sur- gery. The war of the Bebellion in our own country has perhaps added as largely to our experience in the treatment of gunshot- wounds, especially from rifled arms, as any of the wars previ- ously referred to. The Government of the United States, following the example of England, is still engaged in collect- ing and arranging the observations and experience of its med- ical officers during the war of the Kebellion, and has published a valuable and instructive series of reports, covering a large 774 world's iiomceopathic convention-. percentage of the injuries of the war and their results. Illus- trations of morbid specimens and carefully-drawn cuts of sur- gical diseases prepared during and after the war, have been collected and arranged for the Surgical Museum at Washing- o o o ton. The great variety and severity of injuries from gunshot- wounds demand of the surgeon not only a knowledge of their treatment, but of the principles that govern projectiles ; the form, weight and velocity of missiles, and their course and ef- fects upon the body, as well as an intimate acquaintance with physiology and anatomy, in reference to the position of wounds and their consequent effects upon the system. This leads us to consider the qualities and kinds of projectiles in use at the present day, by which direct gunshot wounds are produced, and which are included under the head of cannon, musket and rifle shot, shells, hand-grenades, case shot and other minor va- rieties. Besides these, are the agents by which indirect inju- ries are inflicted, such as stones or other hard substances driven from parapets or the surface of the ground by cannon-shot; splinters of wood from platforms and other frameworks ; iron- spikes or fragments of other hard substances forcibly driven by contact with the flying ball or shot. Founts of Missiles.-Among the various forms of project- iles known in the art of warfare, may be enumerated : 1. The spherical, which includes cannon-balls, grape, musket and pis- tol-shot, and shells; 2. The cylindro-conoidal, such as balls belonging to rifled cannon and muskets; 3. Irregular, but gen- erally bounded by linear and jagged edges, as fragments of shell and splinters. In the largest kind of balls, such as are projected from cannon, siege or field pieces, the form is of little moment to the surgeon. The chief consideration in wounds from these missiles is the degree of force, or the mo- mentum by which they are driven forward to produce their injurious results. In the smaller variety, however, there is much that chal- lenges attention. The effects of the cvlindro-conoidal ball upon the osseous system, are very different from that of the common round ball. The former, with its wedge-like quality, GUNSHOT-WOUNDS. 775 splits the bones into fragments, the direction of the fracture running parallel with the central cavity, the fissures often ex- tending from the seat of the injury to the joints, in which the bones terminated. From the round ball such results rarely oc- cur ; the fragments produced by their impingement being more of a cuboid form. The splintering produced upon the apophysis of a bone by the conoidal bullets extends to a considerable distance into the shaft, while that from the round ball is usually limited to the apophysis itself. A knowledge of these results is of value to the surgeon when the operation of resection is considered, and will often guide his judgement as regards the propriety of op- eratino' when other means of information are inaccessible, o Another result of the wedge-like form of the conoidal bullet is, that in coursing through soft structures it divides and sepa- rates tissues, and is, therefore, less opposed in its passage through their parts than the round ball. It is partly due to the form, as well as the increased momentum, of the pointed bullets, that the lodgment of balls is infrequent now as com- pared with the experience of former wars. Weight of Missiles.-The generally-received opinion among medical men, that the weight of projectiles exercises injurious influences upon the human structure wherever wounded, is not borne out by observation. In the Franco-Russian war, the bullets used by the Russians were nearly one-third heavier than those used by their oppon- ents, yet the effects of these larger masses against bony struct- ure were merely wider in proportion to their greater size and momentum; while in flesh-wounds the increased size of the orifice left by the larger ball gave readier exit to the foreign substances, and to the surface discharges. Mr. Guthrie, who has enjoyed a large field of observation of the effects of missiles upon the human organism, says, that the musket-balls of the English, sixteen to the pound, produced no more mischievous effects upon the French wound- ed than were produced upon the British by the French bullets of twenty to the pound. It seems, therefore, to be well au- thenticated, that the form, solidity and velocity of musket- balls is of greater importance to the surgeon than their weight. 776 world's HOMCEOPATHIC CONVENTION. Course of Balls.-The circuitous and erratic courses of balls through the body, as related by older authors, have rarely been met with in later wars, owing to the fact that the conoidal rifle ball, almost in general use, penetrates soft tissues in a straight line, and enters bony structure like a wedge. It might seem that the track of a cylindro-conoidal bullet cannot corre- spond with a straight line ; but if the surgeon will carefully place the patient in the position he occupied at the reception of the injury, it will be found on examination that the devia- tions from the straight line are more apparent than real. Al- lowance should of course be made for the spasmodic action of the various muscles, and the momentary displacement of other structures on the occurrence of the injury. A case came un- der my observation at the U. S. Mound City Hospital (near Cairo, Illinois) during the late war of the Rebellion, where a soldier, at the siege of Fort Donnelson, received a ball at the back of the neck to the right of the ligamentum nuchae, which traversed the whole length of the spine, and made its exit near the nates. During the inflammatory period, the course of the ball was distinctly visible by a well-defined red line marking its track. Dr. Cauniff mentions a case of a private in one of the New Jersey regiments, wounded in the right arm while in the act of putting a cartridge into his musket. The ball, after cutting off his forefinger, passed directly through the body of the hand, and again entering the back part of the arm, about two inches from the'wrist, ploughed a furrow for a few inches, then penetrating the deeper part of the arm, it finally made its exit, a little above the external condyle of the hu- merus. During my service in the army, I was a witness to many interesting instances of the strange and anomalous course of balls in the various portions of the body. In one case, the bullet made more than two thirds the circuit of the neck, and was cut out just beneath the skin. In another, a ball entered at the crest of the ileum, passed downwards parallel with the thigh, and emerged just above the knee-joint. Illustrative of this point, a case is related wherein a des- perate lover attempted suicide with a loaded pistol, the muzzle GUNS HOT-W0UN DS. 777 having been placed in direct contact with the heart. The bullet in its flight struck the flat surface of a rib, deflected towards the spine, passed downward, and was removed at the buttocks. Bullets sometimes remain in the body for a long time, fre- quently for life, without producing much inconvenience. Lying imbedded in the substance of a muscle or in the layers of its apo- neurosis, it becomes incased within a fibrous sheath and the parts becoming accustomed to its presence, little or no inconvenience is felt by the system. But, when it lies in the course of a consi- derable nerve or large vessel, its pressure in the first instance may produce paralysis, and in the second occasion more or less disturbance in the circulation beyond that point. A most interesting case of this nature occurred in my practice about six years ago, in which a bullet was driven into the upper part of the thigh. All efforts for its removal proved unavailing. The wound healed, and the patient attended to his ordinary duties as if nothing had Happened, when suddenly (four years after the injury) he was attacked with loss of motion in the leg. Having put himself under the care of one of our best surgeons and received no benefit, he presented himself to me for exami- nation and treatment. Placing the body of the patient in the same position as when he received the injury, I examined carefully the upper part of the thigh, and discovered the bullet lying in contact with the crural nerve. The ball was removed, the patient improved in strength and in a short time fully recovered the use of the limb, and up to this time enjoys uninterrupted health. After the siege of Fort Donnelson, among the wounded sent to the Mount City Hospital, under my charge, was a pri- vate in one of the Illinois regiments, who had been struck by a six-pound rifle shot in the fleshy part of the hips. The wound appeared considerably lacerated and contused, but the fact of the missile being concealed within, had escaped the observation of the surgeon in attendance, owino- to the lar^e number of wounded requiring his aid and the want of sufficient time for extended and careful explorations. It was perhaps for alike reason that the ball was not discovered until the second day of his entrance into the hospital, when it was re.- moved after considerable difficulty. 778 world's homceopathic convention. This specimen is still preserved in my private collection, and has created ranch surprise and discussion. The ball is cylindro- conoidal and is of cast iron, with a copper base, and evidently intended for rifled cannon. Velocity of Missiles.-The velocity of motion of projectiles is an important consideration to the surgeon in its bearing on the wounds inflicted. The wounds received in modern war- fare differ materially in character from those inflicted in olden times. In a table showing the force and velocity of certain moving bodies, the common musket ball is set down as moving at the rate of 850 miles per hour; the rifle ball 1,000; the 24 pound cannon shot at 1,600 miles per hour. The musket ball could not be depended on to hit an object beyond 80 yards, the ordinary rifle 250 yards; while the present Enfield rifle is sighted to hit an object at 900, and the short Enfield at 1,100 yards. The effects of these different rates of velocity are observed in the character of wounds inflicted ; thus, a cannon ball, which, with but a slight velocity of motion added to its weight, would knock a man over; at rapid speed will carry away a limb without disturbing the general equilibrium of the body. A musket ball, that would be arrested in its course half-way through a limb, is now replaced by a bullet which at the same distance will pass through several bodies in succession. This increased velocity produces its effects in two ways : first, by the greater destruction of tissues in the track of the projectile; second by the greater disturbance of the nervous system. The portions of the body traversed by a ball with this increased velocity are so shocked and contused, and the vital tissues so impaired, that healing by the first intention is exceedingly rare. Instances are given where gun-shot wounds have healed by the first intention,, but these cases I think, are those wounds, that have been produced by the bullet becoming flat- tened or its edges jagged by coming in contact with some hard substance previous to the injury inflicted upon the body. I have seen a few instances of this kind during my army experience, but these wounds are very different from the inju- ries inflicted by rifle balls under ordinary circumstances. GUNSHOT-WOUNDS. 779 The splitting and destructive effect of conoidal balls on the shafts of the long bones of the extremities, were abundantly witnessed, during the war of the late rebellion. The old round balls, partly from their form, partly from the imperfect mechanism of the gun itself, with the corresponding dimin- ished velocity, on hitting bones, either deflected in their course or broke away a part of the shaft without further in- jury ; or, having broken through the shell of the bone, would be found imbedded in its cancellated structure, or be " planed" without penetrating its substance. The modern conoidal ball is made denser by mechanical pressure and, with its wedge-shaped end, possesses greater power of penetrating the tissues than the old fashioned moulded ball. This is abundantly proved by the injuries inflicted by the Enfield, Whitworth and Minnie rifles during the late American war. Both the records of the surgeon general's office and private collections gathered during the great war of the Re- bellion show that the Minnie ball is rarely deflected in its passage through the body; and even when the ball has been very much battered, it has been known to pass through the largest bones ; and with a lesser degree of momentum to bury itself in the cancellated structure rather than be turned aside by the object. The conoidal bullet seemes to penetrate with both an onward and a spiral motion, by which its destructive power is largely increased. La to of Missiles.-First, the greater the velocity of the pro- jectile, the greater is the danger to life; second, the swifter the bullet, the more direct is its course through the body; (hence, the greater danger of wounds of viscera and other important parts from balls received at close quarters); third, the slower the momentum of a ball, the more apt it will be to splinter the bone struck ; forth, free and primary hemorrhage is more frequent from wounds made by swift, than slow balls; the latter being more frequently followed by secondary he- morrhage ; fifth, a slow round ball, striking a bone without sufficient force to splinter it, is apt to be " planed" upon it; while a swift, round ball, striking against a sharp angle or crest of bone will often be split in two, each portion pursuing 780 world's IIOMCEOPATIIIC CONVENTION. a different course. A ball penetrating the soft structures always produces a contused wound; and from the resistance experienced at the point of entrance, the contusion is more marked than at the point of exit. In consequence of the con- traction of the surrounding structures, the orifice of entrance is smaller, and more contused and depressed from without inward, while that of the point of exit is large, ragged, everted, and irregular in its appearance ; looking more like a lacerated wound. Mr. Guthrie explains these differences as due, partly to the momentum of the ball and partly to the resistance afforded by the soft structures. If the bullet strike the object, immediately following its discharge and when at the maximum of its velocity, the opening made will be small, round and con- tused, the parts appearing to be separated rather than divided. If it pass through soft structure only, its degree of momentum being but little opposed, the point of exit will differ slightly from that of entrance. If, however, the ball is opposed in its pasage by any hard substance, such as bone, ligament or car- tilage, its velocity being lessened, the aperture of exit will be large, ragged and irregular. The point of entrance in all bullet wounds is actually smaller than that of the ball produ- cing it, if made when the ball is flying with full velocity; becoming larger and more irregular in proportion to the di- minished velocity of the missile. The size of the missile inflicting the ■wound exercises consi- derabie influence on the character as well as the appearance of wounds; the larger the missile the greater the destruction of the structures, and vice versa. Chained cannon-shot and dou- ble-bullets were introduced into warfare during the Franco- Russian campaign; but the injuries inflicted by them, if any, have not been made a subject of especial comment. Dr. M. Schrive, in his "History of the Eastern Campaign" notices the fact that incendiary bullets, consisting of a small cylinder of copper, containing a quantity of detonating powder and made up in the form of an ordinary cartridge, wereused by the Rus- sians against their foes. The object of the missile was to explode as soon it had entered the person, thereby inflicting a very serious and dangerous wound. " It was after the siege," GUNS IIOT-WOU N D S. 781 Dr. Schrive remarks, "that these bullets were discovered, and certain wounds of a violent and frightful character accounted for." Balls containing certain poisons, and others charged with detonating powder, are said to have been employed by the Southern army during the war of the liebellion ; but the most scrutinizing search on my part and on that of others connected with me, failed to discover any evidences of such missiles having been used. As the result of extensive lesions made by such missiles, death must take place immediately ; or else the mo t violent and ungovernable gangrenous inflammation must ensue, imposing upon the surgeon amputation as the only alternative. Spent Balls.-In connection with the preceding paragraphs it is proper to notice the effects upon the system of what are termed " spent balls," or projectiles of various weights moving with diminished velocity. After the momentum of a cannon- ball has been so diminished that it falls to the ground, it may, if uninterrupted, roll upon the surface of the earth at a speed a little grater than a man's ordinary walk. Striking an object at this time, it may produce a serious injury even to an extent demanding amputation, if the part struck should, perchance, be a foot or a leg. I was a witness of a severe injury of this character inflicted upon a private in one of the Missouri regi- ments. In a spirit of bravado, he attempted to stop one of these partly spent balls by interposing his foot against its on- ward movement; and lost his leg in consequence. Coming in contact with other portions of the body, a ball of this kind may inflict severe injuries to internal organs ; the surface not show- ing any evidence of external injury sufficient to account few.' the damage done within. In the same manner, though without sufficient velocity to carry away a limb, it may produce exten- sive contusions of the external parts, and cause comminuted fractures of bones. Cannon-balls inflict injuries in two ways. First, they contuse apart without destroying the integuity of the skin; tne ball strikes obliquely, or roils over the surface of the body, completely pulpfying muscles and lacerating vessels and nerves; laying open large joints, and literally 782 world's iiomceopathic convention. mashing bones; and yet, owing to its elasticity, the skin is hardly bruised. By the older writers this was ascribed to what they termed " windage of balls," or the action of a current of air set in motion by the projectile. Second, cannon-balls coming in contact with a limb or portion of the body, carry away all the soft structures before it, tearing and lacerating them and in- flicting the most frightful injuries. This so called "windage of balls" is purely mythical; as is proved by the fact, that during the different naval and military conflicts in the late Rebellion, I have known pieces of dress, parts of accoutrements, buttons, and even portions of the body to be taken away by balls, in rapid motion, without any serious injury being done to the structures beneath. A memorable instance of this kind was witnessed by the writer during the naval and land attack on Syayne's Bluff in 1863. Captain Groyn, commander of the U. S. gun-boat, Benton, while engaging the enemy's batte- ries, received a -wound from a cannon-ball which struck the chest obliquely, and passing onward, carried away the skin and subjacent tissues; even exposing the ribs. This gallant and meritorious young officer lived several days after the injury, and died from the secondary and remote effects of the wounds. Even hair from the head has been shaven off, and portions of the nose and ear have been carried away without any injury to the structures lying beneath or in close proximity, Lodgement of Balls.-Diminished rate of velocity tends to the lodgement in the body of all kinds of projectiles. During the employment of the old fashioned round bullet, lodgement of balls was of frequent occurrence, owing to their small ve- k>city, and their liability to be deflected from a direct course and to be checked by interposing obstacles. Conoidal bullets lodge only when their momentum has been nearly expended before entering the body ; or, from the peculiarity in the posture of the individual wounded. A ball having had force enough to traverse a limb, may afterwards enter into another part of the body and lodge. A ball may penetrate so deep into the muscles, and lie so far from its point of entrance that the surgeon is, either unable to disclose its position, or, finding GUNSHOT-WOUNDS. 783 it, is fearful that in extricating it he may inflict greater dam- age on important parts. In case of lodgement of balls the effects will be either grave or otherwise ; depending, as I have before remarked, upon the site or position of the offending object. Sometimes the "lodged balls " give rise to inflamma- tory trouble, and the formation of abscesses, which will open from time to time, and again heal, until the offending material approaches so near the surface, that it may be extracted with- out much difficulty. Symptoms of Gunshot-Wounds.-Having discussed the Qualities of missiles by which gunshot-wounds are inflicted, I shall now consider the characteristic features and symptoms of the wounds themselves. The symptoms of this variety of wounds are of two kinds, local and constitutional. The local symptoms reflect the condition of lacerated and contused wounds. The leading characteristics are, much tearing and stretching of the tissues, and very often considerable laceration of the soft structures. When a cannon-ball strikes the body in a direct line, it carries away all that is before it. If the head, chest or abdomen be the part struck, an opening is made into it corresponding to the size of the ball; the internal organs are broken and scattered in every direction, and life is extin- guished at once. If it be a part of an extremity which is re- moved, the stump will be found pulpified, contused, and min- ute particles of bone seen buried in the fleshy portions; the end remaining attached to the body swinging uselessly. In a wound by ricochet^ or when the velocity of the projectile is partially expended, the portion struck may likewise be carried away, but the laceration of the structures will be even greater than in the first instance. Muscles will be detached from each other, and their denuded portions appear flabby, with impaired vitality ; spicules of bone will be found attached to the broken surface, and the shaft may be shattered and split far above the line of its transverse division. If the momentum be still fur- ther diminished so as to approach the condition of a spent ball, the part struck may still be carried away, but the external ap- pearances will be limited to extensive contusion and laceration of the soft structures, or great tumefaction and ecchymosis 784 wobld's homoeopathic convention. without rupture of the surface. When a cannon-hall strikes in a slanting direction, the external appearance of the parts will resemble that last described, modified of course by the degree of obliquity with which the partis struck. Fragments of shells and splinters of wood, when forcibly impinging upon the body, produce great separation and laceration of the living tissues, but do not grind and pulpify them as in the case of the round ball. Small missiles upon penetrating the body leave an opening similar to that of ordinary shot, varying, of course, according to the form and velocity of the projectile inflicting the wound. Pain.-Pain consequent upon gunshot in juries is greater or less according to circumstances. In some cases it may be en- tirely absent, the person, although severely injured, being un- conscious of the wound until some minutes after its infliction. It is characteristic of this class of wounds that the amount of pain is not commensurate with the degree of violence done to the parts ; but rather dependent on constitutional peculiarities. I have frequently seen soldiers wounded in various parts of the body, entirely unconscious of their injury and fighting on as if nothing unusual had happened, until they were either overcome by the loss of blood, or had attention called to their condition by a comrade. Wrought to the highest pitch of ex- citement, amid the whirl of events and the continuous din of battle, I have seen some pushing forward, thoughtless of dan- ger and fearless of death, oblivious to injury, and unconscious of their wounded condition ; while others would falter and fall without a scratch, and imagine themselves severely and even mortally wounded. A remarkable instance of this latter kind, showing the impressionable character of some persons, and the powerful effect of the imagination, occurred during the charge of the Government troops upon the rebel batteries at Chickasaw Bayou, in December, 1862; when a young and gallant staff-officer was carried from the field in consequence of an alleged injury to his leg. Arriving at the Brigade Field Hospital, under my charge, he was laid upon a mattress, and an attendant was ordered to strip off his clothing, boots, etc., that the injury might be exposed. Immediate and careful GUNSHOT-WOUNDS. 785 search was made for the worind, but not the slightest abrasion appeared on any part of the body. Mortified beyond de- scription at his self-delusion, the young man hastily rose to his feet, and mounting his horse rode away to the front. When pain attends a gunshot-wound, it is of a dead and aching kind ; and differs essentially from the pain which accompanies either incised or punctured injuries; it is only severe when a con- siderable nerve is divided, and then it assumes a sharp, prick- ing character followed by numbness and perhaps paralysis of that part of the body supplied by the nerve. Thus, division of the sciatic nerve in gunshot-wounds of the thigh, produces loss of both motion and sensation of the distal parts, attended with coldness of the limb. But the pain, which may have been slight at the reception of the injury, becomes intensely aggravated after the inflammatory symptoms have set in. Ilwnorrliacje.-As a rule, haemorrhage is not excessive in gunshot-wounds, norat all in proportion to the severity of the injury. The tissues immediately connected with the track of the ball, are usually so much contused and their vital force so much shocked as to prevent the flow of blood from the smaller vessels. If a vessel of considerable size is partially divided the haemorrhage will be extensive ; but, if the vessel is cut entirely across, the flow of blood is very much diminished, in conse- quence of the vessel retracting within its sheath. In the former case the blood flows freely, and though it may be tem- porarily arrested by the clot, which forms during syncope ; as soon as reaction takes place the clot will be washed away, the haemorrhage again returns and so continues until prevented by mechanical means, or life is extinct from loss of blood. In the case of a vessel being entirely cut through, little or no haemorrhage occurs at the time of the injury, but subsequently takes place when reaction sets in or the clot is washed away by other causes. But, while primary haemorrhage is rare in this variety of wounds, secondary haemorrhage is exceedingly commorf. The lacerated and contused condition of the in jured structures is prolific of inflammation and its consequences, which, under the ulcerative process, sequestrates the injured 786 world's homoeopathic convention. structures, opening the vessels lying in its track, and haemor- rhage of greater or less magnitude is the result. A period of greatest danger in these wounds is when the sloughs begin to separate, which continues from the twelfth to the twentieth day. Previous to this time it is often impossible to ascertain the precise extent of the disorganization. Afterward the pa- tient, if his limb be saved, may have to undergo the long and tedious process of exfoliation of dead bone, thereby incurring the risk of intercurrent attacks of erysipelas, hospital gan- grene and visceral complications. Symptoms.-When an important viscus is wounded, a limb suddenly shattered, or a cavity penetrated by a flying missile, the symptoms by which the system is affected by the injury are called " shock." The sufferer trembles, is pale and faint, and perhaps vomits. The features are shrunken, expressive of in- tense anxiety and distress. At times this " shock " is slight, even under serious injury; while in other cases it is dispropor- tionate to the amount of injury; stout and vigorous persons often swooning away from the most insignificant wound. Whatever is the cause of this difference in the morale of dif- ferent persons, it is certainly true that many live in spite of the most severe injuries ; while others die from comparatively slight and unimportant wounds. Temperament and idiosyncrasy exercise, no doubt, great weight in the production of these phenomena, and should modify largely the prognosis in the case. It is said that veteran soldiers upon the field of battle (other things being equal) suffer much less nervous trepidation on account of their injuries than raw and inexperienced troops. This does not correspond with observations made during my connection with the army during the Rebellion. For exam- ple, in the attack upon the rebel batteries at Chickasaw Bayou, General F. B. Blair's brigade, of which I was senior medical officer, composed almost entirely of raw levies, was ordered to lead the charge. The slaughter was immense, and, as a rule, the wounded, inexperienced, volunteers did fully as well under their wounds, and convalesced as well as the oldest veterans or regulars in the service. Other constitutional symptoms GUNSHOT-WOUNDS. 787 will supervene during treatment due to other causes, such as loss of blood, exhausting discharges, local irritation, insomnia, imperfect diet, etc.,etc. Prognosis.-The prognosis of gun-shot wounds should be made with extreme caution and judgment; more especially when the shock is severe, or there is reason to fear that deep- seated parts are involved, inducing serious constitutional com- plications. The character of the wound, the form of the mis- sile producing it, the constitutional status, previous service and past diseases of the patient; his temperament, idiosyncrasy, age and time elapsed since the injury, should be considered and carefully weighed before pronouncing final judgment upon the termination of the case. The mortality succeeding gun- shot wounds depends less upon the direct effects of the injury received, than upon the subsequent complications; such as secon- dary hemorrhage, gangrene, erysipelas, hectic fever, tetanus, pyaemia, and the results of operations required as consequences of the original wound. J/ C ianical Treatment.-It is impossible, in the limited space allowed for a monograph of this character, to do more than to sketch those general principles of treatment, that attach to gunshot-wounds, and the consequences that ensue from such injuries. The first thing to be accomplished after injury of this kind, is relief of " shock" by the use of those agents which tend to support the vital powers in their endeavor to overcome the deleterious impression made upon them. This is called reaction and is induced by-placing the patient in a horizontal position, dashing cold water on the face, applying Ammonia, or other stimulating: agents to the nose, briskly rubbing the limbs and chest with rubefacients, stimulating injections thrown up the rectum and internal use of those remedies that support the impaired nerve power. If internal haemorrhage occur, those means should rather be employed that favor the formation of a clot, than those which excite the arterial system to increased ac- tion ; as the increased flow of blood through the vessel washes away the clot and induces internal haemorrhage. In such a case the patient should be placed upon his back, stimulants interdic- ted and either of the following remedies given according to its 788 world's iiomceopathic convention. pathogenesis : Aeon., China, Erigeron, Ilamamelis, Secale cor., Ipecacuanha. The treatment of soldiers in the field, whenever circumstances admit, should consist of the use of such necessary surgical appliances and temporary dressings as may be required before they are removed to the Kegimental or General Field Hospitals in the rear. A little attention to provisional dress- ings, and a few judicious directions to the attendants, while transporting them to the rear may avert serious complications in various ways. In the open field and near the scene of con- flict, but far enough removed from danger both to the surgeon 7 o o o and patient, are what are called the " first lines of surgical assistance," where assistant surgeons are placed, to be ready at all times to render such assistance to the wounded as their in- juries require. < In the British service and during siege operations, shot-proof coverings, constructed in the trenches, are placed at fixed points, where the wounded are received for the first examination and dressings, before they are conveyed to the hospitals in the rear. The French troops, in lieu of this service, employ flying field- hospitals {ambulances volantes} stationed at selected spots near the scene of the conflict to perform the like duties. When the wounded arrive at the field-hospital, the surgeons in attend- ance should be prepared to take immediate charge ; to examine carefully each wound, to remove all foreign bodies which may have lodged there; to adjust the edges of the wound accurately and neatly and to apply the necessary dressings. The diagnosis should be made- out as clearly as possible, after the arrival of the patient at the field-hospital; all the attention required for his comfort and safety should be given at this time; the injuries should be carefully examined ; the garments scrutinized to ascertain if any portion has been driven into the wound ; and the required dressings be prepared for service. In all gunshot-wounds the best and most reliable instrument for a thorough and complete examination is the finger of the surgeon. Exploration by this means establishes the direction of the wound ; and, if a bone be fractured, the extent, shape, position, number and degree of looseness of the fragments can GUNSHOT-WOUNDS. 789 be more easily ascertained than by any other known process. If foreign bodies occupy the internal part of a wound, the finger will detect their quality, size and depth within. If the wound is so deep that it cannot be reached by the finger, pressing the soft parts with the other hand towards the explor- ing finger will often facilitate the examination. If the finger should fail, the best substitute is a long silver probe, that can be readily bent if required, the better to adapt it to the irregularities of the wound; or, the bullet detector of Dr. Wilder. Elastic bougies and catheters have been employed by a few surgeons, but in my opinion they are inferior to the probe. As soon as the lodgement of a ball or missile has been ascertained it should be removed ; and either of the following instruments may be employed for the purpose: Coxeter's extractor, Kolbe's bullet extractor, or the bullet forceps (of which there are a variety of styles and patterns.) In certain cases I have employed the ordinary dressing forceps for extracting bullets, when all other instruments failed. In all deep seated wounds, caution must be employed for fear of injuring vessels or nerves which have escaped injury from the penetrating missile. In removing slugs, fragments of shell, planed balls and such like objects, it is necessary to enlarge the wound for the ready exit of the offending materials. When it happens that a foreign body has penetrated only a small distance from the surface, and is felt lying under the integument, an incision may be made over the object to secure its removal, firmly holding it in situ before making the opening. If balls are im- pacted in bone, as may happen in the extremities of the long bones or in the bones of the pelvis, it is just as important that they be removed as those occupying the soft structures; although it is a well ascertained fact, that bullets have lodged in bones without producing any more serious inconvenience than ab- scesses and fistulous tracks. If the lodgement is superficial it can be extracted by means of a steel elevator; but, if the im- paction be deep-seated, the " tire-fond screw " or " lever " sharp pointed bullet forceps, may be called into requisition. It should be impressed upon the mind of the surgeon, that rude 790 world's iiomceopatiiic convention. manipulations and long continued attempts at extraction are not only unnecessary but absolutely injurious. Whenever gunshot-wounds have been subjected to much rude handling, laceration and disturbance of the tissues in extracting the foreign bodies lodged within, it should be the surgeon's duty to readjust and secure the broken surfaces as promptly and neatly as possible, by the application of strips of adhesive plaster, light pledgets of lint, moistened with the remedy to be locally applied, the adaptation of a roller, and the favorable position of the limb or part of the body wounded. Since pres- sure, weight and warmth are injurious to the process of granu- lation and cicatrization, the coverings should be light and the wounds frequently dressed with lint or charpie saturated with the indicated remedy. Velpeau and other French surgtons strongly advocated the use of linseed-meal poultices in lieu of water dressings. Baudens and Stromeyer extolled the topical application of ice by means of bladders : the dry earth treat- ment, and immersion of the extremity under water and retain- ing it there, have both had their distinguished adherents, but all these auxiliaries "pale their ineffectual fires," before the properly selected homoeopathic remedy. After suppuration has fairly begun, the surgeon should be watchful of the accu- mulation of pus, and guard against the fistulous sinuses and abscesses that threaten the deeper seated portions contiguous to and dependent upon the wound. If much tumefaction occur, or abscesses threaten, free inci- sions should be made for the purpose of drainage; and if the communication between the point of entrance and that of exit be tolerably direct, much benefit will be derived by injecting the sinus with warm water and following this with a solution of Calendula or Hypericum. If offensive odors are emitted from the wound, a few drops of Carbolic acid, Salicylic acid, Permanganate of potash or chlorinated Soda, may be added to the lotion for purposes of disinfection. The efficacious prop- erties attributed to Carbolic acid, beside sits antiseptic powers, of preventing the occurence of erysipelas and hospital gan- grene, so common in wards where many suppurating and sloughing wounds are grouped together, make it a remedy GUNSHOT-WOUNDS. 791 of great value. Cleanliness and ventilation are hygienic re- quisites that should be always insisted upon by the surgeon, in the treatment of such cases; especially in tropical climates and during heat of summer. During such times, flies propa- gate with wonderful rapidity, and depositing their ova in the opening of wounds, generate larvm in great numbers. Dr. Proctor, of Kentucky, describes these insects as one of the greatest evils that the surgeons had to contend against during o o o o the war with Mexico. The same trouble was frequently expe- rienced in the war of the Rebellion. Wounds carefully cleaned and dressed in the morning, were found infested with these parasites the following morning. I have seen them present in wounds in great numbers, and in size equal to a crow-quill and from five to nine lines in length. The wounded view their appearance with no little alarm and horror. I have seen the stoutest hearted soldier sick- en at the sight of these disgusting insects, and appear hopeless- ly willing to yield his life without farther struggle. Sometimes they burrow deep into the tissues, producing great pain and distress. The best preventive of these para- sites is continued and unceasing cleanliness with frequent re- newal of the dressings. Afterward bury the affected part in dry bran. In such cases, I have seen the best effects follow' the employment of a solution of Carbolic acid and Glycerine, or Carbolic acid alone, the maggot quickly disappearing after its application. The strength of the solution employed by me, is one drachm of the acid to one quart of w'ater, wdiich will not only destroy the larv®, but will prevent the flies from depos- iting their ova upon the surfaces moistened W'ith it. Dr. Bumford, of Texas, gives particulars in the case of a patient who perished from the effects of the deposition of these insects in the nasal cavities, w'henee they ascended to the fron- tal sinuses, from wdiich it wras impossible to dislodge them by the best directed means. Dr. Comstock, of St. Louis, has de- rived great benefit, in such cases, from an ointment of Elder- bark, applied to the suppurating surfaces. The custom of enlarging the orifices of gunshot-wounds, so much practised among continental surgeons, and so tenaciously 792 world's homceopathic convention. adhered to by the French, has been of late years almost en- tirely abandoned. A modification of this practice was intro- duced into the Confederate service during the war of the Re- bellion, by Dr. Chishold, of South Carolina. lie pared the edges of the wound in such a way as to convert the opening into a subcutaneous wound, but the practice was not attended with the hoped-for success. This process was subsequently practised by the British surgeons in New Zealand in the recent Maori war, but there it also proved a failure. Local Treatment.-After having extracted all foreign bodies that may be found in the soft structures, and bathed the parts 'well with warm water until they are perfectly cleansed from all impurities, a solution of Hypericum perf. (one ounce to one quart of water) should be applied to the wounded part by means of pledgets of lint or charpie laid upon the surface. In the course of the first twenty-four hours, the injured part be- comes stiff, slightly swelled, tender and a slight inflammatory blush surrounds the open wounds. This continues for a day or two, and is succeeded by suppurative action when, under favorable circumstances the wound heals kindly, after a week or ten days, by granulation or cicatrization. If the case does not progress rapidly enough under the use of the above reme- dy, and the suppuration increases and becomes more diffused, recourse should be had to the use of Calendula ofiicin. of the same strength as the foregoing, and kept constantly applied to the suppurating surfaces. Granulation will now soon take place, the length of time depending upon the strength of the patient's constitution, the exit opening being, as a rule, the first orifice to close. At the period of loosening and separation of the sloughs, there is always especial danger of the supervention of consecutive or secondary haemorrhage. At this time the patient requires to be carefully watched, and, if the wound be in proximity to a great vessel, a tourni- quet should be thrown around the limb loosely, so as to be tightened at a moment's notice. If haemorrhage occurs under these circumstances, the artery should be ligated in the wound if possible ; if not, then in the most convenient situation above it. If this does not arrest it, and all means fail in preventing GUNSHOT-WOUNDS. 793 haemorrhage, amputation is the next sad resource, but should never be done until all justifiable means have been resorted to in vain. When the wound is complicated with unfavorable circum- stances, whether inducing in the patient a condition of asthenia or its reverse, the cure may be protracted for weeks and months under the most skillful and careful management. If erysipe- las should attack the wounded parts, the remedies applicable to that disease should be employed, just as if there were no other complications. For all contused conditions of the sur- face, unattended with division of the dermic structure, Arnica is, par excellence, the best remedy both externally and inter- nally, if there are no systemic symptoms contraindicating its use. Arnica.-The effects of this remedy are most marked and beneficial in those cases of gunshot-wounds when there is ten- dency to great depression, even to extinction of the vital pow- ers. It is especially indicated in the contusions that follow gunshot-injuries ; acting powei fully upon the vegetative sphere it stimulates the weakened and depressed absorbents into in- creased activity, especially when their function is impaired or even suspended by external injury. By virtue of this action, it becomes an important agent of cure in all congestions and low grades of inflammation that are the result of blows, kicks, contusions and sanguineous extravasations that follow injuries of whatever nature. Calendula officinalis.-This is one of the most valuable remedies now known for the treatment of suppurating sur- faces, ulcerations, etc., following gunshot-wounds. It exercises a profoundly curative impression upon the diseased tissues, prevents disintegration and ulceration to a great degree, and assists in expediting the process of granulation and cicatriza- tion. I have employed it, with the most satisfactory results, in a large number of amputations, resections, and ulcerated surfaces, in hospitals and private practice, and in a great many instances perfect union of the divided edges was effected with the least possible suppuration. In some of the most fright- fully lacerated wounds, followed by suppurative action, I have 794 world's homceopathic convention. seen its prompt and beneficial effect; suppuration gradually diminishes and granulation takes place quickly ; strikingly in contrast with the increasing suppuration and slow and tedious process of cure under allopathic medication. I consider it the best and most reliable vulnerarium now in use. It may be administered internally as well as locally, and may be continued under appropriate circumstances until complete and firm cica- trization has taken place. Hypericum perf.-This is another valuable remedy in the treatment of wounds, and it is particularly called for when the parts have been extensively lacerated and torn, with engorge- ment of the capillaries, attended with more or less discharge of bloody serum. It stands in the same relation to laceration of the tissues, that Arnica holds to their contused Condition. As a local application in lacerated wounds, before suppuration has set in, it stands preeminently among the most valuable remedies of the Materia Medica. It acts directly in remov- ing the ill-effects of local shock, prevents, in a great meas- ure, sympathetic irritation of the system from the local de- rangement, and modifies, in a corres} ending degree, the subse- quent inflammation and sloughing. In recent cases and after spasmodic irritation of the capillary system has passed away, a solution of this remedy, composed of one ounce of tincture to ten of water, applied constantly to the injured part has ef- fected the most brilliant results in very severe lacerated wounds. The remedy in the slighter forms of laceration, if applied early, will often entirely arrest and always modify the supervention of ulceration and sloughing. By its use, I have succeeded in preserving the vitality of torn and lacerated tissues, when al- most entirely separated from the body, and, in compound fractures of the feet and hands, with extensive laceration of the soft parts, the Hypericum has produced the most brilliant »results. In a case of compound dislocation of two fingers, with severe laceration and tearing of the external structure, the members being severed except by a narrow bridge of skin uniting them to the body, I succeeded, by the use of this remedy, in completely saving the severed digits; the bones uniting on being replaced and maintained in apposition. I GUNSHOT-WOUNDS. 795 believe that this remedy is destined to become one of our most valued curative remedies in all cases of gunshot-wounds, and if I were compelled to select three remedies for the local dressings of this class of injuries on which solely to rely, I should select the three mentioned above ; and by their use I should be certain of producing better and more satisfactory results than with the whole combined armamentarium of the Allopathic School. This I affirm, after a long and continued use of the remedies, and with a full conviction of their cura- tive powers. Momordica hals.-This remedial agent has been highly ex- tolled by Drs. Hill and Hunt as a valued remedy for lacerated wounds, but whether this recommendation is based on practi- cal observation or theoretical induction, I am not able to- say. I have had little experience in the use of the remedy and can- not, therefore, speak ex cathedra of its sphere of action in thb variety of wounds under consideration. Constitutional Treatment.-The constitutional treatment of a patient with an ordinary gunshot-wound uncomplicated with any injury to bone or structures of first importance, is simple, and in accordance with the systemic derangements and irrita- tions as they crop out during the existence of the wound. The surgeon should place his patient under the most favorable circumstances and surroundings; and the temperature of the apartment should be kept as nearly as possible at a uniform standard. Regard should be paid to ventilation ; cleanliness should be observed, and attention given to his diet, and to the regular discharge of excrementitious substances as well as the avoidance of all irregular habits tending to excite febrile dis- turbance or aggravate local inflammation. The diet should be plain and nutritious, but not stimulating. If a tendency to stiffness exists in the limb, or contractions of the extremities be observed, they should be carefully and gradually overcome by passive motion employed from day to day at regular hours; also, frictions with the hand or rubbings with stimulating ap- plications, will be found of service. A favorite remedy among French surgeons, in wounds threatening an unhealthy appear- ance, is a lotion composed of thirty drops of the Perchloride 796 world's homeopathic convention. of iron to six times the amount of water. Combined with the local measures mentioned above, due attention must be given to all constitutional symptoms as they occur. Aconite.-If the subsequent fever be frank and high, with full, bounding pulse, dry and hot'skin, with restlessness and thirst, Aconite takes the place of both local and general bleeding, without the deleterious consequences of either, cur- ing the inflammation " without going out of our way to pro- duce debility, and thus favor the occurrence of toxicmmia." It is generally the first remedy indicated in true inflamma- tory excitement, whether the inflammation is located in the coverings of the brain, the mucous or serous tissues, the mus- cular or glandular system, or the nobler organs in the three great cavities of the body. Its use is to restore "'the capillary equilibrium, and calm the nervous excitability, thereby pro- ducing resolution of the inflammatory process. Its action is primarily upon the cerebellum and the terminal ramifications of the cranial, spinal and sympathetic nerves, interwoven in the capillary tissue. It unloads the contracted, torpid or semi- paralyzed capillaries, which give rise to acute congestion or in- flammation, and directs the blood onward in its course, thus giving freedom to the general circulation. " I have repeatedly felt justified," says Diez, "in declaring that Aconite is a uni- versal anti-phlogistic, and corresponds to the first stage of in- flammation." As a remedy for such, it holds the foremost rank of all medicinal agents which have been proved up to the present. It not omy supplies the place of all the anti-phlogistic remedies of the Allopathic School, but it is far superior to them all, as well in certainty of result, as in harmlessness in action. Belladonna, Apis or Cantharis may be employed against the invasion of erysipelas, which will be indicated by chills, flashes of fever, headache, quick pulse and a simultaneous dry- ing up of the secretions, the margins of the wound becoming slightly swollen and of a reddish tinge. Merc. sol. should be given whenever there is danger of the formation of an abscess; and Ilepar sulph. or Silic., whenever GUNSHOT-WOUNDS. 797 the abscess has been formed, to facilitate its pointing, which should be opened as soon as fluctuation is felt. If the sur- rounding integument assumes a dark red or bluish appearance, with an (edematous condition of the adjacent tissues, Arsen, or Lachesis will be demanded. Baryta and Conium will be found useful whenever induration takes place around the borders or within the deep tissues of the abscess. As soon as suppura- tion becomes fairly established, the diet should be generous. Sherry and other wines may be given, if used judiciously, and the patient's strength be sustained by the best directed efforts of the surgeon. If chills and fever supervene, with great rest- lessness, prostration, burning pains, sweats, etc., Arsenicum should be given and continued until amelioration takes place, when some other remedy may be substituted. Arsenic, and Lachesis are invariably indicated upon the supervention of gangrene. Kuta is useful in injuries of the periosteum, tarsal or carpal joints. Asafoetida, Mezereum, and especially Sym- phytum, are useful in those cases where the bones are affected. Belladonna, Rhus tox. or Bryonia will assist materially when typhoid symptoms are present; also in delirium and in sub- acute inflammation of the brain and its membranes. In fact, whatever complications arise during the treatment of these wounds, they must be overcome by the indicated remedy, the same as if the derangement or disease was of first considera- tion. Gelseminum.-This is a remedy of great curative power in inflammatory affections of a sthenic type, complicated with biliary derangements. In simple irritative fever following gunshot-wounds it is more competent to relieve the accompa- nying phenomena than Aconite; and, in such cases, challenges the attention of the surgeon. It corresponds with excessive nervous irritation, tendency to irregular convulsive action, periods of wakefulness, with nervous prostration and acces- sions of feverish stupor. In the endemic diseases of the Mis- sissippi Valley, and in irritative fevers following wounds and injuries of various kinds, it acts promptly and efficaciously, quieting nervous irritation and excitement, equalizing the cir- culation, promoting perspiration and rectifying the various secretions, without causing nausea, vomiting or purging. 798 world's homoeopathic convention. Veratrum vir.-This remedy exercises a powerful impres- sion on the nervous centres and, through them, upon the great centre of circulation, resembling in its action the impression made by Aconite. Dr. Cauniff says that " it is a powerful anti- phlogistic, that it acts upon the heart promptly and powerfully, producing coolness of the skin with moisture, in a very short time." In pneumonia and pleurisy following gunshot-wounds, I have found it an excellent remedy, arresting the inflamma- tory action Quickly, and saving the lungs from the more severe consequences of the second stage or that of red hepatization. In diseases of the brain assuming a congestive type, and in all plethoric conditions when there is a tendency to organic lesion of the organ attacked, it is one of the most reliable and efli- cient remedies of our School. < Arsenicum.-This remedy is indicated more frequently in the secondary affections following gunshot-wounds, or in those adynamic conditions that are sometimes the result of surgical operations. It corresponds more closely to those adynamic char- acteristics of the system in which the vital organs are more deeply affected by the morbid process, and when there exists a manifest tendency to the formation of sores and petechice, •with evident tendency to decomposition. In asthenic inflam- mations of a malignant type, tending to disorganization with vital prostration, and a predisposition to terminate in erysipe- latous, gangrenous or cancerous affections, this is a potent and reliable remedy, and in these diseases following gunshot- wounds, I have derived from it the greatest amount of benefit. Belladonna is especially demanded in persons of a plethoric nature, with tendency to congestions of blood to the head, lungs, or abdomen. It seems to act primarily upon the cere- bro-spinal system of nerves, and secondarily upon the vascular system. In typhoid fevers following surgical operations, gun- shot-wounds or injuries of whatever kind, where congestive symptoms predominate, it is a remedy in especial favor. In erysipelatous inflammation consequent upon gunshot-wounds, especially when it is disposed to invade the inner tissues, or where it attacks the face and spreads to the head inducing in- flammation of the cerebrum and its envelopes, it is a prominent remedy. GUNSHOT-WOUNDS. 799 The great Liston, in relating the treatment of a case of ery- sipelas, says : " W.e subdued the fever with Aconite, and then administered the Extract of Belladonna, and in twenty-four hours the disease had quite disappeared." And ho adds: " How this effect is produced we cannot say, but it seems to act like magic, and as long as we benefit our patients we have no right to condemn the principles upon which this treatment is recom- mended and pursued." .Baptista tinct. is indicated in those gunshot-wounds where secondary complications ensue, or where there is an adynamic type or condition as in typhoid and those low grades of fever that follow wounds. "Applied in the form of a lotion," says Hale, "to ulcers, mucous surfaces, etc., where there is a ten- dency to putrescence of the fluids and solids, gangrene, fetid discharges, it is said to correct the conditions in a very prompt manner." In affections of the glandular system, scrofulous and mercurial ulcers, erysipelatous degenerations, that may occur in the train of treatment of gunshot-wounds, it is a valu- able addition to the Materia Medica. Bryonia alba is a remedy of remarkable efficiency in many of the diseases incident to gunshot-wounds, especially in those conditions that occupy an intermediate position between in- flammation and nervous irritation. It is especially curative in hypersemia of serous and mucous membranes; in affections where resorption is required, such as typhoid infiltrations, ser- ous effusions and sanguineous exudations. In those tearing and lacerating pains greatly increased by motion and aggra- vated at night it is particularly indicated. Chiniiium sulph. is often of value in periodic diseases fol- lowing gunshot-injuries, or the surgical operations required in their treatment, miasmatic diseases, cerebral congestions which assume a paroxysmal tendency, disturbances of the special senses, and depression of the vascular system, constitute im- portant indications for its use. llepar sulp/t. is more specially indicated in the secondary conditions that crop out in the treatment of gunshot-injuries. It is of primary importance in all those conditions wherein suppuration threatens or the formation of abscesses are appre- hended. 800 world's homoeopathic convention. Calcarea carb, is valuable in all those affections bclon"ins< to a scrofulous degeneration, such as scrofulous ulcers follow- ing gunshot-wounds, wherein the powers of life are depressed in consequence of the constitutional effect of the injury, in psoas abscess, ulcerations of the joints, and during the reunion of bones, in fractures and injuries when the conservative pro- cess is relied upon in the treatment of the case. Sllicea is preferable to the former remedy in affections of the bones, and where there exists a tendency to glandular swellings in consequence of a scrofulous diathesis. It pos- sesses an extraordinary control over suppurative processes, hastens the maturing of abscesses when desired, and certainly reduces suppuration to moderate limits. Symphytum.-In all diseases of bohe following gunshot- wounds, especially after the acute stage has passed away, where there exists an impairment of nerve-power, or debility from any cause, keeping up a retardation of the reparative process, there is no remedy of which I have any knowledge, that compares with Symphytum. It has accomplished in my hands the most beneficial results in assisting the reparative process, causing proliferation of cells and the rapid formation of the constructive process. These are a few of the more important remedies applicable to the treatment of gunshot-wounds; others may be called into requisition, depending, of course, upon the various diseased conditions that may arise during the treatment of the case, each of which must be combatted and controlled by the appro- priate similimum. Surgical Interference.-On this occasion I shall not enter into the comparative advantages of primary as compared with secondary amputations in gunshot-wounds. I would refer the reader to quite a lengthened review of this subject in my treat- ise on the "Science and Art of Surgery," vol. i., p. 119, en- titled "Primary and Secondary Amputations considered." For a long time the opinion has been held that primary am- putations should not be performed until the first inflammation has passed away, but the experience of late years has proved this position to be untenable. GUNSHOT-WOUNDS. 801 The great success of primary amputations seems to depend upon the following conditions: 1. That a mangled and con- tused limb is a constant source of accumulative irritation, and the sooner it is dispensed with the better for the patient; 2. The excitement of battle lends courage to the sufferer in the primary operation, and makes him the better able to bear the early amputation, while the influences that associate themselves with hospital life, are depressing and injurious; 3. The opera- tion removes a continual source of dread and suffering, that must produce its moral effect upon the patient so long as it is impending; 4. Anaesthesia acts more promptly and benefi- cently in the earlier than in the later period of gunshot-wounds. Recent and extensive observations in foreign wars as well as during the war of the Rebellion, have established the fact that primary amputations, as a rule, promise better results than the secondary. Dr. Scrive, in recording the experience of the French army in the Crimea, shows that primary exceed- ed by two-thirds secondary amputations. During my connec- tion with the United States service in the war of the Rebel- lion, especially in the latter part of it, I acted on the principle, that the sooner, after injury, amputation is performed, the better, ceteris paribus, is the chance for recovery. Whenever I could get ready access to the severely wounded requiring surgical interference, even amid the din of battle, my judg- ment led me to believe that immediate operation gave the greatest hope of success. 1 therefore operated at once, using the period of shock, or Nature's anaesthesia, as the most oppor- tune time for surgical relief, without waiting for the period of reaction upon which so much stress is laid by many writers. The best results, as a rule, followed where the operations were performed before the commencement of reaction from the shock of injury. I have operated scores of times during my army service, after waiting for arterial reaction and the ad- ministration of anaesthetics; but I always observed in such cases that the recovery was slower and less certain, than the like operation performed during the period of Nature's shock (wide the author's " Science and Art of Surgery, vol. i., p. 720, et seq.}. 802 world's nOMCEOPATIIIC CONVENTION. During active operations in tlie field, when it becomes ne- cessary to transport the wounded some distance, it is abso- lutely imperative that the surgeon should make all necessary amputations immediately as the surest means of preserving the lives of his patients. The consequences of gunshot-injuries depend in a great de- gree upon the severity and extent of the wound, the nature and importance of the structures affected, the judicious man- agement of the cas'e in the first stage and the constitutional vigor of the patient. Among the most prominent of the dis- eases consequent upon this class of injuries may be specified: erysipelas, inflammation of particular structures, mortification, gangrene, pymmia, fistula, paralysis, tetanus, pneumonia, pha- gedena, hernia, etc., etc. HOMEOPATHIC TREATMENT OF SYPHILIS. J. II. McClelland, M. D., Pittsburgh, Pa. The requirements of my appointment confine me to a con- sideration of the treatment of syphilis, and that only in ac- cordance with the principles and practice of homoeopathy; but fortunately this restriction will not deprive us of the very best methods and means of combatting this much dreaded dis- order. While, as homoeopathists, we do not doubt the curability of this affection, per se, as do some excellent Old. School authori- ties, nevertheless, it is proper not to be over sanguine in regard to the rapid and complete eradication of the disease in all cases. It is well to realize the true character of true syphilis; to have in mind that the chancroid or soft chancre, however it resemble the true indurated chancre, is merely a local sore, and is not followed by constitutional symptoms, except as the absorption of its degenerated pus may produce certain non- specific effects on the system. Hence the cure of such an ul- cer, by whatever means, really amounts to nothing. We should recognize that the development of true syphilis from the indurated (Hunterian) chancre, with its periods of latency and activity, is exceedingly deceptive. For one may adminis- ter a remedy to a given case, and, in the course of two or three weeks witness, with satisfaction, the disappearance of the chancre and regard it as cured. If the case pass from his ob- servation he remains of this opinion ; but it is probable that, in the course of six weeks or six months, the symmetrical mani- 803 804 world's iiomceopathic convention. festations of secondary syphilis appear. These may, in turn, disappear in a few months, and the practitioner may feel sure of having cured his case; but this very case in one, two or twenty years may develop unmistakable evidences of tertiary sequelae. I refer to this because all of this may occur with treatment, and it has occurred just as I have described without any treatment whatever. It behooves us, therefore, not only to exercise caution in affirming a cure, but to use the greatest circumspection in the choice of a remedy into whose keeping, as it were, we commit the well-being of such patients. If it be a question as to whether a chancre shall be cauterized (I speak of the hard chancre, with which we have to do in this paper), I would suggest as not only theoretically correct, but as having the sanction of many able syphilographers, that, as the chancre is entirely analogous to the vaccine vesicle, its de- struction would bear the same relation to the development of secondary symptoms as a similar disposal of the vaccine vesi- cle would to the impression that had been made upon the sys- tem by vaccination. It is clearly immaterial, as to subsequent developments, whether the chancre be cauterized or not. On the one hand, it may change an unhealthy ulcer into a healthy, healing one (and perhaps prevent the absorption of some vi- tiated pus), while on the other, it takes away one of the means of judging of the effects of medication. On the whole, I think it preferable not to molest the chancre save as necessary to cleanliness. Regarding syphilis as a zymotic disease-a true exanthe- matic fever-many have questioned the advantage to be de- rived from any treatment of the primary sore whatever, or that any treatment would modify the secondary manifestations which develop in due course. Homoeopathists will, however, look upon such reasoning as fallacious, and contrary to experi- ence. Good practice and sound judgment will require the ad- ministration of the specific remedy without delay. THE REMEDIES. With singular unanimity, all Schools-and times - have fixed upon one drug as the great anti-sypkiliticum. BOMCEOPATHIC TREATMENT OF SYPHILIS. 805 In the light of homoeopathy this is no wonder. It is not by chance or arbitrary selection that Mercury occupies this position; but, by virtue of its specific relation to the com- plaint ; by virtue of its being one of the few known medicines having the inherent power of inducing-in all their phases- conditions similar to those produced in the human body by the syphilitic virus. It is properly objected that no one medicine suits all cases of a so-called disease. In the Mercurius, fortunately, we pos- sess a drug having the central quality necessary to a corre- spondence with the essential nature of syphilis, differing in its various preparations just enough to satisfy our inexorable law, which demands a correspondence also in the minute differ- ences which characterize individual cases. It is this variety in unity, possessed in so remarkable a de- gree by this drug, which renders it suitable for so large a pro- portion of cases; but, in a given case of syphilis, as in any other disease, should it occur that another drug presents, in its pathogenesis, a greater similarity, it should be preferred, and would doubtless effect the cure. In view of the above, the great efforts of the syphilographer will be directed to the task of individualizing the various pre- parations of Mercury. This done, the main difficulties in the treatment of syphilis will have been overcome. THE DOSE. In no disease, and with no drug, is the question of dose more important. The majority of our School prefer the low- est triturations of Mercury, and, as compared with the doses hitherto employed by the Old School, the amount used cannot be called large. 1 venture the opinion, however, that many cases treated even by our School, are injured and rendered more protracted by excessive medication. Nor will this ap- pear improbable when it is remembered that repeated doses as small as the thirty-second of a grain of the bichloride are known to have produced mercurialization. We must consider further, that, by our process of trituration, this mineral ac quires an activity noc possessed by the cruder preparations, 806 world's iiomceopathic convention. which, in large measure, pass out of the system without exert- ing any effect. It is not difficult to understand that repeated doses of the 1st and 2d triturations, when the system is peculiarly obnoxi- ous to their influence, may exert a very pernicious effect. The similarity in the effect of Mercury to that of syphilis is so great that we, as wTell as the Old School, might readily con- found drug symptoms with those manifested in the natural course of the disease. My experience leads me to conclude, that Mercury should seldom or never be nsed low'er than the third trituration, and further, that the primary and some of the secondary symp- toms have yielded more promptly to this preparation than any other. I would not be understood as doubting the efficiency of the higher preparations, for I have had excellent results from the twelfth and thirtieth (especially with Mercur. corr. and Cinnabaris), and even higher; and I have been assured by some most reliable observers that the high potencies have proved perfectly satisfactory in their hands. INDICATIONS FOR MFRCURIUS. The following are some of the indications for the different preparations of Mercury, and I trust the discussion will bring out more clearly and accurately the distinctive indications for this drug as applied to syphilitic diseases. Nor would we ex- clude other drugs, which have been found curative in this affec- tion, from a thorough consideration at this time. JZ reurius sol. (generally preferred to the vivus).-This pre- paration seems accurately adapted to the typical Hunterian chancre, as well as to the developments which follow. Thus we find: Chancre with indurated base and margin ; indura- tion of the inguinal glands. Excessive languor with fever and sweat-which ushers in the secondary symptoms. Erythe- matous and papular eruptions, ulcers in the throat, etc., all of a milder type. The throat at first dry and itching, becomes filled with excessive secretion; the fauces and tonsils are in- flamed, swollen and ulcerous. Mucous tubercles ; small, itch- ing pimples, which ulcerate and become encrusted. Bupia, HOMfEOPATHIC TKEATMENT OF SYPHILIS 807 with violent itching, becoming worse in bed. Excoriated spots which bleed easily. Syphilides, maculae, and, as further developments, unhealthy, brownish skin, with hard swellings (gummata); pains in the bones, with restlessness, worse at night. Exostoses, caries and necrosis. Emaciation, with slow hectic fever-cachexia syphilitica. Swelling and induration of the liver. ^Lercurius corr. sub.-This more active preparation of mer- cury corresponds to a similarly acting syphilitic virus. The chancres are more inflamed and painful. The ulcers have a lardaceous bottom and secrete a thin ichorous pus. The bu- bonic symptoms are more acute, and the secondary manifesta- tions more prompt than usual in making their appearance. It is particularly useful in iritis, together with affections of the conjunctivae accompanied by acrid discharges, soft flat condy- lomata or mucous tubercles. I have never found it advantageous to continue for any length of time the use of the sublimate (or precip. rub.) in the third trituration, finding it better after the first week to employ the Gth, 12th, or 30th. The administration of the sublimate by hypodermic injec- tion is perhaps worthy of our attention. Lewin, it seems, first systematically practised this method, and sums up the results as most favorable. lie used about one-sixth of a grain in solution daily, and found that " induration of the tissue and frequent unhealthy sloughing ulcers" were produced. Bartholow and others reduced the dose to one-forty-eighth of a grain and obtained much better results. (This goes to prove what has been said about the 1st and 2nd triturations.) The method is to add one grain of the sublimate to an ounce of distilled water and inject ten drops once a day or thrice a week. The back is the most suitable point. My friends Drs. Willard, Burgher, Hofmann and Childs, report having tried this method in some obstinate cases of secondary syphi- lis, with remarkable success. Mercurius protiod.-The yellow iodide seems best indicated in painless chancres, and where the glandular system is largely implicated. The inguinal glands are swollen quite large 808 world's iiomceopathic convention. although not much disposed to suppurate. When the throat becomes affected, the tonsils are very large and the secretions not profuse but rather tenacious. It is perhaps the best pre- paration, when the testicles are involved. For the secondary eruptions and many of the sequelae, it is often better suited than either of the preceding. Mevcurius bin.-The red iodide is indicated when the chan- cre and bubo are particularly indolent, the other symptoms corresponding very closely to the preceding. Mercurius duic.-The chloride deserves more attention than it perhaps receives. I have used it in much the same class of cases as the solubilis, and especially when the eyes and ears are implicated. The roseola is bright red. It acts well in many cases of infantile syphilis, when the symptoms are less violent than those which require the bi-chloride. Mecurius prec. sub.-The red precipitate is called for when the chancre and bubo show a disposition to become phagede- nic, and the various ulcerative processes become destructive. Care should be taken not to continue the lower triturations too long. Cinnabaris.-This is one of the most useful of the mercu- rial preparations, particularly of the secondary and tertiary forms of syphilis. It is in those cases when there is what might be called a " sulphur sub-stratum," that this happy union of Sulphur and Mercury is most curative. Chancres with hard base in scrofulous individuals. The middle of the chancre becomes raised and fungoid. Indurated bubo, iritis, with pains in the supraorbital region commencing at the inner angle and passing around to the temple. It is suited to almost the whole range of syphilodermata, from the humble maculae to the flourishing condylomata. Circular ulcerations in the skin, mouth and throat. Disorganization of the ton- sils. It will be found indicated in many cases of syphilis in scrofulous infants and children. OTHER MEDICINES. The plan I have frequently pursued with benefit in the use of Mercury and other medicines is as follows : HOMCEOPATHIC TREATMENT OF SYPHILIS 809 I usually commence the treatment of the primary symptoms with the 3rd triturations; as improvement sets in I go to the 12th or 30th. In some cases no secondary symptoms appear. But usually they appear in due time, generally of a mild char- acter. Upon the appearance of these secondary symptoms, if no other medicine is particular}' called for, I give Nitric acid, 6th or 30th and continue as long as any improvement is per- ceptible. When this ceases I make a careful selection of one the mercuries, or perhaps the iodide of potassium. If the former, generally in the middle or higher potencies, if the latter usually low. Nitric acid.-This medicine not only holds an antidotal re- lation to the effects of Mercury, but, by its pathogenesis, would indicate a relation to the specific disease itself. It is by no means the only antidote to Mercury, for we have witnessed the excellent effects of such medicines as Kali hydriod., Ile- par., Lach., Carbo veg., Aurum., Asaf., etc., etc., but its simi- larity to Mercury in many particulars renders it the medicine oftenest needed. It is indicated in chancre with raised edges and disposition to bleed easily and profusely. Pale, flabby and prominent granulations. Ulcers incline to spread in circumference rather than in depth, and exhibit a tendency to fungous growth. Discharge various and corrosive; pains as of splinters. Bu- boes threaten to suppurate. Coppery and violet colored spots on the skin; squamae, rupia, mucous tubercles, condylomata. Pains, drawing, pressing and, as if from splinters, particu- larly in the bones of the head. Strong smelling perspiration and urine. Nitric acid has been used in the lowest potencies by most practitioners, but I have also found it very efficient in the high potencies. Kali iod.-Is also indicated after the abuse of Mercury, but the fact that many patients, after the use of this medicine, break out in a roseolous or papulous eruption, together with other symptoms produced in the provings, would lead us to conclude that independent of its relation to Mercury, it may have a specific relation to some of the secondary and tertiary forms of syphilis. 810 world's homceopathic convention. It is indicated where the bubo, in some scrofulous patients, becomes very hard, with a curdy, offensive discharge if sup- purating. Thickening of the spermatic cord. Ulcerations of the nose, mouth, throat, etc., with a corrosive, burning dis- charge. Lancinating pains in the throat. Often required in the secondary and tertiary forms of syphilis after the too free use of Mercury. The system much depressed; effusions of serum into the cellular tissues ; threatening abscess. In indu- ration of the liver it will often procure rapid resolution. The lower preparations of this drug (five grains to the ounce of water-one teaspoonful three times a day) have generally acted best, although I have known much benefit to accrue from the 30th dilution. Thuja.-This remedy has always been recognized as the chief reliance in sycoses (Hahnemann). It is curative in the condylomatous excrescences which appear on the penis, vulva, and around the anus. The inguinal glands are painful, draw- ing pains extending to the knee. Purulent pimplea. Brown or red mottled spots withitching. Red nodosities on the tem- ples. Rupia, condylomata in various parts of the body. Af- ter iritis, tubercles or warty excrescences on the iris. Kali bide.-I cannot but think that this drug would prove curative in many cases of deep syphilitic ulceration. It has been found most useful in syphilitic laryngitis, with hoarse- ness, dry, hacking cough and tenacious sputa. Aurum met.-Syphilis with mercurial cachexia. Most valu- able in secondary and tertiary forms. Preferable to Nitric acid in mercurial iritis, ulcers of the nose and mouth, with fetid discharge. Necrosis of the nasal bones. Nodosities, es- pecially of the cranial bones. It is worthy of remark, as men- tioned by Hutchinson, in Reynolds' System of Medicine, p. 746, that " in association with nodes on the skull various symp- toms of mental disturbance show themselves. . . . They not infrequently result in attempts at suicide." Asafoetida.-Affections of the long bones, attended with severe nocturnal pains. I remember one case of a lady, aged 45, in whom both tibiae were bowed out with the bone swell- ing ; extreme nocturnal pains, preventing sleep for weeks. HOMCEOPATHIC TREATMENT OF SYPHILIS. 811 Had taken Mercury by inunction, and iodide of Potash (which always produced an eruption over the face and body). Had recently taken bromide of Potash, 100 grains in the course of (i single night, with little or no sleep. Asafoetida" very soon relieved the pains and produced sleep. The nodosities of the tibiae also disappeared in two or three weeks. Carbo veg.-In cachexia syphilitica Carbo veg. is required for the extreme prostration, with impairment of digestion, acidity of the stomach, and great flatulence. Suppuration of the bubo ; the parts are livid or mottled. General or partial falling off of the hair, with furfuraceous desquamation. Yel- low skin; shooting pains in the liver and spleen, and palpita- tion of the heart. Carbo animalis.-Is well indicated for bubo which is be- coming phagedenic. I mention the following remedies which have been found efficient in syphilis and the mercurial cachexia, with which it is so frequently complicated, namely: Lach., Ilepar., Phyt., Still., Coral., Sulph., Lycop., Badiag., Petrol., Corydalis, Ar- senic., Arsenic, iod., Iris, Hydras., Clem., Sars., Mez., lod., Staph., Plat., Arg. nit., Fluor, ac., Pod., etc. THE MEDICAL TREATMENT OF VARICOSE VEINS AND HAEMORRHOIDS. John C. Minor, M. D , New York. The various surgical methods of treating varicose veins and haemorrhoids are so well known, and the limits of possible re- lief or cure are so well established that there is very little to be said concerning the surgical treatment of these diseases that would be new or interesting. Their medical treatment, how- ever, is a comparatively new field of inquiry, with some feat- ures of special interest that are of importance in both medical and surgical practice. The two diseases ■which I have chosen for consideration are regarded by some homceopathists as perfectly amenable to treatment, even to the extent of a radical cure in a majority of cases, without surgical interference. This opinion is not by any means a unanimous one, for there are some who deny the curative effect of remedies in these cases on the ground that clinical evidence fails to sustain it, and that pathological evidence renders it improbable, if not impossible. What I have to say concerning the medical treatment of these diseases has some reference to this question. Varix.-I use this term for convenience as signifying a varicose condition of the veins of the lower extremities-a very common affection, so w'ell known in all its features that a de- scription is unnecessary. A clinical study of the disease will be of service in bringing forward some practical points in what might be termed its natural history, in determining its charac- teristic pains, and in estimating the value of medical treat- ment. For the purpose of obtaining clinical evidence bearing 813 814 world's homoeopathic convention. upon these points, 1 lately made an examination of one hun- dred cases of varix in the Homoeopathic Hospital of Ward's Island, New York. There were about five hundred patients in the hospital at the time, and as I had no difficulty in selecting one hundred cases of varix from among four hundred patients, it follows that a very large proportion of hospital patients have varicose veins of the legs. The patients in general belonged to a class that eat little, drink much, and walk a great deal-tramps and paupers. None of these patients had come to the hospital for the spe- cial treatment of varix. Some had bronchitis, some had ulcers, others had phthisis, syphilis, rheumatism, etc.; all the ordinary diseases were represented, while not a few of the cases occurred among those specimens of " hospital bummers " who are never sick in the summer and never well in the winter. It is to be noted as a point of clinical importance that, al- though most of these patients were glad of an excuse to enter the hospital, and many of them were undoubtedly feigning diseases they did not have, not one of them thought the vari- cose veins of sufficient importance to offer as an excuse for en- trance or as a disease to be treated. A large proportion were not aware that there was any thing the matter with their veins, and the most marked case in the hospital, with immense and tortuous veins crawling from the ankles up on the thighs, had never suffered the slightest pain or inconvenience from the disease. This shows that the mere presence of varicose veins is not of itself an indication for treatment. Even an advanced stage of the disease is not incompatible with excellent general health, and does not generally disable the patient. We may reasonably infer from such clinical evidence that a varicose condition in some cases is an overflow that acts as a safety- valve to other parts. One case in particular, of varix occur- ring as the direct result of suppressed menstruation, with peri- odical aggravation of the varicose condition every month, illus- trated the occasional compensating character of the disease. Twenty per cent, of these cases were under treatment for ulcers of the legs, but this fact does not contradict the previ- VARICOSE VEINS-HEMORRHOIDS. 815 ous inference as to the usual harmlessness of the disease, be- cause the relative frequency of ulceration in varix is not to be determined by a compilation which included every varix com- plicated with ulcers, but did not include every uncomplicated varix. Such a percentage must of necessity be too great, and arose from the fact that the inspection was begun in my own surgi- cal wards, and included every varicose vein in the surgical side of the hospital before the medical wards were examined. More- over, many of these ulcers were not due to varicose veins, al- though coexistent with them and influenced by their presence. Still we must regard varix as a predisposing cause of ulcera- tion, and as exercising an undeniable influence in giving to the ulcerative process a chronic character. There was a very remarkable effect produced upon the vari- cose condition by the ulcerative process in many instances. In about half the cases all the pains associated with the varicose veins, the cramps, itching, prickling, etc., disappeared entirely as soon as the ulcerative process had become established, to return a^ain when the ulcer was healed. In a few cases this effect of ulceration proceeded so far as to reduce the size of the varicose veins in a very marked decree, although it did not, in any of the cases examined, bring them absolutely to the normal size and condition. Superficial ulceration and ec- zema appeared to increase the varicose pains; a deeper ulcera- tion and induration of the surrounding tissues seemed to dim- inish them. The characteristic pains of varix are of special importance because upon them depends in a great measure the selection of the homoeopathic remedies for the relief or cure of the dis- ease. Considering such pains generally fully as important as the characteristic symptoms of the remedies, I was more par- ticular upon this point than upon any other. Theoretically, two things are essential to a perfect treatment of diseases in general. First, we must have as perfect a classification of the symptoms produced by the disease as it is possible to obtain, and these are the characteristics of the disease. Secondly, we must have as accurate a picture of the symptoms produced by 816 world's HOMCEOPATHIC CONVENTION. our remedies as study and experiment can develop, and these are the characteristics of the drug. The perfection of treat- ment lies in the accuracy of our comparison between the two characteristics. Practically, I have found that there were other essentials than these required, and that among them the place assigned to physiology and pathology determined much of the intrinsic value of drug-symptoms on the one hand, and disease-symptoms on the other. The following symptoms are the result of a close question- ing of one hundred cases. I have included every pain that was attributed to the disease, or that seemed to be necessarily asso- ciated with it. Cramp in the calves of the legs at night, the most charac- teristic, if not the most prominent symptom of varix, was fbund in about ninety per cent, of the cases. In many in- stances it was the only pain. In all cases it was the first symp- tom in point of time in the history of the disease, and seemed to exceed all others in its persistence. Yet it was rarely mentioned as a very severe or painful cramp, and in no instance did it re- cur with regularity every night. "Two or three times a ■week," "once in a while," " often at night," were the expres- sions that described its frequency. In several cases the cramps occurred early in the morning, before rising; none complained of them during the day, nor until they had rested for some- time in bed. The irregularity with which the cramps appeared corres- ponded very closely with the amount and character of the muscular exercise during the day. In all instances they were most likely to occur when unusual or excessive exercise had been followed by a period of rest. It is probable that this symptom is dependent on dilatation with obstruction of the circulation in the intra-muscular veins, occurring on the first muscular efforts after a period of repose. It is also reasonable to regard this symptom as supporting the views advanced by Verneuil with reference to the pathology of the disease, viz: that the primitive seat of varix resides in the deep veins and extends from them to the subcutaneous veins ; that superficial varices rarely occur without the corresponding deep veins VARICOSE VEINS HEMORRHOIDS. 817 being also affected, although the inter and intra-muscular veins may be dilated without a corresponding affection of the super- ficial veins. The frequent occurrence of the same kind of cramps in legs that give no external evidence of varicosity also points to the same conclusion. The next symptom, in point of frequency, is a prickling, like pins and needles, referred not to any particular locality but all along the leg, although most pronounced over or near the saphenous trunks and sometimes associated with burning in the soles of the feet. This sensation, variously described as prickling, tingling and formication, is peculiarly a nervous symptom and, although very commonly found with varicose veins, is still more characteristic of diseases of the central nerv- ous system. We find it often in cerebral thrombosis as one of the forerunners of hemiplegia, and in spinal congestion and chronic myelitis it is an early and persistent symptom. We meet with it in progressive muscular atrophy and generally in all the chronic affections of the cerebro-spinal system. In central nervous lesions, however, the diagnosis is ren- dered clear by a variety of circumstances which never occur in cases of simple varicosis and which it is unnecessary to con- sider. Moreover, these symptoms are as often due to peri- pheral as to central causes. We may refer them either to me- chanical obstruction, to structural changes in the coats of the vessels impeding the circulation, or to excitation or paralysis of the vaso-motor nerves. A third symptom, more troublesome when it occurs than either of the others, is itching. Not that intolerable itching that is associated with eczema, or a red, swollen and glassy skin ; but another neurosis, without eczema or visible cause except the association with varicose veins. It is more constant when it occurs than any other symptom and is the most an- noying symptom that is associated with eczema, or superficial ulceration. In these cases it is invariably associated with an intense burning pain, is worse at night and aggravated by warmth. Two more symptoms, a peculiar stinging pain in the ankles, and darting pains or stitches in the leg (generally in the trunks 818 world's HOMCEOPATniC CONVENTION. of the saphenous veins), and these complete the list. Very many more symptoms were present in the patients under examination but a careful analysis eliminated all others as due toother conditions than varicose veins. In 100 cases, therefore, the varicose veins gave but five symptoms, viz: cramps, prickling, itching, stinging and darting pains, occur- ring as described. The results of treatment are briefly con- sidered ; all these patients were under homoeopathic treatment for one disease or another. Under this treatment, any or all of the symptoms described as'peculiar to varicose condition if occurring to a noticeable degree, would certainly have formed part of the totality of symptoms upon which the indication for remedies was based. In such cases, although another disease was being treated, the remedies would be as appropriate to the varicose condition as to any other. It follows then that, if homoeopathic treatment was capable of curing these cases, if the disease is perfectly amenable to such treatment as claimed by some, there would be, here and then , a case cured, or at least relieved in a very marked degree by the treatment, even though it were primarily directed towards some other disease. No such cases were found. There were no cures and, in no in- stance was there any relief from the symptoms described that could be attributed to the action of remedies alone. In my own wards which contained the worst cases. I have never seen any permanent benefit from the employment of remedies, noi' any result that surpassed that obtained by rest or mechanical support. In no case have I seen any effect produced by rem- edies internally administered that could be discriminated from the benefit that rest, position, or support gave to the parts, nor have I ever seen the slightest mitigati n of any of the symptoms, unless one or more of those indications was carried out. My experience then leads me to the inference that remedies are entirely useless in the ordinary cases of varicose veins.. For the occasional inflammatory conditions, phlebitis, ulcera- tions, etc., I am confident that remedies are efficient, but these conditions do not enter into our present subject. The difficulty certainly does not lie with our remedies, for we have VARICOSE VEINS H^EMORRIIOinS. 