■'•.•'."'' •:■ '■■•'•.,'■ V<.'1'4 V'v;. V. ■;, • ."V.v ''.,'A'v',! \>vtf/*'\l>\ ■,-. •... ■•■■■. ■ .:;; : : •rV'v*.i>.v' ■'••''■.'■' ''•..... " ■ A^-H^^vV:. •.,■■;•:,•••••' L-& sJo- lid-- £<*** ^f* NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy Jliaesimund panes Library 0* M. ^ ■* ^ -& ,74? &k 'O/l,0EO *$ aW ■a0 HOMCEOPATHY THE SCIENCE OF THERAPEUTICS: % €olhdxon of IJaprs ELUCIDATING AND ILLUSTRATING THE PRINCIPLES OF HOMCEOPATHY. BY CARROLL DUNHAM, A.M., M.D. GRADUATE OF THE NEW-YORK COLLEGE OF PHYSICIANS AND SURGEONS; DEAN OF NEW-YORK HOMCEOPATHIC COLLEGE; PROFESSOR OF MATERIA MEDICA; PRESIDENT OF THE AMERICAN INSTITUTE OF HOMCEOPATHY, AND OF THE WORLD'S HOMCEO- PATHIC CONVENTION HELD AT PHILADELPHIA, 1876; AND MEMBER OF VARIOUS AMERICAN AND FOREIGN SOCIETIES. FOR SALE AT ALL HOMCEOPATHIC PHARMACIES. PRINTED FOR THE PROPRIETOR, BY Francis Hart & Company, No. 63 Murray Street, New-York. 1877. Entered, according to Act of Congress, in the year 1877, By Harriet E. K. Dunham, In the Office of the Librarian of Congress at Washington. >1MJ TO P. P. WELLS, M!. D. THE HONORED COLLEAGUE AND BELOVED FRIEND OF CARROLL DUNHAM, THIS VOLUME IS RESPECTFULLY DEDICATED. NLM CONTENTS. Date. Page. I. Homoeopathy the Science of Thera- , \---1862 1 peutics..................... II. Antagonism between Homceopathy ) and Allopathy..................J III. Relation of Pathology to Thera- peutics .......................... I ....1864 99 IV. Primary and Secondary Symptoms of ") Drugs as Guides in Determining >___1875 115 the Dose.......................) V. The Dose in Drug-Proving...............i860 136 VI. Alternation of Remedies. No. i........1863 156 VII. Alternation of Remedies. No. 2.........1865 166 VIII. Editorial Remarks on Alternation. I... 1865 215 IX. Editorial Remarks on Alternation. II... 1865 223 X. The Use of High Potencies in the ) Treatment of the Sick..........) 3 227 XL Reply to a Letter on High Potencies.. .1864 257 XII. The Question of the Dose..............1864 267 XIII. The Basis of Treatment.................1864 272 XIV. Diagnosis in Homoeopathic Practice, ) with Compilations from Dr. Kas- > ....1852 277 par's Lectures..................) XV. Belladonna—Reported from the German. 1852 343 XVI. A Weak Spot in our Materia Medica---1870 347 CONTENTS. Date. Page. XVII. Directions for Drug-Provers............1869 350 XVIII. Provings of Lilium Tigrinum.............1870 353 XIX. Murex Purpurea........................1864 367 XX. Platina—Adapted from the German.....1853 387 XXI. Remarks on Rumex Crispus..............i860 417 XXII. Remarks on Guao.......................1863 423 XXIII. Remarks on Spigelia.....................1864 427 XXIV. Dr. Harley on Conium Maculatum......1869 433 XXV. Remarks on Conium Maculatum.........1870 443 XXVI. Remarks on Mezereum...................i860 458 XXVII. Deafness Cured by Mezereum...........1858 462 XXVIII. Croup Cured by Bcenninghausen's Powders, i860 467 XXIX. Chronic Diarrhcea cured by a Sin- gle Dose of a High Potency XXX. Pterygium Crassum Cured by a Sin gle Dose in a High Potency n- ) oc \ — . i860 470 Jin- > oc >---1864 474 XXXI. Panama Fever Cured by Arsenicum......i860 479 XXXII. Case Cured by Magnesia Carbonica.....1870 482 XXXIII. Ovarian Tumor Cured by Colocynth---1869 4^5 XXXIV. Baptisia as a Hair-Wash................1868 488 XXXV. Chlorine in Spasmus Glottidis. No. i ...1859 490 XXXVI. Chlorine in Spasmus Glottidis. No. 2 ...1863 497 XXXVII. Chlorine in Spasmus Glottidis. No. 3 ...1869 499 XXXVIII. On the Elimination Theory ............1866 502 XXXIX. Cholera ...............................^65 504 / PREFACE. Since the death of Dr. Carroll Dunham, a desire has been expressed by many of his colleagues that his writings should be collected in book form. The present volume contains such as most directly express his views on the cure of disease by drugs. In their arrangement no attention has been paid to the order of time in which they were written, but those on the principles of cure have been placed together, while clinical cases illustrating these principles have been put side by side; and so great is the unity of thought running through all, that it has not been deemed inappropriate to give to the collection the title of the main Essay. If, forgetting that experience and reflection will, as years go by, modify the opinions of every thinker, any reader should fancy he sees contradictions in these papers, he is referred to the dates at which they were written1 and he will discover a mind ever progressive and hospitable to truth. In 1864 the Author writes: "The object of our professional life is to find out the truth, and shape our practice accord- ingly. Consistency to this object is true consistency, 1 See Table of Contents. PREFACE. while consistency to any form of opinion or doctrine which may at one time have been supposed to be the truth and proclaimed by us as such, consistency to such opinion merely because we may have once publicly uttered it, this is the basest and most ignoble bigotry and cowardice." These papers were occasional, unconnected contri- butions to periodicals, addresses delivered at the request of societies, studies of remedies or some topic connected with them, and clinical cases. Could they have been revised, for publication as a book by the hand that wrote them they might be more uniform in style though scarcely more connected in thought. To the Essay, "Homoeopathy the Science of Therapeutics," the Author devoted more than usual time, and after its publication in the American Homoe- opathic Review it was issued in pamphlet form. The Dedicatory Letter which then accompanied it is here given: To M. J. Chapman, A. M., Cantab., M. D., Edin., London. Dear Friend and Colleague : If I show presumption in honoring these pages by the prefix of your name, I may plead in extenuation that they were in some sort written at your instigation. When I had the pleasure of personal intercourse with you (now ten years ago), you frequently gave me the following advice: " Make a study of Hygiene in its relations to Medicine ! " One could not proceed far in such a study, involving as it does the entire philosophy of the art of medicine, without being compelled to meet the PREFACE. following questions, which have perplexed, and still perplex and divide our school: Is the Homoeopathic law of cure sufficient for all the procedures required in the treatment of the sick ? Or is it, on the contrary, only a part of a still broader generalization ? Or, again, are there other laws which are sometimes to be our guides in Therapeutics ? and if so, 7vhen are they to be used ? Are so-called "auxiliary" means ever requisite? and if so, how does this fact affect the jurisdiction of the law of cure ? Those who give only a limited jurisdiction to the Therapeutic law deduce their faith from their practice; but they have never given a satisfactory defini- tion of the boundaries of this limited jurisdiction. Those, on the other hand, who claim exclusive dominion for the Thera- peutic law, belie their faith by their practice, for in treating the sick they do, as a matter of fact, avail themselves of means and methods which are not author- ized by this law. Yet neither party should be called dishonest. The truth is, their clin- ical instinct, their practical sagacity, has outrun their philosophical acuteness. Each party felt its way nearly to the true ground, but neither has succeeded in vindicating its claim to consistency in occupying that ground. The result has been, on the part of Homoeopathic practitioners, an uncer- tainty of their true position in relation to Old-school medicine,and, consequently, a degree of distrust on the part of the community. It has seemed to me that these difficulties might be removed, and the perplexing questions fairly answered, by an elaboration of the nature and rela- tions of the sciences of Therapeutics and Hygiene, which should show: That Therapeutics concerns herself only with the discovery and selection of an individually specific remedy for each individual case of disease; which is done in accordance with a Therapeutic law. This law may be the Homoeopathic formula, or it may be some broader generalization; but there can be but one law of this kind; That the province of Hygiene is to discover whatever causes may have contributed to induce or perpetuate the diseased condition, and, if possible, to remove them ; That Hygiene alone is sufficient to restore many sick persons to health, and that it is in most cases an indispensable aid to Therapeutics; that, therefore, the practicing physician is at one and the same time Hygienist and Therapeutist, employing often, therefore, for the same case both specific reme- dies and various "auxiliaries; "■ That in so far as Hygiene is concerned, Homoeopaths and Allopaths occupy common ground,—the philosophy of the science being the same for both, however modified and shaded in practical application by the different Therapeutics of the two schools; That in Therapeutics alone—that is, in the discovery and selection of the individually specific remedy for each individual case of disease—do we differ radically from the old school of medicine,— the Allopaths having, in fact, no science of Therapeutics whatever, their philosophy ofcufe beittg an applica- tion of the principles of Hygiene to all diseased conditions, PREFACE. The natural sequence of a study of the philosophy of the science of Therapeutics is the question how to make a practical application of it in the treatment of the sick. I have therefore written of the study of the Materia Medica. Should the views I present throw any light upon these subjects, I shall have to thank you for the direction given to my studies. Should they prove worthless, you will join me in hoping for a sounder fruit from the labors of the next decade. CARROLL DUNHAM. New-York, January, 1863. Should the reader miss in the present volume some Paper he had expected to find here, it is prob- ably among the " Lectures," reserved for future pub- lication, or among the Miscellanies not strictly belonging to the present book. Irvington-on-Hudson, June 25, 1877. HOMCEOPATHY THE SCIENCE OF THERAPEUTICS. Homoeopathy claims to be " The Science of Therapeutics." This claim involves the assumption that prior to the estab- lishment of Homoeopathy on a scientific basis, Therapeutics, as a science, had no existence. It is incumbent on Homceop- athists to show the justice of this assumption. To accom- plish this, it will be necessary to prove that such a science is possible, to demonstrate what its nature and conditions must be, and to show that medicine hitherto has not furnished the means for the construction of a science which fulfills these conditions. It is the object of this paper, first, to discuss the nature and conditions of the only possible science of Therapeutics, to show that these conditions are not fulfilled by what is called rational medicine, and to inquire in what degree they are fulfilled by Homoeopathy. And, second, to examine the | methods by which this science may be most successfully stud- j ied and made subservient to the practical art of medicine. But on the threshold of the discussion we are met by the necessity of defining the term Therapeutics. It will be found that, though still sufficiently comprehensive, it is used by us in a much more restricted sense than that which, in popular thought, is attached to it. Therapeutics being etymologically the science of curing diseases, it would seem to comprise the entire function of the physician. It is evident, however, on slight considera- tion, that the medical man in general practice brings into requisition too great a variety of scientific knowledge to admit of comprehension under a single term. To show o 2 HOMCEOPATHY how great this variety is and at the same time to give an indirect definition and limitation to the term Therapeutics, let us analyze a series of cases which shall not be ideal cases, but drawn from records of actual practice. The physician is called in haste to an elderly person whose only intelligible complaint is of great anguish in the prae- cordia, and which appears by its violence to endanger his life. If he be in immediate danger of death, the state of his affairs renders it desirable that his family should be informed of the fact and how long he will probably live. The prog- nosis is demanded, and its correctness is a matter of great importance. The medical man must rely on his knowledge of Pathology1 for a conclusion respecting the nature, cause, and probable termination of the disease. With this, if it be a fatal case, the function of the physician ends. Yet how important may this function be to the survivors ! Here is as yet no question of Therapeutics. It is merely a problem in the natural history of disease, which the physician regards just as a Naturalist would a problem in Physics, and just as if the idea of curing disease had never entered the head of man. Again, he is called to a man who lies in an epileptiform convulsion. It is well known that convulsions may arise from the most various proximate causes. They may result from physical irritation of the nervous centers or of the extremities of the nerve-filaments, and in this case they will cease to recur so soon as the cause of irritation is removed; or, on the other hand, from modifications of the vital functions, such as are beyond our observation and which we can rectify only indirectly by the action of specific 1 Throughout this paper, as always sues, and is concrete. A corresponding by its author, Pathology is used with a distinction obtains between Physiol- meaning totally distinct from that of ogy, which is the science of healthy Pathological Anatomy. The former processes anti functions, and Physiolog- is the science of morbid processes and ical Anatomy, which is the science of functions, and is abstract; the latter is healthy organs and tissues. the science of morbid organs and tis- THE SCIENCE OF THERAPEUTICS. 3 agents. The first problem before the physician is to deter- mine by a study of the phenomena which the patient presents, to which of these great classes the case before him belongs. It is indispensable to determine this question, because the treatment of the case must depend directly upon it,— in the former case it may be mechanical or hygi- enic, in the latter it must be therapeutic. He determines, we will suppose, in the case before us, that the convulsion is eccentric in its origin and reflex in its nature, and he sees reason for suspecting that it depends on some cause of irri- tation in a nerve-filament of the lower extremity. He seeks, in the history of the case, and by a physical examination, for this irritating cause, and discovers that the patient had, years ago, received a gunshot wound in the thigh. There is no evidence that the ball was ever extracted. A close examination seems to confirm the conjecture that it still lies imbedded in the muscles of the thigh. An exploratory operation is performed and the ball is actually found lying upon a branch of the sciatic nerve. It is removed and the patient has no more convulsions. 1 In this case the physician's knowledge of pathology ena- bled him to discriminate between the varieties of convulsion as to their proximate causes; his acquaintance with physiol- ogy familiarized him with the phenomena of reflex-nervous action and enabled him to detect the seat of the irritation, and finally his dexterity in practical surgery placed it in his power to cure the patient of a dreadful malady. But, in this case from beginning to end, Therapeutics was not called into play. Again, the patient, a child of two and a half years, is subject to epileptiform convulsions, which occur daily, often twice a day. They first appeared when the child was four- teen months old and soon after it was weaned. They are now producing a very sad effect upon the child's intelligence. 1 This occurred in the practice of a distinguished Surgeon of Massachusetts. 4 HOMCEOPATHY The same question of proximate cause, which the last case gave rise to, suggests itself, first of all, to the mind of the physician. Careful investigation satisfies him that there is probably a constant or a frequently repeated source of irri- tation in the digestive apparatus. What so probable cause of irritation in these organs as improper food ? The question is put at once, "What food does your child take?" "Nothing whatever, except molasses-cake and milk." "How do you make molasses-cake?" "Three cups of flour, one of butter, one of milk, one of molasses, one egg and a tea-spoonful of pearlash !" " Very bad for your child ! Give it good wheat bread and milk and nothing else, except this powder" (of sugar of milk as a placebo). The diet of the child is thus reformed, but no medicine is administered and the case is carefully watched. For one week the spasms steadily de- crease in frequency and in violence, at the end of that period they cease and they never recur.1 Thus an abnormal state of things, which would certainly have had a fatal issue, is rectified by the application of a knowledge of Physiology, Pathology and Hygiene ; but Therapeutics has no part in it. Errors in diet being perhaps the most numerous of all of which the community are guilty, instances like this might be accumulated to an indefinite extent. It is clear that a large part of a medical man's practice is made up of similar cases, and consequently that a great many serious cases may be successfully treated without recourse to medicine—without the aid of Therapeutics. Again, a patient presents herself with the following history: Within three months she has rapidly emaciated ; her sleep is disturbed, her appetite gone; she has night-sweats; is prone to diarrhoea; takes frequent deep inspirations which fatigue her; has a dry, hacking cough; complains of extreme weak- ness and despondency. A careful physical examination fails to discover organic disease of thoracic or abdominal organs, 1 This case occurred in 1857. There The child on good diet is healthy. has been no recurrence of spasms. THE SCIENCE OF THERAPEUTICS. 5 nor does an investigation of her domestic or social relations disclose any source of mental or affectional anxiety. The case is perplexing as to its inducing cause, and the physician inclines to ascribe it to dynamic causes and to have recourse primarily to specific remedies for its cure,—in other words, to call Therapeutics to his aid,—when he discovers that the patient is nursing an infant of twelve months. Her milk is very abundant, but a microscopic examination shows that it is extremely deficient in oily matter. It is now clear that the patient is unequal to the drain to which nursing subjects her; she is suffering from consequent anaemia. It is ordered that she wean her babe at once. As soon as she does so, appetite returns, the cough and night-sweats disappear, and strength and flesh are restored. Now, it is true that, in such a case, the decline of vigor may be retarded, and after wean- ing, the restoration may be accelerated by a judicious appli- cation of Therapeutics; but it is unquestionably true that Therapeutics would play a very subordinate part, since no administration of medicines could be an offset to the drain which is exhausting the patient. In cases of similar exhaustion, facial Neuralgia of a reg- ularly intermitting character sometimes occurs and bids defiance to Therapeutics, the patient meanwhile declining rapidly in strength and health until, medicine being perhaps altogether discarded, but the patient induced to wean her infant and thereby enabled to take hearty food, strength and flesh return, and the Neuralgic pains cease. In this case, also, the restoration may be accelerated by a judicious recourse to Therapeutics, but here too Therapeutics must be subordinate to Hygiene. Once more, a patient, who exhibits signs of depraved nutrition, complains of a burning pain under the angle of the right scapula, with a tight aching across the back between the scapulae. I fear that repeated prescriptions will fail to relieve this burning pain unless the physician's knowledge of pathology shall have suggested to him that the symptoms 6 HOMCEOPATHY result ultimately from a too steady use of the needle with too rapid a motion, and unless his skill in Hygiene shall have enabled him so to order her mode of life as to combine due recreation and exercise in the open air with her necessary labor. Here, as in other cases, Therapeutics may of course come in and play a subordinate part. Finally, a patient has severe darting and aching in the shin, especially at evening, with coldness of the extremity, and, after the pain has lasted an hour, great sensibility to touch, relieved by warmth and by continued motion. This case has been treated by a variety of Therapeutic agents in the hands of several learned practitioners, but with no success. It is noticed that the patient, in the course of his business, incurs great exposure to dampness and cold. A woolen stocking is advised, and he enjoys ever after adopting it almost complete freedom from suffering, and which is rendered absolutely complete by a few doses of Rhus tox- icodendron. It must be remarked that this remedy had been previously administered in every variety of potency and- dose. Instances of a similar character to these might be indefi- nitely multiplied. They go to show, not that medicines are vain or unnecessary, but that very many cases of severe suffering and even of what threatens to become fatal disease occur in general practice, which call for and are successfully met by the application of scientific knowledge apart from Therapeutics. They show that an extensive and thorough knowledge of Physiology, Pathology and Hygiene are indis- pensable to the physician to enable him to make that prelim- inary analysis of a case by which he will determine under what category the case belongs, and whether or not it calls for treatment by medicines in part or entirely—whether it comes under the domain of Therapeutics or not. They show, moreover, that, inasmuch as Homoeopathy directly involves the science of Therapeutics alone, there is a large field which is occupied and cultivated in common by Homceopathists and practitioners of the Old School. They serve in part, also, THE SCIENCE OF THERAPEUTICS. 7 to mark the boundaries of that field in which " Rational Medicine " may legitimately claim dominion, in which her chief honors have been won, and in which the great advances which she boasts of having made in the treatment of diseases within the last thirty years have almost exclusively been achieved—the field of Hygiene. It is fitting that we study for a few moments this territory of Hygiene, which is com- mon to practitioners of all the varieties of Therapeutic faith and practice,—this science on which, together with the sci- ence of Therapeutics, the whole art of medicine is based — its subjects, limits, conditions, and mode of growth. The Nature and Limits of the Sciences of Hygiene and Therapeutics. — The living organism possesses a susceptibility to the action of certain general stimuli, such as light, heat, electricity, aliment, atmospheric air, etc. The action and reaction of these stimuli and this susceptibility are the conditions of life. So long as they act upon it in a due relative proportion, as regards intensity and quantity, the equilibrium of the functions is preserved and the organism continues in healthy action. The absolute withdrawal of one of the stimuli for any considerable length of time results in death. A disturbance of their due propor- tion, in respect of intensity or quantity, produces an abnor- mal performance of function in the organism—a deviation from health—disease. But these stimuli are continually varying in proportion, or, in other words, the relative suscep- tibility of the organism is continually changing. Why does not disease constantly exist? Because the organism is endowed with either a faculty of provisionally supplementing to a limited extent one stimulus by another, or with a kind of elasticity,—a power of enduring for a certain time a disturbance of the equilibrium of these stimuli, and of rebounding to a normal performance of functions again so soon as the natural proportion of the stimuli is restored or the deficiency made up. In this respect, the living organism 8 HOMCEOPATHY differs from an inorganic machine, which cannot, in the nature of things, possess any power to endure a disturbance of that equilibrium of forces which is the condition of its normal working without a disorganization from which it has no inherent power to recover. But, in the organism this elasticity has its limits. This "vis medicatrix naturce" is not inexhaustible. If the due proportion of the stimuli remain too long disturbed, the functions of the organism become permanently deranged— at least, to such an extent, that no restoration of the balance of the stimuli will cause a return to their normal perform- ance. The functions are and remain deranged — disease has occurred ; or, if we choose to call every deviation from a state of equilibrium disease, then we may say that now disease ensues which has no tendency to revert to health without the intervention of some extraneous influence foreign to the organism and different from the general stimuli aforesaid. Since, then, the general stimuli will not bring back the organism to a healthy action, a new element must be sought for and introduced, the action of which upon the susceptibilities of the organism may cause a restora- tion to health. This new element will be a special stimu- lus. Being foreign to the organism and different from the general stimuli, not only must it act upon susceptibilities in the organism which the latter do not awaken, but the formula which shall express its relations to those suscepti- bilities, and which shall furnish the rule for its employment, can never be discovered by a study of Physiology, for Physi- ology concerns herself with the relations of the general stimuli aforesaid and the general susceptibilities of the organism. This formula of the relations of special stimuli and special susceptibilities can be discovered only by the application of induction to a multitude of instances of the action and reaction of such stimuli and susceptibilities, and confirmed by subsequent deductive verifications. This for- mula will constitute an empirical law, which will be the law THE SCIENCE OF THERAPEUTICS. 9 or fundamental principle of Therapeutics. For the applica- tion of special stimuli to the diseased organism is the domain of the science of Therapeutics, while all that concerns the restoration and maintenance of a proper equilibrium of the general stimuli appertains to the science of Hygiene. These propositions may be more intelligible if illustrated by a reference to daily experience. A healthy man is ex- posed to an unusual degree of cold; in other words, there exists for him a deficit of heat—one of the general stimuli which are necessary to maintain life. Nature has anticipated variations in the supply of this stimulus from external sources by her liberal provisions of calorific apparatus within the organism. Despite the operation of this provision, he is chilled and suffers from rigors, etc. After a time he seeks shelter, sits by a fire, takes a warm drink; in other words, receives from external sources an excess of that general stimulus from deficiency of which he has been suffering. His functions resume their normal play. He is in perfect health. Here the equilibrium of the functions has been disturbed and (if we use terms with extreme rigor) disease has been pro- duced, but not to a degree beyond the provisions of the vis medicatrix nature? — the natural tendency to a restoration of the balance of the functions. The case was treated upon " general principles" in accordance with the maxim causa sub- lata tollitur effectus. And this maxim represents, in fact, the great law of Hygiene, viz. : that it be ascertained what stimulus has been deficient or excessive in quantity or abnormal in quality, and that the equilibrium of the stimuli be restored. But let us suppose that the same man has again been exposed to cold, perhaps to a greater degree. He seeks shelter and essays to restore the lost heat, but without avail. Despite the fire and warm drinks, the rigors continue and are succeeded by fever and quickened respiration, cough, etc., or by rheumatic pains, redness and swelling, etc. Why this difference between the cases ? This case too has been 10 HOMCEOPATHY treated on "general principles." The cause has been re- moved, why has not the effect ceased ? The equilibrium of the general stimuli has been restored and the loss made good; why is not the normal equilibrium of the functions re-established ? The normal proportion of the general stimuli, it is true, has been restored, but during the disturbance a new element had been introduced into the problem. The organism had suffered a dynamic and then an organic change. The func- tions are permanently modified. The general stimuli may henceforth be balanced never so carefully, and in strictest accordance with the rules of Hygiene; the organism will not respond. Its functions are performed after a new fashion. The organs are not susceptible to the wonted stimuli applied according to the laws of Hygiene. The organism has passed from a state of health into one of permanent disease. The general stimuli which, modified and balanced under the laws of Hygiene, sufficed to steady it as it rocked and swayed in its rapid course along the rough and crooked railway of life, will no longer answer the purpose, for in its rocking it has run off the track, and is now bumping along over the cross- ties, making headway, it is true, but toward its own destruc- tion. It needs now the intervention of some new agent acting under a new law—of a jack-screw and levers operated by forces from without—to re-instate it on the road of healthy action. The wonted general stimuli under the laws of Hygiene being insufficient, new stimuli of a special charac- ter must be applied according to a new law. This new law, whatever it be, is the Therapeutic law, and these new stimuli are Therapeutic agents, and the study of the law and of the agents constitutes the science of Therapeutics. Having thus marked out its limits, we have next to inquire what the nature of any possible science of Thera- peutics must be. Its subject is the modified functions and organs of the body. Its agents are special stimuli drawn THE SCIENCE OF THERAPEUTICS. II from whatever region of the external world. By what sort of a formula can these agents be applied to that subject? Can the Therapeutist act on " general principles" as the Hygienist does ? Can he act on the maxim causa sublata tollitur effectusf Obviously he cannot. In so far as the cause of disease can be discovered in external influences, the treatment falls within the limits of the science of Hygiene as already discussed. In so far, however, as the cause of disease is identical with the essential cause of the modifica- tion of function or organ which we recognize as the disease, it can never be discovered, for it is the same, in its nature, as the, cause of healthy functional or organic action; in other words, it is life itself, the nature of which, as of every first cause, is inscrutable. It being impossible then to ascertain the essential cause of disease, and to apply a remedy accord- ing to the rational method—as the Hygienist does—the Therapeutist is necessarily thrown back from an attempt to investigate^?^ causes, to the study of phenomena and to the adoption of the empirical method. In accordance with this method, the subject of his researches will be respectively the phenomena manifested by the patient, and the phenomena produced by the special stimulus, and, his endeavor must be to discover a general formula which shall express a constant relation between these two series of phenomena and shall serve as the Therapeutic law. In thus acting, and upon this method, he will do precisely what the student of every branch of Natural Science does and has done. For in his inability to find out the essential cause of the phenomena that form the subject of his study, the physician finds himself in the very same predicament as the Naturalist who likewise has vainly sought to discover the essential causes of the phe- nomena of gravitation, of light, of chemical action, and of elec- tricity. As the physician is unable to discover the essential nature of life and organism, whether normal or modified, to ascertain the cause of health or of disease, and is therefore unable to treat disease upon the principle " tolle causam " 12 HOMCEOPATHY (except in matters of Hygiene, as before stated), or " on general principles;" so the Naturalist has been compelled to abandon the rational method, such as Aristotle proposed and philosophers elaborated up to the time of Bacon and New- ton, and to adopt an empirical method in which the funda- mental principle is an empirical law or generalization expressing the relation between two series of phenomena. The science of Physics, for example, consists of the phenom- ena respectively of two bodies, or series of bodies, so far as density and volume are concerned, and of the law of gravitation which expresses the relation between these respective phenomena. , The Therapeutist, then, abandoning all idea of construct- ing a science of Therapeutics on the rational method, must have recourse to the empirical, as the elaborators of other natural sciences have done. The elements of his science will be as follows: He has to deal with a subject known by its phenomena—the sick body, with an agent known also by its phenomena — the drug; and with a law which shall tell how to apply the agent to the subject for the accomplish- ment of a cure,— a law which shall express the general relation between the drug and the morbid organism. The following tabular statement will show more clearly the nature of Therapeutics as a science, and its harmony with other Natural Sciences; for every Inductive Natural Science (except those of classification) consists elementarily of two series of independent phenomena, connected by the formula of their general relation : THERAPEUTICS. Morbid Functions & Organs, } c Toxic Functions & Organs, Or, Pathology and Patho- ( Therapeutic 1 Or, Pathogenesis and Patho- logical Anatomy, ( Law. y genetic Anatomy, Or, Sick-Phenomena, ) ( Or, Drug-Phenomena. PHYSICS. Phenomena of the Sun, ) t f ( Phenomena of the Earth, as regards Volume and > a.^T? < as regards Volume and Density, $ Attraction. } Density. THE SCIENCE OF THERAPEUTICS. 13 CHEMISTRY. } Law of Chemical ( Properties of Potassa, > Affinity and Defi- 2 Properties of Sulphuric acid. ) nite Proportion. ( OPTICS. Properties of the Luminous r J^ . , \ Properties of the light-re- Body, t . . \ ceiving body. Though thus simple in theory, Therapeutics is in reality the most complex of all the natural sciences. Each of the classes of phenomena requires for its study the aid of several auxiliary sciences. Thus, in order to know thoroughly the phenomena of disease, we must call to our aid Anatomy and Physiology, Chemistry, Physics and Psychology. To know and understand thoroughly the phenomena of artificial dis- ease or pathogenesy, we must avail ourselves of the same auxiliary sciences. The more imperfect our knowledge of these sciences, the less complete will be our acquaintance respectively with the phenomena of Pathology and Patho- genesy, and the converse. But, however complete or partial may be our knowledge of these two classes of phenomena, the relation 'between them, as known, remains the same, and is always expressed by the therapeutic law. The same is true of Physics and of all the natural sciences. Our knowl- edge of the physical properties of matter is continually increasing. The more complete it is, the more exact will be our application of the law of attraction. But complete or incomplete, the law is equally applicable, and pro tanto available. The Conditions of a Science of Therapeutics.— We come now to consider two conditions to which every natural science must be subject, and which may therefore serve as tests of its fitness to be regarded as a "Science." The first of these is a capability of infinite progress in each of its elements without detriment to its integrity as a whole. 14 HOMCEOPATHY We have already seen that the science of Physics is capa- ble of such progress in the phenomena with which it deals. Our knowledge of these phenomena is continually growing more comprehensive and more minute, and new elements of knowledge are continually coming into our possession with regard to them ; yet their relation to each other through the law of attraction remains the same, and the science, in its nature and structure, receives no modification. But not only are its subjects, the phenomena, capable of progress; the law itself may advance from a minor to a grander gener- alization, as it was advanced, step by step, by Newton, and still without destruction of the previous steps. The same is true of Chemistry. As our means of investigation become more exact and extensive, our knowledge of the properties of bodies increases; yet the law of Chemical Affinity in definite proportions remains undisturbed. Furthermore, this law itself becomes the subject of more extended generaliza- tions. The law as established by Black and Cavendish was suspended, yet not overthrown (nor the science disturbed) by the wider generalization of Dalton's Atomic Theory; and this again forms but a part of Faraday's Theory of the Identity of Chemical Affinity and Electrical Attraction, and amid all these revolutions in abstract theory, the science of practical Chemistry has held an even way. In the science of Optics, again, the phenomena of the luminous body and those of the light-receiving body are connected by the law of the transmission and diffusion of light. This structure of the science and all that is based upon it rests undisturbed through all the mighty changes which recent discoveries have wrought in our knowledge of Optics—enriched but not revolutionized by them. But while the progress of the science has been thus rapid and uninterrupted, philosophers have been and remain at vari- ance respecting the very nature of light and its mode of propagation. One school holds to the theory of emission, another to the undulatory theory. Now, let us suppose THE SCIENCE OF THERAPEUTICS. 15 that the science of Optics, instead of being based upon an empirical law, the result of induction, and which expresses the relation between two series of observed phenomena, had been based upon a theory of the essential nature of light and its mode of transmission. It is very evident that the whole structure that might be built upon the theory of emission would be toppled over so soon as the theory of undulation should be established. And should subsequent observation again lend countenance to the theory of emission, down would go, of necessity, the whole science as built upon the undulatory theory. And thus, inasmuch as experience and sound philosophy render it tolerably certain that we shall never attain absolute knowledge on this subject, we should have, through all time, an endless succession of half-com- pleted fabrics and hopeless ruins, but no infinitely progres- sive science of Optics. This furnishes an exact illustration of what would be the history of any science of Therapeutics not constructed upon the empirical plan already elaborated. Let us suppose that instead of taking as the subject of action, the phenomena of disease as derived from observation with all the aid which auxiliary sciences can afford, we should take a theory of disease, — its essential nature and mode of development,—and upon this theory should construct a science. All would go well, until facts should show that our theory was insuf- ficient and untenable (and facts would show this, since, as we have already seen, the essential nature of disease is inscrutable). Now our whole structure would be over- thrown, nor would the fragments even be available for the construction of another science or another theory, for they would consist of observations made, not independently, but on the basis of a theory and with reference to it. There could thus be no possibility of steady, uninterrupted, infinite progress in the science. There would be a succession of dynasties of theory, each based on the overthrow of a former, and each in turn demolished by its successor. That i6 HOMCEOPATHY this is the history of the Therapeutics of the Old School of medicine up to the present day is admitted by common consent. It will continue until attempts to erect a rational science of Therapeutics upon a theory of disease, confound- ing the law with the phenomena, shall give place to the construction of an empirical inductive science. "What then ! " it may be asked, "shall we not investigate and theorize upon the nature of disease in general, or of diseases in particular?" By all means investigate and theorize, just as physicists do upon the nature, properties and transmission of light—but do it as studying the science of Pathology, not that of Therapeutics—and avoid most carefully, making these theories which can be at best no more than temporary aids to the observation and grouping of phenomena, the basis of a practical science. If, however, they throw light on the study of phenomena, render our observations of them more keen and more exact, or afford us connecting links between isolated groups of phenomena,— and they will do all this,—they will render valuable indirect aid to the science of Therapeutics, just as similar investiga- tions of light have advanced our knowledge of Optics. A second condition or test of a natural science, and therefore of any proposed science of Therapeutics, is that it shall provide for the prediction of future events within its own domain. It must furnish means of prevision. The problem must be as follows: Given the law and one series of phenomena, to state the corresponding series of phenom- ena on the other side. This condition is admirably stated by Whewell: " Men cannot help believing that the laws laid down by discoverers must be in a great measure identical with the real laws of nature, when the discoverers thus determine effects beforehand, in the same manner in which nature herself determines them when the occasion occurs. Those who can do this must to a great extent have detected nature's secret—must have fixed upon the conditions to which she attends and must have seized the rules by which THE SCIENCE OF THERAPEUTICS. \J she applies them. Such a coincidence of untried facts with speculative assertions cannot be the work of chance, but implies some large portion of truth in the principles on which the reasoning is founded. To trace order and law in that which has been observed, may be considered as inter- preting what nature has written down for us and will commonly prove that we understand her alphabet. But to predict what has not been observed is to attempt ourselves to use the legislative phrases of nature; and when she responds plainly and precisely to that which we thus utter, we cannot but suppose that we have in a great measure made ourselves masters of the meaning and structure of her language. The prediction of results even of the same kind as those which have been observed, in new cases, is a proof of real success in our inductive processes." x The discovery of the planet Neptune by Leverrier and Adams affords an instance of this prevision, in Astronomy, the details of which are familiar to all. The problem was: Given the law of attraction and a series of phenomena, con- sisting of certain unexplained perturbations of Jupiter—to find the other and corresponding series of phenomena. The calculations were made; the resulting phenomena were stated to be those of an undiscovered planet of a given size and orbit and a definite location, the existence of which was accordingly affirmed and its discovery predicted. Physical investigation confirmed the induction. This condition applies to all natural sciences, and of course to Therapeutics. The problem would be: Given the Thera- peutic law and a certain series of phenomena of natural or drug disease, to find the corresponding series of phenomena of drug or natural disease. Does " Rational Medicine " Fulfill these Condi- tions?—This being the nature and these the conditions and 1 Whewell, Philosophy of the Inductive Sciences, vol. ii., pp. 64, 65. 3 18 HOMCEOPATHY tests of the only possible science of Therapeutics, we come now to inquire whether the Old-School Therapeutics are of this nature or will sustain these tests. The works of the foremost men of the Old School abound in admissions of their lack of a therapeutic law and of the chaotic state of their practice.1 But the efforts of these men to remedy this sad state of things show a constant misapprehension of the philos- ophy of the science they are striving to construct. We may divide Old-School Therapeutics into two methods. The one bases the plan of cure upon a theory of the nature of the disease,2 endeavors so to study the pathology of the disease as to form a. sound hypothesis of its modus operandi and then essays the cure upon " general principles." It undertakes, in fact, to act in Therapeutics upon what we have seen to be the true method in Hygiene. There are thre.e objections to this method, any of which would be conclusive were there not a prior difficulty in the simple impossibility of arriving at a knowledge of the nature of the disease, which is modified life. A simple example will show this impos- sibility. In Pneumonia the blood contains an excess of fibrine. How happens this ? Why, either the elimination of fibrine has been retarded or its fabrication has been accel- erated. What are the agents of these respective processes ? Cells—which are essentially similar in all parts of the body —and yet whose structureless walls possess the power of separating from the circumambient fluids the most diverse substances in different organs—nay, even of manufacturing new substances. Now, until we can learn the secret of this mysterious power of the cell wall, which begins and ends with life, which we can neither comprehend nor imitate nor simulate, we shall not arrive at an understanding of the nature of any disease. 1 See Forbes, Bennett, Tod, Holmes says: " In these wards, by those bed- and others. sides, have you seen the patient ap- 2 Thus Prof. Geo. T. Elliott in his plication of the searching analytical recent Valedictory to the Graduating laws by which we seek to discover the class at Bellevue College Hospital essentiality of disease." THE SCIENCE OF THERAPEUTICS. 19 Of the other objections to this method the first two are somewhat paradoxical. The method constitutes rather a congeries of sciences of Therapeutics, based on theories of isolated groups or types of disease, than a single, all-embrac- ing science founded on one comprehensive theory of disease. Hence, a new science must be formed for every new type. It is too special. On the other hand, it is too general to embrace all the phenomena of each individual case. For observation shows incontestably that so great are the vari- eties of temperament and relative organization and condition among men, that no two cases of the same disease, so to speak, are exactly alike. Such a Therapeutics must be necessarily based on a theory which is a generalization, and which therefore over- looks those phenomena of a given case which are peculiar to the individual patient and takes cognizance only of those phenomena which are common to a great number of cases. Now, a method which requires such generalization and makes no provision for the strictest individualization is radically vicious. The eye of science regards natural phenomena with the most absolute impartiality. In her view there are no trifles, no events, subjective or objective, which are "irrelevant" and " of no moment." A method of Therapeutics, however, which selects a few symptoms, calls them pathognomonic of Pneumonia, constructs upon them a theory of the disease, and from this deduces a mode of cure, must disregard many phenomena of every individual case. It arbitrarily pro- nounces them " accidental"—but Nature knows no accidents. So far is this method from meeting the requirements of inductive science, that it is not too much to say that this process of generalization actually leads to the treatment of cases which have no real existence and never had any,— in fact, to the treatment of abstractions. For who ever saw a case in which none but the pathognomonic symptoms of Pneumonia were present—or of Rheumatism or Dysentery ? 20 HOMCEOPATHY Who ever saw ideal cases of these diseases? We all see cases which present the pathognomonic symptoms plus certain others peculiar to the individual, but these vary with the individual, and thus make each case different from every other. We see and treat the Pneumonia or Rheuma- tism of John Doe or Richard Roe, each of which presents, in addition to the pathognomonic signs of the disease, certain peculiar modifications impressed upon these signs by the temperament and idiosyncrasies of these persons, along with other symptoms peculiar to each. For such an indi- vidualization of disease as would give equal (or, as they deserve, higher) rank to these peculiarities of the individual patient, the method under consideration makes no provision. This fallacy was perceived and well exposed by the Leipsic Professor who recently exclaimed to his class: "Gentlemen, we have to do with patients and not with diseases." The next objection to this method is that it does not fulfill the first condition of a physical science. It is not capable of infinite progress. This point needs no elaboration. It was fully considered when the condition was stated. In confir- mation of what was then said, I need not refer to the successive rise and decline of Brunonism, Broussaisism, the humoral and solid pathology, the theory of the dyscrasias and the reign and decadence of Iron, Iodine, Cod Liver Oil, etc. The second method of Old-School Therapeutics is the methodical, which discards theory and founds its rules for treating disease upon numerical data, obtained from observa- tion or by experience upon the sick. Given records of three series of cases, 1,000 in each, and under three modes of treatment: Under treatment A, 500 recovered; under B, 300; under C, 200. A is adopted as the established mode of treatment for the disease—" Risum teneatis, Amicif" An elaborate criticism of this method is unnecessary. It is enough to say that it does not fulfill either condition of a physical science. It is incapable of THE SCIENCE OF THERAPEUTICS. 21 infinite progress. The addition of 500 cases to the 3000 above named might modify all conclusions and place treat- ment C in advance of A or B. There would result a complete revolution in practice and in the direction of investigation. But it utterly fails to enable us to foresee and provide against new forms of disease. If a thousand or two of cases must be seen and experimented upon, in all conceivable ways, before definite and trustworthy conclusions as to the best treatment can be arrived at, who would not pray that his turn might come among the third or fourth thousand ? Who would not pity the victims among the first thousands ? Notwithstanding these obvious objections, this method of constructing a science of Therapeutics upon observation, whether at random or based on experimentation upon the sick, has the sanction of some of the highest names in the profession—among which it is sufficient to name Louis and Forbes. It demands, therefore, a more extended considera- tion. As it involves the application of both Mathematics and Logic, the opinion of the highest authorities in these respective sciences should be conclusive as to the soundness of the method, and we content ourselves with quoting two of them : M. Auguste Comte, one of the first living mathematicians, and who would therefore be disposed to apply mathematical methods to the natural sciences wherever this were possible, expresses himself in the following manner concerning the numerical method in medicine : " Indeed, the spirit of calculation tends in our day to intro- duce itself into this study (Physiology), especially into that part of it which relates to medical questions, by a far less direct method, under a far more deceptive form, and with infinitely more humble pretensions. I wish to speak of that assumed application of it which is called the Statistics of Medicine, from which so many savants expect great things and which, from its very nature, can lead only to profound 22 HOMCEOPATHY and direct degradation of the medical art (which would be reduced by it to a method of blind enumeration). Such a method, if we may be allowed to call it by the name of method at all, cannot in reality be anything else than absolute empiricism, disguised under the frivolous garb of mathe- y matics. Pushed to its extreme logical consequences, it will tend to make all rational medication radically disappear from medicine, by conducting the practitioner to make random trials of certain therapeutic measures with the object of noting down, with minute precision, the numerical results of their application. It is evident, on principle, that the con- tinued variations to which all organism is subject, are neces- sarily more pronounced in a pathological than in a normal state, and as a consequence of this fact, the cases must be even less exactly similar, whence results the manifest impos- sibility of making a judicious comparison between two cura- tive methods derived from data, furnished by statistical tables alone, independent of some sound medical theory. No doubt, some direct experimentation, restrained under proper limits, might be of great importance to medicine as well as to Physiology, but it is precisely under the strict condition that it shall never be merely empirical, but shall always attach itself either in institution or in its interpretation to an entire system of corresponding positive doctrines. Notwithstanding the imposing aspect of the forms of exactness, it would be difficult to conceive of an opinion in Therapeutics more super- ficial and more uncertain than that which rests solely on the easy computation of fatal and favorable cases, to say nothing of the pernicious practical consequences of such a manner of proceeding, when one could not beforehand exclude any kind of attempt. " It is really deplorable that geometricians have sometimes honored with some kind of encouragement, such a profoundly irrational aberration by making vain and puerile efforts to determine by their illusory theories of chances, the number of cases sufficient to make these statistical results legitimate."1 ' Cours de Philosophic Positive, par M. Auguste Comte, torn, iii., pp. 418-420. THE SCIENCE OF THERAPEUTICS. 23 And with a direct reference to the method of obtaining a correct system of Therapeutics by experimenting with indi- vidual medicines and individual cases of diseases, and form- ing of the results statistical tables from which deductions are to be drawn by the numerical method, the highest modern authority in philosophy, John Stuart Mill, speaks in his Sys- tem of Logic:x "Let the subject of inquiry be the conditions of health and disease in the human body; or (for greater simplicity) the conditions of recovery from a given disease ; and in order to narrow the question still more, let it be limited, in the first instance, to this one inquiry: Is or is not a particular medicament (Mercury, for instance) a remedy for that disease ? " The experimental method would simply administer Mer- cury in as many cases as possible, noting the age, sex, tem- perament and other peculiarities of bodily constitution, the particular form and variety of the disease, the particular stage of its progress, etc., remarking in which of these cases it produced a salutary effect, and with what circumstances it was on those occasions combined. * * * * " When we devise an experiment to ascertain the effect of a given agent, there are certain precautions which we never, if we can help it, omit. In the first place, we introduce the agent into the midst of a set of circumstances, which we have exactly ascertained. It need hardly be remarked how far this condition is from being realized in any case connected with the phenomena of life; how far we are from knowing what are all the circumstances which pre-exist in any instance in which Mercury is administered to a living being. This difficulty, however, though insuperable in most cases, may not be so in all; there are sometimes (though I should think never in Physiology) concurrences of many causes in which we yet know accurately what the causes are. But when we have got rid of this obstacle, we encounter another still more serious. In other cases, when we intend to try an experiment, we do not reckon it enough that there be no cir- 1 Harper's edition, 1848, p. 260. 24 HOMCEOPATHY cumstances in the case, the presence of which is unknown to us. We require also that none of the circumstances which we do know of shall have effects susceptible of being con- founded with those of the agent whose properties we wish to study. We take the utmost pains to exclude all causes capable of composition with the given cause; or if forced to let in any such causes we take care to make them such that we can compute and allow for their influence, so that the effect of the given cause may, after the subduction of those other effects, be apparent as a residual phenomenon. " These precautions are inapplicable to such cases as we are now considering. The Mercury of our experiment being tried with an unknown multitude (or let it be a known multitude) of other influencing circumstances, the mere fact of their being influencing circumstances implies that they disguise the effect of the Mercury, and preclude us from knowing whether it has any effect or no. * * * " In phenomena so complicated it is questionable if two cases similar in all respects but one ever occurred; and were they to occur we could not possibly know that they were so exactly similar. " Anything like a scientific use of the method of experi- ment in these complicated cases is therefore out of the question. We can in the most favorable cases, only discover, by a succession of trials, that a certain cause is very often followed by a certain effect." Has "Rational Medicine" Accomplished Noth- ing?—But it may reasonably be asked, can it be possible that a large number of men of every generation since Hippocrates, and among them some of the brightest intel- lects the world has known, should have been engaged in the study and practice of medicine, with no better result than this—a simple vacuity? I admit the rare intelligence and devotion of the laborers. But, in the first place, the task is mightier than any other essayed by man; may it not THE SCIENCE OF THERAPEUTICS. 25 reasonably require ages to complete its plan ? Again, labor, however intelligent and devoted, if misdirected, must fail of its end. If one generation of intellectual giants erect a towering fabric and their equally lusty successors demolish it, what does the third inherit save a heap of rubbish which it may require the best years of its life to clear away. Gen- eration after generation of wise men labored to construct the physical theory of the universe, yet not until the recent day of Newton did we learn how to begin aright. True, Newton's predecessors from the earliest ages observed and stored away a mass of isolated facts of the greatest value, but they knew not the magic word wherewith to charm them into order. In like manner, it is not denied that we are indebted to our predecessors for a vast number of isolated facts of incontestable value as materials to be used in the construction of a science of Therapeutics. We are indebted to them also for the elaboration of those subsidiary sciences—Anatomy, Physiology, Pathology, Chemistry and the like—in which, indeed, the great glories of the medicine of to-day have been won, and without which, we cheerfully admit, Therapeutics as a science could not exist. But it is said that Therapeutics must have advanced inas- much as the rates of mortality have steadily diminished. One sort of improvement we gladly acknowledge. Simul- taneously with the spread of Homoeopathy, Old-School physicians began to learn to abstain from mischievous modes of treatment formerly pursued, and which terribly enhanced the natural fatality of diseases. Professor Bennett, in the introduction to his work on Clinical Medicine, specifies Apoplexy, Pneumonia and Pleurisy, Syphilis, Small-pox, Phthisis, Bright's disease, and Favus, as diseases in treating which, he says, "great improvements have been made;" and he adduces this as a proof of the advancement of medicine. A reference to the chapters in which he treats of these diseases shows that he conceives the " improvement in their treatment" to consist in abstinence from methods 26 HOMCEOPATHY which were formerly employed and which he clearly proves were very mischievous. For example, Blood-letting in Apoplexy, Pneumonia, Pleurisy, Phthisis and Bright's dis- ease—the immoderate use of Mercury in Syphilis—heroic medication and external warmth in Small-pox, and avoid- ance of all internal medication for Favus, which he conceives to be a vegetable parasite. This improvement, then, is purely negative, a very poor ground on which to claim positive advancement in the construction of a science, however deserving of the gratitude of suffering humanity. The formula for improvement of all kinds is, " Cease to do evil; learn to do well." We admit that the Old School are learning to obey the former, the negative clause. We invite them to advance and join us in the latter, the positive. Again, an extended knowledge of the remote causes of disease and of the principles of Hygiene has enabled med- ical men to prevent the occurrence or the spread of many forms of disease. And far be it from us to undervalue, through any love of a newly constructed science of Thera- peutics, this branch of a physician's function, the forestalling or arrest of maladies by Hygienic means. As increased knowledge in this department of science has enabled us to dispense with therapeutic agents in many cases in which they were formerly resorted to, so we firmly believe that, with the advancement of learning, Hygiene will more and more curtail the boundaries of Therapeutics, until the day shall come when the physician shall be prized as the preserver rather than solely the restorer of health, and shall be con- sulted respecting the means of preventing rather than solely of curing disease, and the "family doctor" shall be regarded as the confidential adviser, valuable in proportion as he keeps his client out of bed, just as the family lawyer is con- fided in, for the purpose of keeping his clients out of court! In that day there will be fewer apothecaries. Does Homceopathy fulfill the Conditions of a Science of Therapeutics ?—Returning now to our argu- THE SCIENCE OF THERAPEUTICS. 27 ment, we find that the field is open for a science of Thera- peutics. In the light of what has been said we proceed to examine the claims of Homoeopathy to the honor of being that science. In its structure as a science, Homoeopathy conforms to the model we have delineated. It consists of a law or formula which expresses the relation between two series of phenomena, those of a given case of disease on the one hand and those of a given drug-proving on the other. The elaboration of each of these series is the province of various subsidiary sciences, and they are analogous in their mode of elaboration. Each series, however, is entirely independent of the other. Each may be pursued independently, as a branch of Natural Science and under the heads of Pathology and Pathogenesy respectively, researches may be made in each without any view to a practical application in the cure of the sick. It is only when connected by the law of their relation (the formula of similarities) that they constitute the science of Therapeutics. Their application, moreover, in obedience to this law is based upon no hypothesis respecting the essential nature of either variety of phenomena or of their modus operandi where brought into operation. This may surprise some who know, how earnestly Hahnemann argued on these very points in his Organon. But these arguments were no essen- tial parts of his system. They were the results of an endeavor to commend his discovery to the prevalent way of thinking. They constitute the only controvertible part of his writings, and are the only positions of his which have not triumphantly withstood the assaults of his critics. Coming now to apply to Homoeopathy, as tests, the condi- tions to which we have shown that every inductive science must conform, we find in the first place that it is capable of infinite progress in each of its elements, without such prog- ress involving the destruction or denial of what has been previously constructed or received. The study of the 28 HOMCEOPATHY phenomena (whether of disease or of drug-action) was limited at first to the observation of external manifestations and subjective sensations as these might present themselves to our senses unassisted by any of the aids by which modern science has sharpened them, or to our minds unaided by that knowledge of the connection and mutual relations and dependences of symptoms for which we are indebted to modern discoveries in Chemistry and Pathology. But these advances in Pathology, great as they have been, have not altered the relation which the phenomena of natural disease bear to those of drug-disease. These phenomena respect- ively, whether rudely apprehended, or clearly and fully understood in all their relations and inter-dependences, still bear the same relation to each other—expressed by the law Similia Similibus Curantur. And we can imagine no possible development of the sciences of Pathology and Pathogenesy which could alter this relation. And then the law itself may be but a stepping-stone to a still wider generalization which shall one day embrace both it and something besides, and which shall make clear some things which we now see darkly. But should this occur, as the like has occurred in other Natural Sciences, there will be, there can be, no revolutionary action in it. It may be - that the edifice, as we now occupy it, is still unfinished,— it may be that other stories are one day to be added,—but assuredly, as the tower is to the spire, as the buttress to the pinnacle, so will this generalization be to that which may be constructed upon it,— a basis,—an indispensable first step in the construction of the science. The complete manner in which the second condition — that oiprevision — is fulfilled by Homoeopathy is a source of inexpressible benefit to the race. It follows, from the very terms of the science, that if the phenomena of a given case of disease be known, the law of relation will at once point to the appropriate remedy (if this be contained in the Ma- teria Medica); and this indication may be relied upon with THE SCIENCE OF THERAPEUTICS. 29 implicit confidence, even though no such case of disease has ever heretofore been subjected to treatment. Conversely, when the properties of a given drug have been investigated and its toxic phenomena well ascertained, the physician is able to pronounce with certainty what form of disease it will cure, even though no such disease has ever been witnessed or treated by himself, or by anybody. An illustrious exam- ple of this prevision was afforded by Hahnemann. The terrible fatality of Asiatic Cholera, on its first invasion of Europe, is well known. In extenuation of their lack of success, physicians of the Old School pleaded that the disease was new to them,—they had had no opportunities to study it, and to ascertain by experiment the effects of remedies upon it. The plea was plausible, but fatal to the pretensions of their science. In fact, it was good for nothing. For surely the first thousand cases should have afforded means enough for learning the Pathology of the disease and how to cure it, if this were to be learned from Pathology. But hundreds of thousands perished, and yet the percentage of mortality remained the same. While the disease was still on the confines of Europe,— before it had invaded Germany,— long before either he or any of his disciples had ever seen a case of it, " Hahnemann, guided by the unerring therapeutic rule he had discovered, at once fixed upon the remedies which should prove spe- cific for it, and caused directions to be printed and distributed over the country by thousands; so that on its actual inva- sion the Homceopathists and those who had received Hahne- mann's directions were fully prepared for its treatment and prophylaxis; and thus there is no doubt many lives were saved and many victims rescued from the pestilence. On all sides statements were published testifying to the immense comparative success that had attended the employment of the means recommended by Hahnemann before he had seen or treated a single case. This one fact speaks more for Homoeopathy, and the truth of the law of nature on which 30 HOMCEOPATHY the system is founded, than almost any other I could offer, viz.: that Hahnemann, from merely reading a description of one of the most appallingly rapid and fatal diseases, could confidently and dogmatically say, such and such a medicine will do good in this stage of the disease, such and such other medicines in that; and that the united testimony of hundreds of practitioners in all parts of Europe should bear practical testimony to the accuracy of Hahnemann's conclusions."1 We may add that in the second Epidemic of Cholera in 1849, the Old School, despite their experience in 1831-34, had but little better success, while again the justice of Hah- nemann's conclusions and the claim of Homoeopathy to that prevision which characterizes a true science were vindicated by the splendid success of the Homoeopathic treatment. John Stuart Mill, in the portion of his work on Logic from which we have already quoted, in speaking of the three methods of investigation,—that of observation, that of exper- imentation, and that of deduction,—after showing conclu- sively that the former two are inapplicable to medicine, speaks of the deductive method in terms which are (unin- tentionally of course, and for this very reason they are the more conclusive) a description of the philosophy of Homoeop- athy. " If, for instance, we try the experiments with Mer- cury on a person in health, in order to ascertain the general laws of its action upon the human body, and then reason from these laws to determine how it will act upon persons affected with a particular disease, this may be a really effect- ual method, but this is deduction." How to Study the Science of Therapeutics.— The method of studying the two series of phenomena which, together with the law of relation, constitute the science of Therapeutics, follows from what has been said. When first brought into the presence of a concrete case of disease, the business of the physician is to ascertain what 1 Dudgeon's Lectures on Homceopathy, p. 37. THE SCIENCE OF THERAPEUTICS. 31 branch of medical science he is called upon to exercise. Is the case one which requires hygienic management or thera- peutic, or both, or is the patient beyond the reach of art ? To answer these questions a diagnosis and prognosis must be made, and to make these, a knowledge of the remote and proximate causes and of the course and determination of diseases is required. In a word, a knowledge of Physiology and Pathology is indispensable on the very threshold of med- ical practice and before any question of Therapeutics has arisen. When these preliminary questions have been settled and the case has been found to come within the domain of Ther- apeutics, its phenomena are to be studied in such a way that all deviations from a normal state may be perceived, as well those which are common to a number of similar cases, as more particularly those which seem to be peculiar to the individual case in hand, and which therefore serve to give it individuality and to distinguish it from all other and similar cases. The case is to be then individualized as sharply as possible, and a complete picture of the morbid phenomena obtained in their natural groups and connections. Now, morbid phenomena are deviations from healthy phenomena. How can we recognize the deviations unless we are familiar with the standard ? How can we appreciate morbid phenomena save through a knowledge of Physiology, which is the science of healthy phenomena ? In like manner we are able to get a complete picture of the morbid symptoms only by an orderly and methodical investigation; and such an investigation is possible to those alone who are familiar with the relations and sequences of morbid phenomena,— that is to say, with Pathology. A simple reference to practical experience will prove this. A patient complains of pain in her left hypochondrium, distress and faintness in the epigastrium, vertigo and various symp- toms of dyspepsia, but never thinks of mentioning—perhaps is unconscious of—certain evidences of uterine disease to 32 HOMCEOPATHY which the attention of the physician is instantly directed through his knowledge of the connection and sequence of symptoms. So of the connection of certain forms of vomiting with disease of the brain or of the kidneys, etc., etc. Clearly, then, Physiology and Pathology are quite indis- pensable to the physician, and they speak with little thought who affirm that these sciences are of no value to the Homoe- opathist and are disregarded by him. They are the sciences respectively of healthy and morbid phenomena. He cannot take the first step in the study of disease or of Materia Medica save by their aid. But he restricts them to their legitimate function. Pathology is for him not a guide in Therapeutics, but an instrument which he uses in studying those phenomena which are to be respectively the subject and the agents of his therapeutic operations. Having, by the aid of Pathology, arrived at a complete and comprehensive knowledge of the morbid phenomena, he passes on beyond the confines of that science to a higher and more complex science, whose domain is the relation of the phenomena of which he has thus acquired a knowledge, with other phenomena. Through Pathology he learns to know disease, but it is through Therapeutics alone that he can cure it. And it is quite time that it were well understood not only by the profession but also by the public, that to know the nature and course of a disease is not of necessity to know how to cure it. It may be a necessary preliminary step— but it is nothing more. Nor is this true of medicine alone. My carriage breaks down ; I well know where it has broken and why and how; yet this knowledge does not involve the knowledge how to forge and weld the iron that has broken and so to mend it. For that I require knowledge of another sort. The nature of Pneumonia, of Cholera, or Rheumatism is as well known as those of any disease can be ; "their Pathology," as doctors say, " is well understood," yet this gives no clue to their therapeutic treatment,—it is no guide to the special stimulus which must be brought to bear on the THE SCIENCE OF THERAPEUTICS. 33 diseased organs to lead them back to healthy action. This stimulus must be discovered by quite another method ; its discovery is the object of a distinct process. Thus Pathology, restricted to its proper sphere, is an indis- pensable auxiliary to the study of the subject of Therapeutics. It may be further subservient in enabling the physician to group the symptoms of a case in such a way as more readily to marshal and retain them in memory. Nor is generaliza- tion of this kind at all repugnant to the letter or spirit of Hahnemann's method or of homoeopathic science. The generalization to which Hahnemann objected was to that of disease in general upon nosological hypotheses made on theoretical grounds, and then applied a priori to individual cases. That to which we refer is a generalization made spe- cially in each case, consisting of a grouping of connected symptoms under one general term and extending only to such pathological states as are well defined and constant, such, for example, as Anaemia, Plethora, the proportion between the affections of different parts of the nervous system, etc., under which we may group a number of generic symp- toms to the great relief of our memory, while at the same time the individual or characteristic symptoms are not only not obscured by the process but are even brought more sharply into view, as will be evident when we consider this matter more at length under the head of the Study of the Materia Medica. The Study of the Materia Medica.—The method by which any subject may be most successfully studied must depend on the use which is to be made of the knowledge thus gained. It is proper, then, to inquire at the outset in what way the knowledge of Materia Medica is to be made subservient to the treatment of disease. In accordance with the homoeopathic law, we select for the cure of each individual case of disease that remedy of which the pathogenetic effects are most similar to the symptoms of 4 34 HOMCEOPATHY the case. In the process of making this selection we must pass in mental review the various drugs which compose the Materia Medica, take a comprehensive view of the pure effects of each, and institute a comparison between each in turn, and the case for which we are prescribing. This is the theory of the process. Now, it is evident that, in order to select from a number of candidates one which most nearly resembles a given standard, we must be familiar, not merely with the general properties of all the candidates or of certain classes into which they may be divided, but also with certain properties more or less pecu- liar to each one of the candidates, and which shall serve to distinguish each of them from all the others. In fact our method requires the strictest individualization of both disease and remedy. We are so to study Materia Medica as, above all, to bring into strong relief and fix firmly in memory those peculiarities of each drug which are not met with in any other, and which therefore serve to individualize and give character to the drug that produces them and which are called its " characteristic symptoms." This term having been much and loosely used of late, it may not be unprofitable to devote a few words to the subject of characteristic symp- toms. By some writers the leading and most obvious and most frequently recurring symptoms are called characteristic. Thus Bennett calls fever a characteristic of the Exanthemata. By others the pathognomonic symptoms of a class of diseases are called characteristic,—by others the pathologico-anatom- ical. Now, the signification of such a word as characteristic is not absolute. It depends on the connection in which you please to use it, and which is determined by the question, " Characteristic of what?" In the instances just adduced, the varieties of symptoms cited may indeed be called char- acteristic, but—characteristic of what? Of classes (the Exanthemata), of groups (nosological) — but -not of indi- THE SCIENCE OF THERAPEUTICS. 35 viduals. But the only sense in which Homceopathists can use the term is in its application to individuals. Hence a characteristic symptom must mean one which is possessed by none other than the individual drug of which it is predi- cated, and to which therefore it gives character as an indi- vidual. In this sense it corresponds precisely to those features of a man by which his friends are enabled to distin- guish him from other persons and to recognize him at a glance. It is obvious that these characteristic symptoms so pre- cious to the Therapeutist may seem to be of little or no pathological value,—may even seem accidental to those who forget that there are no accidents in Nature. They would be valueless if we did not need to individualize, but could be content with grouping our diseases and remedies. To the Naturalist whose object it is to group his speci- mens, it is sufficient to know that John Doe has a vertebral column, is a mammal, has two hands, and is a Caucasian — because this enables him at once to place John Doe in the variety Caucasian of the species man, and his analysis goes no farther. From this his whole physiological status follows. But these items of general knowledge would hardly enable the sheriff to recognize John Doe in Broadway. It is of no importance to the Naturalist that he has such " accidental" peculiarities as an aquiline nose, black eyes and hair, and a brown mole on the left ala nasi; but these very peculiarities are all important to the sheriff, for they give him the means of detecting the object of his search upon the crowded street. It must not be forgotten, however, that the points on which the Naturalist laid stress are equally important to the sheriff; for if the latter should bear in mind only the individual peculiarities of the object of his quest and should forget that he is a Caucasian, he might find the former in the person of an Indian, or, if he should forget that he is a bimanous creature, he might arrest a monkey. To drop the figure, then, it is evident that we must seek to discover among the symptoms of every drug certain ones 36 HOMCEOPATHY that are produced by no other drug, and which shall serve to distinguish it from all other drugs similar in other re- spects ; that these symptoms will often be unimportant and trivial in a physiological point of view; furthermore, that we must, for convenience sake, when the number of drugs in our Materia Medica has become considerable, endeavor so to group them, on the basis of certain clearly defined symp- toms or collections of symptoms, that for the purpose of preliminary examination and comparison, these groups may be regarded and compared as though they were individual drugs. Let us suppose a case of uterine haemorrhage. As many as forty drugs probably produce uterine haemorrhage. On the basis of this symptom, they form a group isolated from the three hundred and forty remaining drugs of the Materia Medica. We select this group from the Materia Medica, and now we must select a remedy from the group. It were a tedious task to consider and compare them one by one. But we group them again; ten of them produce dark-colored and ten florid haemorrhage; ten a limpid and ten a clotted discharge. Our case has a dark-colored discharge. Our choice is now restricted to ten drugs. But of the ten which produce a dark discharge, only five produce simultaneously a congestive headache. Thus we are limited to five drugs. Thus far, the distinctions on which our grouping has been based (or which have been characteristic of the groups) have had a pathological significance and importance. We can find no such basis for any further subdivision into groups. But we observe in the case a peculiar subjective symptom. The patient complains " as though a living body were moving through the abdomen." This may seem trivial. It is equally, however, a symptom produced by Crocus, which is one of the five remedies to which our choice had been restricted, and it is produced by no other drug in the Materia Medica. It is, then, a characteristic symptom of Crocus, enabling us to individualize Crocus, and to distinguish it THE SCIENCE OF THERAPEUTICS. 37 from all the other drugs which in many other respects agree with it. It will be observed that dark-colored uterine haemorrhage, though produced by Crocus, cannot be said to be character- istic of it. It is a characteristic symptom of a group to which Crocus belongs, but not of Crocus, for it is produced by the other members of this group as well as by Crocus. Characteristic symptoms must of necessity be for the most part subjective and seemingly trivial phenomena. A list of them alone, if presented as the pathogenesis of a drug, would be as meaningless, and at first sight as ridiculous, as a list of the colors and marks and angles and curves by which friends recognize each other would be, if presented alone as the sum total of the properties of certain genera and species of the animate creation. As a background to the latter, there must be a series of phenomena capable of morpholog- ical and organic arrangement, and as the basis of the former we must have a series of objective and organic symptoms capable of physiological and pathological arrangement and of approximate explanation. But it must never be forgotten that without the characteristics, as we have described them, there can be no individualization, and without this there can be no accurate homoeopathic prescription. The truth of this is made apparent by a glance at the history of Homoeopathy. Certain of Hahnemann's followers discarded the apparently trivial subjective phenomena from the provings of drugs, retaining only the objective, organic symptoms. They thus lost the means of distinguishing between the individual members of the groups of remedies. It was thenceforward useless for them to discriminate closely between individual cases of any one type of disease. Hence, inevitably, arose the fashion of prescribing a specific remedy for a disease,— as the phrase went,—putting the leading members of respective groups of drugs and diseases to rep- resent the whole groups. These were the so-called " specif- ikers,"—who had one or two remedies for dysentery, one 38 HOMCEOPATHY for hooping-cough, one or two for scarlatina, etc., " of whom the world is weary." But the characteristic is not always a definite symptom. Sometimes it is so,— as in the case of Crocus, and as in the peculiar diplopia of Stramonium. But sometimes it resides in a peculiar condition which attaches to some symptom common to two or more drugs. This condition may be of time, or circumstance, or concomitance. Thus, if two drugs have the symptom " dry cough from tickling in the supra- sternal fossa,"—but to one is added the condition "occurring only in the evening,"—this condition of time is the charac- teristic of that drug in so far as the dry cough is concerned; or if one have this condition of circumstance, that " the cough is aggravated by inspiring cold air,"—this condition is the characteristic ; or if one have the concomitant that the cough is attended by retching,— this condition of concomitance is the characteristic. Sometimes the characteristic resides in the conditions collectively. We borrow examples from Dr. Drysdale's admirable Introduction to The British Repertory : " Pain in the stomach with nausea occurs under twenty- eight medicines. " Pain in the stomach in the morning under thirty- seven. " Pain in the stomach with nausea in the morning under four only." Or it may reside in a concomitant. " Dry retching occurs under forty-five drugs. " Dry retching in the morning under five. " Dry retching with eructation under one only—Ledum." Every drug-proving, then, is to be studied in a two-fold way : On the one hand, so as to enable us to attach it in our memory to certain groups of drugs to which it shows marked general resemblances; and, on the other hand, so as to bring out clearly into view those characteristics which distinguish it from all the other drugs of these groups in THE SCIENCE OF THERAPEUTICS. 39 particular and of the Materia Medica in general. Our study will be at once synthetic and analytic. Such a study is of necessity comparative in its nature. Each positive step in the study of a drug involves a question of the correspondence or difference of other drugs in respect of that step. An isolated study of all the remedies would not give us an available knowledge of the Materia Medica. It is not enough to know that Pulsatilla, Nux vomica and Chamomilla each produce diarrhoea of a certain kind. We must also know and fix in our minds the similarities and dif- ferences of each of these diarrhoeas to those of the two other and of all other drugs. The study of one drug is, in fact, then, the study of the whole Materia Medica. One is never so competent to thoroughly master a proving as when he has already mastered all other provings. The first effort must necessarily be the least satisfactory, the most im- perfect. This is the task to which the student of Materia Medica is invited and at which his predecessors have been laboring for fifty years. Why, he may ask, has not this been wrought out and systematized by those who have gone before ? Why is the Materia Medica left in the same state in which Hahne- mann placed it fifty years ago? Our Materia Medica consists of the provings of drugs upon the healthy, made by Hahnemann and his disciples. These provings, as we have them, are, for the most part, a formal arrangement of the symptoms subjective and object- ive observed by the prover or his friends. No attempt is made, with but few exceptions, to trace any pathological connection between symptoms, or to give any physiological explanations, or to distinguish between characteristic and generic symptoms. The symptoms alone are given, just as the symptoms of a case of disease would be given by an intelligent but uninstructed patient who unfolds his case to us in as plain untechnical words as he can, leaving to us the task of tracing connections and contriving explanations. 40 HOMCEOPATHY There they stand, records of facts made in the plain vernac- ular, intelligible so long as the language shall endure. But Hahnemann had a much higher idea of the kind of knowledge of Materia Medica which a physician requires than this statement would imply. In an essay on " The Power of Small Doses," in Hufeland's Journal, he describes this knowledge as follows: "What organs it (the drug) deranges functionally, what it modifies in other ways, what nerves it principally benumbs or excites, what alterations it effects in the circulation and digestive operations, how it affects the mind, how the disposition, what influence it exerts over some secretions, what modification the muscular fiber receives from it, how long its action lasts, and by what means it is rendered powerless, etc., etc." Why, then, did he not construct his Materia Medica on this model ? Un- questionably because, with a wonderful sagacity which together with his brilliant genius and his prodigious learning made him the " double-headed prodigy," which Jean Paul Richter called him, Hahnemann clearly perceived the follow- ing truths : that the positive facts with which a physician has to deal in constructing a Materia Medica are the observations of the prover recorded in plain, unfigurative, non-hypotheti- cal language. That the construction which he saw to be so desirable must be the result of the application of the sciences of Physiology and Pathology to these facts. That the facts of the proving being of the nature of positive observation are enduring and unchangeable. But that the sciences of Physiology and Pathology, being incomplete and progressive, are continually undergoing change, and that their terms must therefore be ever varying in significance as the theories on which the sciences are based vary. That, con- sequently, a Materia Medica constructed by him out of these two elements, one constant and the other variable, would of necessity be transient,—could not be enduring,— would soon grow obsolete and in its decline would carry out of sight the constant element also, and thus the labor of the THE SCIENCE OF THERAPEUTICS. 41 provers would soon be lost to the world. Such a structure would have involved an intermingling of the current physio- logical theories with the facts derived from observation. The precise point and extent of the intermingling would soon become undistinguishable and thus a vitiated record would be transmitted to posterity such as the advance of science would soon render useless. A comparison of the present state of Physiology with that of 1800, of which the very terms are almost obsolete, makes the great wisdom of this view apparent. On the other hand, the pure records of observed facts, untainted by theoretical speculations, come to us from the Master's hand as pure, as intelligible, as available as when first recorded. We have the same material for the construction of a phys- iological theory of the drug-action that Hahnemann had, and we can construct it with the advantage in our favor of the great advances which Physiology and Pathology have made since Hahnemann's day. This is the work which each of us must do for himself. No other can do it for him. The result of his labor may and will differ somewhat from that of every other student, for with the light of the auxiliary sciences he forms a judgment concerning observed facts, and the sig- nificance of a fact is measured by the capacity of the observer} The student should seek his knowledge of Materia Medica at the fountain head, in the original publications of Hahne- mann's Materia Medica Pura and Chronic Diseases in the provings in Stapf's Archiv. and in the Austrian and other journals. The Manuals, however convenient for reference in the hurry of practice, are not suitable for systematic study. In some of them, the phraseology of the prover has been altered. 1 Lest by ah omission I expose my- it is incumbent on each generation to self to misconstruction, I may say reprove to a certain extent the rem- that inasmuch as advances in collat- edies of the Materia Medica so as to eral medical sciences are affording bring these aids to bear on the study continually new aids to observation, of Pathogenesy. 42 HOMCEOPATHY In others, the symptoms, as reported by the prover, have been arbitrarily sundered into fragments and these fragments are scattered throughout the record. Or symptoms ex usu in morbis have been introduced and the names of diseases sup- posed to have been cured by the drug are incorporated with the pure symptoms. In all of them the arrangement is some- what altered. In many, attempts at abbreviation have been made, and with no better success than if one should squeeze one's lemons to lessen the bulk of one's luggage and yet hope to have good lemonade at the end of one's journey; for it always happens, and must from the nature of the case, that the skins are the part retained while the juice is thrown away. If a Manual must be employed, that of Noack and Trinks seems preferable; for it preserves the phraseology of the prover and does not to any great extent sunder groups of symptoms, while it places under distinct headings the pure symptoms, and the clinical effects of the drugs and the theoretical speculations of the compilers, so that the student is in no danger of mistaking the one for the other, a danger to which Jahr's Manual does certainly expose him, and for which reason Jahr's work is less desirable than that of Noack and Trinks. We have dwelt at some length on the sources from which the student should seek his knowledge of Materia Medica__ and with good reason ! " For, can a bitter fountain send forth sweet waters ? " " Do grapes grow on thorns, or figs. on thistles ?" If the student should fall among false or incompetent teachers, could the doctrine and practice he learns be true and successful ? Now, it will be observed that the records and provings and the manuals of Materia Medica. to which we have commended the student are all German works, while nine-tenths of our American and English prac- titioners and students are unacquainted with the German language.1 It is humiliating to us to be compelled to say 1 The Author considered a knowl- to a student of Homoeopathy.__Ed. edge of German almost indispensable THE SCIENCE OF THERAPEUTICS. 43 that there are no trustworthy manuals in the English lan- guage and no translations of the German works which we have named on which reliance can be placed. We have translations of Hahnemann's Materia Medica and Chronic Diseases and of Stapf's Contributions to the Materia Medica, by Dr. Hempel. But, either (perhaps we should say both) from lack of moral capacity, or of intellectual and profes- sional acquirements, or from haste and carelessness, the translator has so marred these works by errors of omission and of translation, that they are to the student and prac- titioner what false lights on a difficult coast are to the unsus- pecting mariner. Dr. Hempel translated also Jahr's New Manual ox Symp- tomen Codex, and claims to have incorporated with it nearly all that is valuable in the Manual of Noack and Trinks, thus making it the most complete and perfect work of the kind in existence, and the best possible in the present state of our science. This translation was published with a preface by Dr. C. Hering and under the high sanction of his name and that of Dr. Gray, of New-York. It is almost universally used in this country and in England, and the knowledge of the Materia Medica and of the true practice of Homoeop- athy possessed by the rising generation of practitioners is, in the main, what this manual is capable of affording. If now, I should say that this translation and compilation contains all the errors, omissions and perversions which ren- dered Dr. Hempel's former translations untrustworthy, along with many others peculiar to this work, I should surely hear in reply that Dr. Hering has expressly'in his preface com- mended the diligence and accuracy and zeal of the trans- lator, and I should be referred to page six of the preface,1 where Dr. Hering is made to say, " The Editor has, with extraordinary minuteness and labor, compared the two man- uals and has transferred to the manual of Jahr all additional drugs and pathogenetic effects contained in Noack and Trinks' work." What could I say in offset to this indorse- 1 Jahr's New Manual ox Symplomen Codex, pref. vi. 44 HOMCEOPATHY ment of Dr. Hering ? There is a word to say on the subject of this preface. It was unquestionably written originally by Dr. Hering in German. The English translation, by whom- soever made, seems not to have been altogether satisfactory to Dr. Hering (as well it might not be), for the German original was published by him (a " verbatim copy," as he says) in the Allg. Horn. Zeitung. The English preface to Jahr's New Manual differs from this German original far more widely than the license of scholarship will at all justify. In a foot-note to the original of the passage we have quoted above in commendation of the Editor and translator of Jahr's New Manual, Dr. Hering says :x " After comparison of the translation with the original, the above indorsement is hereby altogether and completely withdrawn."2 Thus, in an obscure foot-note in a German periodical, seen by not more than one in a hundred of those American and English students who are induced by Dr. Hering's commendatory preface to place confidence in Dr. Hempel's translations and compilations, Dr. Hering vindicates his fame as a good scholar and a faithful champion of our science by withdraw- ing his commendation of Dr. Hempel. If those whose confidence has been misplaced by reason of this indorsement in English, canceled in German only, should, with a measure of just indignation, demand of me why the retraction was not made in the language and in the country in which the commendation was suffered to be pub- lished,— why Drs. Hering and Gray, acknowledged leaders of our school in America, did not suppress this so-called translation or expose its false pretensions, in words as intel- ligible and as widely read as those in which their support of it was permitted,—alas! I have nothing to say. (See Appendix.) To plead that, in a matter which involves the education or perversion of a whole generation and the healthy progress 1Vol. XL, Nos. 23 and 24, Feb- 2 Dies wird hiermit nach Vergleich- ruary and March, 1851. ung der Uebersetzung mit dem Orig- inal ganz und gar zuruckgenommen. THE SCIENCE OF THERAPEUTICS. 45 and soundness of Homoeopathy wherever the English language is spoken,— in such a matter the engrossments of business or tenderness toward a delinquent individual kept them silent, would be to cast a doubt upon the estimate in which they hold scientific truth, a doubt inadmissible in gentlemen of their position. It avails not to say : Why find fault with these translations and this manual, inasmuch as we have no others ? Had the unworthiness of these been made known, had they not, on the contrary, been indorsed by high authority, we had long since had others and trustworthy. An exposure of the imperfections we have spoken of would have created a demand for other works, and it is not less true in science than in trade that "demand creates a supply." Having selected a remedy on which to commence his studies, the student should gather together all the reports of provers, whether in the form of their daily records (in which form our dear and lamented colleague Dr. Joslin published his admirable proving of Rumex crispus, as did also the Austrian provers), or in the Hahnemannian anatomical scheme, and should carefully peruse them. We will assume that he has selected Pulsatilla, and will use this remedy to illustrate what we have further to say. We have no other proving of this drug than the very perfect one of Hahnemann in vol. i. of Materia Medica Pura. During the first perusal, — and several may be necessary for the purpose,—the student should endeavor to make a general analysis of the proving. This analysis would enable him to place the drug along with several others in one or other of certain groups into which he will find, as he advances in his studies, the Materia Medica arranges itself. Among the chief points of this general analysis will be the following: I. Sphere of action in the drug. It will be seen that every drug affects some organs or systems of organs or tissues 46 HOMCEOPATHY more decidedly than others. Pulsatilla, for example, acts pre-eminently upon the vegetative system, upon the organs of reproduction and their appendages, and upon the com- position of the blood, depressing the action of the former systems and producing in the latter a condition similar to that of one form of chlorosis. We learn these facts by bringing a knowledge of Physiology to bear upon and interpret the symptoms of the intestinal tract and of the urino-genital organs, those of the vascular system and the symptoms of the head and disposition. For in these we have retarded digestion, vertigo, audible pulsation of the carotids, momentary loss of sight and hearing on sudden exertion, palpitation, paleness, retarded and scanty menstru- ation with syncope and exhaustion; depressed melancholic disposition. On the other hand, the student will notice that Pulsatilla exerts but little action upon the bones, skin and glands, and this will be another important step toward grouping. II. The extent to which the organic substance is affected. From some provings it must be gathered—Spigelia, for example—that the organic substance is but slightly affected or only in isolated localities, while in other provings the effect is profound and general,— Carbo vegetabilis and Lachesis. In others, again, the affection of the organic substance and the irritation of the nervous system are equal in degree and both are great,— Arsenicum. Conclusions on this head are drawn from the following symptoms: those of the complexion and of the skin generally, as regards color and temperature, which enlighten us respecting congestions, if there be any, and the color and character of the congesting fluid; those of the evacuations from the bowels, bladder, uterus and all secreting glands and surfaces; those of the cutaneous eruptions and ulcers; finally, those which denote the existence of dyscrasias of whatever variety, e.g., dropsies, phthisis, cancer, gout, rheumatism, etc. Under this head we find in the proving of Pulsatilla no evidence of any THE SCIENCE OF THERAPEUTICS. 47 further action than that above mentioned—a hydraemic dyscrasia and which is further corroborated by the abundant serous or thin mucous discharges from secreting glands and surfaces. III. The action of the drug on the vital power, correlative of the above, and shown in the symptoms of the nervous system as they are given conjointly with the symptoms of the various organs to which the different parts of the nervous system are distributed. He may consider the nervous system under five heads, a. The sensorium, of which the symptoms are found chiefly under the rubrics Head and Disposition. b. The general sensibility, c. The general mobility. Data respecting these heads are found in the symptoms of the tissues to which the nerves of sense and motion are distrib- uted, d. The special sensibility, as exhibited in the symp- toms of the organs of special sense—the eye, ear, nose and tongue. e. The sympathetic system—as exhibited in the symptoms of organs containing involuntary muscles—in the intestinal tract and in all the sphincters. In forming conclusions on any one of these points, regard must be had to the entire remaining action of the drug. We should otherwise reach a very false judgment. Pulsatilla, for example, produces blindness and deafness. We might regard these as very important affections of the special senses, did we not learn also that these phenomena occur simultaneously with scanty and difficult menstruation, and with palpitation and throbbing of the carotids, and conjointly with great pallor and frequent syncope. These concurrences compel us to regard the blindness and deafness as sympa- thetic symptoms occurring in a chlorotic patient, and con- nected perhaps with a hydraemia produced by Pulsatilla. These three sections of a general analysis having been elaborated during a first perusal, the student will already be in a position to arrange many drugs in groups by their simi- larities and differences in these respects. He will note, for example, that in their sphere of action Pulsatilla and Nux 48 HOMCEOPATHY vomica are closely allied, while again they differ widely in their mode of action both on the organic substance and on the vital power, etc. The practical use of such an analysis is this: that when such fundamental facts are known of two or more drugs, it is enough to have clearly in mind, in any case of disease, what are the effects of the disease in these three fundamental respects. If, then, the action, for example, on the organic substance be similar to what we have seen to be the effect of Pulsatilla, there can be no possibility of Nux vomica being applicable in the case and no need, therefore, of studying that drug further for the case. This process of elimination by means of a general analysis may be relied on wherever we have good and complete provings of drugs, and where the case of disease presents clear and definite symptoms. When we are dealing with fragmentary provings and obscure cases it is of course not practicable. As further examples, we may adduce the following : Spi- gelia and Silicea both affect the special senses remarkably and similarly ; yet they are extremely different in their action on the organic substance. Hyoscyamus and Carbo vegetabilis affect the sphincters similarly, though in other respects so unlike. After thus generalizing in a comprehensive way, the student will observe certain phenomena of a more special character; for example, that among the variety of sensations recorded as having been produced by the drug, there is a certain uniformity in general character throughout most of the organs affected. But here he meets difficulties arising from inaccuracy of provers, or rather from the fact that, all descriptions of sensations being clothed in figurative lan- guage, the imaginations of different provers suggest to them different modes of expression. The wealth of the German language in synonyms has not diminished this difficulty. An apprpximate analysis of sensations such as has been made by Dr. Dudgeon would be of service in this regard. The THE SCIENCE OF THERAPEUTICS. 49 individuality of some drugs is much more strongly marked than that of others by this feature of their effects, and pro tanto, it serves as their characteristic. Thus Bryonia and Squilla are distinguished by sticking, and Arsenicum by burning, pains. Another point to be noted, and which may serve still further to individualize the drug, is periodicity, which in many drugs is well marked and of a definite type; e.g., Arsenium, Ipecacuanha, Natrum muriaticum, Nux vomica. In Pulsatilla it is very marked, but the type is not constant. But, perhaps, the most important of all the considerations in which resides the individuality of a drug are the condi- tions and concomitants of the symptoms. The conditions are the phenomena of time, place, and circumstance on which the symptoms depend. For example, Pulsatilla pro- duces tearing pain in the hip. So do several drugs, but that of Pulsatilla occurs in the afternoon,— condition of time; it occurs and is aggravated in a warm room,— con- dition of place; occurs during and is aggravated by repose, — condition of circumstance. A concurrence of this phe- nomenon and these conditions is found only under Pulsatilla. Here these conditions are the characteristic. The concomi- tants are those phenomena, whether we call them sympa- thetic or secondary, which always accompany any symptom or group of symptoms. Absence of thirst is a concomitant of many groups of symptoms under Pulsatilla. So likewise are chilliness, cold feet, wakefulness in the evening and sleepiness in the morning, etc. Nux vomica has the reverse. So is cold sweat of the forehead under Veratrum. Having thus made a general analysis of the proving, obtaining,, first, a general view of the action of the drug on the great divisions of the organism and of the pathological conditions which it produces ; and, second, a general view of the characteristics of its action, the student may proceed to a special analysis, which will involve a similar study of the action of the drug on each organ and anatomical region of 5 50 HOMCEOPATHY the body. In this he cannot do better than follow the Hahnemannian scheme. The points to be considered in each region and under each rubric are the following: The organic changes; the sensa- tions,—their nature, locality and direction; the conditions of time, place and circumstance, and the concomitants. Thus, for example, in studying the Head, he may consider: a. The SENSORIUM, under which the subdivisions may be: i. Vertigo, its nature, conditions of time, place and cir- cumstance, and its concomitants. Thus, the vertigo of Pul- satilla is a staggering; it occurs after eating, in a warm room, and during repose (there is a rare alternate effect) ; the concomitants are heaviness in head on stooping, paleness and internal heat in the head. 2. Intelligence, with conditions and concomitants as above. j. Memory, " " " ^. Illusions of the imagination, " " b. Headache, under which the points to be noted are: /. Character of the pain. 2. Locality. j. Its course if it move. 4. Conditions and concomitants as above. c. The Organic Changes, which are to be studied in the same way. These comprise all objective and material phenomena. In this manner, the student will examine the effect of the drug upon each organ and tissue of the body, as will be more clearly shown by a scheme for the study of the Materia Medica which will be appended to this essay. The result will be an accurate knowledge of the action of the science OF therapeutics. 51 the drug, in so far as the proving is complete, upon the whole organism in general and in detail. The special analysis will serve to correct certain errors into which the general analysis might lead the practitioner. Conditions are not always uniform for all the organs. Thus, although the general conditions of Pulsatilla are occurrence and aggrava- tion in the afternoon and evening, during repose and by heat, with relief by motion and cold, and must be so stated in a general analysis, yet there are a few special symptoms to which the opposite conditions attach, and this fact is brought out by the special analysis. The study of a proving to be practically available must be comparative. After ascertaining the properties of each drug by positive investigation and analysis in the manner detailed, the next step is to ascertain what drugs resemble it, and in what features they are like and how they differ. To make such a comparison as this in studying the Materia Medica, a repertory is indispensable, and this need alone, if a repertory were not equally indispensable in daily practice, would be a sufficient reply to those who idly talk about such a work being superfluous or mischievous. Such is a method of studying the Materia Medica which, after much reflection and trial of various plans, I venture with unfeigned diffidence to unfold. It is elaborate and requires a wearying application which those alone can appreciate who have engaged in similar tasks. To complete such a sys- tematic study, even in comparative leisure, might require seven years of unremitting labor—just the period for which a lad is apprenticed to learn his trade. Should we shrink from devoting so long a time to the mastery of the most complex and difficult, and the noblest science and art which are possible to man on earth ? I desire to add a few words of a practical nature. Pre- scribers are liable to two errors of an opposite kind; the possibility of which will be apparent from what has been written. 52 HOMCEOPATHY The one consists in prescribing from a general analysis of drugs without regard to the characteristics which individual- ize them. This is equivalent to prescribing any member indifferently of a whole group of drugs, and necessitates a corresponding generalizing view of disease. It is the method of the Old School which seeks to arrange drugs and diseases in groups and which ignores characteristics and individuals. The other error consists in prescribing on the strength of one or two characteristics which maybe detected, without however examining whether the general effects of the drug correspond to the general features of the disease. Now, characteristics, for the most part, as we have seen, derive their value from their association as concomitants or conditions with some symptom which is not in itself a characteristic. Discon- nected from this, they are as void of significance as a man's nose would be if cut off from his face, though while on his face it might have been the chief feature by which his friends recognize him. I will not deny that by this method, great successes, "lucky hits" I would call them, are sometimes made. But I do stoutly affirm that atrocious and inexcus- able blunders are much more frequently the result. I admit, too, that in certain cases of disease there is no possibility of making such an analysis as we have advised, and that certain drugs are so incompletely proved that we know of them only one or two characteristic symptoms and cannot study them as recommended. All that can be said of such cases is that they are incomplete and come under no rule. We must do the best we can and adopt a defective method, which is nevertheless sometimes successful rather than make no attempt to cure. Better cure by a " lucky hit" than not at all. But let not this lead us astray where we might do better. If one had to traverse a wilderness he would desire first of all a compass. If this were not to be had he might " steer by the stars." If these were obscured he might judge from the direction of vegetation and of hills and rivers. Failing THE SCIENCE OF THERAPEUTICS. 53 these, he might even " guess" and his guess might lead him right. Nevertheless, few travelers of sound mind would be led by such a success to prefer a " guess " to a "compass." A Scheme for the Study of Materia Medica.—In the hope that what has been written may serve not only to explain the method in which I have thought the study of Materia Medica may be best pursued, but also to assist those who are entering upon that arduous study, I publish here- with a schedule drawn up originally for my own guidance, and which, I think, was a great assistance to me. A.—GENERAL ANALYSIS. 1. Action on the Vital Power—as exhibited in the action of the remedy upon—a. The sensorium; b. The special senses; c. The sphincters; d. The other involuntary muscles; e. The power of locomotion. 2. Action on the Organic Substance ; as exhibited in a. The complexion (showing, viz.: the state of vessels and the nature of their contents) ; b. The evacuations; c. Ulcers, if any which previously existed are modified by the remedy or if any are produced by the remedy; d. Erup- tions; e. General affections of a dyscrasic nature, such as dropsy, tuberculosis, etc., etc. 3. The Sphere of Action of the Remedy. What organs or systems of the body are affected in a general way and in what order they are affected. 4. SENSATIONS. What kind of sensations predominate among those ascribed to the remedy in the proving, and what relation, if any, appears to exist between certain varieties of sensation and certain classes of organs or tissues. 5. PERIODICITY. If there be any periodicity in the symp- toms it is to be particularly noted and its character defined. 54 HOMCEOPATHY 6. Peculiarities. There are few good provings which do not ascribe to the remedy certain peculiarities of action which are incapable of classification, which run through the whole action of the remedy and which are peculiar to one remedy and are therefore important characteristics. These peculiarities constitute the conditions of time, cir- cumstance, aggravation and concomitance, which are attached to the symptoms and often give individual character to them as belonging to one remedy in particular, and as incapable of being ascribed in mass to any other drug. A symptom being recorded as produced, for example, by Pulsatilla, the questions "When did it occur?" "When was it aggra- vated?" "When was it ameliorated?" "When did it cease?" give the condition of time which attach to that symptom. In like manner the questions " Under what cir- cumstances (viz., of rest or motion, of heat or cold, etc., etc.) did it occur, was it aggravated, was it ameliorated," give the conditions of circumstance and aggravation which attach to the symptom. It will be observed of almost every remedy that certain symptoms or series of symptoms are accompanied by one or several other symptoms. This fact is the condition of concomitance to which we refer. For example, many symp- toms of Pulsatilla are accompanied by a disposition to weep, of Nux vomica by fugitive chills, of Arsenicum by inordinate weakness, of Veratrum by cold sweat of the forehead, etc. It is further noticeable that in the provings of some drugs this concomitance of symptoms by other symptoms is strongly marked, and almost universal as in the case of Arsenicum. 7.. Resume of the Characteristics of the Remedy. This will include everything in the above analysis which is shown by a comparative study of other drugs to be peculiar to it. It will comprise in particular the conditions of time, circumstance, aggravation and concomitance, and the periods of the day at which the action of the drugs is most marked. THE SCIENCE OF THERAPEUTICS. 55 B.—SPECIAL ANALYSIS. /. Head. a. Sensorium, comprising the subdivisions : I. Vertigo; 2. Intelligence; 3. Memory; 4. Illusions. Each of these subdivisions is to be studied in respect of sensations in so far as they can be predicated of it; of periodicity ; of con- ditions of time, circumstance, aggravation and amelioration ; and of concomitance. And under the latter rubric it is to be especially inquired what symptoms affecting other organs, or systems, occur simultaneously in evident physiological con- nection with the symptom under consideration. b. Headache. The points to be investigated are: 1. The location of the pain if it be stationary — its course if it move; 2. The sensation; 3. The conditions of time, circumstance, aggravation and amelioration, as above explained in detail \ 4. Concomitance. c. Organic changes. These affect the material substances and tissues of the head, and comprise all deviations from a normal material condition of which we can in any way become cognizant—affections, for example, of the skin, glands, vessels, organs of special sense, etc. 2. Eyes. a. The Orbit. 1. Location; 2. Sensations; 3. Condi- tions; 4. Concomitance; 5. Organic changes. These sub- divisions here and throughout the scheme, wherever used, are to be understood and studied as already explained in the general analysis and under the title " Head." b. Lids. 1. Location; 2. Sensation; 3. Conditions; 4. Concomitance; 5. Organic changes. c. Conjunctiva. 1. Location; 2. Sensations; 3. Condi- tions; 4. Concomitance; 5. Organic changes. d. Globe. 1. Location; 2. Sensations; 3. Conditions; 4. Concomitance; 5. Organic changes. 56 HOMOEOPATHY e. Secretions. I. Character, as regards color, acridity,. quantity, etc. ; 2. Conditions; 3. Concomitance. f. Special sense. 1. Vision, altered, intensified, dimin- ished, or perverted. 2. Conditions attached to such altera- tion ; 3. Concomitance. N B. After each such study of a single organ, a physio- logical estimate should be made of the significance of the symptoms. For this purpose a faithful study of the con- comitance is of inestimable value. For example, the proving of Pulsatilla gives sudden loss of vision. Is this Amaurosis ? The concomitance shows that the loss of vision is accom- panied by loss of hearing, by syncope, and occurs at a period of menstrual irregularities. The symptom is at once explained. This is only a very obvious instance of what is not always an easy though always a most necessary task. j. Ears. a. External Ear. 1. Location; 2. Sensations, 3. Con- ditions; 4. Concomitance; 5. Organic changes. b. Internal Ear. 1. Location; 2. Sensations; 3. Con- ditions; 4. Concomitance; 5. Organic changes (as secre- tions, etc.) and their conditions. c. Special sense. 1. Deviations, whether intensified, diminished or perverted; 2. Conditions; 3. Concomi- tance. 4. NOSE. i. Location; 2. Sensations; 3. Organic changes, including secretions. With reference to each of the above, observe, a. The conditions; b. The concomitance. Special sense of smell. 1. Deviations from a normal con- dition; 2. Conditions; 3. Concomitance. 5. FACE. i. Location; 2. Complexion; 3. Sensations; 4. Temperature; 5. Organic changes. As regards each of these subdivisions, study, a. The conditions; b. The concomitance. THE SCIENCE OF THERAPEUTICS. 57 6. Lips. i. Location; 2. Aspect; 3. Sensations; 4. Temperature; 5. Organic changes. Respecting each sub- division, note, a. The conditions; b. The concomitance. 7. Gums AND Teeth, i. Location; 2. Sensations; 3. Organic changes. In reference to each subdivision, note, a. The conditions; b. The concomitance. 8. Mouth, i. Location; 2. Sensations; 3. Organic changes. Of these, a. The conditions; b. Concomitance. p. Taste, i. Deviation from normal state, a. Condi- tions ; b. Concomitance. 10. Tongue, i. Location; 2. Sensations; 3. Aspect; 4. Organic changes. Of these, a. The conditions; b. The concomitance. 11. THROAT and FAUCES. 1. Location; 2. Sensations; 3. Aspect; 4. Organic changes (including tumefaction, secre- tion, deposits, etc.). Respecting these divisions, a. The conditions; b. The concomitance. 12. CESOPHAGUS. 1. Location; 2. Sensations; 3. Organic changes ; 4. Special function. Of these, a. The conditions; b. The concomitance. 1 j. Stomach, i. Location; 2. Sensations; 3. Organic changes; 4. Special function modified, as respects, a. Appe- tite; b. Thirst; and these modifications may be exaltation, diminution or perversion; c. Nausea; d. Vomiting. Re- specting these divisions and subdivisions, observe, a. The conditions; b. The concomitance. 14. Hypochondria, i. Right, 2. Left. As regards each, study, 1. Location; 2. Sensations; 3. Organic changes. As regards each subdivision, observe, a. The conditions; b. The concomitance. (Here and wherever the rubric comprises a region which contains a number of organs, endeavor to make by the aid of the sciences of Physiology and Pathology a rational 58 HOMCEOPATHY appreciation of the organs involved, and in this study, pay especial regard to the concomitance, in order to gain the full physiological significance of the symptoms. For exam- ple, in affections of the right hypochondrium where the liver may be supposed to be implicated, the concomitance will justify the supposition if it show simultaneous and corre- sponding symptoms of the tongue, stomach, head, stool, skin, back, etc., etc. So of the left hypochondrium and the uterine system.) 15. Abdomen, i. Location with appreciation of the organs involved; 2. Sensations; 3. Organic changes. Respecting these divisions, note, a. The conditions; b. The concomitance. 16. Stool, i. Sensations, their character, location and course, a. Before stool; b. During stool; c. After stool. As regards these three subdivisions, note, a. The conditions; b. The concomitance. 2. Organic phenomena, viz., color, odor, consistence, composition, e. g.—digested or not— consisting of faeces alone or combined, etc. 17. ANUS AND Rectum, i. Location; 2. Sensations; 3. Organic changes (including secretions, tumors, condylo- mata, etc., etc.). Respecting all of these divisions, note, a. The conditions; b. The concomitance. 18. Urinary Organs. a. Bladder. 1. Location; 2. Sensations; 3. Organic changes. b. Urethra. 1. Location; 2. Sensations; 3. Organic changes. c. Kidneys. 1. Location; 2. Sensations; 3. Organic changes. d. Ureters. 1. Location; 2. Sensations; 3. Organic changes. With regard to all of these divisions, under each of these organs, study, a. The conditions; b. The concomitance. the science of therapeutics. 59 e. Urine, i. Quantity; 2. Color—physical properties; 3. Odor; 4. Deposits. f. Micturition. 1. Frequency; 2. Sensations. Note, a. Conditions; b. Concomitance. ip. Genital Organs—Male. a. Penis. 1. Location; 2. Sensations; 3. Organic changes. b. Testes. 1. Location; 2. Sensations; 3. Organic changes. c. Special function. 1. Modifications, as regards exalta- tions, diminution, or perversion ; 2. Sensations. Respecting these divisions and subdivisions, study under each, a. The conditions; b. The concomitance. d. Secretion. 1. Quantity; 2. Quality, admixture, etc.; 3. Mode of evacuations, a. Conditions; b. Concomitance. 20. Genital Organs—Female. a. Vulva. 1. Location; 2. Sensations; 3. Organic changes. b. Vagina. 1. Location; 2. Sensations; 3. Organic changes; 4. Secretion, considered as regards, a. Character; b. Quantity; c. Color. c. Uterus. 1. Location; 2. Sensations; 3. Organic . changes; 4. Secretions considered as above. d. Ovaries. 1. Sensations; 2. Organic changes. Under these divisions and subdivisions, note, a. The conditions; b. The concomitance, attaching to each. e. Menstruation. 1. Sensation; 2. Periodicity; 3. Quan- tity; 4. Color; 5. Consistence; 6. Duration. Under these, a. The conditions; b. The concomitance. 21. Respiratory Organs. a. Nasal Mucous Membrane. 1. Location; 2. Sensations; 3. Organic changes ; 4. Secretions, as regards quantity and quality. Respecting all these, a. The conditions; b. The concomitance. 6o homoeopathy b. Larynx andTrachea. I. Location; 2. Sensations; 3. Organic changes; 4. Secretions as above. Respecting all these, a. The conditions; b. The concomitance. /. Cough, a. Its sound; b. Its character, as paroxysmal or otherwise, dry or loose; c. Location of the sensation which provokes it; d. Conditions; e. Concomitance. 2. Sputa. 1. Character; 2. Consistence; 3. Color; 4. Smell; 5. Taste ; 6. Locality from which it appears to come ,* 7. Mode of evacuation; 8. Sensations which precede and follow its evacuation; 9. Conditions; 10. Concomitance. c. Thorax—Internal. 1. Location; 2. Sensation; 3. Or- ganic changes, a. Conditions; b. Concomitance. —External. 1. Location; 2. Sensation; 3. Organic changes (including mammae and nipples); 4. Secretions. Respecting the above, a. Conditions; b. Concomitance. d. Respiration. 1. Sensations; 2. Organic action; 3. Breath, its odor, temperature, volume. Regarding these, a. The conditions; b. Concomitance. 22. Heart. a. Subjective. 1. Location; 2. Sensations. b. Objective. 1. Location; 2. Organic changes as shown by position, sounds, magnitude and by rational signs; 3. Pulsation. Respecting these divisions, a. The conditions; b. The concomitance. 2j. Back. i. Location, dividing the back into regions from below upward and appreciating the organs and tissues involved, as well as the concomitance will admit; 2. Sensa- tions; 3. Organic changes. Under these, a. Conditions; b. Concomitance. 24. Upper Extremities—Right and Left. Re- specting each, study 1. Articulations. 1. Location; 2. Sensations; 3. Organic changes. THE SCIENCE OF THERAPEUTICS. 61 2. Inter articular Region, i. Locations; 2. Sensations; 3. Organic changes. Respecting all of these, a. Conditions; b. Concomitance. 25. Lower Extremities—Right and Left. Studied in all respects as the Upper Extremities. As regards the Extremities generally, note Sensations with their course (and Duration) if they be wandering; e.g., from a right upper, to a left lower extremity, etc. 26. Sleep, i. Character; 2. Periods; 3. Preceded by; 4. Succeeded by; 6. Concomitance. a. Dreams. 1. Conditions; 2. Concomitance. 27. FEVER, as a paroxysm made up of stages. 1. Incomplete Paroxysm, consisting of only one or of two stages. 1. Their order; 2. Relative severity and duration; 3. Antecedents; 4. Sequelae; 5. Conditions; and, 6. Con- comitance. 2. Complete Paroxysm. 1. Order of the stages; 2. Their relation to each other. Then consider the separate stages; e.g.: a. Chill. 1. Character; 2. Precursor ; 3. Succeeded by ; a. Conditions; b. Concomitance. b. Fever, as a single stage, or Heat. 1. Character; 2. Precursors ; 3. Sequelae, a. Condition ; b. Concomitance. c. Sweat. 1. Character; 2. Precursors; 3. Sequelae, a. Conditions; b. Concomitance. Between chill and heat and heat and sweat, study the Interval. 1. Character; 2. Sensations; 3. Conditions; 4. Concomitance. Also the time After the paroxysm. 1. Sensations; 2. Conditions; 3. Concomitance. Pulse. 1. Quality; 2. Frequency; 3. Conditions. 28. Skin. 1. General. 1. Sensations; 2. Organic changes; 3. Con- ditions ; 4. Concomitance. 62 HOMCEOPATHY THE SCIENCE OF THERAPEUTICS. 2. Special. I. Localities affected; 2. Sensations; 3. Organic changes; 4. Conditions; 5. Concomitance. 3. Organic Changes. Under this head are comprised : 1. Eruptions. 1. Aspect; 2. Color; 3. Sensations; 4. Secretions, a. Their color; b. Consistence; c. Odor; d. Quality—e.g., acrid or bland, etc.; 5. Scabs, a. Quality; b. Tenacity; c. Color; d. Odor; e. Conditions of subjacent tissues or secretions. 2. Ulcers. To be studied as Eruptions. 3. Warts. 4. Tumors. 1. Physical properties; 2. Sensations; 3. Conditions; 4. Concomitance. 29. Mind. 1. Faculties Modified. 1. Exalted; 2. Depressed; 3. Perverted. Under these, a. Conditions; b. Concomitance. 2. Memory. As under Faculties. 30. Disposition, i. Quality; 2. Conditions; 3. Con- comitance. APPENDIX. Annotations on the History of Homoeopathic Literature in the English Language. Letter from Dr. Lippe. Dr. Carroll Dunham in his excellent article " Homoeopathy the Science of Therapeutics," published in the American Homeopathic Review, after complaining that it is humiliating to be compelled to say that there are no trustworthy manuals of our Materia Medica in the English language, alludes to the Preface of Jahr's New Manual and Symptomen Codex, by Dr. Constantine Hering, and refers to the subsequent publication of that Preface in the original German manuscript, in the Allg. Horn. Zeitung, and which contains also the following foot-note by Dr. Hering: " After comparison of the translation with the original, the above indorsement is hereby altogether and completely with- drawn." Dr. Dunham further says that if he were asked why this retraction was not made in the language and in the country in which the commendation was suffered to be published, he would have nothing to say. Dr. Dunham further continues : " It avails not to say, why find fault with these translations and this manual, inasmuch as we have no others ? Had the unworthiness of these been made known, had they not, on the contrary, been indorsed by high authority, we had long since had others and trustworthy. An exposure of the imperfections we have spoken of would have created a demand for other works, and it is not less true in science than in trade that 'demand creates a supply.' " Dr. D. Wilson, who is now publishing an article in the Monthly Homoeopathic Review, beginning in No. 7, vol. vi., headed " How far is Dr. Hempel to be trusted as a translator of Hahnemann's works," says, in that number : "Yet, strange to say, no one, as far as I am aware, has hitherto publicly pointed out the blunders that have been perpetrated by Dr. Hempel in his voluminous translations of Hahnemann's works." To correct the above erroneous state- ments allow me then to publish the following facts: Jahr's New Manual and Symptomen Codex, by Dr. C. J. Hempel, vol. iii., was reviewed by me for the Philadelphia Journal of Homoeopathy, in 1852, in vol. i., page 427 to 432, my name not appearing. Dr. Hempel puts in a demurrer in vol. i., page 467 to 476 of the same Journal, dated December 15th, 1852. In vol. i., page 518 to 521 of that Journal, I felt compelled as the Author of the Review to answer, and there say: " I write (this criticism) for the American Homxopathists, to vindicate ourselves before the world," etc. Dr. Hempel answers again, February 24th, 1853, vol. i., page 549, and remarks that the interest of the publisher must be protected; he then appeals to the recommendations of Dr. C. Hering in the preface to the first volume of the 64 APPENDIX. work, to which I replied, March 24th, 1853, vol. ii., page 59 to 61, vindicating Dr. Hering by stating that he could not then publish his original German preface or its correct translation, nor could he withdraw his recommendation in the country in which that commendation was published, as the Homoeopathic Journal then published was in the hands of the publisher of the New Manual, who would not receive and circulate communications adverse to his interests. I further then gave there the foot-note of Dr. Hering in the Allg. Horn. Zeitung, above referred to. "After comparing the translation with the original, I solemnly withdraw this my above communication and indorsement." Dr. Hempel again replied, in vol. ii., pages 318 and 319, declaring me to stand convicted of libel, threatening legal proceedings or demanding an arbitra- tion by committee. The committee report of the 24th of September and the 8th of October, 1853, is published in vol. ii., page 430, and this committee, having examined Dr. C. Hering's original German manuscript of the preface to the New Manual and its publication in the Allg. Horn. Zeitung, with the translation by Dr. Hempel as published, find, that the point assumed by me, viz., that the translation of Dr. C. Hering's preface to the New Manual and Symptomen Codex contained willful perversions and omissions, has been estab- lished. A reply to this report by Dr. C. Hempel is published in vol. ii., page 573, in which he boldly denies that he is guilty of any essential alterations. Later the publisher succeeded in obtaining by some means the names of a few physicians as a recommendation to the Complete Repertory. The Review was published ten years ago. It had only the effect to procure for Dr. C. J. Hempel a professorship in the Pennsylvania College of Homoeop- athy. What effect his teachings and publications had while Professor in that Institute are well known. That ten years later Dr. Wilson, in England, and Dr. Dunham, in the United States, should indorse my review of 1852 is exceedingly gratifying to me, but unfortunately does not remedy the evil done to Homoeopathy and its progress during that length of time. I sincerely hope that Drs. Wilson and Dunham will be more successful in 1862 in arousing the English-reading members of the profession to the necessity of accurate translations and correct versions of Hahnemann's writings and our standard works. Ad. Lippe, M. D. Philadelphia, December 7th, 1862. Note.