819 in Puls., Rhus t., Sulphur, Silicea, Arnica, Secale, Arsen., etc, remedies which cover minutely all the characteristic symptoms of varicose veins, besides being applicable to the utmost va- riety of concomitant conditions. With such a wealth of reme- dial agents clearly covering every feature of the disease, and with so few symptoms to meet, the cure of varicose veins ought to be an invariable rule, if drug symptoms on the one hand, and disease symptoms on the other, are the only essen- tials in practice. We find there is something that interferes with the action of our remedies, and I suspect that it is the pathological condition. It is doubtful, at least, whether rem- edies will repair structural lesions. When, in varicose veins, we have either hypertrophy or atrophy of the coats, fatty, fibroid or calcareous degeneration of the walls, absolute loss of tissue, besides thrombosis, mechanical obstruction and even actual obliteration of veins, it is more than doubtful whether we shall find these conditions perfectly amenable to treatment, however active our remedies may be. The restoration of an am- putated leg would be no more difficult than the task of curing this disease where it has become chronic. There is no cure, medical or surgical, for varix, except in rare cases such as the one already referred to as due to sup- pressed menstruation, where an early removal of the cause may be expected to cure the disease. We may alleviate or palliate the inconvenience or suffering by mechanical support, by rest or position, and when the condition, in rare cases, becomes dangerous or insupportable we may bring operative surgery to bear upon the case for the purpose of substituting a tolerable pathological condition for one that has become intolerable. But the obliteration of a varicose vein is not a restoration to the normal condition and, although in many cases the best that can be done, is not a cure. Fortunately few of these cases suffer much from the disease and although the disease cannot be cured it can be endured. ILemorriioids.-Were haemorrhoids to be classed as the same pathological condition as varicose veins of the legs, and differing only in location the same conclusions would hold good with reference to their treatment; and we might dismiss. 820 world's homceopathic convention-. the subject at once as not coming within the range of medical treatment. We cannot deny the varicose condition in a very large proportion of cases, but there are essential differences between the condition as it occurs in the rectum and in the lower extremities respectively. The distinction between the two is marked by the influence upon the condition exerted by the character of the predisposing or exciting causes. In vari- cose veins of the legs there is a constantly acting cause in mus- cular exercise; in haemorrhoids there is an occasionally acting cause in the portal circulation, and muscular exercise plays no part in producing or prolonging the disease. We find then in the case of haemorrhoids that the disease depends largely upon a cause which is not in constant operation, that the dis- ease has periods of aggravation and of amelioration, and that either of these periods may be so prolonged as to produce either a cure, or, the reverse of this, a condition that is incura- ble except by operation. We recognize also in the portal cir- culation a field for the action of remedies in which their power is undoubted. The character of the cause which operates in the production of hemorrhoids contributes largely to the probability of our reaching the effects of the cause by reme- dial action, and this is confirmed by clinical experience. But the ability of remedies to control the hemorrhoidal condition is a limited one, and the limits are determined by the closeness with which the disease approximates to the con- ditions which prevail in varicose veins of the leg. When the varicose condition of the hemorrhoidal veins has once become chronic, when the vessels from constant distension have under- gone atrophy of the walls, the muscular coat paralyzed, the blood at a standstill in some of the loops, and thrombus with its various degenerations has changed what was formerly a bunch of dilated veins into a sponge-like mass, whose channels are partly the old blood-routes, and partly new ones formed by distended veins breaking through into each other by the destructive pressure on the intervening tissue,-such a condi- tion as this can have no remedy but obliteration by surgical operation. A condition like this prevails in most of the cases submitted to operation; but there are some cases presenting all VARICOSE VEINS.-HAEMORRHOIDS. 821 these features which give very little pain, and in which there is no occasion for operation, and but little for medical treat- ment. The surgical rule holds goods here, as. in varicose veins of the legs, that the pathological condition alone is not a suffi- cient reason for the operation; it is only when that condition becomes intolerable that we are justified in substituting an- other that is tolerable. In all cases it is a good rule to try what remedies will do for the relief of the patient before re- sorting to the operation. I have found that many of these advanced cases of piles were susceptible to the action of reme- dies to a very marked degree, so that the relief obtained was sufficient to render an operation unnecessary. In such cases, however, there was no change in the haemorrhoids except a relief from pain and from all inflammatory appearance. The piles remained, but the pain and inconvenience were gone. The effects of such treatment, although very satisfactory in many cases, do not equal the purely operative methods in certainty or permanence; and, while worthy of trial, the remedies must not be regarded as a substitute for the operation. The remedies which are of use in the treatment of haemor- rhoids embrace all that act upon the portal system. The gen- eral condition of the patient must also be considered and treat- ed, and thus we may easily amplify the subject until we have included the whole of the Materia Medica. In my own expe- rience, while I have derived much benefit from what may be called accessory treatment, the list of remedies with which I first began treating these cases has dwindled down to six reme- dies. 1 speak now of remedies which seem to have a direct or specific effect upon haemorrhoids and not of those which are applicable to the general condition of the patient. These remedies I shall consider very briefly, but, before doing so, a few clinical points need attention. Clinically we find two kinds of piles, external and internal. The external are always venous in character, the internal may be venous, arterial, or capillary. Venous piles, whether ex- ternal or internal, are, by far, the most common, and are the only ones that are subject in the slightest degree to the action of remedies. Arterial and capillary haemorrhoids give little 822 world's iiomceopatihc convention. or no pain, but are more dangerous because the haemorrhage is more profuse. Their location is higher up in the rectum than that of venous piles, and they are not dependent on the same general causes for their development. They require operative treatment, and fortunately yield to it. For the treatment of venous piles the following remedies have proved of service to me: JEsculus hip., Collinsonia, Aloes, Muriatic acid, Nux vomica and Sulphur. ^Csculus hip.- Absence of constipation and a persistent sen- sation t)f dryness in the rectum, are the most marked indica- tions. The piles give great pain but no blood ; they burn but do not bleed. We meet also with sensations of foreign bodies, sticks, splinters, etc., in the rectum, and a fullness as though the mucous membrane were swelled so as to obstruct the pas- sage. There is a sore feeling in the rectum, and, at the anus, soreness, burning, pressure and itching. Many of these symptoms are common to other remedies, but there are characteristic differences which enable us to se- lect the remedy indicated. Collinsonia has the same sensation of a foreign body, splinters, sand, etc., lodged in tlie rectum, but the presence or absence of constipation determines the remedy. Aloes has the same burning in the anus, but it is usually the sequence of a hot, fluid stool, and lasts for some time. The burning also extends up the rectum, which does not happen with JEsculus. The burning sensation of jEsculus is not dependent on diarrhoea, is more transient and belongs to the pile itself ; that of Aloes belongs rather to the diarrhoea acting upon the piles -which, without such a complication, might be painless. Muriatic acid hss a burning sensation in the piles, with a raw feeling like Aloes, but there is generally bleeding, which is absent in Mlsculus, and there is a peculiar sensitiveness of the anus that distinguishes it from every other remedy. Collinsonia.-Constipation always accompanies the piles, •which are chronic, bleeding or not. There is a tendency to flatulent colic, and there is frequently an alternation of haem- orrhoidal trouble with cerebral or cardiac pains. The only marked local pain is a sensation of sticks, sand or gravel in the rectum, with the usual pressure, fullness, etc. VARICOSE VEINS-HAEMORRHOIDS. 823 This remedy is one of the most reliable of its class, and rep- resents in its symptoms a wide application to the disease. It does not possess the peculiarity of symptoms which distin- guish ^Esculus, Aloes and Muriatic acid, as special remedies for exceptional cases. It is rather indicated by the absence of peculiar symptoms, and covers the more common haemorrhoidal conditions. It most resembles Nux vom., but is far more re- liable as a pile remedy. Aloes.-The most important symptoms are: a sensation of heat and burning in the rectum and anus, aggravated or pro- duced by thin watery stools and lasting a long time. The anus feels sore, and the patient dreads another stool, but is un- able to close the sphincters, because there is not only soreness but also a weak, relaxed condition of those muscles. The haemorrhoids protrude, are sore and sensitive. They feel raw, arc apt to bleed, and are relieved by cold water. The piles for which Aloes is indicated are those which are irritated by a characteristic diarrhoea, whose recognition is easy. Coming on in the morning, it drives the patient out of bed, not by the pain, but for fear the faeces will escape if he does not run for it. The moment he lets go the sphincter either of the bladder or anus, there is a windy spurt of a thin stool, hot and burning. There remains a sensation, tenesmus, as though there was more to come, and he is afraid to urinate or to break wind lest the stool escape at the same time. Thus there occurs a characteristic loss of confidence in the anus. Now, if the patient suffers from piles they become very much irritated by the diarrhoea, and are subject to the same burning pains that affect the anus and rectum. Owing to the laxity of the sphincters they protrude, and, owing to the determination of blood to the part, of which tenesmus is one evidence, they bleed. Without this association of diarrhoea I should not know how to characterize the haemorrhoids for which Aloes is suitable, not because diarrhoea is an invariable accompaniment, but because it shows the essentially irritable character of the piles. Huriatic acid.-The character of the haemorrhoids is like that of the Aloes variety in their large protrusion and sensi- 824 world's homoeopathic convention. tiveness, but they do not bleed so much or so often. They are accompanied by an intolerable itching and by a very marked sensitiveness of the anus. This anal pain is the most reliable indication for the remedy. The sensitiveness is so great that the part can hardly be touched ; and although the other pains may be extreme, yet this surpasses them all in se- verity. It does not run far into the rectum like the rectal pains of Aloes, but seems to be confined to the anus. The piles themselves share in this sensitiveness, and are extremely tender and painful. They are not dependent on diarrhoea for their pain, like those of Aloes, nor on constipation, like those of Collinsonia, but are most like the painful haemorrhoids of kEsculus, from which they may be distinguished by the pre- dominance of anal pain, the absence of rectal symptoms and the tendency to bleed. Nux vom.-A close resemblance between this remedy and Collinsonia will be noted in the symptoms of headache, con- stipation, colic and piles. The character of the constipation, however, is different, Nux giving a large, hard and very dark stool, which is obtained, a little at a time, after much ineffect- ual straining. The stool of Collinsonia is light-colored and lumpy, and unaccompanied by the straining effects of Nux. With Collinsonia we are more apt to have an alternation of haemorrhoids with cerebral or cardiac pains; but Nux vom.of- tener associates the haemorrhoidal with other troubles, as a concomitant, rather than as an alternate or substitute. Nux vom. has most of the ordinary symptoms usually met with in cases of haemorrhoids, but the local indications are not of so much value as those which refer to the general condition of the patient. The dull, morose, irritable mood, the bilious temperature, the dyspeptic condition and general sluggishness, are more suggestive of the remedy than any local symptoms. Sulphur.-This is another remedy which, like the preceding, is to be determined by the general rather than the local condi- tion. It is not a remedy for acute conditions, but for cases which, having passed through an acute stage, have gone beyond the reach of other remedies into a chronic state. Its clinical reputation is not confined to homoeopathic practice. VARICOSE VEINS HAEMORRHOIDS. 825 It generally completes the succesful medical treatment of haemorrhoids because it corresponds so closely to the symptoms of chronic cases. These six remedies have proved themselves, in my practice, to be capable of accomplishing a cure in some cases and giving permanent relief in others. But they have often failed to produce any good effect; and therefore, while my experience teaches the possibility of cure by remedies alone, the probabi- lity of such a result does not allow me to regard the operative methods as obsolete. It will be noticed that many remedies usually recommended for haemorrhoids do not appear in the list I have given. This omission is due to the fact that in my hand they have failed to produce any good effect. Hamamelis has been of service when applied externally but, when administered as a remedy, it has invariably failed. Nitric acid, Pulsatilla and many other remedies of service in other conditions of the rectum, have given purely negative results when used for haemorrhoids. GUNSHOT WOUND- CASE OF BALL IN THE SKULL. W. H. Jennet, M.D., Kansas City. I WAS called at 7 o'clock A.M., January 12th, 1876, to see John K. Hallowell, whom I found lying on the right side with a gunshot wound of the head, inflicted by a Smith & Wesson revolver, small size. The ball entered the posterior part of the head near the lambdoid suture on the right side. The wound presented a very gory appearance, and I expected to find the patient unconscious; but on the contrary he seemed as calm almost as if nothing had happened. He would have given me a detailed account of his case had I desired it. He was very pale, but had no appearance of collapse. The wound had bled very freely, but had almost ceased at the time of my arrival, thirty minutes after the accident. I removed the clots, cut away the hair, and probed the wound. The probe passed directly into the brain until it would pass no further, but it struck no hard substance; the ball had undoubt- edly changed its course or gone beyond. I next examined in all directions for pieces of the skull, but found nothing. Passing the probe round the aperture in the skull it seemed perfectly smooth. The wound was three inches in depth, the external parts being very much tumefied; no powder-marks upon the scalp. The probing gave no pain or uneasiness. The patient had vomited at intervals of fifteen or twenty minutes from the time of the injury, for which I prescribed a little diluted whiskey; after an hour or two the vomiting ceased. Pulse at 50 and full. No fluttering or intermission. I applied Arnica dressing, placing the head so that the fluids would exude from the wound, advising perfect quiet, and that the head be placed GUNSHOT WOUND. 827 on a plane with the body. From this time, January 12th, 3 P.M., the patient rested quietly and free from pain, after which time delirium came on, and he seemed to suffer greatly from pain in the wound. Prescription : Arnica 30th; Aconite 30th, in water; dose hourly. January 13th, 9 a.m.-I found the patient in wild delirium. He had passed a very restless night, almost impossible to keep him in bed. The wound appeared to be doing well; very little discharge; pulse 60; iris active; skin dry; kidneys active; perfect control of the sphincters; speech unimpaired; no evi- dence of paralysis; patient imagines that he was thrown from my carriage and had his skull fractured,-that I have taken out a part of the skull, and he is waiting for me to replace it, so that he can go about again. This delusion lasted for four days. January 13th, 3 p.m.-Patient delirious, but not so bad as during the night. Pulse 66; declines to take any medi- cine in water, saying that his stomach was cold. I changed the prescription to Arsenicum 3d trit, and Bell 3d, alternately in powders. Diet, beef tea and milk, which were given every two hours in very small quantities. Perfect quiet enjoined upon all in attendance. January 14th, 9 A.M.-Patient has less delirium ; the bowels have acted naturally; speech unimpaired; respiration labored; skin dry ; kidneys normal; pulse 72. January 14th, 3 p.m.-Less delirium; pulse 58; skin still dry; iris active; wound pains him. January 15th, 9 a.m.-Patient has passed a better night; pain in the wound grows less all the time; delirium slight; patient can be aroused if directly appealed to, but lapses back again.. January 15th, 3 p.m.-Pulse 68; respiration normal; still pain in the wound and delirium. January 16th, 9 a.m.-Patient much improved; pulse 60; mind less confused; respiration normal; skin dry; tongue coated ; kidneys normal in action. January 16th, 3 p.m.-Slight perspiration ; pulse 60 ; no sign of palsy ; pupil active. January 19th, 9 a.m.-Patient passed a good night, free from 828 world's homoeopathic convention. pain and delirium ; external wound is healed and no suppura- tion; wound crusted over and dry ; covered the wound over with adhesive plaster; allowed the patient more liberal diet; color has returned, and reaction seems to be re-established ; allow no one to converse with patient except the family, and then only a few words at a time, and in the presence of the nurse or myself. I visited the patient twice every day from January 17th to Feb- ruary 1st, and watched the case closely ; no symptoms occurred of an unfavorable nature. I left the patient lying flat in the bed, and allowed him no company nor extended conversation with any one, as his mind seemed to wander if past events of any kind were recalled. February 1st.-Patient seemed to be in good condition, and it being the twentieth day since the accident, I allowed him to sit up for a short time, increasing the time daily until he could re- main up for hours without being fatigued, but urging the neces- sity of quiet, and freedom from all annoyance. Nothing hap- pened of importance until February 12th (just one month from time of injury). Patient seemed more obstinate and flighty; had a slight chill; at night wanted to sit up and watch the house for fear of burglars, etc. The day was cold and raw ; his head seemed to pain him over the vertex, and through the temples; patient could not read; complained that the lines ran together ; any attempt at memorizing caused him to look wild and insane. For a few days his symptoms seemed to be periodical, one day well, the next day a little fanciful and quite obstinate; was de- termined he would go to work. This lasted for about a week, and from this time until March 12th he seemed to be doing very nicely, and could read, write, and walk around the house without any fatigue. March 11th. He was determined he would go out; the- result was, he walked a long distance in a high wind, and now he is back again with a rigor, followed by another on the 13th of March, and each night a sweat; pulse does not seem to vary much ; days cold ; pain through the wound. March 14th.-He seems unusually well again, but weak; no sweat in the night. GUNSHOT WOUND. 829 March 15th.-Quite well but a little wild ; reads nearly all the time; memory seems much better. March 19th.-Day cold with heavy snowstorm; patient chilly; complains of pain throughout the wound; this pain has been present since March 17th; nights more restless. Stormy weather affects the patient very perceptibly; it makes him gloomy and obstinate, his mind being very much disturbed, and the head painful. Tracing the pain, as he gave it to me this morning, it extended from the point of entrance of the ball to the coronal suture, but he could not exactly fix the point at which the pain ceased. I told him to mark the exact point if he could with ink, and see if it extended always to the same mark. At no time since his injury has he appeared entirely like himself; inclines, when ex- cited, to aberration. Insanity is hereditary in the family, also phthisis pulmonalis. Patient is twenty-seven years old; san- guine temperament; he has always been temperate, and a hard worker; occupation, accountant. At no time during his sick- ness has he shown any tendency to palsy ; his taste has been unimpaired since reaction came on. The ball, in all proba- bility, has become encysted. Remedies: Aeon., Arnica, Bell., Arsenicum, Hypericum, and Rhus, have been more often indicated than the remaining- one, Calendula. This remedy always charms me by its most excel- lent action in external dressings, both for acute wounds and old ulcers, and I cannot laud it too highly. Since the last of March Mr. H. has steadily improved, although he has not exercised that prudence enjoined upon him from the time of the injury, my constant effort having been to keep him from all kinds of employment. The most notable feature of the case has been that at the return of the 12th of each month (the date of his injury), all the symptoms have become aggravated; the exacerbation would continue for three or four days, after which he would not only return to his former condition, but would find himself far in advance of his previous state. Thunderstorms seem to affect him more seriously than others, although all the rapid changes, whether from hot to cold, or wee versa, affect him very perceptibly, the effect being to cause 830 world's homceopathic convention. sleeplessness. At the present time no pain of importance, or any feeling of discomfort about the head. Until quite recently he had a heavy pressure on the vertex, as if a heavy load was there. Agaricus muscarius removed the feeling, also a feeling of pain through the wound. The chief characteristic symptom that called my attention to the Agaricus was that a thunderstorm aggravated the symptoms. All the symptoms that now remain are those of debility. No recurrence of the aberration, as for- merly, when anything excited him, so as to cause alienation. The patient rode with me this morning for over three hours in a very hot sun, thermometer standing at 98° in the shade, after which time I left him at his residence, feeling no discomfort from his long, hot, and dusty ride. To test his mind, I con- versed with him on geology, knowing this to have been a favor- ite study (for pastime) before his injury. I found that he con- versed fluently, unhesitatingly, and using long technicalities with great readiness. I have seen him daily (except one week when he was on a visit in the country) since his injury, and carefully watched his state or condition, diet, etc. His convalescence has been very gradual indeed, but very decided. Each month has done its work, and it seems to me that all clots must have been absorbed; all bone undergone chemical change has likewise been absorbed, and the ball encysted. If all these conditions have been fulfilled, may not the case be looked upon as in a favorable condition for recovery? Remedies : I have prescribed remedies according to our theory, and have received the same good results when indicated as in other forms of disease, usually finding the 3d att. to act the best. DISCUSSION. FOURTH SESSION. (Thursday, June 28th, 1876.) The Fourth Session of the World's Homoeopathic Convention convened on Thursday, June 28th, and was called to order by the President, Dr. Carroll Dunham, who spoke as follows: Dr. Dunham: The business to-day is the discussion of the papers and subjects presented by the department of surgery. As the debaters are not ready we will listen to a partial re- port of the Committee on Official Correspondence. The chairman of that committee, Dr. I. T. Talbot, then re- ported as follows: The Committee on Correspondence would report that they have carefully examined a portion of the various matters submitted to them, and ask at this time to report thereon : 1st. The Convention has received from the hands of Madame Hahnemann a colossal bronze bust of her former husband, the illustrious founder of homoeopathy, and she accompanies this with sentiments of deepest venera- tion for the memory of one who has done so much for humanity; of cordial sympathy with this Convention, which seeks to gather from all parts of the world means for the advancement of medical science; and of high hopes for the universal adoption of the great principle in medicine for which its founder endured persecution and suffering, and to the advancement of which he devoted the greater part of a long and useful life. Madame Hahnemann here suggests certain matters which the committee do not consider come within the scope or province of this Convention. The committee recommend the adoption of the following resolutions: Resolved, That the World's Homoeopathic Convention assembled in Phila- delphia in 1876, tender to Madame Hahnemann most hearty and cordial thanks for her thoughtful and generous gift,-the bust of her illustrious husband, the founder of homoeopathy, that advanced medical science which has spread to every part of the habitable globe, as testified to by the repre- sentatives and communications of this Convention. Resolved, That, while regretting the necessity that a life so valuable should 832 world's homceopathic convention. terminate, yet we have abundant cause for thankfulness that it was so pro- longed as to enable him, in a measure, to complete his work, and see the fruition of his labors. Resolved, That we extend the warmest gratitude to Madame Hahnemann, who did so much to make the last years of her illustrious busband comfort- able and happy ; we rejoice that she has been spared, and hope that she may long live to witness the widespread growth of the medical system which he founded, and which has given to the world increased longevity and freedom from suffering. LETTER FROM DR. J. KAFKA, PRAGUE, AUSTRIA. To the Members oe the Centennial World's Convention of Homceo- pathic Physicians at Philadelphia, U. S, A. Greeting: Advanced age and family relations forbid me to follow the desire of my heart, and to cross the ocean in order to assist personally at the forum at Philadelphia. Still I am with you in heart; I converse with you in spirit and warm myself at that fire, which instigates every member of your Institute to be as useful as possible in the spread of the science of homoeopathy, and to contribute most earnestly his mite to such an honor- able purpose. Indeed, I would fain wish to express my admiration personally to each and all of you, for the earnestness with which you endeavor to promote homoeopathy, for the zeal with which you pursuesuch a holy object, for the self-sacrificing spirit, which nothing can deter from gaining its purpose, and for the great results which necessarily you have already achieved. German thoroughness and profoundness, which tries to penetrate deeply into the mysteries of nature, and our German irrepressible activity of mind is fairly acknowledged to become dim in comparison with American inde- fatigable labor. By your gigantic energy you have raised schools of learn- ing, from which you year after year send out missionaries to spread our doctrines; by your labors you have gained the victory by which you are ac- knowledged the equal of any physicians in the State or municipality you live in. Can we wonder at such a result? It would be strange if it were other- wise; for science is the shrine upon which you freely offer all your services, the healing of the sick according to the principle Similia sirnilibus curan- tur-the aim to which you concentrate all your extensive learning, all your energy, and all your activity. May the temple, which you have thus raised, last for eternity, and may its dome remain unshaken and unimpaired for- ever. May coming generations work with equal love and earnestness, as you have so nobly done, in order that the building you constructed on such a sure foundation may be still more enlarged. May " constant progress " be inscribed on the banner waving from its turrets, so that it may be known that we do not swear allegiance to any ipse dixit, and that simplicity in curing diseases is the guiding star to lead us onward. DISCUSSION ON SURGERY. 833 Then certainly we may hope for the dawning of that day when the scales will fall from the eyes of our opponents, when the light of truth will disperse their prejudices, their self-conceit and their errors. Then also our labors will be acknowledged, and our principles, for the truth of which we fought and suffered, will shed their light all over the world. Quod bonum, faustuin felixque co-exiat! Dr. J. Kafka, Praga, Austria. April 30th, 1876. COMMUNICATIONS FROM THE SOCI£t£ HAHNEMANNIENNE F£d£rATIVE DE PARIS, FRANCE. Carroll Dunham, M.D. My dear Sir and Honored Colleague : The Hahnemannian Federative Society is happy to testify the sympathy it feels in the grand patriotic cele- bration of the Centennial of American Independence. It experiences great pleasure in the resolution that you have taken to associate the triumphs of Homoeopathy in your dear country on the same days on which you celebrate the benefits and the liberty which you have enjoyed for a century. Permit us then, my dear sir, to commend by a simple but cordial address, your success and your aspirations. May we hope that you will kindly express our sentiments to the Congress about to assemble at Philadelphia. I beg you, my distinguished brother, to receive the expressions of my most cordial and respectful sentiments. Leboucher. To the President of the World's Homoeopathic Convention at Philadelphia, 1876. Honored Sir: Regretting my inability to be present at the Convention and share the labors of my confreres, I had proposed to send you, in token of my sympathy with your work, a paper on the therapeutic effects of Curare.* The demands of professional duties have left me time to prepare only an analytical summary; to trace a furrow parallel to those great works and experiments which our American friends and colleagues continually produce, with a perseverance and success that justify the statement that to- day the scientific equilibrium of our doctrine is reversed. No longer in the land of its birth, nor in the adjacent countries, but in America, the New World, is homoeopathy to-day most worthily represented. Accept, Mr. President, for yourself and our valued confreres in America, the expression of my respect and most fraternal regard, P. PlTET, M.D., General Secretary "of the Soci6t6 Hahnemannienne F6d6rative. Paris, May 29th, 1876. * See page 187. 834 world's homoeopathic convention. Address of the Members of the Hahnemmanian Federative Society to the Members of the World's Homoeopathic Convention, Philadelphia, 1876. The Hahnemannian Federative Society has the honor of saluting the President and the members of the Homoeopathic Congress at Philadelphia. As Frenchmen, we ought to rejoice with all the citizens of America, and take a sympathetic part in the grand festival of their century of independ- ence. As Homoeopaths, we ought heartily to be with oyr learned brothers on the other side of the Atlantic. We are with you, gentlemen and honored co-workers, in proclaiming freely the wonderful development of homoeop- athy over the whole world, but particularly in America, and in applauding the discoveries, the results of which you will bring to the Congress. We believe beforehand that you will contribute in a glorious degree to the enrichment and fortification of the immortal teachings of Hahnemann. The great distance which separates us will not permit any of our number to participate directly in your labors, but we are happy to be able to tell you that Paris contains a group of homoeopaths who are working sedulously to sustain the principles which you will proclaim and defend in your public reunion. Papers sent by two of our most learned colleagues will convince you of the truth of this affirmation. Permit those of us who do not send you articles still to be in your midst by the communion of thought. You have not assembled simply to once more publicly affirm the great truth of the law of similars; but you have all come with the fruit of experience, of long and careful study, to pay a tribute of gratitude to the genius of Hahne- mann, and to add another stone to the edifice whose plan he has so magnifi- cently traced. For you, with us, do not believe the work to be so finished and so perfect that there is nothing left us save to admire while enjoying its benefits. There remain always some details to perfect, and you will not wish any more than we to bar the way to all progress. But you will under- stand the necessity of acquainting yourselves with the nature and the course of that progress. Every one knows that there are on this point certain pos- sible errors which enthusiasm will praise and recommend, welcome and ele- vate to the rank of truth. You understand very well that in such cases you may exercise the right of judgment. If it happens, for example, that an idea is presented as progressive, which is in reality simply a retrogres- sion, you should hinder its advancement, and by so doing prevent it from misleading. Thus, although the laws of posology are very far from being perfect, yet you will not meanwhile consider a return to the powerful doses, too well known heretofore, to be true progress. In spite of the best possible attention the only result would be an insensible return to the paths of the old school, to rules entirely allopathic and directly opposed to that perfection which we should all seek to attain. Should any one propose the bold attempt of reducing the homoeopathic materia medica to some easy generalizations under the plea of simplification, would you applaud it ? Doubtless you would, at DISCUSSION ON SURGERY. 835 first, but reflection would soon show you such distressing pitfalls that you would quickly protest in favor of the Hahnemannian method. The system of generalization would render materia medica easier, but the one who practiced it would no longer treat patients, but diseases, organs and lesions, instead of the individual entity, with its special characteristics. From that time the beacon of individualization, so true and luminous, would be destroyed and the result should be a gradual displacement of cer- tain remedies whose neglect we would greatly regret. Indeed have we not already seen the ostracism of three of our first remedies, Calcarea, Lachesis, and Lycopodium, commenced ? Our archives remain faithful to them. Should there appear a man more speculative than judicious, more imaginative than profound, who fascinates by a wholesale posology, remarkably ponderable, by generalizations more ingenious than happy but agreeable to the memory, could he not even go so far as to teach that homoeopathy is only a branch of therapeutics? You would doubtless exclaim, gentlemen, if any one offered you this as progress, that the author of such a proposition had already strayed from the true path of homoeopathy, that he had lost the correct criterion, that he had turned his back on the light and ignored individualization ; such a one would quickly fall into the allopathic routine, and would soon have at his service only a few specifies. Nothing would remain after that except to mix without rule or measure several of our remedies in one potion ; or even to associate them with the processes of the old school and to maintain that the latter do not at all destroy the effects of the former. After such abuses, we ask, what would remain to homoeopathy? How would it be recog- nized? And what benefit could it derive from processes like these, spite of all the intelligence vainly spent on such a work ; could you honor such aberrations with the title of progress? No ! you would join with us in call- ing it a retreat, a return to the obscurities of the past. That which you desire, gentlemen, is doubtless the light, and in homoeop- athy the light is individualization, which is the best source of all indica- tions. You will have no more desire than we to proscribe generalizations, considered from a pathological or therapeutic point of view, always remem- bering that they are to be used as data to aid the memory and to facilitate profound and severe researches. But they should be simply processes of teach- ing and methods of arriving at individualization, for it must be remembered that the symptoms of the patient express the language of the disease, or as the learned J. P. Tessier so aptly says, " la maladie, e'est le malade." Here is fruitful work for patient and earnest seekers, and work which time will not destroy. Attentive, scrupulous observation proves that, as in the human family no two individuals are exactly alike, so in disease, no two examples of the same morbid species are identically the same. So, too, there are no counterparts among drugs, and we cannot absolutely generalize their appli- cation. The best-homceopath will always be the one who has the most com- plete knowledge of individualization. If we were permitted to point out some desiderata, we could readily mention to observers all dietetic questions and should demand that many of the details of hygiene be revised from a 836 world's homceopathic convention. homoeopathic point of view. We believe that a good book on these topics would be a very useful guide to true homoeopaths, and even to their clien- tage* Since medicine touches upon all branches of human knowledge, it ought to take into consideration everything that affects man and nothing which con- cerns him should be foreign to it. It has the right to estimate and control his physical and moral nature; since health may be attained in the one as in the other of these attributes of mankind, by following the mode of action and application consonant with the characteristic traits of each person. It is still individualization, a word which cannot be too often repeated. The field of labor is vast, there is room for numerous workers, and we must re- member in view of all these problems yet to be solved, that time is not measured by the duration of man, but that of science. Assuredly one may be an excellent homoeopath without a knowledge of all these collateral branches. We have simply pointed out a. few studiesin order to exemplify our idea, and to show also that there is enough to do, without overturning things already acquired. As the perfect adaptation of all the elements of a work is necessary to its harmonious completion, therefore, let no physician suppose that simply in the reform of therapeutics he has seen the whole of homoeopathy; its customs and its methods would still be lacking, indeed, I had almost said its theory also,-but I know very well that everyone would not go so far as that. I hear it too often said : " Let us have good practice ; theory shall have its day, when there is t me for it." We believe it is in this sense that you understand the meaning of progress. Doubtless you all think that the greatest reform of the century is that which has taken place in medicine, inasmuch as it is the most powerful instrumen- tality in that amelioration of mankind which is sought alike by statesmen and moralists : Mens Sana in cot pore sano. To medicine particularly belongs the work of making the body healthy. It belongs to the other learned profession to determine whether it can alone arrive at this supreme end. Should any one in a half century succeed in establishing an increase in the ratio of longevity, then we shall see that the academicians,f homoeopathists, and other learned men are not Utopians in trying to demonstrate that .the human organization is capable of a higher ratio of longevity, proportionately to the variety of climate and the degree of civilization, than it attains in modern times. It is doubtless thus that your illustrious and learned Dr. Hering understands the benefits of homoe- opathy. It was in view of this object, it was to sustain and propogate these truths that one of his admirers, our learned confrere Dr. Charge started the Bibliothlque Homoeopathique. This modest publication, which is in its eighth * Even after Hahnemann's Organon and The Treatment of Chronic Dis- eases, after Leon Simon, Sr.'s, Commentaries on the Organon, after Ruck- ert's Homoeopathic Treatment of Skin Diseases, something still remains to be done. f Flourens. DISCUSSION ON SURGERY. 837 year, has received even in your country such encouragement as proves that it is in the right path. A work which thus has the patronage of enlightened co-workers ought to go on and make our cherished doctrine still more es- teemed by publishing your remarkable works, and translating your studies of new pathogeneses. In order to bring one more proof in aid of the solidity of the Hahnemannian principles, it published in 1871 a report in which the author* has endeavored to show what homoeopathy can do in various dan- gerous diseases. The writer gives as evidence the success obtained in our little ambulance during the siege of Paris, in the midst of the most deplor- able physical and moral circumstances. We lost, however, only two patients out of seventy (no surgical cases were treated, all our patients suffering from diseases more or less dangerous). Every time we publish a clinical report, it is principally with the ideaof showing what may be obtained from homoe- opathy, by adhering faithfully to the precept of individualization. You wish to know the state of homoeopathy in Paris. We are happy to be able to tell you that our Bibliothkque, truly represents the homoeopathic doctrine, and we are pleased to believe that such will be your opinion. This hope encourages us to persevere scrupulously in the paths which we have traced out, and which we believe the surest and truest. It is in this spirit that we present ourselves to you, dear brethren ; may we meet with esteem and a good welcome in your learned reunion. Though separated from you by distance, we still hope to find ourselves in your midst by virtue of sym- pathy of thought, as well as by the community of hopes and beliefs. For all the members of the Hahnemannnian Society. Leboitcher, President. P. PlTET, Secretary. Paris, March 15th, 1876. COMMUNICATION FROM DR. ROCCO RUBINI, NAPLES, ITALY. To the President of the World's Homoeopathic Convention at Philadelphia, 1876. Mr. President: Not being able, because of my inability to endure the trials of a sea-voyage, to take part personally in the proceedings of the World's Homoeopathic Convention, as 1 could have wished to do, I crave permission by a briefly written memorandum, to call the attention of its learned mem- bers to a subject which I should otherwise have submitted to them orally. I speak of CHOLERA. It is universally admitted that against this scourge of humanity officinal medicine has up to this time found no remedy which can reduce the mor- tality below fifty per cent. Homoeopathy possesses several remedies, yet has lost ten per cent, of the cases treated. With Camphor only, prepared by * Ch. Herzmann. 838 world's HOMCEOPATHIC CONVENTION'. my method and used in strong and repeated doses, I have cured all whom I have treated. In three different epidemics, more than seven hundred patients have been under my care, and all have been cured. Accounts of these cases with tables showing the patients treated and cured are printed in my Statistics of Cholera Morbus, of which I send a hundred copies to the Convention. For brevity's sake 1 will not enter upon a dis- cussion of the proximate and remote causes which produce this terrible pesti- lence ; nor unfold the different theories of physicians of all nations ; nor will I speak of the formation of morbid spores on the mucous membrane of the intestines, nor of the various other reasons given for the development of cholera. Putting aside all these diverse theories, I proceed at once to the method of cure which saves the sick from certain death. I will treat: 1. Of the method of preparing the remedy. 2. Of the method of using it as a preservative. 3. Of the method of using it as a remedy. 4. Of the method of using it in a relapse, or in the sequelae of the disease. 1. Preparation of the Remedy.-Mix with pure spirits of wine, rectified to 40 or 45 degrees of Cartier's areometer, or to 96 of Gay-Lussac's, an equal weight of pure camphor ; a kilo of alcohol and a kilo of camphor, for example: Cut the camphor into small pieces and entirely dissolve it in the alcohol. This is the preparation used by me with much success. If the kilo of camphor is not fully dissolved in the alcohol, the preparation will not be good, and it must be concluded that the alcohol has not been well rectified. The preparation in proportions of one part of camphor to twelve parts of alcohol is, therefore, worthless. 2. Ms a Preservative.-Of this alcohol saturated with camphor, five drops at morning and five drops at evening, on a lump of sugar, is sufficient to preserve from a cholera epidemic a man whose mode of life is healthy. 3. As a Remedy.-Four doses of five drops each given daily are sufficient to promptly cure every case of cholerine. When the cholera is in a con- firmed algid state, five drops of this alcohol saturated with camphor, given every five minutes, is sufficient to excite reactionary fever and abundant sweat and, therefore, to effect an almost miraculous and speedy cure. It is, however, necessary that the remedy should be taken in the first moments of the morbid invasion. If the disease is allowed to advance, so that from serous diarrhoea and serous vomiting the blood loses its lymphatic portion, then death is inevitable on account of the coagulation of the blood in the venous anastomoses; as occurred in the case of Miss Marian na Berlingieri (see Statistics of Cholera, p. 35). For the good success of the cure it is, then, essentially necessary that the Camphor should be administered as soon as the first ventral discharges or the first efforts to vomit appear Then the cure will be certain, safe, and complete in two hours, as my repeated experience has always convinced me. When the case of cholera is very severe, the dose should be increased to 10, 15, 20, and 30 drops at a time; thus the reaction and perspiration are ob- DISCUSSION ON SURGERY. 839 tained and the speedy cure is effected. (Statistics, pp. 26-30.) When the cholera is asphyxiated, the same strong dose of 30 drops every five minutes with external friction, with the same Camphorated alcohol, will equally effect a cure. (Statistics, p. 31-iv.) No one has ever mentioned epileptic cholera so far as I am aware. In 1865 in the Gervasi family, for the first time I saw five ladies attacked by it, and two cases of relapse. These seven were very severe cases of epi- leptic cholera. They were all cured with Camphor alone, in very strong doses administered internally, and also externally by constant friction. (Statistics, pp. 4-13.) 4. Relapses and Sequelae -The relapses, always more serious than the primi- tive disease, are yet all cured with Camphor alone, administered in the same manner. Although cured of cholera, many patients still have bilious diar- rhoea; but this is also cured by Camphor administered in small doses. (Sta- tistics, p. 28 ) Conclusion.-It appears, then, that Camphor must be the true specific for cholera morbus. If it preserves from the contagion ; if it cures cholerine in its different stages and in its different forms ; if it cures cholera asphyxia ; if it cures the severest epileptic cholera ; if it cures the relapses and sequelae of the disease, it may be said that Camphor prepared by my method and used by my method is the true specific of cholera morbus. Moreover, the remedy is exceedingly simple. It is only one substance. Every one can prepare it for himself. Every one may, without a doctor, medicate himself and his household, and with this single remedy ward off death without fear of mak- ing a mistake. In case of the recurrence of a cholera epidemic the officers of the government of any place should cause to be distributed to every head of a family a little bottle of this alcohol with some printed directions upon the mode of using it; thus every parent would be doctor of his own house- hold, and by carefully employing this remedy he would achieve cures in two hours, and his family would be safe from all danger. If every wise and en- lightened government would act in this manner we should soon see cholera driven back to the banks of the Ganges and our people saved from its perils. Quarantines and pest-houses would be unnecessary, and commerce, the source of national wealth, would suffer no hindrance, obstacle, or delay. This alcohol saturated with Camphor being, then, a most useful and im- portant article for general benefit to all nations, I hope that the illustrious and esteemed doctors who meet in the Homoeopathic Mcdieal Convention at Philadelphia will take this matter into favorable consideration and urge the government of their free country (which protects truth), to employ these energetic measures for the public health which the senile governments of Europe, influenced by the jealousy and envy of officinal medicine, have not been willing to adopt. Accept, Mr. President, and convey to my illustrious colleagues assembled in the World's Homoeopathic Convention, my expression of profound respect and regard. 840 world's homoeopathic convention. Dr. Rubini has also sent for gratuitous distribution among the members of the Institute 100 copies of his admirable work on cholera. On motion, the report of the committee was accepted. Also, it was moved and carried that the resolutions relative to Madame Hahnemann be adopted and carried out by the officers of the Institute. The regular order of business was then resumed, and Dr. S. R, Beckwith was introduced. Dr. Beckwith : I am requested to say in behalf of the Surgical Bureau that they do not intend to read any discussions, and would earnestly invite the members of the Convention to take part in the debate; they also propose to be as brief as possible; my few remarks will be upon the able essay on the treatment of syphilis, by my friend, Dr. McClelland. We, who claim to be in advance of the ordinary schools of medicine, should certainly adopt some measures tending to pre- vent the extension of this fearful malady ; though for the last half century men, wise in medicine, have endeavored to assist legis- latures and bring about some legislative action by which this scourge might be modified, thus far but little has been ac- complished ; and if our school could propose some practical plan for arresting this terrible disease, it would well repay us for coming here. There is no scourge to humanity that prevails among all classes to so great an extent as syphilis, which affects not only the person having it, but his posterity; and this subject, fraught with such grave consequences and of so much impor- tance to medical men, should receive our most careful con- sideration. In Dr. McClelland's paper, with which I am exceedingly grati- fied, the first position that he assumes, dividing syphilis into the hard and soft chancre, is more in keeping with the experience of observing surgeons of to-day than the theory of but one true syphilis with a simple, hard chancre. In treating syphilis, theories must give way before the hard facts of a man's expe- rience, which are worth more than volumes of theories. If men have observed a soft chancre degenerate into syphilis and so develop constitutional symptoms, it is proven beyond a doubt that the soft chancre is but another species of syphilis. In my opinion there is but one true test of chancre, that of inocu- lation, and the man does not live who can say positively that any ulcer is a chancre, unless he proves it by inoculation ; expe- rience allows him to approximate to a perfect diagnosis, but nothing further. I have made the test in soft chancres seen in DISCUSSION ON SURGERY. 841 all conditions, and they degenerate into a syphilis so far as to produce secondary symptoms, characterized by the ordinary eruptions and sore throat of syphilis. I would most earnestly advise physicians to investigate these symptoms, for in my opinion the soft chancre will, under certain conditions, develop into true Syphilis. The doctor also states in his paper, when speaking of the local treatment by cauterization: " On the whole, I think it preferable not to molest the chancre save as necessary to cleanliness." In this he differs from the allopathic practice which recognizes local treatment. His theory may be correct, but I think that at first, during its stage of incubation, the disease is purely local; and also after the degeneration and suppuration, but not after destruction of tissue, for then a por- tion of the virus may be absorbed and the disease become con- stitutional. On account of this opinion I take exception to his treatment, and I advocate a removal of the chancre in its early stages by Nitric acid, the knife, or the potassa fusa, instead of by Nitrate of silver, which chars the parts and leaves the virus below; while my theory is of no value, my personal experience is valuable, because I have had a large experience as a surgeon in the treatment of primary, secondary, and tertiary syphilis, and this experience I offer here. I most heartily agree with his recommendation of Mercury; for in my judgment there is no other remedy known which will be so certain to eradicate, prevent, and cure syphilis. Each man must be gov- erned by his own experience as to the strength of the dose ; my experience teaches me that the second or third trituration of Merc, cor., sol., or protiodide, given in grain doses every three hours for a week, and then two or three times a day for two weeks, gradually increasing the time between the doses, will most certainly and effectually cure the syphilis. I doubt if it is possible to check this poisoned blood and virus, but I only give my own experience, and I think it extremely important in the diagnosis of the varieties of syphilis to be able to give a clear distinction; yet I do not think any man can diagnose a soft chancre as being anything but a simple, soft chancre in many eases. I do not agree with my friends that the local treatment is enough and that no general treatment is required; because in soft chancre there is a germ of the true syphilis, and secondary symptoms may supervene in soft chancre before suffi- cient time has elapsed for that chancre to become degenerated, and hence every chancre should be treated as a true chancroid, and every chancroid, whether hard or not, as a true chancre. If this treatment is followed, it will result in less cases of 842 world's homoeopathic convention. secondary and tertiary syphilis. Homoeopathic physicians have as many cases of syphilis to treat as the members of other schools, and they have been able to meet this disease with good success. L. H. Willard, M.D.: Our distinguished friend, who has preceded me, takes a different view of this subject from what I do, when he says that by cutting out or burning a chancre he does the best thing to prevent the system from becoming infected. If I may be allowed to differ, I think this is not good reasoning-regarding the disease as a zymosis. That syphilis is a zymotic disease, has of late been conceded by most writers, having its period of incubation, elimination, and sequelae. Like small-pox, after it has once gained an entrance into the circulation, it never leaves the system until thrown off by the evolutions so characteristic of the disease. It has been ascertained, I think, beyond a doubt, that when once the poison enters the circulation there is no abortive treatment which can prevent the constitution from becoming affected. In the first place, to properly understand the treatment, it be- comes indispensable to ascertain its pathology. For many years (and may be to-day) secondary and tertiary symptoms were con- sidered a result of improper treatment; Mercury was given in too great or too small a quantity. The burning of the chancre was supposed by many to be the cause of what are called secon- dary symptoms. In this confusion the true nature of the disease was unknown, although many suspected at that time its zymotic character. From this confusion of ideas in regard to the disease which seemed to possess the medical world for several centuries, we were at last relieved by Diday, who, with a view of ascertain- ing its real nature,' subjected forty-nine of his patients to a dietetic treatment, giving nothing for the disease until a few of the tertiary symptoms in some of the patients made it necessary to resort to specific treatment. The result of these experiments, familiar to all, was such as to prove beyond a doubt that this disease is like variola, measles, scarlatina, etc., in having a period of incubation, elimination, and recovery, followed in a small minority of cases by sequelse. Considering the disease as having this zymotic origin, is it not probable that, in our haste to cure the first stage (which in a majority of cases is useless), we make a mistake and, instead of aiding nature in her beneficent work, suppress the eruptive stage, or so modify it as to produce results which may make their appearance in various ways in after years? We do not try to moderate the rash of scarlet fever; we hail it as a good symptom that the system is being DISCUSSION ON SURGERY. 843 relieved of the morbific poison, and hence, as my friend McClelland says in his paper, we cannot be sure of having cured the disease, when the medicine administered in the first stage has cured the chancre. In reading Hahnemann's writings, we cannot help noticing how very careful he was to enjoin on his followers these outward manifestations of disease, and how earnest in his advice never to suppress a disease characterized by an eruption for fear of bad results; so that at present, knowing and acknowledging its zymotic character, can we consider a thorough cure made, unless we have other proof beside the healing of the chancre, which can generally be accomplished by mercurial absorption? I am happy to see that this paper treats in an outspoken man- ner of this first stage of syphilis, and expresses the idea in a con- cise manner that, whilst we may cure or suppress the chancre by Mercury, there is no reason to suppose the disease is cured, and, if not cured, no fault can be attributed to the surgeon if the med- icine has been administered according to our law. I think that most of us can concur in this and remember cases where medicine was administered according to the way taught by Hahnemann, Jahr, and others, and still the true manifesta- tions of disease showed themselves. From the experience which I have had, I believe secondary symptoms will come on in a great majority of cases with or without treatment, thus showing the specific nature of the disease. Medicines administered properly may modify, but never thoroughly antidote the disease until after the characteristic eruption has shown itself. It has always been perplexing to me that our medical writers treat of chancre and of curing it. One would suppose the disease cured-we may think so or we may not, for immediately follow- ing, the secondary stage is treated of without specifying how it is produced or in what manner. Hahnemann cured this disease with one dose of Mercury 30th, but cautions his followers of the secondary consequences which follow if the disease is not treated properly. Berjeau gives two or three doses a day and cures, but should the cure be improperly conducted, secondary symptoms follow bv what we might understand to be the ignorance or care- lessness of the physician. Jahr gives still more Mercury and cures it in the first stage, and, like Berjeau, believes that when not arrested in this stage it is owing to the fault of the attendant; and so we travel along among the different writers until we come to the present time, when it seems not so much confidence is placed in curing in the first stage, and a very careful prognosis is given to the patient for fear of disappointing results. Now, 844 world's homceopathio convention. if it can be cured in the first stage, why not have it understood so that we can blame ourselves for the non-success of the treat- ment and not the disease I It would seem that we have been in the habit of trying to suppress this disease instead of eliminating it from the system in the manner adopted with all other zymotic diseases. To do this it is necessary, as Hahnemann says, to draw it from within outwards, and hence you may infer that I would not be anxious to give Mercury in the first stage. I would give it, however, but in such attenuations as could by no possibility produce a pathological result. I would prefer, on the other hand, to burn the chancre rather than give the third trituration of Mercury, which is given because it possesses the power of pro- ducing absorption of the effused lymph; of the two, I think the burning the more homoeopathic, for as yet there are no constitu- tional symptoms noticed, and it is only when these symptoms become manifest that, in my opinion, Mercury is homoeopathic. We might reason with those who think the cure can be accom- plished while only the chancre shows the nature of the disease that it might by its power to antidote also become a prophylactic. In regard to burning the chancre, I see no great objection to it. As I have said before, I think it as homoeopathic to the cure as Mercury. The chancre being the initial point of entrance into the system, can never by any possible means be the place of exit, which fact I think cannot be controverted when we consider the zymotic character of the disease; hence by destroying the ulcer we prevent the spread of the contagion to others. Da. A. C. Clifton, of Northampton, England: Only a few days before I left home did I learn that I was expected to take part in any discussion here; I thought to come as a spectator. But I am now expected to speak on the therapeutics of syphilis, and in order to do that or in fact any work with the mercury at 95° in the shade, requires more endurance than any Englishman is gifted with. (Laughter.) On an average I treat 150 cases of syphilis yearly; the pa- tients are poor,dirty, ill-fed, badly-housed, drunkards, etc., which facts it is necessary to notice, as it makes a great difference in the result whether the patients be at the hospital or dispensary, or at their own homes. I accept the pathology of Dr. McClelland dividing syphilis into the true form and the chancroid ; about half my cases are of the latter variety, and I enjoin on them first of all, scrupulous cleanliness, as there are eases produced almost wholly by dirt; and in order to keep them clean I scold them, tell DISCUSSION ON SURGERY. 845 them not to come again until they are cleaner, order them to use soap and water freely. I give Sulphur, Arsenic, Lycop., Hepar, Silicea, Lachesis, in the high potencies, and for local treatment use dry lint, Calen- dula lotion, or Carbolic acid, with an occasional application of Nitric acid. If there is a tendency to spread, or if complicated with bubo, I lance at once. In true syphilis the remedy should be chosen with reference to the grade and character of t he ulcer- ative and general symptoms, because I think the constitution is not invaded in the first stage ; I never apply anything at that time to the sore, but afterwards use a local treatment of black wash as the case progresses; if the ulcer heals and a hardness remains I use Phytolacca, a tincture from the berries, but if a smooth patch remains I use Glycerin and Hydrastis. The internal treatment of primary syphilis is regulated by the grade and the character of the sore, and among the few useful medicines Merc, sol., is better than anything else for the true Hunterian chancre-hard base, sloping borders, grayish adher- entsurface; if the ulcer spreads it is deep. Merc., cor., in chancres, which after taking Merc. sol. show signs of spreading and having a thin discharge. Cinnabaris : chancres with smooth glazed surface, very little if any discharge; reddened edges; I give it internally and also apply it externally. Phytolacca: when the ulcer is nearly healed or healed quickly and hardness or thickening of integument remains. Hydrastis : if tendency to erosion, after healing of ulcer, or if bowels are constipated with thickly furred tongue, prints of teeth and muddy heavy countenance especially after Merc. I do not think there is any marked line between secondary and tertiary syphilis, as one runs into and interchanges with the other, and I therefore speak of them together and give leading indications for medicine. My treatment is much varied, for we must travel from Dan to Beersheba in search of remedies, and the materia medica and repertory require more study than in treating the primary forms, as it is necessary to pay attention to all the manifestations of the disease and the idiosyncrasies of tempera- ment of the individual. Now, as to the treatment: 1st. If the patient has been mercurialized, I put him on Merc. sol.30 for a week or two. 2d. If mercurialized and in a low condition, with fungoid or mucous tubercles, give Nitric acid. 3d. If condylomata are numerous, but dry and seedy; Thuja. 846 world's homoeopathic convention. • 4th. If the patient is strumous, or lymphatic and slow, with want of vitality, and in a low condition, give Kali hydriod., es- pecially for nodes; or, if the discharge becomes tenacious, and forms scabs, or is offensive. 5th. Merc. biniodide: for syphilitic angina; ulcers with over- hanging borders on fauces and throat; pains going up throat; also, for certain skin affections. 6th. Kali bichromicum: for ulcerations of mouth, pharynx, larynx, but discharge forms with scabs, or is tenacious. If throat discharge is offensive, gargle with yeast, or Baptisia. Cist us: Creeping eruptions on face. Staphisagria: Disease affecting gums and teeth. Kalmia: Pains in head and face; bone pains. For the skin affections : Corrallia, Lithia, Iodide, Sulphur, and Arsenic, Lachesis, Aurum, Hepar, Carbo veg. I used the 30th and 200th potencies in the beginning of my practice, for I was taught in a school that considered anything lower than the 30th not homoeopathic, and I continued to use these doses for eight or ten years, then gradually used lower potencies, and about five years ago I began to use the higher po- tencies, and then the dose-question presented itself to me. A case of tertiary syphilis came under my notice, where the man had been afflicted about twelve years, and had been in the hands of six doctors, had taken big and little doses, and a great deal of Iodide of potash. I began to treat him, but he constantly grew worse, until I feared losing him, and I took him to another physician, who ad- vised " salivation." I replied that he had already been salivated four times, and was then advised to give Iodide of potash, which I had given him before, but under the use of three grains three times a day, the man began to mend, and in three weeks he had all thesymp- toms of ptyalism. I at once put him on the remedy, and he had iodism three times: his syphilis got better, but he got iodism. I then gave him twenty-five grains of the Iodide of potash a day and kept him on it for eleven weeks, during which be constantly improved, grew stouter, gained three stone in weight, and lost his syphilis, nor has he had any return of it since, though that was between three and five years ago. I am not prepared to say that high dilutions do not cure, for I think they do, and often use them, but my experience is that the lower dilutions work the best, and I will state the strength of the different medicines, which I prefer: Merc, sol., l°to 3° ; Merc, cor., 3X to 6° ; Cinnabaris, 3° ; Merc, biniod., 1°; Nitric acid, DISCUSSION ON SURGERY. 847 1* to 6 ; Aurum ful., 3 to 30; Thuja, 1 to 30 ; Cistus ; Hydras- tis, Phytolacca and Staphisagria, 12°; Kalmia, 3° to 6°; Kali bich., 1° to 6°; Ol. jecoris, Mezereum, Asafoetida, no action from. H. F. Biggar, M.D. Cleveland, O.: It is necessary to know syphilitic pathology, which is very unsettled ; it is a mooted question whether or not the soft chancre can develop constitutional symptoms, and whether a syphilitic, a Hunterian chancre, will become constitutional; the true hard chancre will develop constitutional symptoms, but I am not prepared to say whether the soft chancre will or will not. I treat my cases as if there were going to be a hard chancre, in order to eradicate it entirely from the system, and I never hesitate to use an escharo- tic; the best one is a local application of Chloride of zinc crys- tals, and I prefer this to Nitrate of silver, because in using the latter an eschar is produced, but the bottom of the sore is not reached. I am not prepared to say whether the soft chancre is constitutional, but as there is doubt about it I wish to give my patient the benefit of that doubt. When I have a chancre which heals soon after the application of Chloride of zinc I sprinkle pure calomel on it, as I think it homoeopathic to the disease and believe, in order to eradicate the disease, it must be fought very persistently. A man's experience is his best guide, and that is mine. Syphilis is syphilis all the world over, in the first, second, or third stages, and it must be treated as such in either of its stages. I like the lower attenuations in the primary, and the higher in the latter stages. While I think Mercury is the backbone of cure in syphilis, I also like Iodide of potassium, each of which medicines should be given in the proper way. Mercury should not be crowded into the system ; for if salivation occurs there is present a mixed disease, which will be more difficult to cure than the syphilis itself. The symp- toms will determine the point at which the administration of Mercury should be stopped, the gums, teeth, and feet tell you. In some cases it is necessary to go to an extreme point, and then it must be antidoted, which can be done by using a satu- rated solution of Chloride of potash upon the gums with a dose internally of Iodide of potassium. Then the Mercury can be continued, if necessary. Iodide of potassium will not, in my opinion, cure syphilis, but it is a remedy on which the patient can rest while under the Mercurial treatment, and which can be used in conjunction with Mercury two or three times a day. The PRESiDENTthen announced that the regular order of debate on syphilis was concluded, and on motion of Dr. W. T. Helmuth 848 world's homceopathic convention. the rules were suspended and the subject thrown open to general discussion in five-minute speeches for half an hour. William Tod Helmuth, M.D., of New York: I have lis- tened with much pleasure to this discussion on syphilis, and having had considerable experience in its treatment, I desire to say a few words, especially about the duality of the virus. For a long time it was considered that there was but one kind of virus with but one kind of syphilis, and that all the forms of chancroid were derived from this one virus. We had a soft, a hard or Hunterian, a phagedenic, and a sloughing chancre, which were all supposed to proceed from the one virus, but in time it became known that there are two distinct varieties or sources of poison. There is one source which does not affect the constitution, in other words there is a chancroid without syphilis, and a chancroid that is most likely to become phage- denic, a chancroid whose virus is inoculable into any part of the body, and a chancre which is more rapidly transported even than the Hunterian chancre, and this chancre is called a chan- croid. The diagnosis of chancroid, before it has become degenerated or inoculated, is easy, for it looks as if it had been cut out with a sharp punch, but in the hard chancre the edges are jagged and uneven, with a lardaceous base. In order to distinguish the two chancres, put your fingers into the inguinal region, and in the majority of instances if the glands are hard and indurated, no matter how small, you have got an indurated chancre, and constitutional symptoms will certainly be manifested. Regard- ing the treatment of syphilis, it must be remembered that a soft chancre is the kind most likely to become phagedenic, and to be followed by suppurating buboes, which do not often follow a hard chancre. The best plan is to cauterize a soft chancre with a paste of Carbo vegetabilis, made by pouring strong Sulphuric acid upon common charcoal; this is applied to the sore and forms an eschar, and when this drops off about the third day you will find a number of granulating spots about the sore. The hard chancre should also be cauterized, because it is the initial lesion, and from it syphilis begins, and the secon- dary symptoms come from it; but if it can be arrested at the fountain-head the virus will be prevented from being absorbed into the system. The best remedies are Mercury and Iodide of potassium. Many others are recommended, and although I have tried a great many, yet, in the treatment of secondary syphilis I cannot get along without the use of Iodide of potash. I wish in some cases I could, but I tell you it cannot be done, or at DISCUSSION ON SURGERY. 849 most I cannot do it, and I am also obliged to give it in tangible doses. A. Varova, M.D., New York: I learn much from what has been said as to the treatment, but I do not agree with the pathology that has been advanced. When we speak of the heritage of true syphilis we must know what syphilis is. It is a living bioplast which, when it comes in contact with living tissue, feeds upon it, proliferates, and reproduces itself. Now, with all due respect to the opinion of my friend, Dr. Helmuth, who holds to the quality of the poison, there is but one form of bioplast, a living germ which resembles somewhat the white blood-corpuscle. It has a fourfold way of reproduction when brought in contact with the living tissue. It may feed upon the fluids with which it is brought into contact locally and there ex- pend its energies, producing a local inflammation, and be dis- charged as dead matter in pus, and this constitutes the soft chancre, which never pervades the constitution; or, owing to certain systemic conditions, it may produce a severer form of local inflammation and then give rise to the phagedenic, or eating and spreading chancre, and still be unconstitutional, or it may first work its way into the blood, or into the system through the lymphatics, and after a period of incubation, varying from one to seven weeks or years, may produce the hard chancre. The rule for treatment is to destroy the bioplast wherever it is found ; if it has merely produced a local sore, destroy that sore; if it has got into the constitution, seek for it there with constitu- tional means. Or if both local and constitutional then the treat- ment must be both local and constitutional. Now, the proof that the poison or germ feeds upon the tissue and is only dis- charged as dead matter in pus is, that wherever pus is found the syphilitic bioplast ceases to be able to reproduce itself. In soft chancre the bioplast can not be reproduced by inoculation. In the pus of a suppurating bubo where, as an exceptional thing, it appears after constitutional syphilis, the bioplast no longer exists, nor is that pus inoculable; but take the syphilis poison from the Hunterian chancre and it will reproduce itself. Dr. Hayward, of Liverpool, England : I wish to indorse the opinions just given ; it does me good to enjoy a day like this where things are so clearly and satisfactorily explained, and I quite agree with my friend who has just spoken, that the unity of the disease is established, although in certain cases it does not show itself any more than does vaccination, which will take effect in some constitutions and will not in others, because in those other cases the person is not susceptible, having been 850 ■world's HOMCEOPATHIC CONVENTION'. vaccinated. Even now I hold that the system may be protected against the syphilitic poison in the same way, and therefore the application of the true syphilitic poison might not produce in one case hard chancre and in another soft chancre. I think, with the former speakers, that we should invariably feel our way, and should treat every sore as though it were infectious, though it may not be so at all, and I agree as to the local treat- ment by means of caustics; we should not entirely avoid local treatment, and as the constitution may be affected even in soft chancre I would always use constitutional treatment. I desire to indorse the previous remarks relating to the treatment with Mercury and Iodide of potash. On motion, Dr. Helmuth was invited to finish his remarks. Dr. William Tod Helmuth : I always have been, and intend to be, a practical man, and I know very well that the micro- scopic theories with reference to certain formations advanced years ago have all been thrown aside. Although these theories are beautiful, and although this theory of bioplasts which my friend has introduced to you may be well in its way, it can- not be proved. True, there are the revelations of the microscope, yet three or four or ten years from to-day another variety of microscope may be discovered which may throw all we know now into the shade. Now, if these are bioplasts, the one being destroyed by pus and the other taken into the system, it does not alter the treatment. What we want to reach, as members of an enlightened profession, is how to cure syphilis, and how to rid humanity of its greatest scourge; and the majority of us setting aside these theories have concluded that the difficulty on account of the treatment is nearly corrected. I would like to hear from some of my friends who deal exclusively in the higher potencies, for I want to learn. I would rather give the medicine in the attenuated form if I thought it as good for the patient. I most earnestly call on any member of this Conven- tion who has had genuine experience in chancres. I want to see a man who diagnoses hard and soft chancre, and I want to know whether he has cured them with the indicated high potencies. This, for my own information as well as for yours, gentlemen. Richard Hughes, M.D., of England: I am not coming for- ward in answer to Dr. Helmuth's invitation, as I am not one of the gentlemen to whom he refers ; but I wish to present to you a question which has not yet been raised on this subject, namely, what is the true relation of Mercury to syphilis? We all want to cure our patients homoeopathically if possible, and unless DISCUSSION ON SURGERY. 851 Mercury be truly homoeopathic to syphilis, we should be loath to use it; and if it be not homoeopathic to this disease, we ought to know it and to know that we are using something exceptional and unusual. It is commonly assumed that Mercury is homoe- opathic to syphilis, because the effects of mercurialization in some vague and general way resemble the condition called constitu- tional syphilis; but I think that if the question be examined more carefully it will be seen that there is not such a similitude. Dr. McClelland, in his otherwise excellent paper, perpetuates a very great mistake in quoting Mercurios as being adapted to the typical Hunterian chancre, and as having distinguishing symptoms which are of unmistakable severity, and these symptoms are found in its pathogenesis. It is only necessary to examine these symptoms for a moment to assure yourselves that we cannot be bound by any particular pathogenesis of Mercury, for many of them are taken from spurious symptoms, removed, but not pro- duced, by the administration of the drug, and these symptoms are given to the ignorant as the true effects of the drug. Now Mercury never caused a chancre with an indurated base or mar- gin, or induration of the glands, and it is so with half a dozen other symptoms presented. There are symptoms which have sometimes disappeared under the action of the drug, but we may study the drug for a lifetime and not arrive at a solution of the question, for there is nothing like induration induced by it, nor anything like true syphilis; and in the secondary stage of the disease, there is still less of any characteristic indications, and still less in the third stage. Therefore I hold that the essential action of Mercury is not homoeopathic but antipathic. The indications and counter indications of Mercury are simple; we have to use the Mercury to liquefy the indurations, and soften the hard chancres to melt away the pus and produce the healthy tissue. E. A. Farrington, M.D., Philadelphia: I can testify thatAw/A potencies will cure syphilis, and potentized Mercurial preparations will produce symptoms similar to those of syphilis ; the Iodide of mercury in the one-thousandth potency has produced a pimple or papule which resembles a hard chancre ; and this same iodide of Mercury, given in repeated doses for days continually, has cured this kind of a chancre in a number of instances. It has also cured a secondary sore throat which was developed six or seven weeks afterwards, but which on the continuance of the medicine disap- peared and for nine years has not been seen. I have also produced similar results with the five hundredth potency, getting an ulcer that looked as though it were punched 852 world's homceopathic convention. out at the top; of this I am positive from my own personal ob- servation, and I know this to be the case in the experience of Dr. Macfarlan of this city, who has proved this thing by experi- ments, and whose cures I have seen. Malcolm Macfarlan, M.D., Philadelphia: Illness has pre- vented me from preparing any systematic remarks, and I would rather some of you would "quiz" me if you have any doubts about homoeopathic medicines curing syphilis. For nine years past I have had a large clinic, at which all forms of venereal disease presented themselves, and though I have no right to force my opinion upon the members of this Convention, yet I tried to impress it upon the minds of my students by cases of actual demonstration. It is hard to convince the general practitioner, who has been in the habit of using crude drugs in this disease, and talk without proof is almost wasted, as it will convince no one, especially if he has been an old-school practitioner like myself, and has seen the ortho- dox treatment. He can not comprehend the Hahnemannian method of examining cases or applying remedies, either in pri- mary or secondary sores. Now it may be said that I do not know what primary or sec- ondary sores are, as physicians can only distinguish them after having seen them; but I have treated a vast number of syphilitic cases in various stages and varieties. I am anxious for criticism, representing as I do a peculiar kind of treatment, purely homoe- opathic. I have made experiments and converted myself, and am very anxious to convert others. Regarding the hard chancre, whether or not you see it in a state of ulceration, it has its char- acteristic appearance at first as a small papule with a hardened red base. As Dr. Farrington has just said, I use among other remedies the Iodide of mercury in a highly potentized form, 200 to 1000, and I think a still higher potency would be equally effective. It should be given on the appearance of the first symp- toms, and where later there is a livid small sore of a reddish or pink- ish color. Under the remedy this disappears, and the induration passes away, the ulcer softens and changes to a healthy natural sore, which heals up by natural granulations leaving no secondary symptoms. If the case is treated early there are no secondary symptoms, provided it is uncomplicated with a previous syphilitic history. I have seen a sore Resembling a chancroid treated by constant repetition of potentized Iodide of mercury, and a pap- ular eruption produced all over the body appearing in two weeks. I think Dr. Farrington also saw the man. This has been fre- quently verified in public clinic. A Member: Did you use any local application in these cases? DISCUSSION ON SURGERY. 853 Dr. Macfarlan: No; I use the simple application of soap and water for cleanliness, but no medical application. A Member : What preparations have you prescribed ? Dr. Macfarlan : All the preparations were from the two hundredth potency up. I am not prepared to speak of Fincke's preparations, not knowing how they are made. A Member: Dr. Hughes said you never could produce hard chancre; have you produced it? Dr. Macfarlan: I have never produced any more than stated above-a general papular eruption and cures! (Ap- plause.) A Member : It was stated by a gentleman that the 100th of Mercury had produced a similar eruption. Dr. Macfarlan : It produced a general papular eruption resembling that following the Hunterian sore, as well as the primary initial papule. A Member: Has Dr. Macfarlan used Syphiline in any potency in the treatment of this disease? Dr. Macfarlan : Yes, sir; I used it some years ago in several cases of soft as well as hard or true chancre, but have forgotten the exact potency ; I got no satisfactory effects. A Member: Have you used the 200th potency of Ura- nium ? Dr. Macfarlan: I have used various preparations, but prefer Fincke's ; they act quickly, and their results are permanent. The preparations I use exclusively in our clinic are known as the 200th of Boericke & Tafd. I have held a public clinic for nine years ; I gave Dunham's 200th during 1866 and 1867, and when Boericke & Tafel's 2e preparations were made I used them, employing the yellow, the red Iodide of mercury. A Member : Do you find much difference between the two Iodides? Dr. Macfarlan: The Biniodideis the better; I have made many experiments with this and other remedies, and wish every one interested in the subject would verify for himself. I give one or two powders, each to be dissolved in water, using a glass and teaspoon which had never been used for medicine before, and the patient takes a teaspoonful every one or two hours. A Member: At what time in the treatment of the disease does this papular eruption appear ? Dr. Macfarlan: At a varying period of the first week. I would particularly mention the dryness about the throat and 854 world's homoeopathic convention. bad insipid taste in the mouth, furred tongue, general malaise, weakness and prostration caused by biniodide of mercury. S. R. Beckwith, M.D., Cincinnati, O.: Experience is the best guide in the treatment of syphilis. My friend's theory in reference to the cause is good, but what we want in this dis- cussion is to find some cure for syphilis. Dr. Macfarlan, bring- ing a large and extensive experience, says he has cured it with high potencies, and this evidence must be taken exactly on the same footing as that of any other man. Now what is the com- bined evidence of all the men who have spoken? It is by that evidence we must be guided. Every physician and surgeon knows that this disease is often self-limiting. There is the record of a man in Paris who often exposed himself to syphilitic women and never contracted any disease that could not be cured in two or three weeks, and in other cases it has been cured without any great disturbance, which proves that it is a local- ized disease. . If there is fibrinous deposit enough to form an eschar and pus collects, the patient requires medicine. I have tried high potencies and have failed. I have seen many cases where Mercury in large doses had also failed because, in my opinion, it unites with syphilis, producing a mercurial disease, and these are the only cases cured by the Iodide of potassa, which, as a rule, has otherwise no relation to syphilis. Many years ago I had charge of a large hospital where I had a syphilitic clinic, but I cannot now give my experience there. Will Dr. Macfarlan tell me how many of his cases became sec- ondary ? Now, perhaps the disease may be mercurial in this locality. I think high potencies will cure ague here, but not a high potentist nor the whole of them combined can cure a case on the Wabash River. Syphilis may differ in intensity in dif- ferent localities. In conclusion, syphilis must be treated as a local disease and the poison destroyed by very severe measures, and it is best to commence with Caustic, watching the cicatrix, and if it heals kindly without any blue line there will be no disease following. If there is a blue line left in the centre there will be secondary symptoms some time in the man's life. I can- not agree with Dr. Helmuth that there is a hardness in the inguinal glands. If he would extend his observation to other parts of the body he would also find many enlargements. W. T. Helmuth, M.D.: That which I said in reference to the hardened glands in indurated chancre comes directly from Ricord's last work. He is my authority, and in his great work on the chancre he describes a certain variety of hardness after DISCUSSION ON SURGERY. 