—The facts respecting the publications in the Philadelphia Journal, in I^52-S3> are essentially as above stated by Dr. Lippe. The reasons why they did not attract general attention and were not accepted by the profession as a withdrawal by Dr. Hering of his strong indorsement of Dr. Hempel's transla- tion of the Symptomen Codex, I suppose to be the following: I. The first paper by Dr. Lippe was anonymous, and therefore was not authoritative in any personal sense. 2. The foot-note attached by Dr. Hering to the German publication of his preface was not quoted by Dr. Lippe until after a succession of demurrers by Dr. Hempel and replications by himself had given the matter the aspect of a somewhat personal controversy; and even then it was introduced as a kind APPENDIX. 65 of obiter dictum, because the foot-note referred to the " Symptomen Codex or New Manual," in two volumes, whereas Dr. Lippe's review had treated almost exclusively of the Repertory, or vol. iii. Now, this repertory was really to all intents and purposes not so much a translation as a new work by Dr. Hempel, and he is entitled to commendation or adverse criticism according to the merits or demerits of the work, as an Author rather than as a Translator. In such a capacity Dr. Hering's foot-note and preface could hardly refer to him, and hence the foot-note, introduced "by the way," in Dr. Lippe's letters concerning his review of the Repertory failed to attract general attention and to vindicate Dr. Hering. But the above " annotations " are entirely satisfactory. Coming, as they do, from a confidential friend of Dr. Hering, and with his express sanction and approval, they are a complete withdrawal of his indorsement of the English version of Jahr's New Manual. They give, moreover, a satisfactory reason why this withdrawal could not have been published at an earlier date in this country, viz.: the fact that the publishing interest controlled all of our Journals from the year 1850 to 1858, to such an extent that nothing in the shape of an adverse criticism of any important publication was allowed to appear in any Journal. This statement the writer can corroborate from personal experience. While accepting Dr. Lippe's annotations as full and satisfactory on these points, I am not disposed to adopt unreservedly his criticisms of Dr. Hempel. I have no evidence that the errors and omissions which render it impossible to receive his works, as trustworthy translations of the books they profess to represent, are willful or malicious. I think they may be all accounted for by the fact that the translations were made in haste and therefore carelessly, and that to some of the tasks which he undertook Dr. Hempel may have been, at the time, hardly competent. And when we consider the immense amount of labor required by these numerous translations, we can hardly wonder that errors have been committed and omissions made. Unhappily, this does not make the books any less undeserving of confidence. Of course an error or an omission is just as fatal to the trustworthiness of a translation, whether it be the result of haste, of carelessness, or of willful perversion—but the interests of science do not require the critic to go beyond a statement of the fact that the work is not trustworthy, and of the particulars in which it fails. In my remarks on Manuals to which Dr. Lippe alludes, I refer only to that part of the New Manual which relates to the Materia Medica. The faults of the English version of the preface, however provoking to the Author of the preface, have not the same kind of relation to the general interests of the science. They do, however, concern the personal and professional reputation of Dr. Hering, and at his request we publish a letter addressed by him to Dr. Gardiner, Editor of the Philadelphia Journal of Homoeopathy at the time of the publication of Dr. Lippe's Review of the Repertory before alluded to. Dunham. [ Copy. ] Philadelphia, August 18th, 1853. Dr. Wm. Gardiner, Sir: You say, in your Journal, the last number, page 318, you " wish to deal justly"—"nothing further to be published on that subject." On the same 6 66 APPENDIX. page you allow your own name to be put at the head of a committee to examine the original manuscript of Dr. Hering's preface, or as an alternative the mean threat of setting New-York pettifoggers upon the first one who has had ability and courage to awake the attention of American Homoeopaths to the danger to which monopolizing and book manufacturing leads our cause. I am willing to lay in the hands of any respectable committee meeting in Phila- delphia, at any time, I. My original manuscript. 2. The verbatim printed copy in the Allg. Horn. Zeitung. 3. The English translation of it as a preface to the Symptomen Codex. 4. A comparison of the translation with the original, pointing out the willful perversions and omissions. Said committee, according to common sense and custom, cannot have any interested parties members of it, but ought to be appointed by them, and of course only of such physicians as understand the German language. You ought to be the umpire. Is not your Journal the proper organ in which such a. report of such a committee ought to be published ? (Signed) Yours, CONSTANTINE HERING- ANTAGONISM BETWEEN HOMCEOPATHY AND ALLOPATHY. Address, delivered at the semi-annual meeting of the Homoeopathic Medical Society of the State of New-York, Albany, February 10, 1863. Gentlemen of the Society: By the request of your president and other officers, I appear before you to perform that duty which, on such an occasion as this, devolves upon the president of the Society, but which the special engagements of that officer, at this season of the year, in New-York, have prevented his ful- filling. The session of this evening brings to a close the first regular meeting of the Homoeopathic Medical Society of the State of New-York. The object of this Society is declared to be " the advance- ment of the science of medicine." In these days, when the value of associated labor is so well understood, one might certainly ask, with surprise, " Can it be that, prior to this year, there has existed in the State of New-York no central organization for the advance- ment of the science of medicine ? " The fact is, there has been a State Medical Society in active operation since 1806. Its object is the same as that of our Society; its organization and its mode of operation are identical with ours. What, then, is the necessity for a second Society ? Why should men of the same profession, engaged in similar labors, for a common object, divide their forces, and thereby diminish their efficiency? What is the nature of the antagonism which this division implies, and what is the 68 ANTAGONISM BETWEEN necessity for its perpetuation ? Candid and exhaustive replies to these questions will explain and justify our posi- tion of separation from the Old School of medicine. They will, at the same time, sharply define the outlines of that branch of medical science to which we have especially devoted ourselves, and will give us a clear view of the labors which devolve upon us for its advancement and develop- ment. 1 propose, therefore, to discuss this antagonism,—first from a historic and then from a philosophical point of view. Samuel Hahnemann, the great reformer of medicine, was a regularly educated physician, of great learning and very uncommon general culture and literary attainments. In the words of Sir John Forbes, who surely cannot be accused of any partiality for the founder of Homoeopathy : " No candid observer of his actions, or candid reader of his writings, can hesitate for a moment to admit that he was a very extraor- dinary man,— one whose name will descend to posterity as the exclusive excogitator and founder of an original system of medicine, as ingenious as many that preceded it, and destined, probably, to be the remote, if not the immediate, cause of more important fundamental changes in the prac- tice of the healing art than have resulted from any promul- gated since the days of Galen himself; * * * he was undoubtedly a man of genius, and a scholar ; a man of indefatigable industry and of dauntless energy."1 Hufeland, the Nestor of orthodox medicine in Germany, in calling attention to an essay published by Hahnemann, in his Journal, in 1801, speaks of him as "one of the most dis- tinguished physicians in Germany." This being the estimate in which Hahnemann was held by his most distinguished contemporary (Hufeland)jmd_j3yhis most ^earnedjcritic (Forhp^), hntTTnf whom, be it observed, were opposed to the medical reform which he had instituted, let us glance at his professional career. 1 British and Foreign Medical Review, xli., 1846. HOMCEOPATHY AND ALLOPATHY. 69 After practicing in various localities and positions, with such success and acceptance as to acquire the reputation which Hufeland records of being " one of the most distin- guished physicians in Germany," Hahnemann tells the pro- fession, in several essays on medical subjects, that he has become so deeply convinced of the uncertainty of medical practice, and of the positive injurious effects of many meth- ods in common use among physicians at that day, that at length he really "doubts whether his patients would not, in many cases, have thriven as well, or better, without his aid as with it." This conviction of the uncertainty of medicine, this sus- picion of the injury which it sometimes inflicts on the patients, were not peculiar to Hahnemann. Girtanner and several others, before his day, expressed them. Sir John Forbes, from whom we have already quoted, says, in 1846, of the medical methods of our own time, '/in a considerable proportion of diseases it would fare as well, or better, with patients, in the actual condition of the medical art, as more generally practiced, tfjdlj^ejii^ie^, at^^ dies, especially drugs, were abandoned.'^'TJiingsJjn^medi- cine] have arrived at such a pitch, that they cannot be worse; they must mend or end."1 Such views have been repeatedly expressed by members of the medical profession in this country. Hahnemann has said nothing more severe nor more sweeping than this condemnation of practical medicine, by the late head of the profession in England. But what did Hahnemann do when he had become con- vinced of the inutility and mischievousness of the current medical methods ? Did he continue a routine practice for the sake of "making a living?" No! like a noble, honest man, he refused to make a pretense of curing where he believed he did not cure. He relinquished the practice of medicine and devoted himself to the collateral science of 1 British and Foreign Medical Review, xli., 1846. 70 ANTAGONISM BETWEEN chemistry and to literary labors. But his mind was ever at work on the great question of the improvement of the prac- tice of medicine, for he was " sure that the Creator had not left His creatures without a means of succor from the pangs and ravages of disease." Thus intent on this subject, he could not fail to remark that although the prevailing treatment of diseases was, in general, blind and at least ineffectual to cure, yet there were certain remedies which were used in the case of certain dis- eases with almost uniformly happy results—or at least with such results as left no room for doubting that in these cases, at least, real cures were effected. This he had observed to be the result of the use of mercury in certain cases, not unfrequently encountered by medical men; but his attention was especially called to the fact in connection with Peruvian bark, the febrifuge properties of which had, during the latter part of the preceding century, become well established and highly prized on the continent. "If," he thought to himself, "if the number of these specific remedies could be vastly increased, and if some sys- tem could be discovered in accordance with which we could ascertain their exact properties and could know beforehand in what cases of disease they would be applicable, then in- deed would the uncertainties of medical practice be removed, then might we anticipate as great success in the treatment of all diseases as we now attain in the treatment of a few for which we have specifics." This desire for specifics was not original with Hahnemann. It had been expressed before his day by Bacon and by Boyle. Sydenham had longed for them in expressions almost pathetic in their hopelessness. But Hahnemann, with his "dauntless energy and indefatigable industry," went to work to discover this system. A casual observation in Cullen's Materia Medica gave him the clue to his discovery, as the falling apple did to Newton, and the swinging chandelier in the church at Pisa, to Galileo. HOMCEOPATHY AND ALLOPATHY. 71 From this observation it occurred to him that provings of drugs upon healthy persons might furnish a knowledge of their specific properties, and that the administration of drugs in cases presenting symptoms similar to those which the drug produces in the healthy subject, might be the law of the ap- plication of specifics. He sought throughout the whole medical literature of ancient and modern times for instances bearing upon this subject, and he collected a large mass of evidence corrobo- rating his speculations. He then proceeded to verify his theory by actual experi- ment. First upon himself and then upon all healthy persons who would join him in these self-sacrificing labors, he proved the effects of a number of drugs. Then, cautiously, first in his own family, and then, little by little, in his general practice, which he had now resumed, he gave, as occasion offered, the drugs which he had proved, in cases of disease that presented symptoms similar to those pro- duced by the drugs. From 1790 to 1805, fifteen years of the prime of his life were devoted to constant, exhausting labors of this nature, during which time he proved on his own person more than sixty drugs ; " for," said he, " when we have to do with an art whose end is the saving of human life, any neglect to make ourselves masters of it becomes a crime ! " x At the end of this period, sure of the truth of the great principle he had discovered,—with all the incidental testimony of history to support it—with the positive results of a long experience to confirm it,— he presented his views and the results of his labors to the profession in an essay of wonderful logical power, of the utmost moderation in expression, full of almost tender persuasion and of the noblest enthusiasm;2 and he published at the same time the first part of his Materia Medica.3 Five years later appeared the more elaborate exposition, the " Organon." 1 Dudgeon, Hahnemann's Lesser 2 Medicine of Experience. Writings. 3 Frag, de Vir. Med. pos. 72 ANTAGONISM BETWEEN This was the turning-point of Hahnemann's career. Let us see what was his relation to the profession at this time. He had, by universal consent, attained a position in the profession which justified him in assuming to criticise pre- vailing methods and to suggest improvements. He had shown the need of improvements, and he had borne testi- mony to his honesty in this exposition, by retiring from a lucrative practice. He now came before the profession say- ing, " I believe I have discovered a system which will render the practice of medicine certain, and its success brilliant. I have labored fifteen years to test my discovery. My own experiments and the testimony furnished by the records of medicine convince me of its truth. I lay it and them before you, my colleagues, and I conjure you in the name of truth, by the interests of humanity, to investigate it candidly and without prejudice." " If," he says in his letter to Hufeland on this occasion, " if experience should show you that my method is the best, then make use of it for the benefit of mankind, and give God the glory !" How were this exposition and appeal received by the medical men of the day ? In 1811, appeared the Anti-Organon of Prof. Hecker—a work full of the most bitter aspersions upon Hahnemann's personal character, whereas, in fact, the question had rela- tion to principles and not to persons ; abounding in the most concentrated contempt and scorn of the system which Hahne- mann had unfolded ; and without a single suggestion to investigate, by practical experiment, the practical method which Hahnemann had stated to have been attended, in his hands, with such brilliant practical success ! And from that day to the present, all the utterances of the Old School, whether from the press, the council, the professor's chair, or in the forum of the academy, have been bitter personal denunciations and aspersions of the character and motives of Hahnemann, and of all who have adopted or have even shown a disposition to investigate his method. HOMCEOPATHY AND ALLOPATHY. 73 But many a scientific discoverer has met with opposition and calumny at the hands of his colleagues. Not to go beyond the ranks of medicine, Harvey was denounced as a quack, because he demonstrated the circulation of the blood ! Jenner was scandalized with most persistent violence because he introduced vaccination. To Hahnemann, however, persecution came nearer home. After he had satisfied himself of the value of his discovery of the true method of medical practice, he resumed the exercise of his profession. His success was more brilliant than it had ever been. His fame as a practitioner grew rapidly, and patients began to come to him from consider- able distances. This good fortune excited the envy of his colleagues in Konigslutter, where he then resided. At their instigation, the apothecaries of the place brought a prosecu- tion against him for infringement of the law which forbids to practitioners of medicine the compounding and sale of the remedies they prescribe. For, it must be observed, that, as an inevitable corollary to his new system of practice, Hahne- mann had come to prescribe only a single drug at a time, and that he used simple preparations such as could not be obtained in the requisite purity at the apothecaries'. In vain it was urged that the spirit of the law was not infringed, since Hahnemann himself was an expert apothecary and chemist, and since his remedies were not " compounded," but simples, and not " sold," but dispensed gratuitously. The opposition was too strong. He was forbidden to practice, save in accordance with the law alluded to. Rather than yield in a matter which he considered essen- tial to the freedom of the physician and to the purity and certainty of his practice, Hahnemann determined to leave Konigslutter; and accordingly, to the delight of his col- leagues and of the apothecaries, and to the regret of the citizens, who were loath to lose their benefactor, and a cortege of whom attended his carriage far beyond the gates of the town, he removed to Hamburg. 74 ANTAGONISM BETWEEN Here, as he became known and appreciated, the same persecution was revived, and with the same result. He removed to Altona. In this way, during a period of twenty-two years, from 1799 to 1821, Hahnemann was constrained, by the persecu- tion of his colleagues, under cover of the law, to change his abode at least eleven times. The last place from which he was driven in this manner was Leipsic—a city for which he had a peculiar affection. Here he had pursued his earliest medical studies and met with his first successes. Here he had, in later years, established a college of Homoeopathy, and had lectured to large audiences. In the shady walks and groves that surround the city, he had been wont to spend the evening of each day in social converse with his family and with the students whom he had gathered about him and who took part in his labors of proving drugs. From this city of his love, the scientific capital of his fatherland, he was now, in the sixty-sixth year of his laborious life, driven away to an asylum offered him in the tiny capital of the tiny Duchy of Anhalt-Coethen! No wonder that he who for so many years had followed the injunction, "When they persecute you in one city, flee ye to another,"—that he who, like the Divine Healer, had gone "about from place to place doing good and healing all manner of sickness and disease among the people"—no wonder that he forgot, under the pressure of this last indignity, that other injunction of the Divine Teacher, to " love them that hate you, and pray for them that despitefully use you and persecute you," and that, like Luther, he now bared his hitherto sheathed weapons of satire and invective against those who had striven to hinder his usefulness—who had so cruelly marred his peace and happiness—all save that peace which can never be taken from the man who has within himself the "mens sibi conscia recti!" If in this he erred and came short of the Divine HOMCEOPATHY AND ALLOPATHY. 75 example, let him among men who is "pure," cast the first stone at him ! Time brings its sweet revenges. After a career of honor and usefulness at Coethen, where his ever-increasing fame brought him throngs of patients from all parts of Europe, and a subsequent residence in Paris, where his reputation extorted from the government a license to practice as he pleased, Hahnemann died at Paris in 1843, full of years and honors. Eight years afterward, in 1851, the town council of Leipsic appropriated a beautiful plot of ground as a site for his monument, and the council celebrated officially the uncovering of a costly and beautiful bronze statue of that man, as one of Saxony's most illustrious sons, whom thirty years before the same council had igno- miniously chased from their borders as an unauthorized and illegal prescriber! Before we leave this branch of our subject, let us draw one lesson from the story of Hahnemann's persecutions. All his sufferings might have been avoided, he might have lived in peace and affluence, enjoying consideration among his colleagues and making plenty of money, had he been willing to "yield a little," to waive the right of dispensing his own medicines, to accommodate his system in various points to suit the notions of his time. The temptation to do this might, by some, be supposed to have been great, for Hahnemann's family was large, he suffered during his wanderings from the pinchings of cruel poverty, and this took from him the leisure so necessary for his studies. But Hahnemann was not made of the stuff that could compromise, for personal ease and prosperity, the charter that God had given him for the benefit of the race. He refused to give up one particle of anything which he deemed essential to the purity and perfectness of his system, and so he has left it to us, pure and perfect! Let us remember his example when prospects of ease and consideration, and of the cessation of strife for the truth, 76 ANTAGONISM BETWEEN tempt us to compromise unworthily with any portion of the Old School of medicine. For there are those among us, as there are men in other walks of life, who, for the sake of what they call peace and union, would join hands with what they know to be false ! aye, even though to do it, they should have to " cut off the fanatics," who adhere strictly to Hahnemann,— to leave the " brains" of their system " out in the cold." This is the origin and the personal history of the antag- onism between Homoeopathy and the dominant school of medicine. Hahnemann showed the imperfections of the current methods. Nobody disproved what he said. Every- body agreed with him and everybody sighed for something better. He discovered something better and offered it to his colleagues, with demonstrations of its value ; he begged them to investigate it; and in case they should find it better than the old method, to use it for the good of man- kind, and give God the glory! Then, with one accord, they denounced him as a vile impostor, and chased him from their midst, nor have they yet ceased to heap ignominy on his name ! It may be objected that I have not stated, the whole grounds of the opposition of the Old School to Homoeop- athy, inasmuch as I have said nothing about the " little doses." If this were true, it would not alter the bearings of the case, because the doctrine of the " little doses," like all the rest of Hahnemann's method, was offered to the profession, to be by them submitted to the test of experience, by which, like all the rest, it should stand or fall. But, in point of fact, Hahnemann came very slowly to see the necessity of giving small doses when he prescribed according to the law of Homoeopathy; and he did not express himself authorita- tively upon this subject until long after the opposition to him and the prosecutions in the name of the apothecaries HOMCEOPATHY AND ALLOPATHY. 77 were in full blast! Therefore, this opposition could not have originated in the doctrine of the dose. Nor is the question of the dose at all essential to the experiments which Hahnemann invited his professional brethren to make for the purpose of testing his system. Intelligent experiments with doses of ordinary size would convince any physician of the truth of the Homoeopathic law; and if he continued the experiments, the inconven- iences that he would find to result from the use of such doses would inevitably lead the experimenter, as they led Hahnemann, to continually diminish the dose, until he should become convinced of the truth of Hahnemann's dogma on this subject also. This has been the uniform experience of all physicians who have become convinced, through experiment, of the truth of Homoeopathy, and have adopted the method in practice. And the more strictly they conform to Hahne- mann's method in prescribing, the more exactly do they agree with him respecting the dose. The number of these witnesses amounts to-day to many thousands, and their concurrent testimony does not admit of dispute. Let us now consider this antagonism from a philosophical point of view. As I have already said, Hahnemann perceived that the prevailing method of treating disease comprised two processes. One of these processes was what was then, and is still, called the " Rational." It involves a theory of the cause and essential nature of the disease, and the resort to some expedient which would be likely to remove this supposed cause of the disease, and to bring about a contrary state, and so conduce to health. Of this kind was Galen's method, which divided diseases into hot, cold, moist and dry; made a similar classification of remedies, and applied to each disease a remedy from a class of the contrary 78 ANTAGONISM BETWEEN nature. Less glaringly absurd, but in no way different in nature, are the theories which hold that certain diseases, for example, are caused by accumulation of the blood in certain organs, and are to be cured by abstraction of blood ; that others depend upon what is imagined to be want of tone, and are to be cured by remedies which are assumed to be tonics; that others are due to a languid state of the "animal spirits," and are to be encountered by the admin- istration of'" stimulants'," etc. That these were the grounds upon which the prevalent methods, in the generation preceding Hahnemann, were based, is shown by Cullen's theory of the action of bark, and also by the following passage from " Sydenham on Pleurisy: " " After attentively considering the various phenomena of this disease, I think it is a fever originating in a proper and peculiar inflammation of the blood,—an inflammation by' means of which nature deposits the peccant matter in the pleurae. In my treatment, I have the following aim in view: to repress the inflammation of the blood, and to divert those inflamed particles which have made an onset on the lining membrane of the ribs (and which have lit up so much mischief) into their proper outlets. For this reason, my sheet-anchor is blood-letting." A modification of this process is that which is known as the Hippocratic method of observing and following the indications of nature; in the words of Sydenham, "watch- ing what method Nature might take, with "the intention of subduing symptoms by following in her footsteps." Accord- ing to this method, if, in any disease, recovery was preceded by a critical evacuation,—such as a copious sweat,— this was assumed to be nature's method, and sudorifics were accordingly resorted to in similar cases. Now, independently of the fatal objection, that this method would confine our curative power to such diseases as Nature herself 'is wont to cure by critical discharges, etc.,— HOMCEOPATHY AND ALLOPATHY. 79 the very diseases, therefore, in which medical aid could be best dispensed with,— while it makes no provision at all for such diseases as rarely or never get well of themselves,— such as nature never cures by critical discharges,—the very cases, therefore, in which there is most need of the intervention of art,— Sydenham tells us that he "found that spontaneous sweats often did good." " But these," he says, "were very different things ixom forced ones." And Hahne- mann showed that " in such cases the critical discharges and the recovery were simultaneous; that the discharge was the consequence and announcement rather than the cause of the recovery; and that to infer from such a state of things that we could bring about a cure by inducing an artificial sweat, would be like ringing bells and lighting bonfires to secure a victory instead of to announce one."1 The other process, which Hahnemann perceived to be comprised in the prevailing methods of treatment, was — administering, in the case of a very few diseases, of which fever from marsh miasma may be taken as the most illustri- ous example, certain remedies which had been discovered to possess, in some unexplained way, a power to cure these dis- eases. Such remedies had been discovered by the merest accident. No method was known by which others could be discovered: no method had been suggested by which it could be more clearly ascertained and defined for what par- ticular varieties of the diseases in question these " specifics,'* as they were called, were especially appropriate. Hahnemann showed the fallacy of the philosophy on which the " Rational" method was based. He showed that, even admitting that accumulations of blood do exist as the " proximate cause" in certain diseased conditions, yet these accumulations cannot be regarded as the essential cause of the disease. On the contrary, that cause must be sought in that force which regulates the circulation and preserves its equilibrium. This force must have been set into abnormal 1 Russell, History and Heroes of the Art ofMedicine.—■" Sydenham." 8o ANTAGONISM BETWEEN action, in order that an accumulation could take place in any particular organs; and, therefore, in the accumulations we see, not the essential cause of the disease, but only one of the results of that cause. To undertake, then, by abstraction of blood to remove a result of the cause, is not to cure the disease by removing the cause, but only to seek to palliate it by carry- ing away some of its products. He showed, further, that this abnormal condition of one of the dynamic forces, the action of which constitutes the life of the body, is beyond the sphere of our observation. Like the healthy action of these same forces—in a word, like life—it is an ultimate fact, behind which we cannot penetrate, and which, therefore, we cannot study as a cause of disease and seek to remove by direct rational means. But Hahnemann went farther, and showed that, although we cannot investigate the ultimate nature and causes of those modifications of the dynamic forces of the organism, which are the essential causes of diseased action, and then remove them, as a " rational" method would propose to do, yet that if, while a disease is in full vigor, we administer a remedy which causes a sudden cessation of the morbid action with- out any abstraction of the fluids or any derivative action whatever, we are then justified in concluding that the remedy we have given has, in some way or other peculiar to itself reached that force which was in a state of abnormal action, and has so modified it as to bring it back to a condition of normal action; that this remedy has a " specific" effect upon that force under certain conditions; and we draw this con- clusion upon the general principle that when an effect ceases we may conclude that the cause has ceased to act. And Hahnemann showed, farther, that if we could discover substances having such a specific action, and a law by which we should know just when to apply them, we should have accomplished the much needed reform in medical science. He appreciated so highly the value of the specifics of which medicine was already in possession, that he consecrated his HOMCEOPATHY AND ALLOPATHY. 81 life to the task of discovering a method of increasing their number and of reducing their use to a system. In this appreciation of the direction in which alone im- provement in the curing of diseases was to be looked for, Hahnemann was anticipated, as I have said, by Bacon, Boyle and Sydenham. Thus Bacon, in the " Advancement of Learning," after a sweeping condemnation of the unphilosophical method of Galen, says : " A work is wanting upon the cures of reput- edly incurable diseases, that physicians of eminence and res- olution may be excited and encouraged to pursue the matter as far as the nature of things will permit; since to pronounce diseases to be incurable is to exhibit ignorance and careless- ness, as it were, and to screen ignorance from reproach." And again, " I find a deficiency in the receipts of propriety respecting the cure of particular diseases." Again, " They have no particular medicines which, by a specific property, are adapted to particular diseases. I remember a learned Jew physician who used to say, ' Your European physi- cians are like bishops; they have the keys of binding and loosing—nothing more !' It would be of great conse- quence if physicians eminent for learning and practical skill would compile a work of approved and experienced medi- cines in particular diseases." The learned Boyle, the father of chemistry, who had devoted much time to the study of medicine, says : " I can- not forbear to wish that divers learned physicians were more concerned than they seem to be to advance the curative part of their profession, without which, three at least, of four other parts, may prove indeed delightful and beneficial to the physician, but will be of very little use to the patient, whose relief is yet the principal end of physic. I had much rather that the physician of any friend of mine should keep his patient, by powerful medicines, from dying, than tell me punctually when he shall die, or show me in the opened car- cass why, it is supposed, he lived no longer." 7 82 ANTAGONISM BETWEEN Again he says, when speaking of the need of specifics: " Finding at every turn that the main thing which does pre- vail with learned physicians to reject specifics is, that they cannot conceive the distinct manner of the specifics' working, and think it utterly improbable that such a medicine, which must pass through digestions in the body and be whirled about by the mass of the blood to all the parts, should, respecting the rest, show itself friendly to the brain, for instance, or the kidneys, or fall upon this or that juice or humor rather than any other. "First, I would demand of these objectors a clear and satisfactory, or at least an intelligible explication, of the man- ner of working of divers other medicaments that do not pass for specifics. For I confess that to me, even many of the vulgar operations of common drugs seem not to have been hitherto intelligibly explained by physicians, who have yet, for aught I have observed, to seek for an account of the manner of how diuretics, sudorifics, etc., perform their operations, etc. " The same objection that is urged to prove that a specific cannot befriend the kidneys, for example, or the throat rather than any other parts of the body, lies against the obnoxious- ness of poisons to this or that determinate part; yet experi- ence manifests that some poisons do respect particular parts of the body without equally or at all sensibly offending the rest; and we see that cantharides, in a certain dose, are noxious to the kidneys and bladder, and quicksilver to the throat and glandules thereabout, stramonium to the brain and opium to the animal spirits and genus nervosum."1 Sydenham expresses himself on this subject with his accus- tomed brevity and directness. Speaking of intermittent fever, he says: "We must do one of two things; we must, by careful and anxious observation of the process by which nature relieves herself of this disease, draw indications as to the man- ner by which the incipient fermentation may be promoted 1 Russell, History and Heroes of the Art of Medicine, vol. ii., p. 101; art. " Robert Boyle." HOMCEOPATHY AND ALLOPATHY. 83 and the patient restored to health, or else we must discover a specific. By the latter method, we shall attack the malady directly." It may be observed that Sydenham did not hesitate to choose the latter method so soon as the specific virtues of Peruvian bark in intermittent fever were recognized, and that he was the chief means of making the value of this great specific known in England; nor have the profession gener- ally, since his day, been disposed to hesitate in their choice between the Hippocratic and the specific methods of treat- ing this disease,—the two alternatives which Sydenham so clearly lays down. He continues: " By no means do I wish to express myself as if wise and learned physicians were to despair; as if they were to think out no better modes of treatment, and as if they were to throw away the hope of discovering nobler and more potent medicines for accelerating the cure of diseases. So far am I from this that I do not despair of finding out, even myself, some such medicines and some such method of curing." These things which Bacon, Boyle and Sydenham point out so forcibly as the desiderata of Medicine, which Syden- ham did not despair of finding out, yet died without dis- covering,—these " specific medicines," and this " methodus medendi" were offered to the profession one hundred years later by Hahnemann. Dr. Lettsom tells us, " the great Sydenham, for all his labors, only gained the sad and unjust recompense of cal- umny and ignominy, and that from emulation of some of his collegiate brethren and others, whose indignation at length arose to that height that they endeavored to banish him from that illustrious society (the Royal College of Physicians), as guilty of medicinal heresy." And yet Sydenham only longed for, and looked forward to, the discovery of specifics and of the law of their employ- ment. He was the Moses of the specific method. It was, 84 ANTAGONISM BETWEEN therefore, in the regular course of historic sequence that Hahnemann, the Joshua of that method, who led the hosts of yEsculapius into the promised land of which the Moses had had a glorious vision, should be unsparingly denounced as a heretic and actually banished from every well-regulated society! This, then, is the antagonism. Hahnemann shows that specifics are to be discovered by ascertaining the effects of drugs upon healthy persons; that they are to be applied by giving to a sick person such a drug as would produce, in the healthy subject, symptoms similar to those of the siqk per- son. He presents this discovery to the profession as some- thing in advance of present knowledge. They refuse to accept or even to test it, and they denounce him for offering it. On which side lies the onus of the antagonism ? But it may be said, however true these statements are as regards the age for which Hahnemann wrote, the scientific progress of the last fifty years has changed all that. It has changed the names of things and little besides in therapeutics. We hear no more, it is true, of "temperaments" and " humors," of the " animal spirits," of the " Arcahus," but instead, the talk is now of " the dyscrasias," of " diatheses," of the "cellular pathology," of "analogies" and "heterol- ogies." There is the same endeavor to draw from a theory of the essential nature of the disease a rational indication of cure, of which Hahnemann exposed the fallacy and impossibility. Indeed, Sir John Forbes affirms, in 1846, "The progress of therapeutics (the cure of diseases) during all the centuries that have elapsed since the days of Hippocrates, has been less than that achieved by the elementary sciences of medi- cine during the last fifty years. This department of medi- cine must indeed be regarded as yet in its merest infancy." It should be clearly understood, and I state it most emphatically, that all expositions of the insufficiency and HOMCEOPATHY AND ALLOPATHY. 85 the chaotic state of the prevalent system of medicine— whether by the outspoken leaders of the Old School, like Forbes, or by Hahnemann and his followers—refer ex- clusively to the department of therapeuties, the science and art of curing diseases by medicines. In the development of the natural history of the healthy and of the diseased body, that is to say, in the sciences of physiology and physio- logical anatomy, and of pathology and pathological anatomy, as well as in the departments of hygiene, surgery, obstetrics and medical chemistry, medicine has fully kept pace with the wonderful progress of scientific knowledge in our day. We profit by the labors of our colleagues in these branches, and accord them full recognition and admiration. But the great end and object of all these things is to cure diseases. If they afford no facilities for this, they are profitless to man- kind. Now, if the same men who have brought these collateral sciences to such perfection have been unable to bring therapeutics out of what Forbes calls its present chaos of " merest infancy," is not the conclusion irresistible that they have not yet got hold of the right clue—of the true philosophy of the science ? There is even a greater indisposition in our day, than in the time of Boyle, to admit the value and to stimulate the discovery of specifics. Nor is this wonderful; for specifics obstinately refuse to range themselves under any rational hypothesis. They exert a peculiar, inscrutable action upon certain organs when in certain conditions, and more than this nobody can say of them. And yet, notwithstanding their philosophical aversion to them, the practical sagacity of our colleagues, with which they keep their philosophy strangely at variance, leads them to seize eagerly upon specifics whenever these are presented to their notice. Witness the avidity with which they have availed themselves of Iodine, Ergot, Cod Liver Oil, the Hypophosphites, Iron, Veratrum viride, as well as of Nickel and Oxalate of Cerium which the Houdin of orthodox medicine has lately intro- # 86 ANTAGONISM BETWEEN duced to them. Nay, people do say that our learned friends of the Old School make frequent use, " upon the sly," of Aconite as a specific in fever, and of Nux vomica and of Pulsatilla as specifics in gastrodynia and dysmenorrhcea, etc., etc.,— remedies of the specific properties of which their only knowledge is derived from the labors of Hahnemann. It is true, they undertake to give a "rational" theory of the action of these specific remedies, but with as little suc- cess as Cullen met with when he attempted to explain the febrifuge action of Peruvian bark. It is all comprised in the doggerel explication that Moliere gives of the hypnotic effects of opium: " Domandatur causam et rationem quare Opium facit dormire. A quoi respondeo, Quia est in eo Virtus dormitiva, Cujus est natura Sensus assoupire." Now, as in the days of Hahnemann, there is an antagonism between the Homceopathists and the Old School. The former hold out to the latter what they believe to be that method which has ever been a desideratum in medicine. The latter refuse even to examine it, and expel the Homce- opathists from all associations over which they hold control. We cannot unite with them in any associated labors without ignoring and disavowing what we believe to be the true theory and practice of the all-important part of medical science—the science of therapeutics. They will not unite with us in associated labors for the development of this science. Had Hahnemann done nothing more than devise a method of discovering and using specifics in the gross and whole- sale sense in which the term was and is understood and used by the Old School of medicine, he would still have been entitled to the gratitude of mankind. He did far more. HOMCEOPATHY AND ALLOPATHY. 87 He perceived that, in the dominant school, a specific was set apart as adapted to any individual member, indiscrimi- nately, of a large nosological group [of diseases]; that bark, for example, was held to be the specific for malarious fevers in general, and that no account was taken of individual deviations within the limits of this group. Whereas, in point of fact, he perceived what is well known within the profession and without it, that although bark is really the specific for many, indeed for the majority of malarious fevers, it is not so for all; since many cases cannot be cured or even improved by its use. Now, this wholesale way of regarding diseases, in groups, was the logical and inevitable consequence of the Old School theories of disease and of the method of cure. When Galen propounded the doctrine that all diseases depend upon one of four conditions, heat, cold, dryness, moisture, it was an inevitable consequence that he should disregard every phe- nomenon presented by his patients, except such as served to indicate that the case belonged to one of the above cate- gories, and that he should have but four classes of remedial agents appropriate to these categories. And when, in our day, physicians assume to ascribe dis- eases to certain pathologico-anatomical states as their essen- tial causes, it is manifest that whatever varieties the case of each one of a dozen patients may present, must be disre- garded, provided the pathologico-anatomical condition be the same in all, for they are grouped on the basis of this condition, and the indication for the cure is drawn from the existence of this condition, and must necessarily be the same for all. Now, just as any spot upon the surface of the globe may be approached by an almost infinite number of roads, and yet, when the traveler has reached the spot, there shall be nothing in the mere fact of his presence there to indicate with certainty the road by which he has come thither, so the same pathologico-anatomical result may issue from the most 88 ANTAGONISM BETWEEN multifarious pathological processes, which processes, however, leave no sign in the result. If, then, the mode of treatment be based on the result, it can take no account of this variety in the processes. A wholesale generalization, then, of diseases and of reme- dies is inevitable from the philosophy of the "Rational" method. The common experience of the community teaches men that diseases to which the same name is given may present in different persons an entirely different aspect. John Doe and Richard Roe both have rheumatism, but their symptoms and whole condition are so entirely different that no one would have imagined them to have the same disease, if the doctor had not said so. The pathologico-anatomical condi- tion, however, is the same in both (viz., the altered condition of the blood), and consequently the rational indications for the cure are identical in the two cases. If the doctor be true to the philosophy of his method, he treats them alike, notwithstanding the difference in their symptoms and ap- parent condition. But I call your attention to the fact which is familiar to every one, that every sagacious and long- headed physician of the Old School pays the less regard to the rules of his art the more experience he acquires at the bedside. In treating disease he " feels his way," as the saying is; he relies on his " practical tact and experience," and often deviates widely from the rules of practice as they are deduced in the books from the theory of the art; he trusts less and less implicitly to a pathologico-anatomical basis of treatment, and more and more to " general indications," by which he means the sum of the symptoms of each individual case. In truth, experience has taught him the fallacy of the science of therapeutics, as founded on the "Rational" basis. Now, if this were a true science, would not experience rather confirm the practitioner's faith in it, and add to his skill in applying it ? HOMCEOPATHY AND ALLOPATHY. 89 When on the other hand we cast aside all endeavors to base a method of treatment upon a theory of disease; when we give over all attempts to discover the inscrutable, essen- tial nature and cause of diseases, and confine our observa- tions to the phenomena of morbid action, whether these be material or functional, then we can take into account the pathological processes as well as the pathologico-anatomical results. We are then in condition to give due weight to the peculiarities of each individual case of disease, to study it, as under other circumstances groups are studied, and to give due attention to the modifying idiosyncrasies of the indi- vidual. Hence, under our method alone is an absolute individual- ization of disease possible. Such a method of studying dis- ease, however, would be barren under the Old School method of treatment, even with specifics. For the properties of spe- cifics were known to the Old School only with reference to large and ill-defined groups of diseases. By us, on the other hand, specifics are studied in the effects which they produce upon the healthy subject, precisely as diseases are studied in the effects which morbific causes produce upon the sick. The same strict individualization, then, is practicable with regard to specifics that we have seen to be necessary in the study of diseases. It is not only practicable—it is fruitful of the richest returns. The case, therefore, is not half stated when we say that Hahnemann discovered the method of specifics. He taught us how to discover and apply, and showed us the necessity of applying, an individual specific to each individual case of dis- ease, as studied in the totality of its phenomena and without regard to the nosological group to which, for purposes of classification, the case might be assignable. As a necessary consequence of this individualization, Hah- nemann taught the value of subjective symptoms. By these, we mean those symptoms of which the physician becomes cognizant through the sensibilities of the patient. Among 90 ANTAGONISM BETWEEN them are all the varieties of pains and abnormal sensations which accompany disease. These symptoms were previously disregarded and are still considered as of no value by the "rational" or "physiological" school of medicine. Thus, Pro- fessor Bock, of Leipsic, in his work on Diagnosis (1853), says : " Only the objective symptoms—of which the prac- titioner derives a knowledge by the use of his own five senses, by sight, touch, hearing, mensuration, percussion, and by microscopic and chemical examinations — are of any value to the physician. The subjective symptoms are in the highest degree uncertain and treacherous." In other words, the disease is to be studied in all cases just as the phenomena of an inanimate plant or mineral are studied; the case of an intelligent and self-possessed patient, just as that of a patient whose intelligence is dormant under the cloud of a typhoid fever! Now, everybody knows that pains and various sensations different from those of health, make up a large and impor- tant part in every case of illness. And what are these sensations ? Unquestionably they are the results of abnor- mal action of the sentient nerves, or else they are evidences conveyed by the sentient nerves of abnormal action in some of the organs of the body. It is in the highest degree unphilosophical to arbitrarily disregard and cast aside any of the phenomena of disease. If they find no place in our system of medicine, why, so much the worse for our system ! If they cannot be made available under our method of treating disease, this fact is prima facie evidence that our method is defective ! Fur- thermore, every physician and every intelligent person knows, by observation and experience, that pains and abnor- mal sensations almost always precede any material or organic evidence of disease. Common sense teaches every man the value, in medical treatment, of the maxim, " Obsta principiis!" Diseases should come under treatment at the earliest possible moment. Some that are curable at an HOMCEOPATHY AND ALLOPATHY. 91 early period are well known to be incurable by our present resources, if allowed to establish themselves firmly. But the first evidences of nearly all diseases consist of subjective symptoms. A method, therefore, which does not provide for the employment of these symptoms in the determination of the treatment, cannot furnish means for encountering dis- ease at the very outset. And, appealing again to the experience of the community to bear me out, I say that honest and candid practitioners of the Old School often say to their patients, " Wait a little until your disease shall have become developed,—at present I know not what to do." Why does he not know what to do ? This question touches the weak point in the philoso- phy of the physiological school. It is because the patient, as yet, presents only "subjective symptoms," which are evidence of "dynamic changes" only,—because he cannot form a theory of the cause of the disease until the disease has progressed far enough to furnish him with some material results of these dynamic changes,—in a word, with objective symptoms. This instance is another evidence of the insuf- ficiency of the Old School philosophy of medicine, while at the same time it shows that, so long as they accept this philosophy, the physiological school are consistent and logical in excluding subjective symptoms from consideration. Not a few diseases — the neuroses, for example—consist almost entirely of subjective symptoms. In these, the phys- iological physician admits his inability to institute a rational treatment, and he resorts at once to specifics. But if the specific method of treatment is available against diseases for which the physiological method fails, as well as for all other cases, is it not confessedly the universal method ? Hahnemann's method, which avails itself of all the phe- nomena which the patient presents,—holding that all, together, make up the disease,—sets a true value upon sub- jective symptoms. Not requiring a theory of the nature and cause of the disease as a preliminary to the treatment, 92 ANTAGONISM BETWEEN but basing the treatment directly upon the phenomena which the patient presents, it can proceed to cure a patient who presents only subjective symptoms as readily and as surely as one in whom these have given place to objective symp- toms. More than this, Hahnemann showed the value of sub- jective symptoms in the aid which they afford us in indi- vidualizing cases of disease, and thereby enabling us to select a specific for each individual case with more absolute precision. Indeed, he showed that it is only by means of subjective symptoms that the application of individual spe- cifics is possible. It has already been remarked that the material or organic changes in the tissues of the body, which furnish the objective symptoms, may have resulted from any one of a number of pathological processes or abnormal alterations of function, and that they give us in themselves no means of knowing from what particular abnor- mal process they resulted. Now, unless we know this, we cannot apply specifics with exactness. The physiological school have no means of knowing it, and therefore they, very logically, do not undertake to apply specifics with exactness to individualize cases of disease. But the subjective symptoms enable us to take cognizance of these patho- logical processes, these abnormal changes of function, and hence the value of these symptoms. To Hahnemann belongs the honor of having demonstrated this value, and of having shown us how to avail ourselves of it. To Hahnemann, again, belongs the credit of having insisted upon the propriety of using only one remedy at a time. As this, however, was clearly expressed by Boyle, and is admitted by Sir John Forbes, I shall content myself with quoting their words. Boyle says (1654): " It seems a great impediment to the further discovery of the virtues of simples, to confound so many of them in compositions; for in a mixture of a great number of ingredients, it is hard to know what is the operation of each or any of them, so that HOMCEOPATHY AND ALLOPATHY. 93 I fear there will scarce, in a long time, be any progress made in the discovery of the virtues of simple drugs, till they either be oftener employed singly or be but few of them employed in a single remedy." And Forbes says, in 1846: "Our system here is greatly and radically wrong. Our officinal formulae are already most absurdly complex, and our fashion is to double and redouble the existing com- plexities. This system is a most serious impediment in the way of ascertaining the precise and peculiar powers (if any) of the individual drugs, and thus interferes in the most important manner with the progress of therapeutics." And, finally, Hahnemann demonstrated these facts: 1 st. That the curative power of a specific remedy is not in the direct ratio of its material quantity. This had been sus- pected by his predecessor Sydenham, with respect to bark. 2d. That a drug exerts a more powerful effect on those organs for which it has a specific affinity when these organs are sick than when they are healthy ; whence it follows that smaller doses of the same drug are required to cure diseases for which it is the specific remedy, than would be needed to produce their symptoms in the healthy person. 3d. That not only are smaller doses of specifics required to cure diseases than to produce their symptoms in the healthy, but that, when the symptoms of the diseased organ- ism are similar to those produced in the healthy subject by a given drug, then this drug will act curatively on that organism in doses so small that they would hardly produce any effect whatever on the healthy organism. But how small ? This is the practical question. A priori, Hahnemann said, "The smaller the better, provided they only cure the disease in the quickest and surest manner." He experimented for the purpose of reaching definite con- clusions, and out of these facts and experiments came the doctrine and practice of the little doses. And I repeat that those who follow Hahnemann most closely, individualize their cases most strictly, and select the individual specific 94 ANTAGONISM BETWEEN with most exactness, will surely arrive, as all such have done, at the conclusion, on this subject, to which Hahne- mann came. It is remarkable that the first and second facts I mentioned respecting the dose of specifics did not escape the acute mind of Robert Boyle. He says : " To show you that a distem- pered body is an engine disposed to receive alterations under such impressions as will make none upon a sound body, let me put you in mind that those subtle streams that wander through the air before considerable changes of weather disclose themselves, are wont to be painfully felt by many sickly persons, and more constantly by men that have had great bruises or wounds, in the parts that have been so hurt,—though neither are healthy men at all incommoded thereby, nor do those themselves that have been hurt feel anything in their sound parts whose tone or texture has not been altered or enfeebled by outward violence." If quantity be accepted as the measure of power, then the question of the dose must be resolved by the well-known laws of physics. But so soon as it is admitted that the power of a drug is not determined by its quantity alone, but also by its form, and still more by the condition of the patient and by the rela- tion of the specific properties of the drug to the diseased condition against which it is administered, then the whole question is withdrawn from the domain of physics and is left open to be settled by experiment. Now, it is admitted by all medical men, that some drugs at least, exert their specific influence more speedily and more powerfully when given in small doses than when given in large doses, as, for example, Mercury, and according to Dr. Chris- tison, Oxalic acid, which shows that there is not always a direct ratio between power and quantity. Moreover, all medical men agree that in certain morbid states, the body is much more sensitive to the specific action of certain remedies than it is, in certain other morbid states, HOMCEOPATHY AND ALLOPATHY. 95 to the same remedies. The phrase that "such or such a disease does not bear Mercury well," is familiar to the pro- fessional ear. This shows that the condition of the patient has something to do in determining the power with which a certain dose of a specific shall manifest its action, and con- versely that this condition should be taken into consideration in determining the dose. These two facts show that the whole question of the dose was, at the time of Hahnemann's writing, an open one, to be settled by experiment alone. And, as Hahnemann showed that those morbid conditions of the system in which a specific exerts the most power in small doses,—in which, in other words, the susceptibility of the system to the specific is the greatest,—are precisely those in which the symptoms are similar to those which the same drug would produce in a healthy person, it follows that no experiment can be valid on the subject of the dose which does not take into consideration the condition of the patient at the time, and which does not require, as preliminary con- ditions, first, that the subject of the experiment shall be sick, and second, that the symptoms of the sickness shall be simi- lar to those which the drug with which the experiment is made would produce on the healthy subject. In none of the experiments on which our opponents base their objections to the dose of Homoeopathy have these con- ditions been observed. In no case in which they have been observed has the result been adverse to that at which Hahnemann arrived. But, in truth, these objections depend in general not so much on the result of experiments as on what is called the a priori improbability, and upon the seeming simplicity and triviality of the means employed in proportion to the end sought to be attained. The improbability exists only in the minds of those who reckon respecting the living organism as they reckon respect- ing an inanimate machine, employing the rules of physics. 96 ANTAGONISM BETWEEN Let me quote again from Boyle: " Whereas," he says, " it is objected that so small a quantity of the matter of a specific as is able to retain its nature, when it arrives at the part it should work on, must have little or no power to relieve it; this difficulty will not stagger those who know how unsafe it is to measure the power that natural agents may have to work upon such an engine as the human body by their bulk, rather than by their subtlety and activity." And as concerns the relative simplicity and triviality of the dose, listen to the practical Sydenham. Speaking of the success of his new plan of treating rheuma- tism with whey, instead of by blood-letting, he says: " Should any one despise this method for its simplicity, I would have him to know that weak minds only, scorn things for being clear and plain. * * * The usual pomp of medicine exhibited over dying patients is like the garlands of a beast at the sacrifice." x Gentlemen of the Society: In the torch-races of ancient Greece the participants ran with lighted torches, each striv- ing to preserve the flame alive, and to hand his torch unex- tinguished to his successor. If the light went out in his hands he was dishonored. This was done in memory of Prometheus, who first brought fire from heaven for the benefit of men. We have received from the generation of the pupils and successors of Hahnemann the blazing torch which the Prometheus of our system lighted at the altar of Eternal Truth. Our honor depends on the care with which we cherish it, and the state in which we, in turn, transmit it to those who shall follow us. The especial direction which our labors should take is determined by the peculiarities of our method. We are to increase the number of specific remedies. We are to labor diligently, as our predecessors have done, to increase our materia medica, until we shall have ascertained 1 Russell, History and Heroes of the Art of Medicine. HOMCEOPATHY AND ALLOPATHY. 97 the specific remedial properties of all substances capable of being used in treating diseases. But more especially are we to labor to make the knowl- edge we thus acquire of new specifics, and the knowledge we already possess of such as we now use, more exact and definite; until we shall possess an exhaustive knowledge of each remedy, and also such a differential knowledge as shall put us in possession of all the points of resemblance and difference between each of our remedies and all the rest. And it is in this particular province that there is the greatest present need of labor. Our materia medica is being filled with the names of drugs of which a few general proper- ties are loosely recorded, but respecting which no exact or exhaustive knowledge has been attempted to be gained. All this must be changed if we would establish and maintain a reputation at all commensurate with the demands of modern science. Finally, we must bring to bear upon our study of materia medica and of symptomatology all that is useful in the labors of the physiological school of medicine, in the depart- ment of the collateral medical sciences of physiology, pathol- ogy, chemistry and physical diagnosis. For, chaotic as are the therapeutics of this school, and based on a false philosophy, we must not suffer this fact to blind us to the wonderful progress made by it in these collateral sciences, and which are as valuable to us as to it. They supply the means of exact observation. We need, then, in part, to ^prove our materia medica, availing our- selves of these improved means of observation; and we must employ the same in our examination of the sick. We are called also to give ourselves to the study of sub- jective symptoms. This is our especial province, because the physiological school discards these symptoms. Prof. Bock says they are "difficult to understand and apt to deceive." 8 98 ANTAGONISM BET. HOMCEOPATHY AND ALLOPATHY. I have yet to learn that a study is to be avoided because it is difficult! or that a precious tool should be cast aside because it requires a skillful hand to use it. The import of subjective symptoms, their connection with each other, their physiological and pathological significance, are all matters which it is indispensably necessary for us to elaborate and master. And, last of all, the still open question of the dose demands our earnest study. Conscientious, untiring labor in these departments will enable us to hold with honor our place in the great race, and to hand our torch, still blazing, to our successors. We shall thus do our part toward making good the confi- dent expectation of our master respecting his system. "Our art," says he, "needs no political lever, no worldly badges of honor, in order to become something. Amid all the rank and unsightly weeds that flourish round about it, it grows gradually from a small acorn to a slender tree; already its lofty summit overtops the rank vegetation around it. Only have patience ! It strikes its roots deep under ground, gains strength imperceptibly, but all the more cer- tainly, and in due time it will grow up to a lofty God's oak, stretching its great arms, that no longer bend to the storm, far away into all the regions of the earth; and mankind, who have hitherto been tormented, will be refreshed under its beneficent shadows." RELATION OF PATHOLOGY TO THERAPEUTICS.1 The question of the Relation of Pathology to Therapeutics is one of exceeding importance, if for no other reason than this : that, by a very large portion of the medical profession, it is commonly held that the whole science of Therapeutics is based, in its general principles and in its special applica- tions, upon the science and the facts of Pathology. Before beginning the discussion of this subject, it is neces- sary to define the terms used in stating the question, as well as certain kindred terms. The study of the tissues and organs of which the healthy human body is composed constitutes the science of Physi- ological Anatomy. It may be pursued upon the living or the dead body, provided the death resulted from violence and not from disease. The tissues and organs of the healthy body are so fashioned as to perform, each, a special work. This act of performing its special work is called the function of an organ. An organ can act only during the life of the individual. Func- tions, therefore, can be predicated only of living organs. The study of the performance of their special work by the aggre- gation of organs which make up the body constitutes the science of Physiology. Physiological Anatomy, then, is the science of the tissues and organs of the healthy body; Physiology is the science ol the functions of the healthy, living organism. When any or all of the tissues or organs of the body have suffered modifications of substance or of structure in conse- 1 Read before the Homoeopathic Medical Society of the State of New-York, May, 1863. IOO RELATION OF PATHOLOGY quence of disease, the study of these material changes, which are the results of disease, constitutes the science of Patho- logical Anatomy. This may be studied upon the living or the dead diseased organism. When, in consequence of the action of a morbific agent, any or all of the organs of the body perform their special work in an abnormal manner; in other words, when the function of any of the organs of the body is perverted, the study of these changes and perversions of function constitutes the science of Pathology, which, like Physiology, can be studied only in the living organism. Pathological Anatomy, then, is the science of the morbid tissues and organs of the diseased body. Pathology is the science of the abnormal functions of the diseased living body. Diseased tissues and organs being modifications of healthy tissues and organs, it is clearly necessary to understand Physiological Anatomy before we can understand Patho- logical Anatomy. Just as necessary is it, for the same reason, to understand Physiology before we can master Pathology. Indeed the latter might be said to exist only by comparison with the former. If this be true of the details of these sciences, it is no less true of their essential nature and philosophy. If one would gain a correct notion of the subject, scope, limits and rela- tions of the science of Pathology, he must first have a just and exact idea of those of Physiology. To the latter, there- fore, I propose to devote a few words. Dr. Carpenter defines the object of Physiology to be the study of "the phenomena which normally present them- selves during the existence of living beings," or, in another place, "the phenomena of health or normal life." Its object, then, is not, as it has been sometimes loosely stated, life itself, but the phenomena which depend upon and result from normal life. The science of Physiology brings these phenomena into systematic form, classifies and com- pares them, analyzes secondary and complex phenomena into TO THERAPEUTICS. IOI their simple elements, and seeks the ultimate phenomenon in which the real elementary manifestation of simple life is made, uncomplicated by secondary or related chemical or mechanical phenomena. Virchow says, " The chief point is to obtain a recognition of the fact that the cell is really the ultimate morphological element in which there is any manifestation of life, and that we must not transfer the seat of real vital action to any point beyond the cell."1 Dr. Carpenter says, "The cell lives for itself and by itself, and is dependent upon nothing but a due supply of nutri- ment and a proper temperature for the continuance of its growth, and for the due performance of its functions until its term of life expires. Its chief endowment seems to be that of attracting or drawing to itself some of the various sub- stances which are contained in the nutritive fluid in relation with it. This fluid is a mixture of a great number of com- ponents ; and different sets of cells appear destined severally to appropriate these. As far as is yet known, however, the composition of the cell-wall is everywhere the same, being that of Proteine." Dr. J. H. Bennett says, " Nutrition is now considered to depend upon an inherent vital property peculiar to the tissues themselves, which exercise a force at the same time attract- ive and selective. By its agency each tissue and gland attracts from the blood that amount of matter which is necessary to maintain it in bulk, and at the same time selects from it the peculiar substance necessary for itself and for the secretion it is destined to produce." According, then, to the most advanced writers on this sub- ject, we are to regard the organism as a complex which is capable of being analyzed into an aggregation of cells, of homogeneous structure, but each of which is endowed with a peculiar inherent vital power of " attraction and selection," which we recognize only in its results and which constitutes the only " real action of life" that we are capable of observing. Cell. Path., Eng. ed., 3. 102 RELATION OF PATHOLOGY In the words of Virchow, "Every animal presents itself as a sum of vital unities, every one of which manifests all the characteristics of life." Life, then, really consists in the exercise by each cell of its inherent peculiar attractive and selective power. Physi- ology concerns herself with the results of this exercise. A cell by virtue of its inherent power abstracts from the nutri- ent fluid a substance which is to serve to nourish the organ to which the cell belongs, or to furnish the secretion of that organ. If the former, then the future history of that organ, its development, its functions and its interstitial decline and dissolution and the fate of its debris belong to the secondary and complex phenomena to which Physiology devotes her- self. With these phenomena, life has no exclusive connec- tion save in the primary exertion by the cell-wall of its " inherent attractive and selective power." Physiologists with great propriety attempt to explain by mechanical, chemical and electrical laws the secondary phe- nomena of the organism, the relations of different tissues and secretions to each other and their mutual reactions. But they make no attempt to explain the action of the cell-wall which is the ultimate and essential phenomenon of life. They accept this as an ultimate fact, they recognize a power pecu- liar to the wall of each variety of cell and different from that of any other cell, and they deal with the results of the exercise of this power. Physiology having been defined as the science of the phe- nomena of normal life, Pathology has been declared by the same writer (Dr. Carpenter), to be the science of the phe- nomena of " disease or abnormal life." If the mutual reaction of two secretions be different in any individual case from that which is observed in the healthy organism, one or other of the secretions must be of an abnor- mal character. This must have resulted from an abnormal exercise by the cell-wall of that inherent selective power, by TO THERAPEUTICS. 103 virtue of which the secretion was made. The essential and ultimate act of disease is found, like that of life, to consist in some abnormal exercise by the cell-wall of its inherent vital power. As we recognize the existence of this power in the healthy cell only through its action and its result, viz., the function of secretion and the substance secreted, so we recognize disease, which is an abnormal exercise of this power, only through its action, viz., the perverted function, and through its result, viz., an abnormal secretion. " Not unfrequently," says Dr. Bennett, " this attractive and selective power in the tissues is deranged, producing increase or diminution in growth or secretion, general or partial. Not unfrequently the selective power appears to be lost, and the attractive power much increased," etc., etc. From this alteration of these forces, diseased conditions of these fluids and tissues result. The secondary and com- plex phenomena resulting from the reaction of abnormal tissues are analyzed by Pathology and referred to this elementary deviation in the selective and attractive forces of the cell-wall. But the nature and intimate cause of this alteration, which is, however, the essence of disease, Pathol- ogy does not attempt to explain or apprehend, knowing it only by its effects. As, therefore, Physiology concerns herself with the results of life, so does Pathology take cognizance of the results of disease. For it must be repeated that as the functions of healthy organs and the tissues of the healthy body which are respectively the subjects of Anatomy and Physiology are not life, but only results of life, so the abnormal func- tions and the altered tissues of the diseased body, which are respectively the subjects of the science of Pathology and Pathological Anatomy are not disease itself, but only the results of disease. These distinctions, it will be perceived, have a direct and most important bearing upon the science of Therapeutics, which has for its object the cure of disease. 104 RELATION OF PATHOLOGY The process by which the secretion of any fluid of the body is accomplished cannot be explained. It is an exer- tion of that peculiar vital power of which we have spoken as inherent in the cell-wall. The secretion of the gastric juice and of the bile, for example, is wholly inexplicable. But when, after being secreted, these or similar fluids are brought into contact with each other or with any foreign substance, whether within or without the body, the actions and reactions which ensue are explicable by chemical, mechanical or electrical laws, and these explanations con- stitute the object of Physiology. It is obvious that these phenomena may be of great complexity and that the explanations may require to state the conditions of several successive series of reactions, which intervene between the external fact or symptom as viewed by the observer, and that ultimate action of the cell-wall which Virchow declares to be "the only real vital action of the living organism"— or, on the other hand, the phenomena may be simple and the explanation may be complete by a simple and direct reference to the selective action of the cell-wall. Thus, for example, the fact of salivation, as noticed by an external observer, is made up of the discharge of the salivary secre- tion into the mouth. The explanation refers us at once to that selective power of the cell-wall of the salivary glands which extracts from the nutritive fluids the constituents of this peculiar secretion which, as such, is not found any- where in the body except in the salivary ducts as the result of the process we have just described. On the other hand, the fact of urination is made up, so far as the external observer is concerned, of the discharge of urine from the urethra and the emptying of the urinary bladder. The physiological investigation, however, shows the process to be quite complicated, and the explanation carries us through several series of phenomena, before we arrive at the ultimate fact. Thus, we trace the urine through its reservoir, the bladder, up the ureters to the tubuli of the TO THERAPEUTICS. 105 kidneys, where it has probably received, if not the whole, at least a great portion of its watery constituents; and this contribution may require a further explanation by the mechanical laws of endosmosis and exosmosis whereby this constituent was separated from the blood. Not tracing this constituent further, for the present, by asking, as we should logically be required to do, how this substance came to be contained in definite quantity in the blood, we seek the other constituents of the urine and find the urea and possi- bly some other of them eliminated by the Malpighian bodies from the blood through the agency of the cell-wall. And yet even this can hardly be called the ultimate vital act, which will require to be sought by a still deeper analysis. For although the cells of the Malpighian bodies do separate the urea from the blood, yet they do not manufacture it from the constituents of that fluid. They find it there already formed, and an exhaustive analysis of the physio- logical fact of urination would require us to seek the origin of the urea in the blood. This would lead us |to the study of the nutrition and decay of the nitrogenized tissues, and in the cell-walls of these we should first meet with that ultimate vital act, in which alone, of all the processes which urination involves, life, pure, simple and inexplicable, is concerned. Physiology goes somewhat further than this analysis of the actual normal functions of the living organism. Under the name of Experimental Physiology she not only seeks to apply the test of synthesis to her analysis, but she endeavors to solve her problems by the substitution of analogous sub- stances for some elements of the nutrient fluid, or for some of the secretions of the organism, and thus light is thrown not merely on the processes of the living organism, but also contributions are made to the derived science of Pathology. Let us now take a similar view of the science of Pathology, which deals with abnormal functions as Physiology does with io6 RELATION OF PATHOLOGY normal functions, and which might almost, by a license of speech, be called the science of Morbid Physiology. The fact of morbid salivation is, to the observer of object- ive occurrences, only a discharge of abnormal salivary fluid. The pathological explanation, like the physiological, leads us to the selection from the blood by the cell-wall of the glands of the substances out of which it fabricates the salivary fluid. If the blood be normal and yet the saliva be, as we have supposed, abnormal, then the mysterious power of the cell-wall must have been perverted, altered or impaired. This manifestation of life must have become a manifestation of abnormal life—which is disease. Here, then, is the seat of disease—just where we found the seat of life—in the inherent attractive and selective power of the cell-wall. This, then, is the nature of disease, a modification of that unknown and inscrutable power, life. "Health," says Carpenter, " or normal life;" "disease or abnormal life." "Not unfrequently," says Dr. Bennett, "this attractive and selective power in the tissues is deranged. Not unfre- quently the selective power appears to be lost and the attractive power greatly increased, and thus," after a few intermediate steps described, "the phenomena which we call inflammation ensue." To take, now, an example of a more complex series of phenomena, the fact of the evacuation of morbid urine, simple as it may appear to the observer of external phe- nomena only, yet leads us, in our search after the original act of " abnormal life " in which the morbid excretion had its origin, to examine first, whether the change was purely a chemical change, originated and effected while the urine was retained in its reservoir, the bladder—for if so, it differs little from a corresponding change which occurs daily in the " vase de nuit"—secondly, whether the urine derived its morbid character from the admixture of morbid secretion, or effusion from the surface of the bladder, of the ureters, TO THERAPEUTICS. IO7 of the pelvis of the kidney, or from the tubuli; from each of which it might receive blood, or mucus, or pus, or, perhaps, liquor sanguinis alone holding fibrine in solution, or finally solid fibrinous casts; or, thirdly, whether the morbid change in the urine came from a loss, on the part of the cell- walls in the Malpighian bodies, of their inherent vital selective power, whereby they are enabled to separate from the blood those substances which it is their province in the healthy body to separate; or, finally, whether the blood no longer contains, as in a normal state it should do, those elements which it is the function of the kidney cells to eliminate from it,—in other words, whether the whole train of processes which eventuates at last in the evacuation of abnormal urine, may be traceable to an abnormal interstitial nutrition and destruction of the nitrogenized tissues; all these are questions which it is the legitimate and very useful business of Pathology to solve. Now, be it observed, whether the cause be traced to abnormal action in the cell of bladder, ureter, kidney, or in that of the muscular or cerebral tissue, we arrive always at the fact that as the action of the cell-wall in the healthy body constitutes the only real vital action of the organism, the only unmixed manifestation of life; so the modified and abnormal action of the cell-wall in the diseased body consti- tutes the only real action of abnormal vitality in the organism — the only unmixed manifestation of disease. It may be objected that no account has been taken in what we have said, of the action of the nervous system, to which, nevertheless, both in the case of morbid saliva- tion and in that of morbid urine, the alteration in the sali- vary gland and in the kidney respectively may have been attributable. But this objection simply adds another step to the analysis. For every action of any part of the nervous system involves an expenditure of a portion of nervous substance, that is, a process of interstitial destruction and reconstruction, and this process is effected only through the io8 RELATION OF PATHOLOGY attractive and selective power of the cell-wall of the nervous tissue. Thus are we brought again face to face with this inevitable mysterious power, the abnormal action of which constitutes Disease. We are now in a position to discuss the relations of this science of Pathology, which treats of the phenomena of the diseased organism, to the science of Therapeutics, which pro- poses to cure disease. It has been stated that a large portion of the medical pro- fession hold that the science and practice of Therapeutics are based upon the science and facts of Pathology. It is held that the explanation of the phenomena of the morbid organism, which Pathology furnishes, gives the key to the procedures which should be adopted for the restoration of the morbid organism to a healthy condition. If, for example, it be ascertained through the investigations which Pathol- ogy makes for us, that a certain series of morbid symptoms may be traced to an abnormal condition of the gastric fluid,— a too great acidity, for example, — "it is," says Dr. Bennett, "the discovery and removal of such causes as this that constitute the chief indications of the scientific practitioner." Let us see in what way Dr. Bennett proposes that this " removal" shall be accomplished. He says, supposing another case : " The capillary vessels become over-distended with blood, and the exudation of the liquor sanguinis to an unusual extent takes place, constituting inflammation. How is this to be treated ? In the early stage, topical bleeding, if directly applied to the part, may diminish the congestion, and the application of cold will check the amount of exuda- tion. But the exudation, having once coagulated outside of the vessels, acts as a foreign body, and the treatment must be directed to furthering the transformations which take place in it, and facilitating the absorption and excretion of effete matter. This is accomplished by the local application of heat and moisture, the internal use of neutral salts to dissolve the increase of fibrine in the blood, and the employ- TO THERAPEUTICS. IO9 ment of diuretics and purgatives to assist its excretion by urine or stool." In this plan of treatment, we have a proposition to adopt mechanical measures—blood-letting—for the diminution of a congestion; chemical means—neutral salts—for the solu- tion of the exudation; and mechanical means again— diuretics—for the removal of the dissolved exudation from the blood. But it cannot fail to attract the attention of every reader that this plan proposes to deal only with the results of disease—not with the disease itself—for the congestion is a primary result of the abnormal action of cell-wall, and the exudation which results from the congestion is a secondary result of the same abnormal action of the cell-wall. This is clearly shown by Dr. Bennett's words already quoted, but which we again cite: " Not unfrequently the selective power of the cell appears to be lost, and the attractive power so much increased, that the liquor sanguinis is drawn out through the vessels, so that its fibrine coagulates in a mass outside of them. This result, preceded or accompanied by certain changes in the vessels themselves, and more or less stagnation of the current of the blood, constitutes the phenomenon hitherto described as inflammation." It is here most distinctly stated, and most conclusively shown, that the cause of the phenomena of inflammation lies behind these phenomena of congestion and exudation, and is to be found in a modification of that mysterious vital power of the cell-wall. It follows from this that a treatment which is addressed to these resultant phenomena, and not to their cause, must be but a palliative treatment. It can in no sense be called a radical or a rational treatment. To remove or assist in removing from the body or any part of it the results of morbid causes may alleviate suffering, may enable the patient to hold out longer under disease, just as pumping out a leaking ship may postpone the time when she will sink, may increase her chances of getting into port before no RELATION OF PATHOLOGY she sinks,— may thus in fact be the means of saving her. But as, certainly, pumping is only a palliative mode of treating a leaking ship—as the stoppage of the leak is the only radical treatment imaginable—so in the case of inflammation the only radical treatment would be one which addressed itself directly to the cell-wall, and in such a way as to restore to it the just amount and proportion of its now perverted " inherent attractive and selective power." It is evident that when this had been accomplished, con- gestion would cease to be produced, and in consequence of this cessation there would be no further exudation. It might now be within the province of Pathology to indicate some mechanical or chemical way of aiding or hastening the removal of the results of disease—the congestion and exuda- tion—but this would be only a sequel of the curative treat- ment. A curative treatment, then, must address itself directly to the cell-wall, which is the ultimate seat of disease. And every method which is directed to the results of disease, which are the proper subjects of Pathology and Pathological Anatomy, must, of necessity, be a palliative method. But, it may be objected, we are unable to plan any such curative treatment, for the reason that we do not understand the nature of this cell force, nor the nature of its perversion, in any case. To recur to our simile of the ship : it is some- times impossible to find the leak, or, if its location be known, to stop it. Nothing remains but palliation. This statement, as applied to disease, is correct in only a few instances, the number of which is becoming continually diminished by the progress of science. It is true that we do not understand the nature of the cell force, whether normal or perverted. Neither do we understand the nature of chemical affinity, nor the modus operandi of chemical reaction. Yet we have an experimental knowledge of each, and we know the peculiar chemical affinities and reactions of a vast number of bodies. TO THERAPEUTICS. Ill In like manner we may learn the reaction of foreign bodies introduced into the circulation upon the inherent forces of the cell-wall. Reasoning upon the general physical law that " like effects are produced by similar causes," we conclude that, if in any case, having introduced into the circulation of the healthy subject a foreign body, we observe the phenomena of congestion and exudation, with stagnation of the current of the blood, identical with those known to us as the phenomena of inflammation, then the peculiar inherent powers of the cell-wall must have been affected by this foreign body in precisely the same way (whatever it be) as that in which any accidental exciting cause of inflammation affects these forces. We thus discover re-agents which act directly upon the inherent power of the cell-wall, and we thus, by experiments upon the healthy, determine precisely the limits and direction of their action. This knowledge is rendered possible and exact by the science of Pathology, which enables us to trace out and analyze the results of intentionally induced abnormal cell-action, just as it does those of accidental disease. This is not a matter of mere speculation. It is well known to every physician that almost every drug, every substance in fact which is not a simple aliment, has, besides any chemical affinities it may possess for some of the secretions of the living organs, a certain peculiar power of modifying the functions of some of the organs of the body, a power which is inexplicable and is recognized only by its results. Examples of this power of drugs are found in that of Tartar emetic to produce changes which result in congestion and exudation, of Opium to produce changes which result in narcotism, etc. These, which are known as the specific properties of drugs, are evidently the properties by which they modify the forces of the cell-wall, and from which all observed Pathological (or Pathogenetic) and Pathologico- anatomical phenomena result. And it is manifest that the specific modifying power of 112 RELATION OF PATHOLOGY each drug can be surely ascertained, as an absolute property, by testing it upon the healthy living organism. And it follows as clearly, from all that has been said, that the appli- cation of specific drugs which have a direct action upon the cell-wall whose inherent forces are acting abnormally under the influence of disease, is the only direct and radical method of curing disease. The task of finding out by what formula the specific action of drugs upon the cell-forces of different tissues should be brought to bear upon the perverted cell-forces in any given case of disease, comes under the science of Therapeutics and lies beyond our present province. It is the problem of the Therapeutic Law. From all that has been said, the Relations of Pathology and Therapeutics may be deduced in a few words. Physiology and Pathology themselves teach us that the science of Pathology can in no sense serve as a basis or foundation of the science of Therapeutics. They show us that whereas Pathology is the science of disease based on a theory of observed morbid processes, Therapeutics, when truly regarded, is a science of cure, based on a theory of cure and resting on a foundation of experiment. Although not the basis of Therapeutics, Pathology must yet be a most important instrument in the practical application of the science of Therapeutics. The problem in the art of medicine being to apply to the abnormally acting cell-wall that remedial agent which is capable of acting directly upon it, and in such way as to restore its normal action, it is clearly indispensable that the physician be able to trace the morbific agent through all its complex resultant phenomena up to the original perversion of cell-force, from which the whole disorder springs; that he be able to analyze secondary and tertiary series of phenomena into their simple elements. And in this work Pathology is the instrument of which he avails himself. I cannot refrain, in conclusion, from rendering homage to TO THERAPEUTICS. H3 that wonderful prevision of genius by which, in an age when Pathology, as we understand it, was unknown, Samuel Hah- nemann anticipated all that we have said, and all that the most advanced writers of our day have taught, respecting the scope and influence of Pathology in relation to Thera- peutics. The symptoms of the urinary organs in connection with the discharge of morbid urine would at one time have been regarded as the proper subject of treatment. But Pathology has now taught us to trace these symptoms back to the kidney, and beyond the kidney to the blood, and beyond the blood to the nutrition and the destruction of all the nitro- genized tissues. As Dr. Carpenter remarks, "When, for example, the urine presents a particular sediment, our inquiries are directed not so much to the kidney itself, as to the constitutional state which causes an undue amount of the substance in question to be carried off by the urinary excretion, or which prevents it from being (as usual) dissolved in the fluid." To'confine the attention, therefore, in prescribing for a given case, to the immediate organ the perversion of whose functions is most obviously pointed out by the prominent symptoms, is to disregard the clearest indications of Pathology. We must analyze these obvious symptoms and must include their remotest elements in our indications. Nay, these remotest elements—the constitutional disturbances, for instance, of which Carpenter speaks—are even more important indications for treatment than the more obvious and objective symptoms. But how can we analyze these more obvious symptoms, and ascertain those " consti- tutional disturbances" in which they have their origin? In no other way than by a study of the functions of the entire organism — in what way and to what extent they are per- formed in an abnormal manner. But this brings us at once to that rule on which Hahnemann so strongly insisted, that the entire organism of the patient should be examined in every possible way, and that the "totality of the symp- 9 114 RELATION OF PATHOLOGY TO THERAPEUTICS.' toms" should be made the basis of the prescription ;~ nay, that the constitutional, general symptoms are often more conclusive as to the proper treatment than the more obvious local symptom. The grand old master reached at a single bound the same conclusions to which the labors of a half century of able Pathologists have at length, with infinite research, brought the medical profession. And those of our school who insist upon Pathology as a basis of Therapeutics, who look upon the single objective symptom and its nearest organic origin as the subject for treatment, and who deride the notion of prescribing upon the totality of the symptoms, and claim to be more than mere symptom-coverers, in that they discover and aim to remove the cause of the disease—these colleagues are as false in their Pathology, according to the highest Old-School authority, as they are faithless to the doctrines and impotent as to the successes of the founder of the Homoeopathic School. PRIMARY AND SECONDARY SYMPTOMS OF DRUGS AS GUIDES IN DETERMINING THE DOSE. As preliminary to an intelligible discussion of this question, we must briefly define primary and secondary symptoms respectively, and state how, in our judgment, the discrimina- tion between them bears upon the selection of the remedy. And this, notwithstanding these questions have been elabo- rately and lucidly discussed by other members of this bureau. For it will not have escaped the reader's observation that these terms are used with different significations by different writers. Symptoms may be called primary as being first in order of occurrence, in comparison with others which, occurring at a later period, are, with reference to time, secondary to them. Or, symptoms may be called primary as being, in a sense, the exciting cause of other and opposing symptoms, which are then secondary to, as being contingent upon, the former. Or, symptoms may be styled primary as being of greater importance or significance than others called, therefore, secondary. The distinction, then, may be based on considerations of time, of opposition in nature, or of rank. And it is impor- tant not to confound or combine these ideas in our discussions. Since most of our traditional notions on this subject originated in Hahnemann's utterances upon it throughout his writings, I will briefly repeat his views before stating my practical conclusions. In an essay entitled Suggestions for Ascertaining the Curative Powers of Drugs, published 1796 (S. W., 312), Il6 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS Hahnemann says: " Most medicines have more than one action; the first a direct action, which gradually changes into the second (which I call the indirect secondary action). The latter is generally a state exactly the opposite of the former. In this way most vegetables act. But few medi- cines are exceptions to this rule, e.g., metals and minerals." He illustrates what he means by the secondary action in the following note: " Under Opium, for example, a fearless elevation of spirit, a sensation of strength and high courage, an imaginative gayety, etc., are part of the direct primary action of a moderate dose; but after eight or twelve hours an opposite state sets in—the indirect secondary action; there ensue relaxation, dejection, diffidence, fear, loss of memory, etc." In the preface of the Fragmenta de Vir. Med. Pos., etc., 1805, Hahnemann says: "Simple drugs produce in the healthy body symptoms peculiar to themselves, but not all at once, nor in one and the same series, nor all in each experimenter; but to-day perhaps these, to-morrow those; this first one in Caius, the third in Titus, but so that on some other occasion Titus may experience what Caius felt yesterday. " A certain drug evokes some symptoms earlier and others later, which are somewhat opposed and dissimilar to each other; indeed may be diametrically opposed. I call the former primary, or of the first order, and the latter secondary, or of the second order. "For each individual drug has a peculiar and definite period of action in the human body, longer or shorter, and when this has passed, all the symptoms produced by the drug cease together. " Of the drugs, therefore, the effects of which pass over in a brief space of time, the primary symptoms appear and disappear within a few hours. After these the secondary appear and as quickly disappear. But the exact hour in which any symptom may be wont to show itself cannot be AS GUIDES IN DETERMINING THE DOSE. 117 positively determined, partly because of the diverse nature of men, partly because of different doses. * * * " I have observed some drugs the course of whose effects consisted in two, three or more paroxysms, comprising both kinds of symptoms, both the primary and the secondary; the former, indeed, as I have stated in general terms, appeared first and the latter second. And, sometimes, it seems to me I have seen symptoms of a kind of third order. " Under the action of moderate or small doses, the symp- toms of the first order come chiefly to view; less frequently those of the second order. I have chiefly preserved the former, as most suitable to the Medical Art and most worthy to be known." Finally he speaks of a class of symptoms which he de- nominates " reliquias," generally the effects of very large doses, and which seem to indicate or depend upon more or less permanent alterations of tissue, including the symptoms of the " agony" in fatal cases. As illustrating these views, I quote remarks prefixed or appended to the symptomatology of several of the drugs mentioned in the Fragmenta. In a note to Aconite, Hahnemann says: " Through the whole course of action of this plant, its effects of the first and second order were repeated in short paroxysms, two, three, or four times before the whole effect ceased (eight to sixteen hours)." And he describes these effects as follows : " Coldness of the whole body and dry internal heat. Chilli- ness. Sense of heat first in the hands, then in the whole body, especially in the thorax, without sensible external heat. " Alternating paroxysms (during the third, fourth, and fifth hours); general sense of heat, with red cheeks and headache, worse on moving the eyeballs upward and later- rally, then shivering of the whole body with red cheeks and hot head; then shivering and lachrymation with pressing headache and red cheeks." Il8 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS In a note to Chamomilla, Hahnemann says: " The course of its action is run in paroxysms of several hours' duration, comprising symptoms of each order, free spaces or remis- sions being interjected, so, nevertheless, that in the earlier paroxysms, the symptoms of the first order, in the later, those of the second order predominate." In a note to Ignatia, he says: " Ignatia is wont to display the curriculum of its operation in several paroxysms com- prising both orders of symptoms, and repeated at intervals of several hours;" and concerning the mental symptoms: " Inconstancy, impatience, vacillation, quarrelsomeness, won- derful mutability of disposition, now prone to laughter, now to tears," he says: "These mental symptoms are wont to be repeated at intervals of three or four hours." Hahnemann's teachings on this subject in the Organon (in which all the editions substantially agree) have been so fully given by Dr. C. Wesselhoeft in the preceding section of the report of this bureau, that I am spared the necessity of quoting them. It appears that Hahnemann, in the Fragmenta and the Organon, teaches that among the symptoms of a drug, there appear series which are opposed to each other in different degrees of diversity, from being " somewhat opposed" to " diametrically opposite;" and that, of these series, that which occurs first in order of time, is to rank among the primary, and that occurring subsequently among the secondary symptoms. But he calls attention to the fact that there are some kinds of symptoms in every proving, to which there can be no series of an opposite nature, i. e., to which an opposite cannot be predicated; for, he says, " Our organism always bestirs itself to set up in opposition to this effect [first drug action], the OPPOSITE condition, WHERE SUCH A CONDITION CAN EXIST."1 In his definition of primary and secondary symptoms, therefore, Hahnemann blended the elements of time and of 1 Organon, 2d and 3d ed., $ 74; 4th ed., $63. AS GUIDES IN DETERMINING THE DOSE. 119 causation or nature (viz., that these classes were opposed in their nature). The secondary symptoms were not an inde- pendent series, but were secondary by virtue of their relation of opposition in nature to a series of preceding symptoms. And such symptoms as did not in their nature admit of an opposite condition (as, for example, pain, cutaneous eruption, etc.) could not be called primary, because, in the nature of things, they could not be followed by an opposite class of symptoms. Nor could they be called secondary, because, in the nature of things, they could not have been preceded by an opposite series, which could stand to them in the relation of primary symptoms. Hahnemann, then, appears to have recognized in the pathogeneses of drugs, symptoms which being opposed in nature could be arranged into series of primary and secondary, and other symptoms not susceptible of such arrangement. He distinctly tell us1 that the primary or positive symp- toms of drugs are those on which we are to base our prescriptions. These statements in the Organon, as quoted by Dr. Wes- selhceft, embrace not only a description of various classes of symptoms as observed by Hahnemann in drug-proving, but also a theory of the nature and genesis of these various classes. A man's observations of natural phenomena, if he be a keen and accurate observer, as Hahnemann unquestion- ably was, are generally correct. His theoretical explanation of them is pretty sure to be tinctured with the philosophy of the period in which he wrote, and is not likely to be accepted without qualification by men of a subsequent period. And, at the present day, few would accept Hahnemann's explana- tion of the genesis of primary and secondary symptoms as representing respectively a state of passivity followed by a state of intensified activity on the part of the vital force; this conception of a vital force, in the sense in which Hahne- mann used the term, being one which, itself, has been 1 Organon, 2d and 3d ed., % 59; 4th ed., $ 152. 120 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS discarded by most physiologists. But the rejection of the explanation offered by Hahnemann does not involve the rejection of the observations to which he attached it. Among the symptoms which he called primary (Erst wirkungen), Hahnemann recognized the occasional occur- rence of what he called alternate (Wechselwirkungen), opposed, sometimes contradictory symptoms, which, never- theless, were not secondary. He does not tell us how to recognize these, nor how to distinguish them from the secondary symptoms. But he does give us instances of what he regards as secondary symptoms, as follows i1 " The gayety which follows the use of coffee is a primary symp- tom ; the subsequent drowsiness and lassitude are secondary symptoms. The sleep which follows Opium is a primary and the subsequent insomnia a secondary symptom; the purging of cathartics is a primary and the subsequent con- stipation a secondary symptom. The constipation of Opium is a primary and the subsequent diarrhoea a secondary symp- tom." And consistently with Hahnemann's instructions, we should not expect to base our prescriptions on these second- ary symptoms. But when we examine Hahnemann's remarks on the indi- vidual drugs of the Materia Medica Pura, we find devia- tions from his definitions and illustrations as given in the Organon. In the preface to Belladonna we read :2 " There is no known drug of long action which expresses itself in so manifold (two and three fold) alternate conditions as Bella- donna. Only compare symptom 15 with 16 and this with 17, 56 with 58, and this with 60, 61 and 114, and these with 113 and 152; again, 62 with 63, 64, and these with 70, and 62 with 72, 158 with 159, and this with 160 and 165, and this with 163 ; and 172 with 174 and 175, and these with 176. Of none of these alternate conditions (Wechsel- wirkungen) can it be said that they are beyond the primary action." 1 Organon, 2d and 3d eds., § 76; *Materia Medica Pura, 1st ed. 4th ed., % 65. AS GUIDES IN DETERMINING THE DOSE. 121 The symptoms thus referred to describe opposite condi- tions as follows: Contracted pupils and dilated pupils. Abdominal pains compelling to bend backward and to sit still,—to move forward and not admitting of motion. Suppressed stool and urine and involuntary stool and micturition, and constant tenesmus. Sleeplessness and deep slumber. Raging delirium and wild fear, and foolish madness, etc. It is evidently Hahnemann's meaning, and surely experi- ence justifies him, that Belladonna may be given (other symptoms corresponding) when either the one or the other (the opposite) of these conditions is present. And these opposites belong to the class described in the Organon as secondary, and on which we are told, we are not to base our prescriptions. In the introduction to Nux vomica {Materia Medica Pura, 1st ed.) Hahnemann says: " The symptoms of a single dose of Nux vomica are wont to recur several days in succession, at the same time of day, even at the same hour, or every other day. Hence the usefulness of this drug in some typical diseases when the symptoms otherwise correspond. Besides this periodicity of the symptoms, and besides the alternation of heat and cold, there follow also upon one another, here and there (as is the case also with other drugs), symptoms which differ very much from one another, and appear to be opposed to each other, although they all belong to the primary action of the drug. We may call these alternate actions (Wechselwirkungen)." And among the symptoms of Nux vomica, Hahnemann calls attention to 232 and 233 "ano- rexia," as contrasted with 236-238, " great appetite," and says these are alternate actions, and belong to the primary symptoms, and are, therefore, to be used as bases of pre- scriptions. He refers also to 369-374, "Constipation with tenesmus," etc.; and to 357~359» "Diarrhoea with desire and tenesmus," etc.; and says, in a note, " Diarrhoea, 122 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS constant, abundant, strictly so called, is not, according to my observation, to be expected in the primary action of Nux vomica; and that which here appears among the symptoms as diarrhoea is partly very small, mostly mucous discharges with tenesmus and pain," etc. Again, in a note to 456, he says : " Discharge of mucus from the nose is an alternate action with dry obstructions of the nose." There is, clearly, a discrepancy between Hahnemann's general prop- ositions in the Organon and his practical instructions in the Materia Medica Pura. For we find from the latter that Bel- ladonna, for instance, may be given for the primary symptom, " sopor," as well as for what in the Organon is called the secondary, but in the Materia Medica Pura the alternate symp- tom " sleeplessness," and that Nux vomica may be given for the primary symptom " constipation," and likewise for what is called in the Organon the secondary, but in the Materia Medica Pura the alternate symptom " diarrhoea." The very terms primary and secondary, as thus illustrated, seem to imply a succession of symptoms, more or less opposed in character, and all of them differing from the equilibri- um of function which we recognize as health. The instances given, and, indeed, the only possible instances, relate to func- tions of which a "more" or "less," or an "opposite," may be predicated; as, for example, temperature, sleep, certain mental conditions, and the secretions and excretions gener- ally. Thus we may have an unnaturally prolonged sleep or wakefulness, gayety, or despondency, and a plus or minus of sweat, alvine discharge, urine, etc., etc. But how could we have an opposite condition to any specified pain or sub- jective sensation, to parenchymatous deposit, to cutaneous eruption, etc., etc. ? The absence of these phenomena would be pro tanto a state of health; it would not be an opposed morbid condition or sensation. The possibility, then, of classifying symptoms into primary and secondary on the basis of the relative nature of the symp- toms, is not co-extensive with symptomatology; it is partial, AS GUIDES IN DETERMINING THE DOSE. 123 confined to a moderate number of conceivable morbid phe- nomena. Shall we, then, in the second place, base the distinction on the element of time, and call the symptoms which first occur primary, and those which come later, secondary? Where then shall we draw the line ? how many hours or days shall we allow for the development of primary symptoms? In view of the immense differences in the rapidity with which the curriculum of action of different drugs is run, it is obvious that a special rule must be established for each drug. Nor is this the only difficulty. The results of different doses on the same provers, and of different doses or even of the same dose on different provers, are so various that, 1st, as Hahnemann intimates in the preface to the Fragmenta, the symptom which appears in one prover to-day will not appear for several days in another prover; and, 2d, a very small dose may pro- duce only one series of symptoms; a larger dose two series of opposed symptoms; a still larger dose two series differ- ently opposed ; and a very large dose again only one series. This point has been so well illustrated by Prof. Allen, with whose views I am glad to express my entire concurrence, that I need not dwell upon it, but may content myself with two illustrations from our Materia Medica. On looking over the register of symptoms of Argentum nitricum,1 we find reported as occurring early in the prov- ing, irritation of the bladder and urethra and increased fre- quency and quantity of urine, and as occurring later in the proving, diminution in frequency of micturition and in the quantity of urine. Surely one might pronounce the former to be primary and the latter secondary symptoms. But on examining the provers' day-books we find that the majority of the provers (being those who took large doses) report the former and not the latter symptoms. It was the prover who took the 30th who reported diminished urine, and he did not report any increase at any time. 1 Oesi. Zeit. I. 124 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS These symptoms, therefore, which appear in the register to be opposed, and properly distinguishable as primary and secondary, did not bear to each other any relation of appo- sition or correlation, as they might have done had they oc- curred in the same individual. They are different, unrelated, independent effects of different doses in different individuals. And let me suggest, in passing, that the beautiful pictures of primary and secondary effects of drugs which we find in works of Old-School writers, and which have been made the basis of " laws of the dose " by writers of our own school, are composite pictures made up from a variety of observa- tions on patients and from cases of poisoning, and bear no more resemblance to a pathogenesis on a single individual, than the composition of an artist which has the mountains of Ecuador covered with the forests of Oregon and decked with the flowers of Java presents to a faithful landscape from nature. Most of the provers of Tellurium taking the 3d trit. had, on the first and subsequent days, symptoms of the general sensibility, of sweat, of the skin, of the bladder, etc., etc. But one prover who took the 4th trit. had no symptoms at all until the fourteenth or fifteenth day, when cutaneous symptoms affecting the ear appeared and were very persist- ent and troublesome. Were these symptoms secondary because they came later than other symptoms in other prov- ers ? And secondary to what ? How can John's lumbago be secondary to James's toothache ? But during the second month this same prover, his ear symptoms having vanished, had symptoms referred to the dorsal spine. Were these secondary to the ear symptoms because they came later? Certainly as regards time they were secondary, because later. But being in nature wholly unrelated, neither opposite nor similar, they cannot be called secondary as regards nature nor as regards rank or value. Both have been repeatedly verified in practice. Again, we are toldx that coldness, a condition correspond- 1 "The Dose," by E. M. Hale, M.D., N. A. J., ix. 265. AS GUIDES IN DETERMINING THE DOSE. 125 ing to the chilly stage of fevers, is the primary effect of Aconite, and that a state corresponding to the hot stage of fevers is the secondary effect of that drug. Let us hear Hahnemann. In the introduction to Aconite1 he says: " Aconite is one of a few drugs whose primary action consists in several alternating conditions of chill or coldness and heat." And now let us study the day-books of the Austrian provers of Aconite. Rothausl took tincture of Aconite in doses regularly increasing from six drops daily to fifteen drops daily for nine days, when, feeling powerful effects, he ceased taking it and noted his symptoms. From the second to the eighth day inclusive, he had the following constantly recurring symptoms: restlessness at night; bad dreams; unnatural heat of body; rawness and increased secretion in the larynx; cough; vertigo; head- ache. On the ninth day, after midnight, severe chill in paroxysms of shivering, starting from the praecordia, lasting two hours, followed by burning, dry heat, with frequent, feverish pulse; and this followed by moderate sweat. For the next six days he had various troublesome symp- toms affecting the chest and limbs, and on the sixteenth day of the proving he had again, at night, a febrile paroxysm consisting of chill, heat and sweat, the first less severe, the last more abundant than on the ninth day. On the seventeenth day, at night, a similar febrile par- oxysm. Then for seven days symptoms of increasing severity in the head and chest, ending with haemoptysis on the nineteenth day, and finally, on the twenty-fourth day, a very severe and well marked and defined neuralgic head and face ache. How can the ingenuity of the most ambitious lawgiver find a pretext for dividing the symptoms (especially the febrile symptoms) of this excellent proving into primary and 1 Mat. Med. Pura, 1st ed. 126 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS secondary ? A febrile paroxysm occurred on the ninth, the sixteenth and the seventeenth days; before it and after it were well-marked symptoms of the chest and extremities. Which shall be primary and which secondary if date of occurrence determine the question ? Which, if nature or if rank determine it ? Certainly, if lateness of occurrence stamp a symptom as secondary, then the neuralgic head and face ache, the very last symptom reported by Rothausl, must be classed as secondary. Not so fast, however! In the proving of Aconite by Zlatarovich with the second decimal, which he took in increasing and very large doses for seven days with- out effect, the very first symptom was a violent neuralgic head and face ache, almost identical with that described by Rothausl on his twenty-fourth day. It appears, then, that Rothausl's last symptom was Zla- tarovich's first. If the time of occurrence determines the class, we must rank Rothausl's headache among the second- ary, and Zlatarovich's identical headache among the primary, and thus we have the same symptom in each class, which is a reductio ad absurdum. It will be noticed that these identical symptoms, produced at different times in different provers of Aconite, were pro- duced by different doses. The opposite symptoms of Argen- tum nitricum in different provers resulted from different doses. Prof. T. F. Allen has shown how greatly the results of different doses vary. Dr. Sharp shows that, in the same prover, Aconite has four different kinds of action on the heart, as shown by the radial pulse, depending on the dose, and that in only two of these is one series of symptoms followed by an opposite series. Hahnemann, who, it must be remembered, had an immense experience as a drug-prover, and who brought to the work a devotion and powers of observation and analysis rarely equaled, was well aware of the fact that the appear- ance of apparently contradictory symptoms in a proving is AS GUIDES IN DETERMINING THE DOSE. 127 greatly dependent on the dose, as appears from § 66 of the Organon (4th ed.), in which, for this reason, he recommends the use of small doses in proving. Passing for a moment to the second division of the subject, the value of primary and secondary symptoms as guides in selecting the remedy, there are many drugs which, having certain constant characteristic symptoms, have also series of alternating symptoms relating chiefly to the secretions. Among them we may mention Veratrum album, which has (122-124) "Thin stool passing unnoticed with flatus. Fre- quent liquid stools. Liquid stools unnoticed with flatus. Diarrhoea of acrid fasces, etc." And also (127-139), " Con- stipation from thickness and hardness of faeces. A desire and compulsion to stool in the upper abdomen, and yet no stool, or a very difficult one, as if from inactivity of the rectum, and as if the rectum took no part in the peristaltic motion of the upper intestines." Also Hahnemann quotes from Greding, "Diarrhoea with copious sweat" and "long-con- tinued constipation." The efficacy of Veratrum in the treatment of diarrhoea of an appropriate character is universally conceded in our school. And in my own practice, Veratrum has for many years been a frequently used and highly valued remedy for constipation in persons of all ages, but especially in infants and young children, in whom digestion appearing to be well performed, the evacuation of faeces appears nevertheless to be impossible because of the inertia of the rectum—a fact demonstrated by the circumstance that a healthy stool can be procured almost at will by irritation of the rectum, as by the common practice of introducing into the anus a piece of soap or an oiled paper, or a rubber bougie. We have here the apparent anomaly of the same remedy equally efficacious in diarrhoea and constipation. Nux vomica furnishes a similar example. Its efficacy in certain forms of constipation as well as of dysenteric diar- rhoea is well known. 128 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS Let us now, for a moment, examine a little more closely the nature of the functions affecting which the alternate series of opposed conditions, which have been called primary and secondary, are mostly observed in drug-proving. 1st. They are such as in the nature of things are periodic, and not continuous; characterized by periods of repose and activity, and susceptible of quantitative and qualitative correlative interchange among themselves. Thus sleep is periodic, and capable of being supplemented to a degree by other forms of repose to the nervous system. The intestinal canal, the genito-urinary apparatus, the skin, in so far as secretion and excretion are concerned, have periods of activity and repose; and the inactivity of one may be made up by increased activity of another. And thus the function of any one of these apparatus may vary widely at different times without a condition of opposition being established. For this reason, then, the mere quantity of one of the excretions, or the degree in which any one of these periodic and convertible functions is performed, does not rank first among the indications on which the selection of a drug is to be based. If we now analyze the prescrip- tions of Veratrum and Nux vomica referred to, we shall find certain constant phenomena characterizing both the constipation and the diarrhoea, and which would determine the prescription almost without reference to the excretion. The Veratrum diarrhoea is uncontrolled and almost unno- ticed by the patient, liquid faeces escaping with the flatus. Here we have a paretic and anaesthetic state of the rectum and sphincter. The Veratrum constipation exists solely because the rectum does not perform its expulsive function, and is not, as normally it should be, irritated thereto by the presence of faeces. Here likewise is a paretic and anaesthetic condition. But Veratrum is not fully indicated in either case without the characteristic general symptoms: general depres- sion of vitality; predominant coldness of the body; pallor and cold sweat of the forehead, or of the whole body, on AS GUIDES IN DETERMINING THE DOSE. 129 slight emotion or exertion, as, for example, on having a diarrhceic stool, or making the ineffectual effort to have a stool, if constipated. Both the constipation and the diarrhoea of Nux vomica are characterized by increased but uncoordinated activity of the intestine, evinced by tormina and tenesmus, and fre- quent insufficient stools; so that the condition of intestinal action is the same, whether there be, as in one case a minus, and as in the other, a plus of excretion; and, indeed, in the Nux vomica patient these conditions often alternate. These remarks and instances will sufficiently illustrate my conclu- sions, viz.: That the appearance or non-appearance of opposed series among the symptoms of a drug depends chiefly, if not alto- gether, upon the dose in which the drug was proved; and that the question of the constant and necessary appearance of such series cannot be determined until experiments with a uniform and the least possible dose shall have been made by many provers with the same drug, and in the case of many drugs, and therefore that, 1st, Although in our Materia Medica, as it now exists, pathogeneses do present certain series of symptoms more or less opposed, nevertheless (excluding the symptoms of the agony which are not available in practice), inasmuch as these series of symptoms occur in different orders in different provers according to dose or idiosyncrasy, no sound practical distinction can be drawn between them, based on assumed difference of nature, by virtue of which they can be designated respectively as primary and secondary. 