855 one has had this disease for a week. Still there is not the hard, indurated, contracted feel that exists with a hard chancre. J. H. McClelland, M.D., Pittsburgh : I will first read a request from Dr. Richard Hughes, who wishes me to say in refer- ence to the relation of Mercury to syphilis, that Dr. Macfarlan's experience purports to be with the Iodide, which is a combina- tion of Iodine and Mercury,-quite a different thing from Mer- cury itself; and that when he says that the Biniodide is more efficacious than the Protiodide, this must surely be from the additional Iodine it contains. I have some hesitancy in speaking after the distinguished gentlemen who have preceded me. Yet I believe that the pathol- ogy of syphilis should be thoroughly understood, and I think it has been thoroughly demonstrated here to-day that there is a duality in the syphilitic virus, though Dr. Beckwith thinks not. He thinks that syphilis is a surgical affection strictly; I think he is mistaken, and I say it with due deference. The elimination of the hard chancre within one or two hours after its appearance has been followed by the most positive and pernicious secondary effects, nor has it been proven that the symptoms following soft chancre are true constitutional symp- toms. There is some sort of pus observed which produces a non-specific secondary effect, but it is not a true constitutional syphilis. It has been intimated here, and I spoke of it in my paper, that the appearance of a hard chancre is analogous to that of a vaccine vesicle, and like that it only appears after a period of incubation. This is evidence enough that it is a constitu- tional affection. After the disappearance of this hard chancre, which may occur with no treatment whatever, the secondary symptoms may appear at any time, and following them the tertiary also. The secondary and tertiary symptoms differ. In the former, which is due to blood disorder, they appear symmet- rically, and this is one of the most important diagnostic signs of secondary syphilis ; the tertiary symptoms appear now and then as a manifestation of tissue-difficulty, an affection of the tissues and not of the blood itself, and crops out in isolated points all over the body. All this has this direct relation to the treatment of syphilis, to which we are coming: It is my expe- rience and that of all others, so far as I can tell, and 1 have tried high and low potencies, that the primary and secondary symptoms must be met by the drug in the same manner as though there was a virus in the blood which must be neutralized or antidoted with some crude and tangible preparation. I would prefer to use the higher potencies if I could give them 856 world's homceopathic convention. successfully; in the tertiary form the higher attenuations are useful. I have made some magnificent cures with Nitric acid, Mercury, and other drugs, away up in the thousandths, but I use a lower potency, first, because I want to be sure of curing my case. I wish to correct Dr. Hughes regarding my paper when giving the indications for Mercury ; I did not put them there to denote the pathogenetic effect, nor did I give these symptoms as drug- effects; I only intended to say that Merc. sol. is useful and curative in such and such symptoms. That was a very natural misapprehension of Dr. Hughes which I wish thus to correct. I am very sorry this discussion has not developed more in relation to the investigation of the different preparations of Mercury, for I think that in some form it suits almost all the forms of syphilis ; it must be individualized, as Merc. cor. will suit one form, Merc. jod. another, and we must find the right variety of Mercury to suit each case. I have used Nitric acid both in its low and high attenuations for secondary symptoms. Merc. sol. will surely cure soft chan- cre and it is quite homoeopathic to it. The Chair: The essayists and debaters on gynaecology, which is the order of business for to-morrow, will hold a conference in the rear room to determine their programme. The next subject in the regular order for to-day is the discus- sion of the paper upon tumors. William Tod Helmuth, M.D., New York : I only saw Dr. Beebe's paper yesterday, and what I say will be upon their diag- nosis. If you look over their medical treatment you will see that certain medicines will cure certain tumors; that one medicine will cure a sebaceous and another a fibroid tumor. It is very well to understand exactly the variety of tumor that is cured. Any one who is familiar with the difficulties attending the diag- nosis of any kind of tumor when it is in the body will understand how uncertain such indications must be. In the pre-pathological times, surgeons generally relied for their diagnosis on their clin- ical experience in tumors, and it was Abernethy, if I remember aright, who first advanced the idea that tumors should be ar- ranged according to their anatomical structure. Bichat next investigated the same subject, classifying them, but leaving out the parasitic, the echinococcus, and cysticercus, which tumors were finally investigated by means of the microscope. Then Ban came in with the microscope, and classified tumors according to their microscopical structure, and told of caudate cells belonging to certain forms of cancer, etc. Then Bierstadt makes a great division of tumors into the malignant and benign DISCUSSION ON SURGERY. 857 varieties, the benign tumors partaking of the nature of the bodily tissues, which is proven by examination after their removal. The structure of the malignant tumors, on the other hand, bears no relation to that of the body, but is totally different. We call the one form homologous and the other heterologous. Now what are the characteristics by which these great va- rieties of tumors can be distinguished one from the other? You all know the abdomen has been opened for tumor and no tumor found. I have known pulsating tumors of the neck to be mistaken for aneurism, as large tumors supplied with very large vessels usually pulsate and present a most unsightly appearance. When you have an innocent tumor, the economy is not affected nor are the surrounding structures infiltrated, the tumor resem- bling in structure some normal parts of the body; on the other hand in malignant tumors there is a point of infiltration which extends and destroys the surrounding parts; it sweeps away bone, muscle, sinew, and nerve, as in the cancerous growths, and affects the general health. It is well to make a dividing line between the different varieties of these tumors. Now a sebaceous tumor, for instance, presents certain ap- pearances ; it has all the symptoms of fluctuation, and you would consider it a sebaceous cyst, but are not certain until it is ex- plored; until then you are not sure that it is not a sanguineous cyst, or a hygroma, or a serous cyst, or even a fatty tumor, which may discharge a certain amount of fluid. It is therefore necessary that we make a very careful diagnosis of the different varieties of tumors in order to render them amenable to the proper homoeopathic medicines, which will cure if they are prop- erly administered in a great many cases. That they will cure all forms of tumors is of course very uncertain, and the ques- tion arises, is it better to extirpate the tumor at once, or to first try the proper homoeopathic medicines. I know that Co- nium, Calcarea, Staph isagria, Phosphorus, anol other rem- edies will remove fibroid tumors of the breast, and I recently succeeded with these four medicines in removing a tumor of the breast of the size of an egg, but it took four months to ac- complish it. If you have tried for some time in vain, anol see that the patient is beginning to succumb, that the tumor is growing rap- idly in size, then it should be extirpated, for in a majority of cases there is nothing to fear from the use of the knife. 858 world's homoeopathic convention. In all recurrent or slow fibroids it is a question whether it is proper to remove them after they have attained any magnitude, but the trouble here in a majority of instances is in the diagnosis, which is very difficult until the tumor is removed. The remark has been made, " Never give a diagnosis of a tumor until you have got it in your hand, because so many mis- takes have been made from time to time." The physician may often compromise himself by giving too strict a definition of any tumor. The recurrent fibroid is a somewhat malignant tumor, that reproduces itself perhaps in the position from which it was removed, or more likely in other parts of the body. I had an interesting case of fibroid of the neck, lying directly on the carotid and jugular vein, which was re- moved after considerable dissection, but in less than four weeks the tumor returned and grew upon the same ground, while on the other side of the neck was a similar tumor. In another case the eyeball began to protrude on account of a tumor at the base of the brain pressing at the orbit, and this re- produced itself in four or five weeks. It must therefore be a matter requiring a great deal of thought as to whether these tumors should or should not be extirpated. I wish now to say a word about malignant and cancerous tu- mors, and when we read in our literature of certain forms of cancer having been cured, I only regret that in the majority of cases the specified form of the disease is not recorded; just as distinct lines are to be drawn between the different forms of can- cer as between the different forms of disease, and I think we shall never be able to properly arrange and treat these tumors until we are able to diagnose them perfectly. When we have a case of cancer- reported as cured it amounts to nothing unless we know the variety of cancer, and of the symptoms developed by that cancer. Most surgeons take the word "cancer" as a generic term for all malignant growths. You say you cure cancer of the breast; do you mean scirrhus, encephaloid; amyloid, or one of the other varieties? Now the marks of diagnosis are so plain that I hardly need recall them. In scirrhus there is a tumor of stony hardness, which has a tendency to contract all the surrounding tissues, which is ac- companied with lancinating pains. In encephaloid the sharp pains are not always present, the tumor is more malignant, growing to a larger size, and the general constitution is more affected. The medicine suitable to each form should be known. DISCUSSION ON SURGERY. 859 I believe I have known true scirrhus to be cured by homoeo- pathic medicine; it was in a tolerably aged patient, where the scir- rhous nature of the disease was perfectly developed, and I bejieve the constant use of Calcarea followed by Conium, with after that Arsenic, given in the 30th trituration, effected a cure, and the patient is alive to-day. Now if this can be done in one case, why not in others? I have never been successful except in that one case, because I did not know the proper medicine, and I suppose I have cut out half a bushel of scirrhi, and have given medicine afterwards. In the case cured I happened to hit the proper homoeopathic medicine, which acted well. Homoe- opathy is never at fault. The only reason why the law of similia similibus curantur fails is that we know so little ourselves! Dr. I. T. Talbot, Boston, Mass. : The subject of tumors is too extensive to go into to-day in detail; my predecessor has run over the ground showing its extent, and every medical prac- titioner present knows that it is one of the most important and extensive subjects in the field of surgery, and the two papers that have been prepared and printed about the two forms of tumors, the malignant and non-malignant, are both suggestive and instructive. The microscope may tell us the anatomical structure, and to that may be added their history; but their nature has but re- cently been understood. Take for instance the simplest form of tumor of the skin, the common wart. But little is known of its origin or growth, why it comes and goes so suddenly, and is affected by the imagination. You all know how the domestic remedies carry them off, and yet sometimes no remedy will re- move them, and when they are removed by the knife they often return. What is true of this simple form of tumor is also true of many of the more severe forms of encysted tumors: they some- times go after remedies are given, and sometimes persist in spite of every remedy. Dr. Beebe has selected some fifty-eight cases of tumors which have been reported as cured under homoeopathic treatment, out of the experience of thousands of physicians during the last sixty years; and he remarks that undoubtedly tenfold more and riper experience lies buried in the memories or in the note- books of busy physicians throughout the world than all we have that has been published ; but if this paper shall fortunately pro- voke the indulgence of some, it surely will have served a useful purpose. Our school should make it a duty to report all unmistakable cases of tumors cured by our medicines. My experience confirms what Dr. Helmuth has said about the forms 860 world's homoeopathic convention. of malignant and benign tumors. With the diagnosis carefully determined and a careful selection of the remedy, the most satis- factory results will often ensue, as in Dr. Helmuth's one case, from homoeopathic medicines, and in all such cases it is our duty to carefully note our experience for the use of others. In a somewhat extended experience in treating cancer, I have got satisfactory results from homoeopathic medicine, and I will briefly mention a few of the most important remedies used. Arsenic has been more serviceable than any other remedy in allaying the pains and sufferings of cancer, and following this is the very old remedy, Conium maculatum, which often follows Arsenic well, after Arsenic ceases to act. In many cases, where a firm, hard, indurated tumor, which has all the characteristics of cancer, and which has been gradually increasing, has been sub- jected to the continued action of Conium maculatum for some time, I have found the pains to lessen, the tumor to diminish in size, and the system to be greatly relieved. Another not so common a remedy, but from which I have seen marked relief, is the Asteriosus rubens, which is useful in the latter stages of cancer, and in the early stages of those very malignant tumors which may or may not result in pure scir- rhus; it often relieves the pains quite promptly, and by its local application the tumor is lessened in size. Calendula is one of the most valuable of remedies when applied locally, in many ways surpassing Carbolic acid. * There is one thing aside from medicinal and hygienic influ- ences that is necessary in these malignant forms of disease, and that is a great care as to the surrounding circumstances. I look upon quiet of mind as the greatest adjuvant in the treatment of malignant diseases, especially in cancer. In some forms of car- cinoma, where great grief and disappointment have come to a person, I have seen, in a few days or weeks, the disease lake a sudden turn and progress rapidly to a fatal result, although previous to that the disease had remained stationary for months or years. I think it the physician's duty in the treatment of this form of surgical disease to pay particular attention to nour- ishment and to hygienic relations. J. H. McClelland, M.D., Pittsburgh, Pa.: In the paper of Dr. Beebe I find little encouragement for the surgeon, from a therapeutic standpoint. He displays a thorough appreciation of the histological and pathological processes involved, and from an old-school standpoint I am led to think his conclusions are fairly drawn; but if we judge from results obtained by the exhibition of remedies chosen in accordance with the principles DISCUSSION ON SURGERY. 861 of homoeopathy, we are forced to a more favorable conclusion with respect to the curative action of drugs upon benign tumors. And while it is doubtless fallacious to accept all cures as post hoc, ergo propter hoc, yet we must admit that the disappearance, during the administration of a remedy, of growths which usually remain stationary or increase, leaves a fair inference that the remedy had some agency in the matter. To confirm this more favorable opinion as to the curability of benign tumors, we need go no further than the paper itself. Here we find recorded many cases cured by the homoeopathic remedy (or what was supposed to be such), and doubtless the authorities given are acceptable at least to the author himself. We have recorded here a list of seven remedies as having proved curative in sebaceous cysts, chiefly Calcarea, Graph., and Silicea, three as having been effective in synovial cysts, some remarkable cures of ovarian tumors, many cases of fatty and fibrous tumors, uterine fibroid polypi, adenoid tumors, etc., and most of these reported by observers whose accuracy and judgment we may not doubt. I say this would be sufficient to establish the cura- tive relation which we believe to exist between our remedies and many abnormal growths of a benign character. Nor do I think it militates against the homoeopathicity of our remedies that provings have not been able to develop abnormal forma- tions similar to those sought to be cured. I approve very highly, however, of the implied caution contained in the excel- lent paper of my esteemed colleague, to the effect that we must not overestimate the part played by a given remedy in the cure of a case which recovers during its administration. It is well to put it thus: after giving such and such a remedy the patient recovered. I will only refer, in conclusion, to the action of Calcarea jod. in fibroid tumors. I believe it to be the most important remedy we have in the treatment of fibroid growths. I have used it mostly in the 30th trituration, although I have no doubt of its usefulness both in the higher and lower preparations. Bushrod W. James, M.D., Philadelphia, Pa.: I think surgeons too often get cases of tumors that have been ne- glected too long and should have been operated on before. It must be remembered that tumors are acknowledged to be symptoms, and not the disease itself, and it is also true that some symptoms cannot be cured medicinally. Among these come some of the growths. Owing to the pathological changes in given cases that have occurred, we know that we can neither ameliorate nor cure. This may seem unjust to the 862 world's iiomceopathic convention. law of similia similibus curantur, but it is much more unjust to the patient to hold out the idea of medical relief. If we prescribe for present relief, we should be honest enough to our- selves and to our patient to say that there is no homoeopathic or any other kind of cure for the case. The homoeopathic law is a curative and not a palliative law; hence, the palliative use of medicine is not strictly homoeopathic, though this is all we do in these incurables. Cardiac valvular ossifications and cerebral abscesses are examples. There is a definite and distinct line between medical and surgical cases as a rule, and this lies most generally at the pathological boundary of disease when permanent changes of structure have occurred. Internal homoeopathic medication will remove the fever, pain, and similar expressions of the diseased condition, but suppose an indurated growth, or varicose vein, or hard haemorrhoidal projection is left, after the remedies have removed all the other symptoms that it is possible thus to get rid of, and then what are we to do? Nature, unaided, may improve or eradicate them in time, but this is a bare possibility. Surgery can remove them, and should, and when this is done and the parts healed, a cure is really effected. It is a medical incurable transferred into a surgical curable. Homoeopathy will never stand on a perfectly secure founda- tion until she admits the operating instruments of the surgeon to an equal rank and importance with that of Aconite, Bella- donna, or any other polychrest. Time will show that the strictures upon pathology and what is called " physiological medication " are too sweeping. Medi- cines will not always remove pathological changes, and the many symptoms depending upon such alterations, while the knife very frequently will; benign tumors, haemorrhoids, and varicose veins, are illustrations in point. Dr. J. C. Minor's 100 cases in the Ward's Island Homoeo- pathic Hospital gives proof of this when the author says : " There were no cures, and in no instance was there any relief from the symptoms described that could be attributed to the action of remedies alone, not even any of the five symptoms which we note as being present in varicose cases, viz., cramps, prickling, itching, stinging, and darting pains." I agree .with him in his experience when he says that he infers that " medi- cines are useless in ordinary cases of varicose veins"-and I will add haemorrhoids, further than the removal of the inflamma- tion. Many a case is held by the physician until there is loss of vision, or1 loss of local power from pressure on a nerve, or until the DISCUSSION ON SURGERY. 863 case becomes a dangerous one from the hazard of operating on a growth that has been allowed to encroach upon very important or vital parts. The surgeon is the best, not the worst, champion of homoeopathy, because he has means at hand in addition to our remedies, which the physician cannot or dare not use for want of the proper study in this branch ; and if the surgeon cannot detect the fine line of hairbreadth division of the symptoms from different remedies as a symptomatologist, he can and does cure many a case that the latter cannot. The benign growth, when incipient or in an inflamed state, may be a curable disease; but if it becomes torpid and does not diminish the surgical remedyshould.be applied, or as soon as it encroaches upon important structures. The surgeon, and not the physician, should judge of this matter, however. Diseases are classified into curable and incurable. To these I want to add another class, namely, the semi-curable. The encephaloid is an incurable form. Haemorrhoids, varices and benign tumors are semi-curable. The physician with medicine removes the pain and distress of an acute attack of haemorrhoids. The enlarged vein still remains, and never goes away; it consolidates, and then to all intents it becomes a surgical case, and all the medicines you have will in most cases be unable to further benefit it. Meteorological observation as to climatic influence upon diseased conditions of a surgical form confirm me in this state- ment,-that some cases can never be permanently cured in an antagonizing climate which will yield to treatment beautifully in a favorable atmosphere. The medical profession should act as quasi surgeons, but should give all the surgical cases they have on their lists to surgeons. Surgeons should decide when medical treatment should cease and surgical begin, thus many eases that are now an opprobrium to our system would be so no longer. And further : Certain localities are known to possess special healing powers simply by virtue of their climate, and certain seasons tend towards good healing and have less disease than other seasons. Take the month of May and early part of June in this place and line of latitude for example. Take some localities in the Gulf States; one, for instance, is situated a little way back of the Gulf of Mexico, north of Mobile (not a malarial district), where I am informed in the spring of the year the most remarkable healing influences exist; almost every surgical wound, even the peritoneal, heal readily. Among the moun- tain valleys and parts of Colorado a non-putrefying influence exists, meats dry up in the open air and do not decompose as here in hot weather. Now, does not this teach us that we 864 world's homceopathic convention. should have hospitals in these localities and on the top of moun- tains for summer operations when they are of'a hazardous nature and must be performed in the depressing heated term ? Pike's Peak and Mount Washington and many other places should be put to such use in hot weather. 8. S. Lungren, M.D., Toledo, O. : I had a case of a tumor of the left ovary appearing six months after parturition. The woman was a war widow, who had been placed by charitable ladies in a hospital, where she had been under allopathic treatment for some time. The tumor was about the size of a hen's egg when first discovered, presenting an almost scirrhous feel. When I saw it it was about the size of a large hen's egg, tender on pressure, and I supposed and feared it would sup- purate and burst in the abdominal cavity. The ladies requested me to take charge of the case, as it was a great expense to provide Morphine and other drugs to keep her quiet at night. I gave her Conium, the first dilution, twenty drops in a tumbler half full of cold* water, two teaspoonfuls every two hours during the day, and after continuing this for four weeks the tumor could scarcely be distinguished, and at six weeks not distinguished at all ; it entirely disappeared, nor had she any return of it nor future trouble, and she is now in perfect health. S. C. Knickerbocker, M.D., Watertown, N. Y.: I rise to state a single case of tumor, on account of the good action of the remedy in that case after the surgical operation had been per- formed on another part of the body. The tumor was of the species called enchondroma, a cartilag- inous tumor, which occurred in a little boy about two years of age, the tumor first appearing on the index finger ; and, secondly, on the middle finger, which increased to four times its natural size, extending into and involving the joint. The tumor was discovered by the mother early in the winter, when I examined the finger, which I found slightly hard and increased in size. I gave a wash for it, but it continued to grow until early in the spring it had become so large that it was determined that ex- cision should be performed. The parents of the child were anxious to have my diagnosis confirmed, and also to obtain the opinion of other surgeons, so they visited New York and con- sulted Dr. Helmuth and other surgeons, who confirmed my diagnosis and advised excision. The parents returned to Water- town much grieved at the prospect, but the two fingers were taken off, and then a similar condition was discovered in one foot, whose little toe was four times its natural size. I said to the mother, " We will try a remedy." I prepared some Silicea, DISCUSSION ON SURGERY. 865 and ordered it given three times daily for three days, then to be omitted for a week ; at the expiration of that time the tumor had not increased, and no medicine was given. After a time the remedy was again repeated, when the tumor began and has con- tinued to diminish, nor is there any evidence of its development in other parts of the system. Now, the potency which I gave was the seventy-five (75) thousandth of Fincke. A. Varona, M.D., New York : I beg pardon for taking the floor always to contradict some one, but this is not only a body of homoeopathic physicians, but of scientific men and women, and I should be sorry to have some statements made here, and which I think were merely lapsi linguae, perpetuated. A gentleman who stands too high to feel hurt at anything that I can say has uttered a scientific heresy, no doubt unin- tentionally, in saying that malignant tumors were heterologous tumors, and that this meant tissues arising from, but consisting of something unlike, the human body. The distinction is this, and in this I think he made a mistake, that a homologous tissue is a tissue similar to the tissue that produced it, and that a heterologous tissue is one unlike the tissue that produced it, and yet like some other tissue; the benign tumors are quantitative errors of nutrition, while malignant or heterologous tumors are composed of tissues unlike those that produced them. By errors of nutrition muscle produces a tumor which is muscle, and bone produces a tumor which is bone, and cartilage produces a tumor which is cartilage, and all these are benign. In malignant tumors a different tissue is produced from that of the part in which they exist, and hence the life of that part is destroyed. The difference between benign and malignant tumors is that the malign tumors invade the surrounding structures while the benign do not. Cancer, if it invaded a tissue like the epithelial tissue would be a benign tumor, but, as having an epithelial struc- ture, invading non-epithelial structure, it is always malignant. Its structure is heterologous, because it is a multiform composed of almost all structures, hence it is almost always malignant. T. W. Donovan, M.D., Staten Island, N. Y.: A case of ovarian tumor occurred some years ago in my practice, of which I wish to speak. It was a very severe case, and was diagnosed by the elder Dr. Blackwell, of New York, afterwards in company with my part- ner, Dr. McVicar, of New York, a well-known practitioner. Dr. McVicar had some doubts as to its being entirely ovarian, 866 world's homoeopathic convention. but it was no doubt a tumor of a fibroid character. It was treated in the beginning with the usual remedies; I first gave Belladonna and a Mercurial, which controlled it, but I noticed some spots of urticaria upon the body, which gave me a hint as to treatment; I then gave Kali bichromicum, and the result was an immediate amelioration of the whole disease; this was followed by intense vaginitis, marked by excessive itching and indications of an urticarious character, which I treated with Digitalis, and the disease was brought to the surface, becoming an urticarious eruption, which lasted for three years, the original tumor gradually disappearing. I think in many of these cases the knife of the surgeon is only palliative, it by no means follows that it is always curative. I have always used the medicines in the thirtieth potency. The Chairman: If there are no more remarks, the paper on " Uro-lithiasis" in Russia, sent by Dr. C. Bojanus, of Moscow, is before you. It has been distributed through the house, obviating any necessity of presenting its synopsis. It was sent to the Convention to be presented at the discretion of the chair- man. It contains 72 cases, and 143 cases of vesical calculi removed by him by operation. Dr. William Tod Helmuth has done me the honor to take charge of the calculi, and will exhibit them to such , as are interested. A number of copies of this paper for the use of the members of the Convention can be pro- cured at the desk ; it has been published in a journal, but will go into the printed Transactions of the Convention. We will now open the discussion of the paper on "The Influence of Homoeopathy on Surgery/' James B. Bell, M.D., Augusta, Me.: The time has passed by for the popular opinion, fostered by our friends of the other school, that the homoeopathic physician is at least not a surgeon. Many brilliant names of men to whom this popu- lar change is due, rise to your memory, and I will not stop to enumerate them. The time ought also soon to come, both in and out of our profession, when it will be fully understood that we practice not only surgery, but we practice homoeopathic surgery. Then may we fully see the influence of homoeopathy upon surgery. The mission of homoeopathy in any branch of the curative art, is to bring everything into the greatest possible nearness to health, to the natural and comfortable performance of all the functions. Now the influence is felt in surgery in two ways : first, positively, and secondly, negatively. Professor Helmuth DISCUSSION ON SURGERY. 867 has shown us something of the positive effects in the cure of surgical affections by homoeopathic treatment. Let us look a little at the splendid effects of homoeopathy in the treatment of cases which require also mechanical assistance. And first in fractures: How hasteful the effect of remedies, internally administered in accordance with the symptoms, in cases com- plicated with pain, with itchings, with lacerations of the soft parts, with tardy union, with constitutional disturbances. Ruta, Hypericum, Arnica, Spigelia, Calc, phos., or any other remedy which may be indicated, carefully chosen, given internally, and not too crudely, will surely do gratifying work. Next, and most important, is the effect of remedies in treat- ment of cases under operation. The preparatory treatment by depletions has been totally abandoned by the old school, but they have nothing to take its place; but we, in cases where time permits, have remedies to remove unhealthy conditions of the skin which will not aid healing, as well as using other bodily and mental states which may lessen the probabilities of a favor- able result. And then after the operation, every indication is met by the appropriate remedy. The ordinary pains are almost always immediately removed or rendered very tolerable by Arnica 30, or 200 internally. Should this fail, indications may point to Spigelia, Hypericum, Asafcetida, or others, and they will not only remove the pain, but in so doing their whole action is toward a cure. Should inflammation, profuse suppura- tion, even gangrene or pyaemia threaten, the indicated remedy is still the most potent agent of relief. In short when we are able in any case to find the truly homoeopathic remedy, its action is a never-ceasing cause of wonder. And I am reminded of a quotation from a favorite German poet who, in describing a spring, after giving a glowing descrip- tion of it, says : "The old man who has viewed its splendors eighty times stands astonished." So the man who has a thou- sand or ten thousand times stood in the presence of a homoeo- pathic cure, stands again astonished. Lastly, the influence of homoeopathy negatively. It banishes from surgery all hurtful use of poisonous, nauseous, offensive agents. And here is a danger which leads me to raise my feeble voice in warning. The study of surgery leads us constantly to old-school sources, and we need to always remember our homoeo- pathic advantages. We need to appropriate the mechanical, the hygienic, but always reject the therapeutic advantages. If we fol- low them carefully we shall find them constantly rejecting their 868 world's homoeopathic convention. own therapeutics. The once vaunted Carbolic acid is now found to be no disinfectant, but to be even poisonous and injurious; for proof of which statement I refer to a paper by a surgeon of the United States Army, published in the American Journal of Medi- cal Science, in which are given the results of experiments that go to prove that Carbolic acid has no power to prevent putre- faction, nor has it its advertised powers, and so must be laid aside; and yet it has been used in the best hospitals in the country. The oncoming Salicylic will share the same fate, and so on through change upon change, with no improvement-we know this not, but predict it. The use of narcotics is more seductive, but equally injurious. In a practice of seventeen years, with a fair propor- tion of surgery, including amputations, ovariotomies, etc., I have never had any even seeming need to give a single dose of any but the indicated homoeopathic remedy, and I respectfully exhort my brethren to follow the same course. There is no need of enforced constipation after operation upon the rectum or vagina. On the other hand, it is positively injurious, or, if deemed necessary, can be induced by Dr. Rest and Dr. Quiet. Our studies should be to forget all allopathic notions, and to more accurately observe and adapt our materia medica to the treatment of all affections. The President then announced that the discussion of the paper on conjunctivitis was in order, and called upon T. P. Wilson, M.D., Cincinnati, O.: The subject of conjunc- tivitis is one prolific of much thought and practical importance, or I would not venture to claim your attention for a moment, in the midst ofso many good things that are being said and so many important subjects that press upon our attention; yet I dare say that among the many diseases the physician meets in ordinary practice, there are few more frequent than morbid conditions of the conjunctiva. I start with the thought that, while we as a school of medicine feel free in one sense to say that we ignore pathology, in another sense we cling to it with more tenacity than any other class of practitioners in the world. We no more deny the existence of pathology than of the disease itself; but pathology as presented by the old school, which we follow to a considerable extent, is utterly useless to us ; and what we need to-day is a larger amount of clinical experience in the treatment of diseases of the eye. The fact is, we possess the most complete preparations for the treatment of all forms of eye disease in our materia medica, which is so rich in its pathogeneses, and which affords us such wonderful pictures of all possible modifications of the tissues of the eye. I do not feel like taking our materia med- DISCUSSION ON SURGERY. 869 ica and begging pardon before tbe world that we are so poorly- prepared to treat eye diseases, for we are vastly well prepared, so jar as our materia medica goes, but we are deficient in clinical experience as to the application of the remedies. Take, for instance, Dr. Norton's paper on conjunctivitis, which is certainly the best monograph on this subject I ever saw ; it is brimful of remedies for every form of conjunctivitis and other diseases of the eye ; but how many out of the great body of the homoeopathic profession are able to diagnosticate the first form of conjunctivitis, how many can distinguish catarrhal from purulent conjunctivitis ? What we need in our specialty as ophthalmologists is that physicians save for us the fruits of their experience. What can we dozen specialists do in the United States? Why. we can get but a fractional part of one per cent, of the material that is wasted in the clinical application of the drugs we are using. We urge time after time in our public assemblies and journals the necessity of a better knowledge of conjunctivitis, so that it may be diagnosed more correctly, and when physicians send us a re- port of a case which they call conjunctivitis it shall not be iritis or choroiditis. That is the point. If these cases are to be re- ported let the true nature of the disease and the special indica- tions for the remedy be plainly given. Dr. Norton's paper confines itself especially to the indications of the remedies, but that is not all we want to present to you ; we wish physicians to study the pathology of these cases, so that when they report a case we may know that it is correctly re- ported. When the pathology and natural and clinical history of conjunctivitis are studied it must be remembered that, in a large proportion of cases, the disease is self-limiting ; almost any case of catarrhal conjunctivitis, with a large swollen eye looking dis- astrously red, will recover in four or five days if let alone, and is, of course, sure to get well under any hygienic treatment, with- out the least possible danger. If the eye looks fearfully in- flamed and swollen, it seems to a man who does not properly un- derstand the condition that it is in great danger of being totally- destroyed ; but if it is a case of catarrhal conjunctivitis, let it alone and it will recover. Do not go to an eye specialist and say that you have cured a case like that in four or five days with Aconite or Pulsatilla, or any other drug, for the case has cured itself. If a case of catarrhal conjunctivitis is taken to a doctor incapable of diagnosing eye diseases, he will be likely to mistake it for puru- lent conjunctivitis, or with half a dozen other diseases which 870 world's homceopathic convention. are of greater importance. A case of iritis, or glaucoma, for in- stance, would, to a careless observer, look to be simply a case of catarrhal conjunctivitis. Any physician is at sea who does not understand the distinctive differences between these diseases. Cases of glaucoma are reported in the journals as having been cured by Phosphorus or Zinc, or some other drug. How are we to be certain that it was glaucoma that was cured ? What proof is presented by the individual relating the case? Yet it goes into our literature to the credit of the medicine, and it is asserted that the drug is capable of curing so profound a disease as glau- coma! Glaucoma might easily simulate catarrhal conjunctivitis, as in iritis the eye would also become injected, and the conjunc- tiva and conjunctival tissues would become much inflamed and infiltrated, and the physician trusting to the drug that seemed indicated would, after failing in its use, set it down to the dis- credit of that drug. Now we, as specialists, ask the general pro- fession to study this subject more carefully, so that the results obtained by practice maybe thoroughly reliable. In the present condition of medical science we cannot accept any offhand statements regarding eye cures by means of any medicine. We know that there are certain diseases that are absolutely incurable now, although I do not know what the future may reveal concerning them. It is within the recollection of some of you that at Niagara Falls a report was presented of a case of cataract cured with some very high potency. Now, in order to successfully treat glaucoma, cataract, amaurosis, and many of the other diseases of the eye, their pathology must be thoroughly understood. The President then announced discussion on the paper on Chronic Diseases of the Middle Ear. W. A. Phillips, M.D., Cleveland, O.: There is a misunder- standing as to the subject of the paper under discussion, which is upon chronic inflammation of the ear; that upon which I propose to make a few remarks is the paper upon acute inflam- mation of the ear, by Dr. Wilson. I do not intend to devote any time to the therapeutics proper of diseases of the middle ear, but there is one point to which I wish to call your attention as general practitioners. One of the severest forms of inflam- mation of the middle ear results from scarlet fever, and as this is a common disease it is highly important that the gravity of inflammation of the middle ear arising from such diseases should be thoroughly understood. DISCUSSION ON SURGERY. 871 Now, a word as to the anatomy of the parts involved. You know the use of the conducting tube which opens into the throat and communicates with what is known as the middle ear, which is about an inch and a half from the throat to the middle ear. The walls of the lower portion of this tube are in contact in health so that practically the middle ear is a closed cavity, its largest dimen- sions being in the neighborhood of three-fifths of an inch; this is closed also by what is known as the drum-head. Now, this closed cavity, a small box, is the seat of inflammation, which ex- tends all along the Eustachian tube from the throat, and attacks the middle ear, following the line of the mucous membrane. The mucous membrane rapidly swells and the inflammatory products are poured out, and gradually it ulcerates its way through the tympanum, and there exists a chronic suppurative discharge from the middle ear, which, as many of you know, is an exceed- ingly difficult thing to cure in many instances. Now, what is to be done ? There are very few who have ever provided them- selves with the speculum and ear mirror, which are absolutely necessary in treating ear affections; then after the throat becomes seriously affected the drum-head should be inspected at least every twelve hours, and so soon as it bulges outwards, because of the inflammatory products within, it should be opened ; by this means a clean cut is obtained, which heals in from ten to forty- eight hours, and the inflammatory products are then let out, and an ulcerative opening is thus avoided, which may last for months and years before it can be closed. This is especially important, because many a child has died of what has been called brain fever without its ever being suspected that the ear trouble was the origin of the fatal disease. A. chronic suppurative discharge from the middle ear in children is always a source of danger, as this little box, the middle ear, in children in many cases has no bony partition between it and the cranial cavity, but is simply separated by a membranous lining; and even in adults there is a process of the dura mater that extends from the upper floor of the middle ear, and this bony plate, when most perfectly de- veloped, is perforated by numerous openings for the passage of bloodvessels and nerves; hence it will be seen how readily in- flammatory action of the middle ear may extend to the brain, and produce meningitis and other cerebral diseases. Do not be deceived as to pain, as the first intimation of any trouble may be a gush from the meatus. Do not make any mistake; your atten- tion may not be called to the ear at all, but as soon as the throat symptoms become severe do not fail to examine the drum-head, 872 world's homoeopathic convention. and as soon as it becomes bulged open it with a clean cut; this cut will soon heal and leave no scar or trouble to interfere with future hearing. This operation is very easily done; there is a little instru- ment made on purpose, which consists of a very narrow-bladed knife; it is attended with no danger. If this be not done the pus collected in the middle ear forces back into the mastoid cells, becomes confined there, and the tendency, sooner or later, is to invade the brain. The therapeutics are treated of in the paper under discussion. A physician of my acquaintance, to whom I had explained this thing, came to me two weeks after- wards with a case in which he knew of no trouble until he saw a discharge from the ear. Now, in determining whether it is necessary to open the drum-head, it should be examined every few hours in order to determine if it be in position. The ad- vance made in aural surgery has been very great during the last few years, and now any man who neglects in every case of scarlet fever to examine the tympanum, or to get some one to do it properly for him, and by his neglect allows the disease to run on to permanent impairment of the hearing, or the death of the patient, should be held responsible. J. A. Campbell, M.D., St. Louis, Mo.: The papers appear to be so fully and completely exhaustive that there is little left to say unless we speak on the acute diseases of the ear. The science of otology may be properly considered to be in its'in- fancy, but the advance made in the last three years has been significant and remarkable. The acute diseases of the middle ear are more important to the general practitioner than to the specialist, because they first come under the care of the physi- cian. In these diseases the original and better classification and division has been abandoned, as simplicity is very desirable. The conditions of the patients, the peculiar states of the parts, their objective and subjective symptoms, have all been well stated in the paper under discussion. It is in these diseases that we see the value of objective symptoms, the distinction between the results of direct inflammation and the mechanical results produced by pent-up secretions. It is often true that these pent- up secretions result in active inflammation, which must be serious. The cause of the trouble is that the physician does not take the time to possess himself with the requisite knowledge, and should be held responsible for the result. It is impossible in a few moments to direct the attention of the physician to the thera- peutic treatment of the ear, but the one thing requisite is that DISCUSSION ON SURGERY. 873 the physician should be able to determine the disease beside the simple remedial means to be applied. The President: This closes the regular debate. If there is no desire to generally discuss any of these papers, the Chair will entertain a motion to adjourn. On motion, the Convention then adjourned until next morning. DEPARTMENT OF OBSTETRICS AND GYNECOLOGY CONTENTS. Hysteria, Dr. Davidson, Florence, Italy. Metrorrhagic Chlorosis, . . . .• . Abel Claude, M.D., Paris, France. Neurotic Element in Local Diseases of Women, B.H.Cheney,M.D., NewHaven,Conn- Membranous Dysmenorrhoea from Repelled Eruptions, Homoeopathic Treatment of Diseases Incident to Pregnancy, R. Ludlam, M.D., Chicago, Ill. H. N. Guernsey, M.D., Philadelphia. Therapeutic Treatment of Diseases of the Diges- tive Centre Incident to Pregnancy, Puerperal Fever, J. H. Woodbury, M.D., Boston, Mass. Homoeopathic Treatment of Puerperal Fever, . 0. P. Baer, M.D., Indiana. Silver Wire Sutures in the Caesarian Section, . S. S. Lungren, M.D., Toledo, O. Discussion. J. C. Sanders, M.D., Cleveland, 0. HYSTERIA. Dr. Davidson, Florence, Italy. The word Hysteria, as its derivation shows, has served from the earliest period to designate a morbid activity of the entire female economy, resulting from the non-performance by the uterus of its normal needs and functions. The theory involved in this name, accepted by Democritus, Plato and their followers on the one hand; and by Hippocrates, Galen and their successors on the other, prevailed without dissent until the beginning of the present century. From that time, although the name itself is still retained, owing perhaps to the difficulty of finding a proper substitute, the ancient theory has been controverted in many ably written works, notably, amongst the earliest, those of Sydenham; but their arguments have not met with general acceptance. It is still believed by many physicians of our day that there is a necessary correlation between the development of hysteria and a morbid state either of the uterus or of other reproductive organs, especially of the ovaries. This last view dates from the discovery of the process of ovulation. Either, it is thought, hysteria originates in an unsatisfied uterus; or it is a neurosis of the uterus; or (as the physiological school holds) it is a symptomatic irritation from a chronic metritis; or, it is a neurosis of the ovaries. While Robert Lee maintains that the morbid impression conveyed by nervous connections through the uterus and ovaries produces directly the globus hystericus and after- wards the general convulsions; it is affirmed by Romberg and Schuzenberger that those phenomena are only produced 877 878 world's homceopathic convention. secondarily, through the reflex functions of the spinal cord. But all these explanations are only varying forms of the prim- itive ideas handed down by the matrons of antiquity to Democritus and Plato, and adapted by physicians of suc- ceeding centuries to the theories which they have transmitted to us. Perhaps the most complete refutation of the ancient ideas is found in the prolonged and conscientious researches of Briquet, to which frequent reference will be made in this essay. This important work of Briquet, the fruit of ten years of untiring labor, sustained by an analysis of 430 closely studied cases, showed how wTell founded were the views of Georget on the seat of hysteria, based on its pathological relationship to epilepsy and mania. Yet, eleven years after the publica- tion of this able treatise, the exploded theory found a new champion in Chairon, physician of the Vesinet hospital in Paris, who maintained a compression of the ovary, and espe- cially of the left ovary, to be a necessary condition of the existence of hysteria. We look in vain for an analysis of the numerous observations adduced by Chairon ; but great stress is laid on the assertion that, in hysterical patients, pressure on a certain spot in the ileo-coecal region, which is assumed to stand in relation to the ovary, provokes a paroxysm, as Schu- zenberger alleged in 1846 ; and it is also maintained that the reflex paralysis of the epiglottis, which exists in all hysterical patients, is the cause of the convulsions; resembling the choke-spasm which the constriction of the larynx produces in those who are hanged. Chairon's work would have been utterly disregarded, despite its pompous preface, if it had not harmonised with the ideas of the physiological school. For the accumulated arguments of Briquet prove clearly the encephalic seat of hysteria; that this neurosis can exist without a morbid condition of the sexual organs : while modern science demonstrates that woman is woman, in all parts of her being, and not merely in virtue of the uterus, to which Hippocrates ascribed so peculiar a nature and influence. This fundamental idea of modern gynecology, in which all HYSTERIA. 879 its future progress depends, dominates, so to speak, the whole history of hysteria. It seems therefore needful to elaborate it, somewhat, in order to convey a clear understanding of a neurosis which is so closely related to all the diseases we observe in woman. The animal economy is in both sexes subordinated to the part assigned to each in the function of procreation. To man, who participates in genesis only by an ephemeral act, is assi- gned the hard problem of protecting and providing for his family ; and for this he is endowed with a physical and moral energy, which has made him king of the earth and a civilizer of the world. The more modest role of peopling the earth, assigned to woman, may be said to dominate her entire being, which is altogether fitted for the painful function of ma- ternity. Hence the old gynecological proverb : " Mulier id est, quod est propter solum uterum," is true only when understood, not in its ancient and restricted sense, but as meaning that woman throughout her economy, is suffused and pervaded by the faculty of maternity. No functions in man correspond to those of incubation, par- turition and lactation, which from an organic point of view are the severest duties of maternity. The physio- logy of the two sexes must therefore be totally different. Peculiar conditions of haemagenesis must exist in the female, most intimately connecting the sexual functions with the vegetative life. Iler relatively small excretion of carbonic acid by the lungs enables woman, immediately after conception, to meet the excess of expenditure consequent on pregnancy. But when no impregnation has occured, the menstrual flux re- moves the products of excessive nutrition accumulated during the preceding month. It may be remarked, that this com- pensatory menstrual excretion is prepared and designed to bring about the maturity and discharge of the ovum, and to induce the erection of the uterus and broad ligaments, neces- sary to fructification ; so that every act of the sexual function indirectly depends on the function of vegetative life. But the participation of the organic functions in the various acts to which pregnancy, parturition and its sequelae and lacta- 880 ■world's homceopathic convention. tion give rise, is much more evident; and each of these three great organic acts constitutes a special physiological condition of the entire economy. It must indeed be admitted that the female organism is much more complete than that of the male, the former posses- sing a remarkable mobility, contrasting strongly with the fixity and stability which characterize the latter. But as a compen- sation for this superiority, the female organism, like every instrument of manifold articulations has less resisting power, less ability to maintain the harmony of its various parts. The uncertain subordination, in woman, of the three great appa- ratus which make up the nervous system : encephalon, ce- rebro-spinal axis and great sympathetic, render their harmony of action especially precarious. An orderless, independent action of their various parts is therefore apt to result; and this constitutes the fundamental character of hysteria. Moreover, the nervous system of woman is kept in far greater activity than that of man, through the manifold impres- sions it must endure, and the numerous resultant organic acts; and also in consequence of the consensus established not only between the functions of vegetative life, but also between these and the sexual functions, to which the former bear such important relation. And the predisposition of woman to this neurosis is strengthened by the preponderance in her of the emotional over the cerebral faculties, and especially over the will; while the vividness and variety of the moral impressions and the conse- quent alertness and mobility of the intellectual reactions, helps to render the equilibrium of the nervous system still more insecure. The encephalon, towards which, as the regulating centre of the nervous system, the organic and intellectual impressions alike converge; and from which proceeds the stimulus to the manifold organic acts prompted by these impressions, must perform its functions with a difficulty proportioned to their complexity. To estimate this complexity properly, we must consider the activity which the intra-uterine incubation and its sequelae impose upon the nervous system; as well as HYSTERIA. 881 the extraordinary mobility which enables the latter to adapt the entire economy to the four so various physiological condi- tions which may succeed one another, at brief intervals, during the period of nubility. There is here an expenditure of force, which can only be produced at the cost of functional energy. Now when, in either sex, the functional energy sinks below a certain limit, either in convalescence from an acute disease, or after important hemorrhages, interesting nervous disturbances are apt to occur. In some the intelligence is affected, in others nutrition and temperature. And, under certain conditions, a man of great physical and moral courage, will resemble an hysterical woman. Of course, these nervous disturbances which enfeebled men are subject to, are more frequent and persistent in women for reasons already stated. When the equilibrium is once disturbed, the first functional disturbance prepares the way for another and so, under the influence of successive dynamic impulses, it is apt to reach the climax of chaotic action in a dangerous hysteria. The disorderly action of the three great apparatus of the nervous system gives rise to a noteworthy ataxia which is one of the chief characteristics of hysteria. This ataxia exhibits such variable and alternating symptoms, that Sydenham was led to say of it : " This neurosis is a true proteus, and may present itself under as many colors as the chameleon," and all writers on hysteria, since his day, have quoted this saying assentingly. We shall have occasion, under the symptomatology, to dwell at length upon this protean character of hysteria, by virtue of which this neurosis may simulate almost every disease. Here it is only necessary to say that this changeability of hysteria arises: 1st. In some cases from the preponderance of the functional disturbances of the encephalon, as in ecstasy and hysterical delirium : in others from functional disturbance of the cerebro-spinal axis, as we observe in hystero-epilepsy, in hysterical chorea, and in catalepsy of the same nature; in others from the preponderance of disturbances of the great sympathetic, which are characterized by uncontrolable vom- itings, hysterical fever, etc. 2d. From the fact that the 882 world's homceopathic convention. dynamic disturbances called out by hysteria, may consist in an over-tension or in diminished tension of one or of several func- tions of one of the three apparatus of the nervous system, and even of one of their parts. 3d. From the alternation of functional disturbances of the most opposite character, as e. g. a complete paralysis of one limb following a contraction which simulated a luxation or a chronic arthritis. This brief enumeration of the chief conditions which de- termine the remarkable versatility of hysteria, enables us to understand the various explanations put forth by different authors concerning the disease ; in which each lays more stress on certain functional disturbances and passes lightly over others. It would lead us too far however, to endeavor to separate the true from the false in these explanations. An example may suffice to show their insufficiency ; namely the theory of Galen and Hippocrates, which gives preponderance to the functional disturbances of the uterus. Now the frequency of these dynamic disturbances is no better reason for regarding hysteria as a disease of the uterus, than the still greater fre- quency of gastric disturbances is for assuming it to be a neu- rosis of the stomach. This latter view, taught by Cullen, may be said to have had no adherents, although it is based, not only on the uncommon frequency of gastric disturbances in, and often long proceeding, hysteria, but upon the effect they have of impairing the blood-composition, and, as a direct conse- quence, the equilibrium of the nervous system. Galen's theory, and especially the hypothesis of the physio- logical school, would have met with the same reception as Cullen's but for the infrequency of hysteria in man, which is so great that its occurence has been positively denied, notwith- standing the formal indications given in Galen's works. Unhap- pily for the I lippocratic theory, the occurence of hysteria in the male is at present fully established by indisputable evidence; as we shall see when studying the eetiology. AETIOLOGY. This study embraces two series of facts: first, the predis- posing causes, and second, the immediate causes. We shall HYSTERIA 883 consider first the predisposing causes, and at some length; because of the importance of their analysis to the comprehen- sion of hysteria and because these causes alone very often suffice to produce the disease. The immediate causes, on the contrary, will be more briefly examined, because they are frequently quite unimportant; and only accidentally related to the disease. PREDISPOSING CAUSES. In the first series, we shall study the influence of sex, age, continence ; and on the other hand, of venereal excess, here- ditary, moral sufferings and other diseases. Contrary to Sydenham's view, hysteria is frequent enough in women en2;a^ed in field-work. But it is much more com- mon in cities than in the country, and reaches its maximum of frequency in large cities, when great luxury prevails and manners are loose, as at the present epoch. 1. The female sex, as before said, is especially predisposed to hysteria. So marked is this, that not only all physicians of antiquity, except Galen, but many of our day hold that hys- teria is never observed in man. Numerous facts, however, refute this conclusion. But while it is demonstrable that hysteria exists in the male, its relative frequency has not been determined. The propor- tion given by Briquet is one to twenty, by others, one to a hundred; but even the lower ratio is much too high, for it would give a greater number of male patients, per annum, to the Paris hospitals than the records show. Equally undetermined are the exceptional conditions which produce it in an organization so little predisposed thereto ; for the facts observed do not justify the explanation proposed by Landouzy, that hysteria is the evidence of a morbid state of the sexual organs. This supposition which is refuted by five out of seven of Briquet's cases, is equally inapplicable to the only case of hysteria in the male which I have personally observed. This was a young man about 23 or 25 years old ; of blameless life, delicate health and feeble constitution, who lived with his hysterical mother. The paroxysms almost always occurred in the afternoon, as a sequence to prolonged study of the mi- 884 world's homceopathio convention. croscope; and resembled in all respects such as we observe in hysterical women. 2. The age of nubility, or the menstruating period of woman's life, constitutes one of the greatest predisposing causes of hys- teria. Its influence is easily understood, if we reflect that, in a majority of cases, it is the implication of the organic activities to which the sexual function from puberty to the end of menstruation gives rise, which predisposes women to hys- teria. The correlation between the sexual function and the devel- opment of this neurosis, is distinctly shown by the four fol- lowing tables giving the age at which hysteria occurs, according, respectively, to Landouzy, Georget, Beau and Briquet, who agree on most points. Hysteria developed: Landouzy. Georget. Beau. Briquet. Total. From 0 to 10 years, 4 1 0 66 71 u 10 " 15 a 48 5 6 98 157 cc 15 " 20 Ci 105 7 7 140 259 20 " 25 a 80 4 3 71 158 a 25 " 30 a 40 3 0 24 67 a 30 " 35 a 38 0 0 9 47 cc 35 " 40 it 15 0 1 9 25 a 40 " 45 a 7 1 0 1 9 a 45 " 50 IC 8 0 1 3 12 a 50 " 55 Ci 4 0 0 3 7 ii 55 " 60 it 4 1 2 2 9 a 60 " 80 a 2 0 0 0 2 355 22 20 426 828 Combining these tables, we find that, of 823 cases of hys- teria, 259 were developed between the 15th and 20th years, and 157 between the 10th and 15th; that is to say, 416 cases, or a little more than one half of the total number, occurred either just before puberty, or shortly after the establishment of menstruation. After the ao;e of 20, the number is seen to diminish ; the cases between the ages of 20 and 25 being about one half, and those of the ages from 25 to 30, one quar- ter only of the number from 15 to 20 years old. Taking all HYSTERIA. 885 the cases thus tabulated from birth downwards, we find that two-thirds, or 612 in 833 cases, occur before the 30th year. Thenceforth the number gradually- diminishes till we reach the period between 45 and 50 years, which exhibits an increase from 9 to 12, over the preceding period. This increase seems to contradict Gardane's view that hysteria is the disease which most frequently occurs about the time when menstruation ceases. Yet this view is not without foundation. For if the development of hysteria at the cessation of menstruation is rare, it is by no means rarely observed that nervous affections which had previously subsided, re-appear at that time, or manifest a renewed energy and violence. And this re-appear- ance of hysteria at the climacteric period, especially the non- con vulsive form, is accompanied by a chloro-ansemic condition very like that which is so common at puberty. In general, we may say, hysteria is not developed after the climacteric period ; only one of our tables, that of Landouzy, mentioning two cases of this neurosis occurring after the 60th year. And that table having been compiled from miscella- neous sources is least worthy of confidence. This view coin- cides with those of Dubois, Beclard etc., viz : that the definitive cessation of the menses (a process often requiring several years for its completion) causes either the disappearance or a consi- derable modification of hysteria. Briquet protests against this proposition; but it is sustained by the great rarity of cases of hysteria amongst the old women in the hospital Salpetriere in Paris, compared with their frequency in other hospitals for adults in that city. Our tabular statistics, as it will be seen, furnish a formal contradiction to the views of Galen and Hippocrates; for if the privation of sexual intercourse were a necessary cause of hysteria, we should see it much less frequently developed between the 20th and 30th years (when women are most sought after) than in any of the subsequent periods, especially that from the 40th to the 50th year, when widowhood or abandonment is more frequent. Yet the reverse is the case. Moreover the first column of the table shows 71 cases of the 823 as developed before the 10th year, being a proportion of 886 world's HOMCEOPATHIO CONVENTION. 12 per cent. In these cases, comparable, in some respects, with hysteria in man, the development of the disease cannot be directly or indirectly ascribed to the sexual function, which, up to the 10th year, is in an absolutely torpid condition, and not competent to awaken desires whose suppression might induce a pathological state. 3. Continence.--The researches of Willis into the causes of hysteria show the power of moral influences in exciting that disease, and are opposed to the ancient assumption that con- tinence is a primary cause. If continence is concerned at all in the production of hysteria, it is only so indirectly and subordinately. What part then, in the development of this neurosis, is to be ascribed to the moral sufferings almost inevitably attendant on female celibacy; and what to the mere abstinence from sexual relations ? The answer must be found in the general results of statistics ; and these are as follows : First. In former times hysteria was very common in the cloistered religious communities, and gave rise to very pecu- liar epidemics; whereas at the present day, and amongst the nuns who are occupied in hospitals and schools, it is very rare. As the nuns in the latter as in the former case are vowed to celibacy, the prevalence of hysteria is clearly due to different external conditions of their lives. Secondly. In hospitals devoted to women the number of virgin hysterical patients in proportion to those who have been wedded, legitimately or otherwise, is very small indeed. It appears further, that the neurosis mostly manifests itself after the loss of virginity, and that, when it existed before, the disease was greatly aggravated after this loss, instead of being cured. Thirdly. The number of widows, is, in the table of both Landouzy and Briquet, whose views differ so widely, compa- ratively small; being, in both together 27 out of 805 cases. It appears also that, in six of these cases, the hysteria was developed on the very day of the husband's death; and, in four other cases, before the end of the first month of mourn- ing. This seems to justify the conclusion, that in these ten cases, HYSTERIA, 887 the hysteria was the result of grief arising from the condi- tion of widowhood and not from the condition itself; which doubtless may be said also of the 17 other cases of which we have no details. Fourthly. With regard to the influence of venereal diseases in developing hysteria in women, the statistics prepared by Briquet in the prison of St. Lazare in Paris give the propor- tion of 106 hysterical patients in 197 venereal; although he adds that the number of hysterical cases among the prostitutes of the lower classes is somewhat less than among the others. These facts show conclusively though indirectly, that conti- nence can be regarded only as predisposing to hysteria while they would seem to indicate that venereal excess is a cause of this disease. But, before we accept this aetiology, supported, analogically, by the frequency of nervous affections in men affected by seminal losses, we should take account of the un- regulated passions of all kinds which characterise a dissolute life, and the many miserable cares it involves; which, even in the midst of the most scandalous luxury, pursue women of loose lives. Due consideration should also be given to the great excita- bility, dating even from childhood, which afflicts many loose women, and to which many of them ascribe their first fault. HEREDITY. • In the opinion of all observers heredity is one of the most powerful predisposing causes of hysteria and almost all cases in which this neurosis displays itself in early childhood may be ascribed to it. Stated in this general way, no one would dispute the proposition, but Georget affirms that we must not only regard the descendants of hysterical persons as predis- posed to hysteria, but also those descended from epileptics, maniacs, hypochondriacs, those born deaf or blind, finally those who have had apoplexy or any other cerebral affection whatever. This view seems somewhat strained. We must therefore investigate what is the predisposition which is brought into activity by. each of the diseases alleged by Georget to produce it; instead of, like Briquet, contenting ourselves with a 888 world's homceopathic convention. general study of this aetiology, which would establish only the encephalic seat of this neurosis. 1. The heredity of hysteria is more than apparent; statis- tics show that, of 100 hysterical mothers, more than 50 have transmitted the disease. We rarely see however, a hysterical mother, all of whose daughters are hysterical; generally a greater or less number of the offspring remain free from the disease. According to Briquet, in the majority of cases, only one daughter, in a small number two, and very seldom three inherit the disease. This heredity must be very carefully taken into account when we are consulted about the education of the daughters of hysterical women. 2. The existence of epilepsy in parents is a less powerful predisposing cause of hysteria than that neurosis itself is. In the six cases of this kind which I have myself observed, the predisposition to hysteria in the daughters, was, as in most of Briquet's cases, the result of epilepsy in the father ; but in one of these cases, hysteria presented that peculiar form of the disease which is, erroneously enough, called hystero-epilepsy. The neurosis was dangerous, and, not only in this case but also in four or five others, so rebellious to treatment that it would appear as though this transformation of the epilepsy of the father into hysteria in the daughter, warrants a grave prognosis. Unhappily, the reports of patients concerning the existence of epilepsy in their parents are often very defective, either because of their reluctance to admit the fact, or because they do not think of mentioning the vertigo and the painless twitchings which characterize the milder form of the disease, but which may, just as well as the most severe forms, be transmuted by heredity, into dangerous hysteria in the daughters. 3. Mania in the father or mother may likewise be regarded as a predisposing cause of hysteria, although, perhaps, less fre- quently so. The number of instances of this transformation, in the various statistical tables is very small; and it is much to be desired that the subject should receive fuller investiga- tion. It is possible, but not yet proven, that congenital blindness HYSTERIA. 889 or deafness, and cerebral hemorrhage, softening or other cerebral affections, in the parents, predispose the children to hysteria. Apoplexy has been mentioned among the heritable antecedents of a certain number of hysterical patients. But we know how frequent and how vague such allegations are among the people. 4. Moral influences, which play an important part in the manifestation of hysteria, are, in the opinion of all observers, a most important predisposing cause. These influences operate on subjects possessing a lively excitable disposition, either congenital, or induced by such unfortunate conditions as too often surround the childhood of orphans. Briquet found, in 425 hysterical patients, only 25 who were not excitable or giddy from childhood; a proportion so small as to admit of the assertion that immoderate excitability is an almost indis- pensable condition of the manifestation of this neurosis. This disposition results from an increase of the prehensile elements which the interesting researches of Cerise warrant us in connecting with the nervous ganglionic system, to which is assigned in woman so much more important a part than in man. Consequently the susceptibility to influences is more common and more pronounced in women. General observa- tion shows that the saddening moral influences, such as grief, fright, jealousy, envy, etc., are alone sufficient to produce hysteria; while those of an opposite character mitigate or cause its disappearance ; and that the moral passions persis- tently indulged, are its especial predisposing causes. And it shows : 1. That hysteria is very common in women who have been brought up too tenderly ; or who have suffered in childhood from the unjust partiality of step parents; or from harsh treatment. Hospital statistics show that, of 74 hysterical patients in whom the disease began in childhood, 26 had suffered from harsh treatment or privations. 2. This neurosis is very frequent in girls who have been unhappy at home, whether from family dissensions or in conse- quence of unforeseen misfortunes, particularly if these are likely to compel celibacy. 3. The neurosis is often observed in women whose marriages 890 world's HOMCEOPATHIC CONVENTION. are unhappy, either from personal ill-treatment, or severe disappointment in relation to the character, conduct, or worldly advantages of husband or children, or because they are childless. 4. As already intimated, this disease is very common in light-minded, frivolous women as a result of cares of all sorts, such as an irregular life involves and which proximately induce the development of hysteria. 5. Finally, hysteria may, according to the classical (etiology, result from disappointed love; but I confess I have never observed an instance, which had unmistakably this origin. Probably, in cases of this kind, the development of hysteria has been favored by a pre-exciting excitability in the subjects ; and that, with such a predisposition, it would have been deve- loped under any other moral depression though unconnected with disturbances of sexual organs. 6. The advances in gynecology for the last 30 years have completely overthrown the views taught by the physiological school. Observation has shown : 1. That hysteria occurs without any lesion of the sexual organs and even among men ; often too in young girls, and the affections of the uterus and ovaries in connection with it are exceptional. 2. That hysteria does not occur in young girls as a conse- quence of affections of the sexual organs, as, for example, with formations of tubercle, which are comparatively common in childhood. 3. That hysteria occurs in a certain number of women who have been married young to strong and healthy men, and have never, at any time, had an organic or functional derange- ment of the sexual organs. 4. That this neurosis is only exceptionally noticed in women who have diseases of the sexual organs, is proved by the very small number of autopsies which the anatomico-pathologists can cite in support of the localization of hysteria in the uterus and ovaries. The analysis of 49 cases, followed by autopsies, the most of which, however, were, unfortunately, imperfect and faulty, HYSTERIA. 891 and which may be added to Briquet's cases, establishes incontes- tably, that hysteria does not require, as a necessary condition of its development, a lesion of any of the sexual parts. One of the first statistical tables, embraces seven observations in which death occurred during or immediately after a convulsive attack and may therefore be ascribed directly to hysteria. Now, in three of those cases, no lesion of the sexual organs was dis- covered ; in two the lesions were simply the normal cicatrices found in the ovaries and in only two were real pathological lesions made out, one of which originated in an old, obscure affection of the ovary, and the other was an ovarian serous cyst. The analysis of 23 cases of the second category, in which death occurred from various causes, although when it occurred the women were still suffering from hysteria, gives a similar result. In ten of these cases, there was no lesion, whatever, of the sexual organs. In the remaining thirteen cases, such lesions existed; But, in each, it was of a different character. In one case there was inclusion of the foetus; in three, cancer or scirrhus of the uterus ; in one, uterine congestion ; in another, an obscure alteration of this organ ; in two, ovarian atrophy, complicated in one case by cysts in a woman aged 37 years, and in another, 47 years old, by old pelvic-peritoneal adhe- sions ; and finally in four cases pelvic intestinal inflammation, chronic in two of them, and in the others acute, purulent and, evidently, the cause of death. We take occasion to say, apropos of the last two instances, that, in most of the cases of this category there is no evidence that the affections of the sexual organs existed before the hysteria ; which, however, we should have, before we can ascribe the development of the neu- rosis to the lesions exhibited by the autopsy. It is needless to pursue further the analysis of these cases which were published to show the various localizations of hys- teria. Because a casual examination of them will show the fruitlessness of all anatomico-pathological investigations hitherto made with a view to connect this neurosis with lesions of the uterus, the ovaries, the encephalon or the intes- 892 world's homoeopathic convention. tinal canal. It must be admitted however that these cases show a more frequent coincidence of hysteria with lesions of the sexual organs than with any other disease ; and that, even if the existence of such lesions is not an indispensable condi- tion of hysteria, there must, at least, be a manifold connection between these two pathological elements. From an analysis of the conditions under which hysteria is developed, we conclude that the frequent coincidence of this neurosis and sexual affec- tions is susceptible of three very different explanations : 1. Sexual affections, and especially pelvic visceral inflamma- tion, like all acute diseases which depress the blood-forming function, may be a predisposing or, more commonly, an exciting cause of hysteria. In cases of this kind, the neurosis is a secondary consequence, sometimes direct and sometimes indirect, of the pathological state of the sexual organ; the primary effect of which is the menstrual disturbance, and the secondary effect the hysteria, as we shall presently show. 2. In a considerable number of cases, sexual disorders, as, for example, the leucorrhoea, are manifestations of diseases which seriously modify the blood-formation, and may there- fore be predisposing or exciting causes of hysteria, while pro- ducing, also, the disturbance of the sexual functions. In such cases the sexual disorders and the neurosis constitute two independent pathological results of a common origin; as for example, chlorosis, w'hich simultaneously and directly gives rise to both of them. 3. Finally, the frequency of the coincidence is owing to the fact that the sexual organs which, like all others, may be the seat of hysterical manifestations, belong to the life of relation, which is oftener disturbed by hysteria than the vegetative life. Under the influence of this neurosis, hysteralgias arise; some, which have been clearly described, are acute, while others, as yet but obscurely defined, are chronic. These are characterised, sometimes only by dynamic disturbances during menstruation; at others by uterine neuralgia also, which rages during the menstrual interval, and in many respects resembles hysterical gastralgia. In the latter cases, the symp- HYSTERIA. 893 tomatic sexual affections are direct manifestations of the neu- rosis : while, in the inflammatory or congestive action of the sexual organs, to which the hysterical dysmenorrhoea and the menstrual disturbance may jointly give rise, its indirect effects are seen. Hysteria, indeed, may indirectly induce disorders of the sexual functions by producing an anaemic state 'which impairs the nutrition of the organs. But at present we are considering only the effect of lesions of the sexual organs arising from other causes as predisposing or exciting causes of this neurosis. An analysis of the cases which have been cited as evidence of the localisation of hysteria in uterus or ovaries, demonstrates that but few of these lesions, which often enough coincide with hysteria, are present in a way that implies a relation of cause and effect between the two pathological elements. The coincidence in the first series, which is quite unimportant, simply shows, that hysteria does not protect women affected by it from any other disease, least of all from uterine disease. In some of the cases followed by autopsy which have been cited, hysteria existed along with cancer, scirrhus, fibroids, ovarian cysts, etc. Like other observers, I have seen these diseases co-existing: 7 o' but the hysteria could not be ascribed to the organic affection, which, indeed, was the more recent of the two. This view accords with the result of an analysis of 48 cases of uterine cancer found by Boivin in 409 cases of hysteria ; in only one of which was the hysteria secondary to the cancel'; having been developed under the influence of exceedingly severe pains suffered by the patient. The coincidence of hysteria and organic diseases is, indeed, rare, because they are wont, for the most part, to occur at different ages ; hysteria being most frequent before the thirtieth year; whereas, of 684 cases of uterine cancer, of which statistics were obtained by Leroy d'Etiolles, in 616 the disease developed after the thirtieth year. The same rare coincidence may be asserted of the tubercular formations in the sexual organs, although these, like hysteria, are wont to occur before the thirtieth year. These affections, although reckoned among the malignant diseases of the sexual 894 world's homceopathic convention. organs, can only be regarded as exceptional predisposing or inducing causes of hysteria. Hysteria is often developed, or its previously indistinct symptoms become pronounced, in connection with the frequent recurrence of those chronic peritoneal inflammations which are the despair of patient and physician. But, in these com- plicated cases, there are many other pathological elements to which its development might also be ascribed. As, for example : 1. To the anaemia resulting from the pain, confinement, and other incidents of a peritonitis, lasting a month or six weeks. 2. The grief and chagrin felt by a married woman in conse- quence of a chronic disease of the sexual organs; or by an unmarried woman whom such a disease may render incompe- tent for marriage. 3. The menstrual disturbances and especially the metro- rhagia which so frequently accompany pelvic peritonitis. These seem to me to be of far more importance as an exciting cause of hysteria than the other two. I have lately observed twocases in which menstrual disturbance, and especially sudden suppression of the menses, in excitable women, was followed, in a few hours by very decided and serious hysterical condi- tions. In cases of this kind, if we do not, with Galen, ascribe the hysteria to a resorption of the menstrual blood, (in which view originated the vapor-theory, so long accepted) we must admit that its sudden development depends upon the shock received by the nervous system, from the suppression of a function so important in woman, by reason of its connection with the blood-formation. We must also remember that every distur- bance of menstruation, affects not only the nutritive functions, but the nervous system, the general regulator of the economy. From this point of view both those who oppose and those who accept the Galeno-IIippocratic theory are agreed on the retiological importance of menstruation and its disturbances. Briquet, to illustrate, in a general way, the influence of mens- truation as a cause of hysteria, says that, whether normal or pathological, it may be regarded as a predisposing cause in HYSTERIA. 895 three eighths of hysterical cases. This is a smaller proportion than that named by Galen and not excessive ; for it may even be said to be a predisposing cause in one half of these cases. In the elaborate analysis which precedes his general conclusion. Briquet affirms: 1. That the first appearance of the menses may, although less often than has been supposed, give rise to manifestations of hysteria; as instanced in seven girls. 2. When once established, the recurrence of menstruation may excite hysteria even when normal; as observed in fifteen women. This result is still more probable when menstruation is abnormal. 3. Of all the menstrual irregularities, sudden suppression of the flow is most frequently and quickly followed by mani- festations of hysteria. 4. In ten cases the neurosis followed upon exceedingly painful menstruation of a longer or shorter duration. 5. Finally, in 83 cases there was a coincidence of hysteria and menstrual disturbance, with signs of chlorosis in 41 cases and none in the other 47. At the end of his analysis Briquet says : the influence of menstruation as a cause of hysteria, is greater by about three to one between the ages of twelve and twenty than at any other time ; and that the cases in which menstrual disturbances are a predisposing cause are usually in the proportion of four of a gradually developing hysteria to one which begins with a sharp paroxysm. With regard to pelvic peritonitis and uterine congestion, it has already been shown that it is the slow and gradual form of the neurosis which results from these repeated disturbances ; because their influence on the blood formation and the ner- vous system is not sudden, but gradual. Undoubtedly, in these cases it would be unreasonable to regard chlorosis and anaemia as the sole and sufficient causes: for the variety of circumstances under which hysteria follows menstruation and its disturbances, show that these exercise a most important influence in its reduction. In some of these disturbances and especially the sudden suppression of the menses in consequence of a moral emotion, the development 896 world's homceopatihc convention. of the neurosis is clearly the effect of a derangement of the nervous system. For if the suppression gives rise to a suba- cute peritonitis, which generally proves fatal in twelve days; or to an acute peritonitis, which is less frequently fatal; hys- teria does not appear, at least in the acute period of the inflam- mation. In such cases we may say that the hysteria is of sexual origin ; inasmuch as it is the effect of a disturbance of the menstrual function, but as this function serves not merely for the elimination of the ovum, but also to preserve the equili- brium of the hematosis, it is obviously the disturbance of the blood-formation and consequently of the whole economy which plays the chief part in the development of hysteria. The conditions of a physiological state may coexist with a slowly developed hysteria, changed no doubt, but not so modified as in dangerous maladies. The peculiar conditions induced in the organism by what may be called " wasting" diseases, such as tuberculosis, cancer, etc., explain the infrequency of hysteria in such cases; although they involve decided anaemia, as well as amenorrhoea or hemorrhages. The effect of chronic organic affections seems to resemble that of the acute state of febrile diseases, which rarely causes hysteria, and appears rather to suspend its action in neuropathic patients; in accordance with the aphorism : febris spasmos solvit. But, in the case of febrile diseases, when the acute period is passed, they often become exciting or aggravating causes of the neurosis. Like other observers, I have seen hysteria developed in convalescence from pneumonia, acute pleurisy, acute rheumatism, etc.; and especially in females from fifteen to twenty years old, previously without a sign of the disease, in convalescence from typhoid fever. In the latter cases the neurosis appeared due to anaemia; two of them having had no menstrual disturbance to which it could be ascribed. When gastric or menstrual disturbances are present, it becomes of course difficult to estimate the influence of chlo- rosis in its production. Here there are three factors: the special anaemia which characterizes chlorosis, and the disturbances of menstruation HYSTERIA. 897 and of digestion, which often induce it; to each of which, ipso facto, the development of the hysteria might be ascribed. The difficulty of explaining facts of this kind increases when, as generally happens in hospital practice, we are not present at the first paroxysms. For hysteria has often a first phase characterized by gastric or dysmenorrhoeic disturbances induc- ing an anaemic condition; and this may be well marked when the first spasmodic attack occurs. But we may give to the prodromal period of hysteria the name of chlorosis, and hold it to be the exciting cause, unless an accidental circumstance has provoked the first paroxysm. It would be a tedious and useless labor to endeavor to de- termine when the diseases which influence the development of hysteria are its predisposing or exciting causes. The causes supposed by patients to have and need the disease are often merely such as bring on a spasmodic attack. EXCITING CAUSES. It may be said, broadly, that all painful, or vivid impressions may be exciting causes of hysteria; provided a predisposition to the disease exists, of one or other kind already specified, especially that arising from an excessive excitability. This predisposition is the original factor of hysteria; and the exciting cause which induces its outbreak has only a minor importance. With so little reliable testimony from patients to guide to a conclusion, the analysis of these causes will be very brief. First among exciting causes must be reckoned disturbances of menstruation, and the diseases enumerated in a preceding paragraph, which often act rather as exciting than as predis- posing causes; likewise all affections that give rise to severe pains; as, according to Boivin, has been shown in uterine cancer. To the same cause may be ascribed the attacks of hysteria observed during parturition, although these are very rare. This comparative immunity during parturition is more easily understood than the absence of such attacks during serious surgical operations. In these latter cases it has been supposed that the volition aroused by consciousness of danger prevents 898 world's homceopathic convention. that disorder of the nervous system which often results from far less severe pains; such, for example, as give rise to the convulsions, the incomplete hysterical attacks, the syncope and the lethargic condition, described by Hunter, Bicord, Robert and Nonat, as resulting from injections or intra-uterine cauterization. Whether the patients were hysterical or not, these writers do not say. As to the convulsive attacks occuring under such circumstances in women who have long suffered from nervous affections, they are clearly of a psychical cha- racter ; and cannot be cited as showing a localization of hys- teria in the uterus or ovaries. Moral or mental sufferings, on the occasion of some adver- sity, are often both predisposing and exciting causes of the disease. The psychical impressions which cause hysteria are generally shown in painful and ungovernable moral emotions; whereas those which act as predisposing causes are manifested rather in repressed moral sufferings, such as induce a prolonged internal strife ; especially in women who have no inherited predisposi- tion to hysteria. In the first class of psychical impressions are the emotions induced by seeing an epileptic or hysterical convulsion. In the latter case, supposing hysteria to show itself in women be- fore free from the disease, does the psychical impression consist, as Briquet affirms, simply in a sensation of fright ? Ilas not imitation something to do with it? I saw in a Paris hospital a woman who had never before been troubled by nervous affections, attacked with paroxysms altogether like those of another woman in an adjoining bed-such as vomitings inter- mingled with characteristic convulsions. These paroxysms ceased at once when the patient first attacked was removed. The imitative tendency is worthy of note in relation to such cases, because its influence is unquestioned as between confirmed hysterical patients, and is allowed as an explana- tion of the singular epidemics of hysteria which are recorded as having occurred in the middle ages and, at intervals, subsequently, to our own day. An analysis of these epidemics will be given in discussing the symptomatology of hysteria. HYSTEKTA, 899 SYMPTOMATOLOGY. Hysteria may cause the most various functional disturb- ances, presenting the most diverse morbid phenomena in reg- ular or abnormal forms; differing also in the character of danger. The abnormity may appear in the most prominent phenomena of a given case, which may deviate more or less from the typical paroxysm or differ altogether from those which characterize hysteria ; or, it may consist in an excessive preponderance of some one symptom over the others, so that, in the convulsive forms the affection may simulate an idiopathic disease. The observation of successive centuries has shown, conclu- sively, that the widely contrasted phenomena of hysteria must, by virtue of certain common features, be regarded as one and the same disease. And yet, even at this day, it is not easy to distinguish the diagnostic elements of the disease from those of numerous diseases which simulate it. It is not possible, within the limits of this essay, to present such an analysis of the manifestations of hysteria as is necessary to explain its protean forms ; we will therefore confine our attention mainly to the convulsive form, at once the most common and the most complete expression of the disease. The symptoms of the convulsive form of hysteria may be arranged in the three following groups, viz.: 1. The symptoms which precede the first paroxysm ; which may not occur for some years after the beginning of the dis- ease, as will presently appear. 