2d: That symptoms, apparently opposed (not including those of the agony), occurring in a drug-proving are equally available as guides in the selection of remedies. Coming now to the special subject of this paper, I justify the length at which the preliminary subjects have been dis- cussed by the suggestion that, if I have shown that there is no basis for a division of drug-symptoms into primary and 10 130 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS secondary, I have thereby shown the impossibility of a law of dose based on such a division. Or, if admitting that in pathogeneses there do appear groups of symptoms appar- ently opposed, I have shown that these refer only to certain functions, and by no means embrace, or could be made to include, the symptoms of the entire organism. I have thereby shown that an alleged law of dose based on the existence of these groups, must necessarily be partial, and therefore devoid of that generality of application to the entire pathogenesis which alone would justify the appellation "LAW;" and I claim to have shown these things. In 1844, Dr. C. Hering in a letter to the German Central Verein in session at Magdeburgh (N Archiv., 21, 3, 166) rejects Hahnemann's explanation of primary and secondary symptoms. He admits that there are in every proving primary and secondary symptoms, in the sense that some symptoms appear earlier and others later in the course of the proving, but affirms that although these may appear to be opposed to each other, they are all to be regarded as drug- symptoms, and as such are to be made the basis of prescrip- tions. He gives instances of such prescriptions in the cases of Conium, Opium, and Mercury. Indeed, he says that the longer-lasting, more permanent and more opposed to the earlier these later symptoms are, the more useful are they in practice. He says further, that "the course of the drug- disease (in proving) must correspond with that of the disease to be treated." Hering further states that "all symptoms which arise in provings of the higher potencies are similar to the later effects of the lower or so-called stronger doses, and are not like the first effects of strong doses." He adds that the great characteristics of remedies [as we have seen in the cases of Nux vomica, Veratrum, etc.] accompany both the earlier and later symptoms, e. g., the burning of Arsenic. From these considerations, Hering deduces the following law of dose: "Having chosen the remedy according to the symptoms of a case from the complete correspondence of the charac- AS GUIDES IN DETERMINING THE DOSE. 131 teristics in disease and drug, we have only to consider whether the symptoms of the case generally have more resemblance to the earlier (primary) symptoms of the drug, and then we give the lower potencies; or more resemblance to the later (secondary) effects, that is, to the symptoms produced by the higher-potency provings, and then we give the higher." It may be said that this is simply saying: Prescribe doses analogous to those which produced, in the proving, the symptoms presented by the case under treatment. But it amounts to a great deal more, for by showing that the symptoms produced in provings by small doses correspond with the later effects of large doses, it enables us to infer the effects of small doses in cases where provings have been conducted with large doses only. In i860, Dr. E. M. Hale published an elaborate article in the N. A. y. of H, vol. ix., on "The Dose," in which he expresses the belief that he has discovered the long-desired law by which "the proper dose for each case may be selected with as much certainty as the proper remedy," as follows: " In any case of disease we must select a remedy whose primary and secondary symptoms correspond with those of the malady to be treated," and " If the primary symptoms of a disease are present, and we are combating them with a remedy whose primary symptoms correspond, we must make the dose the smallest compatible with reason; and if we are treating the secondary symptoms of a malady with a remedy whose secondary symptoms correspond, we must use as large a dose as we can with safety." These propositions rest on the assumption that all drugs produce, and all diseases present, two series of symptoms, primary and secondary, and that in one or other of these classes is embraced every symptom of drug or disease. I have expressed my dissent from this view, and given reasons for thinking that a distinction between primary and second- 132 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS ary symptoms, if ever justifiable, is, at most, applicable to but a portion of the symptoms of each drug. It cannot, if I am correct, be made the basis of a general law. Dr. Hale illustrates his meaning by referring to Aconite, the primary symptoms of which, he says, " correspond perfectly with the chilly stage of all fevers," while the secondary symptoms of Aconite " correspond with the hot stage of fever." He therefore recommends a small dose of a dilution of Aconite during the chilly stage, and large doses of the tincture or ist decimal during the hot stage, and relates results of such treatment, which seem to have satisfied him, but would hardly have satisfied me. Again, he tells us that the primary symptoms of a group of remedies, of which Cinchona, Ferrum, Conium, Nux vomica, and Ignatia are members, are such as to denote that these drugs first " increase the tone and strength of the muscular or nervous system, impart vitality and vigor to the functions of the vital organs;" and that their secondary effects are to cause "a peculiar atony, a condition of deficient vitality, and a cachexia of a more or less obstinate character." And, stating further, that an outbreak of intermittent fever is always preceded by " an era of good feeling," a condition of exalted muscular and nervous tone and vigor, he regards this as the primary stage of that disease, to be treated, when recognized, therefore, by small doses of Cinchona. The outbreak of paroxysmal fever is regarded by Hale as belonging to the secondary series of symptoms, and therefore to be treated by as large doses of Cinchona as may safely be given. In a paper presented to this Institute in 1874, Dr. Hale reiterates these views in substance and re-affirms this alleged " law of dose." He illustrates the two alleged series of symptoms in disease, called primary and secondary, by the instance of inflammation of the urinary passages, in which congestion and arrested secretion with fever and pain appear first, and are succeeded by profuse secretion or suppuration, AS GUIDES IN DETERMINING THE DOSE. prostration and cessation of pain, etc. And he affirms that the group of cognate drugs, of which Cantharis may be the representative, presents similar series of primary and secondary symptoms. Considering, first of all, the last illustration, it is true that the process of inflammation consists of several successive steps, "accelerated and increased circulation, followed by retarded and diminished circulation, exudation of liquor sanguinis, emigration of leucocytes and stasis," and it is true that the earlier steps are prior to the later, but they are equally successive and necessary steps in a uniform and definite process, and nothing justifies the drawing a line anywhere in the process, and affirming that all that lies behind the line belongs to a different and opposite series to that which lies in front of it. Nor can I recognize in drug- provings any such opposed series. Neither Hahnemann's provings of Cinchona and Ferrum, nor Hahnemann's and Harley's proving of Conium, nor Hahnemann's provings of Nux vomica and Ignatia seem to me to support the alle- gations of Dr. Hale. Alluding now to Hale's remarks upon Aconite, I refer to my quotations of Hahnemann, Rothausl, Zlatarovich and Sharp, which show that Aconite does not produce a distinct chilly stage first, followed by continued heat, but, as Hahne- mann says, "alternating conditions made up of shiver- ing or cold and heat, and recurring frequently or at longer intervals." So that while I will not deny that Dr. Hale pre- scribed as he says he did, and with the results which he describes, I do affirm that the pathogenesis of Aconite affords no ground for the theory on which he says he acted, or which he deduced from his action. And, if I may deviate for an instant from the subject strictly under discussion, these statements about Aconite and its application suggest the fact that many prescriptions pro- fessedly homoeopathic are really made ex usu inmorbis, and are not based on a strict individualization of the case, and a 134 PRIMARY AND SECONDARY SYMPTOMS OF DRUGS selection of the drug whose symptoms correspond to it. Aconite, having early acquired a reputation as a remedy in febrile conditions, is too often given in routine fashion, " in all fevers " (to use Dr Hale's phrase), and therefore in many cases in which the symptoms do not at all indicate it. For, as even Hahnemann warned us, "it is not in every case presenting febrile symptoms that Aconite is homceopathically indicated;" and therefore it cannot truly be said to corre- spond to the "chilly" or any other "stage of all fevers." Given when the patient is quiet, lies still, is tranquil in mind and hopeful or patient, it will not remove the symptoms as a homceopathically selected remedy would do. Nor is it indicated by a similarity of symptoms in any save a small minority, if in any, of the intermittent, remittent or con- tinued fevers which so often prevail in different parts of our country, nor in the febrile condition which persists when parenchymatous inflammation is established in any important organ. It was my purpose to follow and analyze the statements and arguments of this writer on this important subject, but I find that I cannot do so. His premises consist of citations from allopathic writers, which seem to me to be statements based on observations of the action of drugs in large doses on the sick, and on theoretical deductions from these obser- vations, and which certainly bear little or no resemblance to the pathogeneses of the Materia Medica Pura, on which I have been wont to rely for a knowledge of drug-effects, but to which my colleague rarely refers. His allusions to treat- ment seem to me to be of a very generic character, based on assumptions of the pathological nature of the disease in question, and consisting of an application of drugs according to a vague and general resemblance of assumed pathological conditions. In all of this I fail to see any allusion to, or any place for, the strict individualization of cases, which is the very essence of sound homoeopathic treatment. In studying these papers, in fact, I hardly realize that I am perusing the AS GUIDES IN DETERMINING THE DOSE. 135 works of a practical homceopathist, according to my concep- tion of Hahnemann's idea of homoeopathic practice, and I perceive, to my dismay, that I do not stand on common ground with the author to the extent necessary to make possible a further discussion of his treatment of the question at issue. I must content myself, therefore, with the simple state- ment that my own observation and experience do not enable me to corroborate Dr. Hale's statement of the " Law of the Dose," based on the distinction of primary and secondary symptoms. Where Aconite has been truly indicated by the symptoms of the case, I have seen prompt relief follow the administration of a high potency, given when the patient was in the hot stage, and likewise when in the chilly stage; and in both the effect has appeared in a much shorter time than Dr. Hale's remarks would lead one to anticipate. In the treatment both of constipation and of dysenteric diarrhoea by Nux vomica in cases in which the characteristics of Nux vomica were present, the higher potencies have been equally efficient, leaving nothing to be desired, and the same may be said of Veratrum album in diarrhoea and in consti- pation, when the characteristics of that drug were present. It may be, and I am inclined to believe, that the law pro- posed by Dr. Hering may be found to represent the facts; but for its demonstration and its general application in practice, we need a much more complete Materia Medica than has yet been furnished us. In conclusion of this branch of the subject, I think that no law for the determination of the dose can be deduced from the relation of opposition or contrariety on the basis of which symptoms have been divided into series of primary and secondary. THE DOSE IN DRUG-PROVING. The symptoms which drugs produce upon the healthy organism vary according to the dose. They may be: i. CHEMICAL—depending on the chemical affinity which exists between the drug and the tissues of the body, and independent of vitality ; or, 2. MECHANICAL (or revolutionary), consisting chiefly in violent efforts on the part of the organism to eject from its cavities the offending substance; or, 3. Dynamic, contingent upon vitality and resulting from the relations of the peculiar properties of the drug to the susceptibilities of the living, healthy organism. These dynamic effects may be: A. Generic—such as are common to all the members of a certain class of drugs and which serve to distinguish this class from others, but do not furnish means of distinguishing between different individuals of the same class. For example, Arsenic in certain doses produces vomiting and diarrhoea, with cold sweat and cramps of the extremities. These are dynamic effects of Arsenic but they are generic, since other members of the class to which Arsenic belongs! viz.: Cuprum, Veratrum, Tartar emetic, etc., in certain doses, produce identical symptoms; and were these reme- dies proved in such doses alone, it would be impossible to distinguish the pathogenesis of one of them from that of any of the others. B. Specific—such as results from the dynamic action of the drug and are peculiar to it. They serve to distinguish a given drug from all others. For example, Arsenic, taken THE DOSE IN DRUG-PROVING. *37 in different doses from those which produce the generic dynamic effects, produces vomiting and diarrhoea or ten- dencies thereto ; but these phenomena are accompanied and characterized by conditions quite different from those which accompany the similar symptoms of Cuprum, Veratrum, etc., and are thus distinguishable from the effects of these drugs. The Specific-dynamic symptoms maybe again sub-divided into Central and Peripheral. The Central symptoms appear speedily after the drug is taken, are generally the result of comparatively large doses and, in the case of many drugs, are confined to the aliment- ary canal and to the organs immediately connected with it. The Peripheral symptoms appear more tardily, are gen- erally the result of comparatively small doses, taken repeat- edly or allowed to act without interruption for a long period, and appear in the bones, skin, glands, etc., and in the coordinated phenomena of life. They are often the mani- festations of a dyscrasia or cachexy. Doses which produce central symptoms do not generally produce the peripheral (or at least not until after a long period has elapsed) and vice versa. For example, Mercury, in certain doses, pro- duces well-marked and characteristic action upon the aliment- ary canal and its appendages. In smaller doses it produces, instead of these effects, a series of symptoms in the skin, bones, glands, etc.—the Mercurial cachexy. The former are what we mean by central specific dynamic symptoms. The latter are the peripheral symptoms. Arsenic, again, furnishes, according to the dose, examples of all of the above varieties of symptoms. In certain doses it develops chemical and revolutionary effects. In smaller doses, as we have seen, generic dynamic; in still smaller doses, specific dynamic symptoms of the central variety. In yet smaller doses, it produces peripheral specific symptoms, which are those of the so-called "gradual poisoning;" as for instance in poisoning by exhalations of Arsenic from green wall- paper, in which the phenomena of vomiting and diarrhoea 138 THE DOSE IN DRUG-PROVING. or the central specific symptoms do not appear, but instead of these we have evidence of a distinct cachexy, in the skin and glandular symptoms, marasmus, etc. Such are the varieties of symptoms produced by corre- sponding varieties in the dose. It is hardly necessary to say that they are not always to be distinguished with precision; but the facility with which we are able to recognize them is in proportion to the completeness of our proving. It unquestionably behooves the homoeopathic physician to have an exhaustive knowledge of the whole sphere of action of his drugs; but, as a prescriber, he must be familiar with the varieties and subvarieties of dynamic effects which we have specified. This knowledge is to be attained in the first place only by drug-proving. The proving of drugs must then be so conducted as to produce in the greatest possible completeness and clearness, each of these varieties and sub- varieties. This, as has been shown, is to be accomplished by a skillful selection and succession of doses. It is not so simple and easy a matter as it might at first view appear to be : for, First: The doses by which the corresponding varieties of symptoms are produced, differ widely in different drugs. For example, a half grain of crude Nitrate of silver or of Sul- phuric acid produces chemical symptoms, while a half grain of Lycopodium or of Silicea produces probably no symptom at all. A grain of Arsenic produces generic dynamic symp- toms, while ten grains of Natrum muriaticum may be inert. Forty drops of Bryonia tincture may excite a fair show of specific dynamic symptoms, while forty drops of tincture of Opium will produce generic dynamic symptoms or full narcotism. Secondly: The susceptibility of different provers to the same drug is very different, and the degree of susceptibility which each prover possesses is to be learned only by exper- iment. For example, one prover will take five hundred drops of Thuja without any effect; another, taking twenty drops, experiences violent specific symptoms. THE DOSE IN DRUG-PROVING. 139 Thirdly : The susceptibility of provers to different prepa- rations of the same drug is very various and apparently capri- cious. One records characteristic specific symptoms from large doses of the crude drug, and is not affected by smaller doses; another is acted on by dilutions and not by any quan- tity of the crude substance. The relative power of a drug and susceptibility of the prover being altogether unknown until ascertained by direct experiment, the proving of a new drug is therefore a matter of pure experiment in every particular, and it might at first view be supposed to be a matter of indifference in what man- ner or with what doses the experiment is begun; which vari- ety or subvariety of symptoms is first developed, whether we take heroic doses and develop chemical symptoms or small doses and produce peripheral dynamic symptoms; since in either case we should be able by subsequent experiments based on the first, to develop the complementary symptoms and thus complete our proving. Experience teaches, however, that this supposition is not sound, and for the following rea- sons : Drugs vary not more in the intensity than in the per- manence of their action upon the organism. Some drugs appear speedily to exhaust, sometimes by a single large dose, the susceptibility of the prover, so that no subsequent doses, whether large or small, produce any effect. Of others again, a single large dose develops some one generic or central spe- cific symptom, and along with it induces such an exalted and distorted susceptibility that every subsequent dose, whether large or small, evokes straightway that one symptom or series of symptoms and none other. Thus the proving is in either case partial and incomplete—we fail to get those symp- toms which are the most valuable of all to us, as being those which clearly characterize the drug and enable us to distin- guish it from all other drugs, viz.:—the peripheral and central specific dynamic symptoms. To illustrate this point,—it is well known that Mercury given in such doses as to produce cen- tral specific symptoms, induces often so great a susceptibility I40 THE DOSE IN DRUG-PROVING. of the organism to the action of this drug that subsequent doses, even of tolerably high dilutions, provoke straight- way a series of central symptoms. The same is true of Ar- senic. We have seen a case in which, generic and specific symptoms having once been produced by massive doses of Tartar emetic, the organism remained so sensitive to the action of this substance, that a few globules of the thirtieth dilution would at any time produce vomiting and diarrhoea, with cold sweat and prostration. It may be said that these are cases of very unusually great susceptibility to the action of the respective drugs. This is true, but it is precisely such cases of great susceptibility that are of exceeding value to us, for in them, by judicious experimentation, we could get most valuable peripheral symptoms, unalloyed by generic or by revolutionary effects. There is no reason to believe, on the other hand, that small doses, so administered as to produce the peripheral specific symptoms, modify the susceptibility of the prover in any such way as to prevent his obtaining by subsequent larger doses the central specific, the generic dynamic, or even the chemical and mechanical effects. It follows from what has been said, that to obtain an exhaustive proving of a drug, we should begin with small doses, gradually increas- ing the quantity until unequivocal symptoms appear. We shall thus, if we continue our experiments a suitable length of time, obtain peripheral symptoms; and these small doses will not have so influenced the system as to prevent our obtaining by subsequent larger doses the other varieties of effects. Inasmuch as, in the nature of things, the peripheral symptoms, representing, as they do, a cachexy, cannot be speedily produced, a considerable space of time should be devoted to our first experiments with small doses. Finally, after an interval of non-medication, larger doses should be taken until we have exhausted the whole dynamic action of the drug, and even obtained a fair picture of its chemical and revolutionary action, although this may in a measure be gained from records of poisonings. THE DOSE IN DRUG-PROVING. 141 But, in this relation, what are the "small doses" with which we are to begin our proving ? The term is compara- tive. Are they drop doses of the tinctures, or are they high dilutions ? They are such doses as have, in the proving of some previous drug, shown themselves capable of produc- ing unequivocal symptoms. We must search the records of provings, therefore, for our standard initial dose. What this is at present we shall soon see: as our experience increases, this standard may from time to time be altered. It is evident that the method of conducting a proving is a matter of great importance, and should not be left to caprice or accident. The completeness of our Materia Medica, and consequently our ability to cure disease, depend upon our selection of a happy method. This important subject has received the attention of the American Institute of Homoeop- athy, to which the Central Bureau of Materia Medica has presented a report on Drug-Provings. The majority of the Bureau repeat Hahnemann's directions for proving as contained in the Organon; and as regards the dose, they recommend " the prover who makes use of potencies" to make a trial of the high potencies first, and afterward, if necessary, to take the lower dilutions and triturations, or the crude substance or tincture, if satisfactory results are not obtained with the attenuations. This recommendation accords with our deductions and corresponds with the spirit of Hahnemann's directions. Hahnemann's instructions differed at different periods of his life. One essential idea, however, pervades them all—a small dose is to be taken at first, and the dose is to be increased until unequivocal symptoms manifest themselves. In the last edition of the Organon he adds, as the result of his extensive observation, that "The most recent experience has taught that medicinal substances, when taken in the crude state, do not for a long time display the full extent of their virtues, as they do when taken in higher developments. Thus any one, even of those medicines whose virtues are I42 THE DOSE IN DRUG-PROVING. considered weakest, is now found to be most advantageously studied if four to six globules of the thirtieth dilution be taken every morning for several days." In this statement, Hahnemann does not contradict the spirit of his former directions, for he adds, "Should the effects of such a dose be weak, it may be daily increased." He further adds, "The more moderate the dose, the more are the primitive effects developed, which are the most important to be known." We see nothing in Hahnemann's writings which shows that he ever thought of restricting the dose in proving to the thirtieth dilution, as some have stated; he simply assures us that unless provings with so high a dilution were made, the prover would fail to get all of the symptoms which the drug is capable of evolving. In the Minority report of the Central Bureau,1 Dr. Hempel differs from the majority in so far as the proving with dilutions is concerned. He would propose that " all such provings should be rejected rather than encouraged;" and he " is convinced in his deepest soul, that it is owing to the incorporation of such provings in our Materia Medica that all the confusion and uncertainties with which it is now tainted, are presenting immense and almost insufferable difficulties to the inexperienced student of our science." We trust that it is unnecessary to say that in commenting freely, as we shall do, on Dr. Hempel's report, we are actuated by no unworthy feeling toward our colleague, whose unceasing and very arduous labors in the cause of Homoeopathy command our highest respect, and deserve the grateful recognition of every English and American Homoeopath. We speak of him only because, by his report, he stands forth as the representative of certain opinions, which seem to us unsound and unsupported by the evidence on which they are supposed to rest. His report may be reduced to the following propositions: i. Drugs should not be proved with attenuated sub- stances. 1 Am. Horn. Review, vol. i., p. 575. THE DOSE IN DRUG-PROVING. 143 2. The middle and higher potencies do not produce reliable symptoms, unless the system has been previously saturated with massive doses of the original drug. Corol- lary : the saturation of the system by massive doses of a drug renders it susceptible to the action of the middle and higher potencies. 3. In exceptional cases a peculiar idiosyncrasy may enable the organism to develop symptoms from the higher potencies; but " it is unreliable to commence the proving with these potencies." The sequence of this conclusion is not very clear. We suppose Dr. Hempel to mean that symptoms developed, where an idiosyncratic susceptibility to drug-action exists, are not so reliable as those developed where there is no idiosyncrasy. It is much to Dr. Hempel's credit that he has not left these propositions to stand in his report as bare unsupported assertions. Recognizing the experimental nature of the question, he has referred for corroboration of his views to the experience of those who have made our provings, and has called to the witness-stand the great body of our drug- provers in the following terms: "All the splendid provings of the original provers of the Materia Medica, and of the Austrian Provers' Union, of the Provers' Society of Prague, and of any other Provers' Society, whose provings are accepted with universal acclaim and confidence, have been instituted with massive doses of the strongest preparations of the drug; the higher and middle potencies were invariably tried after the former." If this statement were literally correct, if, indeed, none of these provers ever began their provings with potencies, then they are incompetent witnesses for Dr. Hempel's purpose—they are incapable of testifying as to the action of dilutions when not preceded by massive doses, since, Dr. Hempel says, they never tried them. If this were so, then the second proposition of Dr. Hempel's report would rest unsupported save by the one witness whom, we neglected to say, Dr. Hempel cites, first of all, in 144 THE DOSE IN DRUG-PROVING. these words: " Dr. Hempel has never been able to elicit any reliable symptoms by means of the middle or higher potencies, unless the organism had been previously saturated with massive doses of the original drug." On' this one point of negative evidence, then, this important proposition stands—"Dr. Hempel has never been able." But perhaps others have been able. Perhaps the very witnesses whom Dr. Hempel has called have been more successful than he. We will cross-examine them. First, then, we call upon the " Original Provers of the Materia Medica," by which we suppose Dr. Hempel means Hahnemann's " Materia Medica Pura" and " Chronische Krankheiten." Of these provers, the " Great Original" was Hahnemann himself. His pupils and friends adhered strictly to his directions and method. What Hahnemann's opinion was as to the propriety of commencing a proving with small doses we have already seen. After thirty-five years' experience in drug-proving, he sums up his observa- tions in the advice to begin with the thirtieth dilution. But what was his practice ? What doses did he actually take ? It has been generally supposed that he did not as a rule record the doses with which his provings were made. Dr. Hempel, however, seems to have had access to some sources of knowledge on the subject that are not open to the general reader, for he tells us without qualification, that "all the splendid provings of the original provers of the Materia Medica were made with massive doses of the strongest prepa- rations, etc." Those who have not enjoyed these unusual means of information, gather from a few observations, scat- tered through Hahnemann's writings, the following facts : Silver was proved by Hahnemann in the first trituration. The Nitrate of Silver, of which he gives a few symptoms, in the fifteenth dilution. Carbo vegetabilis was proved in the third trituration. In a letter in the Neues Archiv. (1813), he directs Stapf to prove Helleborus thus: "Add a drop of the tincture to eight ounces of water and one drachm of THE DOSE IN DRUG-PROVING. H5 alcohol; shake well, and take an ounce every hour and a half or two hours until some decided effects are produced." And camphor, thus : " Dissolve two grains in a drachm of alcohol; shake this well with eight ounces of water, and take in from four to six doses during the day." In the first publication of the proving of Natrum muriat- icum (1830), Hahnemann tells us that a great part at least of this proving was made with the thirtieth dilution, and he adds, that " it is only in such a highly potenized form that this and all other drugs display the whole of their power to alter the condition of the organism." This was Hahnemann's conclusion after thirty years of active experience in drug- proving. As a voucher he gives us the proving of Natrum muriaticum, the value of which is attested by the clinical experience of the last thirty years, and confirmed as we shall see by the Austrian re-proving. In the same volume of the Chronische Krankheiten, Hahnemann published the proving of Kali carbonicum, and large additions to the previously published provings of Carbo vegetabilis, Causti- cum, Conium and Sulphur. It is but reasonable to con- clude that the symptoms of Kali carbonicum, and many at least of those of the other drugs above named, were produced by the thirtieth dilution as well as those of Natrum muriaticum. In view of these facts, it is hardly correct to say, as Dr. Hempel does, that " all the provings of the original provers of our Materia Medica were made with massive doses of the strongest preparations, etc." Second, we call upon the Austrian Provers' Union. This society conducted in the years 1842 to 1848, a series of re-provings of certain of the drugs proved by Hahnemann, in the hope of discovering the pathological connection of the symptoms which in Hahnemann's scheme are disconnected. Conceiving also that some of Hahnemann's symptoms were vague, because produced, as they supposed, by small doses, they pushed their provings with massive doses, in many 11 146 THE DOSE IN DRUG-PROVING. cases to extreme poisoning. With these views we could hardly expect from them much testimony, either positive or negative, on the subject of proving with potencies; but, in that which they do furnish, we should expect them to be unfavorable witnesses for our views, since their proclivities are almost uniformly against the use of potencies in proving or in therapeutics. Dr. Hempel says, " All these splendid provings, etc., were instituted with massive doses; the middle and higher potencies were invariably tried after the former." Let us examine the records. In the proving of Aconite, sixteen provers made in all thirty-seven experiments. Six of these were made with dilutions from the first to the twelfth centesimal, and symptoms were observed in all but one. In five of these cases, large doses of the tincture had been taken before the dilution. In one case the prover began with the first cen- tesimal dilution and got symptoms. In the proving of Bryonia, fourteen provers made twenty- nine experiments, of which ten were with dilutions from the first decimal to the 203d. In two of these, the provers began with the dilutions, viz. : with the tenth and the thirti- eth, and got in one case very graphic symptoms ; in the other, symptoms unequivocal though less numerous. In the cases in which dilutions were used after massive doses of the tincture had been taken, considerable intervals were allowed to elapse after the last symptoms from the tincture- proving disappeared before the dilutions were taken, e. g., forty-one days before the 203d dilution was taken, and yet this dilution appears to have produced decided symptoms. It is true that the propriety of ascribing these symptoms to the Bryonia is called in question by the Editor of the Austrian Journal, but with scarcely sufficient grounds, since a subsequent proving with the 203 d dilution evoked them again. Here, then, in the only two cases in which dilutions were taken before the tincture, symptoms were obtained (while in one case in which they were taken after the THE DOSE IN DRUG-PROVING. 147 tincture, no symptoms were observed, shows that the corollary to proposition No. 2 is at least not universally true). In the proving of Silver we find that the drug was taken by one prover each in the first, second, and third triturations, and in the fourth, fifth, and sixth dilutions, and valuable symptoms were obtained by each. The Editor calls atten- tion to the great correspondence between these symptoms and those of Hahnemann, obtained, as we know, from the first trituration. In the proving of Nitrate of Silver, the Editor remarks: " Between the experiments a sufficient time elapsed to insure against the effects of one experiment being compli- cated by those of a preceding one, two years being con- sumed in the proving." The proving was begun with the first decimal trituration, and subsequently in succession the second, sixth, and thirtieth dilutions were used. The effect of each dose was allowed to expend itself before a new experiment was instituted ; symptoms clear and character- istic, and covering a period of six to nine days, were obtained from a single dose of the thirtieth dilution. Here, it is true, the dilutions were preceded by low triturations, yet the Austrian provers were of opinion that in these cases the lower preparations did not influence the susceptibility of the system to the higher potencies. In proving Kali bichromicum, in only two cases was a dilution higher than the third employed. In both of these the twelfth was used and symptoms were obtained. In one, that of Dr. Wachtl, the symptoms from a single dose give a com- plete picture of the subjective and objective effects of this drug in the pharynx and neighboring organs. In neither of these cases had the drug been previously taken in massive doses. In the proving of Colocynth, fifteen provers made twenty- five experiments. Ten were made with dilutions, and in nine, symptoms were obtained. In three of these, the third dilution was used and no other preparation of Colocynth had previously been taken. 148 THE DOSE IN DRUG-PROVING. In proving Thuja, twenty-three provers made fifty-nine experiments. Seventeen were made with dilutions, and, in thirteen, unequivocal symptoms followed. Nine began their provings with dilutions and got symptoms. Four began their provings with dilutions and got no symptoms. But, on the other hand, seven conducted their provings with massive doses of the tincture without obtaining any unequivocal symptoms. It is evident, then, that negative testimony on this subject is of little value. In proving Cochineal, four provers began their experi- ments with the hundredth dilution, one with the sixtieth and one with the thirtieth dilution, and all got valuable symptoms. One prover, on the other hand, began with the 200th dilution and gradually descended, getting no symptoms until he took massive doses. In the proving of Natrum muriaticum, thirty-nine provers took part. Fourteen began with dilutions varying from the sixth to thirtieth,—the majority beginning with the thirtieth, —twelve obtained symptoms of which some are of great value, lasting and recurring for many days after the last dose. Thus, in twelve cases out of thirty-nine, dilutions were taken before " the system was saturated with massive doses of the strongest preparations, etc.," instead of dilutions being " in- variably tried after" such massive doses. We may remark that in every case in which we ascribed symptoms to the dilutions, except the case of the 203d of Bryonia, they have been so admitted by the Austrian prov- ers themselves. In conclusion, we may observe that with Natrum muriati- cum the record of the Austrian provings closes. In his con- cluding remarks on that drug, Dr. Watzke uses the following language: "lam—alas! — I say, alas ! for I would much rather have upheld the larger doses which accord with current views—I am compelled to declare myself for the higher dilutions. The physiological experiments made with Natrum muriaticum, as well as the great majority of the clinical THE DOSE IN DRUG-PROVING. 149 results attained therewith, speak decisively and distinctly for these preparations. Several of our most cautious provers have obtained unquestionable characteristic Natrum muriati- cum symptoms from them." It is remarkable that as Hah- nemann was evidently led by experience to recommend that in drug-provings dilutions should be used as well as crude preparations, in like manner, the Austrian prover should, as the result of his experience, express himself as above. Watzke further remarks :l " I am very far from regarding a stormy method of proving as the only proper and useful one, and I recognize the conditions of an all-sided knowledge of the remedy, in the free, unrestrained method we have adopted; experiments being made with large, small, and smallest doses according to the disposition, judgment and good pleasure of the prover." And again, in reply to a critic, " My friend says, ' /have proved all my remedies in strong and some in the strongest doses; with many I have also made provings with the higher, even with the thirtieth dilution' — Have /then done otherwise ?" In a recent number of the Allg. Zeitung, it is stated that a member of the Old Austrian Provers' Union has begun to prove Quassia amara with the thirtieth dilution, and has obtained valuable symptoms. Experto crede. In view of these facts, we think Dr. Hempel is hardly cor- rect in stating that "all the provings of the Austrian Provers' Union were made with massive doses, etc.— the middle and higher potencies being invariably tried after the massive doses." The records of the Austrian Union not only prove that dilutions may evoke trustworthy symptoms in a majority of the cases in which they are employed, but they also give us the means of forming a judgment on the propositions which form the substance of Dr. Hempel's report. 1. "Drugs should not be proved with attenuations."— Mow, since it has been shown that attenuations produce Oest. Zeilschrift, vol. iii., p. 64, note. 150 THE DOSE IN DRUG-PROVING. reliable and valuable symptoms, we submit that they should be used and for these reasons: (a.) Because attenuations have produced symptoms which have not also been produced by massive doses, and which have been confirmed by clinical experience. In the proving of Natrum muriaticum, the only distinct picture of periodic fever was induced in Dr. Wurmb while proving the thirtieth and twenty-fifth dilutions. Dr. Schreter, proving the thirti- eth, got symptoms which no prover with massive doses pre- sents. In the proving of Thuja, certain symptoms affecting the vision were produced in Dr. Huber by the sixtieth dilu- tion, and in Prof. Zlatarovich by the twelfth, which no other provers have recorded. In the proving of Colocynth, the third dilution produced symptoms not recorded by any prover who took massive doses, and yet corroborated by a second prover with the third. (b.) Because some provers are susceptible to the action of dilutions or small doses, and not to that of massive doses of the crude substance. For instance, Dr. Wurmb got decided and persistent symptoms from dilutions (thirtieth to sixth) of Natrum muriaticum. From lower dilutions and from the crude substance, even in half-ounce doses and repeated frequently, he got no symptoms. Was this because his system was saturated ? We think not; for on recurring to the dilutions, he again got symptoms as at first. Now, had the provings been confined to the crude substance, we should not have Dr. Wurmb's proving of Natrum muriati- cum, the most complete and reliable single experiment that we possess, and which we could hardly consent to give up, notwithstanding Dr. Hempel's opinion that " potency-prov- ings should rather be rejected than encouraged." The same thing is observed in the provings of Aconite, Thuja and Colocynth. 2. " Potencies do not produce reliable symptoms unless the system has been previously saturated with massive doses of the crude substance; and, Corollary, massive doses THE DOSE IN DRUG-PROVING. 151 render the system susceptible to the action of smaller quan- tities." We have shown that in repeated instances, symptoms which Hahnemann and the Austrian provers regarded as " reliable" have resulted from potencies not preceded by massive doses—symptoms confirmed by other provings and by clinical experience. On what grounds does Dr. Hempel question their reliability ? Again, we have no conclusive evidence that massive doses, as a rule, render the system more sensitive to small doses. In some cases they appear to do so. In others they have the opposite effect. In the records, we find the utmost variety as regards the susceptibility of provers to various doses. Some, like Dr. Wurmb, are susceptible to dilutions alone of a given drug, others to massive doses alone. Many obtain symptoms at first from comparatively small doses of the crude substance, but find it necessary to steadily increase the dose, until finally, after taking in some cases several hundred drops or grains, they get no symptoms at all from any preparation. This looks like a blunting of the suscepti- bility rather than an exaltation. We are not always justi- fied in assuming that, where dilutions were taken after massive doses, the symptoms were due to the massive doses and not to the dilutions. In the majority of these cases a sufficient period elapsed between the experiments to prevent all possibility of the one complicating the other. In a few cases no such period elapsed, and in these it may be that the symptoms ascribed to the dilutions were really due to the previous massive doses, yet even in these cases we cannot be certain of this; for in one of them, that of Prof. Zlataro- vich, who, after taking in the aggregate several thousand drops of the Thuja-tincture, changed without delay to the twelfth dilution, a symptom was observed which had not occurred to him or to any one else while proving the tincture, but only to Huber while taking the sixtieth. In conclusion, we see in the Austrian records more reason 152 THE DOSE IN DRUG-PROVING. to suppose that massive doses, as a rule, blunt than that they exalt the susceptibility, although in some cases they unquestionably have the latter effect. As these cases cannot be recognized in advance, it is clear that in the case of an individual drug or prover, nothing positive on this head can be assumed as a basis on which to plan a proving. 3. It is said that "idiosyncrasy" determines the action of potencies, and that provings having this origin are not reliable. The word " idiosyncrasy " is used in two senses. Properly, it signifies an abnormal sensibility to drug-action; or such a relation to a special drug as that the drug produces in the prover symptoms that occur to no other prover, and which bear no analogy at all to the symptoms which others experi- ence. Such symptoms as these must always be regarded as suspicious until verified by clinical experience. Such an idiosyncrasy is exemplified by persons who have "hay asthma," "rose catarrh," etc. But, as most frequently employed, the word " idiosyn- crasy" is synonymous with "susceptibility," implying an unusually acute, but not abnormal, sensibility to the action of the drug, and a prover who shows a marked susceptibility to the action of a drug is said to have an idiosyncrasy which favors its action. This susceptibility is similar to that which individuals exhibit for natural diseases—some being prone to one kind of disease, others to another, just as one prover is especially susceptible to Thuja, another to Aconite. Now, what pathologist would think of objecting to a case of pneumonia that it was not a reliable picture of the disease, because it could be shown that the patient had a great susceptibility to the disease, and took it on the slightest provocation ? A certain susceptibility to the action of a drug is absolutely necessary to a good proving. Hahne- mann speaks of it in his Organon as a necessary condition. What the Austrian provers think on the subject may be gathered from the following remarks of Watzke (Dr. THE DOSE IN DRUG-PROVING. 153 Wurmb proved Thuja five times,—four times in massive doses and once in dilutions; result very meager): "We may observe that the proving of a drug is not so easy an affair as it seems to be. The individuality of the prover as well as of the drug plays here so important a part, that a successful proving is often an entirely accidental piece of good fortune of the susceptible prover, while the boldest, but unsusceptible prover, with the best good-will and the greatest devotion may obtain only a scanty and one-sided result." This susceptibility may be to the drug in general or to particular preparations of it. Wurmb was acted on only by dilutions of Natrum muriaticum. Watzke only by immense doses of the crude substance. Watzke was sensitive to very small doses of Thuja, while Wurmb and Reisinger were almost insensible to every preparation of it. Obviously, then, a prover's susceptibility varies with the drug and with the preparations, and can be learned only by experiment with all preparations. From the general tenor of Dr. Hempel's report, one might infer that while the middle and higher potencies produce symptoms only in very exceptional cases, massive doses of the strongest preparations act always. The records of the Austrian provings hardly warrant such an assumption. Of the thirty-one experiments made with tincture of Aconite, six were not followed by any trustworthy symptoms. Of the thirty-six made with large doses of tincture of Thuja, seven were without result. Of fourteen made with large doses of crude Colocynth, one was without result. Of the fifteen provers of Byronia, one at least took very large doses of the tincture without observing any symptoms. Several who took large doses of crude Natrum muriaticum were insensible to its action. It is obvious, then, that the development of symptoms is not of necessity copious and satisfactory in the ratio of the dose. The Austrian records abound in editorial remarks, intimating that provers have 154 THE DOSE IN DRUG-PROVING. defeated their object by taking too large doses, and by repeating the dose too frequently. We have seen, then, that potency-provings may be trust- worthy and that they are indispensable to a complete and exhaustive proving. It is to be observed that even the few Austrian potency-provings which we have, were not, gener- ally, conducted in such a way as to demonstrate the full value of such experiments. In very many cases, only a few days were allowed for the development of symptoms before a larger dose was taken. In the few cases in which a different course was pursued, as in Wurmb's proving of Natrum muriaticum, clear and persistent and most valuable series of symptoms were obtained. In order to obtain a perfect proving, the prover should ever bear in mind certain fallacies to which he is liable. These fallacies differ according to the dose which he is employing; they are equal for either extreme of dose. If he use the higher dilutions, he is in great danger of confounding " imaginary" symptoms with real subjective drug symptoms. If he employ massive doses, he is in equal danger of including in his record chemical and mechanical symptoms. Either error is a source of confusion and uncertainty, but he is greatly mistaken who thinks to avoid introducing confusion and uncertainty into the Materia Medica by simply rejecting potency-provings. They can be avoided only by the constant analysis of the symptoms (whether produced with potencies or with large doses), by frequent repetitions of the provings on one's self and others, and by clinical verifications of the symptoms. The Austrian records give an example of the latter fallacy. The symptoms are so intermingled with chemical and revolu- tionary effects, that one cannot use too great caution in basing a prescription upon them. In conclusion, we may assume the following points to be established by induction and by direct experience: THE DOSE IN DRUG-PROVING. 155 In order to obtain an exhaustive proving: I. We must prove the drug both in dilutions and in massive doses. 2. The proving should be commenced with dilutions; and high dilutions should be employed until satisfactory evidence is obtained that the prover is not susceptible to their action. We thus obtain one of the unknown quantities of our problem, viz., the measure of the susceptibility of the prover. 3. Where a keen susceptibility is found to exist, the greatest care must be exercised to avoid blunting or pervert- ing it. With this view, repeated experiments should be made at long intervals, with high potencies, until no new varieties of symptoms are evoked. Then, after a long period of non-medication, the prover should take lower potencies and then small doses of the crude substance repeated at intervals, and finally after another long period of repose, large doses of crude substance. A thorough proving after this fashion may require years for its completion—but it will have an advantage over most of our recent provings, in the fact that it will be thorough, and that it will be of permanent and certain use to the practitioner. 4. In proving with dilutions, as well as with massive doses, a long period of time should be occupied in testing each preparation, in order that the full effect may be seen in the production of dyscrasias, etc. 5. The greatest care should be exercised in verifying symptoms by repeated experiments, in order that "imagi- nary " symptoms on the one hand and chemical and mechanical symptoms on the other may be excluded. The fashion, which has become very prevalent of late, of including in the pathogenesis every sensation which occurs during the proving, without distinction or verification—and which may be called the Pre-Raphaelite method of proving— cannot be too strongly rebuked. ALTERNATION OF REMEDIES. No. I. The following remarks upon the interesting, but, in our judgment, unsound paper on this subject by Dr. J. R. Coxe, jr., published in the February number of the current volume of the American Homoeopathic Review,1 may serve at least, it is hoped, to call attention to this very important approach to Polypharmacy in the customary method of prescribing, and, perhaps, to stimulate a discussion of its necessity and propriety. In admitting that the alternation of remedies is incompat- ible with the theory of a true homoeopathic prescription, our colleague has granted all that the opponents of alternation could reasonably ask. That our practice has not yet come up to our theory, and that we are not yet fully possessed of the means and knowledge to bring it up to that degree of perfection, and that therefore some prescribers may feel con- strained sometimes to alternate remedies, as it were under protest, may not be denied. But to urge that because our practice lags thus behind our theory, we are to rest satisfied with it, nay, to defend it and to conform our theory to it, is a position that would be fatal to all progress, and which we cannot think of conceding. Nor is the appeal to experie7ice in the sense in which our colleague uses it valid. He "has alternated remedies in a practice of twenty-five years, and his practice has been generally successful." We do not doubt this. But we believe his respected father practiced allopathy for a much longer period, and was a successful practitioner; would this fact be a valid argument in favor of allopathy ? 1 Vol. iii.f 1863. alternation of remedies, no. i. 157 Alternation and succession of remedies are not generally understood to be identical processes. By alternation, we think, practitioners generally understand the prescription, at one and the same time, of two or more remedies to follow each other at short intervals, the symptoms of these remedies taken altogether being thought to cover the symptoms of the case more completely than those of either remedy alone would do. The prescription is the result of one single examination of the patient and of one single comparison of the symptoms with the Materia Medica. But when a succession of remedies is given, in either an acute or a chronic disease, the understanding is, that the first remedy, having been carefully selected, is allowed to exhaust its action alone, and then a collection of the symptoms the patient then presents is made, and the case is prescribed for afresh, almost as if it were a new case; and this process is repeated, each new prescription being the subject of a special study, until the case is cured. Such a process is equivalent to prescribing for a number of new and independent cases, and it is evidently not incompatible with the theory of a true homoeopathic prescription. The very thoughtful article by Dr. Payne, to which refer- ence is made by Dr. Coxe, contains nothing incompatible with these views. He instances cases in which a remedy which had covered all the symptoms acts well for a time, then ceases to act, and leaves the case still uncured. He advises then a fresh study of the case, and especially a study of the previous history of the patient, and the prescription of a suitable antipsoric or antisyphilitic — in fact, a strictly homoeopathic prescription de novo. Now, in many such cases, acute though they appeared at the outset, if the pre- scriber had studied thus carefully at the very beginning, not only the present symptoms, but also the previous history of the patient, a single antipsoric prescribed at first might have sufficed for the case. For although chronic diseases may be incurable except by an antipsoric, antisyphilitic or anti- 158 alternation of remedies. NO. I. sycotic, yet these remedies may also be required in the very beginning of diseases that appear to be most acute. I can certainly testify, from repeated observation, to the efficacy of Sulphur30 in most violent puerperal peritonitis, that remedy being all that was required to bring the cases to a speedy and favorable issue. This calls to mind Hahne- mann's admonition— Organon, % 257'. * * * The physician " should never lose sight of this great truth, that of all known remedies there is but one that merits a preference before all others, viz.: that whose symptoms bear the closest resemblance to the totality of those which characterize the malady." Be this as it may, Dr. Payne's advice clearly contemplates a new study of the case for every new prescription, and, if this plan be pursued, the treatment will be strictly homoe- opathic, even though a dozen remedies were required in succession before the case is cured. Alternation, however, as generally understood and prac- ticed, does not contemplate this new study of the case before a second remedy is administered, or before every change of remedies; and herein it fails to come up to the requirements of a true homoeopathic prescription. And this is the kernel of the whole controversy. Suppose a case of pleurisy. Bryonia covers all the symp- toms. The patient improves for a time and then ceases to improve. The case is studied anew. Some symptoms are found to have vanished; some new ones have appeared. The physician studies the previous history of the patient more closely; he may or may not conclude that there is a psoric taint. At all events he perceives that Sulphur corresponds to the symptoms better than any other remedy. He prescribes Sulphur, therefore, just as though this were a new case that had just come under his treatment. This is an instance of succession of remedies. But each prescription is a strictly homoeopathic one, and in every respect commendable. Suppose another case. A patient has acute tonsilitis. ALTERNATION OF REMEDIES. NO. I. 159 The physician collects his symptoms and prescribes " Bella- donna, to be followed in four hours by Mercurius, and that again in four hours by Belladonna, and so on." These two steady nags, so familiar to all, in this relation, are sometimes enlivened by the company of Aconite and Coffea (pro re nata) where the prescriber has no scruples about driving "four in hand." This is an example of alternation of remedies, and is objectionable on the following grounds: Suppose the first dose of Belladonna to have been a judicious prescription, and to have had an effect. How can the prescriber know beforehand that this effect will be just such as to cause the totality of the symptoms at the end of four hours to corre- spond exactly to Mercurius, and, what would be still more wonderful, how can he foresee that the effect of the Mer- curius will be just such as to cause Belladonna to be better indicated than any other remedy at the end of another period of four hours ? The second remedy (a fortiori a third or fourth!) in such cases must always be prescribed without a preliminary study of the actual condition of the patient as modified by the action of the first remedy. It cannot, therefore, be an exact homoeopathic prescrip- tion. Hahnemann has expressed himself fully on this subject in the Organonx as follows: Sec. 272. " In no instance is it requisite to employ more than one simple medicine at a time." 2 Sec. 169. "It may easily occur, on examining a disease for the first time, and also on selecting for the first time the remedy that is to combat it, that the totality of the symp- 1 Fourth edition, British translation. given both remedies at the same time, 2 Experiments have been made by or nearly so; but I earnestly caution some Homceopathists in cases where, all my adherents against such a imagining that one part of the symp- hazardous practice, which never will toms of a disease required one remedy, be necessary, though, in some in- and that another remedy was more stances, it may appear serviceable." suitable to the other part, they have l60 ALTERNATION OF REMEDIES. NO. I. toms of the disease is found not to be sufficiently covered by the morbific symptoms of a single medicine, and that two remedies dispute the preference as to eligibility in the present instance, the one being homoeopathic to one part of the disease, and the other still more so to another. It is, then, by no means advisable after using the preferable of the two remedies, to take the other without examination, because the medicine given as the inferior of the two, under the change of circumstances, may not be proper for the remaining symptoms; in which case, it follows, that a suit- able homoeopathic remedy for the new set of symptoms should be selected in its stead." Sec. 167. "In short, if the application of an imperfect homoeopathic remedy used, in the first instance, cause any accessory symptoms of some importance, the action of the first dose is not allowed to exhaust itself in acute diseases; the altered state of the patient is then to be examined and the remainder of the primitive symptoms to be joined to those which have been recently discovered, to form of the whole a new image of the disease." Sec. 168. "A new remedy that is analogous may then be easily discovered among the medicines that are known, a single application of which will suffice, if not to destroy the disease entirely, at least to facilitate the cure in a great degree. If this new remedy is not sufficient to restore the health completely, then examine what yet remains of the diseased state and select the homoeopathic remedy that is most suitable to the new image that results from it. In this manner, the physician must continue until he attains his object — that is to say, until he has fully restored the health of the patient." The name and practice of Hahnemann, Boenninghausen and Hering have been adduced in support of alternation. Hahnemann's views on the subject we have already quoted from the Organon. The case to which Dr. Coxe refers, as cured by Hahnemann by " the alternate use of Bryonia tinct- ALTERNATION OF REMEDIES. NO. I. l6l ure and Pulsatilla," has escaped our notice, and we should esteem it a favor if Dr. Coxe would inform us whereabouts in homoeopathic literature it is recorded. Hahnemann published very few cases. In vol. ii. of the Materia Medica Pura, third edition, 1838, he relates two cases, one of which was cured by a single dose of Bryonia tincture, and the other by a single dose of Pulsatilla. May Dr. Coxe have, possibly, referred inaccurately to these cases and, by a fault of memory, blended them ? It is often stated, however, that Hahnemann used Bryonia and Rhus toxicodendron alternately in his very successful treatment of the typhus or hospital fever which prevailed so extensively in northern Germany, in 1813-14, after the French invasion. A reference to his article on the " Treat- ment of the Typhus or Hospital Fever at present prevailing," originally published in the Allgem. Anzeig. der Deutschen, number six, 1814, and translated by Dr. Dudgeon among " Hahnemann's Lesser Writings," l will show how erroneous this statement is. He says, " This fever has two principal stages," of which he gives the distinguishing symptoms; the first stage being characterized by "pains and consciousness," the second stage by "delirium and mania." "In the first stage," he continues, "two vegetable sub- stances are of use and generally quite remove the disease at the commencement—the Bryonia alba and the Rhus tox- icodendron." He proceeds to give the special indications for each of these remedies. " If the patient complains of dizziness, shooting (or jerking-tearing) pains in the head, throat, chest, or abdomen, etc.r which are felt particularly on moving the part—in addition to the other symptoms, the haemorrhages, the vomiting, the heat, the thirst, the nocturnal restlessness, etc., we give a single drop of Bryonia12. Improvement takes place in the course of four and twenty hours, and as long as 1 P. 631 et sea., American edition. 12 162 ALTERNATION OF REMEDIES. NO. I. the improvement goes on, we give him no other medicine, nor even repeat the same dose. " If now the amendment produced by the single dose of Bryonia goes off in the course of two, three or four days, that is to say, if the patient then complains of shooting pains in one or other parts of the body whilst the part is at rest; if the prostration and anorexia are greater, if there is harassing cough or such a debility of certain parts as to threaten paralysis, we give a single drop of Rhus toxicodendron12 and no more nor any other medicine so long as the improve- ment is manifest and continued. * * Or, if the symptoms I have just described occur at the very commencement of the attack, we give at its very commencement a drop of Rhus toxicodendron12." * * * * " The whole disease will generally be removed by a single dose of the first or of the second medicine (according as the one or the other is indicated, without the addition of any other). " If, notwithstanding, the disease should pass into the 'second stage' of delirium and mania, then Hyoscyamus niger meets all the indications of the case." These detailed directions for the treatment of an epidemic disease give a perfect picture of a true homoeopathic treat- ment. They state, in substance, that the generic symptoms of the disease are always accompanied in the commencement by one or the other of two groups of characteristic symp- toms. Accordingly, as one or the other of these groups is present, Bryonia or Rhus is to be given. When the conse- quent amelioration ceases, then the case is to be examined anew, and according to the characteristics then found to present themselves, a new remedy is to be selected, and thus the practitioner is to go on until the case is cured. But alternation is nowhere advised or allowed. Hahnemann's brief and very general hints relating to the treatment of croup are of the same general character. In the introduction to Spongia,1 he says: " Homoeopathy has 1 Materia Medica Pura, vol. vi., second edition, Dresden, p. 199. ALTERNATION OF REMEDIES. NO. I. 163 found, in symptom 145 and in other symptoms, the most remarkable applicability of Spongia to that terrible acute disease — membranous croup—provided, however, the local inflammation has first been diminished or subdued by a very small dose of Aconite. The additional use of a small dose of Hepar sulphuris will rarely be found necessary." Nothing is here said or in any way intimated concerning alternation. In giving general directions beforehand for the treatment of this disease, which usually presents a very uniform group of symptoms, he shows that the symptoms, while the local inflammation is still raging, call for a very small dose of Aconite; that when this has acted, it will generally be found that the local inflammation is subdued, leaving a group of symptoms which correspond best to the symptoms of Spongia; that sometimes there may be such a modification as to call instead or subsequently for Hepar sulphuris. When a physician has it in his power to visit his cases frequently, and to watch their course, he has no excuse for deviating from the methods of a true homoeopathic prescrip- tion. If it prove necessary to give a succession of remedies, he is bound to make each successive prescription the subject of a special study, both of the symptoms of the patient and of the provings in the Materia Medica, and to select on each occasion the remedy which corresponds best to the symp- toms of the case. But where, as sometimes happens, the physician is unable to see the case at all, or where he is giving general direc- tions for the treatment of a case which it is supposed may, at some future time, occur, this accuracy is impossible. His duty is then to describe to his client the symptoms which will probably be present in each stage of the disease, if it appear in the ordinary form and follow the ordinary course; to point out the indications for the appropriate remedy in each stage; and to instruct his client to give only one medi- cine at a time at each stage, and never to repeat the dose, or to give any other remedy so long as amelioration is 164 ALTERNATION OF REMEDIES. NO. I. manifest. This is the best the physician can do when treating disease under the disadvantage of never seeing the patient. This is the method adopted by Hahnemann with reference to hospital typhus. It is the method of Dr. Boenninghausen in treating croup. It is well known that Dr. Boenninghausen does not visit his cases, but prescribes chiefly in his offices. He knows that the first symptoms of croup are almost uniformly com- bined with a local inflammation which, along with all the other symptoms, forms a group to which Aconite corresponds better than any other remedy. His first powder, therefore, is Aconite. And his instructions are explicit. The second powder is never to be given until the amelioration, conse- quent on the first, shall have ceased, and so with the remain- ing powders. The recipients of " croup powders" are especially and carefully instructed under what circumstances alone it is proper to give any or all of the subsequent powders. This is as near an approach to a new study for each change of remedy as is possible when the physician does not see the patient. It does not really amount in most cases even to a succes- sion, much less an alternation of remedies, for in a large majority of cases the Aconite alone cures the patient. That Dr. Boenninghausen does not regard this method as an "alternation of remedies" is shown in vol. ii., p. 561, of the American Homoeopathic Review. Indeed, in theory and in practice Dr. Boenninghausen is as decidedly opposed to alternation as we have shown that Hahnemann was. We believe we could say that Dr. Hering's views are similar to those we have expressed, but we prefer to await a statement from his own vigorous pen of those arguments, both theoretical and practical, which none could give so well as he. In conclusion, we hope it is hardly necessary to add, that inasmuch as offensive language and odious epithets lend no ALTERNATION OF REMEDIES. NO. I. 165 strength to argument nor sweetness to persuasion, we entirely agree with our colleague in his closing paragraph. Nay! for that very reason, he will allow us to say, we could almost wish his own expressions had been a very little less emphatic. ALTERNATION OF REMEDIES. No. 2. When, in the February and April numbers of this Review,2 vol. iii., 1863, we published Dr. J. R. Coxe's article on Alternation, and our own modest objections to what we regarded as unsound argument and inaccurate statement on the part of Dr. Coxe, we had no idea that we were enter- ing upon the discussion of a question, about the terms of which there could be any chance for a misunderstanding. Subsequent publications, from various quarters, have shown that all practitioners do not understand the same thing by the word alternation, as applied to the mode of prescribing homoeopathic remedies. We think we shall be able to show that the practice which some writers defend, under the name of alternation, is not properly called by that name. But, before entering upon the subject itself, we desire to make, once for all, two statements of general principles by which we are governed not only in the treatment of this question but of all questions that concern the practice of medicine; premising that we utterly disclaim any disposition to dogma- tize or to speak as with authority on any question of medical practice. If the earnestness of conviction should betray us into too positive warmth of language, this is our misfort- une ; and none can disapprove it more decidedly than we regret it. 1. The business of the physician is to cure his patient; this is the great practical object of his labor. We believe that nature is not always restricted to a single path—and that while some cases are so severe that there is but one 1 American Homoeopathic Review, 1865. 'Ibid. 1863. ALTERNATION OF REMEDIES. NO. 2. 167 way in which it is possible to cure them, there are often several ways in which it may be possible to effect the cure of some other case ; each way having more or less of incon- venience attaching to it and of detriment resulting from it, in proportion as it differs, more or less widely, from the best way. Thus, we believe that Allopathy, with her heroic antiphlogistics, her revulsives (borrowed from the " circum- locution office "), and, still more frequently, with her blind and blundering misuse of specifics, does sometimes "cure" her cases; but this is not the kind of cure that should satisfy the physician's desires. It is neither safe (inasmuch as it is debilitating in itself and is likely to involve damaging sequelae), nor rapid, nor pleasant. Thus, likewise, we know that Homceopathists who mix medicines, whether in the tumbler or in the patient's stomach (conglomerators or alternators), do often " cure " their patients. These cures, if our observations be correct, are neither so rapid nor so pleasant (free from sequelae) as cures might be; and we are confident that by these methods not nearly so large a pro- portion of the sick may be cured as by adherence to the simple, single remedy. Still, we admit that when a physician has cured a patient, by whatever method, he has, in so far as that patient is concerned, done the chief part of his duty. Though his method were not the best of known methods, he is not to be blamed without qualification. 2. But, although, from the ethical stand-point, we may concede that: " ' T is better to have " erred and cured " Than never to have " cured " at all," we think there is abundant reason for cautioning the prac- titioner to beware of confounding the misfortune of the error, with the good-luck of the cure. As one to whom have been confided the interests of that individual patient, he may justly rejoice in the cure ; but do his functions cease here ? By no means. He is a man of science, to whose care are to be intrusted, every day of his 168 ALTERNATION OF REMEDIES. NO. 2. active professional life, case after case of disease which he is to bend his energies to cure. What is it to be a man of science ? It is to be one whose mind is stored with an array of facts carefully observed by others as well as by himself, and methodically arranged, in such wise that principles have been and may be correctly inferred from them—principles by virtue of which new observations may be arranged along with these facts—principles by the aid of which the facts which will result from operations observed to be in progress, or intentionally put into activity, may be accurately predicted, and, conversely, may be produced at pleasure. Such is the scientific physician. Let us note the difference between the action of his mind and that of the patient, after a cure of the latter has been accomplished by the former. The patient says to himself, " I was sick and now I am well. I will pay my doctor and then, to my work again !" This is all his sickness is to the patient. The soliloquy of the doctor will depend very much upon the nature of the mental process by which he arrived at the mode of treatment that cured the patient. It may be: i. -" How can I ever be thankful enough for the lucky accident that made me give him Ledum ! May I be as fortunate when I guess again !" or, 2. " When I gave Bryonia alone and Sepia alone, though each seemed to correspond pretty well, still the patient did not get much better. But when the happy thought of alternating them occurred to me, and I did it, she recovered. From this I shall learn that two remedies, each of which corresponds to part of a case, may cure the case if given in alternation, when neither, if given singly, would cure it;" or, 3. " A year ago I should have given, for such an angina as this, Belladonna and Mercurius in alternation, as Rummel recommends, and the patient would probably have gotten well in two or three days and I should have been satisfied; but since I have studied Lachesis, I find that remedy covers ALTERNATION OF-REMEDIES. NO. 2. 169 the whole case much better than Belladonna and Mercurius would do ; and lo ! he is well in twelve hours. From this, I learn to shun, more earnestly than ever, those expedients which, like alternation, are borrowed from the polypharmacy of the Old School and which, being opposed to sound prin- ciple, must be inferior in their results to some better way which accords with sound principles and which way I shall be most likely to find out if I make my practice follow prin- ciple. This case, then, gives me fresh zeal in my study of Materia Medica;" or, 4. "This case cost me much study. I saw that the symp- toms of the abdomen and digestive canal as well as those of the lumbar region and of the hip and thigh and the general conditions of aggravation and amelioration corresponded admirably to Colocynth, but then, the patient had, in addi- tion, an enlarged ovary (from which, possibly in some way, the other symptoms sprang), and I have never heard of Colocynth in connection with enlarged ovary. I might, therefore, have been tempted to alternate Colocynth with some remedy which is known to have cured and perhaps produced enlarged ovary, such as Lachesis, Apis, Graphites, Lycopodium, Staphysagria, etc., but for my aversion to disregard what seems to me the well-established principle: that maladies are not local affections, but general, pervading the entire organism—that the individual man is not an aggregation of independent monads, each of which may be ill or get well ' on its own hook,' without its neighbor being thereby jostled, and against which may be discharged a cor- responding load of medicinal monads each of which will find its own particular target without hitting any other—not this, but an individual being, whose functions and tissues are so intimately connected, that, ' if one member suffers, all the members suffer;' and conversely, if we get the key to the malady by finding the characteristic symptoms which will point us to the true remedy, .we shall cure the entire suffer- ing, to whatever member we may address ourselves. In this 170 ALTERNATION OF REMEDIES. NO. 2. faith, regarding the characteristic symptoms as calling unmistakably for Colocynth (there was nothing character- istic of any remedy in the ovarian symptoms —the ovary was enlarged, that was all), I give that remedy. And now, while in a few days the other symptoms which plainly called for Colocynth disappeared (permanently, as the event proved), in the space of two months the ovarian tumor had likewise disappeared, and the patient, who had been confined for six years to her room and couch, could now walk, drive, and go about the house as well as ever.1 From this I learn the unity of disease, and by this I am strengthened in my belief that adherence to well-settled principles will, in the end, carry one farther and faster, even over dark and uncertain ways, than any make-shift and irrational expedient would be likely to do ; " or, 5. " In this case of dysmenorrhoea the symptoms of the head and eyes are very characteristic of Cyclamen. But, surely, the menstrual symptoms are too important to be overlooked in this case, and the remedy must correspond to these symptoms in order to cover the case. I looked for the symptoms of Cyclamen on the female sexual organs, and lo ! none are recorded in the Materia Medica Pura. It seems that there was not a woman among the early provers of Cyclamen. What was to be done ? The menstrual symptoms corresponded pretty well with those of Pulsatilla, though the head and eye symptoms did not correspond. Should I alternate Cyclamen and Pulsatilla, which jointly cover the case ? I should have high authority for such a course! But, I reflect, that the same kind of a human organism which, under some disease-producing influence, experiences, at one and the same time, the amenorrhoea and the head and eye symptoms of my patients—the same kind of human organism, I say, experienced also, when proving Cyclamen, head and eye symptoms exactly like those of my patient. Is it not fair to presume that, if this disease- lSee "Observations on Colocynth." ALTERNATION OF REMEDIES. NO. 2. 171 producing cause and the specific properties of Cyclamen are so nearly alike as to produce identical symptoms in the head and eyes, they would have produced identical symptoms likewise in the female sexual organs, had the prover of Cyclamen been a woman ? So strongly did probabilities seem to me to favor this presumption, that regarding alter- nation as an unsound and irrational expedient, I was about to take the risk of giving Cyclamen alone on the strength of this anticipated result of some future proving by a woman,' when, chancing to meet with the new Austrian proving of Cyclamen, I found that provings by women are there recorded which confirmed my presumption in every particular. The case recovering speedily under Cyclamen, I learn from it that in many cases we are tempted to alter- nate because we cannot cover every feature of the case with either of the remedies which we think of alternating. But, in some of these cases, the symptoms which are really characteristic are fully met by one of these remedies, and there is ground for assuming, as clinical records show, that subsequent and more extended provings will demonstrate to us that this remedy, if fully proved, would really cover the entire case, characteristics and all. This experience fortifies me against a temptation to alternate, and leads me to rely more confidently on the indications furnished by character- istic symptoms." If we review these cases and analyze the operations of the physician's mind, we shall see that, in number one, he con- fesses that he has been the " accident of an accident," and he invokes his " good luck" to stand him in stead again. He does not exercise his reasoning faculties at all. Let him pass. In the other cases, there is, besides a thanksgiving for success, an effort of the mind to arrange the facts which the case presents in order, along with some other facts already stored there, and to infer from the aggregate store of facts some principle or plan of action which may be profitably 172 ALTERNATION OF REMEDIES. NO. 2. brought to bear on some future case. It is thus and only thus that "experience teaches." For, since no two cases are ever met with that are in every respect precisely alike, the experience acquired in treating one case can never be avail- able in treating another, except through the intermediate application of the reasoning powers. We hear and observe facts, collect and arrange them, analyze and reflect upon them, induce principles from them, and prepare ourselves to make practical application of these principles when a new case shall call for it. Now, what is this but theorizing ? When we analyze a case in such a way as to suggest to our minds its proper mode or course of action, or to infer from it any principle that might help us in a future case, we form a "theory." We cannot think, indeed, about collecting facts without theorizing. Yet the defenders of alternation invite us simply " to look and see," to " establish facts. These once fixed, any theory which will perfectly account for them is good." These are Dr. Hawley's words.J And the London Homoeopathic Review, vol. ix., p. 432, quotes Dr. Hawley's words approv- ingly: " The homoeopathic system of medicine," * * * says Dr. Hawley, " bases itself, not on theories but on facts as they are observed in the world of man. It frees its dis- ciples from all dogmas and simply asks them to look and see." Well, being thus invited, we "look and see." What do we see ? Why we see Dr. Hawley giving Bryonia and Sepia in alternation in one chronic case and Arsenic and China in another case, and curing both in a way which satisfies him well. This is what we see. But what does Dr. Hawley see when he looks at these same facts ? Why he sees something which proves to him that " for him, the use of remedies in alternation is better than the use of a single remedy." And the London Review sees in the same facts something "which proved to him (Dr. Hawley) that the 1 American Homaopathic Review, vol. v., p. 338. ALTERNATION OF REMEDIES. NO. 2. 175 alternation of medicines is not only admissible, but that cases now and then occur which CAN ONLY BE CURED BY SUCH ALTERNATION." Is not this "theorizing" pretty strongly and on a rather slender basis ? Our friends warn us against " theory " and yet, from two facts, Dr. Hawley concludes that, " for him, the use of remedies in alternation is better than the use of a single remedy." From the same two facts the London Review makes Dr. Hawley conclude that " cases now and then occur, which CAN ONLY BE CURED BY SUCH ALTER- NATION." This is a broad generalization on a very narrow foundation. But Dr. Hawley admonishes us that " we have not yet any such collection of facts as will warrant any generalization." For ourselves, we should not feel justified in drawing any such conclusions as these from Dr. Hawley's cases or from any of the cases already narrated, cured by alternation. When adduced in evidence, we accept them as facts and give them what we consider to be their full value. They prove to us that cases may be cured by alternated remedies, but they prove no more than that. They prove that two remedies in alternation cured a case which neither of those two remedies singly had cured. Beyond this they prove nothing. Assuredly they do not prove that a physician could not have cured each case more quickly with some other remedy, given singly. How could such evidence be held by us to justify such conclusions as Dr. Hawley and his reviewer draw from it, when our daily experience fur- nishes case after case which had been treated ineffectually by physicians who always alternate and which yields promptly to the single remedy. Evidence of this kind whether FOR or AGAINST alternation, will not settle this question. These remarks, extended as they are, have been made for the purpose of showing that clinical experience is available as a means of improvement in medical practice only in so far as it is analyzed, thought about, and, in fact, " theorized" 174 ALTERNATION OF REMEDIES. NO. 2. about; that those who deprecate dogmatism and would put off the formation of generalizations, do, themselves, dogmatize and theorize, and from the nature of the case they must do so in the act of reasoning about the evidence they bring forward. If this be inevitable, then, it must be allowed us likewise to theorize and in what we have to say about alternation we shall hold ourselves justified in basing our argument on generalizations from a multitude of collated facts. We hold that the argument from theory is in order. And regarding a SCIENCE as being a connected and independent series of generalizations based on an analysis of methodically arranged and collated facts, we require the advocates of alternation to rest their cause, as we do our opposition to alternation, on such a generalization. Failing to do this, they have no claim for their method as a part of the SCIENCE of Therapeutics. Failing this, the facts which seem to justify alternation can be used in no other way than in the blind, empirical way of literal imitation, in which accuracy and certainty are quite out of the question. But our whole object in study and labor, beyond the direct need of our patients, is to complete the structure of our science, such as we have defined a Science to be, a means of attaining accuracy and certainty. Some of the advocates of alternation have failed to per- ceive the necessity of raising their procedures to the level of a scientific method. They still rest on the rude empirical ground of unmethodized experience. Their argument is: " I have alternated remedies which, singly, had failed, and I cured. Henceforth I shall alternate." Or, as the London Review varies the argument (9, 432), " The practice of alter- nation of remedies is one so widely adopted that it would appear to have the sanction of very extended practical experience. * * * Experience has proved abundantly that the alternation of remedies increases the rapidity of the cure," etc. The same argument was used by Dr. Coxe,1 who claims to have alternated for twenty-five American Homoeopathic Review, iii., 59- ALTERNATION OF REMEDIES. NO. 2. 175 years, and to have been successful. As we have before remarked, the same argument may be used by Allopathists, and by the advocates of every form of practice, whether pure, mixed, or wholly vicious. The same argument may be, and is, advanced by those who oppose alternation. Others, however, have seen the necessity of basing their advocacy of alternation on some general principles, among them particularly Dr. Drysdalea and Dr. Coe,2 and to these statements of principles we wish to devote some attention. But, first, let us have a clear understanding of what is properly meant by alternation of remedies. As we have stated, the term is used in different senses. 1. Dr. J. R. Coxe (loc. cit.) seemed to think that the opponents of alternation contend that each case of sickness should be treated with one single remedy, and that, if during an illness a change in the symptoms should compel a change in the remedy, this, by whatever name it be called, is, in fact, alternation. He scouts the idea of any real distinction between alternation and succession of remedies. Well, if this be all that alternation means, we have no reason to oppose it. But, what is a case of disease in this sense ? Does it comprise all that may ail a man from the time that he takes to his bed to the time that he goes to his work again ? Suppose a patient sick of dysentery, and recovering finely under the single remedy Mercurius corrosivus. When just convalescent he is seized with rheumatism, and requires Rhus toxicodendron. Is it "alternating" to give it to him? And then, suppose him safely over rheumatism ; but just before he goes to work again, he has a return of dysentery, requiring Mercurius corrosivus. Is it " alternating " to give it, if the symptoms require it ? And if, when cured of this relapse, he gets the measles and requires Euphrasia, is it "alternating" again to give him this remedy? Why, according to this definition, if you call this all one sickness, 1 Annals of British Homoeopathic 2 The American Homoeopathic Re- Society, view, vol. v., April, 1865. 176 ALTERNATION OF REMEDIES. NO. 2. it has been a case of alternation. If you call it four sick- nesses, perhaps not. To the patient, certainly, it is "all one," whatever you call it! Now, suppose the symptoms in a case to have changed just as decidedly as in the case supposed above, but yet not so definitely as to induce you to give to the changes these nosological names of dysentery, rheumatism and measles. The medicines, Mercurius, Rhus and Euphrasia will have been just as clearly indicated by these successive changes, and just as imperatively required as though the patient were regarded as having had four successive diseases. Is it " alternation" to give these remedies successively just as they become clearly indicated ? We think it is not, but some say it is. We are sure it is sound practice. 2. Dr. Quin, of London,1 calls the method of prescribing successive remedies in a case as the changes of symptoms may require them, "alternation a posteriori," and sanctions and defends it. But he reprobates, under the name of "alternation a priori," the practice which, it seems to us, is the only one which can properly be called "alternation," viz.: " Prescribing at the very outset of the treatment—at the very first visit and also, not unfrequently, almost at every subsequent visit, two or more medicines, to be alternated every quarter, half hour, or every two, three, or four hours. It is difficult to believe," he continues, " that such practitioners are in the habit of carefully considering the cases under treatment, or have well studied their Materia Medica, or to divest one's self of the idea that they resort to such slip- shod practice in the hope that if one of the medicines does not hit off the complaint, some one of the others may. One meets with instructions for similar alternation laid down in popular books on Homoeopathy, showing that this a priori style of alternating remedies is, with certain practitioners, more a rule than an exception." 3. Dr. Drysdale defines alternation to be "the giving a second medicine while the sphere of action of the first is still unexhausted." But Dr. Drysdale, while advocating alter- nation, in this sense, in certain specified cases, does not propose to give his second medicine except after a careful Annual Address, Annals of British Homaopathic Society. ALTERNATION OF REMEDIES. NO. 2. 177 re-examination of the symptoms of the patient, and a com- parison of them with the Materia Medica. It is clear, then, that alternation as he defines and defends it, is not the same thing as the alternation a priori which Dr. Quin reprobates, and to which we would restrict the term. Dr. Drysdale's definition seems to us very vague and impracticable. How are we to know when the sphere of action of the medicine is exhausted ? By inferences from the proving ? But we have reason to believe that the speed at which vital processes go on in sickness may be very different from that during a physiological proving. Reduced to a practical rule, Dr. Drysdale's reasoning would amount to this: If, on our second visit, symptoms shall be found to have arisen which seem to call for the second medicine, we should suspend the first and give the second, and then, if, at the third visit, the symptoms be found to have changed again, so as to call again for the first medicine, we should give it. But this, he says, is "alternation." With certain qualifica- tions we agree to his rule of practice, but we object to the name he gives it. And here names are important. It is of great consequence to avoid giving to two radically different procedures one and the same name. Now, what do we mean by "alternation ? " Let us give a practical answer. We have before us a prescription label filled up by Dr. John Doe. It reads thus: "No. 1, Aeon.3; No. 2, Bellad.6; of each, twelve pow- ders. Take the powders alternately as numbered, every four hours." We have another paper containing directions prepared by Dr. Busy, for a chronic patient: "Take as follows: Mercurius hydriod., first decimal tritu- ration, every night for seven nights; "Then Sulphur3, every night for seven nights; "Then Collinsonia', ever)' night for seven nights; 13 178 ALTERNATION OF REMEDIES. NO. 2. " Then Podophyllum pelt.2, every night for seven nights; "Then Ignatia3 and China1, alternately every night and morning, for seven days ; "Then Aurum met.1, every night for seven nights; "Then Pulsatilla1, every night for seven nights ; " Then Phytolacca dec.1, every night for seven nights." We object to these, and to all kindred procedures, that they rest on hypotheses which are not warranted by the present possibilities of science. Dr. John Doe's first pre- scription of Aconite may be all right; the symptoms probably call for it. But the physician cannot know in advance that, in four hours, the symptoms will have so changed that, if he were present, he would perceive Bella- donna to be indicated; and that, in four hours later, Aconite will be indicated again; and that the symptoms will go on, oscillating between these two series of indications, each oscillation consuming just four hours. And "Dr. Busy," by what wonderful gift could he foresee that seven days of Mercurius hydrargyrum would bring his patient to a state requiring Sulphur, and seven days of Sulphur to a state requiring Collinsonia (whatever that state may be), and seven days of Collinsonia to a state calling for Podophyllum (and for just seven days of it too), and seven days of Podophyllum to a state of complex misery that calls for China and Ignatia in alternation (for just seven days likewise) and so on to the end of this long chapter! " Oh, wad some power that giftie gie us! " These instances, and the comments upon them, comprise our definition of " alternation," and our objection to it. It is a practice very prevalent in the United States and in England. It is exceptional in Germany, France, Spain and Italy. The principles which govern the selection and administra- tion of homoeopathic remedies are very simple. ALTERNATION OF REMEDIES. NO. 2. 179 The great law, SIMILIA SIMILIBUS CURANTUR, teaches us to select a remedy the characteristic pathogenetic symp- toms of which are very similar to those of the patient. This is a grand generalization, supported by a multitude of facts. We accept it. It takes no heed of names of diseases, nor of pathological theories of the seat and origin of diseases. Giving a broad and liberal signification to the word " symp- tom," so as to include everything abnormal about the patient, whether it be historical or actual, this law pays regard to the symptoms alone. It requires that the symp- toms shall be collected and compared with the Materia Medica every time a prescription is made, and that the drug that has produced symptoms most similar to those of the patient shall be chosen and given. This is a true homoeo- pathic prescription. No matter how often during the sick- ness of a patient this process be repeated; no matter how many remedies be given in succession; no matter if the first remedy be recurred to after the second and the second after the first—if each prescription have been the fruit of a special collection of symptoms and comparison of them with the Materia Medica—call it "alternation" or by whatever other wrong name you please, it is a sound and defensible homoeopathic prescription, such as Hahnemann taught and practiced, and his followers adopted. But the physician sometimes leaves a second remedy to be substituted for the first under certain specified contingen- cies. Is this alternation ? By no means. In so doing, he makes the attendant his deputy, and describes the series of symptoms which, in his judgment, will be an indication that another remedy is required. He is merely instructing and empowering another person to make, in his stead, the study and selection of a remedy which should precede and be the basis of every new prescription. And wherever, in his writings, Hahnemann has seemed to authorize or sanction alternation, his directions have been of this character. He has mentioned that a certain group l8o ALTERNATION OF REMEDIES. NO. 2. of remedies is likely to be indicated in a certain disease, and although he has sometimes used the word " alternate" (abwechseln), yet, in every case, he has specified the particular symptoms, or groups of symptoms, which would specially indicate and authorize the preference to be given to one or another remedy of these groups. In a previous paper' we showed this to be true of Hahnemann's directions for the use of Spongia, Hepar and Aconite in croup, and also for Bryonia and Rhus in typhoid fever. The same is true of his directions touching cholera. The London Homeopathic Review- says: "Those who combat ' Alternation ' on the ground that it is opposed to the practice of Hahnemann, fall into a grave error. In the introduction to Belladonna in his Materia Medica Pura, he advises the alternation of Aconite and Coffea cruda in purple rash, in these words: 'Aconite and Coffea should be alter- nately given every twelve, sixteen or twenty-four hours, in proportion as one or other remedy is indicated.'' It is true that the above words are contained in the intro- duction to Belladonna, but they are not all the words con- tained in the sentence from which they are quoted. This sentence, complete, is as follows: "There (in the purple rash) Belladonna, naturally, does no good, and the other, common, charlatan treatment must also allow the most of the patients to die of it, whereas they might all be cured by the alternate use of Aconite and of the tincture of Coffea cruda, the former for the heat and the increasing restlessness and agonizing anxiety, the latter for over-excessive pains with a lachrymose humor; the Aconite in the 30th dilution of the juice and the tincture of Coffea cruda in the 3d dilution, both in the dose of the smallest part of a drop, the one or the other every twelve, sixteen or twenty-four hours, accord- ing as the one or the other is indicated." The two groups of symptoms which Hahnemann gives as indications, respect- 1 American Homoeopathic Revieiv, 2 Vol. ix., p. 432. April, 1863. ALTERNATION OF REMEDIES. NO. 2. l8l ively, for the one or the other of these remedies, are omitted by the London Review. They are the essence of the whole matter. Following this advice of Hahnemann, it would not be possible for the practitioner, on meeting a case of purple rash, to begin with a blind a priori alternation of Aconite and Coffea. On the contrary, as we understand Hahne- mann's direction, he should examine his case to see whether it presented the groups of symptoms " heat, increasing rest- lessness and agonizing anxiety," in which case he would give Aconite; or whether the characteristics of the case were " over-excessive pains with a lachrymose humor," in which case he would give Coffea. Suppose at his next visit, twelve, sixteen or twenty-four hours after, he should find, as might well happen, that the group of symptoms first observed had disappeared and had given place to the other group, he would, for this reason, change his remedy. Or, if he lived at a distance from the patient, he might make the nurse his deputy, and, instructing this deputy as to the distinction between the groups of symptoms, might direct her (as Hahnemann has directed us) to make changes in the remedies when corresponding changes in the symptoms should call for them. In this way there would be no assumption and no a priori "alternation." The practice would be sound, fulfilling the conditions of a sound prescrip- tion, viz. : that each prescription be preceded by a fresh collection of the symptoms of the case, and comparison of them with the Materia Medica. Is it suggested that Hahnemann meant to intimate that these groups of symptoms might co-exist in the patient at the same time and might make a " totality of symptoms" that would require these two remedies to cover it ? But these groups are pathologically incompatible. No one con- versant with the phenomena of sickness could conceive of a patient presenting, at one and the same time, " heat, increas- ing restlessness and agonizing anxiety," and likewise over- sensibility to pain and a disposition to weep and despond. No! 182 ALTERNATION OF REMEDIES. NO. 2. patients in a waxing fever often swear; but they seldom//«£ and weep ; they feel general anguish but make light of specific pains. But when the fever has waned, there often succeeds it a stage of over-sensibility and of proneness to weep; and this succession may be repeated again and again, and we sup- pose Hahnemann recommended these remedies to corre- pond to this succession. We cannot comprehend his words in the sense attached to them by the London Review. In the signification in which we have understood them, they correspond precisely to all of his other directions, which have been quoted as favoring "alternation." But, now, suppose it conceded that, while Hahnemann's practical deductions from scientific principles were opposed to "alternation," his practice sanctioned it. Is the argument from his practice all powerful against his principles? This reminds us of what the Chairman of the British Society calls Dr. Drysdale's Socratic irony " — you all object to alternation, and, yet, you all alternate." We have seen that Dr. Drys- dale's definition of alternation is such as to cover almost every actual case of treatment and is different from that of every other writer. But, the argument from the universality of a practice, in favor of its propriety, is a dangerous one to play with. Place it in the mouth of a theologian and see how it reads: You all condemn sin, and yet, you are all sinners!" Does the weight of this argument lie on the side of sin or on the side of the condemnation of sin ! Does propriety necessarily follow from universality ? Are the majority always right, just because they are the majority ? If so, all hail, Allopathy ! The conditions of a true and defensible homoeopathic pre- scription require, in our opinion, that the symptoms of the patient, at the time of prescribing, shall be collected and compared with the provings in the Materia Medica, and that the drug whose symptoms correspond most closely with those of the patient shall be selected. Perhaps no Homceo- ALTERNATION OF REMEDIES. NO. 2. 183 pathician would object to this statement. But let us see what it requires. First. It requires that before every prescription, the symptoms of the patient shall be studied anew. In some way or other, whether it be done by the physician or by a provisional deputy specially instructed for the case (as we have explained that the nurse may be), more or less perfectly, this must be done. We have seen that in the ordinary method of alternation (a priori) this is not attempted to be done and cannot be done; it is not proposed to do it. Second. It requires that the aggregate of the symptoms presented by the patient be regarded as one malady, for which an analogue is to be found in the Materia Medica. We have no authority in science for arbitrarily dividing this aggregate of symptoms into groups, for each of which we are to find an analogue in the Materia Medica, and then giving these analogues, in combination, or in alternation. This requirement is perhaps the most difficult of all to fulfill. In collecting the symptoms, our utmost sharpness of insight and our deepest and most extensive learning in every de- partment of physiological, psychological and pathological science will be tasked to construct, from the patient's history and from his present condition, a complete picture of the morbid phenomena which he presents, from which the physiological idiosyncrasies of his peculiar temperament and personality shall all have been eliminated, and in which his symptoms shall be duly arranged with regard to their mutual relations and dependencies. Then, furthermore, inasmuch as we cannot hope to find, in the proving of any drug, a duplicate symptom for every symptom of the patient, the rarest judgment and most extensive knowledge of semeiology are required to analyze the patient's symptoms and to detect those which are truly characteristic of that individual case, and for which an analogue must be found in the proving; and to set these characteristics apart from the other symptoms, the analogue of which it may be less impera- 184 ALTERNATION OF REMEDIES. NO. 2. tively necessary to discover. It is here, undoubtedly, that the greatest knowledge and ability are required of the physician and here that failures are most frequently made. It is, probably, from failures in this analysis of symptoms, that the supposed necessity of alternation most frequently arises. Third. It requires that a drug shall be selected which has produced on the healthy subject, symptoms very similar to those of the patient. The substance given must have been proved in the same form (not necessarily the same dose) as that in which it is proposed to be given. If Hepar sul- phuris calcareum correspond to the case, this requirement is, by no means, fulfilled if we give Sulphur and Calcareacarbonica combined or alternated, on the ground that these substances are the constituents of Hepar sulphuris calcareum. For, this involves the assumption that the Sulphur and the Calcarea carbonica have undergone no changes during the process which made, out of them, that third substance— Hepar sulphuris. No ! Hepar sulphuris was proved as such. If we select it, for the reason that the symptoms which it produced correspond to those of the patient, then we must give Hepar sulphuris, the very substance that was proved. Otherwise we plunge into a sea of speculation and hy- pothesis and forfeit that certainty which it was the sole object of our science (as of every science) to attain. In like manner, if the Iodide of Mercury had been proved on the healthy subject and its symptoms were most similar to those of our patient, it would not be a compliance with the demands of our science should we give, instead of Iodide of Mercury the very substance that produced these symptoms, the Mercurius vivus and the tincture of Iodine, assuming that, because Iodide of Mercury is a compound of these two substances, therefore the conjoined or alternate action of the elements from whose union it sprang must be identical with its own. From instances like these, it is clearly to be seen that we may not, consistently with the principles of our ALTERNATION OF REMEDIES. NO. 2. 185 science, prescribe drugs in any other form or combination than that in which they were proved. If drugs had been proved in alternation, we might then with propriety, perhaps, prescribe them in alternation. Until this is done, the method is a hap-hazard, chance operation—successful, no doubt, at times, but in such a way that success could never be fore- seen or insured, nor could the experience of the practitioner in any way serve to establish or confirm any principle of medical science. A homoeopathic prescription, as we have defined it, is a deduction from a generalization, which has been established by induction from a multitude of instances. This is the law SIMILIA SIMILIBUS CURANTUR, in accordance with which the remedy is selected, under the three requirements that we have specified. So well established is this law of nature, that if we are so fortunate as to be able, in any given case of disease, to comply closely with those requirements, and particularly with the second, we may with certainty predict, and in confidence await, the favorable result of our prescriptions. Such certainty of foresight and such confi- dence it is our great object to attain, and nothing but a scientific method can afford them. But we have shown that alternation, as we use the term, and as we have described the process, is incompatible with this scientific method. It does not meet the requirements of the law. It does not take the aggregate of the symptoms as the single basis of prescription. It does not give the remedy, single and simple, such as it was used in the proving. But it permits itself to act on two assumptions—that the aggregate of the symptoms may be arbitrarily divided and separately prescribed for ; and that two or more drugs which have been proved independently of each other may be used conjointly as a sort of composite analogue to the aggregate of the symptoms; and all this with equally good and sure results. These two assumptions are not even alleged to be based on any collection of facts. Their introduction 186 ALTERNATION OF REMEDIES. NO. 2. deprives the proceeding of all claim to a strictly scientific process The advocates and defenders of alternation are naturally divided into two classes. The one frankly disavow any pretension that alternation is a scientific deduction from a general principle, and defend it on the simple ground of experience. They have alternated successfully in a case or cases like the present, and therefore they do it again. Now, obviously, with this class we cannot discuss the question on scientific grounds. There is no reason in their method, because there is in it no reference to general princi- ple, to natural laws : it gives no means of foreseeing and providing for future results; it is the simplest form of literal empiricism. We can do nothing more than show, as has been done, its unreasonableness and the precarious and con- tradictory and disappointing character of its results. We can only point out how far it falls below the standard of action to which practitioners of medicine should hold them- selves, and how unworthy, in our judgment, such methods are of reasoning and conscientious men. The second class accept our definition of the requirements of a sound prescription, and our statement of the obligation of scientific men to abide by natural laws. But they claim that alternation does not necessarily, as we have maintained, contravene the requirements of such a prescription; and they claim that there are certain established principles in accordance with which we may, with scientific accuracy, determine when and how to alternate. This class defend alternation "on principle." As the former class comprises some of our most conscientious and estimable colleagues, so does the latter embrace many of the most gifted and learned of our school. Their opinions are worthy of the most earnest and respectful consideration. We have previously stated that some who defend alter- nation on principle designate by that name methods which, we think, ought not to be so called, and which we do not ALTERNATION OF REMEDIES. NO. 2. 187 find fault with; as, for example, Dr. Coxe ; likewise Dr. Drysdale, in so far as his definition is concerned. Their methods do not always, of necessity, conflict with the require- ments of a sound prescription. There are still other pro- cedures, called " alternation," but which are not always necessarily liable to the objections urged against " alter- nation," properly so called, as we have defined it (a priori). The occurrence of complications, and especially of trau- matic complications, such as a burn of the hand, during the course of a pneumonia—a contused vulva simultaneously with a milk fever, are mentioned by Dr. Drysdale, as instances which may require alternation ; as, for example, Urtica urens to the burned hand, while Phosphorus is being given internally for the pneumonia, and Arnica to the vulva, while Aconite is given for the milk fever. Now, of such cases as these it might perhaps be properly said, that they do not come under the scope of our inquiry, inasmuch as the burn and the contusion might be regarded as purely local, and not at all constitutional affections, and the respective applications might be viewed in the same light, and as not capable, when thus used, of affecting the general system, and of thus being, in fact, alternated with the remedy which the patient is taking internally. But, waiving this reply, we may say that the teaching of our own experience is, that, in such cases as these, the best way is to follow the one great rule which governs homoeopathic prescription ; after the occurrence of the complication, collect and scrutinize the patient's symptoms anew. If the burn shall have been so slight as to make no impression on the general system, to produce no modification in the symptoms of the previously existing pneumonia, then there is no reason for doubting that simple protection from the atmos- pheric air will be all that is needed in the way of treatment for the burn. If, on the other hand, the burn have been of a serious character, so as to produce constitutional disturbance, it will 188 ALTERNATION OF REMEDIES. NO. 2. assuredly have modified the symptoms of the pneumonia, and we shall perhaps find, on taking the aggregate of the symptoms again, that some other remedy than phos- phorus is now indicated to meet the new state of things resulting from the pneumonia and the shock of the burn combined, and that this new remedy will meet both troubles. For it must not be hastily assumed, as Dr. Drysdale seems inclined to intimate, that Urtica urens locally applied is always the best (or a good) remedy for burns. They are often (at least) best treated, as Boenninghausen has shown, by an internal remedy. Singularly enough, it once chanced to myself to meet the complication which Dr. Drysdale here supposes. The burn was severe, and the effect of the shock so modified the symptoms of the pneumonia that the result- ing aggregate of symptoms called unmistakably for Arseni- cum, which was given with most gratifying results, as regards both pneumonia and burn. The same may be said of the application of Arnica to contused vulva. Indeed, there is too great haste among us to recur to topical applications. The second " principle" upon which, according to Dr. Drysdale, "the practice of alternation rests," is "the main- taining the susceptibility." Dr. Drysdale says : " In disease we generally find that the susceptibility to the homoeopathic remedy is present from the nature of the case, and our great object should be to manage the doses and repetitions so that it shall not be exhausted before the natural period essential for a cure. This unfortunately, however, not un- frequently happens, in spite of varying the dilutions or originally having chosen the best. In this case the plan has been adopted of interposing doses of another remedy as nearly as possible homoeopathic to the case. This must, of course, be an antidote, but, as in the case of natural disease, it may tend to revive the susceptibility to the first remedy. * Without the use of occasional alternation and intermediate remedies, we should be almost deprived of the ALTERNATION OF REMEDIES. NO. 2. 189 use of a large class of serviceable remedies in chronic disease, such as Opium in constipation, Lobelia, Lactuca, etc., in asthma, Coffea and Aconite in neuralgia, etc." This question of the propriety of alternating for the pur- pose of reviving the exhausted susceptibility may be treated in much the same way as the question of alternating to meet complications. When we have a case under treatment, we shall not be led to suspect an exhaustion of susceptibility, except by a change in the symptoms. Now, if the symptoms have changed, this very change furnishes us the basis for a new prescription. Why shall we not at once proceed, in accordance with the great rule of our art, to select a new remedy corresponding with these changed symptoms ? Why should we prefer, to this certain method, the pathological hypothesis that the susceptibility to a rem- edy which we have assumed to be suited to the disease has become exhausted and needs a stimulant ? This hypothesis may be correct, but can never be a certain basis for practice. But let us take an example : Cases of dysentery not unfre- quently occur in which Nux vomica or Mercurius seemed in the beginning to be very clearly indicated. The patient im- proves for a few days under the use of one of these remedies, and then ceases to improve. On a careful scrutiny of the case it appears that the prominent characteristic symptoms (most of them subjective, of course) have disappeared or be- come obscure. Even the evacuations have ceased to be characteristic of any remedy. The entire system is dull, languid, unimpressible. In such a case as this, we are told that the susceptibility of the patient has become exhausted; that a few doses of Opium will arouse it so that it will again respond to the appropriate remedy, and will be cured. As a matter of fact we know this treatment does succeed in many cases, but the rationale of the process is by no means satisfactory to us. And this is not a solitary instance of a successful practice following, through good luck, from a very faulty theory. If we analyze the case described we I90 ALTERNATION OF REMEDIES. NO. 2. shall find, that when the patient ceases to improve under the Nux or the Mercurius which was first given, his symptoms changed in such a way that their totality furnished a satisfac- tory indication for Opium, and a capable prescriber would accordingly have selected Opium and cured his case, even though the notion of "exhausted susceptibility " had never entered his head. Simple adherence to the great principle of homoeopathic prescribing, viz., that each prescription is to be founded on a new collection of the symptoms and a new comparison of them with the Materia Medica, leads to suc- cess in all such cases, without the intervention of any patho- logical hypothesis whatever ; at the same time it excludes all danger of appearing to sanction the bad habit of alternation. As regards the use of Opium for constipation in chronic diseases, and Coffea in neuralgia, these being used as inter- mediate or alternated remedies, they, like topical applica- tions in traumatic complications, are much abused, and often altogether needless if not hurtful. A single example will illustrate this point: A patient, not long ago, while under a friend's treatment came under my observation. Her symp- toms corresponded exceedingly well with those of Conium maculatum. It was a chronic disease of long standing. She had troublesome constipation, which was sometimes so bad that it seemed to completely neutralize the good effect which Conium was evidently producing. A dose or two of Opium30 would relieve the constipation, and the patient would seem for a while to improve again under the Conium. This might be called an illustration of what Dr. Drysdale refers to as the necessity for alternated or intermediate remedies in either " complications of chronic diseases," or "exhausted susceptibility." It was not, however, satisfac- tory to my friend, nor to myself. He could not regard the regularly recurring constipation as a foreign complication. Believing in the unity of disease, he looked upon it as an integral portion of that patient's sickness and did not rest contented until he had found a single remedy which covered ALTERNATION OF REMEDIES. NO. 2. 191 both the symptoms to which Conium corresponded and the constipation besides. This remedy was Alumina, under which the bowels became, and they have remained, perfectly regular. The patient's improvement, in other respects, was all that could be desired. In this case, as in most cases narrated of cures by alternation, the Opium and Conium, in alternation, seemed to work very well, and promised to effect a cure in the fullness of time. I doubt not that if, to all the other histories of cures by alternation, a sequel could be written, it would be found that each of these cases has, in the Materia Medica (actual or future), its own par- ticular Alumina, which would effect a cure in as few days, as the most sanguine alternate would expect to accomplish it in months. Having thus shown our belief that the alternation which Dr. Drysdale defends, for the purposes of " meeting compli- cations," and of " awakening susceptibility," is not alter- nation a priori, not alternation properly so called, but is compatible with sound doctrine, although explained by the use of unsound pathological hypotheses, we shall pass, next, to the two general principles on which alternation, properly so called, is really based and defended. Before proceeding further in the discussion of the subject of Alternation, let us briefly recapitulate the positions already taken. I. We have assumed that the propriety of Alternation can be argued about only by those who regard the practice of medicine as an art based upon scientific principles, by refer- ence to which it is to be regulated and exercised. We have not considered it possible to discuss the question with those who make their practice a series of repetitions of individual experiences, without the intervention of general principles based on and inferred from -a large number of individual instances. No discussion can be sustained with this class of practi- tioners, for the reason that argument involves, in its very 192 ALTERNATION OF REMEDIES. NO. 2. nature, an appeal to principle and the exercise of reason. When, consequently, an advocate of Alternation objects to our condemnation of his method, that he regards the subject from a practical point of view, while zvc persist in ignoring the practical, and in looking only at the question as one of science, we feel driven to the conclusion that, if excluded from the ground of scientific principle, we have no ground left on which to stand for the discussion of this or of any question of medical practice; and further than this we have nothing to say. 2. We have stated our belief that many writers have defended, under the name of ALTERNATION, modes of practice which are, in our opinion, not properly called Alternation, and which certainly are not open to the objec- tions that we entertain to what we have defined as ALTER- NATION, properly so called. 3. Defining Alternation, as we understand it, we have taken occasion to state the requirements of a sound homoeo- pathic prescription, requirements which cannot be met by the process of Alternation. We come now, in conclusion, to consider certain state- ments of principles by which Alternation, as we define it, has been sought to be justified and defended. Dr. Coe 1 states : " It is an established principle in Homoe- opathy, demonstrated by drug-proving and clinical experi- ence, that each drug has its own specific sphere and manner of action, hence that each remedy acts in a particular manner upon a particular organ or tissue, or upon a particu- lar set of organs or tissues. Another recognized principle in Homoeopathy is, that attenuated remedies act on the system only by virtue of their homceopathicity to the disease by which the system is at the time affected; hence they are inert when taken by persons in health." [One of our best provings of Natrum muriaticum on the healthy was made by Dr. Wurmb with the joth decimal dilution /] * * 1 American Homoeopathic Revinv, vol. v., p. 447. ALTERNATION OF REMEDIES. NO. 2. 193 " But, supposing I find no single remedy that will complete the picture [corresponding to the picture of the disease] ; some part is still defective — it either wants a head, a body, or a limb, what am I to do ? What I do is this: I finish out the picture with something that will complete it. If the head symptoms are unmistakably Aconite symptoms, and nothing else, the chest symptoms unmistakably Bryonia symp- toms, and nothing else, and the symptoms of the lower limbs unmistakably Rhus symptoms, and nothing else,11 can finish my picture in no other way, nor can any one else. * * But the single remedy objector says, one of my medicines will modify the action of the other in such a manner that I cannot rely upon their doing what their pathogenesis would indicate. I think he is mistaken. If attenuated medicines only act homceopathically, as we all hold, only act upon those organs and tissues which are affected by disease in a manner similar to the drug affection, then my Aconite, Bryonia and Rhus each goes to its own place, and performs its own office, without interfering or being interfered with by the others." Dr. Drysdale appears to agree with Dr. Coe, for he says :2 " There are, therefore, no a priori physiological grounds for doubting that two medicines, whose physiological spheres are sufficiently dissimilar, can display their effects without interference, when given at intervals. Let us apply this to the treatment of complications in disease, and by this we may chiefly understand those symptoms or morbid states that are not necessarily dependent on one common proximate cause, but are connected merely by their happening to co-exist in the same individual." [We protest against this cool 1 Humano capiti cervicem pictor equinam Jungere si velit, et varias inducere plumas Undique collatis membris, ut turpiter atrum Desinat in piscem mulier formosa superne, Spectatum admissi risum teneatis, amici ? Horat. Epist. ad Pisones. 2 Annals of British Horn. Society, xvii., 375. 14 194 ALTERNATION OF REMEDIES. NO. 2. assumption that two or more " morbid states may co-exist in the same individual," connected merely by their acci- dental co-existence !] "After exposure to cold we may be attacked with inflammation of the nasal, tracheal or bronchial mucous membrane, or parenchyma of the lungs or the pleura or the parietes of the chest or the liver or peritoneum, etc., according to the specific susceptibility of the tissues attacked; and each of these diseases may exist separately, and be attended with the appropriate essential and sympathetic symptoms of the case. In such cases we ought properly to rely on one medicine, which may be reasonably expected to meet the specific susceptibility of the part primarily affected. But, on the other hand, from exposure to the same cause, inflammation may be set up in several of those tissues at the same time, and thus several trains of morbid symptoms set up that have no necessary [ would the author have better expressed his real meaning if he had said, pathologico-ana- tomical?' ] connection, except that of occurring in the same individual. In that case, how can any one medicine be homoeopathic to the case which does not show its specific relation to all those different tissues in health ? * * " Dr. Cate also brings forward inflammation of the mucous coat of the colon. When it extends to the peritoneal coat of the gut, he gives Mercurius corrosivus in alternation with Sulphur, corresponding to their specific action on their (these) different tissues. Also in inflammation of the mem- branes of the brain, threatening effusion, he finds Bryonia, alternated with Hellebore, more efficacious than either singly. But this is already recognized in Homoeopathy, without stepping into the doubtful regions of pathology." In discussing these statements we desire to use great mod- eration of expression, conceding freely that they involve questions of pathology and pathogenesy, of which our knowledge is only, and perhaps can be only, proximative, and concerning which, instead of absolute facts, we have only probabilities. ALTERNATION OF REMEDIES. NO. 2. 195 Among those who discuss questions of medical philoso- phy may be distinguished two characters of mind, corre- sponding to similar classes among intellectual philosophers— the analytic and the synthetic. The tendency of the one class is to divide an independent group of phenomena, such as a sick man or a drug-proving presents, into elements each one of which it inclines to regard as independent of the others. To the researches of this character of mind we owe our knowledge of Histology, both physiological and pathological, and much else that is of inestimable value in medical science. The same disposition being carried into clinical investigation, the symptoms of the sick man have been analyzed into the perversions of function of the various organs, and the alterations of the different tis- sues of the body, as well as the formation of tissues not found in the healthy body. As a result, we have the precious sciences of Pathology and Pathological Anatomy. Based, as these analyses are, upon material changes of structure and of product, the danger to which those who engage in them are liable is this: that having their attention exclusively directed to material changes, or to visible and tangible results of material changes, they overlook two points to which it is equally important that observations should be directed. 1st. That inasmuch as healthy tissues exist, and healthy functions are performed, by virtue of an imponderable force called for lack of a better name, " vital force," and which is inherent in each tissue, and gives to it its specific proper- ties, there must have been a change in this force preceding every material change. 2d. That this force, though it seem to impart to each tissue and organ a susceptibility to stimulus peculiar to that tissue, yet so pervades and vivifies the entire organism, as to give rise to what is known as sympathy—a property of living organisms, by virtue of which there results, from the serious modification of any function or alteration of any tissue, a 196 ALTERNATION OF REMEDIES. NO. 2. corresponding and definite modification of most if not all of the functions of the body, and an alteration of at least many of the tissues. It is by virtue of this property that each individual man is a living unit, and not a collection of independent monads, which merely chance to co-exist in one human form. No physical research can detect this vital force, nor reveal the nature or modus operandi of this function of sympathy, and hence it happens that those whose minds incline to rest upon the data of physical analysis are prone to overlook them, or, even though they admit them in their philosophy, yet to practically ignore or underestimate them. From this tendency results a disposition to regard the proximate cause of disease—that is to say, the material change of tissue and product—as the essence of the disease, forgetting the modifi- cation of vital force, which must have preceded and been the occasion of this proximate cause,—and a further disposition to look upon the alteration of function and tissue of each organ or system of the body as a separate disease, thus easily admitting the idea of the co-existence of several independent diseases and of complicating diseases without number. From the stand-point of this class of mind it is not easy to perceive the mutual relations and interdependencies of appar- ently remote groups of symptoms—such, for example, as ulceration of the cervix uteri and chronic conjunctivitis, which, if they co-exist in any patient, would be likely to be regarded as independent diseases, and to be treated by independent courses of medication ; whereas, in fact, they are so intimately connected that they are best treated by a single remedy. Nothing is farther from our purpose than to make light of Pathology, which, as an aid in the investigation of disease, is of inestimable value. It is evident, however, that Hahne- mann was right in warning his disciples against making it the basis of medical practice. Its investigations cannot, in ALTERNATION OF REMEDIES. NO. 2. 197 the nature of things, go beyond material changes. Yet dis- ease begins in dynamic changes; and the connections of different groups of symptoms are dynamic, and beyond the reach of physical research. And then, even where the subject is material and amen- able to physical research, to base the prescription upon a determination of the organ or tissue affected by the drug and by the disease, is to go backward from the certainty afforded by a comparison of the symptoms to the uncertainty of a double hypothesis. For, as in the cases supposed by Dr. Drysdale, we have first to assume that the symptoms pro- duced on the healthy subject by Mercurius corrosivus and by Sulphur respectively, show that the one of these drugs acts especially on the mucous membrane of the colon, and the other on the serous covering of it; and, secondly, we must assume that, in the patient before us, the inflammation which began in the mucous membrane has extended to the serous membrane; and on this double assumption our alternation is to be based and defended. Suppose, that in its progress from within outward, the disease also affected the muscular coat—should we give Nux vomica also ? Or the glands likewise — shall we give a fourth remedy, say, Rhus ? Then the vascular system of the gut is probably simultaneously affected — would this call for Hamamelis, or for Aconite for the arteries and Hamamelis for the veins ? Here we should have six remedies to be alternated, the selection of each being based upon its "specific relation to the tissue" affected, etc., etc. Now, what is all this but a revival of the old method, against which Hahnemann so earnestly pro- tested, of prescribing upon the basis of an hypothesis of the nature and seat of the disease—an utter throwing overboard of the whole system of Inductive Philosophy, as so logically and so successfully applied to medical practice by Hahne- mann ? It may be worth our while to dwell for a few moments longer on this very important branch of the subject, for it is 198 ALTERNATION OF REMEDIES. NO. 2. a point on which very many practitioners have gone astray. Indeed, we have seen an attempt to reconstruct our entire Materia Medica Pura, on the basis of the specific action of the drugs respectively upon certain organs and tissues of the body—almost all symptoms not anatomically expli- cable being excluded (the so-called " American Materia Medica"). The statement of a " general principle," which we quoted, viz., " It is an established principle in Homoeopathy, demon- strated by drug-proving and clinical experience, that each drug has its own specific sphere and manner of action, hence(\) that each remedy acts in a particular manner upon a particular organ or tissue, or upon a particular set of organs or tissues," contains, it seems to us, a fallacy. While we admit, of course, that each drug has its own specific sphere and manner of action, it does not seem to us that this is equivalent to saying that each drug acts in its peculiar way on "a particular organ or tissue, or a particular set of organs and tissues," leaving — (for this is implied in the statement, as the rest of the article from which we quote shows)—leav- ing the other organs and tissues of the body wholly unaffected by the action of the drug or disease, as the case may be. Yet it is necessary to assume this fallacy, in order to justify the practice of alternation. On the contrary, we have never met with, and we do not believe in the possible existence of, a case of sickness in which, as adduced by Dr. Coe, the head could be affected in one way, so as to unmistakably call for Aconite, and yet no organ of the body show Aconite symptoms; while at the game time the chest presented exclusively Bryonia symp- toms, and the extremities Rhus symptoms. The uniform tendency of our own practical experience goes to satisfy us that, if any concrete case should present clear characteristic Aconite symptoms in any portion of the body, then not only would symptoms of disease be found in most of the other important organs or systems, but that these systems would ALTERNATION OF REMEDIES. NO. 2. I99 present more or less well defined characteristics of Aconite: or even should they not present characteristics which we recognize as those of Aconite, the symptoms would never- theless speedily disappear under the use of Aconite, if that drug were clearly indicated by characteristic symptoms in the other organs. So abundantly has our experience con- firmed this view, that if we find clear characteristics of any drug in the symptoms of any organ of the body, no matter what symptoms may be presented by other parts of the body, and no matter how little these latter symptoms may seem to indicate this same drug, we never dream of alterna- ting remedies. We are confident that a remedy which is clearly indicated by characteristic symptoms, though they be but few in number, will cover the whole case, and will remove the entire disease. Nor do we, as is assumed by the alternators, expect to accomplish by "succession" what they aim to effect by Alternation. We so thoroughly believe in the unity of disease as to be confident, that, in however many organs and tissues morbid symptoms may present themselves, they still spring from and depend upon one and the same unknown and inscrutable cause, just as the multifari- ous symptoms of a drug-proving depend upon the one cause. viz., the drug; and that though the characteristic symptoms which furnish the indication for the remedy may be observed only in the symptoms of one organ or system, yet the symp- toms of all the rest of the body will be equally controlled by the action of this remedy. It is remarkable, however, to how great an extent, if we observe carefully and intelligently, we may recognize, in the various groups of symptoms affect- ing the various organs of the patient, the characteristic mode of action, and the conditions of that remedy, the characteris- tic indications for which we find in some one organ alone of the patient! The tendency of the second of the classes of minds into which we divided medical philosophy is to synthesis. They are, perhaps, in danger of underestimating those material 200 ALTERNATION OF REMEDIES. NO. 2. changes of tissue which are the proximate cause of disease, because they are intent upon observing and tracing out that perversion of the vital force which must have preceded and induced all the organic and material changes which the case presents, and which perversion they regard as essentially the disease itself. They study this perversion in its various manifestations, viz., the symptoms. They do not seek to analyze these groups of symptoms, for the purpose of form- ing a theory respecting the tissues affected, so as to select a remedy which affects, as they suppose, identical tissues, and in the same way. They do not thus admit hypothesis into their method. They study the groups of symptoms to get at their peculiarities and conditions. Profoundly impressed with the intimate connection of all parts of the body, through the all-pervading Vital Force (whatever it may be), and with the fact, observed every day, that change of function in one part of the body speedily brings about corresponding changes in almost every other part, they seek, by the light of one group of symptoms, to find in the patient other and corre- sponding groups. In these investigations Physiology and Pathology, which teach the relations and mutual dependen- cies of different organs, are of inestimable value, enabling the student to find in remote organs parallel groups of symp- toms; the characteristic which determines his choice of a remedy being often in an organ very remote from that to which his attention was first called as being the seat of disease. Having thus been led, by his philosophy, to collect the various groups of symptoms presented by the entire body, as constituting one single disease, the practitioner surveys this collection in search of the characteristic symp- tom, or group of symptoms which shall point to his remedy. Ninety of the symptoms might be found among many reme- dies, ten perhaps may be peculiar to, and characteristic of, a single drug. This he selects, without hesitation, as his remedy for the entire malady of that patient. Suppose the patient to have taken cold, and to present, ALTERNATION OF REMEDIES. NO. 2. 