2. The symptoms of the paroxysm, the physiognomy of which is not always that of a " nervous attack," and may re- semble an epileptic convulsion, or a syncope, a lethargic cata- leptic condition, a loquacious or restless delirium, somnambul- ism, etc. 3. The symptoms of the inter-paroxysmal interval. These are manifold, for hysteria may disturb every function of the organism ; but they may be described in two groups : One of these is almost constant, comprising unwonted excit- ability, abnormal intellectual mobility, partial anaesthesia, especially on the left side ; as well as pleuralgia of the left 900 world's homceopathic convention. side, and reflex paralysis of the epiglottis. These symptoms are important in the history of the case and, frequently, for the diagnosis; and should be carefully sought for, since patients often fail to call attention to them. The other group, of which patients usually complain bit- terly, consists of disturbances of various functions, which not only vary in frequency and intensity, but occasionally some or all may be wanting. In analysing this group, we shall consider the numerous modalities resulting from the great variations of the symptoms, and the preponderance of some one symptom in certain cases; as, for instance, the uncontrollable vomiting which is sometimes fatal; the hysterical fever ; the absolute suppres- sion of urine of long or short duration. The symptoms which precede an outbreak of the disease do indeed constitute a pro- dromal stage of the convulsive form of hysteria ; though it is otherwise with the form which develops slowly and gradually. The history of cases in which the disease has existed for months, or even, as in many examples cited by Briquet, for years before the first paroxysm, presents a more or less com- plete series of the symptoms observed during the inter-par- oxysmal stage of the ordinary form of hysteria ; the elements varying in accordance with the form the neurosis may present. Where the disease sets in abruptly there may, indeed, be no prodromal stage at all; and even in the large proportion of cases which develop gradually (148 in 289 cases, according to Briquet,) it is extremely difficult to draw the line between the prodromal symptoms and those of the established disease, especially when the exciting cause is unknown. More than one-third of the cases of hysteria met with (138 in 305), commence with a convulsive attack without any pre- monitory sign. This is observed in children especially. In other cases premonitory symptoms may appear after the excit- ing cause, for hours or days before the paroxysm, such as un- usual excitement, headache, vertigo, oppression, palpitation, jactitations, flashes of heat to the face, subjective and objec- tive icy coldness of the extremities, and a feeling of anxiety and oppression at the stomach which takes away all appetite for food. HYSTERIA. 901 After a time there is added to the oppression at the stomach a feeling of constriction, followed in a few minutes by that peculiar sensation of a ball rising from the stomach to the larynx, which characterizes the beginning of the hysterical convulsion. The violence of the convulsion is usually in pro- portion to the abruptness of its onset. We then observe extreme fickleness, great impatience, sadness, weeping and laughing without cause, sleeples ness, frightful dreams, rest- lessness, formication, jactitation, varieties of spasm and gen- eral shuddering and burning heat, alternating with icy cold- ness of the extremities, oppression and particularly gastric disturbances. The patients appear more excitable than common, and ex- hibit more or less uneasiness, with incomplete spasms, until, under the influence of some insignificant excitement, the pre- liminary symptoms of a new paroxysm appear. The symp- toms are most commonly observed when the hysteria is in- duced by grief or trouble and runs an acute course. Briquet, describing the prodromata of hysteria when it begins slowly and gradually, says : In half the cases it begins gradually. Sometimes in young and feeble girls it comes on induced by fatigue, defective nutrition or grief; then come disturbances and suppression of menstruation; or it occurs in married women as a result of contentions, or of household difficulties, or grief, or anxiety. In either case the patients become pale and emaciated ; their excitability increases, their disposition becomes embittered, and on the least provocation their temper is aroused. A slight emotion causes weeping with sobbing; constriction of the larynx, oppression of the stomach and jactitation ; then are developed headache, palpita- tion, dyspnoea and all the phenomena of chlorosis ; the consti- tution changes, the nervous system predominates and the digestive functions become disturbed. Gastralgia appears with all its consequences, and pains in the back and left thorax, and formication and restlessness in the limbs. It will be observed that some of these symptoms belong to chlorosis and anaemia, and it is not easy, therefore, at the bedside, to determine in which disease they originate. 902 world's IIOMCEOPATHIC CONVENTION. In nearly two-thirds of the cases of this form of hysteria (84 in 135) the paroxysm appears within one year of the be- ginning of the disease; in about eight cases in one hundred (16 to 135), it appears within two years. So that in a large majority of cases (100 in 135) the paroxysm occurs within two years of the commencement of the disease. A few cases show an interval of four or five years, and very exceptional ones periods of eight, ten, twelve and twenty years. The paroxysms are usually preceded by prodromal symptoms which are differ- ent after each attack. But generally the patients only speak of an indescribable condition of discomfort, which distresses them greatly, and makes them wish the paroxysm, which it foreshadows, would come on, that they may enjoy the few fol- lowing days of relative quiet. The paroxysm, which almost always occurs in the daytime is ushered in by a great variety of sufferings. Undoubtedly in some cases, of which I have myself lately witnessed one, the the pain begins in the ileo-coecal region and extends to the epigastrium; but in most cases it begins in the epigastric region, where a sense of constriction or of burning is felt, which opens the scene and seems to be the starting point of the phenomena which characterize the paroxysm. Besides the cases in ■which the pain begins in some part of the abdomen and soon reaches the epigastrium, there are others in which it begins ■with headache, vertigo or semi-consciousness, soon ad- vancing to unconciousness ; or in which the first symptom is a sense of constriction without any previous epigastric pains. The cases are exceptional, but yet numerous enough (according to Briquet 31 in 221), in which an aura is observed, passing from one or both of the upper or lower extremities to the thorax and thence to the epigastric centre, giving rise to the epigastric constriction which, in most cases, seems to be the initial phenomenon of the paroxysm. The epigastric discomfort, whether primitive or secondary, lasts from one to fifteen minutes. Then conies the sensation of a ball rising more or less rapidly from the epigastrium to the upper margin of the sternum or to the larynx, where it seems to remain; as we infer from the automatic motions of HYSTERIA 903 the patient, who, during the convulsive period, seems en- deavoring to free her throat from a foreign body. With the rising of the globus hystericus, which has primordial value as a symptom, the patient is seized with violent palpitations, of which she is conscious, until towards the close of the attack; these are often so violent as to perceptibly lift the thorax. I mention this palpitation because it explains the syncope, which in some cases terminates the attack, and in others comes on immediately after the epigastric discomfort, and completes the paroxysm. The feeling of constriction produces one or more shrill out- cries, marking sudden unconsciousness, which in some cases continue during the attack, and remind us of the cries of patients under surgical operations. And with this character- istic outcry (which is so very different from the single, hoarse, unearthly cry of the epileptic), the patient, if she is standing, falls to the ground, but not anywhere, without distinction, like the epileptic. From this moment unconsciousness is, in most cases, com- plete ; the patients neither hear, see nor feel, and, after the paroxysm, have no remembrance of what they have suffered. But this is not always the case. In eight patients out of twenty-two, observed by Georget in the Salpetriere, in Paris, unconsciousness was incomplete, although the most dangerous cases, regarded as incurable, are sent to this hospital. At the moment of the hysterical cry, the oppression seems to be at its maximum; it is a kind of tonic spasm, accom- panied sometimes by a tetanic rigidity of the whole body. The face is red, puffed, injected and has its natural expression, instead of the peculiar repulsive aspect observed in epilepsy. The neck is swollen, the carotids pulsate forcibly, the jugulars are distended, while the abdomen is tumid; finally, the op- pression is so great as seemingly to threaten asphyxia. In fact, in some cases in which death has occurred during the hysterical attack and been ascribed to pulmonary congestion, the autopsy has verified the conclusion. Yet the convulsions are not to be ascribed to the respiratory embarrassment, which depends on the spasm of the larynx which characterizes the 904 world's homoeopathic convention. tetanic moment of the attack. Tracheotomy, which was tried on epileptics, in England, did not abort the convulsions ; and a hysterical patient observed by Briquet had no fewer convul- sive attacks while she wore a tracheal canula after tracheotomy performed on account of oedema of the glottis. The duration of the attack is generally very brief. General convulsions immediately follow the loss of con- sciousness. These convulsions, when of a typical character, have a physiognomy so peculiar that even persons not familiar with medicine recognize them at once; and yet they are so irregular that it is very difficult to describe them. The limbs are now rigid, then spasmodically flexed, then thrown in dif- ferent directions, passing rapidly from flexion to extension, from adduction to abduction, and vice versa; as if the patient were in a spasm of severe suffering, as for example from oppressed respiration. Indeed, from the automatic motions of the hands, the patients would seem to be striving to tear away from the chest or throat something which suffocates them. Hence these convulsive movements, considered by them- selves and characterized as they are by irregularity, resemble voluntary physiological movements, rather than the regular alternate flexion and extension, with lateral preponderance of action, which we observe in epilepsy and eclampsia. The face is but little, if at all, convulsed; presenting nothing of the distortion, the lateral motion of the lower jaw, the bloody froth and the lacerated tongue which characterize epilepsy. And yet these distinctions are not quite pathogno- monic; for some hysterical convulsions are so like epileptic spasms (including even the flexion of the thumbs) that we have to seek in other symptoms the elements of a differential diagnosis. Facts of this lattei* kind have given rise to the bastard nosological variety called hystero-epilepsy, the ex- istence of which seems to me quite problematical; inasmuch as I have seen a number of these cases, pronounced incurable, speedily recover. The convulsive attack generally lasts much longer in hysteria than in epilepsy or eclampsia; and is seldom so uniform as in these diseases, in which the gradually in- creasing cerebral congestion ends in a comatose sleep. In the HYSTERIA. 905 hysterical attack, after a time, the movements become less extended, violent, and disorderly; the dyspnoea and disten- sion of face and neck diminish ; and all the symptoms are less energetic; a sign that in a few minutes the patient will re- cover consciousness. It is not always so, however. Some- times under a slight provocation, sometimes without any, another shrill cry will be heard, and a new paroxysm, some- times more violent than the former, occurs, preceded by like symptoms. Thus an attack may be made up of two, three or more paroxysms, prolonging its duration beyond the average. But the convulsions soon lose their force, and the features hitherto relaxed as in sleep, exhibit various lively expressions, assisted by the unclosing of the eyes which were previously shut or rapidly winking. Some patients express all the passions in succession: fright, rage etc., generally open the scene, which closes with an expression of voluptuousness, owing to motions of the eyes which are turned upwards and inwards and half con- cealed beneath the upper lids. But this expression disap- pears, and then the eyes become suffused, tears flow copiously, and a true crisis of sobbing occurs, in which consciousness is recovered. Hereupon the patient is often compelled to pass a large quantity of clear, colorless urine, containing but a small quantity of salts or urea ; a symptom of diagnostic value to which Sydenham called attention. Some patients, instead of weeping, have an attack of spasmodic laughter; others, of half-delirium, in which they narrate, disconnectedly and often unintelligibly, some incident that has impressed them; or, involuntarily reveal some indiscretion compromising them- selves or others. The succession of these passionate expressions, in which not only the facial muscles but also those of the trunk and extre- mities are co-operators, and which are sometimes accompanied by a cry of fear or rage, or by some unconnected words, is more or less complete in different patients. The frequent facial expression, first of anxiety and then of voluptuousness, seems to support the Hippocratic view; especially when, during the cynical spasm of the eyes, there is a rhythmical 906 world's iiomceopathic convention. propulsion of the pelvis and, as averred by the older authors, at the end of the attack, a copious discharge of vaginal mucus. I have only once had occasion to observe this secretion, the existence of which it is of course difficult to verify. This was in the case of a young woman who had vaginal hyperaesthesia and blennorrhoea of the vulvo-vaginal glands, in whom every introduction of the index into the vulva, to examine the glands of Bartolini, brought on an attack of hysteria. A study of the crises of weeping which occur in the ordin- ary form, and of the expressions of passion that have been here described, will show that, even in the simplest cases, there is during the hysterical unconsciousness, a cerebral disturbance, of which these manifestations are symptomatic. From these pantomimic or spoken dreams at the end of an ordinary spasmodic attack, there is but a step to those more prolonged attacks of somnambulism, convulsion or catalepsy, which follow a spasmodic state generally briefer than in the ordinary form. Indeed, the unusual brevity of the spasmodic period in these cases, explains some abnormal forms in which we observe only a few delirious words or actions, or well developed somnambulism, clonic spasm, or catalepsy, preceded by little or no spasm at the moment of unconsciousness. These abnormal attacks occur exceptionally, in the course of hysteria, under the influence of some vivid moral impression, or through imitation, as in the convulsion-epidemics ; or they alternate with typical attacks ; or they occur in patients who never had any other form. I had a patient of the latter class who died at the end of a cataleptic attack, and whose autopsy revealed no lesion whatever. In this case the diagnosis was based less on the character of the attack than on the interven- ing symptoms: it would, otherwise, have been almost impos- sible to distinguish idiopathic catalepsy from cataleptiform hysteria, as will appear from an analysis of the facts adduced in Fuel's work. In general these abnormal paroxysms do not end in crises of tears or laughter ; judging, at least, from two cases observed by myself in which cataleptic alternated with ordinary hysterical attacks. Both of these young women made • complete recoveries. HYSTERIA, 907 When consciousness returns, the patients complain of head- ache, fatigue and, especially after severe attacks, suffer for 24 hours from feverish lassitude. In the only case in which I have seen the spasmodic attack end in clonic convulsions, the patient fell asleep at the end of the attack ; a phenomenon which sometimes takes the place of the weeping crisis at the end of an ordinary attack. This enables us to explain three abnormal forms of the affection, in which the patient sinks into a soporous condition resembling that of catalepsy. In the simplest of these forms the patient is irresistibly overcome by a deep, often stertorous, sleep, either instanta- neously, or after feeling the globus hystericus and the dysp- noea, or after experiencing only the epigastric oppression, for a longer or shorter time. Here, the sleep is not preceded by a convulsive phase, but comes instantaneously. This sleep, from which it is difficult or impossible to arouse the patient, at least for more than a moment, lasts as long as a paroxysm; or may last hours, days, even months ; sometimes continuous, sometimes interrupted by brief wakings, during which the patient takes nourishment and then sleeps again. Meanwhile the functions of nutrition are normal, the extremities lax, the skin cool, the pulse normal, or else, somewhat retarded like the respiration, which, in a case observed by Pfendler, was scarcely perceptible. In this case the lethargic condition lasted six months. In the second and rarer form, sleep is replaced by coma, during which the patient is insensible to the most powerful excitants. In some few cases of this kind, the coma followed a convulsive attack, taking the place of the weeping-crisis, and lasted several hours ; and, once, four days. In one case the eyes were wide open and the countenance expressed astonish- ment, as in coma-vigil. On waking from this deep sleep, in which they have been entirely insensible, the patients are for some hours in a dreamy or delirious condition; know not where they are ; and complain of epigastric oppression. Afterwards they have headache and a general lassitude which make them aware they have had an attack ; but of its duration or incidents they have no knowledge. 908 world's homoeopathic convention. The third, or lethargic form, is perhaps a little more fre- quent than the other two, or else, from its striking phenom- ena, it has received more attention. The attack is generally induced by some vivid moral emotion, and may be preceded by some of the ordinary prodromal phenomena. Sometimes these consist only in a slight trismus or rigidity of the extrem- ities. Then the patients appear to be in a deep sleep, and can- not be aroused. They do not snore ; on the contrary, the respiratory movements are too feeble to lift the thorax. The face is colorless ; the extremities rigid ; the heart-beats diminished in frequency and force; there is neither sweat, urine nor stool. Sometimes there is simple lethargy; some- times a complete semblance of death. Respiration may be so feeble that a mirror held before the mouth and nose is not clouded; the pulse and heart-beats are quite imperceptible; the skin cold, instead of merely cool; there may even be an appearance of decomposition, owing, no doubt, to the decom- position of the gaseous exhalation from the patient's body when kept in bed. At least it was so in a remarkable case narrated by Pfendler, in which, twenty-eight hours after the patient had been pronounced dead by J. P. Frank, but in which interval all kinds of remedies, especially galvanism, had been used, a kind of respiratory movement took place just as the preparations for interment were being made. After the use of stimulating frictions for an hour and a half, the respiratory movement was repeated and the young woman awoke. This brief waking was followed by a sleep of ten hours, after which the patient returned to consciousness and repeated the Latin phrase in which J. P. Frank had expressed to the five consult- ing physicians (celebrities of the Vienna faculty) his opinion that death had occurred. The awakening of most of these patients is like that from normal sleep ; but some have delirium, confusion of ideas, or some lesion of mobility or sensibility, such as are not uncom- mon after ordinary hysterical attacks. It is remarkable that very many of these patients, after waking, remember all that occurred during their sleep ; this may be attributed to the ter- rible emotion that must be experienced by one who comes HYSTERIA. 909 near being buried alive, like the beautiful Jewess whose case Pfendler describes. A complete recovery from hysteria often follows such dangerous lethargic attacks. More time has been given to these exceptional cases, of which I confess I have never seen an instance, because every physician ought to know that they occur, and to have them in mind whenever a hysterical patient dies, or appears to die, at the end of a convulsive attack. Before we permit interment and, still more, an autopsy, there should not only be an appear- ance of decomposition, which may be deceptive, as in J. P. Frank's case, but actual evidence of real decomposition, which, whatever may be said, is the only sure evidence of death. Vcsale and J. P. Frank are two very great names in med- icine. The error they both committed should be a great lesson to every physician who is treating hysterical patients, warning him against dependance on the alleged infallible signs of death which are so lightly advanced of late years; he may thus avoid the bitter remorse which was the indirect cause of Vesale's death. The diagnosis of these three abnormal forms of the hysteri- cal paroxysm, from the ordinary attack, presents no real difficulties ; but with others the distinctive characteristics are by no means so clear. All, however, may be embraced in the following twelve varieties : 1. The ordinary typical form, subject to certain modifica- tions ; 2. The hystero-epileptic form-the most dangerous of all- sometimes approximating to the hysterical, sometimes the epileptic attack; 3. The syncopal form, sometimes preceded by a convulsive phase, at others consisting only of two or three syncopes ; 4. The spasmodic form, rarely giving rise to a condition of asphyxia, sometimes made up of transient tetanus, trismus and rigidity of the limbs; 5. The clonic attack, which may or may not be preceded by the spasmodic phase ; 6. The form of muttering delirium, in which the first phase 910 world's iiomceopathic convention. is generally irregular, the customary weeping crisis being re- placed by delirium; 7. The form of active delirium, observed especially during the epidemics of the middle ages, but still occurring sporadi- cally in hysterical children ; 8. The somnambulistic form, simple or induced by magnetic passes : 9. The cataleptic form, preceded or not by the convulsive phase; 10. The somnolent form, differing from that in which sleep follows an ordinary attack, in that the convulsive phase is lacking; 11. The comatose form, differing only in degree from the former; 12. The so-called lethargic form, already described. For a clear diagnosis of the paroxysm from the onset of a meningitis, or other idiopathic disease, in case of prolonged delirium, it is necessary not only to ascertain if the patient has previously experienced convulsive attacks, but also what morbid symptoms have existed during the interval, of a kind to constitute the non-convulsive form of the disease. 1. The symptoms of the interval which alone characterize non-convulsive hysteria, may exist for years before a paroxysm occurs, or continue and constitute " hysteria without par- oxysm," which is quite as dangerous as the convulsive form. In some of these cases death has ensued merely from uncon- trollable vomiting. This form of hysteria, more frequent than the convulsive form amongst the rich, is quite as common amongst the general public. Briquet says: " I believe we are not wrong in considering that fully one-half of the women who suffer from hysteria have no paroxysm." From a general point of view, the totality of the symptoms may be divided into three groups : The first comprises those common to all patients ; the second, those which, though not constant, are sufficiently frequent to characterize the disease; the third includes numerous dynamic disturbances ; some common, others rare ; sometimes accessory in character, some- times exercising such a preponderance as to constitute modal- HYSTERIA. 911 ities of hysteria. The most important of this interesting group will be presently described. As constant symptoms we find in hysteria : 1. An uncommon susceptibility to all physical and, still more, to all psychical impressions ; 2. An abnormal intellectual mobility; 3. Various pains in the region of the stomach; 4. A kind of backache, says Sydenham, which is never wanting even in the lightest attacks of hysteric passion. This symptom, though less pronounced, is always present in hysteria without paroxysm, a fact not mentioned by Sydenham ; and it has this peculiarity, that, after it seems to have ceased, it leaves the parts lame, irritable and painfully sensitive to the touch. As regards symptom No. 1, when it exists in a high degree, the patients are constantly in a fearful state of excitement; are painfully sensitive to light, noise and odors, and even to psychical impressions. But the impressions although profound are not persistent, owing to an abnormal intellectual mobility. 2. The character of hysterical patients is peculiar. They may exhibit dullness or intelligence; notwithstanding which the brain may be impaired in some important function. It seems as though, by the excessive expenditure of sensuous and automatic innervation, the superior cerebral function were absorbed, so that we see as characteristic features : indecision, irregularity of volition and a subjection of thought and reason to external impressions. An inattentive mind is one result of this condition, which is also characterized by exaggeration of real sufferings, constant fear of death, a tendency to hypocrisy, deceit and self pity; a state which approximates hysteria to hypochondriasis. The uncontrollable excesses of emotion and expression, which hysterical patients often bitterly regret, cause sufferings which are referred by them to the epigastric region. These sufferings constitute the third constant symp- tom of hysteria. 3. The epigastric distress may consist in cutaneous hyper- msthesia, aggravated by the slightest friction, and is generally accompanied by epigastralgia. Briquet says this exists in nine- 912 world's homceopathio convention. tenths of the cases. In many it is a superficial pain aggravated by slight pressure, and entirely free from any complication involving the gastric function ; while in others', such a compli- cation exists. It presents great varieties. Sometimes a per- verted appetite, sometimes pain is the predominant symptom, which may or may not involve the appetite; and in some cases pressure on the pit of the stomach not only aggravates but induces a paroxysm of pain, such as follows pressure on the ileo-coecal region in subjects of ovaralgia. The gastric disturbances may be dangerous, leading to gradual wasting without positive symptoms ; or to a cachectic state, which results in quick consumption. Yet even in these serious cases the stomach remains anatomically sound. The same is true of that form of gastrodynia of which vomiting is the chief symptom. In some cases the vomiting is constant, preceded by a terrible pain in the stomach when the food reaches it, like that from corrosive poison, and ceas- ing only when all the ingesta have been thrown off. It is re- markable that some patients, who thus reject food almost as soon as it is swallowed, continue to preserve their fresh and plump appearance. 4. The fourth constant symptom of hysteria is a hyperms- thesia of one or more parts of the back; it has been called Kachialgia. Although mentioned by Sydenham, its semeiotic importance was not recognized until our own day, and the recognition is due to the labors of Brodie, Andra], Fleurot and Briquet. Although sometimes not mentioned or even noticed by patients until their attention is directed to it, this symptom was absent, says Briquet, in only five out of three hundred and six patients. It rarely pervades the whole back, but is generally seated in a certain number of spinous processes and the corresponding parts of both sides ; more frequently, how- ever, only on the left side. In a majority of cases the pain extends over only three to five vertebrae. Sometimes it occu- pies the surface corresponding to the last cervical and first dorsal vertebrae; oftener (in half the cases) to the first six or eight dorsal ; sometimes to the last dorsal and first lumbar HYSTERIA. 913 vertebra). In more than two-thirds, the seat of pain is the upper part of the spine. The characteristic of this rachialgia is the aggravation by pressure, and by continued motion of the muscles, which are the seat of hyperaesthesia. In mild cases the pain is trifling unle s after great and prolonged exertion; and firm pressure on the spinous processes and contiguous muscles is requisite to provoke it. If the rachialgia be more pronounced, the patient complains of it, not so much on account of its severity as from anxiety about it. Where the severity of this symptom is considerable it interferes with motion, even with walking: it is aggravated not only by fatigue but also, wfliich is important for the diag- nosis, by moral sufferings, even when these have never in- duced an acute attack of hysteria. To a rachialgia more pronounced and of longer duration, the English have given a special name-" Spinal Irritation." It acts, in time, upon the digestive function, produces leu- corrhoea and menstrual derangements ; and, finally, a kind of hectic which has been erroneously named " Tabes Dorsalis." The spinal pain in non-convulsive hysteria, when it is aggra- vated by pressure on the spinous processes, and especially when it is accompanied by girdle pains as in myelitis, so strongly suggests an idiopathic affection, as to have caused serious errors in diagnosis; and the occasional presence of hysterical paraplegia or contractions has added to the per- plexity. On this subject Brodie remarks : " I have seen not one but many young women condemned for years to a hori- zontal position, or tormented with setons, moxas and issues, whom air, exercise and diversion would have cured in a few months." The pain as if a girdle encircled, or half encirled, the waist is a common symptom of hysteria, which does not always cor- respond in locality with the sensitive vertebrae. It depends on hyperaesthesia of the thoracic muscles or integument. Pleuralgia, the existence of which should be carefully veri- fied, on account of its semeiological importance, is a very constant symptom of hysteria, and one of the most difficult to 914 world's homoeopathic convention. remove ; for when apparently subdued it may recur on the slightest provocation. Briquet thus describes the sympathetic symptoms of a pronounced case of rachialgia: " In this patient, pressure on the cervical portion of the spine produced constric- tion of the larynx ; on the dorsal region, constriction of the chest, oppression and sometimes palpitation; on the lower part of this region, epigastric oppression and pain like that which precedes an hysterical paroxysm." 2. Symptoms, not constant but very frequent, and which also serve to characterize this neurosis. First: Anaesthesia, more or less complete, of the whole body, which is very rare; of one-half, (generally the left), or of a part only, perhaps a very small portion of the surface. This is an interesting symptom, not only from its frequency and its bearing on the diagnosis, but also from the significance at- tached to it, in the middle ages, in the trials of those charged with demoniac possession. Because of it, thousands (100,000) of neuropathic unfortunates are said to have been burned alive. This alleged sima of the devil, which was sought for by experts of the high courts, by methods like acupuncture, is accompanied by more or less ischaemia (stasis) giving rise to a relativepalerand coldness of the parts; from which the blood would sometimes fail to flow when they were pierced by a needle. Chariot relates that, in a patient of his, leeches could hardly draw blood from the parts deprived of sensibility, while they drew it easily from other parts of the body. This explains cases narrated by mediaeval authors, in which blood did not follow sword-punctures; which also caused no pain. When the anaesthesia reaches a very high grade, it involves not only the skin but also the muscles and bones. Briquet says: " I saw a young woman whose skin and muscles were in a state of anesthesia. On the left side she was deaf and blind, while on the right side she heard with great difficulty. She could not smell nor taste nor distinguish different articles of food, and used her hands only by the aid of vision, which was her sole remaining sense. So complete was the insensibility that, if her eyes were covered, her limbs might HYSTERIA. 915 be lifted from the bed, placed naked upon the floor and replaced in the bed, without her knowing anything of what was done." Generally however, the amesthesia is confined to one, most frequently the left, side ; the line of demarcation being in exact correspondence with the median line. In fact, if very pro- nounced, it is a hemiplegia without contraction. These hemiplegias, coming on after a moral emotion, an epileptiform attack, or a soporous state might easily be mistaken for hemiplegia which is symptomatic of a cerebral affection (apoplexy.) Usually in the latter cases there is either no loss of sensibil- ity or it is but temporary. But when this is not so, the diag- nosis is very difficult. To determine it, we have to consider the age, history, and circumstances of the patient; as well as any pre existing symptoms of hysteria. If the hemiplegia has come on during a soporous condition, the demeanor and answers of the patient as she emerges from this condition will exhibit either the characteristics of hysteria, or the mental obfuscation of apoplexy. Very often the anesthesia is seated in a small portion of the integument or mucous membrane; very often in the conjunc- tiva of the left eye, and is often associated with achromatopsia (inability to distinguish one or more colors) as described by Calenzenski. Along with the loss of smell and taste, we often notice anaesthesia of the mucous membrane of the nose and mouth ; but anesthesia of the membrane of the pharynx is still more common. Finally we some times observe anesthesia of the mucous membrane of the anus, pudenda and vagina, which involves loss of genital sensibility, a phenomenon opposed to the Hippocratic theory. The anesthesia may come suddenly, or develope gradually, preceded by formication. It may follow a paroxysm, or occur without paroxysm. The mild form comes suddenly, and is transient; lasting only a few hours, while that which comes gradually and is extensive, is more persistent. 2. Reflex paralysis of the epiglottis. This has been regarded, though erroneously, as a constant 916 world's homceopathic convention. and pathognomonic symptom of hysteria. It is rather a secondary phenomenon, dependent on anaesthesia of the mucous membrane of the fauces, like the partial loss of taste with which it often coexists. It is manifested by a lack of the spasmodic contraction of the pharyngeal muscles, the reflex motion of the oesophagus and upheaval of the diaphragm, which ordinarily follow the introduction of a finger or a foreign body into the back part of the mouth. In hysterical patients, one may glide the finger along the tongue carefully, avoiding the palate, may reach the epiglottis and examine the aryteno-epiglottidean folds, without exciting retching. I have observed this condition in sixteen out of twenty-two hysterical patients; but it occurs also in other diseases. It existed in two out of five male epileptics; and in eight out of sixteen victims of lead-poisoning, some of whom had drop-wrist; while others had only their first attack of colic. 3. Ilyperaesthesia ; its seat may be the skin, muscles, joints, nerves, the various organs of sense, the bronchia, the stomach, intestines, kidneys, bladder or the genitals. Ilyperaesthesia of the skin is far less common than cutane- ous anaesthesia. According to Briquet it occurred in forty- four cases in four hundred and thirty. Its diagnostic im- portance depends not so much on its absolute as on its relative frequency in hysteria, as compared with other diseases. Also on its coincidence with Ilyperaesthesia of the mucous mem- branes, as of the stomach, where, in hysteria, gastralgia is so often attended by epigastralgia. Cutaneous Ilyperaesthesia occurs after attacks, after moral impressions or vexations, in women not subject to paroxysms; with varying intensity and extent. It may affect one side of the body, usually the right, while anaesthesia exists on the other side. If the pain be quite severe, constituting dermalgia, it is generally limited in extent. If it be general, the unfortunate patients cannot, without pain, make the least motion; because usually the muscles as well as the skin are involved ; even the contact of clothing or bedding is painful. The sufferers lie on their backs in bed and pass sleepless nights ; and it is not surprising that some HYSTERIA. 917 of them should be found in a state of feverless irritability combined with great erethism, oversensitive to light, noise and odors. Ilypersiesthesia may occur in the labia or the vagina and constitute a variety of vaginismus, which is distinct from the ordinary form not only by its aetiology but also by the fact that the remedial measures which improve the latter only aggravate this. Hyperaesthesia of the mammary integument, mostly on the left side, and often involving the entire gland, sometimes occasions such intolerable pain, that, in two cases, eminent surgeons have advised amputation ; although, neither in skin nor gland could any modification of tissue be discovered. They were evidently cases of Astley Cooper's "irritable breast," and symptomatic of hysteria from which both patients suffered. Hysterical deremalgia is generally transient or yields easily to treatment; but if seated in the vagina it may be quite obsti- nate. The muscles of the anterior portion of the thorax, of the upper and lower extremities, and of the dorsal spine, may be the seat of hysterical Ilyperaesthesia of great variety in inten- sity and extent. There may be simple discomfort, painful stitchings or contraction of all the muscles involved, which may lead to a febrile reaction followed by persistent contrac- tion. It may be so general and so acute as to simulate an acute muscular rheumatism. One of my patients, extremely hysterical and entirely free from rheumatic tendencies, was taken one day with such severe muscular pains throughout both of the lower extremities, that she lay immovable in bed. The next day, one of the upper extremities was involved. A few doses of Rhus tox. were given her and, after a few days' rest and the recurrence of an obstinate vomiting which had pre- viously tormented the patient, the pains ceased. In connection with this muscular pseudo-rheumatism we must mention the superficial joint-pains of hysterical subjects, which are mentioned by F. Hoffman ; and to which Brodie calls special attention in a remarkable memoir, citing the errors of diagnosis to which they give occasion. They are 918 world's HOMGEOPATIHC CONVENTION. never primary, but occur in those who have long had some form of hysteria. Hysterical arthralgia is generally non-articular. It is most frequently seated in the hip or knee, although it may attack the shoulders or all the large joints of the lower extrem- ities. Its onset is sometimes gradual and slow; but in one- half the cases it comes suddenly and violently without warn- ing, after exertion, a fall or a blow. The pain is constant or intermittent, severe and lancinating; sometimes so intolera- ble that patients demand amputation. The pain may be deep- seated or superficial, but it is never in the location of the synovia. Motion of the hyperaesthetic joints, and pressure of the opposing cartilages against each other, do not increase the pains, a fact on which Brodie lays great stress, as he does also on the fact that the pain is aggravated by moral impressions, which have no effect on inflammation. This is the more im- portant, because Brodie says he has seen in some cases swel- ling of the joint and of the whole limb, which was firm and elastic, but there was no effusion on puncture. Pomme relates a case in which, with this hysterical arthral- gia, there was a spasmodic retraction of the knee, which was treated as a spontaneous luxation of the hip. At the autopsy the parts were found normal. This arthralgia may suddenly cease. Brodie relates that a patient of his who had kept her bed for several years on account of it, was, on a sudden, en- tirely relieved while her confessor was earnestly praying for her cure. Sometimes it is suddenly replaced by some other hyperesthesia ; while in other cases it ceases gradually. Hy- sterical neuralgia, wherever its seat, has the same peculiarities as to the sudden appearance and disappearance, and substitu- tion for other ailments, that characterize all the manifestations of this neurosis. Hysterical toothache has caused the sacrifice of many sound teeth. Headache, which was a constant symp- ton in three hundred of Briquet's three hundred and fifty-six cases, often precedes the outbreak of hysteria, especially in the form of frequent migraine in young women. Such cases should, therefore, come under treatment in the hope of pre- venting the development of hysteria. The hysterical head- HYSTERIA. 919 ache is generally limited to a small point and is very severe, extorting outcries. It resembles the boring of a pointed in- strument, or the sensation of a piece of ice, or of a coal of fire, and is often attended by chilliness, gastric disturbance, vomiting or fever. The pain is often relieved by pressure, from which we may conclude that its seat is the scalp and not the dura mater. The special senses may be the seat of hyperaesthesia, and be so exalted in intensity as to explain to us some of the phenomena ascribed to magnetism. Hyperaesthesia of the laryngo-bronchial mucous membrane may give rise to hysterical cough, to pseudo-croupal dyspnoea, resembling paroxysms of asthma. The cough occurring in hysterical subjects is always a secondary symptom. It follows an ordinary laryngitis or bronchitis, or replaces some other symptom of the neurosis. In some patients it is a constant cough, not allowing a moment's rest except at night, during sleep, which is a noteworthy exception. Usually it comes in paroxysms, sometimes at regular intervals; is provoked by a tickling in the throat; has a very shrill sound and is followed by an acute resonance; these tones being always the same in the same patient. The absence of expectoration and of cough at night are important points for the diagnosis. With hyperaesthesia may be associated spasm of the air passages; and this may be so severe and persistent as to result in dangerous arrest of respiration. Briquet narrates two cases in which tracheotomy was twice performed on this account, once by Michon and once by Velpeau. Sometimes this spasm of the larynx produces aphonia; sometimes it extends to the thoracic and abdominal muscles-a fact which explains some singular features of the mediaeval epidemics. Hysterical patients sometimes involuntarily join in conver- sation, and, though persons of refinement, use coarse and even profane language, etc. These phenomena resemble the par- oxysms of uncontrollable laughter and weeping, of which we have spoken, and which, like all the peculiar noises, etc., of hysterical patients, may be contagious in girls' boarding schools. The anaemic condition of hysterical patients who present 920 world's homoeopathic convention. these symptoms is apt to give rise to dyspnoea and palpitation on slight exertion ; and likewise to dyspeptic symptoms, such as we see in patients with pulmonary disease. There are also rachialgia and pleuralgia resembling the backache and pleuri- tic pains of such patients, and often an irregular febrile state. We are in danger therefore of mistaking these cases for incipient tuberculosis. Indeed, in some cases where there is menstrual disturbance, we see occasional hemoptysis, and in such cases we shall find rales under the clavicles on ausculta- tion. Hyperesthesia of the pharynx or oesophagus is very rare, but when it exists is distressing and very dangerous. It pre- vents nutrition and may thus cause death. Every particle of food, or even of drink, causes constriction of pharynx and chest; the patient is in danger of suffocation, and can hardly be induced to repeat the experiment. Some patients can swallow, but the food does not pass to the stomach, being arrested midway by spasm, and sometimes it is rejected. Some patients, after drinking a few drops, throw away the glass or break it by a spasmodic action ; such cases have been mistaken for hydrophobia. Spasm of the stomach may co-exist with hyperesthesia, giving rise to uncontrollable vomiting or to excessive accumu- lations of gas, which result in noisy eructations after each meal. In the intestines this spasm may give rise to pseudo- tumors, consisting of gas, which sometimes move in the abdomen; a fact in which, doubtless, originated the ancient notion of the ascent of the uterus in hysteria. Hyperesthesia of the intestines is more common than spasm ; it occasions borborygmi, distension and sharp colic. When accompanied by constipation, amenorrhoea and con- stant tympanitis in young women, it may be mistaken for dropsy or even pregnancy. Paralysis of the bladder is quite common in hysteria, both connected with, and independent of, intestinal hyperesthesia; on the contrary, wre see also hyperesthesia and spasm of the bladder, and nervous nephritic colic. Sydenham describes the latter as follows: " Quandoque hoc malum, in alterutrum ex HYSTERIA. 921 renibus incursans, atrocissimum illue parit dolorem, par- oxysmum nephreticum omnino mentitur, non solum doloris genere, locoque quo saevit, sed etaddictis vomitionibus im- manionbus, turn etiam nonnunquam ex eo quod dolor per ureterum ductus propagetur." These affections-cystalgia and nephralgia-are, like hepa- talgia which simulates bilious colic, rare occurrences. Another symptomatic abdominal affection, which occurs rare- ly, it is true, but is formidable from its violence, has received from English physicians the name " Spurious Peritonitis." The diagnosis is the more difficult, because, even according to Briquet, who erroneously ascribes it to intestinal spasm, it is wont to occur only in women who have for some time suffered from uterine or peri-uterine ailments. At the menstrual epoch, especially if it be irregular ; or after a moral emotion, or vex- ation, or fatigue, or a slight cauterization of the cervix, or without any known cause, the patient experiences a little hypo- gastric discomfort, suddenly followed by pain, generally in the left ileo-coecal region. This soon involves the whole abdomen which becomes hard, tense, swollen and so sensitive that pres- sure of the bed-clothes and the lightest touch of the abdomen or the vagina are intolerable. One might think he had to do with a severe metro-peritonitis, threatening death within twen- ty-four hours. By the great inflation of the abdomen, the res- piration and circulation are embarrassed; the pulse rises to 120 or 140, and respiration to 30. The features change, the face becomes pale or livid; the nose pointed; the eyes sunken; and the whole aspect resembles that of dangerous, general peritonitis. Cases of this severity are very rare. Usually the pain is in excess of the general reaction. There is but little vomiting. The pains are of a neuralgic character, and traverse the pelvis in various directions ; are sometimes very severe, and last two or three days. In hysterical patients subject to hysteralgia, and whose suf- ferings resemble those of peri-uterine inflammation, pressure on a certain part of the (left) ileo-coecal region induces hyster- ical paroxysms. This point corresponds exactly with the ovary. But this is true of only a small number of those. 922 world's homceopatiiic convention. patients who have hysterical paroxysms, and these are scarcely half of the subjects of th-e neurosis. It affords, therefore, no evidence that hysteria depends upon ovarian disorder, and most observers agree that it is perceived only in patients who have some pain in that region, either from hyperesthesia of the muscles, or from ovaralgia or hysteralgia. These cases resemble those of severe epigastralgia, in which pressure on the epigastrium will often induce a hysterical paroxysm ; and those of rachialgia, in which symptoms indi- cating a paroxysm are produced by pressure on the spinous processes. From the point on which pressure is made, the pain diffuses itself, palpitation ensues and the globus hysteri- cus, as well as the head symptoms which precede a convulsion, are felt. It is noteworthy that, whereas pressure on the ovarian region will, in many cases, bring on a convulsion, very ener- getic pressure on the ileo-coecal region will, in some cases, suppress a convulsion ; and this even where the convulsion has been induced by moderate pressure on the same region. The firm pressure produces first an arrest of respiration, then re- markable efforts to swallow, and then a return of conscious- ness. Firm constriction of the hyoid region often has the same effect. 3. Infrequent symptoms of hysteria which must generally be associated with some of the preceding, in order to charac- terize the neurosis. First. Various disorders of the muscles of relation, such as constant convulsive movements ; besides the paroxysm, twitch- ings, rhythmical chorea, paralysis and transient or permanent ■ contractions involving these muscles. Second. Various cerebral disturbances, not hitherto men- tioned, such as delirium between the paroxysms. Third. Various disturbances of secretion and excretion, such as galactirrhoea, salivation, anuria, etc. Fourth. General disturbances, such as result from suppres- sion of urine, hemorrhages and fever resembling evening in- termittent; this is quite common, as we have often observed. ..Permanent convulsions are rare, occurring only in young HYSTERIA. 923 women who are victims of a dangerous form of hysteria. They may supervene, without known cause, as a sequel of moral ex- citement, anxiety and other psychical irritation. They may affect all the muscles by alternate flexion and extension ; and we have then rhythmical chorea, differing from common chorea in which voluntary motion especially is confused. The convulsions may affect the eyelids, causing constant winking, except during sleep; or the facial muscles, producing all sorts of distortions ; or the cervical muscles, drawing the head alter- nately backwards and forwards, or sidewise; or the muscles of the shoulders, or of the upper or lower extremities, of one or both sides, may be the seat of the convulsions. These convulsions do not generally last long, though some- times they continue for weeks, months or years; then head- ache and fever set in ; emaciation ensues; the skin of the extremities, which are in constant motion, is excoriated; and death from exhaustion follows. But, even in this dangerous condition, a moral impression or appropriate treatment may quiet the convulsions. Delirium is common in the choreic hysteria. It has been exhibited by many nuns, both in word and deed, who sup- posed themselves to be possessed by the devil. They had attacks of mania every time they entered church or attempted any act of piety; and the exorcisms to which they were sub- jected only made them worse. Save in these epidemics, attacks of delirium, without paroxysms, are very rare. The form of the delirium, the absence of fever, etc., enable us to distinguish these cases from inflammatory cerebral dis- ease. The only difficulty is when it exists in a patient who inherits a tendency to insanity; in such a case the interchange- ability of hysteria and insanity, like that of other neuroses, must be remembered. Paralysis may be a symptomatic manifestation of hysteria, either connected with anaesthesia or, though less frequently, without loss of sensibility. These two phenomena have been confounded, not# only by Hippocrates and Lepois but also by Macario. This loss of contractility affects only the voluntary muscles 924 world's homceopathic convention supplied by the encephalon and medulla oblongata; it does not reach the bronchia, nor the parts of the digestive canal between the stomach and the rectum. But it may affect the larynx, producing aphonia and even simulating laryngeal phthisis, until the aphonia suddenly vanishes. The laryngos- cope, however, makes the diagnosis easy. The paralysis may attack the oesophagus, producing a dan- gerous oesophagismus ; or the diaphragm, inducing a series of remarkable symptoms, well described by Duchene (of Bou- logne) in his work on " Localized Electrisation," to which we refer. Paralysis of the bladder is frequently observed, with or without tympanitis. Hysterical paralysis, involving the voluntary muscles in various degrees, from slight enfeeblement to absolute immo- bility, is a very common manifestation of the disease. Briquet cites it in one hundred and twenty out of four hundred and thirty cases, and Landouzy in forty out of three hundred and seventy ; of the latter, the paralysis was general in three ; hem- iplegic in fourteen ; diagonal in nine. The paralysis was three times as frequent on the left as on the right side ; quite common in the lower extremities and rare in the facial muscles. The preferance for the left side is important for the diagnosis. It should be remembered that hysterical paralysis may come on gradually, and be preceded by stiffness and formication ; or it may come suddenly like that from apoplexy ; and that, in hysterical subjects, there is a different proportion between the loss of motion and the preservation of intelli- gence. In hysterical paralysis, when uncomplicated, the mus- cles are sensitive to the electrical current, which is not the case in paralysis dependent on cerebral affections. This fact is cited by Duchene as a most important element in the diagnosis. But when the paralysis is well marked, it is seldom free from complications. There maybe cutaneous anaesthesia and muscular hypersesthesia ; or muscular anaesthesia, when the muscle will be insensible to the electric current; or the affected muscles may be the seat of persistent contraction, which changes the physiognomy of the case. HYSTERIA. 925 Hysterical contraction resembles, in a more or less persist- ent form, the transient tonic convulsion affecting tlie trunk, chin, neck or face which occurs during the ordinary paroxysm. This kind of tetanus, generally transient, may sometimes last several hours. The trunk, extremities, neck and jaws are the seat of powerful contraction, with the occasional addition of clonic spasms. There is a persistent form of contraction which may last for months or years as an incurable malady, and then suddenly disappear as by magic. This affection is in- teresting to the physician, since it resembles the symptomatic contraction of cerebral disease; and to the surgeon, since it simulates chronic arthritis. Rarely seen in general hospitals, more often in special asylums, it is a symptom of the most serious form of hysteria, generally associated with hystero- epilepsy, characterized by severe and very frequent paroxysms. The contraction is partial. It may involve only one muscle, producing, for example, trismus; or a group of muscles pro- ducing-• 1. Hysterical torticollis. 2. A kind of facial hemiplegia, in which the face is dis- torted on the affected side, instead of being drawn to the op7 posite side, as in ordinary facial paralysis. 3. The tongue may be stiff, may hang out of the mouth, or may cleave to the inner side of the lower jaw ; with this there may be difficulty of swallowing, and even inability to swallow liquids. 4. The symptoms of coxalgia. The contraction may exist in the upper and lower extrem- ities of one side (hemiplegic), or both lower (paraplegic), or all four extremities; more frequently it affects the limbs in succession. An incomplete paralysis of motion and sensation, involving all the extremities, is followed by an attack of con- traction in a lower limb which was previously the seat of for- mication, spasm, pain and, sometimes, of tetanic shocks and trembling, such as Brown-Sequard, rather inexactly, ascribes to spinal epilepsy. Once established, the contraction presents the following char- acter : The hip, knee and foot are rigid in a state of forced 926 world's homceopathic convention. extension and adduction. An attempt to flex or to abduct, causes pain which extends from the point to which force is applied, towards the trunk or even the head. If force accom- plishes a slight flexion of the knee on the thigh, the leg springs back to its rigid extension as soon as the force is re- laxed. The limb appears to be shorter than the other, as in chronic coxarthritis; the corresponding half of the pelvis is elevated, the muscles of the nates tense, and somewhat tender and prominent. When the contraction is general, the thigh is extended ; when it is confined to the hip it is flexed, which increases the apparent shortening. In hysterical coxalgia, superficial pressure is painful, while firm pressure is not so; the opposite is the case in coxarthritis. Under chloroform anaesthesia, recourse to which is sometimes necessary to estab- lish the diagnosis, the joint may be made to execute all the physiological motions without producing any abnormal sounds in it, save, in rare cases, a kind of parchment creaking of which Barwell speaks. The difficulties of diagnosis, which have led to many errors, exist only in cases of contraction confined to the hip, for, when the entire limb is involved, the stiff knee, the club foot (equinus varus) furnish elements of diagnosis. One or all of the toes may likewise be strongly flexed, or the great toe firmly extended and the others flexed ; the foot in these cases rests on the outer margin, and walking is very difficult, often im- possible. In the affected limb, sensibility is blunted, temperature diminished and unpleasant sensations of crawling, stiffness or else piercing pains are present; likewise a trembling which docs not always cease during sleep, but is increased by exer- tion and emotion. Often the seat and form of contraction change after a paroxysm. Contraction of an upper extremity may occur either as flexion of all the joints or as extension of most and partial flexion of one or two, as of the wrist, or one or all of the fin- gers. There may be subjective sensations as in the lower extremities ; and if the condition lasts long, a certain emacia- tion takes place. The prognosis of this affection presents a difficult question. We observe : HYSTERIA. 927 1. That after continuing for years, even after menstrua- tion has ceased, as the last remnant of hysteria, it may sud- denly disappear, or. 2. It may, confine the patient to her bed for an indefinite period without compromising nutrition in any way, or. 3. It may by long continued disturbance of nutrition, induce fatty degeneration of the lateral columns of the spinal cord, as Charcot observed in one case. In the present state of science, no single symptom of permanent contraction is of absolute prognostic value. Convulsive trembling, emaciation, diminished sensibility to the electric current, even these grave symptoms should not, to judge from my own observations, make us despair of seeing the contraction disappear some day without leaving a trace. But atrophy of certain groups of muscles, with fibrillar contractions, and greatly diminished sensibility to faradism should make us suspect not only damage to the lateral columns but also to the anterior cornua of the grey substance. These last symptoms I have seen only in old and desperate cases. The existence of a serious spinal lesion is almost certain when the stiffness of the limb yields only slowly and imperfectly under chloroform. If these symptoms be not present, no case should be despaired of, although con- traction is always a symptom of serious import. I desire, further, to call attention to : 1. Galactirrhcoea, of which Briquet gives a fine case. 2. Salivation which in an amenorrhoeic woman might cause suspicion of pregnancy. 3. Profuse sweat. In this connection I will mention a case cited by Chauffard of Avignon, of a hysterical patient aged twenty-one, not regular, who had convulsions lasting twenty- four to thirty-six hours; during which a red sweat, mixed with blood, appeared on cheeks and abdomen: and he refers to a similar case in Archives de JMAdeclne, 1830, page 572. The bloody sweat in these two cases may be ascribed to a kind of haemophilia produced by the hysteria, giving rise to the numerous hemorrhages to which hysterical patients are sub- ject ; such as hemoptysis, hematemesis, etc.-and which might lead one to suspect incipient phthisis. Nor are these 928 world's HOMOEOPATHIC CONVENTION. hemorrhages always associated with irregular menstruation They depend upon a disturbance of the hematosis resulting from the hysteria. The hysterical fever is very irregular. Sometimes the only symptom is an accelerated pulse, which for months may be over 100 ; in others cases there may be also heat of the skin. In a third class, without any more evidence of organic lesion, there will be, in addition, headache, thirst, anorexia and lassitude. This febrile condition may assume an intermittent type, simulating paludal fever, or hectic, with . its evening aggravation ; or may be continued, and may last for months, as Briquet affirms. I have never seen such a case ; but a fever of short duration from nervous excitement is common; and might be mistaken for incipient phthisis. Unlike those of most acute or even chronic diseases, the functional disturbances which characterize hysteria have no regularity of occurrence or sequence or relative severity. The exceeding variety observed in different cases depends on two pathological elements which are the great factors, not only in developing but also in determining the severity of hysteria. The first is individual excitability, which is some- times almost great enough to ensure the disease without any exciting cause; and which renders the symptoms very severe. The other is the condition of life of the patient; which, if unfortunate, ensures efficient exciting causes; or if fortunate, reduces these to a minimum. It is not easy then to describe the course of hysteria, especially since, neither in hospital nor in private practice, is it usual for the patient to remain, from beginning to end of the disease, under* the care of the same physician. 1. Tn some cases, which are induced in excitable persons by a powerful moral influence, as grief from bereavement, etc., the hysterical symptoms are accompanied by others resembling those of acute cerebral affections. There is high fever, severe headache, vomiting, delirium, sometimes coma, generally convulsions, eclampsic or hysteric, or paralysis. These symp- toms, especially the delirium, have lasted as long as six weeks. This pathological condition is followed by great weakness and a lingering convalescence. HYSTERIA. 929 2. In a second form the symptoms are similar; the cere- bral symptoms are less pronounced and rather simulate those of a typhoid fever, there is high fever, gastric disturb- ance, severe and lasting headache and frequent delirium. These symptoms may last three or four months, are often accompanied by convulsions, and a series of very changeable spasms of all kinds. Despite however their formidable appear- ance, none of the twenty cases observed by Briquet ended fatally. More frequently, after a day or two, a convulsive attack or hysterical spasms occur, attended by some of the more serious incidents of hysteria; such as, aphonia, paralysis, contrac- tion, etc., or these phenomena may occur without convulsions, as in the non-convulsive form of the neurosis. Or the course may be as in this case of Briquet's : " A girl eleven years of age, seeing a dog, which she thought rabid, spring upon her, imme- diately had trembling of the limbs, oppression, epigastralgia, gastralgia, etc.: these symptoms lasted three months. After this, a constant severe headache set in, pains in the abdomen, back and left side, oppression, palpitation, constant retching and vomiting of food. Then came attacks of lethargy, lasting twenty-four hours, followed by great weakness confining the patient to her bed. These attacks lasted with undiminished violence for three years and then gradually ceased." 3. In the case just narrated it was three months before the acute hysteria was well characterized. In some cases several years pass before it is manifest; during which the patient has only ordinary symptoms of the neurosis. This is one of the commonest forms (136 in 400, according to Briquet.) The hysteria, convulsive or not, seems to be less severe in these patients, despite their great excitability, but the moral emotions are much modified; and the slightest excitement gives rise to oppression. Here the acute stage seems to be secondary to a chronic condition ; 4. In this class of cases the symptoms are always chronic. They continually, but irregularly and often interruptedly, increase, according to the external circumstances of the patient. Very often, especially in hospital patients, the aggravation 930 world's homoeopathic convention. consists in the change from the non-convulsive to the convul- sive form, which may present convulsions, spasm or lethargy. Arrived at their maximum, it is usually a long time before the gradual subsidence of the symptoms is perceived; both the development and the decline of this form arc irregular and interrupted; and its entire course may occupy a period of twenty-five or thirty years. 5. A very light form of hysteria, seldom seen in hospitals. The symptoms consist almost entirely of convulsive paroxysms, not very frequent, generally at the menstrual period. Daring the interval, hardly any symptoms are to be found, save a trace of anaesthesia or hyperaesthesia, or a disposition to func- tional disturbance of short duration. 6. In this form, the patients have paralysis, or contraction, or hystero-epileptic paroxysms, sometimes very frequent; and are constantly in what has been called the hysterical cachexy. Charcot states that in this cachexy the temperature of the rectum is not elevated as it is in the epileptic cachexy; this is important for the differential diagnosis. In one of Charcot's patients this cachexy lasted more than two months ; during which time there occured 150 paroxysms in twenty four hours. The temperature of the rectum did not exceed 37.8 C.; on the other hand in the somewhat similar epileptic cachexy the temperature of the rectum rises to 41 C., justifying a most unfavorable prognosis; whereas in the hyste- rical cachexy a fatal termination is exceptional. In these very serious cases recovery is sometimes sudden and complete. Muscular spasms, paralysis, tonic contractions, anuria may disappear suddenly, under a strong effort of will or, oftener, under an equally powerful moral emotion. This explains the so-called wonder-cures; as those of Apollonius before the Christian era; those at the grave of St. Louis, during the middle ages ; those of the so-called Jansenists in the last century ; and finally the sudden cures of our own day, as by the earnest prayer of a priest in Brodie's case; by the dis- covery of pregnancy that had been concealed by the patient, as in Briquet's case ; by an accusation of theft, as in Charcot's case, etc, etc. In these cases the symptoms vanish more HYSTERIA. 931 or less completely, for a longer or shorter time ; health is re- established ; the menses become regular. The course of the disease suffers a complete interruption, which may last several years. The peculiar predisposition of the patient, however, remains the same, and causes such as induced the disease at first may at any time provoke a recurrence. Briquet saw such interruptions of the disease in seventy-eight cases in four hun- dred and thirty, that seemed to depend on : 1. The re-establishment of menstruation. 2. On marriage, which, however, sometimes prejudicially affects the disease. 3. On improvement of social conditions, as on the cessation of ill treatment of wives by husbands and of girls by parents ; 4. On pregnancy, the good effect of which, however, has been exaggerated by F. Hoffman. 5. On the supervention of some chronic disease such as phthisis; or of some dangerous acute disease like cholera. But although the hysteria may be suspended during the active stages of an acute disease, it is apt to recur with greater vio- lence during the convalescence, because of the anaemia then existing. From what has been said, it follows that the prognosis in hysteria is grave; not because the disease directly threatens life, but because even a mild form, if it persist, often involves infirmities of the saddest sort; and may make life intolerable both to the patient and her friends. Our pre- decessors gave a less serious prognosis, because they did not directly connect with this neurosis either the functional dis- turbances of the inter-paroxysmal interval, or the paralyses and contractions. Their prognosis was based on the low mor- tality directly connected with the paroxysmal form of the disease ; and, with this understanding, it was correct. Patients may die : 1. During or directly after a paroxysm, as observed by Helwig, Morgagni, Rullier, Piorry, etc,. 2. In the hysterical cachexy, as observed by Wunderlich. 3. From a cachectic purpura hemorrhagica, as observed by Jaccpies and Georget. PROGNOSIS. 932 would's homoeopathic convention. 4. From starvation, owing to spasm of the oesophagus, as observed by Royer-Collard ; or from uncontrollable vomiting, as in two of Briquet's cases. 5. From ulceration, whether from chorea, or from prolonged decubitus in paralysis. The prognosis then is always serious. For although there are cases in which only a few paroxysms occur, and between them the patient is well, with the exception of an unusual excitability; yet, in most cases, the fairest years of life are clouded by a host of functional disturbances ; and, in the graver cases, distressing ailments ensue which confine the patient for months or years to her room or bed. Although these ailments, in many cases, eventually disappear, yet they may at any time recur, under physical or moral impressions. Moreover, hys- teria is a cause of sterility, as Hippocrates asserted. It is also a cause of abortion, as Briquet's statistics show. From these it also appears that the viability of the children of hysterical parents is low, most of them dying before their twentieth year. This fact should admonish us to recognize hysteria in its earliest manifestation in young children and to prevent its development if possible. Recurring for a moment to the subject of diagnosis ; this maybe difficult in the serious form called hystero-epilepsy, in which some features of the paroxysm resemble hysteria and others epilepsy ; but the symptoms of the interval will gener- ally solve the problem. In hysteria, some form of hyper-or amesthesia is always present; while these are extremely rare in epilepsy. Also, after the hysterical paroxysm, the recovery of consciousness is rapid and complete, so that the patient attends to cleanliness and even to her toilet; ■which is not the case in epilepsy. And Charcot calls attention to the important difference in temperature. The most difficult differential diagnosis is between hys- teria and hypochondriasis. Sydenham said that hypochon- driasis is in the male, what hysteria is in the female. This view, held by many distinguished physicians, is now given up. Hypochondriasis begins generally between the thirtieth and fiftieth year; hysteria seldom after the thirtieth. Be- HYSTERIA. 933 sides the mental and moral symptoms of these affections, present the greatest differences. The hypochondriac is in constant anxiety about his own health; his thoughts are concentrated upon himself until, finally, his perceptive and reasoning faculties become perverted upon this subject. On the other hand, although anxiety about herself is often exhi- bited by the hysterical patient, intellectual unsteadiness and versatility is the great characteristic of hysteria. TREATMENT. With regard to the prophylactic treatment, I will briefly mention the advice we ought to give in the case of children who may early manifest great excitability, being very timid, easily affected by trifles, disposed to weep at the slightest re- buke, or unreasonably fond of caresses, and jealous if these are bestowed on others. This feeling, -which is sometimes so strong that the children of a family must be separated, justi- fies us in anticipating the outbreak of hysteria with advanc- ing years. Such children should have a good diet, that the functions of organic life may predominate; their intellectual functions should not be stimulated, either by early studies, by exciting narratives, or by absurd fictions. Education should be conducted carefully, gently-without weakness but with- out harshness. The latter, combined with bad treatment, is the commonest cause of hysteria. When several children of nearly the same age are together, great care must be taken to avoid showing a preference for one or more over the others; this is a cause of the very frequent appearance of hysteria in the children of a first marriage, where the father has married a second time. Care in these particulars should be redoubled as the period of puberty approaches. Unhappily this time of greatest dan- ger is just the time at which girls are required to make most exertion, and are subjected to most trial. Among the poorer classes they begin to labor; among the wealthier they are shut up in boarding schools, and often insufficiently nourished ; or the severer tasks connected with education as well as the ex- citements of social life commence. It is, therefore, a wonder that a still greater number of women are not a prey to this 934 world's iiomceopathic convention. neurosis, and thus rendered incompetent to the painful duties of maternity. The menstrual irregularities which often follow on these conditions of girlhood have an undeniable bearing on the development of the disease. Physicians, therefore, should earnestly counsel parents to watch over their daughters at this period, and t ike notice of the slightest irregularity. This care must be redoubled if chlorosis appear at puberty, as is so often the case in those predisposed to hysteria. Menstruation once established, the same hygienic care should be exercised while the general transformation is taking place, which con- verts the child into the fully developed woman. Every men- strual irregularity should be noticed and rationally treated. Here I should remark, that between the first and second men- struation, an interval of two, three or six months often occurs in which there is not only no discharge, but no molimen. This is a transition state which the physician should respect; insisting meanwhile on a good diet and abundant exer- cise in the open air. I will add that functional disturbances, such as hysteralgia, lasting during the interval, may induce the belief that uterine or peri-uterine inflammation exists ; and in- judicious treatment, addressed to these supposed affections, is pretty sure to develope hysteria. Treatment must be directed not simply to the functional derangements, but also to the general condition on which they depend ; sometimes to the chlorosis, sometimes to the hysteria, of which the dysmenorrhoea, so common in young girls, is one of the first manifestations. The physician must in these cases endeavor to ascertain and to remedy whatever may be tending to develope the neurosis. Sometimes affectionate mothers, who are themselves hysterical, do much to develope the dis- ease. It will often in such cases be well to remove the chil- dren from home and place them under good hygienic and moral influences. Sometimes a journey and a sojourn at some watering place will suffice. Horseback exercise is an excellent prescription in these cases, when we are sure that the pelvic pains are symptomatic of a dynamic affection, and there are no marked menorrhagias. HYSTERIA. 935 For the laboring classes, we must guard against overwork, and see that diet and regimen are as good as possible. Those who are in school should have good food and hygienic condi- tions ; should exercise much in the open air without great fatigue and receive instruction in social arts, especially music, which has been most unjustly condemned by many neuropath- ists. Reading romances should not be permitted, although Tissot rather exaggerates the importance of the prohibition, when he says, " every girl who reads romances at fifteen is nervous at twenty." Although I do not accept the statement of Hippocrates, " every hysterical woman gets well when she marries," still it may be wise to recommend marriage in certain cases, when it can take place under favorable circumstances. It may otherwise do much injury, as, for example, when for any reason the marriage is repugnant to the woman. When, on the other hand, the patient has passed the age at which marriage is most common, and suffers from the natural anxi- eties and chagrin of a single life; marriage may, under favor- able circumstances and companionship, be of eminent service. From what has been said it must appear that therapeutics, especially allopathic, plays a very subordinate part in the gen- eral treatment of hysteria. Indeed, throwing out of account the transient hysterias which disappear when menstruation is established, or when a happy marriage has been followed by a successful accouchement, we may say that therapeutics (strict- ly speaking) has seldom cured a case. This inefficiency of therapeutics, similar to what we observe in insanity (of which, indeed, hysteria is often only a transformation) is intelligible if we remember that this is a constitutional disease dependent on an inborn or acquired excitability, and developed by un- favorable conditions of life which we can seldom control. Our therapeutic efforts must be directed to the control of the symptomatic manifestations of the general disease. It would, undoubtedly, be well, as Romberg advises, to persuade the patient to the exercise of a strong will to overcome her ailments; but it is vain to expect success from a simply moral treatment. The will is pathologically enfeebled by the results of an excessive sensibility to all impressions, which is character- 936 world's homceopathic convention. istic of the disease. The first duty of the therapeutist, there- fore, is to diminish, if possible, this abnormal excitability. The two chief remedies of hysteria are Ignatia and Taran- tula. The similarity of the pathogenesis of the latter to the symptomatology of hysteria is so striking that I present a special study of it. 1. Lesions of tissues or of nutrition. Alteration and distortion of features, pallor, sadness of ex- pression. Eruption, like miliary eruption on the face. Eruption of little pustules on the whole body, especially on the head and temples, accompanied by sticking and burning, ending in slight suppuration. Red pimples on the neck and sometimes on the cheek. Eruption with yellow crusts along the sagittal suture (with pricking). Redness of the cornea, especially towards the inner canthus (with feeling as of a foreign body). Very painful aphthae on the tongue. Liver-spots here and there on the body. Jaundice. Ecchymotic spots on the skin of the extremities and fleshy parts, from the size of a half dime to that of a silver dollar, with uterine hemorrhages, weakness and gastric malaise. General, almost sudden, infiltration, with oppression. Anxiety, clenched teeth and nervous symptoms. General and partial dropsies. CEdematous infiltration of the abdominal parietes and feet, with weakness and syncope. Gouty swellings, with general pains. Various swellings on the hands, especially the fingers, fol- lowed by abscess. 2. Disturbance of vegetative functions. a. Disturbance of circulation. Fever, generally preceded by yawning, spasms, hiccough, eructations, complaining and sighing, tremblings from general coldness (with infiltration of the abdominal walls and legs). TARANTULA. HYSTERIA. 937 General sweat (after the favorable action of music on the symptoms, or after great excitement caused by music). Burning heat, alternating with icy coldness of the whole body, causing trembling, and often repeated ; feet always cold. Burning heat, great thirst and' longing for sleep • nervous excitement prevents sleeps. Burning heat of the skin, which is scarlet; excessive thirsty headache withlassitude of the whole body for an hour ; then copious general sweat, strong fever-odor, headache, pains all over and thirst ; sleep during sweat and heat. Precordial oppression, shivering, coldness, strong palpita- tion, with blowing sound at the heart. Great irregularity of the circulation {compressive pains at the heart, the left clavicle, the carotids), with violent pulsation of these arteries and the heart. Alternate heat and cold (with acute pain in region of the liver), daily evening fever. b. Disturbances of respiration and hematosis. Oppression and difficult respiration (with anxiety and gen- eral restlessness), oppression on the slightest motion, with loss of power. . Dry cough, with sticking in the larynx. Great oppression ; constant longing for fresh air. Cough with thick and difficult yellow sputa. Cough with loss of strength, headache, pain in chest and abdomen, or with general' heat and scarlet color of the whole body, and sweat of head and face. c. Disturbances of digestive functions. Loss of appetite for all food, even that she likes best (every- thing has a bad taste ; stomach-ache); the lack of appetite is attended by great thirst; canine hunger. Mouth and pharynx dry and bitter, with burning thirst, bad breath, hiccough, waterbrash ; nausea and vomiting; flatulent colic; meteorism, heat and redness at the anus after stool. Constipation : stools mixed with blood, followed by pain and burning in the anus, tenesmus; watery stools preceded by colic. d. Disturbances of the urinary functions. 938 world's homoeopathic convention. Very abundant urine ; urine containing much sugar; abundant and clear with frequent desire. Diabetes ; pain in the kidneys, bladder and urethra after urinating. Dysuria, ischuria, hematuria. Thick, offensive urine, full of salts and mixed with small stones, the discharge of which relieves indescribable pains in kidneys, bladder and genitals. Cystitis; incontinence of urine (in a woman) while coughing and on quick motion, with regular stools, eight days. Pain in the kidneys and feet, with continued desire to uri- nate ; inability to walk. e. Disturbances of the sexual and mammary functions. In the male, painful congestion of the testes and spermatic cord, especially on the right side. Erection, with or without desire. Pollution with increased desire; coitus slow, difficult, not pleasurable, followed by lassitude and cough ; bloody discharge. In the female, utero-vulvar pneumatosis. Enlargement of the uterus, with contraction ; difficulty in walking. The uterus is hard, and seems to contain a foreign body. Metrorrhagia, with pain in the groins, kidneys and thighs ; bad digestion, alternating with exhausting leucorrhcea. Menses anticipate; menses delayed; they are more profuse than common, and when they cease the urinary symptoms recur; fibrous tumors and loss of pale blood (weakness, oppression, palpitation, general malaise). 3. Disturbances of animal f unctions. a. Of the special senses. Dim vision. Appearance of luminous spots, sparks and other objects; optical illusions; .stickings and pains at intervals in the eyes ; pricking and irrita- ..tion of the eyelids ; lachrymation ; photophobia ; Orbital pain. Taste : Bitterness in the mouth, with dryness of the larynx. Hearing*: Earache; noises as of bells, whistles ; sticking* pains in the inner ear and eustachian tube, extending over the whole head ; deafness, with roaring and vertigo. Smell: Irritation of the nasal membrane, with exaltation or .diminution of the sense of smell. Coryza, epistaxis. HYSTERIA. 939 6. Disturbances of general sensibility. Increase of sensibility. Burning heat in the head and ears, with real elevation of temperature in these parts. Malaise, vertigo. Burning heat of the whole body, alternating with icy cold- ness and trembling, often repeated ; feet always cold ; coldness and general shivering, more in the lower extremities. Cracking noise in the hip-and knee-joints, with copious cold sweat. General lassitude. Creeping, itching and sticking over the whole body, espe- cially in the head, face, eyelids and temples. General arthritic pains, boneache; pains in the arms and wrists with swelling of the latter ; sticking pains in the groins, hips and right thigh ; rheumatic pains in the anterior and middle portions of the thorax, extending on the left side. Vertigo, yawning, malaise. Headache, with sensation as if cold water were poured on the head and body, (a sensation caused by few remedies in the Materia Medica). Headache accompanied by fear of dementia, by oppression, palpitation, sadness and desire to weep. The headache resembles megrim, the patient cannot open the eyes, the head inclines forward, with dyspnoea. The headache is pressing, hammering, with stitches, espe- cially on the right side extending over the whole side of the face, with malaise and gastralgia. Frontal pains are as marked as temporal and occipital. Sen- sation as if the heart turned over, with thoracic pains and general sweat. Compressing pain about the heart, left clavicle and carotids, with strong pulsation of the arteries and heart. The cough is accompanied by pain in the head, chest and abdomen. Toothache. Dryness and heat of the mouth with peppery taste, sore throat. Gastralgia, arousing sympathetic pains of a neuralgic or con- gestive character, in the sides of the face, the ears, jaws, teeth. 940 world's homoeopathic convention. Muscular contractions of the stomach, with restlessness. Tearing pains in the stomach with pressure in the left side of the thorax ; great thirst and restlessness of the extremities. Sticking pains in the spleen, stomach and uterus. Rather acute pains in the region of the liver; with alternate heat and coldness. Contractive pain in the hypochondria. Pains and stitches in the abdomen ; the bladder-pains react on the uterus. In the male, pain and drawing in the spermatic cords, especially the left; the testes hang and are sensitive. In the female, severe, bruised, cutting, aching uterine pains, radiating to the abdomen, hips and sacrum, with feeling of a great weight which hinders walking. Pressure in all the sexual organs ; the kidneys and thighs are painful; cannot walk. Feeling as if a foreign body moved in the stomach and sought to rise to the pharynx. Heat at the anus and pain succeeding the (bloody) evacuations. c. Disturbances of locomotive power. Great heaviness in the limbs; difficult locomotion, inability to kneel; and need to sit, on account of oppression ; cough and sweat. General spasms. Contraction of the abdominal muscles with restlessness. Yawning. Twitching of the muscles. Convulsive trem- bling of one half or all the body. Chorea. Convulsions; tonic contraction of the entire trunk with inability to move the head, arms or even the trunk. Paralysis of the lower extremities. Severe pain in the back, making the least motion intole- rable. Nervous attacks, with oppression, weeping, laughing, crying and stretching. d. Emotions. Necessity to keep the whole body and espe- cially the' lower extremities in motion. This necessity extends to the arms with longing to take hold of some object, and then to throw it away, followed by general lassitude. HYSTERIA. 941 Need to turn the head to one side and rub it against some- thing. Restlessness ; fear, he must change place continually, sit on the ground, weep, keep in constant motion, with restlessness and excitement, especially in the lower limbs ; is compelled to take all possible positions. After repose, the lassitude con- tinues, but with cheerfulness and desire to laugh, which lasts until bed-time when he is again sad. Formication over the whole body, with yawning, colic, sexual excitement. General inward burning heat, with desire to make contor- tions ; sadness and weeping without cause (may be accom- panied by thoughts of death). Desire to weep, without ability to shed tears; as from deep grief; moral depression. Melancholy, anger, impatience Bad or variable temper. Delirium in which sad thoughts predominate ; opposition and a contradictory condition ; sadness following gaiety; gaiety after fixed ideas ; longing for hilarity ; disposition to jest; outbreak of nervous laughter; nervous excitement and ill-humor on the slightest contradiction ; laughter to suffocation ; weak- ness of memory ; dread of losing one's reason ; sexual desire; hysteria in every form. Hysterical mania, under the influence of an unhappy passion. Restlessness in the hands; motions as though one were weaving, followed by general, very pronounced trembling, especially in the lower limbs ; restlessness in the legs, com- pelling constant motion ; dread of early death. e. Sleep (dreams). Complete relaxation and general prostration of strength, with lethargic sleep; quiet sleep, intermingled with dreams. Sleepless and restless till towards morning ; then short sleep, with sad unpleasant dreams. Starting out of sleep, panting with strong palpitation and much emotion, as from nightmare. Restless sleep with pollutions, dreams of death, of wild beasts, of great perils ; irresistible sleep during which one is at work. 942 world's homoeopathic convention. Irresistible sleep at the same hour ; music makes a sad im- pression. Facial neuralgia of the right inferior maxillary nerve; with gastric symptoms and pains in some joints; ending in a long sleep. Sleep during the sweating period of the fever. 4. Modality according to circumstances. Periodical recurrence of sufferings. Alternation and opposition of symptoms. Intermittence often prolonged during weeks, months and even years. Amelioration from motion, sweat, open air, and moist weather; aggravation from rest in bed and during dry weather. Amelioration from music, diversion, staying in the country. Irregular pains are relieved by rubbing. Aggravation from witnessing another's sorrow, from noise, conversation and tobacco smoke ; and, in the case of women, by a mere nothing. Muscular pains in the whole body from washing the hands in cold water; which also aggravates the heart symptoms etc. The most comfortable posture is sitting on the floor. Aggravation of symptoms, especially afternoon and evening, from change of weather and dampness. Towards noon great sadness with thoughts of death; going off at supper time. Music induces discomfort, longing, restlessness, contraction of the fingers, and desire to keep in motion ; it diminishes the symptoms. The amelioration or excitement produced by music is followed by profuse sweat. The so-called tarantella music pleases and excites; the patient keeps time with the head, trunk and extremities. Headache is most common at night, or morning on rising; it o' O O' is worse on bending the head to one side. The uterine pains are relieved by the so-called tarantella music; so are all the forms of hysteria. Dry morning cough ; as in the beginn'ng of a phthisis : dry, fatiguing, convulsive cough at night in bed (ceases on smoking), HYSTERIA. 943 on waking; hoarseness with feeling of soreness in chest and larynx. Cough aggravated by coitus. The characteristics of this remedy may, according to Dr. Nunez, be stated as follows: "Every convulsive affection in which there is a desire to keep in constant motion, as well as periodicity of symptoms, may indicate Tarantula. Fear, dread of impending death, with vertigo and precordial anxiety, com- plete the indications. The symptoms of a nervous and of a rheumatic character, which Tarantula causes and cures, are relieved by motion, sweat and open air ; aggravated by rest, and the bed ; dry and cold weather increase them ; moisture relieves. The moral affections are relieved by music, diversion, and sojourn in the country." We have used the pathogenesis of Dr. J. Nunez, for this work; where it was possible, without omitting any character- istic, we have given in a single phrase many similar oft-re- curring symptoms, carefully emphasizing those cited by the author as characteristic or as verified. Thus it happens that the same symptom is repeated in different groups and rela- tions. Potencies hitherto used have been the third, twelfth, and two hundredth. ANTIDOTES. Phosphorus, and Tarantula itself in a higher dilution. In anaemic or chlorotic subjects we should seek to improve the general condition by a generous meat diet, a moderate use of beer or wine, or iron, if indicated. In the case of onanists, the sexual desire should be regulated, moral influence be earn- estly used, and Nux vom., Calcarea carb., China or Phos- phorus administered. We cannot refrain from quoting the interesting and effica- cious treatment of Kafka in this disease " Too frequent coitus must be prohibited, and excitement of the nisus sexualis from abstinence quieted by Cannabis indica, Nux vom., Zincuni or Ignatia. In treating the more pronounced grades of hysteria, we must keep the prominent symptoms in view. The best remedies for the general hysterical hypersesthesia 944 world's homceopathic convention. are: Belladonna, Nux vom., Coif., Iodine, Calc, carb., China, Agaricus, Ignatia, in the third or sixth dilutions, two or three times daily. In hyperaesthesia of single senses, we follow the local speci- fic mode of treatment. In hyperaesthesia of the eyes to light, we give : Belladonna, Atropine, Iodine, Ignatia, Graphites, Mercurius sol., Arsenicum or Stramonium. For hyperaesthesia of audition : Arsenicum. Of smell: Phosphorus, Hepar sulph. or Agaricus. Of taste : Calcarea carb, or Coflea. Of touch: Secale corn. For excessive sensi- bility of certain parts of the body to touch: Belladonna, Chinin., Hyoscyamus, or Nux vom. For hysterical arthralgia: Belladonna, Atropine or Asa- foetida1, or Ruta1, two or three doses daily. For hysterical gastralgia: Belladonna3, Nux vom.3, Ignatia3, Lactuca viros.3, Calcarea carb.3, Asafetida3, China3, Arsenic.3 ", Veratrum3 and Zincum3 have been very useful. For hysterical borborygmi: Nux vom.3, Natrum mur.8, Carbo veg.8, Asafoetida2, Chamomilla3, Ignatia3, Sepia8 and Sulphur8. For hysterical dysuria: Belladonna or Hyoscyamus, Nux vom. or Pulsatilla3, or Cantharis3 8. Painfulness of the vagina during coitus is relieved by Fer- rum acet. For hysterical asthenopia : Conium3 or Phosphorus.3 For hysterical deafness : Belladonna or Hyoscyamus. In obstinate cases : Calcarea carb, or Silicea8. For hysterical loss of smell: Pulsatilla3 or Silicea.8 For loss of taste, Pulsatilla3 or Silicea8. For anaesthesia of the upper extremities : Secale3 or Plumb. acet.8 Of the fingers : Arsenicum3 or Lachesis8. Of the lower extremities: Arsenicum3 6, or Lycopodium8 to 3'. In hysterical dyspepsia we get speedy good results from Nux vom.3, Nux mosch.3, Bryonia3, Ipecac.3, Veratrum3, Sepia8 or Sulphur8. For hysterical constipation : Bryonia3, Nux vom.3 Natrum mur.8 or Sulphur8. For vaginal anaesthesia during coitus : Phosphorus3. HYSTERIA. 945 For the ordinary convulsive attacks, the remedy best indi- cated by the pathogenesis and approved by experience, is Chloroform by inhalation. It has over other remedies the advantage of instantaneous action. Moschus is the chief remedy for spasm of the glottis and diaphragm. It must be given in large and increasing doses. For hysterical spasmodic laughter we give Belladonna or Stramonium. For spasmodic weeping: Pulsatilla or Ilyoscy- amus. For spasmodic yawning : Ignatia, Cocculus, Platinum or Natrum mur. For spasmodic retching: Ignatia, Bella- donna or Magnes, carb. For the globus hystericus : Belladonna, Arsenicum or Plumbum acet. For spasmodic hysterical cough: Lactuca virosa, Carbo veg. or Kali carb. If combined with vomiting: Verat., Ipecac, or Arsen. For spasmodic, noisy, tasteless and odorless eructa- tions : Cocculus, Agaricus and Magnes, mur. For spasm of the upper extremities alone: Belladonna, Cocculus or Stra- monium. For spasm of the lower extremities alone : Arseni- cum or Lachesis. Hysterical paralysis yields promptly to Sepia, Plumbum acet., or electricity. The best remedies for the emotional disturbances are: Ignatia, Pulsatilla, Belladonna, Aurum met., Natrum mur. Lycopodium. For rapid changes of temper and going to extremes: Ignatia, Platinum, Aurum met. and Zincum met. To patients of very excitable and feeble constitutions, we recommend, at the same time, resort to cold bathing, water treatment or sea baths. METRORRHAGIC CHLOROSIS. Abel Claude, M. D., Paris. Chevalier de la Legion d'Honneur; formerly Resident Physician of the Homoeopathic Hospital, St. Jacques, Paris; Recording Secretary of the Societe Medicale Homoeopathique de France. Among affections peculiar to women, few have attracted so much attention from ancient and modern observers, and have been so long discussed, as chlorosis. Even now it is a dis- puted question whether chlorosis be a special disease, of which anaemia is only one of the symptoms, or whether both anaemia and chlorosis belong to the same pathological category. The latter affection occurs almost exclusively in young girls at the period of puberty, coinciding with the rapid develop- ment of the genital organs, and the appearance of menstrua- tion. This singular malady appears just as the girl is passing into womanhood ; and its most evident sign, the greenish complexion induced by it, is sufficient to'characterize it. Without dwelling on the entire symptomatology of this affection, we propose to consider a somewhat rare phenomenon -metrorrhagia complicating the ordinary course of chlorosis or preceding it. All authors, before Trousseau, have spoken of dysmen- orrhoea or amenorrhoea as essential characteristics of all dis- orders of the reproductive functions, to which chlorosis could give rise; and if they saw diseases present evidences of chlorosis with uterine hemorrhages, they denied the existence 947 948 world's homoeopathic convention. of chlorosis and ascribed the hemorrhages to anaemia. Trousseau has the credit of beino; the first to show that uterine hem- orrhages, as well as dysmenorrhoea, may be due to chlorosis and of describing a menorrhagic chlorosis, giving illustrative cases. He did not, however, define the cause nor themechan- ism of these hemorrhages. This is what, aided by the labors of our predecessors, and depending on our own observations, wre now propose to attempt. Like Trousseau, we shall keep the treatment of this compli- cation continually in view. It will be evident that, in certain particulars, we differ essentially from that eminent practi- tioner. But before discussing these, we must present certain questions, not pretending to solve them all, but with the ob- ject of studying the metrorrhagias under all aspects; and in the hope that, when once the attention of our colleagues shall have been effectually called to them, facts essential to their solution may be collected. Metrorrhagia is regarded as a rare phenomenon in chlorosis. Its relative frequency, compared with dysmenorrhoea and amenorrhoea, may be stated as one to twelve in young girls and one to four in adults. These are Trousseau's figures; but new observations seem to us necessary to establish the real average. Nevertheless the fact is established that uterine hemorrhages are much more frequent in adults, which is explicable by the greater fre- quency of uterine lesions. Authors have said nothing respecting the influence of cli- mate, constitution, occupation, diathesis, etc., and our own observations do not warrant any positive conclusions on this point. We have noticed, however, that the hemorrhages are more frequent and more profuse in robust brunettes; and this accords with M. Saville's* remark, that " these copious hem- orrhages are observed in women of a predominant nervous temperament, with black hair and of a dry constitution." Since etiological conditions, independent of the individual patient, give us but little help in comprehending the mechan- ism of chlorotic metrorrhagias, let us endeavor to find, in the * These, de Paris, 1854. METRORRIIAGIC CHLOROSIS. 949 condition of the patient herself, the explanations which we seek in vain elsewhere. Many authors at the present day admit that chlorosis is a disease of development; that it results from some trouble of affecting the evolution of the genital organs at the epoch of puberty. At this period, all the functions languish; the constitution of the blood undergoes important changes. Thus Trousseau * ascribed the hemorrhages to lack of plasticity and to liquefaction of the blood. And, to show how much import- ance he attaches to these facts, he reminds us of the difference between the phenomena of a wound in a vigorous and one in a scrofulous person. In the former, he says, the hemorrhage stops of itself in a very short time ; while the scrofulous subject loses two or three times as much blood as the other. This theory seems to us inadmissable. In fact, it has been proved by the researches in luematology of Andral and Ga- varret, that all chlorotic patients are in identically the same condition, so far as the anatomical condition of the blood is concerned. There exists always a state of aglobulism, a de- ficiency in the quantity of iron. If, therefore, these derange- ments had any pathogenetic effects, all chlorotic patients should have metrorrhagia. But clinical experience shows that this form of hemorrhage is quite rare among them. Gueneau de Mussyf has put forth an idea which seems to us nearer the truth : " The fluidity of the blood, perhaps the diminution of vaso-motor tonicity, are regarded as the instru- mental causes of this occurrence, the pathogenetic conditions of which are not sufficiently elucidated; " and he cites two observations in support of his theory. In one of these, by Marjolin, the hemorrhage was arrested by driving in a carriage, which, he says, has the effect of stimulating the vaso-motors and causing the uterine vessels to contract. It may be so; but if we go to the bottom of things we find that this explanation amounts to nothing. In fact, v hen a spontaneous hemorrhage takes place there is always a previous dilatation of the vessels, and it seems to us evident that the * Journal des Connaissances Medico-Chirurgicales, 1838, p. 221. f C Uniques} 1874, p. 192. 950 world's homceopatiiic convention. cause of this dilatation must, m tnis case, have been some local lesion of the organs by way of which the hemorrhage occurred. The observations of Gueneau de Massy, of Trousseau him- self, the researches of Virchow, of Raciborski and the study of what takes place during menstruation, all favor this idea. It is a remarkable fact that almost all the patients of whom Trousseau speaks were women who had recently borne children and in whom menstruation had not, in all cases, been regular since that event. They were consequently in a condition very favorable for the occurrence of hemorrhages. Two of them had positive uterine lesions. AVe will give these observa- tions : 1st. Mlle S., 28 years of age. Two previous deliveries, copious menorrhagia; anteversion; hypertrophy of the uterus; swelling and separation of lips of the os uteri; excoriation of the mucous membrane of the cervix, with abundant granula- tions. 2d. Two previous confinements. Two and a half months after the last, copious metrorrhagia for fifteen days; excoriation of the cervix, noteworthy swelling of the body of the uterus and pain in the ovarian region. G. de Massy cites the case of an arthritic girl with granulations of the cervix, the cure of which by cauterization, caused the cessation of the he- morrhage. Racsiborski* had already remarked that there was a great tendency to hemorrhage during the first menstrual epoch after confinement. He explains this by the lack of firmness (consistency) in the new uterine membrane. And, further, speaking of metrorrhagia in chlorosis, he says : " The ana- tomical conditions of the uterus play an important part. A somewhat increased vascularity of the vascular plexus, the relaxation of the muscular fibres, which surround them on all sides in the erectile tissues, the diminution of the consistency of the uterine walls-all these things favor the occurrence and the abundance of hemorrhage." Finally, recent researches of Virchow f enable us to de- * De la Menstruation, 1868, p. 381. f Article, " Chlorosis;" Dictionaire Encyclopedique de De Chambre, Pozzet. METRORRIIAGIC CHLOROSIS. 951 monstrate that there is an intimate relation between the development of the reproductive organs and that of the central organs of circulation. Thus, in a large number of chlorotic patients, he has demonstrated the existence of congenital aortic stenosis, to which two different states of the reproductive organs correspond-either an incompletely developed, or an excessively developed reproductive apparatus. Two opposite clinical conditions correspond to these different states-ame- norrhoea to the former, and menorrhagia to the latter. The relation of cause to effect seems to us to be very evident in this instance; we are no longer dealing with a simple hy- pothesis, but with a theory resting on facts which have been verified by a man of indisputable anatomico-pathological authority. A glance at what occurs on the part of the reproductive organs at the appearance of the first menstruation, supplies another proof of the view which we are supporting. We need only remember the congestive phenomena presented by the uterine mucous membrane, in order to perceive the relation which menstruation bears to the metrorrhagia which is observed during chlorosis. From this discussion of the intimate mechanism of hem- orrhage, two principal facts result-one theoretical, the other clinical. The theory has just been stated ; we shall not repeat it. The clinical result is its logical consequence; examine the reproductive organs in chlorosis and especially whenever uterine hemorrhage takes place in the course of the disease. Let us now describe the symptomatology of this affection. Hemorrhage may be, sometimes, one of its first manifesta- tions ; in this case, if it continues a good while without the other characteristic symptoms of chlorosis appearing, we should be tempted to regard it as the cause rather than as a symptom of that affection. It is nevertheless admitted on all hands that metrorrhagia as well as dysmenorrheea is an indication of the organic action on which chlorosis depends. Most frequently these hemorrhages supervene during the course of the disease. Their duration and extent are very variable. Sometimes the blood is pale, serous, not abundant; 952 world's HOMCEOPATHIC CONVENTION. leaving upon the linen a pink spot, surrounded by a greyish circle ; the flow is irregular, ceasing several times in the month and reappearing and finally ending in leucorrhoea. In other cases, the quantity is large, out of proportion to the resources of the organism. In these cases, menorrhagia often precedes metrorrhagia; the former becomes more and more copious, then, as the disease progresses, metrorrhagia supervenes, and recurs two, three or four times during the menstrual interval. Or, the flow may not cease at all during this interval and we recognise the menstrual epoch only by the increased abundance of the discharge. The following case, reported by Trousseau * may be regarded as typical of this form of the disease : " Mlle St. -, 16 years of age. The first and the last menorrhagias were very copious. During the course of the night, two woolen mattresses and one of hair were saturated and under the bed was a pool, not of blood, but of a liquid exactly like water in which meat has been washed." In these conditions we not infrequently observe uterine congestions considerable enough to cause utero-placental hem- orrhages and placental apoplexies;! and this gives us the key to the abortions which are so common among chlorotic subjects. But, however copious, these hemorrhages are almost always passive. The pale diffluent blood escapes like a veritable tran- sudation. The coagulum which forms has often a consistence such as we do not see in hemorrhages of subjects wTho are simply anaemic, the relative excess of fibrin- forming a thick buffy coat. When the metrorrhagia ceases, it may be replaced by sup- plementary hemorrhages, as, for example, by hemoptysis, as we see in a case reported by Pinel.| Finally, interstitial hemorrhageshave been observed, though, rarely, coinciding with metrorrhagia. We find two cases of * Loco citato. f Grassct, Thesis, 1858. | Pinel, Nosographie Philo sophique, 3e classe. METRORRHAGIC CHLOROSIS. 953 purpura cited in Martin's * thesis. And we have had the good fortune to meet a third case in our own practice. A. Cooper met young chlorotic subjects in whom the hemorrhage took the form of spontaneous ecchymoses of the mamma. But in these cases there was no menstrual discharge and the ecchy- moses may be regarded as supplementing the catamenia. We subjoin these remarkable cases of purpura: 1st. Hospital St. Antoine (service of M. Richard)-" A young girl, aged 17 years, was admitted, evidently chlorotic; on examination we are struck by the presence of little red spots, round, separated by other larger spots. They do not disappear under pressure; are less abundant on the arms than on the legs ; are painless; in disappearing they assume, first a livid, then a yellowish tint; and are replaced, day after day, by other spots which pass through the same phases. The patient made a good recovery." 2d. Observation of Stoss-" A young girl, of 20 years, with copious metrorrhagia and all the symptoms of chlorosis. Considerable purpura. She died ten days after her admission." 3d. My own patient. Before passing to the treatment of this complication, we could have wished to show the influence of metrorrhagia on the course of chlorosis, which, however, has not as yet been sufficiently studied. It is a gap which we are not able to fill. Nevertheless, it is evident, a priori, that copious hemorrhage, occurring in a woman already decidedly anaemic, must seriously aggravate her condition. It is therefore most impor- tant to have at our command efficacious remedies, of sure and constant action, whereby we may control a complication which puts the patient's life in jeopardy. We believe we are justified in saying that such remedies are in our hands. Miss X., vest maker, 20 years of age, is the subject of the observations to which we have referred. This young woman, who menstruated at the age of 16 years, has been subject since that period to almost continual hemorrhages. She can no longer distinguish the catamenial from the abnormal flow. She tells me that the menses were wont to recur three days * Martin, Thesis, 1866. 954 world's homceopathic convention. after their cessation and then continue a week. The quan- tity of blood lost on each occasion is very considerable, red and fluid. There is no leucorrhoea ; but she has dull constant pain in the left ovarian region, to which are superadded, at frequent, irregular intervals, very severe colics. Iler complexion has not lost its color, but she is easily fatigued and very nervous. All the other functions are normal. There is a moderate blowing, perceptible at the carotids as well as at the base of the heart, with the first sound. The latter is very faint, scarcely perceptible and intermittent. It seems at times to be only a slight prolongation of the cardiac sound. Alimentation is excellent. The patient craves meat and might be said to eat too much of it. Iler lodging is dark and somewhat damp. For the last eight months, her whole body, except the face, has been covered with innumerable little spots of purpura, and on the skin of the face large ecchymotic patches appeared. I prescribed successively: Secale corm, Ruta, Sabina, Bella- donna, Colocynth. The last remedy alone had any effect; and this merely diminished the frequency and severity of the colics. I then tried Trillium pendulum, but without success. Finally, I prescribed, five months ago, Ilamamelis. I have varied the dilutions, but the patient has always had a dose every morning and evening. The interval between the hemorrhages was at first increased to eight days; then to twenty days ; at present, twenty-four to twenty-five days. I can not say the patient is as yet restored to a normal condition, but her health is greatly improved. She is still taking Ilamamelis. I have gone from the tincture to the twelfth dilution. In conclusion, I will state that in this case a physical exam- ination was not practicable, nor could I gain much information from careful interrogations. The purpura continues, but the eruption is more discreet. The ecchymoses have never been the seat of any hemorrhagic accident such as we see in hemo- philia, and of which I was in constant dread. Aran and Beau, French allopaths, ascribe brilliant success in chlorotic and other metrorrhagias to the use of Ruta and Sabina Extract from Elements of Practical Medicine, by Jousset, Vol. IL; Article, "Metrorrhagia:" METRORRHAGIC CHLOROSIS. 955 Treatment.-Arnica, Sabina, Secale corn., Crocus, Chamo- milla, Thlaspi, Ledum palustre, Ignatia, Platina, Pulsatilla, Digitalis, Argentum oxidatum, Arsenic, Ipecacuanha and China are the chief remedies. Arnica is suitable for copious hemorrhage, especially if it be of traumatic origin. Sabina for copious hemorrhages, accompanied by uterine colic. I have almost always prescribed this remedy during and after abortion, using habitually the third dilution. Two or three times I have given with success one or two grammes of the first trituration. Secale corn, for cases analogous to the above, but especially when the patient is debilitated by loss of blood. The remedy is chiefly indicated by the lack of uterine contraction. It is the remedy for copious hemorrhages following delivery, and for such as accompany polypus and large fibrous tumors. It is often necessary to give the first triturations and even, after delivery, the crude substances in doses of fifty centi- grammes, every twenty minutes. Chamomilla for copious hemorrhage with colics; at the commencement of abortion or during menorrhagia complicated by dysmenorrhoea; little chills, yawning and concomitant diarrhoea ; the third dilution. Thlaspi bursa pastoris\s given empirically in metrorrhagia. I have had excellent effects from it in copious metrorrhagia with uterine colic ; in hemorrhagic chlorosis ; in the sequelae of abortion or accouchement, I have almost always given one gramme of the mother tincture in two hundred grammes of water. Ledumpalustre corresponds especially to slight hemorrhages, a constant draining away of blood ; it may, nevertheless, be serviceable in copious hemorrhages. Pain is not a necessary condition for its employment. I have had excellent results from it in the hemorrhages symptomatic of fibrous bodies. Ignatia is particularly indicated when the menses antici- pate; and, almost always, if it does not diminish the amount of the hemorrhage, it prevents the anticipation. THE NEUROTIC ELEMENT IN THE LOCAL DISEASES OF NOMEN. B. H. Cheney, M. D., New Haven, Conn. The object of this brief article is to invite attention to an element in the causation and treatment of the local diseases of woman, which seems too much neglected, both in text-book and practice. This element is the neurotic. Considering the eager advances made of late in the patho- logy of the nervous system, and in investigating the manifold relations of the functions of this system to pathology in general, it is a matter of surprise that more attention has not been drawn to it as an etiological factor. True, the didactic works have usually something to say of the influence which the im- pressionable nervous system of woman has upon her diseases, predisposing to their attack, modifying their course, and af- fecting their result; but this is only in a general way, and, when considering her special diseases, even this is apt to be lost sight of, in the greater attention paid to the local lesion. Indeed, where any preeminence is given in this connection to the nervous system, it is only from its salient symptoms, which are usually considered, and not unfrequeutly are, simply results of the local trouble, whether this be a displacement, an ulceration, or a leucorrhoea. The existence of these, and such like conditions, is acknowledged by all writers to develop more or less disturbance of the nervous system, and produce other symptoms in distant organs, by means of reflex action. But this is generally the extent of consideration given to the 957 958 world's HOMCEOPATIHC CONVENTION. nervous system in such cases. So that when we come to the therapeutics taught accordingly, we find that local treatment, and treatment based upon, and addressed to the local condition, is made by far the chief, and frequently almost the only ne- cessity. Other matters of treatment are classed under the vague term kC hygienic, " and are too apt to be considered, by both the author and his reader, and hence by the practitioner, as merely adjuvant, and perhaps not essential. Xnd yet, these very conditions of the nervous system, so vaguely treated, and so lightly dismissed from therapeutic consideration, are frequently, and we think we may safely say usually, not only the predisponents, but the active agents in causing and maintaining the abnormal state, whatever its local manifestation. The nervous system, lying, so to speak, upon the confines of physiology and psychology, is always chary of results to the scientific inquirer. It laughs at the microscope, and holds chemical analysis in derision. Still, patient investigation has done much of late to shed light upon the laws regulating its action, and the labors of Bernard, Moleschott, Romberg, Pfliiser, and others, are not without fruit. It is no small thing to know that a hyperaemia, and the frequently co- existing hyperaesthesia, are due to a paresis of the vaso-motor nerves. It is a great step, not only pathologically, but thera- peutically as well, to learn that this paresis may be, and is, perhaps generally, induced by over-excitation of the cerebro- spinal system. It helps much also to find out that a local excitant, acting either upon the past itself or upon another part remote from that affected, may, by its reflex inhibitory {hemmu/ngs, Pfliiger) action, induce this same paresis of the vaso-motor nerves and its consequences. Bor, knowing this, if we find, for example, a hyperaemic condition of the cervix uteri, associated with hyperaesthesia or not, complicated with displacement or not, we surely, as philo- sophical physicians, shall not go to work upon these local re- sults of diseased action in the system, with the object and ex- pectation of curing the patient. Do we not rather seek to as- certain what cause has produced the paresis, leading to this LOCAL DISEASES OF WOMEN. 959 state of affairs locally, and either remove it, if possible, or, at least, modify, as far as we can, its influence, as the first step in a rational therapy? Yet the former is almost uniformly the therapeutics of the class-room, of the text-book and, what is worse and most important, of the bedside. It is not to be denied that such local-conditions may have their share in main- taining the diseased condition, nor that they frequently act themselves as secondary centres of irritation, inducing second- ary symptoms. Nor is it argued that, under such circum- stances, some temporary benefit may not sometimes accrue from local helps to the cure. For, the removal of a predispos- ing cause does not, of necessity, imply the disappearance of its results. But, although the hyperplasia may be temporarily modified by a glycerine tampon, although the displacement may be for a time relieved by an appropriate pessary, these, and all such expedients, should be regarded as subordinate, and doubtless only necessitated at all by the imperfect state of our knowledge. On the contrary, they are too often, if not generally, regarded as constituting the treatment of the case. If we seek for the cause of this great preponderance given to local treatment in the therapeutics of diseases of women, we find it easy to discover and understand. Gymecology is a science, courteously so-called, of our own day. The modern student of medicine, familiar with the varied forms of disease peculiar to woman, the diversity of their manifestation, and the usual precision of their diagnosis, is surprised when he learns of how very recent date is all this accuracy of examina- tion and nomenclature. Certainly no one can surpass the writer in his respect and admiration for the earnest workers in this department of medicine, whose labors have resulted in comfort and life to many, who, only a century ago, must have lost one or the other, their disease being past finding out, and its remedy unknown. But as a local examination and the use of instruments only have revealed these conditions, and are necessary to their accurate diagnosis, so in the minds of both physician and patient, the local treatment becomes a necessity for their cure. Further, the recurring treatment and the use of instruments (themselves inspiring respect in the non-pro? 960 world's homoeopathic convention. fessional mind), gives the patient that " fulcrum " which our poor human nature seems to demand fully as much, if not more, in matters medical, as in those theological, political, or social. The patient is, therefore, gratified to feel that some- thing is being done ; the physician, confident that all his pa- tient's symptoms and ill-health are dependent upon her local condition, expends his chief care and solicitude upon the latter. The result, in the great majority of cases, is more or less un- satisfactory. Yet, when the general practitioner looks to the leaders in this department of medicine, what does he see ? Discussions are desirable, differences of opinion are unavoidable ; but here are factions. One party contends that displacement of the womb is the prolific source of woman's ills; another, the ma- jority, find their ready explanation in inflammation or ulcera- tion of the os and cervix uteri; while a respectable minority point to a catarrhal inflammation of the mucous linings, and the consequent leucorrhoea, as sufficient to account for all the other conditions and results. Furthermore, when, as is fre- quently the case, all these conditions co-exist, the discussion is then as to which of them was first in point of time, and hence the cause of the others. But every practitioner knows that when such a case presents itself for treatment, the local condi- tions are usually a tangled skein, of which he can find neither beginning nor end, so far as their mutual relations are con- cerned. Indeed, the most expert specialists and the most emi- nent pathologists differ in this matter. The venerable Dr. Hodge, in his work upon Diseases of Women, exalts the nervous system to a place of chief import- ance. But he considers the multiform derangements of this system as almost uniformly dependent upon a displacement of the womb. He argues, therefore, that the use of an appropri- ate pessary will, by removing the local difficulty, relieve the general disturbance. On the other hand, Dr. Bennett and his numerous disciples, pointing to the fact, that with the displacement, there gener- ally exist structural changes, look upon a supposed inflamma- 'tion as their source' and as the cause of all the rest, local and LOCAL DISEASES OF WOMEN. 961 general. Inasmuch as this doctrine has obtained great promi- nence in gynaecology, and has been so largely adopted by the profession, it seems to demand some notice in passing. The theory of local inflammation as the great cause of wom- an's sexual diseases, was to most medical minds, trained in the doctrines of the day, simply irresistible. For inflammation is the ignis fatuus which seems fatal to the medical mind in pur- suit of scientific truth. Indeed, it is not very long since it was considered as " almost the one disease, and the agent of all repair." So it was very simple and very plausible to as- cribe an enlargement of the cervix to inflammation and its products, while a granular condition of the os was not only ex- alted to the pathological importance of an ulcer, but regarded as the little fire which had kindled a great matter of associated symptoms, local and constitutional. But, granting, for the sake of argument, the inflammatory character of these and analo- gous conditions of the cervix uteri, if they can be the source of the many and varied derangements of the general organism with which they stand charged, it is truly wonderful -with what impunity the system endures the heroic operative pro- cedures, cauterization, scarification, dilatation, amputation, etc., to which this same cervix is subjected. The fact is, the part is of little individual vitality, and of limited physiological in- fluence, and hence offers nn inviting field for operative inter- ference. For there is such a thing as a cacoethes secandi, con- tagious even to sincere minds. But the best pathologists now acknowledge that the condi- tions under consideration are not inflammatory. To include them under the head of inflammation, the boundaries of its definition would have to be so enlarged, that the word would lose all distinctive meaning. For, in enlargement of the cer- vix, for example, wre have a positive increase of connective tissue. Inflammation destroys, but does not create this tissue. Nor is the condition identical with hypertrophy, which is an increase in the normal constituents of an organ or part by in- creased nutrition, as its name implies. But here is abnormal nutrition, of which we have additional evidence in the fre- quent presence of hyperaesthesia. For, in the forcible words 962 world's homceopathic convention. of Romberg, "pain is the cry of nerve for healthy blood." But this very hyperaesthesia is often crudely mistaken by both physician and patient as positive proof of the existence of in- flammation. The pathological condition is " diffuse prolifera- tion of connective tissue " (Klob), and various writers have proposed for it as various names. That of " areolar hyper- plasia," suggested by Dr. Thomas on the basis of Virchow's views, is most in accord with the present state of pathological knowledge. But, notwithstanding the doctrine of inflammation has been given up as untenable, the main treatment is still directed against the local condition. This, the result of diseased action, is still made the disease to be treated. The structural changes in the part are regarded as constituting its pathology. This, however, is not pathology, but pathological anatomy, a distinc- tion which should be borne in mind in this, and many other cases. But the refinements of pathological speculation are of little practical worth, except in so far as they have a bearing upon therapeutics. As the end of this discussion, then, there comes the important cpiestion, how is it to affect our treatment of a given case? Let us, by way of illustration, suppose such a case, one very commonly met with, in which there exists the complication of a displacement, a hyperplasia of the cervix, and a cervical leucorrhoea, with more or less granulated condi- tion of the os. Even if it were possible to determine posi- tively which was the primary lesion, it would not be of much use in the treatment, beyond a temporary alleviation. For, back of all this lies the cause of the primary lesion itself, and this must be got rid of, before anything like a permanent cure can be expected. In the great majority of cases, this first cause will be found in some derangement of the general nerv- ous system, leading to lesions of innervation. This derange- ment may be dependent upon errors in dress, or mode of life, upon some constant mental fret, or upon some form of disease, such as malaria, or upon some previous condition, such as preg- nancy, delivery, or lactation, etc. Any of these may act as excitants to the cerebro-spinal system, and wTe have already LOCAL DISEASES OF WOMEN. 963 seen how this would produce the pathological condition lead- ing to all these results. As regards errors in dress and mode of life, they are so com- mon as to be the rule, rather than the exception. Few cases of disease peculiar to women will come under the physician's notice, which do not need and require attention in this respect. It is not necessary here to go into detail regarding the require- ments of hygiene. The object of this paper is simply to bring these into the foreground of treatment, instead of considering them as subsidiary to local treatment, and therefore of second- ary importance. Homoeopathy may point without arrogance to the increased attention paid to hygiene, and the radical changes in the general management of disease, since " the gen- tie power" made its way into the sick room. Still, there is room for much improvement in this respect, not only in our knowledge, but in the therapeutic use of what we already know. We consider, therefore, that in the management of such a patient, the necessity of obedience to the laws of hy- giene is of cardinal importance. This is of no less consequence, if we find that our patient has some form of disease, such as malaria, which we consider as the first cause of her present condition. Of course it is our effort to remove the malaria or other disease, by appropriate medication, still the true homoeopathic physician will always remember that he does not prescribe for a disease, but for the patient. We say "homoeopathic physician," not offensively, but because all other systems (so-called) of medicine base their therapeutics upon the disease as an entity; and as each individual case is treated according to the opinion of the at- tending physician, the whole of therapeutics becomes of neces- sity purely a subjective matter. But it is well for us to re- member, perhaps oftener than we do, that Ilygeia is a goddess who cannot be propitiated by drugs alone, even though given homoeopathically. In this connection must be mentioned the frequent exist- ence of ovarian irritation and disease, which, though often it- self the result of other causes, becomes a frequent cause of the more manifest local difficulties. The ovaries are beyond the 964 WOKLd's HOMOEOPATHIC CONVENTION. reach of much local treatment, and it is perhaps well for the future of mankind that this is so, but they and their condi- tions should be borne in mind in prescribing. Mental difficulties and conditions are proverbially hard to reach. In such a case as the one before us, they may either exist in the patient herself, or in some outward disturbance, domestic or otherwise. Or. as is frequently the case, both may be present together. Where this occurs, the former is usually dependent upon the latter. They alone or combined cause a depressed state of the nervous system, which manifests itself not only in hysteria, or irritability, or melancholia, or other mental phase, but no less surely in a displacement, or a leucorrhoea, or some analogous physical derangement. Any practitioner may verify this statement, and its truth is a part of the observation and experience of many. To wholly remove these causes of mental disturbance, may not be in the power of the physician, but he can do much by judicious counsel to the patient and to those with whom she is in daily association. Further, he can greatly modify their effect, by uniformly in- fusing hope and good cheer in his patient. The magnetic in- fluence of the cheerful physician is often a powerful tonic and help to Nature in her effort to throw off disease. Its ef- fect is nowhere better seen than in cases like this. With reference to those local difficulties which are the re- sult of previous conditions which have ceased to be operative, such as pregnancy, prolonged lactation, etc., very much must be left to the experience and judgment of the practitioner. Many of these cases are knots hard to untie. Far more can, however, be done for their relief by attention to the general health, and by appropriate medication, than by local treatment. To this, of course, should be excepted those cases in which there is a mechanical lesion, as, e. g., a ruptured perinseum or a vesico-vaginal fistula. The almost uniform predominance of debility in these affec- tions, is a fact very important to remember, and may be re- garded as additional evidence of their neurotic origin. The debility is often in direct ratio to the excitability of the ner- vous centres. Hence, in the treatment of such cases, every- LOCAL DISEASES OF WOMEN-. 965 thing should tend toward repair, and building up. By build- ing up, we do not mean the use of stimulants, except in rare cases and temporarily. For, while these may arrest waste and give apparent strength for a time, the reac- tion comes, and more is lost than gained. The so-called "tonics" come under almost the same condemnation. Where these act beneficially, it is generally by virtue of their homoeo- pathic, relation to the condition. For it is a well known fact that the long continued use of medicines of this class, produces results analogous to the conditions for which they are so uni- versally prescribed. The Quinine cachexy does not differ materially from that caused by malaria. The continued use of stimulants and tonics acts as an irritant to the nervous centres, and it is in accordance with a uniform law of nature that an increased amount of vital energy, purchased in this way, must, like an overdrawn account at a bank, be met and made good, at same time. Fresh air, a proper amount and judicious kind of exercise, and last, not least, good food, are the most important agents in the building up. There can be no proper and healthful nutrition even, without healthy nerve to regulate the processes of assimilation, secretion, etc., and there can be no healthy nerve without good nourishment. And as, owing to the requirements and details of civilization, our patients rarely have the appetite which they should, a good cook frequently proves a very good doctor. We find, therefore, that from whatever standpoint we re- gard them, these affections in all their complexity of character and manifestation can be satisfactorily accounted for, only by referring them to the nervous system. It is not by considering them as inflammations, nor as mechanical disturbances, but as neuroses, that we obtain comprehensive ideas of their nature, and clear indications for their treatment. Having, then, by due attention to hygienic requirements, put the patient in a condition as favorable as possible for cure, we proceed to the choice of a remedy or remedies. That there are cases which, owing to the present limited state of our knowledge, may need the temporary aid of local appliances, we do not deny. To consider these in detail does not come 966 world's homceopathic convention. within the scope of this paper. We may remark, however, in passing, that whatever is harsh, whatever gives pain, or aggra- vates the symptoms, is not simply useless, but positively inju- rious. Furthermore, it is a matter of experience, that many cases are protracted by repeated introduction of the speculum, and by local applications, no matter how mild, and that such cases improve rapidly, on the cessation of all local treatment, by rest, specific medication, and attention to the general health. The temporary use of the pessary may be more justifiable, as this does not necessitate constant examination of the patient, while in certain cases it removes secondary causes of irritation, which may, by their presence, prevent the action of the remedy. If any be used, it certainly should not be one of those abomina- tions with a cup, or a stem, which by their pressure not only increase existing difficulties, but are the fruitful source of additional ones. Moreover to crowd the womb upward by a force acting upon its apex, is in defiance of mechanical laws. In any case, it should always be remembered that the pessary is, like the sling for a dislocated arm, for temporary use only. But while there arc some cases which seem to require the temporary aid of such local appliances, we consider the selec- tion of the remedy as of far greater importance. For this acts, or is intended to act, upon the remote cause existing in the individual. It is impossible to explain the action of highly attenuated remedies upon the organism, but it cannot be doubted that it is through the medium of the nervous sys- tem, and, as the protean manifestions of disease in the sexual organism of woman, varied and complex as are features and character, can be accounted for only by considering them to arise from the nervous system, so can they be met and success- fully treated only by a system of therapeutics which gives us remedies of equally varied and characteristic pathogeneses. Much, of course, remains to be done in this department. Yet we arc not of those who consider it necessary that a given pathological condition should be reproduced in the pathogenesis of the remedy. This may be very desirable as confirmatory of its choice, and, if the remedy be well selected, will doubtless often be found to exist, as our provings become perfected. LOCAL DISEASES OF WOMEN. 967 But the salient characteristics of the remedy as an individual are more delicate, and should usually determine its choice. There are some who regard the selection of a remedy upon any other than a pathological basis as unscientific. But there can be nothing unscientific or unphilosophical in following in- dications which rest upon established principles and a definite law. The pathological indication alone is often insufficient, either because, on the one hand, we are ignorant of its cor- responding remedy, or because, on the other, there are so many corresponding, that peculiar characteristics are necessary to decide in the selection. However beyond our comprehension, or however trivial these may seem, if they have stood the test of clinical experience, it is well not to neglect them in prescrib- ing. Above all is this the case with those discovered and laid down by the genius, we might almost say by the inspiration, of Hahnemann. With the views advanced in this paper, it seems less scien- tific to prescribe for a result, than for its cause. The latter, we think, can be satisfactorily done only by individualizing both the patient and the remedy. The more closely this is done, the less desire or occasion shall we have to resort to local ap- pliances, or expedients of any kind. In conclusion, we should remember that while we regard much of the pathology of the past as crude, and even ridicu- lous, a like fate may be in store for much that now bears the seal of scientific approbation. Without presuming to speak in a magisterial spirit, the writer yet ventures the prediction that nothing is more likely to meet with this fate, than the practice of endeavoring to cure a patient, by a treatment di- rected against the local results of disease having its origin and seat in the nervous system. MEMBRANOUS DYSMENORRIKEA FROM REPELLED ERUPTIONS. R. Ludlam, M. D., Chicago, III. Not the least curious and wonderful of all the physiological processes known to us is the periodical development of the lining membrane of the uterus. This process of " nidation," or nest-making, is as essential a factor in menstruation as it is in generation. If it occurred only once in a year, as in the oestruation of animals, it would still be remarkable for its delicacy, and for the peculiar contingencies with which it is beset. But, in women, its monthly repetition multiplies the risks of its becoming disordered, and there are comparatively few who pass through the whole period of menstrual life without suffering some of these consequences. Membranous dysmer.o rhoea is not so well understood, ncr so skilfully and successfully treated as other kinds of painful menstruation. This fact is partly due to its relative infre- quency. For, compared with the spasmodic and obstructive varieties it bears about the same proportion that cases of breech presentation do to those of the cephalic extremity. Now that the shreds, or casts, thrown off in this disease are known to be caused by the exfoliation of hypertrophied mu- cous membrane of the uterus, and not by the exudation of lymph, and the formation of a new or croupal membrane, its morbid anatomy is very much simplified. And the fact that this product is decidual and not diphtheritic, homologous and not heterologous, is destined greatly to modify its special the- rapeutics. 969 970 world's homoeopathic convention. But, however great the advance that has already been made, the etiology of membranous dysmenorrhoea is incomplete. For, although the felt-like shreds, or strips, which are moulted in this disease are recognized as portions of a menstrual, or nidal decidua, it still seems practically impossible for physi- cians to separate in their minds the formation of this product from the existence of the inflammatory process. The most recent author even proposes to style it an epithelial endome- tritis (endometritis exfoliativa).* On the one hand he de- clares that the sieve-like casts and pieces, consist of the hyper- trophied mucous membrane which, from the rapid production of free cells, is detached and thrown off at stated periods; on the other that the process is inflammatory and exudative, and not a mere exfoliation. Experience proves, however, that while a woman with membranous dysmenorrhoea may also have ende- metritis, she is quite as likely to have ovaritis, or even endocar- ditis as a coincident affection. Accepting the view of Oldham and others that the cause of this disease may frequently be found in ovarian irritation and inflammation ; the idea of Dewees that the rheumatic dia- thesis is responsible for its existence in a certain proportion of cases; and the more modern claim that it may be caused by uterine deviations, my experience leads me to conclude that there are some examples of this affection which are inexpli- cable and incurable by, or through, either or all of these dif- ferent theories. In other words, these theories do not apply to all cases indiscriminately. The most intractable cases of this singular affection that have come to my knowledge have been associated in their clinical history with the existence and sudden disappearance of a cutaneous eruption. This eruption may, indeed, have been very slight and possibly have been forgotten by the patient herself. It may also vary in its character in different persons, being either papular, herpetic or vesicular, squamous, syphil- tic, or erysipelatous. In one of my cases it was a "rash, like prickly heat; " in another, the patient was positive that she had once had the " hives," and that her menstrual difficulty followed directly upon theii' being "driven in." *Dr. Beigel, in the Archiv.fur Gynakol., Band ix. Heft I. MEMBRANOUS DYSMENORRHCEA. 971 Sometimes the appearance of this eruption upon the face, hands, or body, alternates with the menstrual disorder ; but more frequently, unless medicines have been taken to " drive it out," no trace of it can be found at any time. In one case of erysipelas of the legs and thighs the lesion extended to the genitals, and to the womb, and a membranous dysmenorrhoea of six years standing was the direct result. In one of my patients, who was very ill with this form of dysmenorrhoea, the repercussed eruption had not been seen for eighteen years until it blossomed out as the result of my treat- ment ; and I have recently cured another in whose case the "salt rheum" had disappeared twelve years before, with the immediate advent of shreds and bits of membrane in the mon- thly discharge. The comparative frequency of cases of this kind, which have been more or less intimately associated with skin affections, pre- cludes the possibility of their accidental relation. For, out of twelve cases of real membranous dysmenorrhoea which I have treated within the last live years, eight of them have been of this sort. In this list I do not include those milder cases which are very much more numerous, and in which there is merely an in- creased desquamation of the uterine epithelium in the form of diaphanous shreds, or patches. This contingent of menstrua- tion is sometimes met with in uterine deviations, catarrhal endometritis and menorrhagia, and is much more easily cured. Sterility is as common and constant a symptom of mem- branous dysmenorrhoea as is the shedding of the membrane itself. And there can be no better guarantee of'the cure of a case of this form of dysmenorrhoea than is furnished by a. fruitful conception and labor at term. The clinical history of barrenness often includes the history of old skin affections which, in some unaccountable way, have interfered with the function of reproduction. The remarkable effects of certain mineral waters as a cure for sterility, and for complicated disorders of the catamenial function, can best be explained by their value in some chronic cutaneous diseases which have first been repelled and then resisted other modes of treatment. Anatomically the epithelium is the epidermis of the mucous 972 world's homoeopathic convention. membrane. Clinical experience lias long since demonstrated the mutual sympathy and morbid relations of these two sur- faces. The occurence of a metastasis of disease from one to the other is in no wise rare or remarkable. Indeed it is very common, more especially in case of those membranes which, like the lining of the nose, of the throat, and of the utero- vaginal tract, are in direct continuity with the external integu- ment. The modern classification and description of skin affections is quite in accord with the idea that, under certain circum- stances, almost any of them might be translated to the uterine mucous membrane. The moment we define eczema as "a ca- tarrhal inflammation of the skin," * we have declared up'on its proneness to migrate from the outer to the inner surfaces of the body, and to work mischief in them. Manifestly, the internal lesion, which is due to this cause, will be intractable, if not grave in character, in ratio with the delicacy of the function involved. For the monthly forma- tion, enlargement, separation and reproduction of the uterine mucous membrane, its progressive changes, its retrogressive or fatty degeneration, and the escape and cessation of the flow are so many physiological steps that such an invasion would almost certainly interrupt or modify. And it might very easily change the natural and proper exfoliation of the uterine epithelium at the mouth into a morbid separation of the sub- jacent mucous layers, and the shedding of a thick and tough cast of the uterine cavity. That these identical consequences do sometimes follow the repercussion of an eruption, I am fully persuaded, not only because I have been able to trace the beginning of a mem- branous dysmenorrhoea directly to such an accident, but also because I have found it possible to cure this secondary form of the disease through a knowledge of this fact, and by using it as a key to the special therapeutics of the case. Since the preparation of this paper was begun, two of my colleagues have consulted me concerning the best treatment * A Handbook on the Theory and Practice of Medicine^ by F. T. Robert, M. D„ etc., p. 1018. MEMBRANOUS DYSMENORKHCEA. 973 for membranous dysmenorrhoea, each of them having a case of the kind under his professional care. The above theory of its exceptional origin was explained, and they were asked to inquire particularly with reference to the clinical history of a previous or coincident skin affection. The following evidence afterward supplied by these gentlemen, has the merit of being fresh without having been fabricated expressly to support the theory under consideration. Case 1.-This case is reported by Prof. G. A. Hall, M. D., whose notes read as follows: " Mrs. M., aged 35 years, resides in Chicago. The menses first appeared at 13 years of age, and were natural until her marriage, at twenty-two. She has two children, the first of which was born ten months after mar- riage, and the other three years later, with one abortion since that time. " During her youth and up to the period of her first labor, she was troubled with the i hives,' or nettle-rash, but after the birth of the child it ceased, and she had nursing sore-mouth for weeks. This was followed by a chronic diarrhoea, which lasted for several months. The tongue has remained soft, patulous, spongy, and is sometimes slightly ulcerated. " After the diarrhoea was controlled, a small, round spot, as big as a half-dollar, would appear on the inside of the left thigh. It came first before, and remained during the men- strual flow. It looked very red, and was attended with an in- tolerable itching, but it disappeared nearly three years ago, at the time of the miscarriage. The latter was not painful, but after a moderate flowing for twenty-four hours, the embryo and placenta were thrown off intact. Ten days later she had secondary haemorrhage which lasted for ten weeks. She was greatly reduced in strength, and lias never fully recovered her health. " Four weeks after the cessation of that flow the menses were resumed, and for the first time the membranous shreds and casts, of which I send you a specimen, appeared. Her ap- petite became morbid, and she craves starch and salt. Since the miscarriage she has never had the itching spot on the inside of the thigh, or anywhere else externally. The catamenia are 974 world's homoeopathic convention. now attended with moderate pain and flowing for three days, when the membrane is extruded, after which the pain ceases, and the flow continues for three days longer, but moderately." Case 2.-For the details of this case I am indebted to J. E. Morrison, M. D., of Hyde Park, Illinois. " Miss G. M., twen- ty-three years of age, began to menstruate in her twelfth year. From her second year until puberty she had suffered from running sores, and occasionally from an eruption like bee- stings, with a fine rash over the body, but especially about the waist. For the first three years, or until she was fifteen, her skin was never well, nor was the menstruation either painful or too profuse. " About this time, however, the eruption would sometimes disappear from the external surface, and this change was al- ways observed to increase the monthly pain. For the last four years, excepting only at very long intervals and temporarily, no sign of the skin affection has shown itself; but the dys- menorrhcea has become more and more pronounced. Within that time it has assumed the membranous form, and firmly or- ganized shreds are thrown off at every return of the ' period? Iler suffering in that interval has been very severe, and thus far has resisted all medical aid." Concerning the curative indications which are deducible from this bit of clinical experience, we have to acknowledge that as yet they are neither very explicit nor complete. To have treated only eight cases of this particular kind of mem- branous dysmenorrhoea, and to have been consulted in perhaps a dozen others by letter and otherwise, does not warrant us in dogmatizing upon its special therapeutics. The temptation to speculate upon this subject, however, is very strong, but we forbear. For what a remedy "ought" to do, and what it really will do, are not always the same thing. Where the precise character of the eruption which has pre- ceded the menstrual lesion is unknown, we can not, perhaps, do better than to begin the treatment with the use of Sulphur. In the case already referred to,* where the eruption had not * Vide the author's Clinical and Didactic Lectures on the Diseases of Women, 1872, p. 195. MEMBRANOUS DYSMENORRHCEA. 975 been seen for eighteen years, this remedy, in the thirtieth dilu- tion, had the desired effect, and produced a marked and lasting amelioration in the uterine symptoms. But, if the nature of the eruption can be determined, either by direct inspection, when it crops out occasionally ; through the description of an intelligent parent or patient, who remem- bers just what it was; or, by the ferreting action of Sulphur, we shall know better how to proceed. In this case we vent- ure to recommend the following practical hints for trial and confirmation, or rejection, as they shall prove worthy or other- wise : If the eruption is, or has been, like Urticaria, give Arseni- cum alb., Rhus tox., or Urtica urens. If what is vulgarly called the "hives," Apis mel. (in the third decimal trituration), Belladonna, Chamomilla. If it is, or was, herpetic or vesicular, Cantharis, Rhus tox. If squamous, or " scurfy," Borax,* Arsenicum, Nux mosch., Dulcamara, Silicea, Sepia. If scrofulous, and otherwise unclassifiable, Sulphur, Calc, carb., Hepar sulph., Mercurius. If syphilitic, Thuja, Nitric acid, Mercur. iod., Kali iod., Me- zereum. If from suppressed rubeola, or if it alternates with ophthal- mia, Pulsatilla; or, in the former case especially, Cuprum acet. If it is erysipelatous, Belladonna, Cantharis, Rhus tox., Apis mel. Should further experience verify the importance of knowing that repelled eruptions do sometimes cause a membranous dys- menorrhoea, this limited and imperfect list of remedies will doubtless be very much changed and enlarged. It is not im- probable that there are some medicines which, although they are not now supposed to possess any curative relation to the disease in question, may yet prove, through this general indi- cation, to be very useful in its treatment. * Transactions of the Homoeopathic Medical Society of the State of New York, Vol. X., p. 280. 976 world's homoeopathic convention. There are undoubtedly good grounds for confidence hi the virtues of the Calcarea carb, as a remedy in this particular variety of dysmenorrhoea. It does not appear to be suited to all cases, and certainly does not deserve to be extolled as a specific; but, when it is appropriate, its curative action is quite as marked as it often is in too frequent menstruation and in menorrhagia. I have no question that, as a uterine polychrest, it is possessed of an intimate and specific relation to the fatty changes which occur each, month in the uterine epithelium, the physiological separation of which permits and provides for the exit of the menstrual blood from the surcharged capillaries. We have a forcible illustration of this quality of the Calcarea, in its ability to discuss certain moi bid growths, which it re- solves away through a similar metamorphosis; but more crudely, in the power of lime to detach the pseudo-membrane in croup and diphtheria. Our workers in the Materia Medica, and in gynaecology, should define this relation, and develop this suggestion. The frequent indication for Calcarea carb, in scrofulous and other skin affections is suggestive of its value in the mem- branous dysmenorrhoea, which is secondary upon these erup- tions. With the few exceptions in which I have prescribed the sixth or the twelfth attenuation, I have always given the third decimal trituration in these cases. If we find, in a given example, that dysmenorrhoea due to this cause is complicated with ovaritis, or rheumatism, the pre- scription may need to be modified. But it should not be for- gotten that ovaritis itself is as likely to result from certain sup- pressed eruptions as it is from the sudden metastasis of a gon- orrhoeal inflammation. In a certain ratio of cases, the best-chosen remedy that is prescribed on these, or similar indications, will fail to complete the cure without manual assistance of some kind. This is more especially true of the treatment of membranous dysmen- orrhoea when it coexists with retroflexion (not retroversion) of the womb. Under these circumstances the reposition of the organ, as a condition for the prompt and ready exit of the flow, allays and averts the tendency to a moulting of its nidal MEMBRANOUS DYSMENORRHCEA. 977 membrane. And the effect of this expedient is still more de- cided if a free dilatation of the cervical canal is also secured at the mouth. It is possible that this disease may arise as a secpiel to diph- theria, when it would require to-be treated accordingly. But the off-hand method of prescribing for it as though it were always and strictly a pseudo-membranous affection, is not only unsatisfactory in theory, but unsuccessful in practice. HOMOEOPATHIC TREATMENT OF DISEASES INCIDENT TO PREGNANCY. H. N. Guernsey, M. D., Philadelphia, Pa. The present advanced and perfected state of the Arts and Sciences, in general, is due to man's persistent application of the laws of Nature; as, for example, the laws of chemical affinity, of gravitation, of motion, etc., to the object of his research. Every time these laws are properly applied in the arts, another proof is afforded of their infallibility. In the science of Medicine we hold.that the law expressed in the formula "Similia similibus curantur" is the law of Cure existing in the nature of things, and, therefore, of universal application in the art of healing. And this law of healing is just as applicable as are the laws of chemical affinity in all operations of chemistry, the laws of gravitation and of motion in all matters in which the relations and movements of bodies are concerned. Every physician who is true to the law of similars in his attentions to the sick, may feel sure of doing for medical science what other scientists have done and are doing in their respective departments. The condition of pregnancy represents the female exercising the grand function of reproduction, from the moment of con- ception to the termination of parturition. All deviations from a healthful state of pregnancy fall within the scope of our prescribed subject: "The homoeopathic treatment of dis- eases and affections incident to the condition of pregnancy." To treat of all these deviations particularly, however, is quite 979 980 world's homoeopathic convention. beyond the purpose of this paper. We simply intend to show the perfect applicability of our law to all these various diseases and affections ; and the absolute necessity of adherence to it. If we would develop and advance our science year after year as other arts and sciences are advanced and perfected, and such should be the honest wish of every homoeopathic physician, we must persistently and correctly apply the law that under- lies and governs it. The law of Cure is not only the guide, but the bond of union of our profession. There is quite too much theorizing, too much of a disposition to set up individual opinion, based upon the most flimsy and untenable ground,-too little regard for the grand law of healing which must of necessity, as it is the only law, guide and unite us all in one grand brotherhood of healers. Governed by the above considerations I commenced the practice of medicine thirty-two years ago, and have labored hard to apply our law in all cases in which dynamic forces displayed abnormal action. After an abundant experience, I now testify and assure and reassure the profession at large, that, to regenerate the physical condition of the human race and heal all curable diseases, it is only necessary, after duly observing the hygienic laws, to apply rigidly, in every case of abnormal dynamic manifestation, the grand law expressed in the formula, " Similia similibus curantur." Women who have been treated according to the above law (during their pregnancy) invariably get on much better in every respect than if treated otherwise. They give birth to the best developed and most healthy offspring ; have much easier labors ; are much less liable to hemorrhages, malpresentations, convulsions, or to postpartum troubles of any kind, besides getting up from their confinement in a shorter time and a better state of health. And they are much less liable to abor- tions or premature labors. These casualties lessen, year by year, as improvements are made in applying the law, and advantages increase in the same ratio by the same means. A few illustrative cases will now be adduced showing what is to be understood by the application of the law of cure. DISEASES OF PREGNANCY. 981 The law must be applied to all cases most faithfully and rigor- ously ; and, if failures occur, the failure is to be attributed to the ignorance of the prescriber, not to the inefficacy of the law. First,-I cite an example of threatened abortion from trau- matic causes. A lady, pregnant, at the term of six months, while lying on her back, was severely injured by a little child sitting down heavily upon her abdomen. Flooding and labor pains quickly ensued, threatening immediate abortion. Coming to her assistance, I at once prescribed Arnica200 in solution, at first giving a teaspoonful every ten minutes, then at longer intervals as improvement advanced. 1 prescribed this remedy because, according to the law of cure, it seemed to be called for in every way by the symptoms of the patient. After a few days of rest in bed, all symptoms having abated, she was allowed to resume the care of her house and attend to her duties as usual. At full term she was happily delivered and made a perfect recovery. Arnica is not always the remedy for these traumatic conditions. A combination of circums- tances, sensations and conditions must always decide, and the law must be strictly applied. Second,-An example of threatened abortion from dynamic causes. Twenty years since, a Mrs. D. was threatened with a fourth consecutive abortion, not a single pregnancy having gone to full term. The history of the case revealed to me that in every pregnancy, at about the second or third month, she would experience stinging pains in the left ovary. These pains at the outset appeared at long intervals, gradually be- coming more and more frequent; till, finally, labor pains came on, accompanied by some bloody discharge, terminating in abortion. The stinging pains, resembling in sensation a bee- sting, being the most characteristic, and all her other symp- toms agreeing, according to the law of healing, Apis200 was administered. The symptoms gradually abated; she went on to full term, was happily delivered, and has since given birth to eight healthy and well developed children, and has not again been threatened with an abortion. Other cases might require different remedies, but if we adhere faithfully to the 982 world's homoeopathic convention. law and correctly apply it, success will always attend the effort. Though after-pains do not strictly come within the scope of our subject, such has been our perfect success in this direction that we venture a remark thereon. The remedies called for are very numerous, from Cuprum for the terrible cramping, agonizing abdominal pains of the multipara to Carbo veg. for those equally agonizing which appear in the remote shin- bones. These sufferings are of very great variety, but are all perfectly amenable to the homoeopathic medicament properly selected. Abnormal presentations at birth, being a consequence of abnormal dynamic influences (see my Obstetrics, p. 162), are also controlled by our law of cure. The history of a certain multipara revealed the fact that in every pregnancy a peculiar state of nausea and vomiting appeared, which, with other symptoms, indicated certain remedies. She had always been under allopathic care, and in each labor the presenting part was a shoulder. At an early stage during the first pregnancy in which I was called upon to attend her, the same symptoms presented themselves as in the previous pregnancies. Appro- priate remedies were administered occasionally, as often as seemed necessary for her comfort, and at full term the vertex presented naturally. During her many succeeding pregnancies and confinements there were no more malpresentations. In another case I was engaged to attend, I was told the face had always presented in previous labors. The patient responded happily to the medicines prescribed according to our law ; and in her following and several subsequent, deliveries she had vertex presentations. So we perceive how our law becomes a sure guide to the accomplishment of results whose causes are the most occult. In constipation and diarrhoea the same good effects attend our following strictly the law of the similars, though a great variety of medicines has to be consulted, and often to be used in the highest potencies. In dropsical affections of all kinds, even in those obscure cases of hydrorrhoea and dropsical affections of the amnion, a DISEASES OE PREGNANCY. 983 persistent application of the law of cure leads us to a happy issue. All the various gastric troubles, such as nausea and vomiting, heartburn, disgust, longings, etc., yield readily to the influence of the medicine suited to each peculiar case. Hemorrhages, such as epistaxis, hematuria, hematemesis, hemoptysis, and those that may take place from the vagina (excepting in cases of placenta preevia, concerning which see my Obstetrics), all are controlled by the medicine, which exactly corresponds to the abnormal dynamic condition which produces the flow of blood. Rigidity of the os and of the soft parts, as well as contrac- tions of the os, need no mechanical aid. These various con- ditions are simply out-croppings of some abnormal vital force, which is as capable of being corrected as any other abnormity, by the influence of the properly selected medicine ; t .en dila- tation will be normally effected, and delivery will promptly ensue. Twenty years ago I was called to a primipara in the first stage of labor. It was with difficulty that I could intro- duce my index finger through the canal of the vagina, owing to its being so contracted, to reach the os. Here appeared to me an insurmountable obstacle to the birth of the child. I paused to consider. Succeed I must, and that by law of the similars. The condition of the patient mentally and physic- ally indicated Aconite. Accordingly, a solution of the two hundredth potency of Aconite was administered, a teaspoonful every half hour, and in the space of about twelve hours, the child was normally delivered. All similar cases since met with have promptly yielded to the same means. Surely these could not all have been coincidences. Time and again, have I succeeded in effecting prompt deliveries, with great amelio- ration to the sufferings of the patient, by the exhibition of either Belladonna, Chamomilla,Gelsemium, Lycopodium, Rhus, Sepia, etc., and 1 am confident from what I have experienced, from the application of the law of the similars, that all cases of this kind will promptly yield to the same treatment. Leucorrhoea should be managed, and is perfectly curable, by homoeopathic medication, and in no other way. This requires 984 world's IIOMCEOPATHIC CONVENTION. great study and a most careful selection of the medicines, following up their action persistently ; repeating more or less frequently as necessity demands till the object is effected, the laws of health being in the mean time duly observed. Pruritus of the vulva, too,-I can never forget a distressing- case of this kind which I was called upon to treat some twenty- seven years ago. The patient had already aborted three or four times from this terrible itching, and she was apprehending the catastrophe again, when I was requested to do what I could to prevent it. All her symptoms clearly called for Sepia. She was promptly cured by that remedy and, after going safely to her full term, was happily delivered. She required Sepia again during her next pregnancy, though the recurrent attack was not nearly so severe as on former occasions. All cases of this kind are not curable with Sepia, but they are all curable by the administration of medicines in accordance with the laws of the similars. Abnormal and false pains are as easily controlled by the application of medicines chosen and administered according to our law, as any abnormal departure of the dynamic forces. Many a time have I been called to supposed labors, which have apparently come on a short time before they w-ere expected, and found all preparations made for the anticipated event, the patient suffering very much. Here, a wise choice of the medicine being made, the pains cease and we go home and comfortably await the full term. Retarded labor, when not due to mechanical causes, is in good time convertible into a perfectly normal labor, solely by the intervention of the remedy homoeopathic to the specific case. Often and often have I witnessed this event. A few years since I was called to a case of labor, the seventh child, the previous children having been born under allopathic care. All the labors had been tedious, lasting for two or three days, with great suffering. Labor had been in progress six hours when I arrived. The symptoms all pointed to Pulsatilla, which I administered, and in less than two hours the child was de- livered. We have seen too many similar cases to regard them as mere coincidences. DISEASES OF PREGNANCY. 985 Puerperal eclampsia is a disease amenable only to pure homoeopathic treatment; and it promply yields to that remedy, whose pathogenesis closely corresponds to the manifestation of that dynamic force cropping out in the convulsion. Many a case of this kind have I cured with the highly dynamized remedy. Where convulsions commence before the termination of labor, many have been cured during parturition, some not until afterward. Albuminuria is simply the result of abnormal dynamic forces, set in motion by the condition of pregnancy, latent till then. It invariably yields to the well-directed homoeopathic remedy. Varices or varicose veins, wherever found in the pregnant woman, gradually and entirely disappear under the influence of the properly chosen homoeopathic remedy. Very, very often have I produced such a result in from two to three weeks by a single dose of Lycopodium100000, Pulsatilla16000, Arnica40000, or some other remedy, according to the indications. Cramps during pregnancy come under the head of abnormal pains and are as easily vanquished. Relaxation of pelvic articulations, even in parturient women, when the patient cannot walk, stand or sit-absurd as it may seem to some-is very much relieved and often cured ere the the approach of parturition. Swooning during labor needs no such restoratives as camphor, liquors, hartshorn or anything of the kind. The properly selected homoeopathic remedy is all-sufficient in sustaining the woman, and soon prevents a recurrence of the attacks. About 126 years ago Watt discovered the power of steam by observing that the lid on a kettle of boiling water was forced upwards, as he thought, by the power of the steam. To test the correctness of his observation, he held a spoon over the spout of the tea-kettle to arrest the escape of steam in that direction, to see what would be the effect of a still greater amount of steam upon the lid. This experiment, the first ever made to test the power of steam, was perfectly satisfac- tory ; and every subsequent experiment concerning it has only confirmed the first induction. If any man at that time 986 world's HOMEOPATHIC CONVENTION. had prophesied that so little a matter would ultimately become the motive power of the world, so to speak, propelling enor- mous ships across the waters to all parts of the globe, driving ponderous locomotives and railway carriages across vast plains and over lofty mountains ; in short, doing all manner of work that man may devise, he would surely have been called a mad- man, and would not have been listened to for a moment. By obeying the laws of that power, a power peculiar to itself in all respects and ever uniform-by applying them most carefully and exactly; not being discouraged by the various explosions, accidents and failures for want of proper application, men of science and energy have brought it to be what it really is, the motive power of the world, always safe and successful under proper management. What study, what patient research, what trials has it not cost to bring out and to fully develop that first observation, viz.-the effect of steam upon the lid of a kettle of boiling water. The failures of a few men in attempting to bring good out of the apparently trifling cir- cumstance did not deter other men from pursuing and im- proving what promised to be of use to mankind. And this result, of inestimable value, has been brought about by observ- ing the law which expresses the power of steam. Wherever this law has been properly applied, not a single failure has ever occurred. About 8G years ago Samuel Hahnemann discovered the Law of Cure, the only law of cure for all manner of diseases in all living creatures. He conceived and propounded the following indubitable triune doctrine, viz : a. The Law of Cure embodied in the formula " Similia similibus curantur b. The fact that disease is not material, but is a disturbance of the vital forces ; c. The fact that the active power of drugs is not the mate- rial itself, but the vital force that produced the drug. The law of the similars is universal, is peculiar to itself, is uniform and correct in all respects like every other natural law. It only awaits the fulfilment of all conditions in which it is to be used, like the using of any other natural law, the DISEASES OF PREGNANCY. 987 inherent power of steam for instance, and its success is equally perfect. Before another Centennial, this law of cure will be as univer- sally acknowledged as are now the power and applicability of steam. All other modes of healing will be as little known and sought after, as are, now, other motive powers than steam. Men of the highest mental culture are investigating this law, are rapidly working it up to its purest and fullest extent and are treading more and more closely in the footsteps of its immortal founder, Samuel Hahnemann. Well knowing the perfection of the law and the fallibility of the human mind, they do not stop at a few failures or a few explosions. The formula " Similia similibus curantur " expresses an infallible law. Those who accept this law will surely show the world that in this instance, as in all others, truth is mighty and will prevail. THE THERAPEUTIC TREATMENT OF CERTAIN OF THE DISEASES OF THE DIGESTIVE CENTRE INCIDENT TO PREGNANCY. J. C. Sanders, M.D., Cleveland, O. The therapeutics of the diseases of pregnancy is, as a whole, toio extended a subject for the prescribed limits of this paper. I shall, therefore, confine myself to the therapeutics of the more important maladies which affect the digestive organs and functions. 1st. The Therapeutics of Ptyalism.-The common and milder forms of this affection are ordinarily promptly amenable to treatment. Aconite.-This remedy alone will commonly effect a cure, cov- ering as it does, by its broad pathogenesis, not only the local erythema of the salivary glands, but the irritated ganglionic nerve centre which is a prominent factor in the disorder. But other remedies may be required, and we may consult with great confidence of success the following: Podophyllum Pelted.-Copious salivation ; offensive odor from the mouth ; putrid taste, closely simulating mercurial salivation, and especially where there is evidence of mercurial dyscrasia; in such cases the use of Mercurius should be forbidden. Mercurius Solubilis.-Absence of mercurial dyscrasia, and yet the characteristic profuseness and fetor of the saliva are present; tumid and tender and discolored gums; tumid and tender glands; stomacace and aphthae. Pulsatilla.-Putrid taste in the mouth, especially in the morn- ing; ptyalism, the saliva tasting sweet. Natrum Muriaticum.-Ptyalism obstinate; teeth sensitive to DISEASES OF THE DIGESTIVE CENTRE. 989 air and contact; gums tumid and sensitive to cold and warmth; bad digestion ; constant craving, which is allayed by the smallest quantity of food. Argentum Nitricum.-Gums tumid, tender and easily bleed- ing; tongue with painful and red tip; fetid odor from the mouth; violence characterizes the gastric symptoms-violent belchings, violent colic, violent emissions of flatulence, especially at night, affording relief. Caladium Seguinum.-Ptyalism excessive, the saliva resem- bling; the white of an egv. o oo Conium Mac.-Ptyalism violent; gums bluish-red and swollen, and bleed easily; tongue swollen and painful; globus hystericus; mammary indurations. Colchicum.-Profuse ptyalism with dry sensation in throat; tongue stiff and white-coated; aversion to loathing at sight or smell of food, hiccough, peevishness. Kali Kydriodicum.-Ptyalism, with viscid and saltish secre- tion, burning sensation at the tip of tongue. Veratrum Album.-Ptyalism, the secretion having a saltish pungent taste; strong desire for acids; pallor and faintness. Antimonium Crud.-Ptvalism, with saltish-tasting: secretion, white-coated tongue, aversion to all food, longing for acids, hot and itching cheeks. Acidum Kitricum.-Ptyalism associated with a scorbutic, mercurial, or syphilitic dyscrasia; tongue very sensitive; putrid or cadaverous breath. Sulphur.-Ptyalism profuse and nauseous; bitter saltish taste in mouth; aversion to meat and craving for brandy; belchings and eructations; cold hands and feet. Cases proving obstinate or intractable under the therapeutics here indicated should by no means be given over as hopeless of relief by the homoeopathic therapeia, but should stimulate and extend the range of our inquiries to other centres, the gastric, duodenal, and enteric, and especially to the uterine centre, where may be found the primary or sustaining irritation. I am satisfied cases are sometimes abandoned to empiricism or given over to the interferences of obstetric art, and our blessed system 990 world's homceopathic convention. thereby dishonored, through lack of this wide-reaching scrutiny? and consequent limited range of therapeutics. Indeed in all the maladies reflex in character incident to gestation the fact of in- tractableness should always direct our attention to the condition of the utero-ovaric centre, for in this centre may be found not only the distinctive irritation of the case, but the symptom or symptoms which may guide to a prompt success. Moreover I have no doubt that independent of such local uterine or ovarian irritation, ptyalism and other forms of disordered digestion may occur as a local expression of a constitutional dyscrasia or psora, which gestation has aroused or stimulated into appreciable manifestation. A few suggestions relating to regimen are essential to the suc- cess of this course of therapeutics. Free and frequent rinsings of the mouth with water of the temperature most agreeable; cold is generally preferred in the early stages; food nutritious but sim- ple ; plenty of good air and pure water as drink to allay thirst and to supplement the loss of fluids incident to the excessive secretion ; sufficient exercise daily in the outer air if practicable ; carriage-riding is greatly preferable to other forms of exercise; perfectly ventilated sleeping-rooms; cheerful associations and surroundings, and the mind, so far as possible, disburdened of anxiety and care. 2d. The Therapeutics of Stomatitis.-An accurate rec- ognition of the wide range of pathological causes or conditions of this malady is essential to a proper conception of its thera- peutics and best possible success in its management. a. As in the non-gravid so in the gravid state it may occur as a purely local disease, and depend primarily on various irri- tating and offending articles of food or drink ; and, secondarily, on disordered states of the stomach or intestine. b. It may depend on deficient general vitality, a general dyscrasia, the constitution of the patient not possessing or main- taining vitality sufficient to sustain both the general nutrient and the gestative nutrient functions at the same time. Whether such failure of the general nutritive functions is pri- marily a fault of the blood-mass, or primarily a fault of the gan- DISEASES OF THE DIGESTIVE CENTRE. 991 glionic nerve centres, is a nice and unsettled problem, but sooner or later there gradually appears the unmistakable tracery of what we are accustomed to designate anaemia, expressed by gen- eral pallor and general impairment of strength, varying in de- gree in different cases. The popular idea that the stomatitis or the concomitant disor- dered conditions of the gastro-alimentary tract explain the anaemia and impaired general nutrient powers in such cases is unphilosophical, though it embodies an unquestioned truth, viz., that these disordered states of the digestive'organs and functions sooner or later react upon and directly contribute to the general blood depravation. The great truth which underlies the proposition which is sought here to be enforced is this, viz., that generally not alone the local stomatitis but the disordered digestion and assimilation depend primarily upon, and are sustained by, the antecedent and continued deficient vital forces, which, inadequate to sustain both the gestativeand general nutritive powers, betray this inadequacy first and chiefly through failure of the general assimilative functions, and sooner or later through a more or less severe stom- atitis or other severe local irritation. Nature in such cases seems conservatorily to protect and secure the consummation of the generative functions at the expense and risk of the general powers of the body. This deficiency of vital power, which inheres in the constitu- tion and constitutes its own individual dyscrasia, may present itself in so general and so subtle a form as scarcely to admit of being defined ; or may declare itself in the character of one or another of the various appreciable cachexise, either malarial, scorbutic, mercurial, strumous, or syphilitic, or in these variously combined. These unquestionable propositions in its pathology must nec- essarily make the treatment, both by therapeutics and regimen, broadly discriminate in order to secure a result broadly success- ful. They are equally necessary to explain the widely different and al most opposing opinions and treatment of different and equal- ly reputable practitioners. I will make only one citation by way 992 world's homceopathic convention. of illustration. Professor R. Ludlam, in his estimable work on Diseases of Women, in Lecture 12, page 210, says, in reference to the nature of this malady, that the " most plausible of the various opinions is that which refers its phenomena to a scorbutic ca- chexia." Then he follows with an argumentative series of comparative propositions to corroborate and make evident its scorbutic origin. He says: " 1st. The causes are such as tend to derangements of nutrition and assimilation." Granting the truth of this by no means es- tablishes a commonness of pathology, for the proposition applies equally to cancer or any heterologous disease. " 2d. It is invariably accompanied by anaemia." So is Bright's disease, and yet between Bright's disease and scurvy there is nothing common. " 3d. Except in degree of violence many of its symptoms are identical with those of scurvy." So far as my observation and study have been concerned, I have never been impressed that there.exists any real identity between the characteristic phenom- ena of the two diseases. Foul breath, ulceration, flabby and bleeding gums and loose teeth, anorexia and languor are the only points of seeming identity, and yet the same group of symp- toms we can produce by the influence of Mercury, and they are no more identical in the former than in the latter. "4th. The same dietetic regulations are requisite to cure the one as the other. Both demand a pabulum largely composed of vegetables, and of vegetable acids especially." My own ex- perience is wholly opposed to this proposition. I never saw a case wherein a pabulum composed largely of vegetables was either needed, or vegetable acids could be borne at all. The attempt to use the latter especially, however much longed for, inevitably and speedily has brought about aggravation or in- duced relapse. This will suffice to illustrate the error of assuming that there can be only one pathological condition of so common a malady as stomatitis ; and he demonstrated how varying and almost antipodal the opinions and practices of different physi- cians may be in the same disease, and may be equally accurate and skilful, a paradox satisfactorily explained by this unques- DISEASES OF THE DIGESTIVE CENTRE. 993 tioned variation in the diathesis of different sections of country, and the varying standards of health and habits, and the varying cachexiie of widely separate communities. Asa purely local disease, and excited by offending or irritating articles of food or drink, as food or drink too hot, or too pungent, or too sharply acid: Aconitum.-Will promptly cure, and render additional thera- peutics unnecessary, the offending exciting cause being in the meantime ruled out by a careful regimen. It can be used to great advantage locally, as well as by internal and general administra- tion. This is true of every remedy used in the treatment of this disease. Its special indications are dryness and redness, and tick- ling-stinging sensations ; white-coated tongue and bitter taste. Arnica Montana.-Resulting from bruising the inner mouth surfaces, as by biting the inner wall of the cheek, or by use of dental instruments. White-coated tongue; offensive odor from the breath and putrid teeth. Calendula Officinalis.-Resulting from laceration of inner mouth surfaces. The wound inflaming and becoming raw and painful, red and stinging. As a local disease, and dependent on disordered conditions of the gastro-alimentary tract, the disease is more common and prone to be more intractable. A rigid regimen as to special arti- cles of food or drink, palpably noxious to the stomach by quantity or quality in some cases, as in pampered habits, excluding all animal food for a few days, and allowing nothing but milk, with bread or rice or oatmeal, and excluding all acids, except where associated with scorbutic cachexia, and acid fruits of every kind, in rinsing the mouth frequently and freely with cold or tepid water as is more agreeable, will prepare the way for the prompt and successful administration of remedies. Aconite, already noticed, has an extensive range of indication, and may be relied upon almost alone. The younger and more vigorous the subject, the more appropriate and successful will be its administration. If it does not prove wholly curative, it will surely and well pave the way for any necessary additional specific medication. 994 world's homceopathic convention. Gclseminum.-May be found preferable to Aconite as a means to disburden not only the mouth but the gastro-enteric tract of the acute and initiatory symptoms, if the patient is not vigorous or the general standard of health is any way impaired. Dispo- sition irritable, and her ideas confused and incoherent ; taste and breath fetid; mouth burning; saliva sticky; eructation sour ; empty sensation at the pit of the stomach ; cold hands and feet; prone to much chilliness in case of febrile reaction. Baptisia.