201 in consequence, a malady which, anatomically, is made up of a pneumonia and hepatitis. It is all well enough, and doubtless important for the purposes of diagnosis and prog- nosis, to make this pathologico-anatomical analysis of the case. But when we come to regard the case from the stand-point of Therapeutics, we are not surely to follow the plan which Dr. Drysdale seems to sanction, viz., to look among the drugs which are shown by provings to act on the tissues of the lung, and select the best from among them, and then to look among remedies which act on the tissues of the liver, and select the best from among these remedies, and to alternate the two thus selected. What if, as would be likely in such a case, the pleura, likewise, were inflamed ? Should we have a third remedy ? Or the kidneys also ? Should we have a fourth ? " Quousque tandem----" On the contrary, we should collect the various groups of symptoms, as well those from which the Pathologist infers that the tissue of the lung is affected, as those from which he infers that the tissue of the liver is affected. All other symptoms likewise would be gathered. We should examine these symptoms, in the manner so often described, for the purpose of finding in them the peculiar characteristics of some particular drug. In thus dealing with the case, we should have this advantage over the Pathologist, that whereas his inferences may lead him astray, since the lung tissue may not be affected as he thinks it is—and likewise the tissue of the liver—we, on the other hand, taking into account only the obvious symptoms, avoid at least one very patent source of fallacy. Our own experience has alto- gether misled us if we do not find, in the case supposed, that if the lung symptoms give us characteristic indications for a remedy, the liver symptoms not only will not contradict this indication by affording one for some other remedy, but they will corroborate the indication, so as to give us no pre- text for alternating. But another case is supposed, viz., that a pneumonia is 202 ALTERNATION OF REMEDIES. NO. 2. present, and a remedy has been well selected for it, and now a hepatitis supervenes to complicate the case. Here, we are told, is a new disease, which can have nothing to do with the previously existing pneumonia, and which must require a distinct treatment, in the way of alternation. This is in no way different from the complication of a burn, of which we have already spoken. If the complication is serious enough to produce constitutional symptoms (as a hepatitis would surely be), it would always (or our observa- tion has uniformly deceived us) modify all existing symp- toms. For example, a severe burn would give a typhoid character to an existing pneumonia. We must then make a new collection of the symptoms, and proceed as before to select a remedy. Under any other plan — if we are to select our remedy according to correspondence of known drug-action and disease-action upon the tissues of the body—not only are we liable to errors already pointed out, but our scope is wonderfully restricted. How could we find remedies for changes of structure, such as we can never expect to see in drug-provings, such as cancer and heterologous growths of all kinds ? How, for affections which do not depend on or involve any definite known change of tissue, as intermittent fever, epilepsy, hysteria, and the host of chronic ailments ? The two principles on which alternation has been sought to be defended have been stated as follows: 1st. "Each drug has its own specific sphere and manner of action; hence that remedy acts in a particular manner upon a particular organ or tissue, or upon a particular set of organs or tissues." 2d. " Attenuated remedies act upon the system only by virtue of their homoeopathicity to the disease by which the system is at the time affected." The artificial disease intentionally produced by a drug, and the natural disease which results from the usual morbific predisposing and exciting causes may, for all purposes of ALTERNATION OF REMEDIES. NO. 2. 203 argument, be regarded as identical. Principle No. I might, therefore, with equal propriety, be expressed thus: " A disease has its own specific sphere and manner of action; hence that disease acts in a particular manner upon a particular organ or tissue, or upon a particular set of organs or tissues." A corollary of this proposition is, that, inasmuch as the drug and the disease respectively act in a particular manner and upon particular organs or tissues, they leave other organs and tissues of the body altogether unaffected, in their normal state and performing their healthy functions, and liable to be themselves attacked by some other disease, which may affect them in its own particular manner, and may run a simultaneous and independent course. This is the argument for alternation which is constructed upon these principles: a certain disease affects in a peculiar way certain organs or tissues of the body, leaving the other organs and tissues in the fulfillment of their normal functions. Attenuated medicines may be administered to cure this disease. Attenuated medicines " act only by their homoeo- pathicity to the disease." "They are inert" so far as action on the healthy organs or tissues is concerned. Homoeo- pathic medicines act only where, says Dr. Drysdale, they find that preternatural susceptibility to their action, which inheres in organs or tissues diseased in a manner similar to the morbid state which those drugs can produce on the healthy. These attenuated medicines then may be given for the case we have supposed. They will act upon the diseased organs and tissues, but will not affect the healthy ones at all. Now, then, during the existence of this disease, which, as stated, affects in a particular manner certain organs and tissues, and leaves all the rest undisturbed, a second disease may attack the individual (may we call one who may be thus divided up an individual ?) acting in some other par- ticular manner, upon some other particular organ or tissue. 204 ALTERNATION OF REMEDIES. NO. 2. To meet this new disease, co-existent with the original, it is affirmed that a second remedy homoeopathic to it may be administered simultaneously with the former remedy. Or rather, since to administer it simultaneously might involve the risk of the chemical reaction of the drugs, the remedies may be alternated. It will not interfere with the former remedy, because attenuated medicines act only by virtue of their homoeopathicity to the disease (to which they are respectively homoeopathic). Thus each drug " will go to its own place," like the respective members of a well-trained coach team when the winding horn announces that the coach is ready for the new relay ! Such is the argument for alternation succinctly, and, we think it will be conceded, fairly, stated. In a former discus- sion of this subject we showed that, assuming natural disease and drug disease to be, for the purposes of this argument, substantially the same thing, it was proving too much to demonstrate that two or more diseases co-existing in the body could not and do not affect each other. This would render a cure of a disease impossible; for in the act of curing we propose to cure a natural disease by creating in the body a drug disease which shall annihilate the natural disease, and shall, in that very act, be itself annihilated. When a certain form of rheumatism exists in the body, we give Bryonia, and our intention is that Bryonia shall so act upon the body (producing, therefore, virtually, a Bryonia disease) as to cause the disappearance of the rheumatism and at the same time not to leave in its stead a Bryonia disease nor any other disease. But if two diseases co-existing cannot react upon and modify each other, how could a cure take place ? The proposition is evidently too broad; the argu- ment proves too much. Dr. Drysdale provides against this objection by limiting the alleged possible independent co-existence of diseases, to diseases which act in a dissimilar manner upon remote or unrelated organs and tissues. ALTERNATION OF REMEDIES. NO. 2. 205 According to this view, two diseases might co-exist and not modify each other, if seated in organs distant from each other or, which is equivalent, a natural disease may exist, and a drug may be given which acts only upon organs remote from those which are the seat of the disease, and (if the doses be strong enough) may produce its peculiar drug disease without at all affecting the natural disease which is already present. In other words, it is only diseases (whether natural or drug diseases) which are homceopathically related to each other, that are incompatible and may not co-exist without modifying each other. Dr. Drysdale and several other physicians hold these views, and appeal to their own observation and experience. If we may be allowed to draw an inference from Dr. Drys- dale's remarks,1 he believes that a hepatitis may supervene upon an already active pneumonia, and that each may run an independent course, and be treated independently by alter- nated remedies, without modifying each other or blending into one morbid state. Our own experience has led us to very different conclu- sions, and we have on our side the names of colleagues who, not having deviated from the modes of practice observed by Hahnemann's early disciples, do not feel compelled to acknowledge and lament, as Dr. Drysdale does, that their practice is "not proportionally so successful as was that of Hahnemann's early followers.2 How can this direct contrariety of inferences from observa- tion be explained ? We have altogether too profound a respect for the observing and reasoning powers of our dis- sentient friends, to set them a particle below our own ! There must be an opposition in some of our methods of observa- tion, or principles of inference. It will be found, we think, in the fact that to the word "disease" we respectively attach 1 Annals of British Horn. &f., No. iNew Repertory, Introduction. »7> P- 375- 206 ALTERNATION OF REMEDIES. NO. 2. very different ideas. We mean by disease the aggregate of those symptoms presented by the sick man, which are char- acteristic of his particular deviation from a healthy state. The colleagues from whom we differ speak of disease as denoting a definite pathological and pathologico-anatomical change of the functions and tissues of some definite organ or system of organs. In this latter view the patient might present evidence of those pathological changes in the organs and functions of respiration, to which the name pneumonia has been attached. Here then is one disease, pneumonia. He may also present evidences of those pathological changes of function and tissue in the liver which give rise to the name hepatitis. And here would be another, co-existent disease, hepatitis; and these two pathological and pathologi- co-anatomical conditions might, we freely admit, from the pathological and nosological stand-point, run their course to resolution or to destruction without so modifying each other as to coalesce or in any way blend or be confounded ; for the lungs and the liver can never collide. But, let it be borne in mind, we are discussing a question of practical medicine and not one of pathology or of nosol- ogy- How would this case look from our stand-point? The patient has, we suppose, dyspnoea, stitching pain in the thorax, hard, dry cough from tickling behind the sternum, scanty and occasionally bloody sputa—headache on the vertex, and sharp fever. He is worse at night; his pains are much aggravated by motion, and are relieved by repose and by warmth. We have selected Bryonia for him—had previously diag- nosticated pneumonia (physical signs aiding or confirming our diagnosis). Now he gets, in the hepatic region, stick- ing pains, fullness and tenderness; he has bilious vomiting and bitter taste. Aided again by physical signs, we diag- nosticate hepatitis, complicating the pneumonia; but the ALTERNATION OF REMEDIES. NO. 2. symptoms still indicate Bryonia, and so we continue that remedy. But, we shall be asked, suppose the new symptoms do not indicate Bryonia, but, on the contrary, some other drug, will you not give that other drug for the liver and continue the Bryonia for the pneumonia ? To this we reply that in so far as our observation has taught us, in such a case the supervening of these new symptoms (of the liver, namely) will have so modified the whole organism, including the diseased respiratory organs, that Bryonia will no longer be indicated by any symptoms ; but the aggregate of characteristic symptoms of the entire sickness will now indicate some other remedy which will apply to and will cover the whole morbid state of that individual. Here we are again at issue. Dr. Drysdale and his friends appeal to certain observations which we will now briefly discuss. In the discussion which followed the reading of Dr. Drys- dale's paper in the British Homoeopathic Society, Dr. Rus- sell took the same ground as Dr. Drysdale. He said: " That two morbid specific actions could occur simultaneously in the human body, and each pursue its course without arrest- ing or modifying the other, is a proposition entirely at variance with the opinions of the old pathologists who flourished before the time of Hahnemann. * * It is of great importance to us to know whether this pathological doctrine be in accordance with the larger experience and observation to which we now have access." We could hardly have two diseases more specifically distinct than typhus and small-pox, yet, in the following narrative, we have a description of the two running their course, side by side, without either interfering with the other." The case occurred in the London Fever Hospital, and is quoted by Dr. Murchison. Dr. Russell proceeded to say : " There are many instances 208 ALTERNATION OF REMEDIES. NO. 2. of a similar kind on record, and we must frame our theories so that they shall embrace this new category of cases. Suppose we encounter a case, and there are such on record, of a combination of scarlet fever and of typhus, how are we to deal with it ? Are we to engage only one of the two destroying agents, and let the other alone until the first be entirely subdued ? If we believe it is impossible for two medicinal actions to proceed pari passu in the animal economy, this is the rational course to pursue, and the one recommended by Hahnemann!" (This is an inexcusably lax statement. Hahnemann nowhere ever recommended that we should make only a part of the patient's ailment the basis of our choice of a remedy; he always strongly insisted on our considering the " totality of the symptoms," and this would include both scarlet fever and typhus.) But, if two entirely different natural morbid processes can co-exist in the human body without the one affecting the development of the other, what reason is there why there may not be two artificial simultaneous series of morbid phenomena, each equally independent of the other ? If scarlet fever, or if small-pox, can each run its course, while at the same time typhus is doing so likewise, why may not Belladonna and Arsenicum each run their course when given in alternation."1 In reference to this last question, we may ask, would Dr. Russell expect to get pure symptoms of any drug if it were proved simultaneously with another drug; would he believe that the two drug-diseases would run an independent, simul- taneous course in a prover ? Would he practically believe it by consenting to rely upon a materia medica pura made up in this way ? Or, which is the same thing, would he trust to a materia medica composed of the results of an artificial (drug) disease running " an independent course simultaneously" with "a natural disease?" In other words, would he trust provings made on sick persons ? 1 Annals British Homoeopathic Society, xvii.,p. 399 et sea. ALTERNATION OF REMEDIES. NO. 2. 209 We know he would not; for he is one of those who reject or suspect the provings of many of our most val- uable drugs, because symptoms observed on the sick are included in the list, or because the provers were not careful enough to exclude other morbific or toxic agents while proving. But this inconsistency aside, let us take notice that in these remarks, and in this citation of a case of the co-exist- ence of two diseases, Dr. Russell speaks altogether from the stand-point of the pathologist and nosologist, and not at all from that of the practical physician—the stand-point of therapeutics. He thinks he has proved his case if he has established, what nobody is disposed to deny, viz., that two nosological abstractions, called by distinct names (to wit, scarlet fever and typhus), may co-exist. Does he forget that nothing is more firmly established in homoeopathic practice than that the " name " which we may feel authorized to give to a sickness in no wise determines our treatment of the sickness ? Because we call the sickness typhus, we do not therefore, of necessity, give Arsenicum, or scarlet fever Belladonna ! We may as often have to give Arsenic in a case that we should call scarlet fever, and Bella- donna in a typhus. What, then, guides us in selecting a remedy ? Nothing save the aggregate of the characteristic symptoms. We might divide and subdivide the symptoms and signs that the sick man presents (including under the designation " symp- toms and signs " everything that distinguishes that sick man from himself when not sick) into a dozen nosological groups, each having a distinct name, and yet the aggregate of these symptoms might (and we think it always would) point to one single remedy as corresponding to, and indicated by, the entire morbid state of that sick man. To prove his case by the argument and instances quoted, Dr. Russell must show that the symptoms of the scarlet fever and of the typhus, respectively, were incompatible in 15 2IO ALTERNATION OF REMEDIES. NO. 2. the case cited by him, and that they did not combine to present the characteristics of one common remedy. For this is the point of the whole discussion. No matter how many of the pathological groups which are dignified by the names of distinct diseases may co-exist in a patient, if they be so blended and mutually modified as to indicate, in the aggregate, one single remedy, there can be no call for alternation. Inasmuch as Dr. Russell rests his argument for alternation on the possible and frequent co-existence of distinct, specific forms of disease, it is incumbent on him to show that these co-existent, distinct forms of disease do not, by their co-ex- istence, modify each other and blend into one harmonious aggregate of symptoms, the characteristic ones of which may be covered by a single remedy. In our experience this has always seemed to be the case, and we shall adduce other evidence to the same effect. But before citing authorities, let us point out how far Dr. Russell's argument, even allowing it full force, comes short of being a defense of alternation, as it is actually practiced here and in England ! Dr. Russell allows it where " two distinct, specific forms of disease " co-exist, such as scarlet fever or small-pox and typhus—a phenomenon that no physician in ordinary family practice is likely to observe more than once a week! Yet how -many times a day do a majority of our colleagues alternate? It is safe to say that, with very many, the giving a single remedy is the infrequent exception! Their case is exactly met by the following remarks of Dr. Russell, one of the champions of alternation: "The objection usually urged against alternation is that it leads to laxity of practice. True, if we give two medi- cines instead of one and let the system take its choice, as it were, to which it shall submit—if, in a given case, for example, we find two medicines pretty nearly indicated, and, instead of ourselves selecting the one and rejecting the other, we toss them both in, trusting that the right one will act, ALTERNATION OF REMEDIES. NO. 2. 211 and the other be a nonentity or negative quantity. No ONE WHO DEALS CONSCIENTIOUSLY WITH HIMSELF WILL DELIBERATELY APPROVE OF SO SIMPLE A METHOD OF EVADING THE DIFFICULTY OF CHOICE." A few instances and citations may serve to recall to the minds of practitioners of medicine, the frequent instances in which two varieties of disease, co-existing, modify each other. A young person whose parents died of consumption, and who has himself had abscesses of the cervical glands and eruptions of the face and who takes cold readily—is feeble and pale—who, in short, has scrofulosis and is a pre- destined victim of consumption, gets an attack of enteritis or of pneumonia. Is it not notorious that the joint action and reaction upon each other, of this chronic scrofulosis and the acute enteritis or pneumonia, will be such that instead of the acute affections running the short and sharp course which they would follow in a robust subject, they will almost surely degenerate into tuberculosis of the mesenteric glands with colliquative diarrhoea, and of the lungs, respectively? And would any one dream of treating these acute affections in such a subject just as they would treat them in a subject otherwise and previously healthy? But why not ? Because the previously existing disease modified and (so far as symptoms are concerned) blended with the acute attacks. No doubt one single remedy will cover this blended case. When a patient has suffered from paroxysms of intermit- tent fever, and on the cessation of their regular recurrence he is still sallow, feeble, dyspeptic and full of malaise, there can be no question that he still suffers from the disease—the result of marsh miasm. If now this patient get a pneumonia or a neuralgia, here will be a second and a distinct and dissimilar disease co-existing with the former. So different, however, will be its course from what it would have been in a patient not laboring under miasmatic disease,—so blended will it be, from the beginning, with the latter,— that, though 212 ALTERNATION OF REMEDIES. NO. 2. a wholly distinct "pathological form" of disease, it will require the identical treatment of miasmatic disease and will yield to nothing else. The same thing is eminently true of syphilis in the system. Bonchut says:x " Syphilis, herpetism, scrofula, the marsh- miasmatic disease, etc., often appear under forms not habitual. * * * We imagine that we are deal- ing with acute or chronic inflammations, and we treat them as such until, some day, changing our method, we see them recover, one under Mercury, another under Sulphur, another under Sulphate of quinine, another under Iodine, etc. Is there anything stranger than those observations in marshy countries, where pneumonia, fever, encephalo-meningitis, are cured by Quinine rather than by blood-lettings and by antiphlogistics ? " Another instance of the modifying power of two morbid influences co-operating on the same individual is furnished by the fact that when an epidemic prevails not only are almost all healthy persons, to some extent, affected by the epidemic influence, but the maladies of all sick persons, whatever their nature may be, are modified and changed into a greater or less conformity with the epidemic, what- ever it may be. Dr. David Hosack uses these words:2 " The fact stated by Sydenham and other writers on epidemics, that the prevailing disease swallows up all other disorders; that is, that during the prevalence of an epidemic plague, typhus, dysentery or other diseases of this class, every indisposition of a febrile sort readily assumes the character of the prevail- ing disorder. We know this to be experienced in the diseases of other countries, and we see it daily exemplified in our own." Homoeopathicians especially, since their observations are finer and are less exposed to fallacy from drug-poisonings, 1 Pathologic Ge'ne'rale, p. 269. z Copland's Diet. Pract. Med., 2, 404, note. ALTERNATION OF REMEDIES. NO. 2. 213 have opportunity to make observations of this kind, and they have often noticed how, at one season and under one epidemic, a single drug or group of drugs corresponds to the most diverse pathological forms of disease, while at other seasons and under other epidemic influences, very different groups of remedies are indicated by the same pathological forms of disease. And we believe that most Homoeopathicians who have dealt much with chronic cases, must have fallen in with patients who labor under such a constitutional affection as herpes or cancer, and which, under favorable circumstances, is kept in a latent condition by the occasional use of some clearly indicated remedy. If these patients get an acute disease of whatever kind, this disease is almost sure to present, at an early period, symptoms which indicate this same remedy that suits their chronic malady. Does not this argument a posteriori show that these two independent, co-existent maladies blend and modify each other, at least in the view of the therapeutist ? The entire homoeopathic doctrine of chronic diseases, and the use and necessity of so-called antipsoric remedies, are based upon this same idea of the mutually modifying influ- ence of two co-existent maladies. Hahnemann says he found that in some persons acute disorders did not yield promptly to remedies which seemed indicated and which quickly cured them in others. On examining closely he found these patients presented, in the present or in the past, symptoms indicating their infection by certain miasms which he reduced (whether rightly or not is immaterial) to three miasms—psora, syphilis and sycosis. He sought for remedies which would meet the indications of these chronic miasms and the acute affections combined, and this led him to prove, and use the remedies known as the antipsorics. Our success with those remedies might be taken as another a posteriori proof of the blending of two co-exist- ing diseases. ALTERNATION OF REMEDIES. NO. 2. Dr. Drysdale, apologizing for the practice of alternation, says: "We have not a few examples where the patient has, through ignorance or design, unknown to us, taken large doses of heterogeneous drugs, such as Quinine or Opium or purgatives, and yet our higher dilutions have taken effect notwithstanding. On this subject Trinks confirms Kampfer's remark, that, in chronic diseases which have been long treated with excessive doses of allopathic medicines, we often find a great susceptibility to the action of homoeopathic medicine." Are these writers to be understood as maintaining that chronic drug-poisonings, such as the mercurial, the sulphur, the iodine, the quinine, the iron or the opium cachexy, do not cause acute disease to be most difficult of cure ? The contrary is notoriously the case, as the literature of phy- sicians of every school abundantly shows. How can this be, unless the artificial chronic disease, viz., the cachexy, blend with, and modify, the supervening acute, natural disease ! These remarks might be extended to great length by mul- tiplied instances. They suffice, however, to show distinctly the practical conclusions to which, what we conceive to be sound principles, as. well as accurate observation, have led us. With them we conclude what we have to say concerning the alternation of remedies, taking our leave of the subject in the spirit of Bishop Chillingworth's declaration : " I will take no man's liberty of judgment from him ; nei- ther shall any man take mine from me. I will think no man the worse man, * * I will love no man the less for differ- ing in opinion from me. And what measure I mete to others I expect from them again." EDITORIAL REMARKS ON ALTERNATION.1 I. We publish with great pleasure articles which, like the above, though they seem to favor a practice which we depre- cate, are, nevertheless, honest expressions of the earnest convictions of men of close observation and faithful study. Nothing could be farther from our intention than to undertake to dogmatize on this question, which we admit to be an open question, and on which men of eminence enter- tain opinions at variance with our own. It may be allowed us, nevertheless, in all courtesy to our contributor, to signify the points on which we take issue with him. I. We assuredly do entertain the belief that "two or more medicinal forces (or, we prefer to say "morbific forces") cannot together act upon the economy without so modifying each other that neither shall produce the effect it would if only one were acting." This belief has prevailed among medical men from the earliest ages. It is the foundation of the practice of polypharmacy in all its varieties, from the complex prescriptions of the seventeenth century to the alternations of our own colleagues. For we hold, with Dr. Sorge (by no means a Hahnemannian, let us add), that " the practice of alternation, as it exists among homoeopa- thicians, is only another form of mixing remedies with the intention of getting an effect compounded of the action of the two or more drugs that are alternated." We say, this belief is the foundation of polypharmacy. The rationale of a compound prescription we take to be the following: the drug which is regarded as the one chiefly 1 Suggested by a contribution by Dr. H. to the American Homoeopathic Review, vol. v., February, 1865. 216 EDITORIAL REMARKS ON ALTERNATION. indicated possesses, let us suppose, certain properties which would be hurtful to the patient. Another drug is conjoined with it for the purpose of antidoting those hurtful proper- ties. Again, it lacks the power to produce certain effects which are deemed desirable. Another drug is added to supplement this deficiency, and so on, ad infinitum. This entire procedure rests on the belief that these medicinal forces will so modify each other in the economy that neither shall produce the effect it would if only one were acting. As an example, we mention calomel and opium, a very familiar combination. Certainly the object of giving the opium is that it may modify the action of the calomel, and in a way which conforms to the known action of opium when given alone. If there were no reason to believe that " two or more morbific forces (a drug is a morbific agent exciting a morbific force) could not together act upon the economy, without so modifying each other that neither shall produce the effect it would if only one were acting," how could we ever cure disease ? The morbific force which constitutes the disease is acting upon the economy, and we bring to bear upon the economy another morbific force, viz., a drug. Now, if the latter be properly selected with reference to the former, we know that these forces will so modify each other that, on the one hand, the manifestations of disease will cease, and on the other hand, the drug will not produce pathogenetic symptoms as it would on the healthy subject. This state- ment rests on the basis of such "facts" as our friend invokes. On what other theory than the mutual modification of mor- bific forces acting together upon the economy could it be explained ? On what other theory could we explain the action of antidotes as homoeopathicians understand and employ them ? How else could we explain the action of Belladonna, in large doses, in antidoting poisonous doses of morphine1 as 1 American Journal Medical Science, January, 1862. EDITORIAL REMARKS ON ALTERNATION. 217 well as the mutual antidoting powers which allopaths have recently discovered, many of the cerebro stimulants and spinant alkaloids to possess ? How else, finally, could we explain the efficacy claimed for the practice of alternation in general and for certain instances of it in particular, such as the cases related by Dr. H., and which we fully credit, where Belladonna and Bryonia in alternation accomplished what neither could do singly, and where Arsenic and China in alternation cured a case which neither alone had cured ? How else but by conceding that two or more medicinal forces cannot act together upon the economy without so modifying each other, that neither shall produce the effect it would if only one were acting ? The fact that medicinal or morbific influences must be avoided when we are engaged in proving drugs is universally admitted; even Dr. H. assented to it. But on what other grounds than the belief already stated ? That persons long accustomed to use tobacco or coffee are not easily affected by drugs is accounted for, probably, by the fact that long habit has, in so far as those persons are con- cerned, caused tobacco or coffee to cease to be " medicinal forces." Use has become "second nature." That in per- sons not accustomed to the use of coffee, a dose of it will modify the action of another morbific, or medicinal, force is demonstrated by the effect of coffee antidoting opium, Nux vomica, alcohol, as well as in neutralizing the beneficial curative action of many drugs, as our clinical observations often satisfy us that it does. The same statements apply to tobacco. 2. We think we may then assume, as conceded, the fact that "two or more medicinal forces cannot at the same time act upon the human system, without mutual modification." It is now asked, whether granting this modification, we may not avail ourselves of it to derive, from the alternate use of drugs which modify each other, good effects that we have attained in no other way? There can be no doubt of the 218 EDITORIAL REMARKS ON ALTERNATION. possibility of this being done, no doubt that it has been done with advantage; as, indeed, Dr. H. shows by two instances. But, in the present state of our science, it would be impos- sible for any one to lay down rules for the selection of reme- dies to be given in alternation, with the view of gaining any desired modification of the action of each. Nor can we con- ceive of the possibility of arriving at any such law. The rule of the ancient polypharmacy, viz., to select remedies according to the effects which they produce singly, and to combine them with reference to the effect desired, does not always work well in practice. For example, calomel and opium produce a combined effect, which is clearly a modifi- cation of the known action of each drug. But on the other hand, the combined action of opium, ipecacuanha and the sulphate of potash in Dover's powder is quite distinct and different from that of either constituent alone, and is such as could hardly be anticipated from what we know of these constituents. Arsenic and China produced a combined effect which cured an ague that neither singly would cure. Now, if this fact were to be taken as a guide in selecting a combination for a case of uterine disease, for example, in which we were at a loss to decide between Sepia and Pulsatilla, it might lead us to alternate those two remedies. But it is not three months since one of us took charge of a case in which this alternation, on this very ground, had been employed, but the patient had not recovered. We were led to the conclusion that the Sepia was really the remedy indicated — that it did good, but that its effects were constantly antidoted by the Pulsatilla. We omitted the Pulsatilla, gave Sepia judiciously, and the patient promptly recovered. When, in addition to this difficulty arising from the fact that alternated drugs do not always produce a morbific action which can be predicated in advance from their known single action, we consider that the various degrees of suscepti- EDITORIAL REMARKS ON ALTERNATION. 219 bility of the organism to drugs indicated with different degrees of accuracy, will cause the modification by drugs of each other's action to be different in each individual case, we clearly see that we can never be in a position to predicate, in advance, the effect of the joint administration of several drugs. We can never, therefore, have a scientific indication for such a combination or alternation. If we make it, it must always be the result of "guess-work"—of "feeling our way along," just as Dr. H. did in the cases he relates. But we claim superiority for Homoeopathy in that it gives us the means of selecting our remedies with a reasonable certainty of their effects, and we rightly claim that medicine should not rest content with anything short of a method which, given the symptoms of a disease, points us to a cer- tain remedy if our materia medica contain it ; or, given the pathogenesis of a drug, indicates to us, a priori, the complex of symptoms which the drug will remove. But the method of alternation throws us back from all such certainty—back to the field of unmethodized clinical experience—back to the trackless wilderness of polyphar- macy and allopathy. For these reasons, briefly and imperfectly stated, from the stand-point of science we hold that homoeopathic medicine cannot countenance nor tolerate alternation. And we have such a faith in the unity of nature as to believe that what sound reasoning shows to be erroneous, accumulated facts will prove to be mischievous and unnecessary. 3. But there is another view of this matter from the practical stand-point. Dr. H. says : " Grant that in a given case of the use of two remedies, some one remedy might have been found that would as well, or better, have answered the purpose * * * the question is not, Could some other person have done better than I, but Have / done the best I could ? Undoubtedly, yes ! And, so far as the prescriber's own conscience is concerned, this answer exonerates him, even though his prescription were a faulty 220 EDITORIAL REMARKS ON ALTERNATION. one. And in so far, from the practical point of view, alter- nation may be justifiable. But will this question, ' Have I done the best I could ?' if affirmatively answered, always justify the prescriber? The practitioner of one year's experience may commit a sad blunder and yet be fully justified, because being inexperienced and young, bad though his error was, he did 'the best he could.' Would this plea justify the same blunder ten years later ? Obviously it would not. Yet is it not the tendency of this plea to satisfy a man with the knowledge he has and with the methods he pursues, and thus to blunt his zeal for greater knowledge and better methods ? Remonstrate with the allopathist for murdering patients with lancet and purge; he replies, ' I act according to my light; I do the best I can.' And so through all degrees of error and imperfect knowledge. It is a dangerous plea, unless its complement be always added, ' I have done the best I can, but, please God, I will do better next time !'" And here we see the advantage of a sound "theory," which our friend holds in so light esteem. Suppose a practitioner driven, as Dr. H. was driven, to alternate. The patient recovers. He has, nevertheless, a conviction that drugs modify each other's action in a way that we cannot foretell, and that the action of the entire organism is so harmonious that " two morbid states cannot co-exist independently," and that, therefore, the morbid state being essentially one, there must be a possibility of one similar drug-disease to oppose it. A sound theory compels him to the belief that alternation is not justifiable nor defensible on scientific grounds, and that it can do nothing to advance our knowledge of Therapeutics, but rather con- fuses it. He enters in his mind a protest against the practice to which the necessities of practical duty and his limited knowledge of the materia medica have constrained him, and turns with redoubled vigor to the study of materia medica, smarting a little with shame that the exigencies of practice EDITORIAL REMARKS ON ALTERNATION. 221 have found him unprepared, and have compelled him to a resort which, though successful, his reason condemns, and determined that the next time he will, if possible, be equally if not more successful, and by a method which shall commend itself to his reason, and shall add to his stock of knowledge for future use. And if, while " doing the best they can," as each case presents itself, practitioners will earnestly and systematically study the materia medica, determined to do better and better the next time, we shall have no word of reproach to utter against their temporary expedient of alternating drugs. With broader knowledge they will alternate less and less, and we are very sure that they will see, as we have done, how, in case after case in which they had alternated, the recovery was in truth retarded by the mutual reaction of the drugs; and how the careful individualization of the case, and the painstaking selection of the single drug in the manner that Hahnemann advised, will be in their hands the means to a success far beyond any ever reached through alternation. For, though we have admitted and do admit that success is often attained through alternation, and that " success is the object of all our labors," we are nevertheless convinced, through our own experience,—for we have alter- nated in our day,— that a much larger measure of success is obtained by adherence to the rule of administering single remedies, and that closer study of the materia medica and sharper investigation of cases will preserve us from those dilemmas in which we are tempted or compelled to resort to alternation. 4. And if we appeal to the experience of Hahnemann, let it be understood that we appeal to the man who both knew materia medica better than any other man ever knew it, and who had more practical experience than any of us has had. Let us not indulge in the fallacy of supposing that, because we are now practicing in the fifty-ninth year since the Organon was published, we have had fifty-nine 222 EDITORIAL REMARKS ON ALTERNATION. years' experience in homoeopathic practice, and have been studying materia medica fifty-nine years. On the contrary, our own experience is measured only by the actual number of years we have practiced ; since in this matter of assimila- ting to one's own mind the facts of the materia medica, and of seeing the correspondence between these and the facts of the disease, we can borrow but little from the experience of others. If then we, from our little experience of fifteen, or ten, or five years, appeal to Hahnemann with his venerable experience of more than fifty years of active practice, with his unapproachable knowledge of the materia medica, of which he might justly say like JEneas, " magna pars fui," with his unrivaled powers of observation and discrimination; if we appeal to him as "authority" on this question, at once practical and scientific, can it justly be said, that we are seeking some "authority outside of and beyond our own reason?" Our colleague appeals to collections of "facts." Is not Hahnemann's statement of his practical conclusions a most stupendous "collection of facts?" Who ever observed so many of them ? Who ever observed so well as he ? Facts must be received on testimony; who ever reported more graphically and more faithfully than Hahnemann ? If we doubt his ability, his capacity, his candor, what are we doing with his materia medica, on the truth of which we risk our patients' lives ? This outcry against "swearing in the words of the master" has come to have a very different meaning from that of the ancient original protest. It was never meant to intimate that the opinion and testimony of him whose abilities had crowned him "king of men" should not have a royal weight of influence. EDITORIAL REMARKS ON ALTERNATION.1 II. This article very justly affirms that the question of alter- nation, being a practical one, " must be decided by experi- ence ; " that no dogmatism will satisfy those differing in opinion. The writer then straightway proceeds to dogma- tize on the basis of two assumptions, which he claims to be " established principles in Homoeopathy," but which very few will concede in the terms in which he has expressed them. Having referred the question to experience, he makes no appeal to experience, whether his own or his neighbor's- If he have experience which can throw light on this question, it ought to be comparative experience. He ought to be able to say: " For a certain period of times I avoided alterna- tion, selecting my remedies as Hahnemann directs ; then, for a period I alternated. My success under the latter method was the greater." Such a statement as this would carry weight. But we gather from this article that the author has always practiced alternation, deriving his ideas of its pro- priety and necessity from the assumed "established prin- ciples " upon which he bases his arguments, and upon the assumed imperfections of the materia medica. If our conjecture be correct, then his experience, being confined to the practice of alternation and not bearing upon the opposite method, can have only a negative value. It merely shows that a measure of success does attend this faulty form of practice, a point which was freely conceded to Dr. H.2 But inasmuch as no advocate of alternation claims invariable success, the question remains, " Might not the 1 Suggested by a contribution by Dr. C. to the American Homeopathic Review, vol. v., April, 1865. * See previous paper. 224 EDITORIAL REMARKS ON ALTERNATION. success have been greater if alternation had been avoided? " Not having any comparative experience by the light of which to answer this question, the alternator ab initio, could not reply. Our editorial note to Dr. H.'s paper expressly referred to Hahnemann's experience, and to the experience of the writer, as being of this comparative character, and as, there- fore, bearing on this question, and as showing, so far as they go, that the results of adherence to the single remedy are more satisfactory than those of alternation. Some of the points touched by Dr. C. are too important to be treated in this annotation. They will be discussed in a future number of the Review} Suffice it now to say that, when he states that " the only reason why he practices alternation is the want of perfection of the materia medica," he concedes (if he will allow us to add one other analogous reason, viz., " want of perfection in the knowledge possessed by practitioners of the materia medica which we already have") all that the opponents of alternation contend for. For this position admits that alternation is wrong in principle, and is only necessitated by a temporary emergency. We contend that the emergency, instead of being common, is rare, if not altogether imaginary, and we appeal to our practice. How dangerous it is to discuss a question of science with rhetorical figures ! Dr. C. makes merry over his imagined double-headed monster, for each head of which he provides a club, and he grows happy at the thought that by his two-handed energy he will have destroyed this figurative disease much more quickly than the luckless editor could do it, whom he restricts to the use of a single club to be applied to but one head at a time. Now, we have always supposed that the efficacy of an armament depended not so much upon the number of 1 See "Alternation of Remedies," Nos. i and 2. EDITORIAL REMARKS ON ALTERNATION. 225 efficient weapons as upon the skill with which the weapons existing were used, and one club in a vigorous right hand might do more execution even on a double-headed monster than two clubs even in the hands of our ambidextrous cor- respondent. But why restrict the monster to the "two- headed " form ? If we are to admit the dual or multiple independent co-existence of disease, why not liken it to a centipede, each foot "possessing independent vitality?" With what armament now will our friend cope with his antagonist ? Shall he call Briareus in consultation, and arm him with one hundred clubs ? We do not believe in the multiple co-existence of disease. Leaving out of view traumatic affections which may supervene during idiopathic sickness, as Drysdale shows, we believe in the unity of disease, and we expect to find one remedy of which the characteristic symptoms cover the whole case. The figure of the two-headed monster is, therefore, in our view, defective, but, admitting the figure, why must we use clubs at all ? In the days when brute force reigned supreme they were well enough. But surely in this day of enlightenment "clubs are not trumps." Hercules was the embodiment of brute strength as dis- tinguished from intellectual acuteness and skill. Surely his subjugation of the Lernean Hydra should not serve us as an example in treating disease. We cannot afford to spend so much time as the club treatment requires; for both the experience of Hercules, and that of our Irish friends at Don- nybrook Fair, prove that the breaking of heads by clubs is a tedious and uncertain affair. We decline to enter into competition with our friend in the use of his favorite thera- peutic agent, the club, whether he use it single, double, or a hundred fold. But, if he insist on a mechanical figure, we will suggest that, while he is counting the heads of the monster and is casting about in his club-room for a bludgeon adapted to each head, and is fitting his hand, for the arduous effort, and is so getting his balance as to make sure that the 16 226 EDITORIAL REMARKS ON ALTERNATION. complex wielding of his numerous weapons shall not trip him up, we shall humbly survey the monstrous form with the intent to study the controlling characteristics of his anatomical structure, and when we shall have learned to what type he belongs and what are his characteristics as an individual, then with one single weapon (a slender sword, it may be, or a bodkin, or a drop of prussic acid), we shall touch the vital part (the heart, or the medulla, or a delicate mucous membrane) on whose integrity depends the life of all the heads and all the rest—and presto—before the ponderous clubs have time to fall on those devoted heads "belaboring them simultaneously"—the work is done ! Multiplicity in armament is generally inconsistent with simplicity and efficiency, and is characteristic of a barbaric age or race. Thus the double-club array is known as the " Indian Clubs." The Japanese wear two swords, and yet cannot stand a moment before the single rapier of the Frenchman. The savage of the Southern States glories in his belt full of six-shooters, and his boot-legs bristling with bowie-knives. Before the single purpose of the Northern Farmer he is rapidly passing into the realm of history. THE USE OF HIGH POTENCIES IN THE TREATMENT OF THE SICK. Having been honored by the President of the Society1 with an appointment to report on the use of High Potencies in Chronic Diseases, I trust it may not be considered an unwarrantable presumption if, for the following reasons, I venture to modify, to a slight extent, the theme assigned to me. First. The subject contemplates a report of a practical nature. But from the stand-point of practice, I think that a clear and well-defined distinction between acute and chronic diseases is not possible. If we attempt to base such a distinction upon the element of time alone, paying regard only to the duration of the disease, it cannot be made at the beginning of the treatment, and cannot therefore be of any practical value in determining the potency to be used. If we base the distinction upon a pathological conception —that is, upon the presumed existence in the patient of some dyscrasia, diathesis or miasm — it is equally impossible, at least in very many instances, to make it at the commence- ment of an illness. It is a matter of common remark that cases which begin without any sign of miasmatic or dyscratic complication often develop in their course unequivocal evidence of such complication, so that a case which would, in the outset, have been regarded as, in this sense, unquestionably acute, proves in its course to be unmistakably chronic. Second. Furthermore, the subject as stated, involves a kind of petitio principii. To require a report on the " Use 1 The Homoeopathic Medical Society of the State of New-York, Oct., 1863. 228 THE USE OF HIGH POTENCIES of the High Potencies in Chronic Diseases" is in some sort to imply that these potencies are especially useful and appropriate, if at all, in the treatment of chronic diseases as distinguished from acute diseases—an implication which it is true corresponds to a very widely received opinion among those physicians who have but little practical acquaintance with the action of the high potencies, but which, as we shall see, is not supported by the results of experiment. By the kind indulgence of the Society, then, I shall beg leave to report on the " Use of High Potencies in the Treat- ment of the Sick." No question connected with Homoeopathy has given rise to more vigorous controversy or to more earnest partisan feeling than that concerning the infinitesimal dose. The most bitter opposition of the Old School to Hahnemann was based on this question. It has been also the chief ground of division and contention among homceopathists them- selves. After an animated disputation covering a period of more than fifty years, there seems now, however, to be a cessation of hostilities between the advocates and opponents of the higher potencies. There seems to be a mutual disposition to suspend the discussion hitherto maintained chiefly on hypothetical grounds, and to appeal in good faith to the "ultima ratio" — experiment. The times are favorable, therefore, for a quiet survey of the field and for a dis- passionate estimate of the experimental knowledge of which the practical labors of our colleagues have put us in pos- session. It is probable that Hahnemann was never what could be called an "heroic prescriber." In his work on The Venereal Disease, published 1789, before he had discovered the hom- oeopathic law of cure, he portrays the evil effects of exces- sive doses of mercurial preparations, and speaks of radically curing some cases of syphilis by the use of a single grain of IN THE TREATMENT OF THE SICK. 229 Mercurius solubilis in divided doses; and says that eight grains thus administered will often be sufficient to cure "very severe cases of syphilis." Compared with the practice of his contemporaries, these are almost infinitesimal prescriptions. In his first essays upon the homoeopathic law, Hahnemann advises the administration of doses but little, if any, smaller than those he had previously used. We first meet with the recommendation to use infinitesimal doses in the essays on "Scarlet Fever," published in 1801, but referring to cases treated in 1799. He here advises Belladonna and Chamo- milla to be given in preparations which correspond pretty nearly to the third centesimal dilution. It pleases Dr. Dudgeon to suppose that "this sudden change," as he calls it, from material to infinitesimal doses, was a matter of expediency and policy rather than of con- viction on the part of Hahnemann, inasmuch as it coincided in point of time with the prosecutions of Hahnemann by the apothecaries. But there is no evidence that the change was so very sudden as to require such an explanation. Even so short a period as one year spent in constant practice might be suffi- cient to satisfy so acute an observer as Hahnemann, that remedies given according to the homoeopathic law must be given in very small doses. The whole career of Hahnemann is a consistent protest against the adoption or renunciation of any procedure con- nected with the practice of medicine, on grounds of mere policy or expediency. Hahnemann's long life was a con- tinual sacrifice of ease and prosperity and highly prized friendships to his convictions of truth. While therefore, during a period of twenty years he submitted to be driven from city to city rather than renounce the right of dispensing his own medicines, is it at all probable that he devised the method of diluting or potentizing remedies and insisted on the superiority of potentized remedies, simply, or in any degree from motives of expediency ? 23O THE USE OF HIGH POTENCIES In subsequent essays Hahnemann advises still more dis- tinctly the administration of potentized remedies, and in the first edition of the Organon, published in 1810, he says: "Scarcely any dose of the homceopathically selected remedy can be so small as not to be stronger than the natural disease and not capable of overcoming it." About the same period he advises the use of the ninth dilution of Nux vomica and the eighteenth of Arsenic. In the earlier volumes and editions of the Materia Medica Pura, Hahnemann recommends a particular dose for each remedy. Some remedies are to be given in the first dilution, some in the third, some in the ninth, some in the fifteenth, some in the twenty-fourth, some in the thirtieth. In subsequent editions of the Materia Medica and in the work on Chronic Diseases, Hahnemann, as is well known, advises that all remedies be given in a uniform dose—the thirtieth dilution. In the latter years of his life he speaks of using with great success the sixtieth, one hundred and fiftieth and three hun- dredth dilutions, and it is well known that during these years he did not confine himself to a uniform dose, but used in some cases the lower potencies, and in some the very highest. It is not unworthy of remark that as Hahnemann's prac- tical experience in the treatment of disease increased, so did his estimate of the advantage and necessity of using higher dilutions, in at least many cases, likewise increase. The promulgation of the dynamization theory by Hahne- mann, and his adoption of the practice of giving infinitesimal doses, were the occasion of the most violent denunciation of Homoeopathy by his professional opponents. Indeed, to this day, this really subordinate department of the method is regarded by allopaths as the essential feature of Homoe- opathy ; and to a superficial observer it would seem as if the infinitesimal dose were almost the only obstacle to a blend- ing of Homoeopathy and the so-called Physiological School of Medicine. IN THE TREATMENT OF THE SICK. 231 The progressive advocacy by Hahnemann of the higher dilutions, and especially the introduction by Korsakoff of what are technically known as the "high potencies" (the one hundred to fifteen hundredth) gave rise, as has been said, to a lively and bitter and decidedly personal contro- versy among homceopathists. In every party or school which is still a minority, there are always Conservatives, who regret the necessity which compelled a separation from the party or school of the majority; who strive to make that separation as little decisive and marked as may be; who stoutly oppose any measure which would tend to increase the division or to make it irremediable ; and who hail with delight almost any project of compromise or reunion. There are also Radicals, whose turbulent nature revels in the sensation of opposition; whose tendency it is to lay more stress on points of differ- ence than on points of coincidence; who, having once separated from the majority, will not only entertain no thought of a reunion with them, but consider that fidelity to the principle on which their separation was based, requires that the separating chasm should be made continually wider. They seem to glory, not so much in the truth for the sake of which they separated, as in the mere fact of separation. These two classes are necessary in every progressive school. The Radicals furnish the propelling force—the steam. The Conservatives supply the restraining and moderating influence—the fly-wheel. Among the followers of Hahnemann, the Radicals and the Conservatives were the respective parties to the contest about the potentization theory; and in weighing the argu- ments which each side brought forward, we must not lose sight of the respective tendencies of these two parties. The law, Similia similibus curantur, which is the essence of Homoeopathy, was not an absolute novelty in medicine. Indeed, Hahnemann's first argument in favor of it was drawn from the records of medicine. He showed that, in all 232 THE USE OF HIGH POTENCIES ages, many cures had been made in accordance with it. He proved that his contemporaries, often unwittingly and some- times consciously, applied it in treating the sick. To urge its admission as the universal law of cure was, therefore, simply to advocate the recognition, as a universal truth, of that which was already received by medical men as, at least, a truth of partial and limited application. Accordingly, the opposition to Hahnemann was, at the very first, moderate. It was somewhat of the nature of a demand for more conclusive testimony. Men of conservative tendencies might very consistently, at this time, have become homceopathists; for it was not unreasonable to anticipate, at some period in the not dis- tant future, a universal recognition of the homoeopathic law of cure and a consequent reunion with the dominant power. But the dynamization theory was in irreconcilable opposi- tion to all the notions of Hahnemann's opponents. It taught that doses inconceivably small were sufficient to effect radi- cal cures in acute and dangerous diseases—that such doses were even more efficacious than larger ones. It taught that instead of the curative power of the drug being directly in proportion to its material quantity, there was reason for believing. that, to some extent, at least, the converse was true. There could be no such thing as a compromise on this question. Truth lay either with Hahnemann or with his opponents. It could not lie between them. To maintain this dynamization theory would be to make the separation between homoeopathists and the dominant school of medi- cine perpetual and irremediable It is easy to perceive what sort of a reception was likely to be accorded to the dynamization theory by the Conserva- tive homoeopathists. They could not regard it without unfavorable prepossessions. If compelled at last to admit its soundness, this would not be until irresistible testimony in its favor had been amassed—nor even then without regret IN THE TREATMENT OF THE SICK. 233 for the fact and deprecation of the obstacles which it created in the way of a reunion with the Old School. All their a priori assumptions would be unfavorable to its validity. The Radicals, on the other hand, would receive with joy this additional element of difference from the Old School of medicine. They would advocate it with enthusiasm. Their a priori arguments would lend it a vigorous support. Thus in relation to a question that can be settled by experiment alone, and by a course of experiment requiring careful unprejudiced observation through many successive years, we have all the conditions requisite for an ardent con- troversy at the very outset, before any valid evidence could possibly have been gathered by either party. We shall be less surprised at the vigorous opposition to the dynamization theory, if we recollect the condition of medicine and pharmacy at the beginning of the present century. The posology of that period was decidedly heroic. Drugs were given in the crudest forms. Pharmaceutical chemistry had not yet discovered the essential principles of drugs, the use of which at the present day has made doses of the one-fourth, one-eighth, or one-twentieth of a grain familiar even to practitioners of the Old School. The microscope was still a rude and primitive instrument; quantitative chemical analysis had not attained any great development; much less was there any thought of applying, as is now done, the reactive susceptibility of the living organism to detect, through its specific affinities, particles of matter so small as to elude the microscopist and the chemist. In fact the doctrine of the extreme divisibility of matter rested, at that time, rather on the speculations of the meta- physician than on the demonstration of the naturalist. For this very reason, on the other hand, the speculations of the metaphysician had at that period the wider scope and the greater authority. And thus it was very easy for some of Hahnemann's more radical followers to erect on a 234 THE USE OF HIGH POTENCIES figurative illustration used by him in the Organon a " cloud- capped" theory of the transplantation of the medicinal force from the substance of the drug to the substance of the vehicle used for dilution, and upon the basis of this airy hypothesis to explain all manner of supposed action and reaction of drug-spirit upon diseased force, etc., etc. These considerations will, I think, justify us in passing over with scarcely a word of comment all that was so copi- ously written on the subject of the dose, from the date of Korsakoff's first publication to the date of Dr. Trinks' public letter to Dr. Stens in 1859. The principles involved in the question of the efficacy and advantages of high potencies are these: 1. The curative power of a properly selected drug is not in the direct ratio of the quantity of the drug. 2. The process of potentization which Hahnemann in- vented, develops a curative power in substances, which in the crude form, manifest no such power; and it increases the curative power of drugs which in the crude form do manifest a curative power. Now, although these principles had been satisfactorily established, one would think, by the successful use of the third or sixth potencies, long before the controversy about the " high potencies " began, yet it will be perceived that almost all the objectors who began to write after Korsa- koff's publication and Hahnemann's cautious and conditional approval of it, derive their arguments from considerations of the probable quantity of the drugs which these high potencies might contain. Thus we are cautioned, even by those who admit that higher potencies have curative powers, that they are not to be trusted in acute diseases which have a rapid course, because, as Dr. Scott expresses it, " in these diseases the vital forces act with exaggerated energy and to act upon them, we require a greater amount of medicinal power, that is, a lower dilution." This statement, it will be perceived, regards the curative power as directly propor- IN THE TREATMENT OF THE SICK. 235 tioned to the quantity of the drug, and begs the whole question at issue. But when Hahnemann had shown that a more efficient curative power was exerted by the first dilution or tritura- tion, or even by drop doses of the mother tincture of drugs than by massive doses, as he had done to the satisfaction of all homoeopathists, long before the higher dilutions were ever made, he had demonstrated that the curative power of drugs is not in the proportion of their material quantity, and had thus established the first principle of the dynamization theory. When, furthermore, he showed to the satisfaction of all homceopathists, that substances which in their crude state exert no medicinal power, such as gold, charcoal, tin, com- mon salt, etc., etc., do, after dilution, trituration or potenti- zation, come to possess a medicinal power, he demonstrated, in part, the second principle of the dynamization theory. These demonstrations removing the question of dose entirely from the domain of mechanics, in which power is directly proportioned to quantity, left the whole question open for experiment. The points to be determined were these: 1. The curative power of a drug not being directly pro- portioned to the quantity of the drug, what relation does exist between this power and quantity ? What effect does a continued diminution of quantity exert upon the curative power of the drug ? 