-May be preferable to Gels, in the incipiency of attack, when the patient furnishes evidence of generally impaired health. Mouth feels sore as if burned ; saliva profuse, viscid, and flat-tasting; tongue coated white in centre with edges red and shining; dull burning pain in the pit of the stomach; empty, gone feeling in the same; loss of appetite; thirst, with constant desire for water; slight nausea. Hydrastis canadensis is closely related to the last two rem- edies in its adaptations to this malady. Sensation as if the mouth had been scalded or burned; inner mouth-surface raw and angry; excessive secretion of tenacious saliva; gums dark- red and swollen ; great sensation of sinking or prostration felt in the epigastrium; sour eructations; constipation. If the cases are recent the timely use of one or another of these remedies, with the regimen just indicated properly enforced, will probably render other remedies unnecessary. If, on the contrary, they have continued for some time with or without the use of either the aforementioned remedies, there will prob- ably be found indications for other and additional medicines. We will name them in the order of their commonness of indi- cation. Pulsatilla.-Putrid smell from the mouth, especially in the morning; bitter, or putrid, or sweetish taste, especially after eating or drinking; tongue coated white or yellow, and when dry feels as if burned in the middle; when moist from abundant saliva the saliva has a sweetish taste; thirstlessness as to water, but great thirst for strong drink and beer; has aversion to fat food, and even bread and milk; is hungry for something, she knows not what; has eructations tasting and smelling of what DISEASES OF THE DIGESTIVE CENTRE. 995 has last been eaten; has troublesome pulsation in the pit of the stomach. Nux Vomica.-Mucous surface of the roof of mouth and gums and throat inflamed and swollen, and covered with foul ulcers; gums easily bleeding; foul odor from the mouth ; tongue coated heavily white, or is dark-red and creased along the edges ; bitter, sour eructations ; no food has naturalness of taste; morning thirst, and yet has aversion to water. Staphisagria.-Mouth and tongue covered with blisters; gums ulcerated and very painful; has an unsatisfied hunger; waterbrash; experiences bitter belchings after sour food or drink. Millefolium.-Stomacace and ulcers on gums; painful gnaw- ing at stomach as from intense hunger; pain in the pit of the stomach when much excited; nausea with vertigo; fetid flatu- lency. Lycopodium.-Gums inflamed and bleed easily; tip of tongue covered with ulcers, and ulcers on and under the tongue, which are very painful; food tastes sour; longs for sweet things; small quantity of food satisfies and leaves a full and bloated sensa- tion ; much rumbling in the abdomen, especially in the hypo- chondria; cold feet. Petroleum.-Mucous surface of cheek covered with ulcers; putrid, flat taste; white-coated tongue; a garlic odor from the mouth; canine hunger; violent thirst, especially for beer; water- brash ; empty, weak sensation in the stomach; nausea and vom- iting, the former especially when riding. Mercurios.-Inner mouth inflamed, swollen, and burning; much salivation; fetid breath; spongy, easily bleeding and dis- colored gums; tongue swollen, flabby, and covered with fetid, tenacious mucus; bitter, sweetish, or putrid taste; burning pain in the pit of the stomach, which is sensitive to pressure; violent thirst; greedy hunger without relish; acrid, bitter, offensive eructations; night aggravations; skin moist with un- z O CO J relieving perspiration. Borax.-General stomacace in the mouth, the ulcers raw and easily bleeding; flatulent distension of stomach and abdomen 996 world's homoeopathic convention-. after eating; everything tastes bitter, even the saliva; induced by excessive use of acid fruits. Veronica Beccabunga.-Dr. W. H. Prentice reports to the American Institute universal success in this disease by the use of this drug, but furnishes no clue by any given symptoms by which another may prescribe its use. It appears from his state- ment that he uses it with like success in the stomatitis of chil- dren, and the inference is rational that as in the latter it cures by some influence exerted upon a disordered digestive function, so in the former its curative range is through some influence exerted upon disturbance of the gastro-alimentary centre, and hence the mention of the remedy in this connection. We will pass to the therapeutics of another order of cases, such as we have designated as dependent primarily on deficient or faulty general assimilation, a condition or state which is called by some anaemia, and by others dyscrasia, and which is not fully defined by either term, since these terms limit the morbid condition to the state of the blood, the former defining it as a deficiency, and the latter as bad or vitiated blood; whereas it is a state or condition into which the great nerve cen- tres enter as important and unsuspected factors, and therefore is best defined by the term cachexia. When a cachexia exists, a supervening stomatitis will probably prove intractable under the use of means which will promptly cure the malady when occurring in one or the other of the simpler forms we have just considered. In cachectic stomatitis there will probably be found indica- tions for remedies not hitherto mentioned, and which will vary according to the particular cachexia existing, or which predom- inates. We will consider these remedies in the order of the cachexia in which they have particular applicability, and in the order of their commonness of indication. A. Malarial Cachexia.-Arsenicum.-Burning mouth; sa- liva profuse and offensive; violent, burning thirst, which is tem- porarily satisfied by a small quantity of the fluid longed for; •anxiety and burning and pain in the pit of the stomach; pallor DISEASES OF THE DIGESTIVE CENTRE. 997 of face and oedema of face, especially around the eyes ; great exhaustion; acrid leucorrhoea. Natrum Muriaticum.-Great smarting: and burning: at the seat o o of the ulcers; burning: at the tip of the tongue; continued thirst; longing for bitter food and drinks; yellowish pale face; pruritus; acrid greenish leucorrhoea, aggravated by walking; great weakness from the least exertion. Ammonium Carbonicum.-Tongue and buccal surfaces covered with burning vesicles and painfully sensitive to cold air and drink; great thirst; heartburn; stomach sensitive to pressure; hoarse, weak voice; tumid, itching vulva; great debility, com- pelling her often to lie down. Rhus Tox.-Putrid taste in mouth, and offensive smell from the mouth; buccal and tongue surfaces burning and red, tip of tongue especially red; excessive and implacable thirst; hunger without appetite; bearing-down pain when standing; soreness in the vagina; pallor; great debility and unrest. China.-Heavily coated tongue, white or yellow; burning buccal surfaces, and burning tip of tongue; bitter taste; violent thirst; stuffed and oppressed sensation at the stomach and in the abdomen; feeling of fulness, pressure, and heaviness in the uterus; feeling of great languor and wretchedness; pale, sickly look; sallow, dry, and flaccid skin; swelling of feet and limbs. Ipecacuanha. - Smarting of the inner mouth-surface and tongue; tongue coated yellow or white; thirstlessness ; anorexia; continuous nausea, easy vomiting; restlessness, impatience, and ill-humor. Nux Vomica.-Already symptomized. Page 995. Pulsatilla.-Already symptomized. Page 994. Gelseminum.-Already symptomized. Page 994. Ignatia.-Red, sore, inflamed inner mouth ; continuous sensa- tion of a lump in the throat, which swallowing does not relieve; profuse acid-tasting saliva; sour taste in mouth; evening hun- ger, which prevents sleep; capricious appetite, which nothing satisfies; bitter belchings; sensation of sinking in the pit of the stomach; swollen epigastrium; throbbing in the abdomen; has attacks of uterine spasms with bearing down; clay-colored and 998 world's homceopathic convention. sunken face; perspiration limited to the face; restlessness at night; dreamy sleep; sensitiveness and timidity. B. Strumous Cachexia.-Calcarea Carb.-Swollen gums and tongue so sore she can hardly talk ; heartburn and eructa- tions ; bloated and distended stomach ; vertigo; pale, yellow face; easily out of breath from walking or talking; itching in vagina; milky leucorrhcea; cold, damp feet ; apprehensive and despairing; easily offended; leucophlegmatic temperament. Silicea.-Swollen, sore, and painful gums and tongue; hunger without appetite; waterbrash and vomiting; pruritus; earth- colored pallor of face; emaciation; great nervous debility; despondency and melancholy. Phosphorus.-Inflamed, ulcerative, and bleeding gums; sting- ing in the tip of tongue; burning in the oesophagus; saliva pro- fuse, saltish or sweetish; hunger just after eating; eructation frequent, empty, sour ; stomach tender to touch ; sticking sensa- tions extending up the vagina; face pale and haggard; great emaciation and nervous debility; quiet, silent sadness, or de- pression and anxiety. Jodium.-Inner mouth inflamed, aphthous and ulcerated ; putrid smell from mouth; inflammation and burning extend into the fauces; saltish, sour, or sweet taste on tip of tongue; greedy appetite; pulsations in pit of stomach and in the abdo- men; great emaciation and debility, with great excitability of the nervous and mental spheres, and great restlessness. Lycopodium.-Already symptomized. Page 995. Sulphur.-Inner mouth inflamed and burning, as if it had been scalded ; stomacace and aphthae ; offensive breath ; tongue bordered and tipped with red, and white in centre; offensive breath; sour, bitter, putrid taste; waterbrash; burning tender stomach ; cold feet and hands ; weighty bearing-down sensation in the pelvis ; pale, yellow color of face; irritability. Hepar Sulphuris Calcarea.-Inflamed gums and inner mouth- surfaces, with lardaceous-looking ulcers; burning and painful tip of tongue; sensation of a plug or something sharp in the throat when swallowing; dry throat; great thirst, especially for acids and strong-tasting articles of drink; burning in stomach and DISEASES OF THE DIGESTIVE CENTRE. 999 painful distension ; a bruised, sore feeling in the abdomen ; great sense of weakness in the chest; great sensitiveness and dejection. Sepia.-Tongue and inner mouth-surfaces burn as if scalded ; gums painfully swollen and easily bleeding; tongue coated white with burning sore tip; dry and sore and stinging throat; saltish, putrid, sour taste; burning in stomach and pulsation in same; yellow and pale face; yellow circle round the mouth; yellow saddle across the nose; burning sweaty feet; cold sweaty hands ; stitches in the vagina ; pruritus, especially of the labia; restlessness and dread of being alone. Graphites.-Swollen fetid gums; fetid odor from mouth; continuous accumulation of mucus in the throat; sour eructa- tions with bitter taste; canine hunger; distended crampy abdomen; pale, yellow color of face; habitual dryness of skin when sweaty perspiration is offensive and has an acrid odor ; great emaciation ; inclination to grief, easily worried. Kali Carb.-Inner mouth and tongue inflamed and covered over with painful burning vesicles; bitter taste ; great desire for acids or sweets; difficult, slow deglutition ; stringy mucus clings in the throat, and provokes a more or less constant hawk- ing; sour eructations ; colic after eating ; deficient perspiration ; burning, itching skin ; cold feet, especially in bed ; yellow bloated face; puffiness between eyebrows and eyelids; dread of labor; easily vexed. Kali Hydriodicum.-Inner mouth ulcerated and burning without ptyalism, or profuse ptyalism with viscid saltish saliva ; burning vesicles on tip of tongue; continuous and excessive thirst; great bitterness in the mouth; urine blood red; dry scanty stool; wants to get out into the open air; is loquacious and j estive. Chimapliila Umbellata.-This remedy is here recommended from clinical experience alone. There have yet been no ex- haustive provings of the drug. It is worthy the attention of the Bureau of Drug Provings. Several cases of grave stomatitis have come within my observation, of obstinate intractableness until this remedy was used, but in which it proved rapidly and 1000 world's homoeopathic convention. surprisingly curative. Every case embodied four prominent characteristics. 1st. Strongly marked strumous diathesis. 2d. Rapid and deep ulceration. 3d. Anorexia, putrid breath, and scanty turbid urine. 4th. Great depression of strength. C. Scorbutic Cachexia.-Acidum Nitricum.-Teeth loose, elongated, and gums tumid, white, and easily bleeding; ulceration characterized by pricking pain; tongue sensitive; rank-smell- ing urine, like the urine of the horse; great debility; despond- ency and anxiety. Acidum Sulphuricum.-Aphthous ulceration of the entire inner mouth-surface; sour eructations and heartburn; longing after acids, especially fresh tart fruits ; pallor of skin ; trembling and weakness all over ; sense of general soreness ; capricious temper; restlessness and irritability. Acidum Muriaticum.-Gums tender, bleeding, and ulcerated ; ulceration of inner mouth-surface, the ulcers deep, and with dark base and ragged edges ; the inflamed surfaces stick together as if glued; pungent, putrid taste; bitter and offensive eructations; pungent thirst; a gone feeling in the pit of the stomach; great debility and marked weakness of memory. Acidum Phosphoricum.-Gums tumid and bleed easily, and part off from the teeth; tongue inflamed and swollen, and cov- ered with thick sticky mucus; longs for something fresh and succulent; heavy pressure in the stomach as from a load ; sound of something gurgling in the intestines with great flatulency ; feeling as if air was in the uterus; milky-looking urine; formi- cation in different parts of the body ; pale, sickly color of face J low-spirited and sad ; great loss of strength. Staphisagria.-Already symptomized. Page 995. Carbo Vegetabilis.-Dry burning mouth; great thirst, es- pecially for coffee ; nausea and eructations ; bloated abdomen, especially after eating; greenish pallor of face; great sense of exhaustion, most felt about noonday. Graphites.-Already symptomized. Page 999. D. Mercurial Cachexia. Acidum Nitricum.-Already symptomized above. Lachesis.-1Tongue swollen, dry and red, especially the tip ; DISEASES OF THE DIGESTIVE CENTRE. 1001 inability to put it out or to move it; ptyalism; the saliva viscid, accumulates in back part of the mouth, plugging up the fauces, giving a painful desire to hawk it out; great thirst; sensitive stomach, especially to external pressure; pale yellow face ; cold hands and feet; restlessness and loquacity. Kali Bichromatum.-General erythema of the mouth, includ- ing fauces and soft palate; ulcers painful and stinging ; anorexia and thirst; nausea and vomiting; metastatic pains; tympanitis; great debility with desire to lie down ; pale yellow complexion ; mind ill-humored or depressed. Sulphur.-Already symptomized. Page 998. Carbo Vegetabilis.-Already symptomized. Page 1000. E. Syphilitic Cachexia. Mercurius.-Already symptomized. Page 995. Nitric Acid.-Already symptomized. Page 1000. Kali Bichromatum.-Already symptomized above. Lachesis.-Already symptomized. Page 1000. Sulphur.-Already symptomized. Page 998. Thuja.-Teeth decaying in their fangs ; inner mouth colored with aphthae; sweet taste; swallowing difficult, as from a plug far back in the fauces ; wants food and drink cold ; acid eructa- tions; swelling of the pit of the stomach ; brown, dirty-colored skin ; emaciation; sycosis and condylomata; abstract or fixed ideas. Before dismissing this part of our subject I feel constrained to overstep its proscribed limits to give expression to my strong', conviction that a discriminating diagnosis is never more essen- tial to the success of therapeutics than in the treatment of Stomatitis, whether by regimen or remedies. Gestation, though a purely physiological condition, per se, in the average woman, imposes a great tax upon the vital powers and tends continuously to impoverish the blood and enfeeble the general nervous centres. Woman, in gestation, therefore when in her best health, needs good and nourishing food, pure water and air, daily exercise, cheerful associations and surround- ings, and the greatest possible immunity from all depressing in- fluences, anxieties, and cares; but when her constitution is already 1002 world's homceopathic convention. burdened and her vitality depressed by some inherent cachexia, her general nerve centres may become so enfeebled, and her general assimilative functions so interrupted or impaired by the exhausting influences of the gestative process, that in order tem- porarily to counteract these and enable her thereby the better and more promptly to overcome the malady under considera- tion, in addition to the regimen just indicated, she may need for a time, and to a greater or less extent, judicious stimulation. I am well aware this is in conflict with the opinions of some of our best authorities, and may encounter a strong protest on the part of some in this distinguished body. But facts of experience are stubborn things, and this is one of the facts of my experi- ence, that the promptest and happiest results have waited upon the use of stimulation, reluctantly adopted, I admit, in some very grave cases, occurring in cachectic constitutions. Under its use the vis medicatrix naturae was made more promptly and surely responsive to the selected remedy. This proposition I am sure will find corroborative analogies in the treatment of asthenic traumatic phelgmasias incident to modern surgical experiences. 3. Therapeutics of Nausea and Vomiting.-Remedies in the order of their commonness of indication : Ipecacuanha.-Continuous nausea; stomach rejects everything fluid or solid ; vomiting of large quantities of mucus, with or without bile; thirstlessness; tongue coated white or yellow; im- patience and restlessness. Tartarus Emeticus.-Continuous nausea or vomiting; vomit- ing characterized by much straining and retching, causing the perspiration to start, especially from the forehead; tongue coated white or yellow; thirstlessness, or longing only for acids and cold drinks; pallor; weakness and fainting; cheerful during the day, anxious and desponding at night. Nux Vomica.-Nausea in the morning and after dinner; bitter, sour taste; sour belchings; constipation; irritability and cross- ness ; sedentary habits. Pulsatilla.-Morning and evening nausea ; bitter, putrid taste; thirstlessness; undefined hunger, craving, she knows not what; DISEASES OF THE DIGESTIVE CENTRE. 1003 eructations tasting and smelling of what has been eaten ; chil- liness ; dizziness on rising after sitting; timidity and tear- Z O O Z V fulness. Sepia.-Nausea when stomach is empty, and when riding. Morning vomiting, with headache; sour or bitter, or putrid eruc- tations, especially tasting like rotten eggs; soreness of the abdo- men ; parturient-like pressure within the pelvis ; sadness, and dread of being alone. Natrum Muriaticum.-Nausea continuous, and associated with thirst and profuse waterbrash ; hunger without appetite; craves salt; is easily angered, and has difficulty in collecting her thoughts. Digitalis.-Morning nausea, with vomiting; nausea unrelieved by vomiting; sick, deathlike feeling after eating; the act of ex- pectoration provokes gagging and vomiting; slow or intermitting pulse; great depression of strength ; gloominess and anxiety. Chamomilla.-Nausea as if she would faint; painful distension of the stomach, especially in the morning; morning bitterness of mouth; loathing of food; vomiting of food or bile; abdominal spasms; irascibility and restlessness. Argentum Nitricum.-Nausea with extreme accumulation of gases in the stomach, from which it seems as if it would burst; violent vomiting; violent belchings, with no relief; vertigo; general hastiness and impulsiveness. Carbo Veg.-Morning nausea; evening, vomiting of food; extreme distension of stomach and abdomen after eating; dis- posed to miscarry; sensitiveness and restlessness. lodium.-Nausea; violent vomiting renewed by every attempt at eating; spasmodic pain in stomach renewed by eating; con- tinuous empty belchings ; everything tastes saltish ; acrid leu- corrhoea; flabby and wasted mammae; great excitability. Magnesia Carbonica.-Nausea and vertigo while eating, fol- lowed by retching and vomiting; much loathing without desire to vomit; bitter, sour taste; heavily coated tongue; extreme thirst for water, especially in the evening and night; acrid white leucorrhoea; great sense of fatigue; anxiousness as to something that may happen. 1004 world's homceopathic convention. Magnesia Muriatic.-Morning nausea, with faintness; vertigo on rising and during dinner; eructations of water and ingesta; choking sensation as by a ball rising up in her throat from the stomach, which is relieved by belchings ; sore bruised feeling over the abdomen ; enjoys being alone; is taciturn. Arsenicum.-Burning in the pit of the stomach ; vomiting of the ingesta, and worse from rising up; great thirst, but drinking little at a time ; great unrest; pale white face; great debility. Oxalate of Cerium.-Am not aware of any provings of this drug except clinical. It has proved exceedingly prompt in some few cases. The cases in which only it has proved serviceable have been characterized by burning, severe and raging burning, associated with nausea and vomiting. The stomach represented as feeling on fire, and the nausea continuous. Cocculus.-Nausea recurring spasmodically, with tendency to faint; nausea and vomiting with spasms of pain and cramp in stomach and abdomen; aggravated by riding and by becoming cold; the oesophagus burns and feels paralyzed; metallic taste in mouth; the lower extremities feel benumbed, with a sense of paralytic weakness across the sacrum. Antimonium Crud..-Nausea and vomiting; vomiting severe and persistent; white-coated tongue; aversion to all food ; bitter taste in the mouth ; great thirst at night. Belladonna.-Nausea with a gagging sensation in the fauces; empty retching; hiccough; vomiting; great thirst, which drink- ing aggravates; parturient pressure in the genital organs ; dread of light and noise; face flushed or pale ; nervous anxiety. Bryonia.-Vomiting of bile;. vomiting of solids and not of fluids;, tongue coated and dry, without thirst; dry parched lips; abdominal pain, and sense of burning in the uterus; restlessness, yet feels better for keeping quiet. Conium Maculatum.-Nausea suddenly supervening after taking food ; vertigo on looking around or turning the head ; acrid leucorrhoea; mammary induration; forgetfulness. Graphites.-Nausea with vertigo ; morning nausea, and after each meal;, morning thirst; distended abdomen; thin profuse leucorrhoea; sensitive vagina. DISEASES OF THE DIGESTIVE CENTRE. 1005 Hepar Sulph.-Morning vomiting; frequent sudden attacks of nausea; sore, bruised feeling in the abdomen, especially in the morning; burning in the rectum. Valeriana Officinalis.-Nausea as if a string were hanging down the stomach, and which promotes vomiting; nausea, with faintness and pallor; tallowy taste in the mouth; restlessness and capriciousness. Veratrum Album.-Nausea with faintness and violent thirst; violent vomiting; smells the odor of manure; burning in the pit of the stomach and in the abdomen ; great sensitiveness of the stomach ; cold perspiration on forehead, with vertigo ; great prostration. Euphorbia Corollata.-Sudden nausea, with or without vomit- ing, and watery diarrhoea; sinking, anxious feeling of the stom- ach ; faintness; cold hands and feet. Euphorbium Officinarum.-Nausea with trembling; vomiting with diarrhoea and burning; intense burning in the stomach and bowels, though the surface of the body feels cold. Iris Versic.-Vomiting with diarrhoea; nausea and vomiting of ingesta; a watery acid substance and bilious matter ; distress- ing vomiting with headache; cold head and face; great debility ; mental depression and discouragement. Podophyllum Peltatum.-Violent vomiting of food, and regur- gitation of food with putrid taste and odor ; morning headache, with flushed face; diarrhoea with natural stool; can only lie comfortably on the stomach; unrefreshing sleep; apprehension and discouragement. Ignatia.-Nausea without vomiting; vomiting of food at night; sensation of sinking and weakness in the stomach; heaviness and pressure in the pit of stomach; distension of the stomach, capricious appetite; sour taste, or food has no taste; labor-like spasms of the uterus; changeable disposition, irresoluteness. Sulphur.-Morning nausea; vomiting of ingesta; empty eruc- tations ; cold hands and feet; perspiration on the face; feeling of coldness about the head, requiring covering of the head for comfort. Yellow corrosive leucorrhoea; restlessness. Anacardium.-Morning nausea ; vomiting of ingesta, which 1006 world's homoeopathic convention. gives relief; great thirst; white rough tongue; diminution of the senses taste and smelling; painful haemorrhoids; itching leucorrhoea; obtuseness of the moral sentiments. There are a few points in the general regimen applicable to this malady so essential to complete therapeutic success that I feel compelled to obtrude them here, howsoever commonplace they may seem to some. 1. Within a reasonable range of propriety, capricious appe- tites and longings may with safety and advantage be gratified, and should therefore be indulged. 2. The meal or food which either provokes nausea and vom- iting, or is rejected by the act of vomiting, should be partaken of with the patient in bed or on a lounge, and the attitude main- tained until its digestion is so advanced as to preclude the possi- bility of its rejection. 3. Diluent foods should be as little used as possible. The more solid and drier the articles of diet the less liability of their rejection. 4. In case the stomach persists in its rejection of food, or to such an extent as to reduce the strength in any special degree, enemas of food, such as animal broths and oat-meal or barley gruels should be substituted, as they may be relied on as an abundant means of sustenance for a surprisingly long time. 5. The mind of the patient should be kept aloof from the de- pressing emotions, apprehensions, fear, sorrow, grief, disappoint- ment; but if this is impossible they should be counteracted and resisted to the utmost possibility. 6. Great fatigue should be scrupulously avoided, whichever of the great nerve-centres is primarily or chiefly acted upon by its causes. 7. All sexual intercourse and sexual excitation should be per- emptorily forbidden, and the abstinence rigidly enforced. 8. The condition of the uterine and ovarian centres should be kept under constant surveillance, since out of one or both of these may spring a single symptom or a group of symptoms which may guide unerringly to the remedy capable of rendering prompt or sure relief. DISEASES OF THE DIGESTIVE CENTRE. 1007 9. When by reason of some cachectic taint and consequent enervation of the great ganglionic centre, the alimentary tract becomes so intolerant of nourishment, whether by eating or by enemas, as to threaten health with serious deprivation, or put life in peril, the free yet cautious use of the lighter stimulants should be tried, as they may prove invaluable adjuvants with which to help tide the patient through this crisis of danger. A form of fermented milk, called Koumiss, embodying as it does not only an agreeable form of food, Carbonic and Lactic acids, but a delicate trace of Alcohol, must prove most servicea- ble in some of these cases, where acids are craved and a delicate stimulant is warranted. From what I have used of it, and seen usedin other forms of deranged digestion, associated with sensitive stomach and general cachexia, I would suggest its use in this mal- ady as most probably of great value and profitableness where there was craving for acids and the peculiar flavor of the Lactic acid taste was not objectionable, and delicate stimulation was de- manded. PUERPERAL FEVER. J. H. Woodbury, M. D., Boston. The task of writing an essay upon this disease presents many and peculiar difficulties. The term itself has been loosely used to designate special groups of symptoms and even pathological conditions which differ from each other in many very essential points. In fact the whole history of the disease as well as the different descriptions of its phenomena, is but a mass of mingled theory and fact, of conflicting statements and, not unfrequently, of diametrically opposite deductions and conclusions. The more conversant one becomes with the liter- ature of this subject, the greater seem the difficulties which surround the attempt to reconcile conflicting statements and to harmonize the views of different authors into a definite and consistent theory. The disease has been recognized and described for more than a hundred and fifty years, and during that time it has occu- pied the attention and the pens of many of the best minds in the profession, and yet, the discussion at the recent session of the London Obstetrical Society exhibited the widest discrepancy in the views of the various speakers ; there could hardly have been greater disagreement, had the subject under discussion been some new epidemic which the different members had seen and described from diverse standpoints. These difficulties meet us at the very outset of our investigations, for hardly any two writers agree exactly as to the proper definition of " Puer- peral fever." 1009 1010 world's homoeopathic convention. Dr. Arthur Farre defines it as "a continued fever commu- nicable by contagion, occurring after childbirth, and often associated with extensive local lesions especially of the ute- rine system ; " and, as if aware of its vagueness, he adds that " this definition is simply for the purpose of identification," and that " it does not pretend to indicate the nature of the disease, or to explain its phenomena." Even this definition, loose and indefinite as it is, was objected to by some of the leading British obstetricians, while other pronouced it "absolu- tely perfect." Dr. Wm. 0 Priestly, the illustrious President of the London Obstetrical Society, assents to this definition of Dr. Farre " if only it be borne in mind that, in this sense, puerperal fever is a comprehensive term, including a diversity of febrile affections, without expressing any theory or doctrine as to their pathological nature," and further on he gives us to un- derstand that his views of this disease have recently undergone a great change and that he no longer regards it as a specific disease as he formerly did. Prof. Leishmann, of Glasgow, who had very recently described it as a " disease belonging to the so-called zymotic class, the proximate cause of which is some peculiar poison to which lying-in women are liable by contagion, and which is, under certain circumstances, developed in the puerperal state," made, on this occasion, a formal recantation of his views, and declared his belief that a large proportion of the so-called puerperal fever had its origin in pyemic or septicemic infection. On the other hand, Prof. Fordyce Barker, of New York, in his recently published lectures on Puerperal Diseases, in his "confession of faith," expresses the belief that "there is a fever peculiar to lying-in women ; and that the symptoms of this fever are essential and not the consequence of any local lesion: that it is as much a distinct disease as typhoid fever or relapsing fever; and that it belongs to the class of zymotic diseases and results from some unknown blood-chann-es." o Extracts from other writers, of a similarly diverse character, might be multiplied indefinitely, but these are sufficient to show that among the leading minds of the medical profession PUERPERAL FEVER. 1011 at the present time, there exists the same degree of diversity and as little tendency to harmony as was apparent in the writ- ings of their predecessors of twenty or fifty years ago: although it must be said that the prevailing "trend " of medical opinion, at the present moment, is in favor of its pyemic or septicemic origin, modified in its course and development by the peculiarities of the puerperal state: but still essentially the same and not constituting a separate pathological genus. While this disparity exists between the views of various English and American observers, as to its pathology, I must not fail to call attention to the recently published report of AI. Hubert Jr. Professor of Obstetrics of the University of Louvain, in which he attributes puerperal fever to " atmos- pheric action infecting the whole economy before producing- morbid lesions." He considers " therapeutic means powerless to combat the evil, prophylactic measures being the only avail- able resource to save humanity from this terrible scourge." Of a similar character are the conclusions of AI. Lefort of Paris, who " does not wish to dwell on the nature of puer- peral fever or on its characteristic lesion. " " It is unknown at present, and medicine is useless against it." Having thus briefly sketched the widely different views entertained as to the nature of puerperal fever, let us proceed to examine them a little more in detail as shown in the works of the most recent writers and investigators. It would be very satisfactory in the commencement Of this resume, to find some point of substantial agreement as a basis or starting- point, and from this to trace the divergence of different writers. Unfortunately this is almost an impossibility for, if we except the communicability or contagiousness of the disease, there is not a single fact connected with it, upon which there is a sub- stantial agreement among authors. Here, there is a nearly unanimous sentiment, but only as to the fact of its communi- cability ; upon the nature of the virus and the manner of its transmission there is still the widest disagreement. Hubert attributes it " to atmospheric action, affecting the whole econo- my," while he regards its transmissibility by the finger, forceps, sponge or sound, and its propagation by contaminated objects 1012 world's homceopathic convention. as " points pending scientific demonstration." On the other hand, a very large and justly influential class, believe the causes of its transmission and propagation to be identical with those governing septicemia. Cruvelhier draws attention to the strong similarity which exists between the uterus after delivery'and an amputated stump; inasmuch as its muscular walls are laid bare, and at the placental spot are the gaping orifices of the divided vessels. The same idea was elaborated by Prof. J. Y. Simpson in his essay on the analogy between puerperal fever and surgical fever, published in 1850. Similar views are held by a large number of recent French writers, promi- nent among whom may be mentioned D. Espine, who regards puerperal septicemia and puerperal fever as identical. He believes that the disease is more or less grave, in proportion to the extent of the traumatic surfaces in the utero-vaginal canal, and does not think that it is at all restricted by the puerperal state, but that it closely resembles that following surgical operations. He regards the lymphatics as the channels of absorption and the peritonitis as the result of the absorp- tion of septic matters. He claims that " the ordinary milk- fever is due to the absorption of septic material from the lochia by the small denuded surfaces in the uterus, vagina and vulva." In Germany the septicemic theory is accepted by the majority of recent writers. In this country, with the notable exception of Prof. Fordyce Barker, I am not aware of any recent expression of the views of our leading obstetricians. Many other theories have been presented and found able and strenuous advocates during the past forty years. Prominent among these was the theory that the fever is the direct result of a local inflammation. This view was ably maintained by the late Prof. Meigs, who taught that " this fever is the direct consequence of intense constitutional irritation, from a simple state of inflammation in certain tissues of pregnant and partu- rient women." Prof. Alonzo Clark believed that " the primary lesion of pu- erperal fever is in the organs of generation ; the secondary, in the blood." It is highly probable that the theories of these emi- nent men, when carefully analyzed, would be found to closely PUERPERAL FEVER. 1013 approximate those of the septicemists. Indeed, Dr. Clark re- garded those cases of puerperal fever, without anatomical lesion, as endometritis followed by pyemia. Another class regard pu- erperal fever as " an essential protopathic fever, prepared and developed by the puerperal state, giving rise to morbid pro- cesses of which the genital organs are the usual seat, and which consist of suppurative inflammations and other pathological changes, such as softening, gangrene and haemorrhage." This view is supported by the authority of many eminent obstetri- cians in both Europe and America. Another class include, un- der the term puerperal fever, all the zymotic diseases occurring at the puerperal season, whether typhus, scarlatina, erysipelas, diphtheria or hospital gangrene. They do not absolutely reject the theory of the primary vitiation of the blood, but term the disease a puerperal fever, whatever the specific nature of the primary poison. They seem to use the term puerperal fever more for the purpose of classification than as a description of special pathological condition, in a manner similar to that of the Registrar-General of England, in his use of the term " Metria," as comprising all cases of death from acute affections of the pu- erperal state. This class includes the great body of the British obstetricians. By them contagion and infection are regarded as the chief sources of this disease, and they, with truth, regard the lying-in woman as in a condition to become, if brought in contact with any of the before-mentioned zymotic diseases, the subject of puerperal disease; or that this disease may arise in individual cases from decomposition of portions of retained placenta, membranes or coagula. Dr. Barnes, who belongs to this class, divides the causes of puerperal fever into two classes, the heterogenetic or those arising external to the patient, and requiring to be brought to her, and the autogenetic or those arising and developing within the patient herself. These two classes, as will be readily seen, cover the entire ground of con- tagion and septicemia in their broadest sense. The theory of the similarity of puerperal fever and diphtheria has also found some advocates of character and position, among whom Prof. Martin, of Berlin, holds a conspicuous position ; indeed he may be said to be its author. 1014 world's homoeopathic convention. Many other theories of less importance have been published, but they are the result, manifestly, of observations made upon a few cases or a single epidemic, and are too restricted in their terms to allow of a general application. A careful study of the literature of this disease will convince any one, I think, that it is impossible to formulate any theories of its cause and essential nature, which will command universal assent. That the disease is caused by, or, in its early stage, gener- ates a morbid poison, which vitiates the blood and produces a great variety of symptoms, according to the state of the pa- tient, the nature and intensity of the virus and the amount ab- sorbed, most modern observers acknowledge, and also, to a very great extent, they yield assent to the statement of Dr. Barnes just quoted : that it has two sources, in the one case originating in matter from without; in the other case formed within the patient's own body, as the result of morbid changes in some special part, which infects eventually the patient's whole sys- tem. This class includes all cases due to septicemia or pye- mia, cases in which the virus originates from the absorption of septic material derived from the decomposition of portions of retained placenta, coagula or shreds of membrane, or where wounds of the uterus or vagina may have taken on an un- healthy action, and organic substances in process of decompo- sition are absorbed and vitiate the blood. Unquestionably, from these two sources originate a large proportion of the cases of puerperal fever. The condition of the uterus subse- quent to delivery is highly favorable to the transmission of fluids into the blood, not only through the absorbents, but also through the uterine sinuses. Magendie has clearly shown that, with empty vessels, ab- sorption is especially rapid, not only in the uterus, but in other parts of the body; and Dr. Snow Beck has shown by experi- ments that, when the uterus had been injected with Perchlor- ide of iron, to arrest post-partum haemorrhage, the sinuses have been found filled with a grumous fluid containing an abundance of iron ; and Dr. Graily Hewitt urges the impor- tance of thoroughly promoting contraction of the uterus after the expulsion of the placenta, by the statement that he has PUERPERAL FEVER. 1015 never seen an instance of puerperal pyemia in a case where the uterus was thoroughly contracted. Dr. Tilt considers pu- trid lochia as a frequent cause of febrile action in the puer- peral state, and believes that the lochia are rendered noxious by any of the zymotic diseases occurring in the lying-in woman. This fact illustrates the importance of perfect cleanliness in all cases where, from any causes, lacerations or contusions have taken place during labor. With reference to pyemia as a cause of this disease, distinct from septicemia, it is claimed that in many cases the presence of pus in the blood is due to inflammation of the patient's veins, and to suppuration in their interior; while septicemia is induced by inflammation of other tissues than the veins, whether spontaneous or in- duced by an irritant from without. The investigation into the sources of the heterogenous or external forms of the virus, imported from without, brings us to the study of three important questions: 1. What is the. source of the virus ? 2. Is it always the same ? that is, Is it homogeneous like the virus of small pox or scarlatina, which always produces, by transmission, the same disease; or, are there several poisons capable of producing different diseases in non-puerperal patients, but causing generically the same re- sults when introduced into the body of a recently-delivered woman ? These two bring us to the third, most important and practical, question of the relation of puerperal fever to the other zymotic diseases. Upon the settlement of these questions depends almost entirely the extent and rigor of the prophylac- tic measures necessary to prevent the spread of this disease. That puerperal fever is highly contagious is now a well-settled point; hardly any author at the present time being found to dispute it. The testimony on this point is too abundant, di- rect and positive to admit of further controversy as to the di- rect transmissibility of the disease from one patient to another by various methods, as by direct contact, by proximity in the same room or ward in a hospital, or through the agency of physicians and nurses who have been in attendance upon pa- tients suffering from this disease. The literature of puerperal fever is filled with instances con- 1016 WORLD'S HOMOEOPATHIC CONVENTION. firming the truth of all these propositions, and I need not cite them here. The fact that this fever, when once established, has a marked tendency to propagate itself, is the one settled and acknowledged point connected with its pathology. An equally important, but still somewhat mooted question is, that one comprised in our second interrogatory. It is claimed by many that, if the lying-in woman is exposed to scarlatina, small pox, measles, diphtheria, etc., the virus of these diseases is excessively prone to develop puerperal fever, and the claim is supported by an array of evidence which would be deemed ample to establish the point, were it not for the formidable array of exceptions, presented by instances where lying-in women exposed to some one of these diseases, have had that disease, uncomplicated by any symptoms of puerperal fever. This has been especially true with regard to scarlatina, while the opposite has been the rule with erysipelas. In fact so fre- quently has exposure to erysipelas been followed by all the phenomena of puerperal fever in lying-in women, that it has led to the theory of their identity. There can be no doubt at least of their very close affinity. Instances are by no means rare where the infants of women suffering from puerperal fever have died from erysipelas, even before the death of the mother. Nor are instances rare of physicians attending a pu- erperal fever patient, who have been seized with erysipelas and died. In view of this close relationship, Virchow speaks of puerperal fever as u puerperal erysipelas. " With regard to typhus, instances are frequent of lying-inpa- tients having been speedily attacked with puerperal fever after exposure to typhus. A striking example occurred in the Dub- lin Lying-in Hospital, where puerperal-fever appeared in forty- eight hours after the introduction of a case of typhus into the wards, although the hospital had been free from it for a year before. Although the typhus patient was removed in a few hours, the patients in the beds on either side were attacked with puerperal fever and died. As an example of the rapidity with which a puerperal epi- demic may spread when the nidus for it exists, I would call attention to a recent epidemic which appeared in Glasgow PUERPERAL LEVER. 1017 Maternity Hospital, where six cases occurred in five days. An investigation showed that the delivery-room in which the patients remained only about one hour each, was the source of the infection, at least for the last five cases. The epidemic ceased after a thorough renovation of this room. The peculiar constitution of the puerperal woman added to the increased susceptibility of the nervous system, greatly in- creases her liability to be affected by any prevailing febrile disease, and favors the development of rapid changes in the composition of the blood. These facts may help to explain the peculiar susceptibility which lying-in women manifest to the virus of septicemia or of zymotic diseases. Attention has been called in this connection to the baneful effects of sewage-air and depressing mental emotions. The greater proclivity of unmarried women to this disease has been noted and commented upon by nearly every writer who has had charge of lying-in hospitals where it has appeared. After a careful study of the subject, I think any one will admit the truth of the conclusion arrived at by Dr. West, that " there is not one single solitary cause to which we can refer the symp- toms of puerperal fever; that it occurs now from one cause, now from another." It is equally evident that the term puerperal fever is and has been loosely applied to a great vari- ety of febrile affections occurring at the puerperal period and tending to a fatal termination. Of these affections the fever is perhaps the most constant and most striking symptom ; but it is only a symptom of an underlying disease, of whose nature we know as yet but little. While the contagiousness of the disease is now generally ad- mitted, a warm discussion is still going on as to whether it is even really epidemic: that is, whether it is even dependent upon atmospheric influences independent of the miasms of hospitals or the transmission of the disease from one patient to another either directly or through the agency of a third party. Upon this point a mass of testimony has been accumulated by Hirsch and Ferguson in Europe, and Dr. Fordyce Barker, in this country, all going to prove that, at different epochs, 1018 world's homoeopathic convention. this fever has appeared as an epidemic not only in cities bnt in rural districts. Indeed some of the most fatal epidemics have appeared in sparsely settled parts of the country, where its prevalence can be accounted for in no other way. if we ex- cept the possibility of its transmission by the attending physi- cian who is now proved to be a ready agent in spreading the contagion. A few illustrations will render my meaning a lit- tle clearer. Dr. Fordyce Barker describes an epidemic which occurred in a country district in Connecticut, in which every woman who was delivered within a certain area, for some two months died; and in Bath, N. II., a little village of fifteen hundred inhabitants, twenty mothers died from this disease ; and many similar instances are on record. It is manifestly impossible to decide whether these cases were the result of at- mospheric influence, or of contagion transmitted by the attend- ing physicians, until the further fact shall be known that they occurred under circumstances rendering such transmission im- possible. For many instances are on record where every pa- tient in the practice of a certain physician, for many weeks was attacked with this disease; and, when we recollect that there is a paucity of physicians in these sparsely-settled regions, the theory of its transmission by contagion will remain possi- ble, until disproved by evidence of its impossibility. The question of the contagiousness of puerperal fever gives rise to two others of great practical importance. 1. The best prophylactic measures to prevent its spread ; 2. The advisa- bility of entirely abandoning maternity hospitals on account of the facilities which they offer for the propagation of the disease. It no longer remains a matter of doubt that the disease is frequently spread by physicians, midwives and nurses, and to disregard these plain proofs of its contagion which have been accumulated would amount to a dereliction of duty on the part of those having the medical charge and nursing of cases of this character. One of the strongest instan- ces of its communicability is that given by Dr. Robertson of Manchester, England. In the space of one calender month, one midwife belonging to a public charity, attended twenty cases ; of these sixteen died of puerperal fever. Other mid- PUERPERAL FEVER. 1019 wives of the same charity, attended during the same time, and in the same district three hundred and eighty women and none of these were affected. What then is the duty of the physician who finds himself unfortunately in attendance upon a case of puerperal fever? How long ougnt he to remain " in quarantine" and abstain from attendance upon confinement cases? And what are the best means of purification ? Upon these points as on all others connected with this disease, there is a diversity of opinion. It is claimed that all kinds of puerperal fever are not equally contagious ; that cases arising from extraneous sources are most so, and those arising from poison generated in the patient's own system the least so : also that the most acute forms run- ning to a rapid termination are most likely to be highly con- tagious. These conclusions are not how'ever well established and until more is known upon this point, it is well for the physician to exercise a high degree of caution in attending these cases, that he may not become the vehicle for the trans- mission of the virus to other lying-in women. At the recent meeting of the London Obstetrical Society, a great variety of views were expressed, as to the time during which a physician should abstain from obstetric practice after treating a case of this fever. Some thought a week a sufficient time, others that a month was none too long a time. The general sentiment, however, seemed to be that, where a physi- cian had treated but one case, with proper purification, a week was sufficient; but if he found himself in the midst of an epi- demic, or when a series of cases had occurred in his practice, he should decline such cases, for at least a month, and that during both the longer and the shorter interval, the means of disinfection should be carried out. Also that a physician in attendance upon severe cases of scarlatina, diphtheria or erysi- pelas especially, should exercise extra caution as to the clean- liness of his hands; and so far as possible, he should visit his midwifery patients before seeing cases of infectious disease. When it becomes necessary to handle cases of this latter class, he should thoroughly bathe his hands in some disinfectant, such as chlorinated water or a solution of carbolic acid, before 1020 world's homceopathic convention. going to the bedside of a lying-in patient. Upon the second point the conclusions of M. Hobart, of Louvain and M. Lefort, of Paris, in their reports presented to the Brussels Congress, are highly important and practical. The first of these points out the advantages of small over large maternity hospitals in the diminished risk from contagion and also the necessity of providing spare houses for occupancy in case of the breaking out of this disease in the hospitals. The second is more radical and urges the restraining and possibly the suppression of lying- in hospitals. After discussion, the section of Gynecology and Obstetrics adopted the following conclusions: 1. A medical reform of the means for the delivery of women is urgent. 2. The total giving up of large maternity hospitals. 3. Replacing the large hospitals with the midwifery school, by small lying-in houses with isolated rooms. 4. The establishment of a spare house near the lying-in house, but with separate administration. 5. Extending as far as possible the home assistance by aid and succor of every description. To these conclusions M. Lefort added the following : Delivery at the midwives' houses free of cost and under medical surveillance, should diminish the number of deliveries in the hospitals and lessen the mortality. The scheme of break- ing up the large maternities and substituting delivery at the houses of the midwives, received the full assent of the general assembly. It has been tried for two years in Paris, on a large scale with much better results than are shown by the large hospitals : the mortality in the latter being one in twenty-four while in the midwives' houses it was only one in three hundred and twelve. The expense under tlie new method was but slightly increased over the old, being only twenty francs more for each patient. In attempting a description of the symptoms of puerperal fever we meet with the same difficulty which has attended the subject in previous stages; the absence of any well defined views as to its pathology. Excluding therefore the large class of cases of simple peritonitis and metritis, I shall limit my PUERPERAL FEVER. 1021 description to the class of cases which is characterized, from the first, by symptoms indicating the operation of a virulent poison. As in all the zymotic diseases, so in puerperal fever, the symptoms vary greatly, not only in different epidemics, but also in different individuals in the same epidemic. In some they are far more intense and fatal than in others ; thus in one epidemic we have a low percentage of deaths, while in another the patients are struck dead by a fever which runs its course in a few hours. As a general rule, epidemics occuring in hospitals are much more fatal than in private practice. In the great hospital in Vienna the death rate has at times reached as high as one in six. Another noticeable fact connected with it is its tendency to return in a hospital when it has once ap- peared. So true is this of the hospitals of Paris that Tenon observes that " it has come to prevail more and more and to be as it were naturalized." As a rule it originates in the course of the second, third or fourth day after confinement, although sometimes later, and cases have been reported where it came on before delivery. It is sometimes ushered in by a rigor, though this is far from invariable; and the violence of rigor is no indication of the gravity of the impending fever. There is usually from the first a feeling of great depression, often accompanied by head- ache and praecordial distress. Even before the appearance of anymore definite symptoms, the patient often presents a hag- gard countenance with trembling lips and sunken cheeks. The pulse following the chill is seldom less than 130, feeble and easily compressible. The temperature, as indicated by the fever thermometer, is from 102° to 105°, and the skin generally hot and dry, though not always, for sometimes it is bathed in perspiration from the first. Soon after the chill there is a sudden development of abdominal pains, sometimes with definite location, but gener- ally beginning in the uterine region. This is one of the most constant symptoms of the disease. Baker observes that this symptom is less prominent in cases associated with septicemia, and that it seldom occurs in auto- genetic septicemia. In a few cases the free perspiration proves 1022 world's homeopathic convention. to be critical and brings relief; but, in the majority of in- stances the course of the disease is unaffected by it. The tem- perature is always from three to six degrees above the normal standard, and is said to range decidedly higher when the case is complicated with septicemia. The great frequency of the pulse is a constant symptom. The small quick pulse of the chill becomes fuller as soon as it has passed, but does not in- crease perceptibly in force, and is always easily compressible. As death approaches, it becomes very frequent, irregular and thread-like. The respiration is hurried, ranging from 25 to 50 per minute. The tongue at first presents no distinctive characteristics. It is covered with a deep, white fur, easily indented by the teeth, and is moist and white, or dry and brown, according as the patient breathes with the mouth closed or open. In the early stage the abdominal walls are usually soft and yielding, and the abdominal distention not very great. Dur- ing this stage also, the patients are able to lie on either the side or the back, with the legs extended. As the case advances the abdominal distension increases often with extreme rapid- ity ; and the patient's sufferings are proportionally augmented. She is now obliged to lie on her back with her legs drawn up, her countenance wearing a ghastly expression of distress, which is painful to witness. The intellect generally remains clear throughout the course of the disease, but in some cases there is low muttering delirium, with subsultus, and in others deliri- um which is worse at night, when the patient has hallucina- tion, cries out and tries to get out of bed or escape from those whom she fancies to be detaining her from going home. Vomiting is not an uncommon symptom, the matter ejected being dark colored, like coffee-grounds, or greenish, containing a large quantity of bile, and sometimes very offensive. Hic- cough is also present in grave cases. Diarrhoea is almost an invariable attendant upon puerperal fever. In cases of the more malignant type, it comes on early with evacuations of a very offensive nature. It often seems to supplant the vomit- ing, the two symptoms rarely occurring at the same time. In a very few cases both are absent during the entire course of PUERPERAL EEVER. 1023 the disease. In the last stage the diarrhoea becomes involun- tary. The effect produced on the milk and the lochia is very variable. In a majority of cases they both entirely disappear; the breasts are left peculiarly soft and flabby, a condition which continues for a long time, when recovery occurs. Sometimes the normal lochia are succeeded by a very scanty brownish offensive discharge; and, in a very few cases both the lochia and milk are said to have been increased. I have never met an instance of this kind, nor have I seen these se- cretions restored after convalescence, as is claimed by some writers on this subject. The symptoms which I have given above may be termed the general symptoms of puerperal fever in its ordinary form; but the varieties observed in different patients are infinite, resulting from modifications of the dis- ease by epidemic influences, or the special character of the sec- ondary lesions. It has been noticed that different epidemics of puerperal fever manifest a tendency to different special lesions; thus, in one, those of the peritoneum prevail; in an- other those of the uterine tissues; and in others there is a pe- culiar tendency to phlebitis, to embolism, or to pyemia; while in others still, the lesions are found to be in the thoracic vis- cera almost to the exclusion of the pelvic tissue. Of course the predominant lesion, whatever it may be, will modify the local symptoms of the case; thus, with the peritoneal, we find pain commencing in the hypogastrium or one of the iliac re- gions, and gradually radiating over the whole abdomen ; in some cases slight, in others serious, in some continuous, in others it returns in paroxysms. But neither the severity nor the persistency of the pain is to be relied upon as a measure of the extent of the lesion, for in some cases where there has been no pain, the most extensive peritoneal lesions have been revealed by autopsy. When the uterine lesions are most prominent we usually find a certain amount of pain in the re- gion of the uterus, increased by pressure made over the pubes or the sides of the uterus. Involution is arrested and the ute- rus is larger, harder and more sensitive than usual, and there is generally suppression of the lochia, except when the mucous coat of the uterus is the seat of the lesion, then it is increased, 1024 world's homceopathic convention. but at an early period becomes purulent. With this condition also, there is often a very distressing strangury. The local symptoms peculiar to the other lesions are not very marked. Prof. Behier insists that in lesions of the uterine veins, if the bladder be empty and the uterus firmly held by one hand, and compression be made on the sides of the organ by the thumb and finger of the other hand, a painful cord-like undulation will be found on one side or the other, near the attachment of the placenta or extending to one of the iliac fossae. Other writers, however, do not consider it pathognomonic as it oc- curs in cases where autopsy revealed no such lesion. With the phlebitic lesions we generally have more cerebral disturb- ances, and when associated with purulent infection and recur- rent chills. Lesions of the broad ligaments and ovaries can only be determined by physical exploration. Auscultation and percussion will enable us to determine the secondary tho- racic lesions. Septicemia in puerperal fever may be either primary or sec- ondary. The primary or autogenetic is developed soon after delivery ; the secondary, frequently not until the fever had existed for a week or ten days, when the usual symptoms of this condition, such as apathy, dry, hard tongue, dullness of intellect, difficult, indistinct articulation, sweatings, persistent diarrhoea, with offensive discharges, indicate, with sufficient clearness, the nature of the infection. This disease runs its course very rapidly. Fatal cases usually terminate before the seventh day, sometimes on the second, and a large proportion on the fourth day. When death occurs later than the seventh day it usually results from some secondary affection. In a small proportion of cases the recoveries are also rapid; but, generally, the convalescence is slow and dependent upon the extent and variety of the secondary affections. Among the favorable symptoms a permanent decrease of the pulse and corresponding fall of temperature are of the greatest significance. If the pulse is found to be less fre- quent, while the temperature remains unchanged, the appar- ent improvement is not likely to continue, and an increase of the pulse may be expected during the next twenty-four hours. PUERPERAL FEVER. 1025 Indeed, where both pulse and temperature have fallen, these sudden relapses are by no means uncommon, as though from some cause there had been an accession to the force of the dis- ease. Disappearance of abdominal pain, with corresponding decrease of tympanitis and tenderness on pressure are also favorable indications; but the subsidence of the pain alone, without change in the other symptoms mentioned, is no proof of permanent improvement. Cessation of vomiting is also a good indication, especially if not followed by an exhausting diarrhoea. The occurrence of a moderate diarrhoea in the lat- ter stage is often favorable, as is also the appearance of ab- scesses and herpes labialis. Among the very gravest symptoms may be mentioned a high pulse (from 140 to 160 per minute) a high temperature, 104° and upward; a rapid, laborious respiration, severe diar- rhoea in the early stage, or vomiting and diarrhoea occurring together. When this combination of symptoms is found to existat the same time, the prognosis is very grave, and is likely to be soon followed by profuse sweats, irregular, feeble pulse, cold ex- tremities, and death. The development of pyemia or septice- mia is, of course, of the most serious consequence. Purulent effusion into either of the large serous cavities is generally fatal. The treatment of puerperal fever is quite as unsettled in the allopathic school as its pathology. A few years since, the only hope of the woman suffering from this disease lay in the most heroic blood-letting; and, possibly, with the apparent inclination of that school to " restore the lancet to its honored place," the same treatment may again become fashionable. Emetics, especially Ipecac., formerly had a great reputation in this disease, but have now largely fallen into disrepute. The same is true of purgatives and mercurials, whether adminis- tered as purgatives or for their supposed effect upon phlebitic lesions. And now the sulphites, which at one time gave promise, in the hands of some Italian physicians, of being of service, are pronounced to be entirely without efficacy. Dr. Barker, of New York, advocates the use of Aconite or Verat- 1026 world's homoeopathic convention. rum vir. in the first stage, the Veratrum vir. being evidently his favorite. He gives, at the commencement of his treatment, five drops of the tincture every hour; if a decided impression is not made after two or three doses, he increases by one drop each dose, until a decided effect is produced, or until the pulse is brought down from 120 or upward, to 80; and this treat- ment is kept up until all constitutional disturbance has sub- sided, and for two or three days thereafter. After the pulse is once reduced much smaller doses, two or three drops every two hours, will be found sufficient to keep it down. This treatment is to be continued for two or three days after all constitutional disturbance has subsided. If the Veratrum in- duce vomiting, or if it comes on from any other cause, stop the medicine till the pulse begins to rise, and then begin again with the minimum dose. The Veratrum should not be given when there is a feeble, thread-like, irregular pulse, profuse sweats and cold extremities. To allay pain, quiet nervous ir- ritation, and procure sleep, Dr. Barker recommends, as we might expect, the use of opiates. He prefers Magendie's solu- tion of Morphia (Morph. Sulph., grs. xvj; water, § j), either by the stomach or by hypodermic injection, if the stomach be irritable and does not tolerate it. This to be continued till all sensitiveness has ceased to exist. For the reduction of the fever (temperature) the doctor remarks, " we can no longer use the antiphlogistics" (why?) "but we rely upon another class, which have been termed antipyretics." Quinine, the mineral acids, cold sponging, alcohol and appropriate diet are the most efficient antipyretics in puerperal fever. The Quin- ine he gives in full doses, five to ten grains in the morning, and ten to fifteen grains at night, rather than in smaller and more frequent doses. He prefers Phosphoric acid, from the belief (well founded) that it decidedly allays nervous irritation and that it acts specifically as a nerve tonic. A teaspoonful of the dilute acid in a tumblerful of water, with a little simple syrup is given to the patient ad libitum. Cold sponging he directs to be used at least twice a day. Upon the use of stimu- lants he offers nothing new ; he would give them as soon as feebleness of the pulse and other symptoms of sinking appear. PUERPERAL FEVER. 1027 The administration of food in this disease he considers a part of the medical treatment. He insists upon its being given in liquid form, in large quantities and of various kinds, and adds the very sensible remark that, "a patient may starve with an abundance of beef-tea; " a fact which cannot be kept too prominently before the profession. I have devoted a good deal of space to the treatment laid down by Dr. Barker, because it is the latest, emanating from allopathic sources, aud because it is so wide a departure from, and in so pleasant a contrast with nearly all that we find pre- scribed by any other author of that school, from that of Dr. Gordon, who bled to the extent of from twenty to twenty-four ounces at once, and ten ounces more after a short time, fol- lowed by a cathartic which was kept up through the whole course of the disease; or, the still more heroic treatment of Hay, who early bled his patients to the extent of thirty, forty or even fifty ounces, and thoroughly purged them throughout the whole course of the disease. Hardly more agreeable or remarkable seems the treatment adopted by Dr. Copeland, in Queen Charlotte's Hospital, in 1823. He gave, every four or six hours, a bolus containing from eight to sixteen grains of Camphor, ten to twenty grains of Calomel, and from one to three grains of Opium ; and, soon after the second bolus, half an ounce of Spirits of turpentine, and an equal quantity of Castor oil, to be doubled and trebled if they did not move the bowels freely in three hours ; this is to be followed by an ap- plication, over the abdomen, of cloths wrung out in hot water sprinkled with Spirits of turpentine. Is it any wonder, in the light of such treatment, that other members of the profession declared that, "do what you will, three out of every four pa- tients will die." Nor is the treatment improved by the sub- stitution of active emetics, blisters and large doses of Mercury for that just mentioned. It is recorded that, in the Westmins- ter Lying-in Hospital, twenty grains of Calomel were given every day with purgatives, and that sometimes the gums are affected, and where that happened the patients invariably re- covered. Commenting upon this statement, a shrewd Scotch physician remarked that " this might be explained on the sup- 1028 world's homceopathic convention. position that if they lived long enough for the gums to be af- fected by the mercurial, they had lived till the danger of the disease was passed, and had survived both the disease and the treatment." At the present time the allopathic school, taught by their own failures and the success of the milder measures of the homoeopathists, have lost all faith in the barbarous (I have too much respect for the word to call it heroic) treatment of the past. They now either adopt infinitely milder measures as taught by Barker, or they fall into utter skepticism, and say with M. Hubert, Jr., "therapeutic means are powerless to combat the evil; " or, with M. Lefort, " medicine is useless against it; " and turn their attention to prevention, to prophy- lactics, as the only possible direction in which successful war- fare can be waged against this terrible scourge of large hos- pitals and densely-populated, badly-drained districts. The homoeopathic treatment of puerperal fever, so far as our literature is concerned, is fragmentary and incomplete, very few well-reported cases being on record. This is not strange when we recollect that the disease is so largely a prod- uct of large hospitals, and that these are, as they always have been, under the control of the allopathic school, and that, in this country, the disease has not, for many years past, appeared in an epidemic form. Therefore, the only clinical results available are the scattered reports of a few sporadic cases oc- curring at long intervals and at widely-distant points. By the law of Similia, Hahnemann was able to announce the appropriate remedies for the cholera, even before its ad- vent into Europe ; so his disciples, aided by the same light and by their knowledge of the action of medicines on the sick, based on their observations of their effects on the healthy, are able to dispense in no small degree with the results of clinical observation. But the results of these observations become all the more valuable and gratifying when confirmed, as they have been in numerous cases of this disease, by actual trial. The slightest study of the list of symptoms given on a previ- ous page would suggest to the mind of the homoeopathist two remedies, from which to make his selection at the outset of the disease. These are Aconite and Veratrum vir. Almost every PUERPERAL FEVER. 1029 case would find its appropriate remedy in the first stage in one or the other of these, for, as we have seen, the outset is characterized by a chill, followed by high fever, quick pulse, hot, dry skin, or else moist and covered with perspiration. When there is high fever, dry skin, intense thirst, great rest- lessness and fear of death, Aconite would be preferred, and the Veratrum vir. where there is very rapid pulse, 140 to 160 per minute, with a tendency to drowsiness, and especially if there is persistent vomiting of mucus and bile, with great prostration. The remedy selected should be given of sufficient strength to measurably control the arterial action and reduce the pulse. In some cases this may be accomplished with highly attenuat- ed medicines, in others, drop doses or even larger of the tinct- ure may be required. 1 deem it of great importance to reduce the pulse at as early a stage as possible, to 100 per minute, or even less. This treatment should be continued until all danger of a recurrence of the fever is passed. It is peculiarly a characteristic of this fever to return with increased intensity after the pulse has been reduced by proper remedies to less than 100, as if it had received from some source a new accession to its force ; hence, it is well to continue the above-named remedies till all danger is passed. I cannot allow this opportunity to pass without al- luding to the very great benefit to be derived at this stage from the use of cold embrocations. A sheet doubled length- wise, or two thicknesses of cotton-cloth should be wrung out of cold water, and the patient's body wrapped in it from above the waist to below the hips; this should be covered with a blanket, and the patient allowed to rest from forty minutes to .an hour, or until the sheet has become quite hot when it should be again wrung out and applied. By this process a great amount of heat is abstracted from the patient's body, the rest- lessness greatly diminished, and the tenderness of the abdo- men and the tympanitis greatly lessened. The late Dr. Samuel Gregg was in the habit of putting these patients into a cold sitz bath twice a day in addition to the " cold pack," and by this treatment was reported to have saved 1030 world's homoeopathic convention. several very desperate cases of puerperal fever. Both these measures, as well as the frequent cold sponging of the entire surface of the body are of great service during the intensely febrile stage. Arsenicum.-Will be found of great value where there is burning pain, indescribable anguish and restlessness, sudden sinking of strength, great thirst; the patient drinking often, though but little at a time; burning in the veins, with pyemic indications; vomiting and diarrhoea of a watery character. Belladonna.-Will afford relief when there are violent pains coming on by spells, clutching pains in the abdomen, great sensitiveness and heat of the abdomen, painful bearing down in the pelvis toward the genitals and rectum with frequent ineffectual desire for stool, suppression of the lochia or else vitiated fetid discharges ; congestion of the head with delirium and redness of the face and throbbing carotids ; drowsy dozings or drowsiness with inability to sleep. Colocynthis.-Colicky pains in the bowels, with deathly color of the face, increased by taking food or drink ; quick pulse; bitter taste in the mouth; vomiting and diarrhoea. Hyos cy am us.-Typhoid state, with complete apathy ; or else great excitability, spasms, twitchings and wild staring delirium. Brea sole.-Putrescent state of the uterus, with discharge of dark offensive blood ; dullness of the head; pulse small and soft; alternation of chilliness and heat, with thirst. Mercurias sol.-Moist, soft tongue showing the imprints of the teeth; profuse sweat without relief ; worse at night; green slimy diarrhoea, or discharges streaked with blood; with tenesmus and burning in the rectum. Phosphoric acid.-Great debility; sinking condition with irregular, intermitting pulse ; profuse sweat, indifference to everything, dullness of the head; low delirium; coldness of the extremities. Concerning the value of this remedy, I can fully endorse the statement of Dr. Barker when he says : " I believe it decidedly allays nervous irritation and that it acts specifically as a nerve tonic ; " a fact which any homoeopathist could have taught him anytime during the last thirty years. Both in puerperal and typhoid fever and in small pox, with the above symptoms, I have seen it of the most decided service, PUERPERAL FEVER. 1031 in some cases rescuing the patients when in an apparently hopeless condition. Secale comutum.-Putrescent condition of the uterus; ab- domen distended but not very painful; brownish offensive discharge from the vagina; ulcers on the external genitals become discolored and spread rapidly ; burning fever inter- rupted by shaking chills; small, sometimes intermitting pulse ; great anguish ; pain in the pit of the stomach.; vomiting of decomposed matter ; offensive diarrhoea; suppressed secretion of urine; discolored inflamed places on the skin with a ten- dency to mortification; the patient lies either in quiet deli- rium or is wild with anxiety and a desire to get out of bed. The pathogenesy of this remedy presents a very close resem- blance to the symptoms observed in septicemia, and it is in this form of puerperal fever that it has been found of the greatest service. For this reason I wish to call especial atten- tion to it at this time, and to urge a more careful study of it as a remedy in all diseases of a septicemic nature or derived from nosocominal malaria. Terebintkina.-Is a valuable remedy in this disease, not in the form of allopathic " stupes " or " sprinkled over the abdo- men," but administered according to the law of Similia, where there is general languor and weakness, high fever, quick pulse with frequent headache, and a sensation of dryness of the mucous membrane : meteorism, great distention of the abdo- men : frequent colic and rumbling in the bowels; complete suppression of the urine. Where this condition exists, I have several times seen Terebinthina afford prompt relief. In a case, which very recently came under my observation, where the tympanitis was very severe it was greatly relieved in a few hours by the use of this remedy, administered by the ttending physician in the following manner : 01. tereb. gtt. x. to Gum arab. § iv., a teasponful every hour. Many other remedies will render good service, in fact, be found indispensable in the treatment of this disease, whose indications I have not room to record. Prominent among these will be found Bryonia, Baptisia, Chamomilla, Crotalus, Lachesis, Rhus, lodium, China and Nux vom. The sanitary conditions of the patient should be of the very 1032 world's HOMIEOPATHIC CONVENTION. best possible character. The room should be well ventilated and the air frequently thoroughly changed by freely throwing open the doors and windows if necessary. The vagina should be gently but thoroughly syringed, at least twice every twenty- four hours with a solution (3 to 5 per cent) of Carbolic acid. I now make it a point to use this solution after every case of severe labor, whether natural, manual or instrumental. I com- mence on the second day after delivery, and use it for at least the five following days, and longer if the lochia are in any way abnormal or examination reveals the existance of injuries or abrasions of the uterus or vagina. Recently I have used Salycilic acid, five grains to the ounce, in the same manner, but I am not yet prepared to give it any decided preference over the Carbolic acid. The diet should be as liberal as the patient can take; in many cases the nausea and vomiting will absolutely prevent the taking and retention of food, but when it is possible it should be given freely, in a liquid form and in great variety: beef tea, chicken broth, milk, oat-meal gruel, or milk punch, when there is great debility. As to the use of stimulants in this disease, I believe that the same rule holds good here as elsewhere ; and that while alcohol confers no strength upon the patient, it does, in some way, support for a time her flag- ging powers, and thus we may sometimes be enabled to bridge over a crisis, whose occurrence was too sudden to be foreseen, or where the strength of the patient is rapidly sinking in spite of the administration of a due amount of food. This condi- tion of extreme prostration not ^infrequently occurs in the latter stages of puerperal fever, and is by no remedy so promptly met as by alcohol in some of its various preparations. We may use whisky, brandy, wine or beer, whichever is most agreeable to the patient. In closing this paper let me say, I lay no claim to originality in much which it contains. I have simply endeavored to give a plain but condensed statement of what is known of puer- peral fever at this time, together with the most approved treatment both allopathic and homoeopathic. To this end I have drawn freely from every source available to me in the current literature and recent publications of both schools. THE HOMCEOPATHIC TREATMENT OF PUERPERAL FEVER. 0. P. Baer, M.D., Indiana. No disease incident to the puerperal condition is more in- teresting to the scientific physician than that which is called puerperal fever. The incipiency of this fever may date from several days before delivery, but its manifest outbreak does not occur until after this event, when it may appear at any time within two or three weeks. Cases of illness occurring later than three weeks after delivery cannot properly be denominated puerperal fever. About four-sevenths of all the cases of puerperal fever coming under my notice have manifested themselves between the first and fourth days after accouchement; about two-sevenths between the fourth and seventh days inclusive, and one-seventh after the close of the seventh day. The cases occurring before the close of the fourth day almost invariably arise from very acute metritis, endometritis, uterine phlebitis, or active inflammation of some, or all of the uterine appendages, including, of course, the ovaries and the Fallopian tubes. The cases occurring after the fourth and before the close of the seventh days, generally arise from either acute or sub- acute inflammation of the peritoneum and its attachments, often implicating all the abdominal viscera. The disease may result from contagion, carried by physicians, nurse, or friend, from other puerperal cases, or even from erysipelas-for it is a notable fact, that lying-in women are very susceptible to the poison of erysipelas. Cases occurring after the seventh day are of a more general 1034 world's homceopathic convention. character, and usually assume the typhoid type. They are far less inflammatory, less immediately dangerous, but oftentimes much more prolonged. The first class of cases generally check the lochia and prevent the formation of milk. The second class may, or may not, check the lochia, which are often increased and become very offensive, while the secretion of milk fre- quently remains normal. In the third and last class we often find phlegmasia dolens, permanent check to the lacteal secre- tion, weak eyesight, dyspepsia, irregular bowels, and future tardy menstruation. These are some of the concomitants and sequences of the various types of puerperal fever. The symp- toms of the general attack are various, while the special manifes- tations of symptoms in the organs, primarily affected, are but few, and these are easily recognized. The attack almost univer- sally begins with chilliness, or a very severe chill, followed by great febrile excitement, rapid pulse, from 100 to 160 per minute; intense, burning heat of the whole surface. Sometimes we notice a high pulse, while the heat of the surface is quite below the normal standard; and again the pulse will go down nearly to, or even below, the normal rate, while at the same time the surface is really hot. This condition is ominous, and should be carefully watched, as it shows conclusively that some important internal organ is being seriously invaded. Hurried, short respiration, with more or less pain on a full inhalation. A great deal of thirst, with occasional pain in stomach and bowels on drinking very cold fluids of any kind. Nausea and even vomiting, or retching, is a very frequent attendant symptom, and particularly where the uterus is the primal organ impli- cated ; especially is this the case after hard, prolonged, or in- strumental labors. Tympanitis, pain and soreness of the whole abdomen, causing the patient to lie constantly on her back with her limbs drawn up, to relieve the tension; suppression or alteration of both milk and lochia. The expression is that of anguish and distress, with flushed face, reddened eyes, dry mouth, quick, angular motions, easily fretted, and with general indifference to her surroundings; frequent changes from better to worse, and from worse to better again ; sleep is always more HOMCEOPATHIC TREATMENT OF PUERPERAL FEVER. 1035 or less disturbed with unpleasant or even frightful dreams; wakefulness, prolonged occasionally, for several days in succes- sion, causing great nervous irritable debility ; appetite gone and tongue heavily coated, with extremely foul smelling breath. Profuse sweating is also very common in this disease. The patient is frequently drenched with sweat, accompanied by a hot skin and quick, irritable, though full and soft pulse. The urine is usually turbid, dark, and sometimes loaded with abnormal products. Diarrhoea is also a frequent trouble, particularly in malignant cases. We have thus enumerated most of the promi- nent symptoms belonging to puerperal fever, and now propose to give our experience in its treatment. Where preliminary symptoms appear before delivery, such as feverish and nervous excitement, weak vision and slight shuddering, without chilli- ness, I give Gelseminum three or four times per day with the happiest effects. Aconite is very seldom, or never called for in these lentescent attacks, for the very good reason that there is always a soft and often an easily compressible pulse. Should cases present themselves, apparently demanding Aconite, it should be used very sparingly, and not lower than the 30th dilution. Before I thoroughly understood Aconite in pre- delivery cases, I often regretted having used it, and would give China to help my case through. I know of no remedy yielding more satisfactory results in all such cases than Gels. Veratrum viride has done me very good service, where, added to the above symptoms, there were twitching, involuntary jerking, and jacti- tation of the muscles of the face, neck, arms, and legs. It is a powerful remedy and acts very promptly, and therefore should not be given lower than the 30th, and should not be continued very long. Neither ought either Gelseminum or Aconite be continued after the symptoms, for which they are given, begin to abate. This triplet of remedies, as triplets generally do, re- semble each other very much indeed. Yet, like triplets, when examined with a critic's eye, they are very different in many of their characteristics. Aconite is rarely serviceable during preg- nancy, because it acts primarily upon the circulation. Veratrum viride acts secondarily upon the circulation through the pneu- 1036 world's homoeopathic convention. mogastric nerves, and is therefore not so directly depressing. It warms a cool, moist surface, while Aconite cools a heated one. Gelseminum acts more properly upon the great sympathetic nerves, and therefore quiets nervous irritability better than either of the remedies named. The foetus often moves with a great deal of force against the walls of the uterus, causing un- equal pressure, and consequently soreness, and frequently, almost unbearable pains, lasting for days at a time, often producing lameness of one or both limbs. We have no better or more efficient remedy in all such cases than Arnica, used daily, in the 30th dilution, until general health is again restored. Where evening feverishness, with indefinable, straggling pains appear here and there over the entire person, with sadness, de- spondency, fear of a severe or impossible delivery, dread of the event, and its consequences, I always prescribe Pulsatilla. I am satisfied that Pulsatilla has very frequently saved my pa- tients from child-bed fever, by quieting nervous and emotional excitement. I place a higher value on Pulsatilla in the treat- ment of all disorders of pregnancy, than upon any other remedy in our materia medica. Caulophyllum is also an invaluable remedy to prevent prema- ture labor-pains ; and very materially regulates parturient pains ; and aids in conducting the case safely through all painful troubles to full convalescence. I find Pulsatilla and Caulo- phyllum twin sisters in this respect. Pulsatilla benefits, more particularly, the women of full, soft muscle, mild disposition, disposed to be sad and weeping at trifles. Caulophyllum suits the hard, thin, and vigorous muscled, with cheerful mind, and careless mien. Such at least has been my experience in their use ; and my acquaintance with them has extended over many years. They both control irregularities, and hence promote and sustain the normal standard of foetal life. Their sphere of action extends through gestation and delivery to the close of lactation. This being true, they surely may be prophylactic against all cases of puerperal fever. If, notwithstanding such precautionary treatment, puerperal fever should occur, we deem it an imperative duty to search dili- HOMOEOPATHIC TREATMENT OF PUERPERAL FEVER. 1037 gently for the direct cause. This done, we examine the patient's surroundings thoroughly, and require constant cleanliness, pure air, light and water ; quiet, cheerful faces; pleasant conversa- tion, if any, and in an ordinary tone; no whispering, as the patient is on the alert, and will catch anything which may be said in relation to her condition and prospects. Her diet should be simple, nutritious ami light, such as milk, oat-meal, moderately acid stewed fruits, stale light-bread, crackers, double baked rusks, sago, tapioca, and similar food. The patient's moral and mental state, as well as her proclivi- ties and predilections, should also receive strict attention. Her temperament, age, previous confinements, constitutional tenden- cies, vital force and energy, and her susceptibility to remedies should be studied. Thus prepared, we collect, arrange,and di- gest all the symptoms of the case, and now seek the similimum ; this may require some close discriminations and earnest, hard study, but we shall be amply repaid in all cases. The remedies most generally demanded are first of all Arnica-particularly, in primiparae, who have suffered dystocia, bruises, lacerations, retained placenta, or placental shreds, and have foul smelling lochia. Severe chill throughout the whole body, hands and feet cold ; head and face hot; no thirst; yawning and sleepless- ness until after midnight, yawning with nausea, and bruised feeling, itching and tingling down the back and lower limbs, with shiverings in streaks down the back and thighs, fever after a long chill, lasting until late in the evening, with sour smelling sweats towards morning; tongue rough and heavily coated; ropy saliva and sour breath ; frequent flushes of heat to the chest and face with anguish and oppressed breathing, with abdominal soreness at the same time ; sudden starts in sleep as if frightened, sleep restless and full of dreams, waking up tired and tremulous ; dizzy on raising the head, flashes of heat from the uterus through the abdomen, to the stomach, creating nausea and even vomit- ing. I also use Arnica as a wash to the internal, as well as the external parts, ten drops to the ounce, of rain-water Arnica cases always occur from the first to the fifth day; it is rarely efficient in cases occuring later. It never disturbs either 1038 world's homceopathic convention. the lochia, or ingress of milk, but the contrary, promotes func- tional life. The office of Arnica is to repair losses. Calendula has very many similar symptoms, and should be pre- ferred to Arnica in cases where the vulva has been distended for several hours, the anus bruised and both openings torn into one, from the careless use of instruments, or sheer neglect. I was called to an instrumental case of this kind ten years ago; the in- struments had slipped several times, and the parts were badly lacerated and tumefied. I was called on the morning of the third day, found the patient with a slight chill, which lasted more than two hours, without thirst; followed by high fever with great thirst; aching all over. I used Arnica, but it failed me. I then used Calendula internally and externally with very prompt results. After five days use of it, my patient was convalescent. This case of puerperal fever was primarily inflammatory ; induced by instrumental contusion of the parts. This is the only case in which I have given the remedy, but its effects were so satisfac- tory that I confidently recommend it in similar cases. Aconite cannot be praised too highly in puerperal fever, where no appearance exists of mechanical injuries, but a general inflammatory action supervenes., attended with shiverings, rigors, chattering of teeth, and tenderness over the whole abdomen, fol- lowed by intense continued heat, thirst, short breath, head aches all over with swimming' sensation, forcing- her to turn to the right; she feels as though the bed were turning round, inclines to lie on the right side, speaks quickly, acts hurriedly, and is peev- ish and fretful, apprehensive, vigilant, and anxious. No appe- tite, loathes food, the smell of food often nauseates. Pulse is hard, non-compressible; orgasm of circulation with corre- spondingly rapid hard breathing. Flying, stitching, sharp, cut- ting, burning pains here and there all over the bowels, with occasional flatulency. Urinates often with shudderings. Thin, watery, painful diarrhoea often sets in in Aconite cases, and is very troublesome. In such cases I have used one drop of mother- tincture of Aconite to four ounces of starch-water, with very happy results. Gelsemium is another remedy of great merit in puerperal fever, HOMOEOPATHIC TREATMENT OF PUERPERAL FEVER. 1039 particularly where vision is impaired, great sensitiveness to light, photophobia, and large black spots flickering before the eye. Eyeballs sore to the touch, and lids dry and burning; face flushed, with frequently circumscribed red spots over the malar bones. Headache extending down the spine, and frequently be- numbing the tongue and arms, as though paralysis were coming on. Stupor, drops to sleep easily, is quickly roused but soon sleeps again. Her mental faculties are sluggish ; fever and chill are distinct; the chill is well defined; and the fever runs high, with a hard, wiry pulse, becoming compressible as the disease advances. Dulness of hearing, without much pain. Weakness and empty feeling of stomach, with crampy sensation, leaving a sense of weight and oppression, extending through to the back. A cramplike pain in the uterus, extending down the limbs, and radiating upward on either side of the abdomen. Veratrum viride is another remedy of much importance in this fever; where the attack comes on suddenly with a slight chill, or nervous shuddering, followed by the intense fever, with much oppression in the chest; head and lungs more or less congested; spasmodic twitchings, and restlessness; sudden suppression of the lochia; all the symptoms occur suddenly ; the shock to the system is so great as to drench the patient with a cool, profuse sweat, which often persists for hours. Pulsatilla.-This remedy is my great favorite; it has helped me out of so many serious difficulties, that I really know not how to praise it commensurately with its merits. It suits best patients of a mild, versatile character, who easily cry, laugh, or are sad and melancholy. Its attacks are not violent like those of Aconite, Gels., or Verat. vir., but they are no less dangerous, as they often creep on slowly, mildly, and stealthily, but surely, and if not watched closely will soon place the patient hors de combat. The lochia and milk are both suppressed, or at all events, ab- normal ; all the symptoms are greatly aggravated toward night; more thirst, more pain, more despondency, more very severe after-pains, with dull, heavy, aching pains in the back; small pulse, even when the fever runs pretty high, causing burning skin, followed by profuse sweat, often cool and rather clammy, or 1040 world's homoeopathic convention. sticky ; with a soft, flabby feel of the flesh ; some cough towards evening, with spitting of stringy mucus; urinates often, with some disposition to diarrhoea. Palpitation of the heart, trem- bling of the hands and voice; sight somewhat dim, etc.; hearing also impaired. The patient starts and twitches in her sleep, often moans, and wakes somewhat bewildered; has a feeling of gnawing in the stomach as if hungry, but when she eats her stomach pains, and she has nausea, and sometimes even vomiting. The abdomen becomes tender to the touch ; flatulent and colicky pains play about the umbilicus; also pains cutting through the pelvis across and from the back to the front. I had one case with not only fetid flatus from the bowel, but also loud reports from the uterus, with a feeling of weight, pressure, and fulness; now and then dry burning heat in vagina and uterus, with thick, offensive discharge, causing itching and general irritability ; feet jerked, tingled, and were disposed to go to sleep. She frequently desired them rubbed. She lay mostly on her back, either awake or asleep. Sleep was restless (cat-naps), full of dreams; she waked often, very much disturbed, to soon fall asleep again; sweat during sleep; was easily chilled, and often had icy cold feet, hands, and forehead. The changes in a Pulsatilla puerperal fever are very numerous; one hour you may fancy your patient better, when in another hour she is alarmingly prostrated ; she may sleep and eat, talk and sit up in bed one day, and need the doctor two or three times the next. Stick to Puls.; all will be right. Belladonna is also a remedy of great importance. Its fever is marked by frequent alternations of chill, heat, and perspiration; or, frequently the patient will be chilly for some time, over chest, shoulders, sides, back, and limbs; then hot, and often chilly again. Pains are sharp, quick, electric-like, intermittent; bear- ing down with an involuntary straining force; says, "I cannot help it." Is sensitive to light, noise, and motion ; jarring the bed, or walking heavily disturbs her very much; is delirious at times, often furious, and nervously excited ; mind often wanders. Urine, lochia, and milk generally diminished in quantity and altered in quality; urine and lochia often very offensive. Bell. HOMCEOPATIIIC TREATMENT OF PUERPERAL FEVER. 1041 is particularly called for in fright, grief, mortification, chagrin, cold, and hard labor. The patient every few moments draws up her limbs to relieve the tension of the abdomen. Bell, always acts best upon persons disposed to be fleshy and rather angular in their motions, language, and thoughts. Apis met. is also an invaluable agent in this most trying dis- ease. Restlessness from a fine, rough, red, stinging rash (fre- quently called nettlerash, lying-in rash, nursing rash, and heat rash). Breathing hurried and difficult, feeling as though she could not breathe; excited and anxious; wants to get up every few moments, and then drops back again; is uneasy, and fears death; seems disposed to scold, but gets confused ; complains that she cannot collect her ideas; head feels stupid; dull, stinging, burn- ing pain in abdomen, with rumbling and uneasy distension, ac- companied by a feeling as of the approach of diarrhoea ; bearing- down feeling, with heat, and dry burning of vagina; suppression of lochia. A downward pressure from the abdomen upon the ovaries and uterus, with moaning and muttering; hysterical laugh and cry, so connected as not to be distinguishable in their extremes. Mercurius soL has also done me very signal service, particu- larly when my patient was drenched in sweat night and day, but worse during the night, with chilly and heated spells mixed; generally thirsty without appetite; extremely sensitive to touch and pressure ; feels sore all over as though she had been beaten ; has bruised spots upon her arms and legs from handling. Countenance looks dirty and wan; mouth full of mucus; teeth covered with the same ; tongue heavily coated yellow ; frequent spitting of ropy, tenacious mucus; abdomen sore, burning, weak, painful, with slimy, bloody stools, great pressure on rectum, vagina, and bladder, with tenesmus; moans, starts, and frets. In puerperal peritonitis it is more frequently called for than almost any other one remedy, at least such has been my expe- rience. Bryonia does good service where the fever runs high, and is nearly or quite equal over the whole body, with great thirst; sensitive to motion, often screaming when moved from side to 1042 world's homceopathic convention. side; irritable, irascible, and moodish ; abdomen painful, par- ticularly on pressure ; cough, dull headache, and red cheeks. Nux vom. where there is constipation with painful urging; vaginal heat and sudden suppression of the lochia, with weight and painful burning in the abdomen and sexual organs, and small of back; aching through the thighs and down the legs ; sight is weak, headache over the vertex, with faint feeling ; longing for sour drinks, etc. Rhus tox. where typhoid symptoms appear. Where the cor- respondence between the heat of the surface and the stroke of the pulse is broken, and we find cool surface and high pulse or low pulse and hot skin; vital energy depressed; apathetic, stupid, dull, listless. The remedies above enumerated will, in myopinion, cure nine- tenths of the cases occurring in this country; but the following synopsis of remedies in different stages of the disease, may be profitably referred to when circumstances require, etc.: Puerperal Metritis.-Aeon., Apis, Verat. vir., Arn., Bell., Merc., Puls., Nux v., Stram. Puerperal Ovaritis.-Bell., Lach., Apis, Merc., Plat., Puls., Sabina, and sometimes Conium. Puerperal Peritonitis.-Aeon., Apis, Bell., .Bry., Cham., Coloc., Merc., Nux v., Puls., Rhus. Gangrene, or Putrescence of Uterus.-Sccale, Carbo veg., Arsen., Ustilago, Sulph. Puerperal Typhoid.-Bry., Bell., Baptisia, China, Rhus tox., Arsen., Arn. Puerperal Haemorrhage.-Bell., Croc., Sabina., Plat., Secale, Cham. SILVER WIRE SUTURES IN THE CAESARIAN SECTION. S. S. Lungren, M.D., Toledo, 0. It is the purpose of this article to place before the profession a method of operating in that dernier ressort of midwifery, the Caesarian Section, with an illustrative case, and in so doing I shall briefly allude to the reasons which have induced me to select this method. Becoming satisfied long since that the main cause of failure by the ordinary operation was because the uterus was left to itself, or was closed imperfectly, and being also satisfied, from using them frequently in other operations, that silver wire sutures could remain for years encysted within the abdominal cavity, I determined to employ them in this operation, although, from all the information at my command, I was unable to learn that any one had used them for this purpose previously. Spencer Wells, it is true, used a continuous silk suture, one end of which passed through the vagina, and was withdrawn after some days. The traction exerted upon the edges of the incision must have been very slight indeed if it could have been withdrawn in this manner, but was enough perhaps, as his case recovered. If we look at the direction taken by the peristaltic action of the uterus during a labor-pain (and contractions after labor are essentially the same), it will convince any one who examines the condition carefully of the great importance of sutures in the uterine wound after this operation. Muller, Michaelis, and Wigand teach that contractions commence at the cervix and travel toward the fun- dus, returning thence toward the os uteri. During a labor-pain the os uteri grows tense from contraction of the circular fibres, which, being short, act with great mechanical advantage, and " if the fibres of the cervix contracted with the same force as the rest of the fibres of the uterus, this organ could scarcely be emp- tied of its contents." The fibres of the body of the uterus presenting no resisting force after division, unless secured by sutures, contractions of the longitudinal and transverse fibres and closure of the os uteri 1044 world's homoeopathic convention. by the circular must cause gaping of the wound, with extravasa- tion of the contents of the uterus into the abdominal cavity, when subsequent decomposition gives rise to fatal peritonitis and septicaemia. This, I am assured, aside from shock and haem- orrhage, is the great cause of death after this operation. For, as Wi'nckel has observed, " in many fatal cases, the edges of the uterine wound was found flaccid and gaping." Any one can form an idea of the result of the contractions by making a small slit in a hollow rubber ball and slightly squeezing it. A second detrimental cause, producing mainly the same result as the former, is the rapid fatty degeneration of the uterine walls. The edges of the incision become thin and separated; gaping is produced as in the former case, followed by a fatal result, except in those fortunate cases where union takes place between the uterine and abdominal walls, thus preventing the escape of the uterine fluids. As the fatty degeneration of the uterus after delivery commences on the interior surface, and proceeds towards the peripheral, the sutures (as will be seen further) being introduced partly through the wall of the uterus, the peritoneal surfaces are retained in contact until union takes place, and all danger of escape of fluids averted. This method of introducing the sutures is the more necessary, for as soon as the incision is made and the contents of the womb extracted, retraction of the circular fibres causes eversion of the lips of the wound to a very great degree, as was seen in this case, the ex- ternal edges being bevelled off, and as soon as absorption com- mences below in the interior the slit is enlarged, affording ready exit for the fluids. To obviate such result was the aim in the introduction of sutures. In February, 1871, I assisted Dr. G. D. Beebe, of Chicago, in an operation for the removal of an ovarian tumor. During the operation it became necessary to introduce four silver wire sutures into the body of the uterus to arrest haemorrhage. The patient lived in this city, and I took charge of the case subsequently. There was no trouble from the sutures at the time, and she made a rapid recovery. More than five years have elapsed without the patient having any indication of their presence. With this experience, also, silver wire was preferred and used. Carbolized catgut sutures have been proposed, but should they act as so many points of animal poison they could greatly interfere with a favorable result. I have had no experience with them. With these prefatory remarks I will give the his- tory of the case as briefly as possible: Anna Marie K., set. 29, a Bavarian by birth, the wife of a SILVER WIRE SUTURES IN THE CAESARIAN SECTION. 1045 tailor of this city, and the youngest of six children, was affected with rachitis when she was a year and a half old. Her father died of phthisis at that time. She was placed in a hospital for children, and remained in the institution until she was two and a half years of age. She married at twenty-one, and since her marriage has been pregnant four times. The first time the foetus died in utero, and was expelled in a week afterward. She thought she was pregnant about six months when this event occurred. Twice she had abortions at three and four months respectively, one produced by the physician in attendance, once from some cause unknown. About the middle of March, 1875, I was consulted by the patient and requested to take charge of her case, in her then expected confinement. I had attended her some years previously for uterine disease, and then, upon mak- ing an examination, became aware of malformation of the pelvis at the inferior strait. The os pubis was two and a half inches wide and projected backward inferiorly. The concavity of the sacrum was very great, while the coccyx curved forward like a hook. She was advised then of the abnormal condition and of the importance of consulting a physician in the early months of any subsequent pregnancy. The case passed into other hands afterward, and I did not see her again until the time above men- tioned. As she was already seven months advanced in her preg- nancy at the date of this consultation, and as it was my opinion that the deformity of the inferior strait would permit the pas- sage of the child in a viable condition at this age, I thought labor should be induced at once. Accordingly, with the kind assistance of my friend and former pupil, Dr. M. H. Parmelee, dilatation of the os and cervix uteri was commenced. Moles- worth's Uterine Dilators were used, gradually increasing until the largest size was introduced. At this time it was discovered that the greatest deformity existed in the superior strait, where the promontory of the sacrum, feeling like the head of the child, projected into the middle of the excavation. A very careful examination, made by Dr. Parmelee and myself, confirmed sub- sequently by several medical gentlemen, revealed the fact that the greatest antero-posterior diameter of the superior strait was from 2| to 2| inches. Further attempts at dilating the womb were now abandoned. We had used great care not to rupture the membranes, and as they were now intact it was decided to let the case go to full term, and then, if after mature consideration it was deemed best to perform the Caesarian section, the child would be more likely to live at that period than at the present time. The patient, 1046 world's homoeopathic convention. taking advice of some female friends at this juncture, declared her unwillingness to have any further interference, as they had induced her to believe that "it would be all right and help itself" when the full time of her gestation was completed. So we could do nothing else, had we desired, but wait the result. Telling the patient to keep her bed for a few days, she was soon after allowed to attend to her domestic duties. I saw her fre- quently and finding she was doing very well, left directions to send for me when labor-pains came on with regularity. On May 8th, 1875, at 10 A.M., I was called and found slight labor pains. A consultation of several medical friends was called at 3 p.m. At that time we found the pains coming at intervals of ten minutes, the bag of waters dilating the os uteri to the extent of about one inch. It had remained patulous since the previous dilatation. Auscultation was now resorted to, in order to discover whether the child was alive. It was the unanimous opinion that the child lived, although the mother declared that she had not felt the motions of the child for several days previously. The placenta was supposed to be attached anteriorly. The patient being laid upon a table thickly covered with blankets, chloroform was given, and a final examination was made, under the relaxing influence of that agent, to beabso- lutely certain that there had been no mistake in any of the measurements of the pelvis taken previously; and, also, as the pains were now quite strong, to discover the exact relations of the child's head to the contracted opening, and whether embry- otomy could be safely performed. The question now resolved itself into these two points,-embryotomy or Caesarian section. Taking into consideration the extremely contracted opening, the risk from embryotomy was very great to the mother, and one life would of necessity be sacrificed, perhaps both. The Caesarian section gave the possibility of life to both. The latter alterna- tive was adopted. The administration of chloroform was continued, and assisted by my friends, Drs. E. P. Gaylord, A. C. Barlow, E. M. Good- win, M. H. Parmelee and S. S. Parker, an incision was made through the integument reaching from the umbilicus to within one and a half inches of the symphysis pubis. There was marked separation of the recti muscles, and the linea alba was wide, as is usual in advanced pregnancy. Its substance being divided the peritoneum was reached, and a small opening being made in that membrane, the forefinger of the left hand was introduced, and, using it as a director, the peritoneum was divided to the full extent of the external opening. The uterus being steadied by SILVER WIRE SUTURES IN THE CJESARIAN SECTION. 1047 the assistants, it was divided layer by layer, taking care to make the first opening into its cavity at the lower end of the wound to avoid the placenta, should it be attached, as we supposed, anteriorly. Such was unfortunately the case, and as soon as the uterus was opened to the extent of two inches, the placenta was wounded. At once a catheter was introduced through the mem- branes into the vagina, followed by a large sponge probang, to allow a free exit for the waters through the natural passages, th us avoiding their escape into the abdominal cavity. Then using the finger as a director as before, the uterine wound was en- larged to the extent of six inches, when the right arm and shoulder of the child presented at the opening. By flexing the chin upon the breast and turning the child the vertex presented, and delivery was speedily accomplished. The placenta was removed through the opening immediately afterward. The child was alive and cried lustily. At this stage of the operation there was a great amount of haemorrhage, but, by seizing the womb with both hands to induce contraction, the bleeding was par- tially arrested. But the division of the fibres of the womb on one side and contraction of the other fibres, caused eversion of the edges, and opening of the wound was produced. From this opening the blood flowed freely. Five silver wire sutures (wire No. 28) were now introduced to close the uterine wound. The sutures were entered about one quarter of an inch from the edges of the incision, and carried nearly through the sub- stance of the uterus as in hare-lip operation. Each suture was twisted tightly, twice only, and the wire cut off* closely to the twist, which was then turned downward into the wound, at right angles to the suture, care being taken to approximate the peri- toneal edges. The uterus now contracted well, and the haem- orrhage ceased. After sponging out with great care all clots from the abdominal cavity, the external wound was closed by using silver wire for the deep sutures; silk was used to unite the integument. The peritoneum was included in the deep sutures to avoid blood or pus falling into the cavity of the abdomen. Strips of lint, saturated with a mixture of Carbolic acid, one part, linseed oil two parts, were laid lengthwise over the incision. Strips of adhesive plaster between the sutures, three-quarters of an inch wide and twelve inches long, completed the dressing and prevented all access of air to the wound. A binder was placed round the body, and the patient placed in bed. The whole oper- ation was completed in twenty-five minutes. The case was treated strictly homoeopathically ; no Morphia 1048 world's homoeopathic convention. was allowed to quiet pain, which, after the first night, was not present to any extent. Aconite 3d and Arnica 3d were given in alternation every hour at first, then every two hours, for four days, and to show how little irritation was set up in the system by the operation, or the presence of the sutures, and the aid afforded to nature by the remedies, I will transcribe from my notes a synopsis of the symptoms for the first few days: May 8th, 1875, 9 p.m.-Four hours after the operation, pulse 100, soft; complains of much pain in the hips and back; gave orders to have her remain on the back all night. May 9th, 8 a.m.-Fifteen hours after operation. The patient has had a restless night; complains of pain in the incision, hips and back ; pulse 90, soft. 8 p.m.-Pulse 80, soft. Temperature 100degrees; has taken a little milk and water during the day. May 10th, 10.30 a.m.-Forty-two hours after the operation. Countenance good; slept three hours during the night; temper- ature 99f degrees; pulse 70, a little harder ; has taken a pint of beef tea since last visit; complains of but little pain ; has nursed the baby some; tongue moist, with a slight white fur upon it; no redness of tip or edges. 8.30 p.m.-Pulse 68 ; temperature 100J degrees ; baby has nursed several times during the day; abdomen is soft; no tym- panites; skin soft and moist; respiration natural. May 11th, 11 a.m.-Sixty-six hours after the operation; pulse 66 ; temperature 99 degrees ; ate rice and beef tea this morning ; slept about five hours last night, two hours at one time; breasts full, milk abundant. 5.30 p.m.-Tongue cleaning; pulse 70; temperature 99J de- grees; says she wants to get up for she feels so well; lochia normal. May 12th, 9 A.M.-Patient slept for six hours during the night, and two hours after daylight this morning; pulse 68, soft; temperature 99J degrees; tongue quite clean; no tympanites; feels quite comfortable; only tired of lying in bed; says she could have another the same way, if it were not more painful than this, etc. 5 p.m.-Pulse 70 ; temperature 99J degrees; has all the milk the baby needs. May 13th, 11 a.m.-Pulse 72; temperature 100 degrees; appetite good ; no pain on slight pressure over the abdomen ; can raise the legs and put them down without pain; lochia normal; no pus discharged per vaginam. SILVER WIRE SUTURES IN THE C2ESARIAN SECTION. 1049 5 p.m.-Pulse 77 ; temperature 99j- degrees; holds the child to the breast herself. 9 p.m.-Pulse 75; temperature 100J degrees; passed urine involuntarily, and she had to have her clothing changed ; com- plained of pain afterwards; examined the uterus per vaginam; the temperature seemed normal ; has taken about a quart of beef tea in the last twenty-four hours; gave Aconite and Arsenicum. May 14th, 10.30 A.M.-Pulse 74; temperature 100 degrees; no pain or tympanites ; no stool since the operation; no appear- ance of pus in the external wound. 9.30 p.m.-Pulse 70; temperature 99f degrees; complains of great itching along the line of incision. May loth, 11.30 A.M.-Pulse 72; temperature 100 degrees; milk abundant; patient laughs, and says she feels as well as usual; no pus under the external dressing; no desire for stool, neither are the bowels distended with gas. 7 p.m.-Pulse 74; temperature 99| degrees; nothing new to report. Sunday, May 16th, 11 a.m.-Ninth day; pulse 80; temper- ature 99| degrees ; removed one silver suture and two of silk from the lower edge of the wound, which seemed to have united by the first intention, as there was no pus visible, as far as could be seen, without removing all the dressing; gave injections of warm soapsuds ; patient had natural stool soon after. 7.30 p.m.-Pulse 80 ; temperature 100J degrees. May 17th, 11 a.m.-Pulse 88; temperature 100J degrees; slept all night with but few waking periods; feels well. 6 p.m.-Pulse 96 ; temperature 101 degrees ; lips a little dry; wants to drink often, but a little at a time. Gave Arsenicum 3d every two hours; milk not so abundant as usual. May 18th.-Pulse 88 ; temperature 100 degrees; removed all the silk and silver wire sutures ; of the latter seven had been used (one to the inch); a little pus was found around one of them ; not much lochial discharge. May 23d.-Patient looks and feels entirely well; pulse 78 ; temperature 99 degrees; no medicine. From this time I ceased to take any further notes of the case, nor would I have given these details, so similar in character, from day to day, but that I considered it was of much import- ance to know that so grave an operation was followed by symp- toms so trivial in their character. All the pain of any severity was endured within the first twenty-four hours after the operation, and it was not apparently greater than many women suffer from "after pains " during that 1050 world's homoeopathic convention. period. She appeared almost as well as women usually are after labor, and begged to get up long before I was willing that she should do so. Five weeks after the operation, she performed all her domestic duties, including washing, and June 21st she walked to my office, a distance of one mile from her residence. More than a year has now elapsed since the operation. Mother and child are well. There has not been the least trouble from the sutures, nor any indications of their presence. DISCUSSION FIFTH SESSION. Friday, June 30, 1876. The fifth session of the World's Convention was convened at 9 J o'clock Friday, June 30th, by the President, who an- nounced that the order of business for the day would be the dis- cussion of the papers pertaining to the department of obstetrics and gynaecology, and that in accordance with the printed pro- gramme the discussion would open upon the paper on Puerperal Fever. S. P. Burdick, M.D., of New York: The first question in my mind is, What is Puerperal Fever? Does its name, per se, refer to a special or to a general condition ? I had hoped when receiving this paper to have a rich mine from which to ob- tain truths that would throw some light upon this subject; but I must confess that I think those who have read it carefully will agree with me that we find no light in it, as it is simply a repe- tition of a variety of views of men chiefly of the old school of medicine, who boast of their pathological education. This is not what we require as homoeopaths; but we want to understand its therapeutics, and we w'ant to know its origin, whether it is small- pox, measles, scarlet fever, typhoid fever, or some unknown blood- poison without name or origin ; we are leaving ourselves in the dark when we adopt this sweeping classification of disease called puerperal fever. From careful observation and information I conclude that the true puerperal condition is a septicaemia, and we may find a case of abdominal and pelvic peritonitis that has be- come puerperal from a traumatic influence; or puerperal disease may result from suppressed perspiration or careless nursing. I have in lying-in rooms repeatedly seen the most violent abdom- inal and pelvic peritonitis arising from traumatic causes placed, side by side with other patients without any unpleasant results. Again, I have seen puerperal fever induced by septic poison, and the contagion would spread through the wards like wildfire. Puer- peral fever arises from a specific poison, but it does not follow that the poison which once produces this disease will always pro- duce it. Puerperal fever may arise, from thepoison of phlegmonous 1052 world's homoeopathic convention. erysipelas, or from poison received from a cadaver, or from scar- let or typhoid fever, or diphtheria, or the poison may be commu- nicated to a puerperal patient and from that patient communi- cated to others, producing erysipelas or other kindred diseases ; in which case it is not, properly speaking, a contagious disease, although it is a septic poison. The poison may affect the puer- peral patient through some abrasion or rupture that may be present in the mucous membrane of the vagina or uterus, or from a laceration of the vulva. Now, if in consequence of imperfect or improper cleansing of the hands or dresses of those in atten- dance, who have been in contact with the decomposed or organic matter, any particle of this matter comes in contact with the sen- sitive or abraded surface, there will be absorption and puerperal fever, and by this I mean a purely septic poisoning. When this poison is brought in contact with the denuded sur- face of the mucous membrane of the uterus we may have endo- metritis which may be fatal; but in a majority of cases the poison comes directly in contact with laceration of the vagina and vulva and the poison is absorbed and carried into the cellular tissue, producing perimetritis; exudation into the pelvic cellular tissue follows, and as a secondary result we have pelvic peritonitis, which extends into the abdomen. In the progress of this disease the lymphatics are much in- volved and thrombosis occurs, by which they are occluded, and the spread of the disease cut off from the more extended lymphatic vessels and glands; as the disease progresses and the inflam- mation extends to the abdominal viscera there is exudation into the abdomen, with extensive ulceration, which may extend into the diaphragm and thence to the pleura, and in fact almost every organ in the body may be involved. We can only recognize this disease in contradistinction to the ordinary abdominal or pelvic peritonitis by external and internal examinations. By the internal examination the diseased action will be found loca- ted in the cellular tissue, and on account of the exudation thick- ening will be found on the sides of the uterus in the form of a furrow. In the early stages the patient can turn from one side to the other without inconvenience, as the perimetritis may not .go on to such an extent as to largely involve the peritoneal membranes; but when the inflammation extends to those mem- branes then the patient is unable to turn in bed, the limbs are* flexed upon the body, and the symptoms which occur in peri- tonitis are observed. When purely abdominal peritonitis grows out of this trouble, the use of Arnica, Bryonia, and Aconite will, in a large majority of cases, control the disease and speedily DISCUSSION ON OBSTETRICS AND GYNAECOLOGY. 1053 restore health; but if there is septicaemia it is a much more serious condition, for we must meet the inflammatory condition, and also provide for the elimination of the poison from the sys- tem, and in order to do this we must depend on those remedies which tend to counteract that blood-poison, when Secale and that class of drugs will be most useful. The President : I am requested to say that as some lady physicians attending the meetings of this Convention desire to become better acquainted with each other, they are invited to meet this evening at the house of Dr. Harriet J. Sartain. Dr. O. P. Baer, of Richmond, Ind.: I claim to be a prac- tical man, and I deal most materially with materia medica and disease-pictures. I take exception to Dr. Woodbury's paper, and as the paper I have prepared is too long to read here, I pro- pose that Dr. Smith, of New York, read that part which refers to the symptomatology and treatment.* Dr. R. Ludlam, of Chicago Ill.: I take great pleasure in speak- ing upon the subject of puerperal fever, more especially as my views concerning it have within two years undergone a very remarkable change. Two years ago, at the meeting of the American Institute of Homoeopathy at Niagara Falls, I read a paper on puerperal fever; a discussion followed, during which my friend Dr. Swazey, of Massachusetts, a thorough and distinguished physician, astonished some of us by saying he had never treated a case of puerperal fever. We thought it a little remarkable at the time, but at present I do not believe in the existence of a dis- tinct diseased condition which should be called by this name. There is no such thing as puerperal fever! I can add nothing to what my friend, Dr. Burdick has stated so well and clearly. We should study the affections of the puerperal state, and not talk about a fever which is incident to all of them. If we do study the various conditions of lying-in women, we can then treat them intelligently, and not treat them under the name of a fever which, before another Centennial, will be like ship-fever, un- known only by name. Dr. Woodbury's paper will be intensely interesting as a mat- ter of history. I think his treatment is indicated in puerperal septicaemia; and I think that puerperal septicaemia, which un- derlies and complicates all this class of diseases, unless there is pyaemia instead of septicaemia, is incalculably infectious but not contagious. In brief, I think that Schroeder's theory in regard to the in- * See Therapeutics of Puerperal Fever. Page 1033. 1054 world's homoeopathic convention. variable existence of a class of lesions mnst refer oftener to the mucous membranes of the vagina and cervix in the mildest cases, where there is retention and absorption of organic matters, whether introduced into the body or directly into the circulation. Puerperal septicaemia occurs, as a rule, before the little rents and abrasions commence to granulate, as after that stage there is no longer danger of the poison being absorbed. I think it is rather an irritation at the seat of the placenta, which was by Simpson regarded as a stump after amputation, and the fever he considered identical in nature with surgical fever. According to Schroeder's observations in 1835, in thirty- two cases of perfectly natural labor, these rents of the vagina, vulva and cervical mucous membrane were found; the only wonder when we think of it is that any woman is exempt from puerperal septicaemia. I wish to allude for a moment to the use of the clinical ther- mometer, which in this class of cases has a wide range of utility. There is no possible means by which we can ascertain so early, surely and clearly a threatened septicaemia condition in lying- in women as by its use ; it is an electrical bell, warning us ofthe condition, and by its use we are led to anticipate serious conse- quences. The pulse is unreliable, the chill may or may not occur, the patient may or may not be delirious; there is nothing to be depended on like the clinical thermometer. The patient's temperature should be taken every morning and evening from the hour she is delivered until the sixth day, and were this always done, many serious consequences might be averted. Puer- peral septicaemia occurs previous to, and pyaemia after, the sixth day. Now if the temperature is higher in the morningthan it is in the evening it is a bad, but not necessarily a fatal sign. The use ofthe thermometer also gives us reliable information about the progress of the disease, as well to what extent our remedies are checking its progress, unbiassed by an opinion of our own, the nurse's, or patient's ; it is something certain. If after giving the indicated remedy the temperature goes down, it proves that it is acting well; otherwise not. No matter where the pulse is, if the temperature is nearly normal, the patient is not sick; and if it is high, no matter where the pulse is, the condition is serious; this is sound theory based upon experience. The thermometer is useful in pyaemia in cases that run along from five or six days to three weeks, and in which the temperature has continued high; now if it suddenly drops below the ordinary standard the patient will die; but if it only DISCUSSION ON OBSTETRICS AND GYNECOLOGY. 1055 drops two or three degrees, there is no cause for alarm, unless there is some other complication. The temperature often sud- denly falls in pyaemia when an abscess is forming, and that must be located before making a prognosis; these cases often recover. There is an idea that puerperal pyaemia is necessarily fatal; but this is erroneous, because abscesses will occur in the mammae, and they are often favorable to the patient, as it had better be there a thousand times than once within the abdomen or other important cavity that cannot be reached. We have a high range of remedies, and when we come to un- derstand their application we shall be able to work wonders. We have the indications for remedies given by my friend, Dr. Baer, and so far as my experience goes they are reliable; but there are other indications connected with the use of the ther- mometer, which should lead us to give something to lower the temperature as soon as it commences to go up. We have reme- dies that will do it, but there is no time to wait for the slow- acting remedies, like Arsenicum ; we must bring the heat down between the morning and evening visits. Let the pulse alone; it is not so reliable as the thermometer, but it is well in its way. Veratrum viride is useful in lowering the temperature, which will sometimes fall two degrees after its use. C. A. Bacon, M.D., New York.* The Chairman: This closes the discussion of Dr. Wood- bury's paper on puerperal fever. The discussion of the paper on "Diseases Incident to Pregnancy" is next in order. J. H. Gallinger, M.D., Concord, N. H.: Ordinarily I am averse to making apologies, but in this instance I feel it my duty to depart, in some measure, from an established custom, and to preface my remarks with a word of explanation. I find myself assigned to discuss the paper of our distinguished colaborer, Dr. H. N. Guernsey, of Philadelphia, on "The Homoeopathic Treatment of Diseases Incident to Pregnancy." No man in our school is more ready than myself to award to Dr. Guernsey the meed of praise that he so richly deserves for his painstaking and zealous efforts to advance the cause of homoeopathy.; and could I consistently do so, it would certainly be to me a very pleasant task to indorse and applaud the paper that is before us for dis- cussion. But to my mind it contains many statements seemingly at variance with facts, and hence is calculated to mislead the younger members of our profession, especially in hours of pecu- * Debate not received.-Ed. 1056 world's homoeopathic convention. liar anxiety and under circumstances of the most painful solici- tude. Remembering the injunction of our President, in his open- ing address, to be honest in the expression of individual views, I find myself in the position of a critic of the writings of a man much older and more learned than myself, and whose name in our ranks stands certainly as high as that of any other member of our profession. That the task is an unpleasant one I admit, and that I will be regarded by many as audacious, to say the least, I confidently expect. Dr. Guernsey prefaces his paper with the declaration that " in the science of medicine we hold that the laws expressed in the formula 'similia similibus curantur' is the law of cure existing in the nature of things, and, therefore, of universal application in the art of healing. And this law of healing is just as applicable as are the laws of chemical affinity in all operations of chem- istry, the laws of gravitation and of motion in all matters in which the relations and movements of bodies are concerned." He also says that " if we would develop and advance our science year after year, as other arts and sciences are advanced and perfected, ... we must persistently and correctly apply the law that underlies and governs it." In another part of his paper we are told-and his words are quoted literally in every instance-"The formula 'similia similibus curantur' expresses an infallible law." Now, it seems to me like the height of presumption for any man to claim infallibility for the homoeopathic law, or to assert, as Dr. Guernsey does, over and over again, that it is " the only law of cure." If it be true that the homoeopathic law is " infal- lible"-as unvarying as the laws of chemical affinity or gravita- tion-then I would ask, as deferentially as possible, why it is necessary, as he advises, to "develop and advance our science year after year?" Can infallibility be made more complete? After calling attention to the fact that the introduction of steam by Watt was at first ridiculed, but finally gained universal recognition, Dr. Guernsey adds: "The law of the similars is universal, is peculiar to itself, is uniform and correct in all respects, like every other natural law. It only awaits the ful- filments of all conditions in which it is to be used, like the using of any other natural law, the inherent power of steam, for in- stance, and its success is equally perfect. Before another cen- tennial this law of cure will be as universally acknowledged as are now the power and applicability of steam. All other modes of healing will be as little known and sought after as are now other motive powers than steam," etc. While this grand pro- DISCUSSION ON OBSTETRICS AND GYNAECOLOGY. 1057 phetic faith of the author's is refreshing to the minds of all of us who claim the title of homoeopaths, yet the doubting Thomases will likely be inclined to reserve their opinions until the arrival of the next centennial. Already it is a demonstrated fact that electricity is a motive power hundreds of times greater than steam, and only awaits the discovery of a cheap substitute for zinc to enable it to supplant steam entirely, and so it may be that in the persistent search for scientific knowledge it may be demonstrated that homoeopathy is but the stepping-stone to a better and grander, because more perfect, system of therapeutics. Probably whatever that system may be " similia " will be the arch to the temple. I now come to a consideration of the illus- trative cases introduced to prove the correctness of his prelimi- nary declarations. In any further criticisms that I may make I wish it distinctly to be understood that they are simply the logical expressions of a mind desirous of securing the greatest possible good from this discussion, and not instigated by any unworthy motive or purpose. The paper asserts that when women have been treated in accordance with the homoeopathic law, " they invariably get on much better in every respect than if treated otherwise. They give birth to the best-developed and most healthy offspring ; have much easier labors ; are much less liable to haemorrhages, malpresentations, convulsions, or to post-partum troubles of any kind, besides getting up from their confinements in a shorter time and a better state of health; and they are much less liable to abortions and premature labors." It is certainly a matter of great pleasure to us all to learn this fact, which, in the light of our author's extensive experience, we gladly accept as true. The first case presented is one of threatened abortion from traumatic causes. The patient was six months pregnant, and was injured by a little child sitting heavily upon her abdomen. As might have been expected, the symptoms of miscarriage followed. The patient received Arnica 200th, and, ergo, the accident was averted, the symptoms abating after a few days of rest. Now, before I ever gave a homoeopathic prescription precisely similar experiences came to me ; and since giving Arnica in such cases I have in some instances failed to avert miscarriage that resulted from traumatic causes. The doctor's isolated case proves noth- ing whatever, as rest will frequently be sufficient to avert the danger, while other cases will go on to complete abortion in spite of Arnica or any other remedy-at least that has been my experience. The second case is one of threatened abortion from dynamic 1058 world's homceopathic convention. causes. The patient had aborted three times, and was threatened with a fourth. An inquiry into the case revealed the fact that about the second or third month she would experience stinging pains in the left ovary. This naturally suggested Apis, which was given in the 200th attenuation. Gradually the symptoms abated, the patient went to full term, and was afterwards fortu- nate enough to give birth to a family of children. Now, while we all recognize this as an excellent cure of ovarian inflamma- tion, yet will not some minds be unbelieving enough to ask what would become of the assumption that the cure was made in accordance with " the only law" governing the action of remedial agents, provided a similar cure was made by a physician of the old school through the instrumentality of counter-irritation and rest ? Dr. Guernsey next asserts what we all know to be true, that after-pains are quickly relieved by homoeopathic remedies, but so also they are by eclectic and allopathic doses, which probably are not administered in accordance with "the only law of cure." In a case very similar to theonecited by Dr. Guernsey, in which frequent abortions occurred, I found that a displacement of the uterus was the cause of the entire trouble. Mechanical appliances remedied the trouble, and future pregnancies went on to full term without any mishap whatever. Abnormal presentations at birth, our author declares, are likewise remedied by treatment subsequent to confinement. However skeptical we may be on this subject, I for one am content to let it rest at present in that form, subject, however, to future investigation. All the various gastric troubles, such as nausea and vomitings, etc., are declared to be readily amenable to homoeopathic treatment; yet I recently saw a case of vomiting from pregnancy that termin- ated in death before the third month, notwithstanding the most earnest efforts of several homoeopathic physicians to avert the calamity. Had the uterus been emptied by mechanical means, at the proper time, a valuable life might have been saved. Bi- gidity of the os and of the soft parts, as well as contraction .of the os, are said to need no mechanical aid, and a case is cited of extreme contraction of the vagina, at the time of pregnancy, which promptly yielded to Aconite 200. While in such a case I should prefer either Gelseminum or Lobelia in tincture form, yet doubtless the spasmodic rigidity of the os and soft parts will yield to a great variety of remedies. And again, it is not an unusual circumstance for a case of rigidity of the soft parts to yield almost instantaneously without any indication, while rupture of the uterus sometimes occurs in spite of our best-directed DISCUSSION ON OBSTETRICS AND GYNAECOLOGY. 1059 efforts. I am quite unwilling to give up the valuable aid that Caulophyllum, Cimicifuga, and Ergot render us in some cases as agents that induce contractions of the uterus when the pains are feeble and the labor correspondingly tedious. Yet the action of these remedies in palpable doses can hardly be called homoeopathic. Passing over some points that I would gladly notice, did time permit, I come to the following declaration: " Varices, or varicose veins, wherever found in the pregnant woman, gradually and entirely disappear under the influence of the properly chosen homoeopathic remedy. Very, very often have I produced such a result in from two to three weeks by a single dose of Lycopodium 100,000, Pulsatilla 10,000, Arnica 40,000, or some other remedy according to the indica- tions." With the potency I have no controversy. If remedies cure in the 12th attenuation, I see no reason why they may not cure in the thousandth or ten-thousandth. What I take excep- tion to is the statement that those cases are ever cured, during the progress of pregnancy, by medication. Let us glance at the pathology of these cases. The gravid uterus presses upon the ascending vena cava, interrupts the upward flow of the blood, and necessarily induces a varicose condition of already debilitated or diseased bloodvessels in one or both of the lower extremities. Do the members of this convention be- lieve that so long as that pressure continues any medicine, high or low, will effect a cure? But I go further, and say that in many cases the bloodvessels are so distended as to break down the internal coat, thus resulting in what might be called a surgical injury, and these cases are absolutely incurable even after confinement is completed. Assuming a chronic form they will occasion comparatively little suffering, but a permanent cure is not to be expected. In the same connection our author says: " Cramps during pregnancy come under the head of abnor- mal pains, and are as easily vanquished." But what if the cramps are due to the pressure of the gravid uterus upon the spinal nerves? Will remedies then always suffice? I trow not, or at least relief can only come slowly and uncertainly. If our distinguished author means to say that his high attenuations will cure a constitutional dyscrasia that predisposes to the varicose condition, I have no controversy on the point; but when the statement is unqualified, that all cases of varicose veins in the pregnant woman will promptly yield to the administration of such remedies as he advises, I certainly feel like respectfully holding on to my hat while the high dilution gale blows by. 1060 world's homoeopathic convention. H. N. Guernsey, M.D., of Philadelphia, was then introduced and spoke as follows : Dr. Guernsey : It seems hardly worth while for me to defend my paper, for no homoeopathic physician who understands and practices the law of cure as given by Samuel Hahnemann in his Organon of the Healing Art would have written such a reply as the preceding to my paper. I retract nothing that I said in it, for it is all true! Our law of cure is perfect, and consequently infallible. What we need is, to learn how we can better and more widely apply it. That is what I meant by saying, "we must develop and advance our science." Dr. Gallinger has referred to a case of death caused by vom- iting during pregnancy at three months, " notwithstanding the most earnest efforts of several homoeopathic physicians to avert the calamity." And further, "had the uterus been emptied by mechanical means, at the proper time, a valuable life might have been saved." The clause "might have been saved" is well added, for the doctor must know that many "a valuable life" has been sacrificed by enforced premature labor. In the case he mentioned, was our law in fault or did the "attending homoeopathic phy- sicians" (perhaps only so called) fail to properly apply that law? We all meet with failures, but I always charge the failure to the physician and not to our law. Hence the need of study for its more perfect application and development. In my case of threatened abortion from traumatic cause, cured by Arnica, I did not say that this was the only remedy. On the contrary, I carefully stated (though my reviewer in his criticism omitted to say so), that " Arnica is not always the remedy for these traumatic conditions. A combination of circumstances, sensations, and conditions must always decide, and the law must be strictly applied."* Regarding the treatment of varicose veins in pregnancy, my reviewer takes up some of the old doctrines found in allopathic books, which state that varicose veins are produced by pressure on the gravid uterus and bloodvessels-views I think false. I accept Hahnemann's pathology, and, like him, select some remedy that has the conditions of the system present at the time of prescribing, and I have known hundreds of cases of varicose veins to be cured by highly dynamized homoeopathic remedies. The men who strictly follow the teachings of Hahnemann know what success in the treatment of any kind of disease really is. * See page 981, line 18 from top. DISCUSSION ON OBSTETRICS AND GYNECOLOGY. 1061 The chair then announced that the paper on "Hysteria" was next in order, and it was taken up, the first debater being Dr. H. N. Guernsey, of Philadelphia. Dr. Guernsey : I have but a few words to say about the treat- ment of hysteria ; the pathology given in this paper is much like what we find in the medical literature of the present day. I believe hysteria to be a curable disease when treated homoeo- pathically, but not when treated in the manner spoken of by this gentleman, who recommends the inhalation of chloroform at each paroxysm. The paroxysm of hysteria is, in itself, nothing more than an opportunity afforded the conscientious physician to study care- fully the symptoms. I earnestly seek to find the cause for all the mental and physical symptoms; then I collate these with the genera] condition of the patient, getting a careful history of the case from her early life to the present time. I then select and give the remedy according to its characteristic indications, and it gradually overcomes that morbid state called hysteria. Such diseases cannot be cured in a hurry; they disappear slowly, improving week after week, month after month, or year after year, the paroxysms growing lighter and lighter until they disappear. Cure the patient, and there will be no paroxysms. Concerning puerperal fever, I desire to say that I treat what is called puerperal fever on exactly the same principle as I would treat typhus, intermittent, croup, or any other disease; and I can always cure it. I keep the whole case in my mind, and get the remedy that will completely cure the "totality of the symptoms presented." The more carefully we select a remedy the less often shall we be obliged to change it; but we must be sure to get the right remedy at first. Veratrum viride or Kali carb, are useful. 1 do not fear an epidemic of puerperal fever. I wish to defend the system of homoeopathic treatment given to us by Samuel Hahnemann in his Organon of the Healing Art. For with that and our materia medica we have all we need with which to combat disease. (Applause.) O. B. Gause, M.D., Philadelphia : I regard hysteria as an acquired, and yet to a great extent an idiosyncratic disease; that is, it is not a form of disease to which all are liable, but requires for its victim a person of a peculiar temperament. In order to treat it successfully we should investigate the history of the patient from childhood up. The paper under discussion is val- uable according to the conclusions of its author. Pie thinks that hysteria is not a disease depending upon sex, but admits that it is more frequently seen in women, and after puberty, which as- 1062 world's homoeopathic convention. sumptions are true. We can conclude from this that there is, after puberty, an excitation of the emotional nature which causes the condition called hysteria, and I think that many young and middle-aged ladies who have hysteria were unfortunate as to proper educational influences and discipline. They were not taught to use their will-power in the direction of self-abnegation, but were permitted in childhood to enjoy their wishes and whims until they became, to a great extent, masters of their parentsand lost all self-control; then as they developed into womanhood the habit grew with them, and they became hysterical from having a peculiarly nervous temperament. Now, if these patients can be taught that they have the power given them by the Almighty to exercise self-control, and if they can be induced to use that power, we have a very useful adjuvant to assist in our treatment. I agree with Dr. Guernsey that it is not essential to attend to the paroxysm alone, but that the idiosyncrasies and general condi- tions of the patient ought to be considered ; the remedy should be given without regard to the paroxysm further than as a factor of the whole condition. I wish to emphasize what I have said in reference to the proper education and discipline of hysterical women. The want of this I consider a cause of hysteria, and the use of it a means or an adjutant in its cure. I wish to speak on the very valuable, though brief, paper on " Membranous Dysmenorrhoea," by my highly esteemed friend, Dr. Ludlam, and I will say that he has given me a new thought in advancing the idea that in nearly all cases of what is termed ovular abortion, which frequently occurs in women subject to membranous dysmenorrhoea, and who are sterile because they conceive and do not know it, the trouble results from the sup- pression of some acute disorder by external means. The dis- order remains hidden in the system, and is only manifested by means of this dysmenorrhoea or ovular abortion. When I read the paper I had under treatment a patient about whom I have been exceedingly interested and anxious for five or six years. She has been a wife many years, and both she and her husband are anxious to become parents. 1 made up my mind several years ago, after a monthly period, during which an almost perfect cast of the mucous membrane of the uterus was discharged, that it was a case of ovular abortion. When I got this idea of Dr. Ludlam's I did not think I had all I wanted, but went to work and got the patient's family his- tory. According to her statement she had had no form of cuta- neous disease, so I thought perhaps the husband was in fault; I .found that he had suffered for many years with a chronic eczema DISCUSSION ON OBSTETRICS AND GYNAECOLOGY. 1063 of the limbs and body which had been a pest, and of which he could not get cured. Iler abortions are all ovular. She has never gone to that point where an absolute nutritive circulation could be established between mother and child, and I trust in Dr. Ludlam's next paper on this subject that he will say some- thing about the influence of the husband upon such conditions. The Chair: This concludes the discussion of the paper on " Hysteria," which is now open to general debate. We will next take up the paper presented by Dr. A. Claude, of Paris, upon " Menorrhagic Chlorosis." Richard Hughes, M.D., England : I have the pleasure of Dr. Claude's personal acquaintance, and I know his intelligence and worth. He is a young man who I think will yet do good service for our cause. He is the recording secretary of the Homoeopathic Society of Paris, and is a frequent contributor to the French medical journals. His paper consists of a mention of that unusual form of chlorosis in which the accompanying state of the menstrual func- tion is not normal, and in which there is not merely menorrhagia, but metrorrhagia. This is a rare form of disease, yet it occurs sufficiently often to be noted and its causes ascertained. Dr. Claude discusses these points with the fluency and precision so characteristic of the French school in treating of every form of disease. The paper contains much that is interesting and val- uable. I can say nothing in criticism of the position that Dr. Claude assumes, except I think the case of his own of which he speaks was an instance of the disease in question. As I read it his case is one of simple haemorrhage which has caused an anaemic condition. He has undertaken to treat the patient for metrorrhagia, and has already gained a very great success, the patient being much better. The medicine with which he has been most successful is Hamamelis. Dr. Claude is doing good work in introducing the new remedies, as yet little known among them, to our French colleagues. I consider Hamamelis to be one of the most valuable additions to the materia medica which this country has contributed. I have the utmost confidence in it for many forms of haemorrhage, and I think of it for almost all forms of passive haemorrhage, from any part of the body, unless there is some special indication for another medicine. I am glad that its usefulness is being recognized by the old school in my country. Dr. Seguin, whose manual of therapeutics you have doubtless all seen, and who is a physician to the college and hos- pital, and a professor of materia medica in the college attached, in the fourth edition of his work introduces an article on Hama- 1064 world's homoeopathic convention. metis, in which he gives the credit to Dr. Preston, of America. Although Dr. Preston is an eminent homoeopathist, he mentions his name and lauds him for furnishing a drug so valuable in haemorrhage and bleeding piles. My own success has been most marked in bleeding piles. He gives the medicine in four-drop doses several times daily, and I think in that dose he does the patient no harm. He states : " I hope the time will comewhen we shall have a great many more of these new remedies." I mention these things that you may know that many of our ad- vanced men are looking into homoeopathy, and I have every rea- son to hope that the time will soon come when the source from which many of these new remedies are derived will be acknowl- edged, and then we shall have worked to some purpose in our special field. The chairman announced the paper on " Membranous Dys- menorrhoea " to be next in order, and called upon Dr. T. G. Kinne, of Paterson, N. J., to open the discussion. Dr. Kinne : After reading the excellent paper on 11 Dys- menorrhoea," by Dr. Ludlam, I found that I agreed with him in all respects, and what I have to say will be more complimentary than otherwise to Dr. Ludlam's paper. By the term dysmenorrhoea we understand difficult and pain- ful menstruation, without regard to quantity of flow or regularity of occurrence. It may be regarded rather a symptom than a disease as we recognize the prior existence of various morbid conditions. The kind of dysmenorrhoea depends upon the character of the affec- tion ; whether it be an irritable state of the nerves, change, either acute or chronic, in the parenchyma of the uterus, dislocation or malformation of the organ, impeding the exit of contained fluid, or an abnormal development of the mucous membrane lining the uterine cavity. This last receives the title of membranous dys- menorrhoea. The mucous membrane of the uterus consists of two layers, epithelial and basement. The epithelium varies in character according to the region it occupies ; that in the body of the uterus being ciliary. Just here let me suggest this query, May not the loss of the cilia through disease be the predisposing cause of placenta praevia? The basement contains the glands, vessels, and nerves. The mucous coat is of varying thickness, but becomes much hypertrophied at regular intervals. This thickening seems to be coincident with the ripening of the Graafian vesicle that matures at an uncertain moment during the menstrual cycle. Ovulation being the first stage, and the uterine congestion the second, the hypertrophy is greatest when the DISCUSSION ON OBSTETRICS AND GYNECOLOGY. 1065 vesicle bursts. From this moment the process is retrogressive. Fatty degeneration ensues in the outer layers of the mucous membrane, which, lifted from its seat, becomes ready for extru- sion either as a whole or in shreds. From the denuded vessels blood is poured forth, and, issuing from the organ, completes the phenomenon. It follows then that menstruation proper, so far from being the climax of a process, is but its closing step. To Dr. Oldham, of England, is due the honor of having first demon- strated the identity of the casts in membranous dysmenorrhoea with the lining of the uterus, and that the process was due to ovarian excitation. Virchow declares that the constituents of mucous membrane are almost always found in the discharge from the reproductive organs when in a normal state. So we are brought to the conclusion that this pathognomonic symptom is of some pre-existing disease. Regarding the remote causes of this disease we know but little. The recent discovery of its true character, its comparative infre- quency and toleration of the system to its presence, have tended to retard research in this direction. That irritation of the ovarian plexus causes congestion of the uterine vessels we recognize as a fact. The greater the irritability during ovulation, the more excessive is the congestion likely to be. Influx of blood pro- duces contraction of the muscular fibres surrounding the vessels, and stasis is the result. Degeneration follows, the mucous membrane becomes to all intents and purposes foreign, and nature frees herself rapidly as possible. Limited time pre- vents noting each successive change, but I have endeavored to briefly sketch the main features. Endometritis was formerly considered a cause, but, it being an affection of the utricular glands, it tends to prevent the very condition we find in mem- branous dysmenorrho3a. In subinvolution, too, we see relief for the congestion in that state of the venous sinuses which, not inaptly, has been styled a haemorrhoidal condition. It remains for some investigator to differentiate the causes of the various diseases peculiar to the generative organs and show under what condition we may expect to find this ailment. With pathology rests the key that shall unlock this mystery and reveal the measures for relief. The symptoms of this malady are pain, commencing at or just before the flow, and increasing in violence till the exfoliated part is discharged; menorrhagia, which often follows ; and ab- sence of pregnancy. The differential sign is the membranous cast. In a case now under my care there are two paroxysms of pain. 1066 world's homceopathic convention. One occurring the first two or three days of the menses, the other during the third week and lasting five days. This last is severest in the left ovary. The activity of the two ovaries is in the ratio of 4 to 1. When the irritation is in the right ovary the patient has but little discomfort during the menses, and I have been unable to discover any pieces of membrane. She was emaciated, anaemic, and hysterical. Phosphorus has done more for her than any other remedy, and she bids fair to recover. In the treatment of this ailment homoeopathy again shows its superior- ity over the empirical practice of the older school. Schroeder distinctly states, "A cure cannot be attained by internal remedies." Another noted writer holds up his hands exclaiming, "There is no help for it, but local measures should be tried." So they compensate deficiency by energetic applica- tions. As to the remedies, I can add nothing to the suggestions made by eminent specialists of our own school, with which you are already familiar. 1 am glad to acknowledge the obligation under which I, for one, rest toward the author of the essay under consideration, and free to admit the added light thrown upon cases that in the past have proven intractable. F. H. Krebs, M.D., Boston, Mass.: Dr. Ludlam's essay on " Membranous Dysmenorrhoea from Repelled Eruptions " is a timely contribution, and valuable on account of its practical bearing upon the treatment of that distressing disease. The essayist has given his experience in twelve cases, and two are reported by other physicians. The sympathy which exists be- tween the inner and the outer skin is sufficiently understood. Hahnemann knew it when he pointed out the many acute and chronic diseases which were caused by repelled eruptions, and hence we believe that the antipsoric remedies will prove benefi- cial in membranous dysmenorrhoea, and enable us' to cure this disease without the aid of surgery or any other mechanical appliances. It is said that the material for the production of the dysmen- orrhoeal membrane is contained in the catamenial discharge of every menstruating female, and the question arises, what agen- cies are set to work which cause the mucous lining of the uterus to become hypertrophied, and the uterus made a fertile ground for its formation? Are there other causes besides "repelled erup- tions" which aid in the formation of this membrane? Fur- thermore, is the primary cause in the ovaries or in the uterus? It would be very gratifying to us if we could answer these questions, but until more light is thrown upon this yet dark subject we must rest satisfied with the present knowledge, which DISCUSSION ON OBSTETRICS AND GYNAECOLOGY. 1067 enables us to give relief, and sometimes even to cure our patients. Our medicines generally act promptly in mitigating the suffer- ings in dysmenorrhoea, and even in membranous dysmenorrhoea they give temporary relief; whether they accomplish it by retarding the pouring-out of the menstrual fluid between the lining membrane and the parenchyma of the uterus, thereby preventing the violent contractions of that organ, and a more gradual exfoliation and expulsion of the membrane, or whether the medicines influence directly the ovaries and thereby lessen the formation of this hypertrophied membrane, we cannot say, but we know that they give relief. The menstrual decidua has been microscopically examined, and has been demonstrated as existing of three distinct layers of tissue, viz.: 1st, fibrous, 2d, glandular, and 3d, granulated. Sometimes the first two tissues are thrown off alone, and the third or last follows in a day or two under less violent contrac- tions. Cases of cure have been reported by many physicians belonging to the different schools of medicine. Outside of the realms of homoeopathy caustics have been applied directly to the inner surface of the uterus. The Lapis infernalis in sub- stance, the Tincture of Iodine, and of Ferrum muriaticum have been principally used. This practice is simply barbarous, and is not without danger. The homceopathist is guided in this disease as in all others by the totality of the symptoms, which, according to Hahnemann, alone constitute the disease, and not by the mere fact that a dysmenorrhoeal membrane exists. F. B. McManus, M.D., of Baltimore: I have heard con- siderable talk about babies, and I wish to show to the members of the Convention a baby that I brought with me from Bal- timore. I call it a baby, because, like most babies, it is small. It is the first published proceedings of the American Institute of Homoeopathy published in New York, and contains an ac- count of a meeting held in Philadelphia in 1846. I hold, side by side, before you now this little baby and the big baby of the last session, the first and last publications of the Institute! I look upon its annual proceedings with much pride, for I note an increase of size in each year's volume. This first little pamphlet commences by giving the constitution, by-laws, order of business, and the proceedings of the third anniversary meet- ing of the American Institute of Homoeopathy. Dr. McManus then read some extracts from the volume, and stated that his own name appeared as chairman of the committee on elections. I thought it would be a pleasure to the members of this 1068 world's homceopathic convention. Institute to hear this, and see how rapidly it has grown in the last thirty-two years. R. Ludlam, M.D., Chicago: When making my little speech, I labored under the embarrassment of not having an hour in which to speak. I wish to say a word about the means to be used for lowering the temperature, which is so very important in puerperal diseases. I have great confidence in Veratrum viride, though I would not use it in all cases, nor below the second decimal attenuation. When the Veratrum viride fails, I believe in the use of alcohol, i. e., whiskey, and I think it acts the same as after surgical operations; when the temperature is up to 104°, 105°, or 106°, and must be reduced very quickly, the alcohol given freely will, as a rule, reduce it in a very little while. 1 think the patient should be well nourished, and I give alcohol in the form of milk punch as often and as much as she will take. I have seen the temperature go down from 105° to 102° under the use of alcohol, but it should not be used in every case indiscriminately. Another agent, especially in the West, is one or two doses of Quinine, given with the same end in view, and it will reduce the temperature quicker than any other known agent; in ovarian disease two-grain doses are sufficient, and in ordinary cases one-grain doses repeated will answer, after which the remedies as indicated by the symptoms should be given. This treatment has recommended itself to me in an experience of nearly thirty years. The patient should be thoroughly washed, the room well ventilated, and these cases will not recover without the use of proper disinfect- ants, the most valuable of which is Chloride of potassa, used in a solution of 2 or 3 grains to the ounce; this solution being applied to the vulva, injections of it are thrown within the vagina, and some of it is to be kept about the bed-clothing, while the same mixture may be placed in a saucer upon the mantel. It should never be put upon the floor, if the object is to disinfect the room. The Chloride of potassa is much better and less objectionable than Carbolic acid as a disinfectant in the lying-in chamber. Now, as to the action of alcohol in these cases, I believe it counteracts the condition precisely as it does in cases of poison- ing, as all conditions of poisoning are characterized by a very high temperature, and alcohol is the best antidote, because it reduces the temperature at once, and saves life, if enough of it be given. There being no more remarks, the Convention adjourned until next dav. SIXTH SESSION. Saturday, July 1st, 1876. The sixth session of the World's Convention was assembled on Saturday, July 1st, at 9 o'clock a.m., and was called to order by the President, Dr. Carroll Dunham. The President: We will now listen to the final report of the Committee on Correspondence. Dr. I. T. Talbot, of Boston, Mass., the chairman of that committee, reported as follows : Dr. Talbot: Among the remaining articles submitted to your committee is a communication from the Homoeopathic Med- ical Institute of Mexico, through its President, extending the warmest congratulations to this Convention, and expressing the hope that its labors may redound to the good of homoeopathy and to the advancement of science. There is also a similar com- munication from the Homoeopathic Assembly of Colombia, South America, stating that they had appointed a commission of some of their most honored members to represent the Assembly in this Convention : United States of Colombia. Colombian Homoeopathic Assembly. Bogota, May 10th, 1876. To the President of the World's Homoeopathic Convention at Philadelphia. Responding to the honor you have done us in inviting the corporation of homoeopathic physicians of Colombia to appoint a scientific commission to. represent it in the World's Homoeopathic Convention, we have appointed, as such commission, the following honorable physicians: Drs. J. Peregrino Sanmiguel, the actual Dean of Colombian Homoeopathy, Ignacio Pereira, Vice-President of this Assembly, Secundino Alvarez, Pedro Vera, and J. Luis Paez, all honorable scientific and practicing professors of homoeopathy. I doubt not that they will worthily fill the high mission intrusted to them,, and will suitably respond to the great honor conferred by your invitation. 1070 world's homceopathic convention. This generous invitation shows that the barriers which separate nations will disappear in proportion as the human mind becomes freed from the prejudices of sect, of party, etc., which spring from ignorance and egotism, and in which men have lived since the dark ages. Now that true civilization, the daughter of moral truth, which is nothing else than universal brotherhood, is pervading the human mind, the divisions of races, religions, nations, political schools, and peoples, appear more and more ridiculous. The moral progress of humanity will advance, and, with it, the knowledge of natural laws, fusing all peoples into one, and humanity will enjoy the im- mense benefit of universal fraternity. I hope for great good from these meetings of international congresses; they make us known to each other, and tend to develop in us that charity which God requires as the essential spirit in an immense variety of forms. The great Convention over which you will preside, is one of these grand international congresses, and will contribute much to the physical and moral welfare of humanity. I hope that God may protect and bless this Convention, and fill it with scientific and moral light. With sentiments of the highest consideration and regard, I subscribe my- self, Fraternally yours, Joaquin Calvo, M.D., Of the National Academy of Medicine of Paris; mem- ber of various learned European societies; Presi- dent of the Homoeopathic Assembly of Colombia, South America. There is also a communication from Dr. Jose Peregrino San- miguel, a man who occupies a very high position in the United States of Colombia, in which he gives the experience, especially of Dr. Louis Paez, in the treatment of certain severe and violent diseases of a malarial nature, in which the success of homoeopa- thy was very remarkable and creditable. Also, a communication from the "Assembly of Homoeopaths of the United States of Colombia," in which they present cer- tain propositions for the consideration of the World's Conven- tion ; many of these pertain more particularly to their own form of government, and were not deemed within the province of this Convention. Your committee were, however, pleased with one proposition, which recommends a meeting of the World's Ho- moeopathic Convention to be held as often as once in every five years, under the same plan of organization and work as at the SIXTH SESSION. 1071 present meeting, and your committee, therefore, beg leave to present the following resolutions: Resolved, That the success which has attended this World's Homoeopathic Convention, alike in bringing together in pleasant personal relation phy- sicians from different parts of the world, who have a common interest in the advancement of a science which benefits a common humanity, in develop- ing and publishing new and valuable facts and information pertaining to that science, and in gathering statistics of the position and progress of homoeop- athy throughout the world, fully justifies the recommendation that another and a similar Convention should be held at some future time. Resolved, That the executive officers, together with the honorary Vice- Presidents of the first World's Homoeopathic Convention, held in Philadel- phia in 1876, be, and hereby are, appointed an Executive Committee, with power to consult and enter into correspondence with the homoeopathic phy- sicians or societies of the various countries, and to determine a suitable time and place for holding a second World's Homoeopathic Convention at some time within five years; and to assist in all preliminary arrangements until such time as executive officers shall have been appointed by some suitable body of homoeopathic physicians of the country in which the said Conven- tion is to be held. The above closes the report of the Committee on Correspond- ence. On motion, the report and also the resolutions of the commit- tee were adopted. The President: This concludes the stated business before the Convention, and, if there is no miscellaneous business to come before it, a motion for a final adjournment will be enter- tained. Lewis Sherman, M.D., Milwaukee, Wis. : Mr. President and Members of the World's Homoeopathic Medical Convention: I desire to call the attention of this body to the subject of an Inter- national Homoeopathic Pharmacopoeia. We have already the Pharmacopoeia of Jahr and Gruner, the Pharmacopoeia of Dr. Schwabe, the French and the British Pharmacopoeia. These works, though all serving a good pur- pose, do not furnish pharmaceutists with more than a small part of the information they need in preparing homoeopathic medi- cines. In addition to this, if the time of the Convention allowed, I could show that these works contain many errors and absurdities. In the manufacture of tinctures it is of prime importance 1072 world's homceopathic convention-. that the properties of the drug be known. Our Pharmacopoeias seldom give any information on this subject, except to direct in a general way the use of strong alcohol. This direction, if fol- lowed by our pharmaceutists, would give us a very inferior quality of tinctures, and, in case of many drugs, an inert prepa- ration. Again, it is important that the strength of our tinctures be definite and uniform. At the present day scarcely any phar- maceutist gives the physician the strength of the tinctures he sells, and in most instances the pharmaceutist does not know the strength. It needs no demonstration to this learned body that every drug has its proper solvent, and a determinable maximum strength of solution. Nux vomica will not yield its medicinal virtues to water nearly as well as to alcohol, nor to alcohol alone as readily as to water and alcohol. Aconitum tincture may be very appropriately made of the strength one-half. This is not done by following the directions in the books, and using one part of juice to one part of alcohol; nor is it certain that the juice contains all the medicinal virtues of the plant. We must first determine the proportion of liquid already in the plant, for this liquid is mingled with the alcohol of the menstruum, and forms a part of the tincture. We will assume, for illustration, that Aconite plant contains in ten parts by weight eight parts of water and two parts of dry substance. To make a tincture of the strength one-half we must then add one and two-tenths parts of alcohol, in this case, of 87 per cent, strength. We then have two parts of tincture representing one part of Aconite plant. I have for myself approximately determined the proper solvent and maximum strength of solution of about five hundred of the drugs of our Pharmacopoeia. I am not aware that any one else has done this work, but those familiar with pharmacy are well aware that this and much more work needs to be done and pub- lished before we can have reliable medicines. I move that this Convention appoint a committee to prepare for the homoeopathic profession an international Pharmacopoeia in the German, French, and English languages; to publish the SIXTH SESSION. 1073 same, and to present it for acceptance to the several national medi- cal societies of the countries speaking those languages. Dr. Richard Hughes, of England: I wish to say a word on this subject. I heard with great pleasure the proposition made, and think it very desirable. Now that so much inter- national intercourse has occurred, which I hope through our World's Conventions will be continued, it is very desirable to possess a uniform standard in our tinctures, and, as far as pos- sible, to have them of a uniform strength. The gentleman who has just spoken has very judiciously insisted upon the importance of alcohol in making the tincture, and I wish to call his atten- tion to the fact that in the British Pharmacopoeia now in use, and which has been in use for the last five years in England, great care has been taken to insist upon the use of alcohol only in the rectified spirit. In our country the first publication, that of 1870, is now nearly out of print and the British Society has instructed such of its members as are acquainted with this subject to collect all the information possible of different chemists relating to the practical uses of a Pharmacopoeia, so that we could publish a second, which is, I think, finished, and by this time published. I think it very advisable that the Institute take up this mat- ter, comparing all the materials which we now have, and have the result ready for the next World's Convention, if we hold it, as I trust we shall, five years hence. By that time there will be such a demand that the Pharmacopoeias will be pretty nearly exhausted, and we can then publish a new, international one. I cordially support Dr. Sherman's proposition, and hope it will be carried out. Dr. Dunham : If the Convention will allow, the Chair would like to say a few words in regard to having in charge the prepa- ration of a Dispensatory under the order of the American Insti- tute of Homoeopathy, which Dispensatory comprises a Pharma- copoeia, with some additional items of information not generally contained in a Pharmacopoeia. Certain portions of that work I have completed, and the whole is in a state of great forward- ness. Correspondence has been for several years maintained with those having in charge the preparation of both the first and 1074 world's homceopathic convention. second editions of the French Pharmacopoeia, and more recently with the pharmaceutists and some homoeopathic physicians in Germany who are especially interested in this same subject, with a view of reaching, as far as possible, a unanimity in the preparations of tinctures and in the nomenclature of drugs. Of course as an international Pharmacopoeia must be a mat- ter of agreement between physicians and pharmaceutists of different countries, I think all this is in process of accomplish- ment as rapidly as the complex nature of the work will allow. The motion of Dr. Sherman relating to a Pharmacopoeia, as amended by Dr. Hughes, was then carried. On motion, Dr. Jenney, of Kansas City, Mo., was invited to read a paper on a case of gunshot wound. W. H. Richardson, M.D., of St. Louis, presented a paper on Ovariotomy, giving the details of an interesting case in which Dr. Lungren introduced the silver wire suture, and moved that the paper be published as part of the Transactions of the World's Convention. After some discussion an amendment to the original motion was made referring the papers of Drs. Jenney and Lungren to the Committee on Publications, which was agreed to. Dr. Hayward, of England: I wish to call your attention to homoeopathic publications. In England we have a society called the "Sydenham," for the publication of allopathic works on medi- cine; and we have also in the homoeopathic ranks a similar society for the publication of monographs and other works which are too restrictive in their circulation to admit of any publisher taking the risk of their publication alone, but which the committee of our society judge essential to the homoeopathic profession. That society is composed of any member of the profession who will pay a subscription in the association. This subscription is only paid to the society, which undertakes to produce, by translation or otherwise, matter to be published at least to the value of a guinea, and each member of the society gets yearly a guinea's worth of books. I wish to call the attention of the members of this Convention to the fact that should there be any good work even by American authorities on any homoeopathic subject that is needed and wor- thy of publication, the Hahnemann Publication Society will pub- SIXTH SESSION. 1075 lish that work, and introduce it to their members under the terms mentioned above. I think it a matter of great importance that any book which a publisher dare not undertake can thus be published. I am sure the secretary of that society would be happy to receive the names of any homoeopathic practitioners in America. Dr. I. T. Talbot, of Boston : I wish, before we adjourn, to present a resolution, in which I am sure that every member of the Convention will heartily join : Resolved, That the World's Homoeopathic Convention, assembled at Phila- delphia, tender to its President, Carroll Dunham, M.D., its warmest thanks and sincerest regards for the great and efficient labor he has per- formed in organizing and arranging the work of this Convention ; in con- ducting the difficult and extensive correspondence required ; in the uniform courtesy and kindliness he has exercised towards all connected with the Con- vention, and in the able and impartial manner in which he has presided over all the deliberationsand sessions of the Convention ; and that we recognize in his labors the principal cause of the remarkable harmony, good feeling, and success of this Convention. R. Hughes, M.D., of England: I wish to second this mo- tion ; and I desire to say one word in behalf of the foreign visitors to the Convention, although we do not consider ourselves as foreign visitors. While there are many names of homoeopathic physicians which are held in honor in England, no one stands in more prominence on the roll than that of Dr. Carroll Dun- ham. We have all known of his renown, and have understood something of his reputation among his colleagues; and, when we knew that he was to be President of this Homoeopathic Conven- tion, we felt that the choice had been well made. One of my greatest privileges, during my visit to this country, has been the personal acquaintance of Dr. Dunham. I take great pleasure in supporting this motion, and I am sure we shall approve it by rising, and thus testifying in the warmest manner our appreciation of the great services he has rendered this Convention, as well as the cause of homoeopathy and medicine. Dr. Talbot : I request that Dr. Hughes, of England, Vice- President of this Convention, put this motion by a rising vote. Dr. Hughes : Gentlemen, you have heard the motion as 1076 world's homoeopathic convention. made and seconded and supported; if no one has any remarks to make concerning it, it is desired that it be carried by those who testify in its favor by rising. The motion was unanimously agreed to, and Dr. Dunham was called for. Db. Cabroll Dunham, of New York: Gentlemen: You are very kind, but I must say to you that in a work involving the securing the co-operation of so many persons of different views and nativities spread over the world-or, even if only spread over our own country, it is not the labor, however great, however earnest, of one man, nor the labors of a committee of fifty or one hundred men, that secure success. As it takes two to make every bargain, in this it certainly took one on one side and a host on the other. Regarded as an integer to make this bargain, which we gratifyingly and cordially regard as a success, to that which has made the World's Homoeopathic Convention the suc- cess that it has been, and that which has made the hard work pleasing, has been the unexpected kindness, and cordiality, and heartiness with which the applications for labor have been re- sponded to. And thus the work has been rendered pleasant by those with whom I have been in correspondence, and their name is legion, both in our own and in foreign countries. There has been no exception to this, and it is that which has made the suc- cess. It is not so much the question of scratching a match and applying it to the fuel, for if the fuel be not there to burn there will be no fire. I must again say, what I have had occasion to say before, that I have, during the whole of my connection with this business, and of my labors in regard to it, been very much touched, again and again, by the tender courtesy and consideration that have been manifested toward me by my colleagues. There seems to have existed in the minds and hearts of my colleagues a sort of tender confidence in me, and for that I thank you all, here and in foreign lands. (Applause.) On motion of Dr. McManus, the World's Homoeopathic Con- vention of 1876 adjourned sine die. APPENDIX. HISTORICAL SKETCH OF MATERIA MEDICA A By Constantine Hering, M.D., Philadelphia, Pa. During the spring of 1869, a course of lectures upon the his- tory of the healing art, was delivered at the Hahnemann Med- ical College of Philadelphia, from which it may not be amiss to repeat such points as bear especially upon the study of the Ma- teria Medica. We will begin by taking a hasty retrospect of the various methods which, from time to time, have been employed for the cure of disease. The progress of medicine for centu- ries was but slight, being like the waves of the ocean, which though rising and falling, seemingly moving forward, are never- theless but a vertical rising and falling of the water, each so- called wave being as it were repeated almost in loco. The history of medicine is divisible into seven distinctly marked periods, which though varying greatly in length of time, still may be said to represent decided epochs in medicine. The first of these periods we shall call the Egyptian; the second, the Galenic; the third, the Paracelsian; the fourth, the anti- Paracelsian ; the fifth, the Hahnemannian; the sixth, the anti-Hahnemannian; and the seventh, one which is but just begun with the noble works of Grauvogl-works in which we find the most severe and incontrovertible attacks upon the methods of the old school, and at the same time a most * The profession is indebted to Dr. A. Korndoerfer, of Philadelphia, for the translation and revision of this essay, in condensed form, from the origi- nal MSS. of Dr. C. Hering, some months after the latter's decease. For un- avoidable reasons this work could not be finished in time for insertion in the Materia Medica Department at the beginning of this volume.-Ed. 1078 world's homceopathic convention. thorough and scientific expose of all the anti-Hahnemannian attacks upon the propositions laid down by Hahnemann as the results of his experience. If nothing prevents the promised incorporation of Hausmann's pathology in the expected new edition of Grauvogl's Textbook we may hope soon to behold medicine established upon a thoroughly scientific basis. Part I. The Egyptian. According to Dr. Brugsch, a well-known authority, it would appear that the healing art stood in high repute among the Egyptians. Already in the days of Homer we find evidence of this expressed in the Odyssey, IV, 229. In the first of the before- mentioned lectures, a fac-simile was exhibited of a portion of a genuine Egyptian writing, which, according to experts, must have been written some 3200 years ago. As far as it was possible to interpret the papyrus, it appears that much of it relates to the modes of living, food and drink, washing and bathing. In it we also find mention made of the clyster and bloodletting. For external diseases remedies were applied externally, even as children in undeveloped judgment to this day will apply a given remedy directly to the painful part, be the cause what it may. Inunctions, salves, cataplasms, and medicinal washes are rec- ommended. Remedies against vermin found in the houses, are placed in the same category with the remedies against internal and external diseases. Although the names of the plants referred to are not all known with certainty, we may still feel assured they are not lost to us ; in fact a thorough Hahnemannian might still be able to de- cide upon them, though much time would be needed. At present we have only the Squilla and Cepa in our materia medica. It is worthy of note that iron, Natrum carb., and Natrum mur., as well as pitch, were used as remedies. Among the articles of ani- mal origin mentioned, are the various milks and fats, each care- fully differentiated according to its source, also the blood, bile, urine, and feces of many animals. It appears to have been the custom to first mention the name of a disease, and then give the various prescriptions for the treat- HISTORICAL SKETCH OF MATERIA MEDICA. 1079 ment of the same, the remedies to be tried according to their rank of importance; thus already in these early groupings do we find the beginning of that most pernicious practice of prescribing rather upon the pathological name, than for the individual case of disease, a practice existing largely even to this day. Another point to note is the fact that almost all remedies were incorpo- rated with a vehicle, such as honey, wine, vinegar, etc. The papyrus upon which Dr. Brugsch makes the report is 16 feet long and 7| inches broad, and dates back to the fourteenth century before Christ. Before its contents were fully inter- preted, a fortunate investigator discovered in Thebes, during the winter of 1872-73, an unusually well-preserved papyrus of more than 60 feet in length by 11 inches in breadth, which, according to experts must have been within some 200 years earlier than the first mentioned. In fact, written when Moses was about twenty-one years of age, and the Israelites still in bondage. This Papyrus Ebers has been chromo-lithographed and pub- lished by Breitkopf and Hartel. A copy may be seen at the Astor Library of New York. In the Scientific American of December 11th, 1875, may be found a fac-simile of a portion, together with its translation. Since 1868, our homoeopathic colleague, Dr. Mahendra Lal Sircar,* of Calcutta, India, published the Sanskrit original, and a translation of the Charaka SankittA, in his journal of medi- cine. We are indebted for both text and interpretation to Kavi- raj Rama Nath Varat, a gentleman well versed in the literature of his profession, and having in his possession a valuable collection of ancient Sanskrit works on medicine. For the revision of the text and interpretation weare under especial obligations to Pan- dit Ishvara Chandra Vidyasagara, whose profound knowledge of the Sanskrit language and literature is too well known to re- quire any eulogy from our pen. Dr. M. L. Sircar is responsible for the English rendition. The publication of this valuable ancient writing has been interrupted on account of want of means. Tracing our history on its way around the borders of the * Wrongly spelled Sier court on page 293 of this volume.-Ed. 1080 world's homceopathic convention. Mediterranean we must mention the rules laid down in the sacred books of Moses. The dietetic rules therein found give evidence of superior knowledge. We find here an entirely new feature, i. e., the serpent of brass, which, though of miraculous nature, still appears to show the foreshadowings of the law of cure. With regard to the Mate- ria Medica known to the Hebrews we would refer to the care- fully elaborated work of R. J. Wunderbar, Biblisch Talmudische Medicin, Riga, 1850. We next come to the Grecian borders. What has been pub- lished under the name of Hippocrates is now known to be but a collection of observations made by priests during several gener- ations. Indeed we find but little new until we come to the time of Dioscorides, 50 years B.C. He was evidently a man of clear mind and a good observer, and, in addition, having accompanied the Roman armies, he had especial opportunities for making observations. "In the cam- paigns he served as physician and thus gained his knowledge." "His works are of worth even to us, his observations being made with peculiar simplicity, clearness, and accuracy." One point in illustration of this we may be allowed to offer. He says: "The onion will cure abrasions of the heels," a condition often re- sulting from long marches. Shortly after the Cepa was proved (1847) an opportunity offered in which to test this. The re- sult was a corroboration of the old observation by Dioscorides. Part II. The Galenic Period. During the second century of the Christian era, there arose in the medical world, Galen, a man who had grown up under the most favorable surroundings. Although by birth an Asiatic, the greatest of Greek philosophers were numbered among his teachers, the Greek tongue being the language of the educated world. Having determined upon medicine as his life-work, he sought instruction from the most celebrated physicians of his day. In Alexandria he sought the full of Egyptian wisdom. Rome next offered him a home, and he there acquired a great reputation. From thence he was recalled by the Emperor Marcus Aurelius. Having now much leisure he procured many writings, and HISTORICAL SKETCH OF MATERIA MEDICA. 1081 wrote or had written many works, in all about 500 treatises, on various subjects. Of these only 82 of undoubted authority still exist. In addition to' which some of doubtful and some of positively spurious character, about 98 in all, have been by some classed with the genuine; these may, however, be readily dis- criminated. We have here only to do with the treatises on medicine. Galen, in accordance with the Greek philosophy, adopted the so-called opposites, as heat and cold, dry and wet. These asso- ciated afforded him the four elemental forms of fever, i.e. heat with dryness, cold with moisture, heat with moisture, and cold with dryness. In accordance with the same rule the four winds, the four seasons, and various other conditions were classified. Galen included in his theory the four fluids of the human body, i. e., mucus, blood, yellow bile, and black bile, and upon this, also, based his theory of the four temperaments, the last of these remaining even to our day as a spectre of the ignorance of the past. These so-called opposites, it should be remembered, are but grades or degrees, being but more or less of heat, moisture, etc., yet upon such erroneous theories as laid down by Galen the whole rule of contraria contrariis has been built. Galen was greatly disposed to such theorizing; Sprengel expresses it thus: "His love of theories appears to have prevented him from being a good observer." Among other errors multiple prescriptions of most extreme forms became the fashion. It is recorded that Galen sold a panacea, or universal remedy, which was composed of some hundred of the most varied drugs. Regarding his many writings, Sprengel says: " His Asiatic prolixity he tried to excuse on the ground of the necessity of clear exposition; his repetitions are numerous, his statements not free from subtleties, and, though his logomacy is conspicuous, he is not guarded against criticism. His discourse at times bor- ders npon the loquacious, and where he cannot convince by rea- son he seeks by persuasion to overcome. Through his prolixity he makes himself accountable for numberless contradictions." Notwithstanding all this, the teachings of Galen became the 1082 world's iiomceopathic convention. standard authority in medicine, and for centuries found no pow- erful opponent. In fact thirteen centuries elapsed ere one arose who had the moral courage to cast aside all of Galen's teachings, and he (Hohenheim), some fifteen years later, was murdered by his opponents, and since has been subjected to the meanest calumniations, and his teachings most grossly misapplied through his so-called followers. Nearly a century later Harvey made his great discovery; this was about 1425 years after the death of Galen; and the followers of Galen cried, Malo cum Galeno errare quam cum Ilarveyo esse circulator. One writer seeks to gloss over such unheard-of and injurious authority by the following paragraph: "An Asiatic compiled the particular features of the world-renowned Greek healing art with the intent that at Rome they might be presented in a sys- tematic arrangement. That this was an Asiatic work is evi- denced by the bombastic Oriental, bazaar-like embellishing, which makes it difficult to separate the really useful from that which is mere tinsel." Most of the writers who still overflow with praises of the Galenic peculiarities have evidently not even read his works. In the homoeopathic literature this is most certainly the case; we find only copies of what others have said. By some he is still held to have been very sagacious. To this we may appropriately apply that remark of Jean Paul Richter, as, on one occasion, he, with Ernst Wagner and Goethe, was partaking of a fine Thii- ringen roast of mutton; holding, with evident satisfaction, a juicy piece upon his fork, he said, "Werden ersten Schoeps geschlach- tet, der war gewiss keiner 1 " This saying allows of many ap- plications. We may justly say, he who holds Galen as sagacious, himself certainly is not so. Regarding the materia medica we may say that it was not improved in any respect by Galen. Pie was neither a good observer, nor had he the slightest idea of a clear method. He was theoretical only, and his theories were positive errors. Later, however, his greatest admirers, the Arabians, did appreciably improve the materia medica. Abn Mussa Dschafar al Sofi, known by the name of Geber, opened up a new road in pharmacy. We have him to thank for the introduction of the milk of HISTORICAL SKETCH OF MATERIA MEDIC A. 1083 sulphur, Nitro-muriatic acid, Nitrate of silver, Mercur. subl. cor., and Merc, praec. rub. He also introduced the use of sugar, tinctures, and various other preparations. Part III. Paracelsian Period. The grand master of the Knights of St. John, a man of high rank,-for such only were eligible who could prove thirty gener- ations of noble descent,-George Bombastus, of Hohenheim, wedded a woman of inferior family; his son William, therefore, though having the right to take the father's name, could not share the father's rank. The family name of the Von Hohen- heim's was Bombastus ; this was given with their coat of arms, i. e., three black balls upon a white field, probably as the discov- erer of a kind of bomb, a form of projectile at that time coming into use. The " hasten " signified in those days the same as " making." Only the first letters give it a resemblance to the Greek and Roman word " bombax," to which some writers would trace it, and as little has it to do with the name of the East Indian cotton-tree. The son of this marriage of Grand Master George Bombastus von Hohenheim was William von Hohenheim. He adopted the medical profession, and became physician to the hospital of one of the most noted resorts for pilgrims, at Maria Einsiedeln, Switzerland. Here he married an attendant at the cloister, a nurse in the hospice, and in 1493 a son was born unto him, who, in baptism, received the name Theophrastus, not after a holy one of the Catholic Church, but in honor of a learned botanist and student of Aristotle, Theophrastos von Eresos. From such an instance we might be led to infer that the father's attention was directed more to the medicinal plants for remedies. Later, William von Hohenheim removed to Ksernthen, where he was held in high esteem. A picture of him is still in exist- ence, representing him with a flower. He educated his son as a physician, sent him to eminent chemists to be instructed, and allowed him to travel, according to the custom of the times, throughout Europe. After his return he, already in his thirty- 1084 world's homceopathic convention. third year, was made professor of medicine in Basel, 1526. He had the moral courage, not only as the first in Europe to deliver his lectures in the German tongue, but had also the courage and the knowledge to entirely set aside the thousand years' accepted system of Galen. We find in our own day a somewhat similar occurrence in the works of Schoenlein. He, too, as a very young man, was placed in charge of one of the largest hospitals of Germany, and devoted his best endeavors to the establishment of pathology upon a scientific basis. Hohenheim was, on account of religious reasons, compelled to leave Basel; so Schoenlein, on account of political reasons, was compelled to fly. The few lines allotted to this subject, though quite inade- quate, are nevertheless indispensable that justice may be done one whose real worth was not recognized, and who for three hundred years has been slandered by many otherwise reputable men. During the past three centuries, save only of later times, it has been the custom to refer to him always in the same words,- we find them in Kopp's History of Chemistry, vol. i, p. 92,- "Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim, as he styled himself." This, however, is not true, for he never, on any occasion, so styled himself. When speak- ing of himself he used only his baptismal and family names. Rarely do we find the addition Paracelsus, this name being in all probability given to him by others. It was a poor transla- tion of " Hohenheim," such rendering of the German family names into a foreign language being in accordance with the fash- ion of the times. Kopp was not only a learned man, but he was also a reputable, well-meaning, and trustworthy historical writer, with whom justness in judgment was held as of highest import- ance. This can be verified both by personal friends still living, as well as through letters still in existence. He did not live to edit the second edition of the History of Chemistry, else he might have corrected the errors of the first. What he said in regard to Paracelsus contains many gross untruths, which he, with honest intent, inserted, having taken them from standard authorities. This is also the case in all en- HISTORICAL SKETCH OF MATERIA MEDICA. 1085 cyclopaedias, British and American, and, worst of all, in the highly esteemed German Encydopcedia, by Ersch and Gruber. The renowned Haller, a well-meaning man, deals with him very severely ; this, however, may have been owing to religious hate. Sprengel, the well-known writer of the history of the healing art, endeavors by all means to prove that Paracelsus had no knowledge of Latin. Paracelsus was the first to deliver scientific lectures in the German tongue, and Sprengel cannot forgive him the innovation, though since his time it has become more and more the fashion. Sprengel seems to have forgotten that Paracelsus travelled beyond Germany, and certainly at- tended various universities, which would have been impossible had he not understood the Latin. Finally, Sprengel brings forward another quite new evidence that Hohenheim could not have had a literary education, accus- ing him of declining the indeclinable "tonitru." Sprengel, who certainly understood the Latin, must have entirely forgotten what every student learns as soon as his third or fourth course, i. e., that even Cicero declined the word thunder. These faultfindings are groundless, as are all the others, both collectively and individually. All which we assert can be historically proven, being based mostly upon the fortunate possession of the only two books which Hohenheim had printed during his lifetime. In addition to which we have the work of an excellent investigator, Professor Marx, of Gottingen, " Zur Wiirdigung des Theophrastus von Hohenheim," 1842. Professor Marx, without ever having seen the just-mentioned two works of Hohenheim, nevertheless speaks as a true investi- gator, and we may say, as the first actually non-partisan judge, showing with great clearness and tact by what means we may distinguish the genuine writings of Hohenheim from spurious works. In the Huser collection of ten quarto volumes, and in other collections of Hohenheim's works, but above all in the mutilated edition of Bitiscius, three volumes, in most execrable Latin, 1086 world's homceopathic convention. scarcely one-seventh is genuine; and even in these portions do we find many disfigurements. On comparing such work with the volumes published during his lifetime, we find but few superficial expressions agreeing with the original, and yet, in accordance with such rubbish found in all the libraries is this man judged! In relation to the materia medica we have Hohenheim to thank for breaking down the Galenic power, and at the same time for extending our store of remedies. It was he who brought the. chemical preparations into permanent and increasing • notice. His greatest service, however, was that he, in medicine, like Leonardo da Vinci, of Lombardy, in Natural Philosophy, first insisted upon the strict inductive method. It is quite possible that young Hohenheim in his travels visited Leonardo, and from him learned how an investigation must be conducted in order to draw therefrom a right conclusion. These two were the founders of the strict inductive method, through which, since then, science has made such gigantic strides. The honor has, however, been falsely attributed to that empty courtier, Lord Francis Bacon, to whom it was probably accredited by his friends among the nobility to cover in part, at least, the ignominy of his official life. We could scarcely con- ceive of the possibility of such a one, who made sport of the system of Copernicus ; of one who styled the great Harvey a "sawbonesone who was a credulous believer in the formulae for the transmutation of metals, and advocated the same in his writings; one who had not the most remote idea of the actual requirements of an experiment, as being the originator of the philosophy of induction. Hohenheim, who introduced this strict method in the study of medicine, was also the actual founder of physiology, as well as of the doctrine of the genius epidemicus. He was the first physician who looked upon surgery as belong- ing properly to the healing art. In addition to these steps of progress we find enjoined the oath which he required of his students, " Never leave a woman during the throes of labor." These advance positions have at last been realized by the pro- fession, especially in this country. HISTORICAL SKETCH OF MATERIA MEDICA. 1087 Let us therefore honor the man who had the courage to first openly declare, yea, even demand, such advance over his prede- cessors. We must also here remark that he was a decided opponent of the prevailing astrology and alchemy, and, in fact, of all other deceptions of his day. He was so free from superstition that he boldly taught that the so-called Nixenkindern were suffering from actual disease and might be cured by natural means. Part IV. Anti-Paracelsian Periods. The murder of Paracelsus in 1541, by being thrown over a precipice by his opponents, which fall fractured his skull, was demonstrated by the learned anatomist, S. Th. Sommering, who was in Salzburg at the time of the opening of the grave of Para- celsus, which until then had remained undisturbed. He made a careful examination of the remains prior to their transportation, and found a fracture extending through the base of the skull, such as could have happened only during life; this evidently was the cause of death. Subsequent to the death of Paracelsus his pupilsand followers degenerated more and more. They dis- torted his teachings and falsified his writings, which at that time were in increased demand. They substituted a bombastic bun- gling style, such as he would have held in utter contempt, and sought to procure favor of the people through most absurd boast- ings. Circumstances at this time, as portrayed with such clearness by Professor Marx, all seemed to conspire to undermine the position of Paracelsus. Controversies between the degenerated followers of Paracelsus and the advocates of the old folly ran high during the hundred years following his death. During this time, however, we find in Italy the Belgian, Vesa- lius, and his successor, Eustachius Fallopius, endeavoring to advance the knowledge of human anatomy, Pare, in France, making great progress in surgery, Agricola doing likewise for mineralogy, and C. Gesner for botany and zoology, each endeav- oring to place his specialty upon a scientific foundation. In other departments also we find progress being made. The 1088 world's homoeopathic convention. healing art, and materia medica the highest of all, alone remained without manifest improvement, confusion still reigning. The only points worthy of passing note are the slowly increasing rec- ognition of the chemical remedies, and in relation to the vegeta- ble remedies, the so-called Signatura rerum-a theory that certain peculiarities in the external form or color of plants gave evidence of their adaptability to certain forms of disease. This latter has at times been attributed to Paracelsus, though upon the best evi- dence attainable its origin must have had a much earlier date. About one hundred years after the death of Paracelsus, Baron von Helmont, a highly gifted man, attempted to interpret his writings, though evidently without a proper understanding of the same. To him however belongs the credit of making personal provings of remedies, this being a decided step in the direction of improvement of the materia medica. He thus proved Aconitum, which since has been of such inestimable service, notwithstanding the erroneous theory which he based upon his investigation. About this time came Harvey, who in physiology made a step of progress greater than any since the time of Hohenheim. In all the sciences we now find progress being made through the strict method of induction. Materia medica alone remained without improvement. Theory followed theory, yet not one of them all was developed through this only correct way. Many meritorious men arose in the profession: Sylvius, who founded the chemical school. Sydenham, who spoke much of the pure observations of Hippocrates, and showed great apprecia- tion of Hohenheim's teachings relating to the genius epidemicus; Stahl, too, a highly spiritual yet deep thinker, and Boerhaave the eclectic, each gaining renown, yet without advancing the materia medica one whit. Fr. Hoffman followed with his mechanico-dynamic system, dazzling through its specious, plausible clearness. Then came Haller, a student of Boerhaave, who gained such prominence through his investigations relating to muscular ir- ritability, though more especially should he be remembered for his earnest efforts to improve the materia medica. One of the HISTORICAL SKETCH OF MATERIA MEDICA. 1089 most important features of his work in this direction we find referred to in the introduction to his Flora Helvetia, in the following words: "We should prove our remedies on the healthy." Though in this he stands so prominent, we must not forget to give equal share of honor to one of Britain's greatest physicians, W. Alexander, of Edinburgh, the actual forerunner of Hahnemann. Finally, in relation to the materia medica, we may mention, as characteristic of this period, a general tendency to sweeping declarations regarding the utility of certain articles, declarations based upon most insufficient grounds. This feature was favored by the introduction of many new remedies from the Western World, among which were some of great importance, such as Guaiacum, Sarsaparilla, Ipecacuanha, and Cinchona. During all of this time errors in theory were increasing, one error being discarded only to give place to another. Among others may be mentioned Brown's system of medicine, a very seductive theory, which soon became the fashion, and for some years was well received in Germany. A masterly criticism of this system, from the pen of Hahnemann, may be found in HufdanJs Journal, vol. v, 1801. Times like these would scarcely seem propitious for the work of speedy removal of such confusion of error, yet we find Hahnemann entering upon the work with earnestness, persistence, and a faithful reliance in the ultimate success of the truth which he gave to the world. Paet V. Hahnemannian Period. Hahnemann's translation of Cullen's Materia Medica was published in 1790, the year in which Cullen died. In this work he felt it his duty to give everything which Cullen had said, though he felt it an equal duty to correct such of Cullen's errors as pertained to Germany. Such corrections were made in short annotations. Thus we find in vol. ii, chap, ii, page 89, under Cascarilla, the following: "The Stahlians, fond of anything as a substitute for the Peruvian bark, have given many testimonies of its efficacy, but its virtues are not peculiar nor considerable, 1090 world's HOMCEOPATHIC CONVENTION-. and there is no just foundation for the prejudice which the Ger- man physicians have conceived in its favor." To this Hahne- mann makes the following comment: " Perhaps Cullen refers to the few remaining; old armor-bearers of the Stahlian knights (noch iiebrigen alten Waffentrager der Stahlischen Ritterschaft); they have, however, nearly become extinct. The physicians of our day hold the Cascarilla in such slight esteem that one must needs be very ignorant to charge the German physicians of to- day with any especial predilection for the Cascarilla." This rather ironical way in which Hahnemann spoke of the followers of Stahl, who antedated Cullen by about eighty years, shows that he, with Cullen, was entirely on the side of the rationalistic school, and not, as has been so frequently charged, on the side of the spiritualistic school. To the latter belong Hohenheim, Helmont, Stahl; to the former, Vesalius, Sydenham, Fr. Hoffman, and all the teachers of Hahnemann in Vienna. The force of the above note and of others made by Hahnemann prior to the year 1800, seems to have been overlooked, while their importance in forming an impartial judgment of Hahne- mann has not been appreciated. In fact, to this none have given heed, although attention was called thereto in an article written for the Hygea, March, 1846. As before remarked, Hahnemann was not the first to investi- gate drug action by such personal experiment. Thirty years before, Stoerck made similar experiments with Cicuta, and later with Stramonium, Hyoscyamus, Aconitum, and Clematis. Rob- ert Whytt made similar experiments with Camphor. But above all the predecessors of Hahnemann must be mentioned William Alexander, who proved not only Camphor even unto danger of life, but made provings of other drugs, among which may be mentioned Castoreum, Crocus, and Saltpetre. He was the first to notice the similarity between Opium and Camphora. Yet more than all this he was the first (1766) to declare: "Such experiments upon the healthy man are the only sure methods to lead us to a discovery of the real virtues and effects of medicines, to establish certain determined ideas of their operation, and to HISTORICAL SKETCH OF MATERIA MEDICA. 1091 enable us to prescribe them with more reasonable hopes of suc- cess than we have hitherto done." What Haller says, eight years later (1774), in the Introduc- tion to his Pharmacopoeia Helvetia, was founded, no doubt, upon the above suggestion; for Haller had ready access to the works of Alexander through the Gottingen library. Hahnemann, owing probably to limited opportunity for refer- ence to the English original of Alexander's works, mentions Haller only as "having ever thought of this method." Further evidence of this may be found in the meagre extract of symp- toms from Alexander's provings, incorporated by Hahnemann in his Materia Medica; such symptoms were evidently taken from incomplete epitomes. Hahnemann was the first, however, in the history of the heal- ing art who through such experiment instituted a pure inquiry. What is the action of Cinchona? was the object of his investi- gation. All others who before him attempted somewhat similar experiments invariably had some subordinate aim in view. Stoerck wanted to know if Aconitum would develop sweat. Alexander wished to ascertain whether Camphor was a cooling or heating remedy, while in addition there was the underlying query: Was Galen right or wrong? Hahnemann reached his answer, which is now so well known, through the strictest induction. All the symptoms which he had experienced some twelve years before, while suffering from intermittent fever at Siebenbiirgen, reappeared. What had been cured by the Peruvian bark was now developed thereby, he be- ing in a state of health. As a true thinker this led him to a second experiment, and with like result. " For a number of days, twice daily, did he take four drachms of good Peruvian bark, when there reappeared all those symptoms which had characterized his previous attack of intermittent." "These par- oxysms continued from two to three hours each time, and were renewed when he repeated the dose, otherwise not." He stopped the proving and was again well. What was then his next step ? He said naught of similia sim- ilibus, but as an actual investigator applied the idea, substances 1092 world's homceopathic convention. which excite fever, such as Coffee, Pepper, Arnica, Ignatia, Ar- senic, allay the same. Then, as a true investigator, he began to experiment, that he might discover the action of each on the healthy, in order to differentiate their fevers. Pie first selected only the last three drugs just mentioned, and soon found marked differences, not only between each other, but between each and Cinchona. These inquiries were not such as looked to some merely abstract quality, as tonic, bitter, or astringent, but looked to the specific individuality of the entire sphere of the symptom- excitant power of each drug. Thus Hahnemann labored with iron will and indefatigable energy for seven years before he publicly advised the proving of drugs in the healthy, in the following words: " In my notes to Cullen's Materia Medica (written 1789), I have already stated that bark given in large doses to sensitive, yet healthy persons, produces symptoms very similar to intermittent fever, and for this reason it probably cures the latter. Now, after mature ex- perience I add not only probably but quite certainly." Hufe- land's Journal, 1796. Thus we see that Hahnemann not only worked long, but advanced cautiously. This is the first article written by him, in which the words similia similibus are expressed, and even here with such rare conscientiousness that he refers it to chronic diseases only. He exercised such caution that even four years later, when he made the great discovery of the use of. Belladonna in the treatment of scarlet fever, he ventured to recommend it only for healthy children as a prophylactic. Not until after he had been brought to the dilutions did he use it as a curative remedy. Nor did he publish the Organon (1810) until after an experience of a full score of years. All of which thoughtful painstaking care should be a full and sufficient answer to the unjust charge of baste or lack of careful investigation. While making his drug-provings he became convinced that provings with small doses were necessary, the symptoms from cases of poisoning being of comparatively little use as guides to the application of drugs for the cure of disease. He also found it necessary to notice peculiarities of action which till then had HISTORICAL SKETCH OF MATERIA MEDICA. 1093 been regarded as unimportant or unworthy attention ; careful observation of such peculiarities was necessary to a clear differ- entiation of remedies. When after fifteen years of arduous labor in this new field he published the results of such provings, he chose the Latin lan- guage, in order to make them accessible to the entire scientific world. The time, however, was not propitious, as nearly every European state was shaken by the turmoil of war; the current philosophy had estranged physicians from purely scientific and exact thinking; the distorted Brunonian system had scarcely been forced into the background, when a caricatured imitation appeared in Rasori's Contrastimulus, followed by a last flicker- ing up of the bloodthirsty teachings, in Broussais's one-sided and exaggerated gastro-enteric doctrine; all combining either to make physicians neglect science, or to produce among them a disgust for all so-called systems. Hahnemann's "Fragmenta" forms the turning-point in the history of medicine. The accomplishment of this task shows with what energy and faith in his convictions he labored. Full fifteen years were spent in developing the provings prior to their publication. In the preface he says : " Quatenus observare mihi datum est, veritati litavi scrupulosissime, religiosissime." What was not of his personal observation, he selected with due care and discrimination. He says: " Adj eci ad calcem cujuslibet medicaminis ea, quae scriptores medicinse de positivis medicse- mentorum viribus, quasi aliud agendo adnotarunt." Nor was the work represented in the "Fragmenta" accomplished in ease and affluence. Persecution and want obliged him to change his abode ten times during the fifteen years of its development. The "Fragmenta" contained twenty-seven remedies, com- prising about 4000 single symptoms and groups of symptoms. Subsequently, owing to the increase in the number of remedies, the difficulty of reference increased to such a degree as to lead Hahnemann to prepare an elaborate index, in which symptoms pertaining to each organ, locality, sensation, functional change, 1094 world's homoeopathic convention. condition, and modality, as well as each combination of symp- toms, could be found and compared. Aided by this " bulky " index, Hahnemann succeeded in curing a young man who had for years been tortured with most horri- ble pains, the result of old-school medication. This young man subsequently became the head of the publishing house of Arnold, in Dresden, and out of gratitude he offered to print the Organon in 1810; this was followed by the first volume of the Materia Medica, in 1811. Aftei' the war, the remaining' volumes of the Materia Medica followed in quick succession, vol. ii, 1816, vol. iii, 1817, vol. iv, 1818, vol. v, 1819, vol. vi, 1821. Nine years elapsed before the first edition of the Organon was sold, and eleven years were required to sell the edition of the first volume of the Materia Medica. In the Materia Medica Pura, Hahnemann adopted a new and very practical schema for the arrangement of the symptoms, one which with but few modifications is still in use. In 1813, after the battle of Leipzig, Hahnemann gained his greatest triumph, by his successful treatment of the very malignant war typhus, which followed that battle. This brought him his first powerful adherents; and as the Russian government had possession of Saxony, the new healing art spread into Russia, where it took strong hold, and where in later years Korsakoff, a noble of high standing, made the first high potencies. Thus we find Hahnemann, first cautiously suggesting the ap- plication of remedies under the law of similars in the treat- ment of chronic disease only, then learning the need of smaller doses applying the law to acute affections, and finally reaching his greatest triumphs in the cure of violent acute diseases, as the war typhus in 1813, and the Asiatic cholera in 1830, one of the most malignant scourges which ever visited Europe. In fact no greater triumph is recorded in the annals of history than that of Hahnemann and his followers ovex' the Asiatic cholera of 1830. Following the battle of Leipzig a more favorable opinion of Hahnemann's doctrine spread among the people, and physicians of his school gained reputation and standing. Physicians of the HISTORICAL SKETCH OF MATERIA MEDICA. 1095 old school gave increasing attention to our literature, and many became converts. This developed a need for a second edition of the Materia Medica Pura, and in 1830 a third edition was printed. The first edition of " Chronic Diseases," five volumes, was sold and a second edition begun. But progress was already arrested. The anti-Hahnemannian period had begun. Part VI. Anti-Hahnemannian Period. We pass by the allopathic opponents of homoeopathy; their objections have been sufficiently answered. They now have but little to say, having veiled themselves, with an impudent air of superiority,in silence. Doinghomage toa phantom-the so-called " professional honor,"-they, without courage or conscience, sever themselves from chance of contact with the adherents of Hahne- mann. It was a touching naivete of Hahnemann, when he gave the Organon to the world, to suppose that all physicians wished to cure their patients and would devote care to the experiment which he proposed. Himself honest, he thought others likewise. Little was he prepared to find men so perverse; yet the same spirit prevails in our time as during the days of Hahnemann. When Grauvogl, more than ten years ago, was asked how the action of high potencies could be scientifically proved, he an- swered in a masterly essay, in which he showed what should form the foundation of every investigation and what maxims must be observed, closing with the words : " These are the max- ims of exact science, with which we can face every scientific man and boldly ask, Is there anything about them that is not right?" Subsequent to this essay he wrote a most learned " Textbook yet what good has it done? But few care to be convinced. Hahnemann's greatest desire was to heal the sick, and enable others to do likewise ; he therefore so arranged his observations that others as well as himself might be able to apply them in practice. Nothing more was needed for the repetition of the experiment by others, save ability in observation and untiring industry. " Machts nach aber machts recht nach," said Hahne- 1096 world's homceopathic convention. mann. Few have been willing to do so faithfully, and these few have had slander heaped upon them as disciples of Hahnemann. The old phrase of the Middle Ages, " he swears by the word of his master," was revived and offensively employed against those who after experiment were convinced of the truth of Hahne- mann's doctrine. In addition to the obstacle found in the necessary form of our materia medica, we find that the small doses gave unpar- donable offence. Hahnemann, impelled by his desire to cure the sick in the mildest manner, was after years of experience led step by step, with fear and trembling, into this hitherto unheard- of way,-a way which was beyond the comprehension of those accustomed to crude drugging. To this extent they might be considered excusable, but that they rejected every experiment on the assumption that such small doses could not act is beyond excuse. When Galvani observed (Nov. 6th, 1780) the twitching of the frog's leg which he had suspended, and, on further investiga- tion, discovered that contraction took place only when the limb was touched by two different metals simultaneously, the French Academy dubbed him " dancing master of frogs." Humboldt put an end to this by his experiments, and Volta built his " pile " before the close of the same century. Long ere another century passed, the wires which annihilate space were stretched across land and sea. The new "nothing" became a power to move the world. During the year in which these investigations were begun, a Pa- risian lady, while examining a cabinet of minerals, took into her hand a very rare and beautiful crystal, which she dropped as she handed it back. The crystal was broken; her companion, the Abbe Hany, with true French politeness, took all blame upon himself amid the bitter reproaches of the collector. On picking up the fragments he observed that the outer surfaces of the crys- tals corresponded with the inner broken surfaces. Many others had seen this but thought nothing of it. In him, the schooled mathematician, it excited the desire for further investigation. From that time forth he broke every crystal which came into HISTORICAL SKETCH OF MATERIA MEDICA. 1097 his possession, measured their angles, and calculated their di- mensions, until the science of crystallography was established, this again became the basis of mineralogy, and has illuminated the interior of our globe with the light of science. Thus, too, from small beginnings, was the science of acoustics created by Chladni. But, it may be asked, why were each of these great discoveries corroborated by manifold experiments within a few decades, so as to establish a science, while Hahnemann's far more important dis- covery remained so long in dispute ? In answer we will say, there is an internal as well as an external reason. The internal reason is that the others, being demonstrable mathematically, were open to ready investigation ; the theory of the action of drugs upon the healthy has not this advantage. Physiology has but lately made a beginning, while pathology has not yet been so success- ful. Still greater difficulties are met with in the domain of materia medica. Here only the most astute observers can make progress; judgment and discrimination are called for more loudly than in any other sphere of investigation. The manifold confusing and interfering influences, many of which can neither be averted nor easily eliminated, necessarily complicate the work ; yet prog- ress has been made, and particularly by the physicians of Amer- ica. Innumerable cures have been wrought, and the ridiculous efforts of the old school to attribute these to " faith " has long since been abandoned. The effort to attribute the cure to that old chimera, the so-called "vis medicatrix naturae," even though supported by a voluminous literature, has failed to find retainers. All, all have failed, and the law of cure, though still at times fiercely assailed, yet stands to the glory of Hahnemann ! Under that law Hahnemann observed that the action of the remedy when curative is from " within outward," and that other princi- ple, i. e., that in the treatment of a chronic disease the symptoms last manifested are of the highest importance, and that against these the remedy must be prominently directed; and further, that the curative remedy removes, without exception, the symptoms of the disease in the reverse order of their appearance; yet all this positive knowledge was passed by unheeded. Doubt was exer- 1098 world's homoeopathic convention. cised, but not the power of observation. A majority of so-called homoeopaths ever found it much more convenient to doubt; ob- servation meant labor. Shortly after Hahnemann's great triumph over the Asiatic cholera of 1830 the malcontents organized (1834) a journal of opposition to pure homoeopathy, ably edited; every effort was made to win the favor of the masses. In 1844 the "Oestes- reichische Zeitschrift " appeared. About this time a band of provers organized a society at Vienna. They, although of dif- ferent faith, allowed their leader to proclaim Jorg as their model, and he, being a most passionate opponent of Hahnemann, sought every opportunity to attack both him and his disciples, repeat- ing, whenever possible, the allegations of the avowed opponents of homoeopathy. Such was and is the character of all the intra- mural opposition, and such will it remain. This society, however, worked with zeal for years, making re- provings of Hahnemannian remedies, and these provings con- firmed nearly all the important symptoms given by Hahnemann in his Materia Medica. Much opposition was expressed in regard to the small doses, yet even the Austrian journal was finally compelled to ac- knowledge that the so-called small doses (higher potencies) act more efficiently on provers as well as on patients than the larger (more crude) doses of the same drug. Again, much clamor was made on account of the failure to print the day-books of the provers in full. Though such publi- cations would have been very desirable, it must not be forgotten that during the first four decades it would have been quite im- possible to find a publisher willing to risk their publication. Hahnemann's sole idea was to cure the sick, and in giving his Materia Medica to the profession, his principal thought was to make it practically useful. Next we find much fault expressed with Hahnemann on account of the insertion of such symptoms as were experienced by the sick, only after the administration of the curative remedy. This practice, though dangerous in the hands of the inexperienced, is nevertheless allowable to the ac- complished observer. Already in 1810, in the first edition of HISTORICAL SKETCH OF MATERIA MEDICA. 1099 the Organon, Hahnemann expressed himself clearly upon this subject as follows : " To distinguish, particularly in chronic dis- eases, the symptoms of a simple remedy from those belonging to the disease, requires a higher faculty of observation, and should be left to master observers." A generation later, one who is neither a master-thinker nor observer, pretends to be astonished at the use of such symptoms by Hahnemann. Yet in spite of all the opposition without, and contention, ignorance and perverseness within our school, prog- ress is steadily being made. The many cures wrought by Hahnemann and his faithful fol- lowers could not be denied. The excellence of his works was acknowledged, but the arrangement of their contents was looked upon without favor by many and deprecated by others, yet much good resulted from the application of the facts therein given. Then came an attempt to excuse the violent opposition to the plan adopted by Hahnemann, and at the same time account for his remarkable success in the treatment of disease. They said : " Hahnemann having made these experiments himself, or per- sonally directing them, must undoubtedly have seen a physio- logical connection and systematic order where others find nothing but chaos or fragments and hieroglyphics." They vainly sought new ways instead of following the one simple and true way trodden by Hahnemann and his pupils; that is, by examining the patient closely and then accurately adapting the remedy ac- cording to the totality of the symptoms of the individual case. This was the whole secret. Those who followed in this path were derisively termed Hahnemannians, and on every possible occasion were attacked and slandered. The anti-Hahnemann- ians were nearly unanimous in discarding the manner of prov- ing. New provings with few symptoms were called for, Hahne- mann's arrangement of symptoms abandoned, the power of reme- dies to aggravate symptoms of the sick denied; triturations and dilutions were retained, but the lowest decidedly preferred. What cost Hahnemann years of most diligent research was cast aside, per ordre du mufti. Generalizations became the want of the day, although Hahne- 1100 world's homceopathic convention. mann, after an experience reaching through several decades, prefaced only a few poly ch rests with characteristic general indi- cations. By this time Noack and Trinks found it easy to manu- facture such generalizations by the dozen. The Psora theory was discarded and ridiculed by many of these would-be wise ones. Then came the most formidable and elaborate attack on Hahnemann's Materia Medica, in the tenth volume of the quarterly of Clotar Muller (1859), under the modest title, Studies of Materia Medica, occupying in all more than a thou- sand pages of this valuable journal. This was finally aban- doned in 1864. The author of these " Studies " was evidently well acquainted with Hahnemann's Materia Medica, and most cun- ningly began his criticism with remarks on Agaricus muse, and Indigo, two of the less-proved remedies, and endeavored to prove that they were not useful in epilepsy. The author of these " studies," Roth's Razzia, as we designate them, assumed an air of thoroughness and impartiality, and at the same time excited the curiosity of his readers by promises of what would follow, a trick learned from French feuilletonists. He won many friends from among those to whom the unlimited expunging of symp- toms was welcome. But his criticisms bear such marked evi- dence of unfairness that they stand a monument to his shame. Part VII. Grauvogl. Grauvogl's Grundsatze of 1860 had some influence with the profession, but his Textbook of Homoeopathy of 1866 exerted a powerful influence on both sides of the Atlantic, and really opened a new era in medicine. In the year 1867 appeared Hausmann's Pathology, a work which will set tasks and open prospects of a scientific certainty in our materia medica such as no other branch in medicine enjoys. As Humboldt first gave us charts which place before our eyes the formation of our globe, mountains, rivers, etc., air currents, the distribution of heat to plant, animal, and human life, with their conditioning connec- tions, so do we find clearly exhibited by Hausmann the har- monization of chemical elements and their crystalline forma- HISTORICAL SKETCH OF MATERIA MEDICA. 1101 tion, with the vegetable and animal kingdoms, up to the tissues of the human organism, in health and disease, with constant ref- erence also to symptoms manifested in the provings. He points out a way to the solution of our greatest problem,-the relative rank of symptoms. Gross's Comparative Materia Medica was an important work in a new direction, while later comparisons by Farrington add valuable material in this field of labor. In addition to these important works, we have now in progress of publication several works upon materia medica, i. e., Allen's, Dadea's and Sircar's. Besides which we shall receive a collec- tion of characteristics this year, and soon after we hope to fur- nish as complete a collection of cured symptoms as possible. This work, Guiding Symptoms, including as it does a class of cured symptoms, which have been omitted by Allen, will be complementary to the Encyclopedia. All such works on ma- teria medica should receive the earnest support of the profes- sion. Finally, having dedicated our best efforts to the promulgation of the truth which Hahnemann bequeathed us, let us endeavor to live in the spirit of the motto of Augustine : 11 In certis unitas, in dubiis libertas, in omnibus charitas." In order to do this let us yet a moment review the injunction contained. 1st. In certis unitas. What is certain ? Here unfortunately opinions will already begin to vary. In a small book written by Rupertus Meldenius during the forepart of the seventeenth century we find this clause rendered li in necessariis unitas," and where necessity governs we may indeed hope for unity. What then is necessary ? First, let our answer be, to heal our pa- tients ; it is not at all necessary that we should convince a single opponent. The people as patients will judge, and by their judg- ment we must stand or fall. That system which cures will be held in highest esteem. Secondly, it is necessary that we more and more perfect our art, and above all develop the science of materia medica. Thirdly, it is necessary that we agree upon a method, and that method Hahnemann's. This method consists in the careful and exact observation of the symptoms as they are presented in the patient; the most accurate adaptation of lan- 1102 world's homoeopathic convention. guage to the observations of provers and patients, all without hypothesis or abstraction ; and, finally, the strict adaptation of the remedy under the law of similars to the symptoms of each individual case. Such adaptation being not only as to general expression, but in accordance with rank and degree of impor- tance,-their therapeutic value. 2d. In dubiis libertas. What is doubtful ? As we have to deal with materia medica alone, that is with produced and cured symptoms, we may say, that at first all is doubtful until proved to satisfaction. Because to believe a thing without sufficient evidence is childish; in a full-grown man, foolish; in an educa- ted, scientific man, wellnigh unpardonable. But it should be added, to doubt without sufficient reason is worse than foolish, it is absurd; and with the learned man, wellnigh criminal. The great error of the whole sixth period was condemning without sufficient reason ; let not the seventh sin likewise. In order to eliminate as far as possible all errors from our ma- teria medica, we have adhered to the following course. 1. Provings were repeated by the same pro ver. 2. The same drug was proved by other provers. 3. The observations or obtained symptoms were compared. 4. The symptoms were compared with physiological truths. 5. The symptoms were compared with pathological truths. 6. The symptoms of one drug were compared with symptoms of other drugs. 7. The symptoms were tested in practice according to the law of cure, until confirmation of proved symptoms, being repeatedly corroborated, finally led to characteristics, or guiding symptoms. But one word more in regard to the word libertas, even liberty has its limits; it borders not on libertinism. 3d. In omnibus charitas. Webster gives us a definition well adapted to our use. " Candor, liberality in judging of men and their actions, a disposition which inclines men to think and judge favorably, and to put the best construction on words and actions which the case will admit." Thus we will have charity toward all, yet where wilful ignorance or malicious intent is at the foundation of opposition, it becomes our duty to expose the same and to the best of our ability to defend the right. HISTORICAL SKETCH OF MATERIA MEDICA. 1103 Homoeopathy has had to contend with both ignorance and malice, yet notwithstanding all opposition, it has spread over the whole globe and found its way to every people. Not only has the materia medica met with much opposition, but more especially the small dose. The high potencies were truly a stumbling-block to many. A Russian nobleman of high standing made known to the profession the result of his long series of experiments with remedies prepared by what he termed potentization by contact. He was denounced as a mountebank. A nobleman from the northern part of Germany, who as a cavalry officer had fought under Wellington at the battle of Waterloo, on one occasion, while travelling on horseback in a mountainous region, met a pair of runaway horses which were greatly endangering the lives of a gentleman and lady who were seated in the carriage. By means of his courage and won- derful strength he succeeded in stopping the frantic horses. He had saved the life of the Grand Duke and Duchess of Saxe Gotha. In honor, the duke gave him the title of Master of the Horse. This man was Jenichen, whose high potencies have been so well and favorably known. The ignorance and prejudice of the opponents of high poten- cies have led some to slander this truly noble man, perverting the meaning of the title and ignoring the dauntless spirit which led to it; they called him hostler and horse-trainer. Certainly charity has its limit. Hahnemann's homoeopathy has gone on in spite of all the anti- Hahnemanian opposition, and, though still in the minority, it nevertheless is steadily increasing both in numbers and influence. The use of the high potencies has gained ground notwithstanding all the unscientific opposition which has been brought to bear against it. Our assembly here in a World's Convention " certainly bears evidence of this assertion. Let us then in harmony and with united efforts strive to advance this most beneficent art of heal- ing, keeping constantly in view its elevation to a science, always remembering the motto, " In certis unitas, in dubiis libertas, in omnibus charitas." INDEX A few thoughts on the study and practice of homoeopathy, 206 Abortion, averted by Arnica, 981; Apis, 981 Academy of Natural Sciences, invitation from, 54 Aconitum in conjunctivitis catarrhalis, 598 ; in conjunctivitis trachomatosa, 609; in gunshot wounds, 796; in intermittent fever, 390; in measles, 473; in purulent conjunctivitis, 604 ; in ptyalism, 988; in stomatitis, 993; in puerperal fever, 1035, 1038 ; preparation of, 1072 ; in abdominal peri- tonitis, 1052; in contracted vagina, in labor, 983 Acute diseases of the ear-their homoeopathic treatment, 635 Address of President Carroll Dunham, M.D., 37 ; instructions to print 5000 extra copies, 50 yEscuIus hip., in haemorrhoids, 822; in intermittent fever (with case), 390 After-pains, Cuprum in, 982; Carbo veg. in, 982 Ailanthus, prophylaxis in scarlet fever, 458 Allium cepa, in conjunctivitis catarrhalis, 599 ; see also Cepa. Aloes in haemorrhoids, 823 Alumen exsiccatum, in conjunctivitis trachomatosa, 609 Alumina, in conjunctivitis trachomatosa, 609 Ammonia, in phlegmasia alba dolens, 535 Ammonium carb., in cataract, 197; prophylaxis in scarlet fever, 458; in malarial cachexia, 997 Amputation averted by use of Calendula, 698 Anacardium, in nausea and vomiting, 1005 Aneurism, abdominal, cured, Secale200, 678; of rightcommon carotid, cured, Bell.200, 679 ; carotid, Lycopod.12, 679; popliteal, 679 Angina pectoris, a symptom, 523 ; synonyms, 524 ; symptoms of, 525; cases, 525-530 ; Curare in, 197 ; discussion on, 589 Angustura ver., in intermittent fever, 391 Anus, prolapsus, cured, Merc., 679; prolapsus, improved, 679; fissure of, cured, 679 ; mucous tubercles of, cured, 679 Antimonium crud., in intermittent fever, 391; in otitis, 647; in ptyalism, 989 ; in nausea and vomiting, 1004 Antimonium tart., in variola, 453 Apis mellifica, 131; effects of, on the skin, eyes, hair, mouth, fauces, throat, stomach, and intestinal canal, 132; on the urinary apparatus, sexual or- gans, ovarian dropsy, dropsical swellings, 133; on the brain, sensory nerves, intermittent fever, vascular system, 134; on glands, diseases of children, women, widows, 135; in diphtheria, 519; in goitre, 692; in gunshot wounds, 796 ; in intermittent fever, 392 ; in conjunctivitis ca- tarrhalis, 599; in conjunctivitis phlyctenularis, 613 ; in ovarian tumors, 763 ; in purulent conjunctivitis, 604; in pustular keratitis, 613. Com- pared with Arsenicum, 139; Bell., 136; Cantharides, 142; Graphites, 144; Thuja, 149 ; in abortion, 981 ; in puerperal fever, 1041; in hives, 975 ' Aranea diad., in intermittent fever, 392 1106 INDEX Argentum nit., in conjunctivitis catarrhalis, 599 ; in conjunctivitis fracho- matosa, 609; in ophthalmia, 624; in purulent conjunctivitis, 605; in ptyalism, 989; in nausea and vomiting, 1003 Arnica mont., memoir on, 81 ; a case of poisoning by, 81 ; action of, upon the intestinal canal, cases, 82-86 ; action of, upon the nervous system, cases, 86; enteric action, 93 ; action of, upon the eyes, nose, and ears, 99 ; the cin- chona of the poor, 102-112 ; action on the nervous centres and heart. 102 ; exanthems, 105 ; in traumatism, 115 ; unknown to the ancients, 116 ; phys- iological action of, 119; therapeutic applications of, 122 ; cramp in the stomach, 127 ; in capillary bronchitis, catarrh, pleurisy, pneumonia, 129 ; action of, on the muscular system, 129 ; derivation and meaning of, 299 ; root but not flowers to be used, 299 ; insects found in the flowers of, 300; in conjunctivitis catarrhalis, 599 ; in gunshot wounds, 793; in uterine haemorrhage, 955; in intermittent fever, 393; in puerperal fever, 1037 ; in abdominal peritonitis, 1052; in abortion, 981 ; in sto- matitis, 993 Arsenicum album, in intermittent fever, 436 ; in intermittent fever (with its history in these cases), 394; in variola, 453 ; in measles, 475; in di- arrhoea, caused by Quinine, 577 ; in ovarian tumors, 763; in gunshot wounds, 797, 798; in conjunctivitis catarrhalis, 599; in conjunctivitis trachornatosa, 610 ; in conjunctivitis phlyctenularis, 613 ; in cancer, 859, 860; in diphtheria, 520; in otitis, 647; in malarial cachexia, 996 ; in nausea and vomiting, 1004; in eruptions, 975 Arum tri., in diphtheria, 520 Asafoetida, in gunshot wounds, 797; in syphilis, 810 Asarum Europ , in intermittent fever, 403 Aster, rubens, in cancer, 860 Asthma thymic, case of, 223 Atropine in conjunctivitis phlyctenularis, 618 Aurum met., in conjunctivitis trachornatosa, 610; in conjunctivitis phlyc- tenularis, 614; in otitis, 650 ; in syphilis, 810 Baptisia tinct, in gunshot wounds, 799; in diphtheria, 594; in stomatitis, 994 Baryta carb., in conjunctivitis phlyctenularis, 614; in fatty or adipose tu- mor, 763 ; in gunshot wounds, 797 Baryta mur., in otitis, 651 Belladonna, failing or sudden disappearance of scarlet rash, 468; in con- junctivitis catarrhalis, 600; in conjunctivitis phlyctenularis, 614; in conjunctivitis trachornatosa, 610; in diphtheria, 520; in fibrous tumors, 764; in gunshot wounds, 796, 797, 798; in intermittent fevers, 405; in measles, 475; in sebaceous cysts, 762; in variola, 453 ; prophylaxis in scarlet fever, 458; in nausea and vomiting, 1004; in puerperal fever, 1040; hives, 975 Berberine, in intermittent fevers, 404 Bcenninghausen, therapeutic pocketbook, taschenbuch, 211, 212 Borax, in eruptions, 975; in stomatitis, 995 Bronchocele (see also Goitre), remedies, 767 Bronchopneumonia, moist, warm air in, 585 Bryonia, failing or sudden disappearance of scarlet rash, 468; in gunshot wounds, 797, 799; in intermittent fevers, 405 ; in measles, 475 ; in vari- ola, 453; some characteristics of, 200; in nausea and vomiting, 1004; in puerperal fever, 1041; in abdominal peritonitis, 1052 Bursitis, remedies for, 762 Cachexia, malarial, 996 ; mercurial, 1000; scorbutic, 1000; strumous, 998; syphilitic, 1001 Cactus grand., in intermittent fevers, 406 ; in pneumonia, 588 Caesarian section, case of, silver wires in, 1043 INDEX 1107 Caladium seg., in ptyalism, 989 Calcarea carb., in intermittent fevers, 406 ; in sebaceous cysts, 762; in gan- glion of wrist, 763; in fibrous tumors, 764; in polypoid growths, 766; in bronchocele (see Goitre), 768 ; in gunshot wounds, 800 ; in conjunc- tivitis catarrhalis, 600; in purulent conjunctivitis, 605; in conjunc- tivitis trachomatosa, 610; in conjunctivitis phlyctenularis, 614; in otitis, 647, 651; in fibroid tumors, 857; in cancer, 859; in strumous cachexia, 998; in eruptions, 975 Calcarea caust., in conjunctivitis trachomatosa, 610 Calcarea iod., in conjunctivitis phlyctenularis, 614; in uterine fibroids, 765; in polypoid growths, 767 ; in bronchocele (see Goitre), 768 Calcarea phos., in polypoid growths, 766 Calculus, cases of, 690 Calendula, amputation avoided by use of, 698 ; in gunshot wounds, 793 ; in stomatitis, 993; in puerperal fever, 1038 Campbell's, Dr., St. Louis, experience at the Centennial, 17 Camphor, in cholera (Rubini), 837 ; preparation of, 838 ; as a preservative, 838; as a remedy. 838; see also Cholera; in intermittent fevers, 406 Cancers of the uterus, 224; cases of, 684-688 ; scirrhus, cure of, 859 Canchalagua, in intermittent fevers, 407 Cantharis, in gunshot wounds, 796; in eruptions, 975 Capsicum ann., in intermittent fevers, 407; in diphtheria, 520; in otitis, 652 Carbo animal , in syphilis, 811; in otitis, 652 Carbo veg., in intermittent fevers, 407; in otitis, 647, 652; in syphilis, 811 ; in scorbutic cachexia, 1000 ; in mercurial cachexia, 1001; in nausea and vomiting, 1003; in after-pains, 982 Carbolic acid, not a disinfectant, 868 ' Caries of femur, of maxillary bones, of maxilla, of ossium digitorum, of temporal bone, tibiae, of supraorbital arch, of dorsal vertebrae, cases of, 679-681 Cataract, Ammon, carb, in, 197 Cauliflower excrescence, case of, 690 Caulophyllum, to induce uterine contractions, 1059; in puerperal fever, 1036 Causticum, in otitis, 653 Cedron, in intermittent fevers, 408 Censors, election for board of, 1877, 13 ; final report, F. R. McManus, M.D., 14; complete report, 19 Cepa, known to the ancients, 1078; in abrasion of heel, 1080. See Allium. Cephalalgia from pressure on brain, case of, 690 Cerium, oxalate of, in nausea and vomiting, 1004 Certain diseases of children, 479 Chamomilla, in intermittent fevers, 408; in uterine haemorrhage, 955; in conjunctivitis catarrhalis, 600; in conjunctivitis phlyctenularis, 615; in purulent conjunctivitis, 606; in hives, 975; in nausea and vomiting, 1003 Chancre, local treatment of, 841, 844, 847, 848; diagnosis of, 848 Chancroid, diagnosis of, 848 Characteristic symptoms, necessity of the study of, in homoeopathic thera- peutics, 199 Charaka sankitta, 1079 Chelidonium, in purulent conjunctivitis, 606 Chimaphila umb., in strumous cachexia, 999 China, case of, after bloodletting, 204; in measles, 475; in otitis, 653; in malarial cachexia, 999 Chinium sul., in gunshot wounds, 799 ; in intermittent fever, 410 Chiniumars., Vai., in intermittent fevers, 410 1108 INDEX Chloride of potassa, as a disinfectant, 1068 Chlorine, in purulent conjunctivitis, 606 Chlorosis, metrorrhagia, 947 Cholera, 837 ; asphyxiated, 839; epileptic, 839; relapses and sequelse, 839 Chorea, Tarantula in, 333 Choroido-retinitis, cases of, 630, 631 Choroido-iritis, case of, 627 Cimex, in intermittent fevers, 411 Cimicifuga, to induce uterine contractions, 1059 Cina, in intermittent fevers, 411 Cinchona, of the poor (Arnica), 102; in intermittent fevers, 409; in otitis, 661 Cinnabaris, in syphilis, 808, 845; in conjunctivitis catarrhalis, 600; in con- junctivitis phlyctenularis, 615 Cirrhosis of the liver, 369 ; disorders accompanying, 369 ; causes of, 369 ; diagnosis, 370; prognosis, 371; treatment of, 372; alcohol in, 373 ; Ar- gentum nit. in, 376; Phosphorus in, 377; Mercury in, 378; Hepar sulph. in, 380; Hydrocotyle asiat. in, 381 Cistus, in syphilis, 846 ; syphilitic eruptions, 846 Clematis, in conjunctivitis phlyctenularis, 615 Clifton, Dr. Arthur, England, introduction and remarks of, 53 Climatic influence upon surgical operations, 863 Clinical medicine department, contents and authors of, 306 Cocculus, in intermittent fevers, 411 ; in nausea and vomiting, 1004 Coitus, painfulness of the vagina during, Ferr. ac., 944 ; vaginal anes- thesia during, 944 Colchicum, in ptyalism, 989 Collinsonia, in hemorrhoids, 822 Collodion, to prevent scarring from variola, 457 Colocynth, mental, 203 ; in ovarian tumors, 763 Committees, of publication, report of, 9; of arrangement of the World's Homoeopathic Convention, report of, 10; for 1876, VI; on correspond- ence (foreign) appointment of, 11; report of auditing, 12 ; on official (foreign) correspondence, 831 Condylomata, 689 ; Thuja in, 845 Congestion, of the lungs, collateral and compensatory, 346 ; passive, 347 Conium mac., in conjunctivitis phlyctenularis, 615 ; in otitis, 648 ; in fibrous tumors, 764; in polypoid growths, 766; in sarcocele, 768; in gunshot wounds, 797; in fibroid tumors, 857 ; in cancer, 859, 860 ; in ptyalism, 989 ; in nausea and vomiting, 1004 Conjunctivitis catarrhalis, 597 ; purulenta, 603; trachomatosa, 609; phlyc- tenularis, 612 Cotyledon umb., in otitis, 654 Cramp in the stomach, Arnica, 127 Cranium, fracture of, cases, 681, 682 Crocus, in fatty or adipose tumor, 763 Croton tig., in conjunctivitis phlyctenularis, 615 Croup, 485; Iodine, vapor of, in, 489; Bromine, vapor of, in, 490; reme- dies in, 490; tracheotomy in, 491; more frequent and fatal with boys than girls, 494 ; cases of, 495, 500; bibliography of, 502-513 Cuprum, in after-pains, 982; in eruptions, 975 Cuprum alum., in conjunctivitis trachomatosa, 610 Curare, some therapeutic effects of, 187; its source and nature, 189; action of, 191; cases where administered, 192; angina pectoris, 197; eczema, 198 Cysts, sebaceous, remedies for, 762 Cysts, synovial, remedies for, 762 INDEX 1109 Detwiller, Dr. Henry, elected Vice-President of Convention, 549 Diarrhoea, caused by abuse of Quinine, cured by Arsenic, 577 . • Diet, in diphtheria, 553, 573 Digitalis, cough, shortness of breath, palpitation, anasarca, 67 ; in latent pneumonia, 337; in nausea and vomiting, 1003 Diphtheria, 479; (Joslin) symptoms, 480 ; remedies, 481 ; recumbent posi- tion in, 481; paralysis of the heart in, 481, 482 ; diet in, 553, 573 ; Nux vomica in, 552 ; not caused by presence or action of bacteria, 563 ; pro- duced by petroleum, 568; (Lippe) etiology of 515; pathology of, 517 ; diagnosis of and treatment, 518; Apis, Arum tri., Arsenic, Bell., Capsicum, Kalibich., Lachesis, Lycopodium, Merc, iod., Nitr. ac. in, 519-521 Diphtheritic membrane, experiments with, 362 Discussion, on clinical medicine, 549; on materia medica, 254; on obstetrics and gynaecology, 1051; on surgery, 840 Distortio spinalis, cases of, 681 Doses and potencies in tropical climates, 220 Dropsy, hydrothorax, anasarca, cases of, 691 Drosera, in intermittent fevers, 411 Dulcamara, in eruptions, 975 Dunham, Dr. Carroll, congratulatory resolution to, 15; closing remarks to the World's Convention, 1076 Ears, action of Arnica upon, 99; acute diseases of the, their homoeopathic treatment, 635; acute catarrhal inflammation, symptoms of, 638; acute suppurative inflammation of, 641 Eczema, Curare in, 198 Elaps corallinus, in otitis, 655 Elections. (See Officers, Censors, Members, Meetings, etc.) Enchondroma, cure of, 864 Enteric action of Arnica, 93 Epidemics, see Modifying influence of Epilepsy, value of Hydrocyanic acid in, 177 Ergot, to induce uterine contractions, 1059 Eruptions behind the ears,, remedies for suppression of, 315; gastralgia from metastasis of herpes from anus, remedies, 315; metastasis from genital organs to throat, remedies, 315; metastasis to urinary bladder and uterus, 315; of anus and scrotum, repelled to liver or intestines, 315; of scrotum and nates, suppressed, impotence and spermatorrhoea resulting, remedies, 315; laryngitis from suppressed, remedies, 315; ophthalmia from suppressed, remedies, 314; of the head, remedies for suppression of, 314; pharyngitis from suppressed, remedies, 315; sup- pressed on back of hands, remedies, 315; suppression of, metastasis to the heart, remedies, 315. Remedies for, 975 Eruptive fevers, 447 Erysipelas from Arnica, 112 Eucalyptus glob., in intermittent fevers, 412, 432, 577, 578, 579 Eupatorium perf., and purp., in intermittent fevers, 413 Euphorbia cor , in nausea and vomiting, 1005 Euphorbium offic., in nausea and vomiting, 1005 Euphrasia, in conjunctivitis catarrhalis, 600; in conjunc tivitis phlyctenularis, 615; in purulent conjunctivitis, 606 Exanthems of Arnica, 105 Exostosis (see also Hyperostosis) radii, 679 ; on frontal, parietal, and occipital bones; from Mercury ; syphilitica, cases of, 681 Experiments with medicines on the sick, 60 ; on the healthy, 62 Eyes, action of Arnica upon, 99 1110 INDEX, Felons, cases of, 703 Femur, fracture of, cases, 682 Ferrum acet., painfulness of vagina during coitus, 944 Ferrum met., in intermittent fevers, 414 Fibroid tumors, remedies, 857 Fibroids, uterine, remedies for, 765 Foundations and boundaries of modern therapeutics, 57 Fracture, of cranium, 681; of femur, cases, 682; of sup. maxillary, cases of, 682 Fungus, on gums, 700 Fungus haematodes oculi, case of, 690 Ganglion of wrist, remedies for, 763 Gangrene, cases of, 691 ; of the mouth. 482; symptoms of, 483; contrasted with ulcer of the mouth, 484; Chlorate of potash in, 484 Gastralgia from metastasis of herpes from anus, 315 Gelsemium. as preventive in intermittent fevers, 581 ; in gunshot wounds, 797; in intermittent fevers, 414; in otitis, 661; in rigid os, 1058; in puerperal fever, 1035, 1038 ; in stomatitis, 994 ; in malarial cachexia, 997 Genesis and etiology of acute and chronic diseases and deductions for their treatment, 307 Gerstel, Dr. Adolph, Mezereum, 155 Goitre, cases of, 692; (see also Bronchocele); remedies, 768 Goldleaf, the use of to prevent scarring from variola, 457 Goullon, Dr. H., Jr., Apis mellifica, 131 Gourbeyre, Dr. A. Imbert. memoir bn Arnica, 81 Graphites, in conjunctivitis catarrhalis, 601 ; in conjunctivitis phlyctenu- laris, 616; in otitis, 648, 655; in ovarian tumors, 763; in sebaceous cysts, 762; in strumous cachexia, 999 ; in scorbutic cachexia, 1000 ; in nausea and vomiting, 1004 Gunshot wounds, homoeopathic therapeutics of, 771 ; symptoms of, 783 ; pain, 784; haemorrhage, 785; prognosis of, 787; mechanical treatment, 787 ; diagnosis of, 788; tumefaction or abscesses, 790; local treatment, 729; remedies, 793-800; constitutional treatment, 795; surgical inter- ference, 800; consequences, 802. Case of ball in the skull, 826 Gynaecology and obstetrics, contents of department of, 876 Hahnemann, bust of, presented to World's Convention, 831; resolution of thanks to Madame, 54 Hamamelis, in haemorrhage, 1063 Haupt, Dr. Albert, Germany, introduction and remarks of, 52 Hayward, Dr. John W , England, 52 Haematocele, case of, 693 Haemorrhage, cases of, 693 Haemorrhage, Hamamelis in, 1063 Haemorrhoids, 819; remedies for, 822-824 ; cases of, 694; Lamium album in, 196 Heart, action of Arnica on, 102 Hellebores nig., in intermittent fevers, 415 Hepar sulph., failing or sudden disappearance of scarlet rash, 468 ; in gun- shot wounds, 796-799 ; in conjunctivitis catarrhalis, 601 ; in conjunc- tivitis phlyctenularis, 616; in intermittent fevers, 415; in otitis, 648 ; in purulent conjunctivitis, 607 ; in otitis, 656 ; in eruptions, 975 ; in strumous cachexia, 998; in nausea and vomiting, 1005 Hernia, cases of, 695 Herpes crustaceus, Mezereum, 172, 173; zoster or zona, Mezereum, 173 Hip disease, case of,.696 INDEX 1111 Historical sketch of materia medica, 1077 ; Periods: Egyptian, 1078; Ga- lenic, 1080; Paracelsian, 1083; anti-Paracelsian, 1087; Hahneman- nian,1089; anti-Hahnemannian, 1095; Grauvogl, 1100 Homoeopathic therapeutics, of aural surgery, 645; remedies, 647; in gunshot wounds and the sequelae of operations, 771 Homoeopathic treatment of diseases incident to pregnancy, 979 ; of puer- peral fever, 1034; publishing society in England, 1074 ; treatment of syphilis (see Syphilis)., 803 Honorary members (see Members) Hughes, Dr. Richard, England, introduction and remarks of, 51; Hydro- cyanic acid, its value in epilepsy, 177 Hyalitis, case of, 630 Hydrarthroses of knee-joint, case of, 697 Hydrastis can., in stomatitis, 994 ; in intermittent fevers, 415; in otitis, 656 ; in syphilis, 845 Hydrobromic acid, in otitis, 661 Hydrocele, cases of, 696 Hydrocyanic acid, case of poisoning by, with post-mortem, 180; its value in epilepsy, 177 Hyoscyamus, in intermittent fevers, 415 Hypericum perf., in gunshot wounds, 794 Hyperostoses (see also Exostoses) radii; femoris; foot; humerus, tibiae, cases of, 679-682 Hysteria, 877 ; etiology of, 882 ; predisposing causes, 883 ; heredity, 887 ; moral influences in, 889; exciting causes, 897 ; symptomatology, 899: prognosis, 931; treatment, 933 ; indications for remedies, 943; case of Tarantula in, 333 ; will-power in, 1062 Ignatia, in conjunctivitis catarrhalis, 601 ; in intermittent fevers, 415; in uterine haemorrhage, 955; in malarial cachexia, 997; in nausea and vomiting, 1005 Infinitesimal doses, to investigate the question of, 76 Inflammation of the conjunctiva, 597 Influence of homoeopathy on surgery, 663 Intermittent fevers, 383 ; pernicious, 384; etiology of, 386 ; symptoms of, 387; treatment of, 390; remedies, Aeon., 390; Aescul. hip. (with case), An- gust. ver., Antim. crud., Apis, Aranea diad., Arnica, Arsenic (with its history in these fevers), Asarum eur., Berberin, Bell., Bry„ Cactus, Camphora, Canchalag., Caps., Carbo veg., Cedron, Cham., Cinchona, Chiniumarsen.,-Sul.,-Val.,Cimex,Cina, Cocc., Dros., Eucalyptus (also 577, 578, 579), Eupat. perf., Eupat. purp., Eerrum met., Gels, (also as a preventive, 581), Hell., Hepar sul., Hydr., Hyos., Ignat., Ipec., Kali carb., Lachesis, Ledum, Lycop., Menyan. (also 554), Merc., Mezer.,. Momordica, Natr. mur., Nux mos., Nux vom., Opium, Petrosel., Phel- landr. aquat., Podop. pelt., Puls., Rhus t., Sabad., Samb., Sedum acre., Sepia, Silicea, Staph., Strain., Sulph., Tarax., Tartar emet., Thuja, Valerian, Verat. alb., Zincum, 390-429; remedies, modus faciendi, 429; in Italy, 431 International Homoeopathic Pharmacopoeia, 1071 Intestinal canal, action of Arnica upon, cases, 82-86 Iodine, in bronchocele, 768; in otitis, 657; in ovarian cyst, 676; in stru- mous cachexia, 998 ; in nausea and vomiting, 1003 Ipecacuanha, in intermittent fevers, 416; failing or sudden disappearance of scarlet rash, 468; in malarial cachexia, 997 ; in nausea and vomit- ing, 1002 Irido-ehoroiditis, cases of, 628, 629, 632 Irido-cyclitis, 632 1112 INDEX Iris versic., in nausea and vomiting, 1005 Iron, as a remedy known to the ancients, 1078 Jenichen, why called Master of the Horse, 1103 Kafka, Dr. J., letter from, 832 Kali hich., in conjunctivitis phlyctenularis, 617 ; in conjunctivitis tracho- matosa, 611 ; in diphtheria, 520; in otitis, 657; in syphilis, 810, 846 ; in syphilitic cachexia, 1001 Kali brom., in ovarian tumors, 763; in sebaceous cysts, 762; in mercurial cachexia, 1001 Kali carb., sac between eyelid and eyebrow, 200; in intermittent fevers, 416 ; in strumous cachexia, 999 Kali hyd., in syphilis, 846 ; in uterine fibroids, 765; in ptyalism, 989; in strumous cachexia, 999 Kali iod., in bursitis, 762; in syphilis, 809; in eruptions, 975 Kalmia, in syphilis, 846; syphilitic pains, 846 Keratitis, pustular, Apis in, 613 Koumiss, as a food, 1007 Kreasote, in purulent conjunctivitis, 607 Lachesis, failing or sudden disappearance of scarlet rash, 468; in diph- theria, 521; in gunshot wounds, 797; in intermittent fevers, 417; in ovarian tumors, 763 ; prophylaxis in scarlet fever, 458; in otitis, 657 ; in mercurial cachexia, 1000; in syphilitic cachexia, 1001 Lamium album, in haemorrhoids, 196 Laryngitis, resultant from suppressed eruptions, remedies, 315 Latent pneumonia in the aged, Digitalis, 337; symptoms of, 337 Leboucher, Dr., letters from, 833 Ledum pal., in intermittent fevers, 417; in uterine haemorrhage, 955 Leucorrhoea, herpetic, remedies, 315 Limits of medicine, to discover the, 78 Lipoma, remedies for, 763 List of names of those attending the World's Convention, 23 Lithiasis, uro-, with tables, 705 Liver, cirrhosis of the (see Cirrhosis, etc.) Lobelia, in rigid os, 1058 Lungs, primary congestion of (see Primary, etc.) Lycopodium, in diphtheria, 521; in goitre, 768; in intermittent fevers, 417; in polypoid growths, 767 ; in otitis, 657 ; in stomatitis, 995; in strumous cachexia, 998 Magnesia carb., in nausea and vomiting, 1003 Magnesia mur., in nausea and vomiting, 1004 Malarial cachexia, remedies for, 996 Materia medica department, authors and contents of, 56 Materia medica of places and climates, to study the, 77 ; historical sketch of, 1077 Measles, prophylaxis, 471 ; treatment, 472 ; Aconitum, Pulsatilla in, 473 ; Bry., Phos. in, 474; Arsenic., Bell., China, Strain., Opium in, 475 Medical science, survey of, 226 Meeting, 1877, places proposed for, 13; election of place of, 14 Members, honorary, election of, 13; honorary and corresponding, nomina- tion of, 15; corresponding, election of, 15 Membranous dysmenorrhoea from repelled eruptions, 969 ; case of, 1062 Mentagra, Mezereum in, 172, 173 Menyanthes tri., in intermittent fevers, 418, 554 Mercurial cachexia, 1000 INDEX. 1113 Mercurius, in conjunctivitis phlyctenularis, 617; in intermittent fevers, 418: in purulent conjunctivitis, 607 ; in puerperal fever, 1041 ; in erup- tions, 975 Mercurius biniod., in sarcocele, 768; in syphilis, 808, 846 Mercurius corr., in conjunctivitis phlyctenularis, 618; in syphilis, 807, 845 Mercurius dulc., in conjunctivitis phlyctenularis, 618; in syphilis, 808 ; in otitis, 657 Mercurius iod., in bronchocele (see Goitre), 768; in diphtheria, 521; in eruptions, 975 Mercurius nit., in conjunctivitis phlyctenularis, 618 Mercurius prsec. rub., in conjunctivitisphlyctenularis, 618; in conjunctivitis trachomatosa, 611; in syphilis, 808 Mercurius protiod., in conjunctivitis phlyctenularis, 618 ; in syphilis, 807 Mercurius sol , in conjunctivitis catarrhalis, 601 ; in conjunctivitis phlycten- ularis, 619 ; in gunshot wounds, 796 ; in syphilis, 806, 845; in ptyalism, 988; in stomatitis, 995; in syphilitic cachexia, 1001 Mercurius viv., in otitis, 658, 648 Metrorrhagic chlorosis, 947 ; remedies for, 955 Mezereum, case of poisoning by, 158; chilliness of, and accompanied by thirst, 166, 167; eruptions, itching, etc., 159; in conjunctivitis phlyc- tenularis, 619; in gunshot wounds, 797; in intermittent fevers, 418; in otitis, 658 ; inframaxillaris nerve, 173 ; liver spots, freckles, pus- tular eruptions, 171 ; localities affected by, 165: pityriasis versicolor, and capitis, 170; portion of a physiological study, 155; preparation and provings, 156; pruritus senilis, 168, 169; rupia prominens, herpes crustaceus, mentagra, 172; scalp, hair, 169; skin, affections of, 165; in eruptions, 975 ; skin affections, ulcers,* 171; syphilitic and mercurio- svphilitic ulcers, 174; tetter, 171; twitching and jerking of,168 ; zona, 173 Miliary pneumonia, clinical studies of Tarantula, 323 Millefolium, in stomatitis, 995 Missiles (from guns), forms of, 774; weight of, 775; course of, 776; velocity of, 778; law of, 779; spent balls, 781; lodgment of balls, 782 Modifying influence of epidemics on therapeutics, 531; influence of greater epidemics, 537; influence of lesser epidemics, 539; endemic influence, 541; changing nature of epidemics, 542; constant genius epidemieus, 545; inferences drawn, 547 Momordica, in intermittent fevers, 418; in gunshot wounds, 795 Moschus, in spasm of glottis and diaphragm, 945 Muller, Dr. Clotar, Germany, introduction and remarks of, 51 Muriatic acid, in haemorrhoids, 823; in scorbutic cachexia, 1000 Natrum carb., in goitre, 768 ; known to the ancients. 1078 Natrum mur., in conjunctivitis phlyctenularis, 619 ; in conjunctivitis trach- omatosa, 611; in intermittent fevers, 418; in ptyalism, 988; in mala- rial cachexia, 997 ; in nausea and vomiting, 1003 Natrum phos., in conjunctivitis trachomatosa, 611; known to the an- cients, 1078 Nausea and vomiting, therapeutics of, 1002 Navarro, Jose T., potencies and doses in tropical climates, 220 Naylor, Dr. R. G., remarks of, 292 Necessity of the study of the characteristic symptoms in homoeopathic thera- peutics, 199 Necrosis, cases of, 683 * All skin affections of Mezereum appear in places devoid of fat, as the shin, or in thin subjects. 1114 INDEX, Nervous system, action of Arnica upon, cases, 86 Nitric acid, in diphtheria, 521; in purulent conjunctivitis, 607; in syph- ilis, 809, 845; in tumor of gum, 767; otitis, 658; in eruptions, 975; in ptyalism, 989; in scorbutic cachexia, 1000; in mercurial cachexia, 1000; in syphilitic cachexia, 1001 Nose, action of Arnica upon, 99 Number of diseases, to diminish the, 78 Nux mosch., in intermittent fevers, 420; in eruptions, 975 Nux vomica, in conjunctivitis catarrhalis, 602 ; in conjunctivitis phlyctenu- laris, 619; in conjunctivitis trachomatosa, 611 ; in diphtheria, 552; in haemorrhoids, 824 ; in intermittent fevers, 420 ; in otitis, 658 ; in stoma- titis, 995; in malarial cachexia, 997; in nausea and vomiting, 1002; in puerperal fever, 1042 Obstetrics and gynaecology, contents of department of, 876 Officers, for 1876, 5; election of, for 1877, 13 Ophthalmia, from suppressed eruptions, remedies, 314; phlyctenularis. (See Conjunctivitis phlycten.) Ophthalmic therapeutics, 623 Opium, for coma in scarlet fever, 469 ; in intermittent fevers, 421 ; in mea- sles, 475. Organization, registration, and statistics, report of bureau, 15 Otitis. (See Homoeopathic therapeutics of aural surgery.) Ovarian enlargement, ease of, 697 Ovarian tumors, 673; cure of by Apis, 675; cure by Iodine, 676; cure of case, 677 ; cured, 699, 700 ; remedies for, 763 ; cure of, 865 Oxalate of cerium, in nausea and vomiting, 1004 Papyrus Ebers, 1079 Paralysis agitans, Tarantula, 334; hysterical remedies, 945 Periostitis, case of, 684 Petroleum in conjunctivitis trachomatosa, 611 ; in otitis, 649; in stomatitis, 995 Petroselinum in intermittent fevers, 421 Pharmacopoeia, International Homoeopathic, remarks on, 1071 Pharyngitis, resultant from suppressed eruptions, remedies, 315 Phellandr. aquat., in intermittent fevers, 423 Phlegmasia alba dolens, Ammonia in, 535 Phosphoric acid, in scorbutic cachexia, 1000 Phosphorus, in measles, 475 ; in polypoid growths, 766 ; in otitis, 658 ; in vaginal anaesthesia during coitus, 944; in pneumonia, action of, 588; in fibroid tumors, 857 ; in strumous cachexia, 998 Phytolacca, in syphilis, 845 Picric acid, in otitis, 649 Pitet, Dr. Paul, letter from, 833 ; some therapeutic effects of Curare, 187 Pitch, as a remedy, known to the ancients, 1078 Pityriasis versicolor, and capitis, Mezereum, 170 Platina, in ovarian tumors, 763 Pleuro-pneumonia, moist, hot applications in, 585 Plumbum arcet., in hysterical paralysis, 945 Pneumonia, miliary, symptoms of, 325 ; terminations of, 328 ; crisis of, 329 ; sputa in, characteristic of remedy, 558 ; senile, treatment of, 587 ; latent, in the aged, 337 Podophyllum in ovarian tumors, 763; in ptyalism, 988; in nausea and vomiting, 1005 ; in intermittent fevers, 423 Polypi, cases of, 697 Polypoid growths, remedies for, 765, 766 Potencies and doses in tropical climates, 220 INDEX 1115 Pregnancy, regiminal rules in nausea and vomiting in, 1006 Primary congestion of the lungs, 341; etiology and pathogenesis, 343 ; path- ological anatomy, 347; symptoms, 348; diagnosis of, 359; prognosis of, 362; treatment of, 363 ; literature of, 366 Provings, doses of, 73 ; rules of, 209 Pruritus senilis, Mezereum, 168,. 169 Pruritus, Sepia in, 984 Psorinum in conjunctivitis phlyctenularis, 620; in otitis, 649, 659 Ptyalism, therapeutics of, 988 Puerperal fever, 1009; symptoms of (see also 1034), pulse, temperature, 1021; termination, 1024 ; remedies in, 1030-1032 ; see also homoeopathic treatment of, 1034; haemorrhage, remedies for, 1042 ; metritis, remedies for, 1042 ; ovaritis, remedies for, 1042; peritonitis, remedies for, 1042 ; septicaemia, upon expulsion of placenta " stump," 1054: typhoid, reme- dies for, 1042 Pulsatilla, in conjunctivitis catarrhalis, 602 ; in conjunctivitis phlyctenu- laris, 620; in conjunctivitis trachomatosa, 611 ; in intermittent fevers, 424 ; in measles, 473 ; in purulent conjunctivitis, 608 ; in sarcocele, 768 ; in ptyalism, 988; in stomatitis, 944; in malarial cachexia, 997; in nausea and vomiting, 1003 ; in eruptions, 975 ; in retarded labor, 984 ; in puerperal fever, 1036, 1039 Putrescence of uterus, remedies for, 1042 Pyelitis, case of, 698 Quinine in puerperal diseases, 1068 Kanula, cases of, 698 Regiminal rules in nausea and vomiting in pregnancy, 1006 Report of the treasurer (for other reports, see Censors, Committee, etc.), 12, 20 Resolutions, condemnatory, 18; congratulatory, to Carroll Dunham, M.D., 15, 1075 ; of thanks to Madame Hahnemann, 54, 831; to hold a second World's Convention, 1071 Retarded labor, Pulsatilla in, 984 Rheumatism, sequence of suppressed eruptions, remedies, 315 Rhus tox., in intermittent fever, 424; in variola, 453 ; prophylaxis in scarlet fever, 458 ; failing or sudden disappearance of scarlet rash, 468 ; in con- junctivitis catarrhalis, 602; in conjunctivitis trachomatosa, 621 ; in con- junctivitis phlyctenularis, 620; in purulent conjunctivitis, 608; in gunshot wounds, 797 ; in malarial cachexia, 997; in puerperal fever, 1024 ; in eruptions, 975 Roman fever, 439; preservative rules, 441; remedies in, 443 Rubini, Dr. Rocco, communication from, 837 Rupia prominens, Mezereum, 172 Ruta, in gunshot wounds, 797 Sabadilla, in intermittent fevers, 425 Sabina, in uterine hasmorrhage, 955 Salicylate of soda, in otitis, 661 Salix niger, in bronchocele, 768 Sambucus, intermittent fevers, 425 Sanguinaria, in conjunct, catarrhalis, 602; in polypoid growths, 765,' 767 Sarcocele, remedies, 768 Scarlet fever; prophylaxis, Bell., Ailanth., Ammon, carb., Lach., Rhus, 457 ; treatment, Belladonna, 459 ; Ailanthus, 462 ; Lachesis, 462, 468 ; Crotalus, 462; Lachesis, 463; Rhus, 464; Sulphur, 469; Bry., Bell., Hepar, Ipec., Rhus, Sepia, Stram., Sulph., 468 ; coma in, remedies for, Opium, Stram., 469 1116 INDEX, Scorbutic cachexia, 1000 Secale, in uterine haemorrhage, 955 ; in septicaemia, 1053 Sedum acre, in intermittent fevers, 425 Sepia, failing or sudden disappearance of scarlet rash, 468 ; in conjunctivitis catarrhalis, 602; in conjunctivitis phlyctenularis, 620; in hysterical paralysis, 945; in intermittent fevers, 425; in strumous cachexia, 999; in nausea and vomiting, 1003 ; in eruptions, 975 ; in pruritus, 984 Septicaemia, puerperal, 1054 Sharp, Dr. William, foundations and boundaries of modern therapeutics, 57 Shipman, Dr. George E., discussion on expunging his name from list of se- nior members, 15 Silicea, in bursitis, 762; in bronchocele, 768; in fibrous tumors, 764; in ganglion of wrist, 763; in gunshot wounds, 796, 800; in intermittent fevers, 426; in otitis, 649; in sebaceous cysts, 762, in tumors of gum, 767; in enchondroma, 864; in otitis, 659 ; in strumous cachexia, 998 ; in eruptions, 975 Silver wire sutures in the Caesarian section, 1043 Skin affections, syphilitic, remedies, 846 Skinner, Dr. Thomas, England, introduction and remarks of, 54 Society, Hahnemann Publishing, in England, 1074 Soci6te Hahnemannienne F5derativede Paris, communications from, 833-837 Spigelia, in conjunctivitis catarrhalis, 603 Spinalis, distortio, cases of, 681 Spongia, in bronchocele, 768 Sputa in pneumonia, characteristic of remedy, 558 Squilla, known to the ancients, 1078 Staphisagria, in intermittent fevers, 426; in sebaceous cysts, 762; in syph- ilis, 846; in fibroid tumors, 857 ; in scorbutic cachexia, 1000; in stoma- titis, 995 Stomatitis, therapeutics of, 990 Stramonium, failing or sudden disappearance of scarlet rash, 468; for coma in scarlet fever, 469; in intermittent fevers, 427; in measles, 475 Strumous cachexia, remedies in, 998 Sulphur, failing or sudden disappearance of scarlet rash, 468; in conjuncti- vitis catarrhalis, 603 ; in conjunctivitis phlyctenularis, 621; in conjunc- tivitis trachomatosa, 612; in baamorrhoids, 824; in intermittent fevers, 427; in otitis, 649; in polypoid growths, 766; in purulent conjuncti- vitis, 608; in scarlet fever (with case), 469; in otitis, 659 ; in ptyalism, 989; in strumous cachexia, 998 ; in mercurial cachexia, 1001 ; in syphi- litic cachexia, 1001 ; in nausea and vomiting, 1005; in eruptions, 975 Sulphuric acid, in scorbutic cachexia, 1000 Surgery, department, contents of, 596 Surgical operations, climatic influence upon, 863 ; remedies after, 867 Survey of medical science, 226 Symphytum, in gunshot wounds, 797, 800 Synovitis, case of, 699 Syphilis, high potencies in cure of, 851-854 ; homoeopathic treatment of, 803; nature of, 848-850; remedies for, 806, 845 Syphilitic and mercurio-syphilitic ulcers, 174 Syphilitic cachexia, 1001 Tarantula, in hysteria, 936; observations upon the action of, 331 Taraxacum, in intermittent fevers, 427 Tartarus emet., in intermittent fevers, 428; in purulent conjunctivitis, 608; in nausea and vomiting, 1002 Tellurium, in conjunctivitis phlyctenularis, 622; in otitis, 650, 659 Tetter, Mezereum ip, 171 Teucrium, in otitis, 660; in polypoid growths, 766, 767 INDEX 1117 Thanks, votes of, 18 The medical treatment of varicose veins and haemorrhoids, 813 The neurotic element in the local diseases of women, 957 Therapeutics, foundations and boundaries of modern, 57 ; of benign tumors, 759; treatment of certain diseases of the digestive centre incident to pregnancy, 988 Thermometer, clinical, in puerperal fever, 1054 Thlaspi burs, past., in uterine haemorrhage, 955 Thuja occid., in condylomata, 845; in polypoid growths, 766 ; in syphilis, 810; in variola, 451 ; in conjunctivitis trachomatosa, 612; in intermit- tent fevers, 428; in otitis, 659 ; in sebaceous cysts, 762 ; in syphilitic ca- chexia, 1001 ; in eruptions, 975 Thyroid cyst, case of, 692 Topical applications, 71 Traumatism, Arnica in, 115 Tropical climates, potencies and doses in, 220 Tumors, adenoid, remedies, 767; adipose, remedies for (see Lipoma), 763; cases of, 692; fatty, remedies for (see Lipoma), 763; fibrous, remedies for, 764 ; of the gums, remedies, 767 Ulcers: breast, coccyx, foot, neck, tibia, toe, etc., cases of, 700 University of Michigan, report from J. C. Morgan, M.D., 16 Urethra, stricture of, case, 702 Urethritis, 689 Uro-lithiasis in Russia, with tables, 705; immunity from, in females, 741 Urtica urens, in eruptions, 975 Ustilago m.,in uterine fibroids, 765 Uterine derangements, stony enlargement of os, case of, 689; Tarantula in, 335; fibroids, remedies for, 765 Uterus, cancer of, 224; gangrene of, remedies for, 1042 Vaccination, 449 Vagina, contracted, in labor, Aconite, 983 Valeriana oft'., in nausea and vomiting, 1005; in intermittent fevers, 428 Variola, Antim. tart., Ars., Bell., Bry., Rhus, in, 453 ; eruption of, remedies in, 454; desiccation, treatment, diet, regimen, 456; its prophylaxis vac- cination, 449; prevention of scarring, Gold Leaf and collodion, 457 ; treatment, Thuja, 451; ulcerative fever, or typhoid character, reme- dies, 456 Varix, 813 Veratrum alb., in intermittent fevers, 428; in ptyalism, 989 ; in nausea and vomiting, 1005 Veratrum vir., in gunshot wounds, 798; in puerperal fever, 1035, 1039; in lowering temperature, 1055 Veronica bee., in stomatitis, 996 Vomiting and nausea, therapeutics of, 1002 Warts, cases, 702 Wesselhoeft, Dr. C., appointed Chairman of Materia Medica Bureau, 14; Survey of medical science, 226 Whitlow, cases of, 703 Wilson, Dr. David, a few thoughts on the study and practice of homoeop- athy, 206 Whiskey, in puerperal diseases, 1068 Zincum, in conjunctivitis catarrhalis, 603; in conjunctivitis phlyctenularis, 622 ; in intermittent fevers, 429