2. It being admitted that the potentization process does develop the curative power, what are the limits of this development ? What varieties in the nature and extent of this developed power are produced by various degrees of potentization ? Obviously these questions were to be solved only by a long course of methodical experiment. While the controversy on hypothetical grounds was being carried on by the Conservative and Radical homce- 236 THE USE OF HIGH POTENCIES opathists, reports of cases were accumulating in the homoe- opathic journals, which furnished indisputable testimony to the action of the higher potencies. Among those who pub- lished these records, the names of Gross, Stapf, Hering, von Boenninghausen, ^Egidi and Nunez are conspicuous. Their testimony was disputed on various grounds. Against some cases it was urged that they were inconclusive, since it was not clearly shown that the cure resulted from the remedy given and not rather from some hygienic prescrip- tion or restriction resorted to at the same time. Such criticism is legitimate, and cases to which it is fairly applica- ble must be excluded. Against other cases it was urged that the data were not so fully recorded as to enable the reader to make sure of the diagnosis. I do not think such criticism as this is admis- sible, unless in a very few cases. The value and authority of clinical records always depend on the reputation of the reporter for knowledge, accuracy and integrity. Now, whether, in reporting a case of alleged pneumonia, the reporter simply state that it was a case of pneumonia, presenting such or such characteristic symptoms, or whether he present a minute and elaborate detail of all the rational and physical signs of the patient, obtaining by the aid of auscultation, percussion, mensuration and chemi- cal and microscopical analysis—in either case, we have nothing to depend upon but the scientific capacity and the integrity of the observer. If he have these qualities in a sufficient degree to obtain with certainty the requisite physical and rational signs on which to base a trustworthy diagnosis of pneumonia, his statement of this diagnosis will be sufficient without the details. If he have them not, no details which he might pretend to give would be deserving of the slightest confi- dence. These considerations annihilate the objection made by Dr. Watzke to cases published by Gross and Boenning- hausen in the Archiv. IN THE TREATMENT OF THE SICK. 237 In general, however, it were well to exclude, provisionally at least, all cases of doubtful diagnosis. While cases demonstrating the value and efficacy of the high potencies were accumulating, a few cases were also published in which, the higher potencies having been used without effect, a lower potency or a crude dose of the same drug effected a cure. Dr. Black relates that in a case of headache Lachesis30 only produced symptoms of nervous dis- turbance, while Lachesis6 effected a cure. Dr. Trinks records a case which had been treated by Hahnemann for nearly two years with Rhus in a higher dilution without effect, and which he himself cured within a few months by repeated doses of the mother tincture of Rhus. The angry controversy was brought to a temporary close by Dr. Trinks' public letter to Dr. Stens, in which he states: " I was born a skeptic. As to the wonder cures (cures by the high potencies) published in the journals, I can only say, I do not believe a word of them." "Non credo quia impos- sible est," seems to be the creed of Dr. Trinks—the impossi- bility consisting in a mere assumption, on his part, that such preparations cannot possess any power. This same argu- ment— "non credo"—may, with equal force, be urged by the allopathists against the first or third dilutions, which Dr. Trinks is in the habit of using. The argument proves too much. If Dr. Trinks may dismiss with " I don't believe it," the testimony of those who advocate the high potencies, on the same grounds may these reject his accounts above referred to, of the cases in which he alleges that the lower potencies were efficacious where the higher had failed. But the opponents of the high potencies were not content with seeking to invalidate the testimony of the advocates of these preparations. Some of them presented records of cases in which they had made unsuccessful trials of the high potencies. Of these, many were no doubt made in good faith, and must be accepted as evidence that there 238 THE USE OF HIGH POTENCIES are cases in which the high potencies fail to cure. But the majority of these records are like those of Dr. Watzke, referred to by him, in the CEsterreichische Zeitschrift, vol. ii., where he says, the patients on whom he tried the high poten- cies suffered for most part from diseases in which there was little reason to expect a favorable result from any remedy, in whatever dose, for, he says, they were cases of "dis- solving pulmonary tubercle, of fungoid tumor of the brain, of cerebral and pulmonary apoplexy, of spinal paralysis, of chronic hydrocephalus, valvular insufficience of the heart, of fibrous tumor of the uterus, etc., etc. Yet, no doubt, Dr. Watzke is one of those who would exclaim against the unfairness of Andral in pretending to test Homoeopathy in the Paris hospital, by giving a single dose of a homoeopathic remedy to a patient laboring under incurable disease! Dr. Watzke himself, though so bitterly opposed to the advocates of high potencies, is constrained to state in his resume of the proving of Natrum muriaticum, in the fourth volume of the Austrian yournal, " I am, alas ! — I say, alas ! for I would much rather have upheld the larger doses which accord with current views<—I am compelled to declare myself for the higher dilutions. The physiological experi- ments made with Natrum muriaticum, as well as the great majority of the clinical results obtained therewith, speak decisively and distinctly for these preparations." This is strong language from an avowedly unwilling witness ! The conclusion to which an impartial estimate of the evidence concerning the high potencies, up to the year 1850, would lead, is well and justly expressed by a writer in the British yournal of Homoeopathy, vol. v., p. 154: " 1. The high potencies do act. " 2. They act sometimes very energetically. " 3. They often act curatively with surprising rapidity. " 4. They sometimes cure where the lower dilutions have failed—though the evidence on this point is scanty." IN THE TREATMENT OF THE SICK. 239 The same writer gives the following points as still requir- ing to be proved: " 1. That the higher are always to be preferred to the lower dilutions ; or that they are generally to be preferred to them. " 2. That they will oftener succeed in curing than the lower." To these points may be added the question which at that time was still an open question, viz., whether the higher potencies were applicable and trustworthy in acute as well as in chronic diseases. During the last twelve years a large mass of evidence of a most interesting and conclusive character has been accu- mulated on this subject. Of so much of this as was fur- nished by European observers, I proceed now to give a brief summary. Inasmuch as the question has been the subject of somewhat earnest personal controversy among ourselves, and "scars may yet be tender," I prefer to pass by, for the present, with a few trifling exceptions, all that has been contributed by American practitioners. I shall pass over also all endeavors that have been made to explain or to limit by hypothetical reasoning on physiological premises, the action of the high potencies. The question is purely a practical and experimental one. One assumed explanation, however, of the action of dyn- amized remedies should be noticed, inasmuch as it will enable us to state distinctly what we mean by a higher potency. It has been alleged that, admitting that an apparent devel- opment of curative power does result from the potentizing process in the case of some drugs at least, such as Silex, Gold, Natrum muriaticum, etc., this is simply because this process renders soluble these substances which, in the crude state, are insoluble, or that it reduces the size of their particles to such an extent that these particles are capable of entering the smallest blood-vessels, and of thus coming into contact with the diseased tissue and of acting directly upon it. This 240 THE USE OF HIGH POTENCIES curative power which is pretended to be developed by potent- ization is, they say, simply a facility of action produced by minute subdivision. Hypothetical explanation does not alter facts. If, how- ever, the above were the sole explanation of the action of potentized remedies, then it should result that the highest development of the curative power should be reached in that dilution in which the particles have been reduced to a size appreciably less than that of a blood corpuscle. And, indeed, this ground has been taken by some writers. Now, arithmetical calculation, as well as microscopic observation, fixes upon the third centesimal dilution as that in which the above degree of subdivision has unquestionably been attained. If this view were correct, then, dilutions higher than the third should not display a curative power; or if they do display such power, it should not be in any case superior to that of the third dilution. Now, if it should chance to result from actual, incontro- vertible experiment, that potencies higher than the third do display, with rare exceptions, a greater curative power than the third or lower potencies, this superiority must be directly attributable to the process of potentization. I deem it right, therefore, to call all those potencies above the grade of that of which the action admits a mechanical explanation—" the higher potencies." The term will apply, in this view, to all above the third centesimal. In 1850 Drs. Wurmb and Kasper took charge of the Leopoldstadt Hospital, in Vienna. Their views on the subject of the dose were no secret. They had no faith whatever in the higher potencies. They were physicians of much more than ordinary scientific attainments, and of great devotion; and Dr. Wurmb, at least, had few superiors in an exact and thorough knowledge of materia medica. In their "Clinical Studies," published in 1852, they thus express the posological views with which they entered on the charge of the Hospital: IN THE TREATMENT OF THE SICK. 241 " We have given almost always the thirtieth decimal dilu- tion, and only exceptionally a higher or a lower dilution. * We propose to adhere to this dilution for two years longer, then to give another dilution for an equally long period, and finally to give for a similar period still another dilution. Such experiments as these are indispen- sable to the solution of the question of the dose, but mani- festly they are valid only in the case of disease with regard to which the preliminary question, What can Nature do, and what can Art ? has already been definitely answered, and in favor of the latter?" Here is the plan of an experiment which, if faithfully carried out, gives promise of some very conclusive data on the subject of the dose. Such questions as this require for their solution a multitude of instances such as can hardly be gathered in private practice. But a hospital affords an appropriate and sufficient field for their collection. The hospital of Dr. Wurmb is the only one which has been devoted to such uses. Before the expiration of the three periods, of three years each, involved in the plan as above stated, Dr. Kasper was succeeded by Dr. Martin Eidherr, who has published in the CEsterreichische Zeitschrift, for 1862, the result of the ten years' experiment. It seems that in i860 the Austrian Homoeopathic Society of Vienna proposed as a subject for consideration the ques- tion of the dose, inviting all homoeopathists of all countries to take part in the discussion. A large number of responses, both verbal and written, were made to this invitation, some of which are published in the, Austrian yournal, for 1862. Dr. Eidherr, the Editor of the Journal, remarks: "These discussions have, as is well known, led as yet to no positive result, because they rest exclusively on subjective grounds. While some record most brilliant cures effected only by the higher dilutions, others narrate similar cases cured only with the lower. Consequently, the society regards the question 17 242 THE USE OF HIGH POTENCIES as still an open one and calls for further communications on the subject." At this point it was suggested that the material in the shape of clinical records which had been for ten years accu- mulating in the archives of the Leopoldstadt Hospital might, if collated, throw some further light on the subject. Dr. Eidherr undertook the task. He resolved to confine his investigations to a single disease, pneumonia (which by the way is very prevalent in Vienna), for the reason that the diagnosis of this disease is easy, and that, by means of the physical signs, its course and progress and decline may be more accurately followed and observed than is the case with many other acute diseases. During the ten years, from 1850 to 1859 inclusive, all cases in the Leopoldstadt Hospital had been treated for the first three years with the thirtieth decimal dilution, for the second period of three years with the sixth, and for the remaining four years with the fifteenth decimal dilution. It was pro- posed to compare the results of the treatment of pneumonia during these three periods. But, in order to avoid La fallacy in drawing conclusions from this comparison, it was necessary, first, to inquire whether the Genius Epidemicus was the same for these three periods, or, if not the same, how great an influence, and in favor of which period, did the difference exert? To meet this preliminary question, Dr. Eidherr made a study, first, of those conditions which favor the origin and spread of pneumonia : and, second, of the prevalence and course of pneumonia in the great General Hospital of Vienna during the same periods of time. The first section of his treatise consists of tabular state- ments of the meteorological phenomena of the decennium in question, and of the relations of these phenomena to the prevalence of pneumonia as observed in the great General Hospital of Vienna. The second section comprises short and succinct accounts IN THE TREATMENT OF THE SICK. 243 of the cases of pneumonia treated in the Leopoldstadt Hospital during the three periods into which, as already stated, the decennium was divided. The third section contains a statement of the results of the treatment by the different dilutions used during the three periods in question, taking into account the modifying influence of the different atmospheric conditions of these periods. The cases occurring during the three periods of time into which the whole period of ten years was divided, are called by Dr. Eidherr—Groups 1, 2, 3. Group No. 1, embracing the years 1850, 1851 and 1852, was treated exclusively with the thirtieth decimal potency. Group No. 2, embracing the years 1853, 1854 and 1855, was treated exclusively with the sixth decimal potency. Group No. 3, embracing the years 1856, 1857, I^S^ anc» 1859, was treated exclusively with the fifteenth decimal potency. A careful estimate of the different meteorological con- ditions of these epochs leads Dr. Eidherr to the conclusion that during the first epoch the atmospheric conditions were most favorable to the prevalence and severity of pneumonia, and therefore the least favorable for the treatment; during the second epoch least favorable for the spread and severity of pneumonia, and therefore the most favorable for the treatment. In observing and recording cases of pneumonia in this hospital, the physical signs have always been carefully noted. and records have been made of the following points in the history of each case : 1. The seat of the infiltration. 2. Its duration, reckoned from the time at which it was first perceived to the time at which it was noticed that it began to be resolved (?). 3. The time at which resolution of the infiltration began. 4. The time at which resolution was completed. 244 THE USE 0F HIGH POTENCIES 5. The time at which all physical signs disappeared. 6. Duration of convalescence. The comparison between the three groups is made with reference to all of these points. The results are stated as follows : Group 1, treated with the thirtieth decimal dilution ; The average duration of the infiltration was three days. The average date of commencing resolution was the third day. The average date of completed resolution was 4.9 days from the beginning. The average date of vanishing of the physical signs was, as concerns the infiltration, 7.1 days; as concerns the exuda- tion, 12.3 days from the beginning. The average duration of convalescence was 4.4 days. Group 2, treated with the sixth decimal dilution during the years 1853, 1854 and 1855 ; The average duration of the infiltration was 4.1 days. Resolution began, on the average, in 3.5 days, and was complete in 6.9 days. The physical signs disappeared, on the average, as concerns the infiltration, in 9.3 days; as concerns the exudation, in 20.5 days. The duration of the convalescence was, on the average, 5-3 days. Group 3, treated with the fifteenth decimal dilution, during the years 1856, 1857, 1858 and 1859; The average duration of infiltration was 3.4 days. Resolution began in 3.2 days. It was complete in 6.3 days. The physical signs disappeared, so far as the infiltration was concerned, in 10.3 days; so far as the exudation was concerned, in 18.1 days. Average duration of convalescence, 4.8 days. To recapitulate the above— IN THE TREATMENT OF THE SICK. 245 The average duration of the infiltration was : For Group 1, 3.0 days. 2, 4.I 3, 3-o " Resolution began: For Group 1, on the 3d day. 2, " 3.5 " 3, " 3-2 " Resolution was complete: For Group 1, on the 4.9 day. 2, " 6.9 " 3, " 6.3 " The physical signs of the infiltration vanished: For Group 1, on the 7.1 day. 2, " 9.3 " 3, "< 10.3 " The physical signs of the exudation vanished: For Group 1, on the 12.3 day. 2, " 20.5 " 3, " 18.1 " Dr. Eidherr gives also a tabular statement of the average number of days during which each case of each group remained in hospital—that is, the total duration of each case from its reception to its dismissal, as follows: Group 1, treated with the thirtieth decimal dilution; fifty- five cases were treated; their aggregate residence in the hos- pital amounted to 680 days; or an average of 11.3 days each. Group 2, under the sixth decimal dilution; thirty-one cases, 606 days; an average of 19.5 days for each case. Group 3, treated with the fifteenth decimal dilution; fifty- four cases, and 795 days; an average of 14.6 days for each case. 246 THE USE OF HIGH POTENCIES I now proceed to give as briefly as possible the conclusion to which Dr. Eidherr is led by this careful study of his statistics. He says: "This is the most extensive experiment that has ever been made, bearing on the question of the dose. Its subjects were 107 cases of pneumonia. Each case was the subject of careful investigation. Every imaginable care was taken to obviate every source of fallacy." The experimenters were not radical homceopathists. Their prepossessions were rather against the high potencies. I can bear personal testimony to the fact that, in 185 1, while the thirtieth dilution was the standard used in the hospital, Dr. Wurmb frequently expressed himself as believing that statistics would decide in favor of lower dilutions. It was not known how statistics had decided until Dr. Eidherr made the analysis from which I have quoted, and which shows that in every point of view the action of the thirtieth dilution, in so acute and dangerous a disease as pneumonia, is more certain and more rapid than that of the fifteenth or the sixth dilution, and that the fifteenth is preferable to the sixth dilution—or, to translate the decimal into the centesimal scale, the fifteenth is better than the seventh, the seventh than the third. Against this record Dr. Trinks would raise in vain his cry "non credo." If we refer now to the points which were stated in 1850 as still requiring to be proved in relation to the high poten- cies, we find the third question satisfactorily solved by this experiment in the Leopoldstadt Hospital. For the exper- iment proves beyond a doubt, that the higher potencies are applicable and trustworthy in acute as well as in chronic diseases. It enables us also to give a probable affirmative answer to the first question, and to say that the higher are, at least so far as pneumonia is concerned, to be preferred to the lower dilutions. The second question, viz., whether higher dilutions will IN THE TREATMENT OF THE SICK. 247 oftener succeed in curing than lower dilutions, is left unaf- fected by this great experiment. Let us now recapitulate the points at issue. I think we may safely state that, up to the present time, experience has established these facts: that the continued diminution of the material quantity of a drug through the process of potentization does not diminish the curative power of the drug when homceopathically applied; that, on the contrary, the process of potentization does positively increase the curative power of a drug when homceopathically used; that this increase of curative power is progressive, as far at least as the fifteenth centesimal dilution, and is demonstrated in the treatment of both acute and chronic diseases. It was incumbent on the advocates of the higher potencies to demonstrate not only that these preparations are effica- cious, nor simply that they are equally efficacious with the lower potencies, but that they are superior in efficacy. This has been shown by the Vienna experiment up to a certain degree. The seventh centesimal has been shown to be superior in the treatment of pneumonia to the third, and the fifteenth to the seventh. There, is a natural desire to find the limit of potentization. The Vienna experiment gives us no reason to suppose that this limit has been attained in the fifteenth potency. Many most eminent practitioners assert for what are technically termed the "high potencies," as great a superi- ority over the fifteenth and thirtieth as the latter have been shown to possess over the third. Cases are accumulating in our journals which go to corroborate these assertions. We cannot refuse to believe these narrations. While they have not yet established a general superiority of the "high potencies" (sixtieth to two hundredth) over the fifteenth and thirtieth for the treatment of all cases, acute and chronic, they nevertheless prove beyond dispute that the rapid and permanent cure of both acute and chronic diseases is within their scope. 248 THE USE OF HIGH POTENCIES They establish, moreover, the fact that in many cases these high potencies (the two hundredth, for example) cure diseases in which the lower potencies of the same drug have failed. The determination of absolute superiority and of definite limits of increase of curative power, is impossible from our present data. Among those who have long used the high potencies (in particular the two hundredth), Dr. von Boenninghausen stands pre-eminent. It is true that his practice lies chiefly among chronic diseases. Nevertheless, many acute diseases are treated solely in accordance with his directions. He has for many years used exclusively the two hundredth potencies. His increasing fame and practice attest the validity of the services which he renders to those who consult him. The high character which he has always borne as an acute and sagacious observer of natural phe- nomena, the unblemished reputation which he has sustained throughout his long and eventful life, cause his observations and his statements to be received with implicit reliance and belief by all who are at all cognizant of his social position. He does not hesitate to express a decided conviction of the great superiority of the high potencies over the lower, in both acute and chronic diseases. Dr. JEgidi, who, after having, on their first introduction, spoken favorably of the high potencies, retracted to some extent this good opinion, has recently announced as the result of a long course of experiment in his private practice, embracing the history of more than 4,000 cases, a clear and unequivocal preference for the high potencies in both acute and chronic diseases. Dr. Battman has, within the last two years, published a series of cases of severe membranous croup, and of very dangerous acute pulmonary affections, cured in a marvelous manner with the two hundredth potency; and basing him- self on these narrations, he makes a warm protest against IN THE TREATMENT OF THE SICK. 249 the irrational conduct of those homoeopathists who, at the same time that they object to the illogical conduct of the allopathists in refusing even to listen to any evidence in favor of Homoeopathy, obstinately close their own ears to all that is alleged in behalf of the high potencies. Of six physicians of Austria and Hungary who presented written essays on the question of the dose to the Vienna society, none denied the curative action, often prompt and surprising, of the high potencies (one hundredth to the three hundredth) in both acute and chronic diseases. Only one expressed a doubt that they were in any case superior to the lower potencies. Two did not hesitate to claim such superi- ority for them in decided terms. Dr. Wurmb, the head of the Leopoldstadt Hospital, states1 that often remedies in the higher dilutions act, where the lower dilutions of the same remedy had failed to act. He gives an instance in which Belladonna100 effected a cure in chronic migraine, in which a lower potency of the same remedy had failed to do any good. The one hundredth and two hundredth potencies are now not infrequently adminis- tered in the Leopoldstadt Hospital. Dr. Wurmb remarks2 that " since he has had experience with the one hundredth dilution prepared by Dr. Eidherr, and has satisfied himself of the wonderful effects which often result from them, he prescribes them in suitable cases with greater preference than the thirtieth or any other potency." He does not state what he considers to be "suitable cases." It is probable that he does not consider his experience to be great enough, as yet, to justify him in laying down any general rules on the subject. It is likely that he decides for each particular case, according to his view of probabilities, and that he cannot always give a clear reason for his preference of one potency over another. Each case thus treated may be regarded as in some sort an experiment—a contribution to that multitude of instances from an analysis of which we 1 CEst., Zeit., I. 158, 1862. s Loc. cit. 3, p. 137. 250 THE USE OF HIGH POTENCIES may hope to deduce, at some future time, a general law of posology. If, after this general view of the evidence on the subject of the high potencies, it be appropriate for me, on such an occasion as the present, to state my own experience and methods, it may be done very briefly. Before I had fairly entered to any great extent upon the responsibilities of the practice of medicine, I had the advan- tage of observing the practice of some very eminent physi- cians and of listening to the counsel of others. Not to mention American physicians, I heard in England chiefly the advocates of the low and the lowest potencies. The high potencies were at that time rarely mentioned in England except in terms of ridicule. And the contempt which the assumed non-material nature of these potencies inspired in the matter-of-fact mind of that taurine nation- ality, whose devotion to the pound avoirdupois is even greater, if that were possible, than to the pound sterling, was cordially extended to the intellectual acuteness and the scientific acquirements of all who believed in these potencies and who used them. Since that period the cause of the high potencies has been nobly advocated in England, by a few of those strong men, who are the true glory of the nation. Passing from England to Westphalia, I enjoyed free arid full and long-continued opportunities to observe the practice of Dr. von Boenninghausen, who used the two hundredth potency exclusively. There was, certainly, in his practice, less parade of scientific auxiliaries than I had seen at the English hospitals or in the English dispensaries ; but I do not think the diagnosis was less accurate on that account. I am very sure that the success of the treatment left but little to be desired. Though some acute diseases were here treated with high potencies under my observation, yet the majority were chronic cases, and, deeply impressed with the great responsibility involved in my judgments, I was hardly ready, from these observations, to conclude on the advantage of IN THE TREATMENT OF THE SICK. 25 I using high potencies in a general practice. Nevertheless, the effect of these observations was such as to satisfy me of the efficacy of the higher potencies in all forms of diseases. The question remained, "Are they superior to the lower?" Stapf, who was then living in retirement, counseled me to use the high potencies in chronic diseases, and thought the medium potencies were all that could be desired in acute diseases. He had no statistics of comparative observations by which to justify his opinions. In Vienna, Wurmb and Kaspar were in the middle of the first epoch of the decennium of which Eidherr has given us the analysis. They were treating all diseases with the thir- tieth decimal dilution. Their examinations of patients were minute and masterly, their prescriptions careful, their suc- cess very striking. Fleischmann, at the same time, was giving the mother tincture or the lowest dilutions. His diagnosis was careless, his success neither rapid nor, except as compared with heroic allopathic treatment, very striking. His prescriptions were not accurate. He did not individualize his cases, but pre- scribed according to a coarse and rude generalization. On the subject of the potency, his opinions, I learned from him- self, were immovably made up. I perceived that he had ceased to be capable of learning, although he still lived; that, in knowledge, as in stature, he had attained his growth; ossification was complete in his perceptive intellect no less than in his physical skeleton. In Paris, Tessier was treating acute diseases in the hospital Ste. Marguerite with the sixth, twelfth and fifteenth dilu- tions. His success exceeded that of Fleischmann. It was inferior to that of Wurmb, but it was easy to perceive how inferior he was to that excellent physician in minute and comparative knowledge of the materia medica. In Paris, Dr. Perry was prescribing at his dispensary the two hundredth potency, with but few exceptions, in all forms of disease. The reports indicated a very wonderful success, 252 THE USE OF HIGH POTENCIES but, from the nature of a dispensary practice, this could not be made the subject of exact observation. My conclusions from all these observations were favorable to the high potencies, so far as to admit their energetic action on acute as well as chronic diseases and their general supe- riority in the treatment of the latter; but I was not satisfied that they were so trustworthy, as a general rule, in the treat- ment of acute diseases as to be preferable to the lower poten- cies. I therefore began, in my own practice, with the use of the lower and medium dilutions (third to twelfth and fifteenth) in acute diseases. When very sure that my selection of the remedy was entirely correct and that the case would not suffer should my first prescription prove inert, I ventured, during the first few years of my practice, to give a high potency in acute diseases. I now look back on this period with wonder that the idea of a definite and direct relation between the curative power and the material quantity of a drug should have been so hard to eradicate from my mind. Experience of the action of the higher potencies, on my own person, in very acute illness, first fully convinced me— perhaps, because, in my own case I took the risk of trying the experiment more freely and fully than I had ever done in the case of others. For the last five years1 I have used the high potencies (two hundredth of my own manufacture and of Lehrmann's, indiscriminately) in all forms of disease that occur in a general practice. I am very sure that my practice has grown more successful every year. While I trust that an increasing knowledge of the Materia Medica may have con- tributed greatly to this result, I cannot be mistaken in the belief that much is also due to my more and more frequent use of the high potencies. I cannot say that every prescription has done everything I expected or hoped from it. Nobody's practice can be 1 Written in 1863. IN THE TREATMENT OF THE SICK. 253 free from painful failures. In such cases, wherever I have been tolerably sure that my choice of remedy was correct, I have repeated the same remedy in a higher or lower potency as the case might be, and while I have collected from my practice many instances in which a high potency has acted promptly where a low had failed to act, I have noted only one case in which a high potency acted but inefficiently while a lower gave prompt and complete relief. From my own experience, then, the presumption would lie in favor of the high potencies in both acute and chronic diseases. A few instances will serve to illustrate what has been said. They are presented only as illustrations, by no means as the evidence on which my convictions rest. A gentleman who had suffered many years from necrosis of the femur was subject to acute attacks of periostitis. The twelfth potency of Asafcetida was found to relieve his suffering, and repeated doses of it generally effected a cure within three or four days. After treating several attacks in this way, I gave him, at the commencement of a fresh attack, a dose of Asafcetida200. The cure was effected in the space of six hours. A difference so remarkable was very obvious to the patient, who, learning from me the difference between this and my former prescriptions, requested to be treated always thereafter with the two hundredth. Here, whatever cavils may be raised about the diagnosis or other points, the fact remains incontestable, that attacks which required for their cure several days and repeated doses of Asafcetida12, were cured in six hours by a single dose of the two hundredth. Could it be that repeated treatment of these attacks had modified their severity, and that the ameliora- tion chanced to coincide, in point of time, with the change of potency ? To satisfy myself on this point, I once reversed the experiment, and without my patient's knowledge gave the twelfth instead of the two hundredth potency. The attack came on with its ancient severity and persistence, 254 THE USE OF HIGH POTENCIES much to my patient's disgust, who was abundantly satisfied , with the high potency, but much ashamed of my want of confidence. Even after I had become quite satisfied of the superiority of high potencies in most acute diseases, I yet hesitated to employ them in a malady so fearful and so rapid as croup. In this I still adhered to the low (the third) dilutions of Aconite, or Spongia, or Hepar, as the case might require, or to the watery (first centesimal) dilution of Bromium or Iodine, if these remedies were indicated. Notwithstanding I had actually witnessed most surprising success in Dr. von Bcenninghausen's practice with the two hundredth potencies in severe croup, I hesitated to use them. I argued to myself: "These low potencies have served me well. The majority use them. I do not know that the high are better, even if they be as good. The success with thepi may be exceptional. I dare not risk the loss of time which would accrue from an unsuccessful experiment with them." Thus it turned out that I never used the high potencies until, three years ago, in the most severe case of membran- ous croup I ever saw, the low potencies in which I had always trusted failed me utterly, and I knew not what else to do. A resort to the use of the two hundredth potencies of Aconite, Hepar sulphuris and Spongia saved my patient from this extremity of danger, and satisfied me that a trial of the high potencies in the outset of an attack of croup, instead of involving a risk of wasting time, does in truth obviate such a risk from the employment of the lower potencies. From this time on, in the treatment of croup, I have uniformly begun with the two hundredth potency of whatever remedy was indicated. My success has been more uniform and much more rapidly attained than ever before. My first use of a high potency of Bromine was accidental. Called to prescribe for a severe case of croup, in which that remedy was indicated, I found that the crude substance or a low dilution was not to be obtained. I had the two IN THE TREATMENT OF THE SICK. 255 hundredth potency in my pocket-case. I gave it with a result equally happy, and much more speedy than I had ever before witnessed. This was altogether contrary to my preconceived notions concerning Bromine, and it summarily upset a very pretty chemical theory I had formed. As already remarked, I have sometimes met with facts of a contrary significance. In a case of chronic asthma, of great severity, I have recently found Glonoine of the greatest service. I first prescribed the sixth potency, having no other at hand. When the action of this dose was exhausted I gave the two hundredth. The result was by no means satisfactory. The sixth again produced happy effects as before. Repeated experiments of this kind convinced me that in this instance the high potency did not act so favor- ably or so efficiently as the low. Whether this peculiarity should be accounted for by assuming an idiosyncrasy on the part of the patient, or a peculiarity of Glonoine which renders it incapable of high potentization, or whether the action of the Glonoine in this case will prove to have been only palliative, and therefore temporary, is a question which can only be solved by a wider experience than I possess in the use of various potencies of this new but valuable remedy.1 But this fact that a low potency succeeded where a higher had failed, together with similar facts reported by other prac- titioners, must have a bearing upon general conclusions. In conclusion, I think the following statements are war- ranted : 1. In prescribing, the first essential is the correct choice of the remedy. The second point—which is also, in many cases, though not always, essential—is the judicious choice of the potency. 'The subsequent history of this case recurred with its original severity, and confirms the suspicion that the great no form of Glonoine (nor of any other relief afforded by Glonoine was pallia- remedy that I tried) availed to give live. After a few months the disease relief. 256 THE USE OF HIGH POTENCIES. 2. That, in both acute and chronic diseases, the prefer- ence, other things being equal, is to be given to the higher over the lower potencies. The experience of Wurmb shows that, in severe pneumonia, the fifteenth is to be preferred to the seventh and the seventh to the third (centesimal). I should go further and say that, in general, preference should be given to still higher potencies, even to the two hun- dredth. 3. Experience shows that, while the majority of cases, both acute and chronic, are cured more speedily by the high than by the lower potencies, yet, in some cases, the converse is observed. No explanation of this difference has been discovered, nor can its occurrence be foreseen in any case. While therefore the presumption, in every case, being in favor of the high potencies, the treatment should be begun with them, nevertheless, should no favorable result ensue, recourse should be then had to lower potencies, provided always there be a reasonable certainty that the remedy has been rightly selected. 4. The question, whether the " high potencies " are more generally successful than the lower, and in what proportion they are so, is yet to be determined by statistics drawn from methodical experiment. 5. A general law for the a priori selection of the potency suitable for a concrete case, if such a law be possible, is yet to be discovered REPLY TO A LETTER ON HIGH POTENCIES. The questions contained in the following letter, recently received, represent a class of queries that are frequently propounded both orally and in correspondence. It has appeared not inappropriate to publish a general reply to these and similar questions : " i. In what form do you use these potencies, in the shape of pellets or liquids? " 2. Do you use the decimal or the centesimal scale in the preparation of the high potencies ? "3. Do you repeat the high potencies in rapid succession in acute diseases, as you do the low preparations ? "4. If you use pellets, do you consider them perfectly reliable ? and how many, as a general rule, constitute a dose, either dry or taken in water ? "5. Do you alternate the high potencies, or do you rely upon the single remedy ? "6. Do you believe that the high potencies, from your own experience in the use of them and from what you have beheld in the practice of others, are far superior, in all respects, to the low preparations as remedial agents ? "Some of these questions may seem in themselves to be insignificant, but I do not consider them so, for in making my first trial I wish to start right, that the experiment may be made fairly, with a sincere desire to know the truth, the whole truth, and nothing but the truth. " In conclusion, let me say that you may rest assured your answers to this communication will be kept perfectly private, and no publicity (as coming from you) given them. "Permit me to repeat that it is only a sincere desire to 18 258 REPLY TO A LETTER seek out and find the truth that has led me thus to trouble you." We heartily respect our correspondent's earnest desire to get at the "whole truth," and to "start fair" in his experi- ment; and we respect his hesitation to use the high potencies until he should have a reasonable assurance that in so doing he would not be hazarding the interests of his patients. We take this public manner of replying to his questions, partly with a view of convincing him that we have no wish that our "answers to this communication" should be "kept strictly private." On the contrary, we should be glad to have "publicity (as coming from us) given them." For they are expressions of our honest convictions, the result of as careful observations and as cautious and complete experiments as we have up to the present time been capable of making. They express our present opinion,— those views in accord- ance with which we shape our daily practice. But we hold ourselves bound by them only so long as they shall continue to be our honest convictions. Should further observation and more extended experience satisfy us that any of our present positions are untenable we shall gladly abandon them for others, and shall then, likewise, be not only willing but anxious to have "publicity (as coming from us) given" to these new views. The object of our professional life is to find out the truth and to shape our practice accordingly. Consistency to this object is true consistency; while consistency to any form of opinion or doctrine that may at one time have been supposed to be the truth and proclaimed by us as such,—consistency to such opinion merely because we may have once publicly uttered it, — this is the basest and most ignoble bigotry and cowardice. In the article1 to which our correspondent refers, we had no object but to express frankly and plainly the views which govern us in the practice of medicine. We would call his attention to the fact that the greater part of the article 1 " The Use of High Potencies in the Treatment of the Sick." ON HIGH POTENCIES. 259 consisted of citations of the opinions and experiences of other practitioners whose conclusions were but corroborated by our own. 1. In what form do you use these potencies, in the shape of pellets or of liquids? As a matter of fact, we use them in the form of pellets. As a matter of faith, we know no difference between pellets, pills, triturations or liquids. The pellet is merely a conven- ient means for dividing a drop of liquid into a number of equal parts, and it is for this object that we use them. We have been in the habit of buying unmedicated pellets or globules at Smith's Pharmacy, and medicating them with liquid potencies of our own preparation. Pellets thus medi- cated we find retain their remedial powers for several years at least,— exactly how long we cannot say. They are so much more portable and more convenient to administer than liquids, that this furnishes us a sufficient reason for preferring them to the liquid form of prescriptions. A writer in the British yournal of Homoeopathy, some years ago, published an essay on the Globule versus the Pillule, making out a very bad case for the unlucky globule as calculated to bring Homoeopathy into contempt in the eyes of persons not indoc- trinated. There is something laughable, if it were not deplorable, in this argument, the pith of which is this: "We give small doses, to be sure, but let us not, by using the pellet, appear to give small ones; let us use as big a pill as anybody that we may not seem to give a small dose, and may not rudely jostle the prejudices of our patients." But surely, if contempt would have damaged Homoeopathy, this luckless science, despised, scorned, ridiculed, and, scores of times, extinguished by Homeric laughter, should have been done for long ago ! To adopt and defend this much contemned science, and yet to shrink from the obvious smallness of a pellet-dose—is not this " to strain at a gnat and swallow a camel." Nothing will gain the confidence of a patient so surely as 260 REPLY TO A LETTER success ! His confidence, once gained by success, cannot be shaken by the form of your dose! Yes, it may though! If he sees that while your doctrines require you to give small doses, you yet dissemble and juggle, and, by using large pills and lozenges and mixtures, try to make it appear that you are giving as large doses as your Old-School neighbor, he will suspect that your faith in the system you profess is not really strong, and he will have doubts of both you and your system. The sick man who feels that you are curing him, cares not a straw for the logical improbabilities of your doctrines, nor for the scientific difficulties attending the expla- nation of the action of your little dose. Large or small,— much or nothing,— if, under your auspices, his health return, he will have faith equally in yourself and in your methods. We have been amazed at much that has been said and written on this subject. Our own patients have rarely remarked upon the pellet. One, who had never seen them before, once said to us, " Do you really hope to cure me with those tiny pills?" "Yes, certainly." "I should not believe they could possibly have any power." "Why? Because they are so fine and small for pills?" "Yes." "Then, my dear sir, instead of regarding them as 'fine pills,' consider them to be very coarse granular powder, and you cannot fail to be impressed, a priori, with their immense power!" He perceived the absurdity of his objection, which was to the outward form and not to the inherent power. The success of the prescription satisfied him of the virtue of little pills. Another patient objected to the very small vials of my pocket-case. I replied they were a matter of convenience to me, but if he would be better satisfied I would, next day, bring his dose in a quart bottle and pour out the same quan- tity (pellets). He also perceived that his objection was frivolous, and was content. 2. Do you use the decimal or centesimal scale in the prepa- ration of the high potencies? ON HIGH POTENCIES. 26l As a matter of fact, we use the centesimal scale in prepar- ing the high potencies and all the potencies which we use, and have used since we began to practice medicine. As a matter of opinion we see no reason to prefer the decimal. It does not insure a more uniform gradation as has been claimed. The use of it leads to confusion and is to be regretted. We prefer adhering to Hahnemann's scale. It is easy to convert the one into the other in reporting cases or in reading reports. If our correspondent will refer to the article which prompted his letter, he will note that in the treatment of pneumonia Wurmb and Eidherr used potencies prepared on the decimal scale, which fact we there stated and we reduced their numbers to the corresponding ones of the centesimal scale. In general in this country where the facts are not specifically stated, it is understood that the centesimal or Hahnemann scale is intended. Our own preparations were made in strict accordance with Hahnemann's directions and so are the high potencies of Lehrmann, as we have learned from Dr. von Boenninghausen, who directed their preparation, and from Lehrmann, himself. 3. Do you repeat the high potencies in rapid succession in acute diseases, as you do the low preparations? How shall such a knotty question be unraveled ? It involves two assumptions, two beggings of the question, viz.: 1. That we do repeat the low potencies in rapid suc- cession in acute diseases; and, second, that we make any such distinction between acute and chronic diseases, as to admit of a radical difference in our principle of prescribing. 1. We recognize but one rule touching the repetition of the dose. It was laid down by Hahnemann and is as follows: Do not repeat the dose of the remedy given until the effects of the previous dose shall have ceased to be evident. Our most grievous failures have come from a vio- lation of this rule. Our most brilliant and complete suc- cesses have coincided with a strict observance of it. If we are sure that our remedy has been rightly selected, we 262 REPLY TO A LETTER sometimes direct, particularly in cases that have been actively treated by allopathic physicians before we were called, and in which we apprehend a sluggish response to remedies, a repetition of the dose every few hours, until some ameliora- tion or decided aggravation appear, but we always order a suspension of the remedy as soon as either is manifest. 2. We know of no clear distinction between acute and chronic diseases on which to base a difference in treatment. Indeed no difference whatever, unless it be one analogous to that which Hahnemann laid down, viz. : that chronic diseases are based on the awakening of miasms that had hitherto lain dormant in the system. For instance, is scarlatina an acute disease ? Assuredly it is so regarded. Yet, on the third day, scarlatina often shows that it has awakened and ingrafted itself upon the scrofulous (or psoric ?) taint in the patient's constitution and then, surely, it becomes typically chronic. This is an example of what we see happen in all forms of disease. It prevents an available distinction between acute and chronic diseases. We can assure our correspondent that it is safe and advantageous to strictly follow the Hahnemannian rule about the repetition of the dose in acute no less than in chronic diseases. But let us anticipate a possible confusion in his mind. Some writers—Dr. Drysdale we are surprised to see among them—seem to think that Hahnemann, when he said, " Wait till the first dose shall have exhausted its action," meant to say, "Do not repeat the dose until that period shall have elapsed which I have indicated in the Materia Medica as the duration of action of each drug." This period for some drugs is several days, for others several weeks or even months. We do not so understand him. The duration of action of a remedy on the healthy subject (prover) furnishes no criterion of the duration of its action on the sick. Again, the duration of its action on one sick person furnishes no criterion of the duration of its action on another sick person. Surely the vital processes are much ON HIGH POTENCIES. 263 more rapid in acute pneumonia than they are in tubercu- losis. Is it not probable that the duration of action of a dose of medicine would be shorter in the former than in the latter ? We suppose Hahnemann meant as follows: " If ameliora- tion follows a dose of medicine, do not repeat the dose until the amelioration ceases to progress, Then, if the symptoms be the same as before, though mitigated in severity, repeat the dose. If the symptoms be different, study the case anew and make another selection of remedy." It is in this sense that we have understood and that we apply Hahne- mann's rule. Not pretending that we do not often, through errors of judgment, infringe it, we are sure that whenever we do so, misfortune follows, and that in proportion to our faithfulness, so is our success. In respect of the repetition of doses, as well as the form of the prescription, we have no difficulty with our patients. Patients are like soldiers; they believe in a man who believes in himself. We say this in all humility, for, in a matter of science, belief in one's self is faith in the laws one has under- taken to carry out in practice. And if the physician show confidence in his methods, his patients will yield themselves implicitly to his guidance. The prejudice in favor of large and many doses is a relic of past ages, when the practitioner was paid, not for his skill and personal services, but for the medicines he furnished,— a barbarous usage, which, along with slavery, we received from our British progenitors. Unlike them, we have discarded the former but not the latter. 4. If you use pellets, do you consider them perfectly re- liable? Assuredly, or else we would not use them. We medicate them ourselves. And, how many constitute a dose? If, properly medi- cated, one is as good as one hundred. As there is a possi- bility that, in medicating several thousands at one operation, a pellet here and there may fail to get saturated, we usually 264 REPLY TO A LETTER give about four to six. We use the smallest pellets as most easily and surely medicated. 5. Do you alternate the high potencies, or do you rely upon the single remedy ? Here again our friend confounds a principle and quantity. If it be right and advantageous to alternate the low, it is right and advantageous to alternate the high potencies. But, in fact, we do not alternate at all. We always rely on the single remedy at one time. Dr. Drysdale says that everybody alternates, and, therefore, there must be some necessity for the practice. But his illustrations are so far fetched, and his definition of alternation is so contrary to the conceptions which all other homoeopathicians, from Hahnemann down, have had on the subject, that, notwith- standing our respect for Dr. Drysdale, we must repeat, in the very face of his learned paper, that we do not alternate. Our understanding of the practice of alternation, and our objections to it were stated, as well as we are able to state them, in the American Homoeopathic Review, June, 1863, vol. iii., No. 12.1 We are opposed to it in theory, and we abjure it in prac- tice. It is an abominable heresy. As a shot-gun maims where the rifle would kill, so alternation may change and modify and maim the disease, but it never does nor can effect the clean, direct and perfect cure that a single remedy, exactly homoeopathic, will accomplish. As a relic of the polypharmacy which has been the stumbling-block of the Old School, we loathe it. As a refuge of the careless pre- scriber and slothful student, we despise it. As an anomaly in homoeopathic practice, a fatal obstacle to progress in the clinical portion of our Materia Medica, we deplore it. 6. Do you believe that the high potencies, from your own experience in the use of them, and from what you have beheld in the practice of others, are far superior in all respects to the low preparations as remedial agents ? 1 See "Alternation of Remedies," in this book. ON HIGH POTENCIES. 265 An affirmative answer is involved in the statement that we use the high in preference to the low preparations. For details we refer again to the article which prompted our correspondent's letter. Personally we have suffered, and do now suffer, from chronic organic disease, and from occasional very violent acute attacks. We always use the high potencies in these cases, preferring them to the low. We use them in our family and among our friends. We use them in general practice. Many of our friends and patients, non-professional persons, know the fact and freely say that they and their children are more speedily cured by the high than by the low potencies. N. B. The imaginations of our friends aforesaid are not more lively than those of the average of other people. Indeed, they are plain, matter-of-fact persons, possessing much common sense, but, for the most part, no genius. They prefer high potencies. And now, having replied in detail to the queries of our correspondent, let us add a few remarks which we beg him to receive in good part. To change the aspect of a case, to cause the original symptoms to be supplanted by other symptoms, this is no more a cure than "a strategic change of base" is a "victori- ous campaign." Yet this may be effected by repeated doses of a drug in a low potency, whether the drug be strictly homoeopathic to the case or not. And a succession of such changes and supplantings may be effected, day after day, until finally the patient gets well or nearly so. Meanwhile the patient may be amused by the varieties which each day brings forth, and if he know nothing of a true homoeopathic cure, but have heretofore had only the heroic treatment, he may fancy he has been doing finely. Now, in this way, with low potencies, a practitioner may do quite a business on a very slender capital of knowledge. Not so if he use the high potencies. With these no change is effected in the case unless the remedy have been 266 REPLY TO A LETTER ON HIGH POTENCIES. strictly homoeopathic to the case. They are like the rifle- ball— if they hit, they kill; if not, there is no record of the shot. There can be no good luck from scattering. Now it will be perceived that the question of cures with high and low potencies is not merely a question of potencies, and our friend's trial will not be a fair one unless he make sure that his selection of the remedy in each case in which he tries the high potencies is strictly homoeopathic. If he make sure of this and be correct in it, then let him go on in confidence with his experiment. We bid him God-speed. THE QUESTION OF THE DOSE. In a report to the Homoeopathic Medical Society of the state of New-York, on the "Use of High Potencies in the Treatment of the Sick," published in this Review,1 I stated, "that I have noted only one case in which a high potency acted but inefficiently, while a lower gave prompt and com- plete relief;" and, again, "that a general law for the a priori selection of the potency suitable for a concrete case, if such a law be possible, is yet to be discovered;" and, again, "this fact that a low potency succeeded where a higher had failed, together with similar facts reported by other practitioners, must have a bearing upon general con- clusions." The question of the dose is manifestly an open one. Expe- rience must be accumulated before we can hope to discover a law for our guidance on the subject. Every fact bearing on the question should have our candid and careful study. In the report alluded to, a portion of the evidence in favor of the high potencies was detailed. The following cases present evidence on the other side and deserve particular attention. They are published by Dr. Arnold, of Heidel- berg, in the Homceopathische Vierteljahrschrift? together with some very fair and ingenuous remarks by Dr. Arnold, who, it may be remarked, is in the habit of using only the lowest potencies or massive doses. Psoriasis Guttata cured by Arsenic.—The power of the preparations of Arsenic to cure psoriasis is so well known that I should not publish this case, were it not that it fur- 1 North American Homoeopathic *Homceopathische Vierteljahrschrift, Review, vol. 4, p. 303. January, 1864. 268 THE QUESTION OF THE DOSE. nishes, in addition, a striking evidence of the fact, that even in chronic diseases we are often obliged to give strong doses even of the very heroic remedies if we would accomplish a cure. A lady, eighteen years old, whose childhood had been healthy, and who had never had any sickness worth naming, who felt perfectly strong and well, and had a blooming. appearance, and in whom no predisposing cause for any skin disease could be discovered, observed several years ago, on certain parts of the body, isolated, red, somewhat elevated spots, on the surface of which small scales were visible. Inasmuch, however, as she felt well and the spots had spared the face and neck, she did not think it necessary to seek medical advice. Gradually the spots became more numer- ous, their dimensions also increased, and although the patient had no other complaint, she was yet induced to seek the advice of a physician on account of the itching, which was often troublesome, especially at night. Purgatives and the so-called blood-purifying tea (species lignorum) had no result. In the spring of 1861 she came to me. The eruption was over the whole skin with the excep- tion of the face and hands; the spots were large and confluent. I gave her at first one grain daily of the sixth decimal trituration of Arsenic. But as no change had occurred in fourteen days, I changed to the fourth decimal trituration, of which a grain was taken every forenoon. In fourteen days I found a slight improvement, in that certain spots seemed to be less red and did not itch so much at night. I now intermitted the use of Arsenic for three weeks, and after this period found again the old evil condition. One grain of the third decimal trituration of Arsenic, which was now given daily for fourteen days, wrought a more striking improvement, as well in relation to the development and size of the spots, which were much less, as also in respect to the itching at night which had almost altogether ceased. But inasmuch as, after a pause of fourteen days, this improve- THE QUESTION OF THE DOSE. 269 ment had again partly disappeared, I felt myself obliged to resort to a still stronger dose of the remedy in order not to put the patience of my client to too severe a test. She now received, once every day, two grains of the second decimal trituration—that is, one-fiftieth of a grain of Arsenious acid. The action of this dose resulted, after two weeks, in a very striking improvement, which moreover maintained itself during a suspension of the remedy for the next two weeks. I therefore allowed the patient to continue the remedy for two weeks longer, taking daily a two grain dose of the second decimal dilution. The cure was complete and per- manent; for a half year afterward I had an opportunity of seeing the lady, and was assured that the recovery had been lasting. On the subject of the homoeopathic relation of Arsenic to psoriasis, scarcely any physician who is familiar with the effects of this remedy can entertain a doubt. I must confess, too, that I have often seen a cure result from the use of the sixth, but still more from the fourth decimal trituration of this drug. Even in the case just related, the amelioration might have proceeded to an enduring cure if the use of the fourth trituration had been continued for a longer time. But inasmuch as the patient had borne the Arsenic very well, and not a single symptom of its pathogenetic action had been apparent, even after a daily dose of two grains of the second trituration, there was no reason for losing time in the use of small doses. In any case, this is a new evidence that in chronic diseases even very heroic remedies must sometimes be given in very large doses. Nasal Polypus cured by Calcarea.—A lady, aged fifty-five, of respectable position in society, pale, of delicate constitu- tion, small and rachitic from childhood, but never seriously ill, perceived, several years ago, in the right nostril an impediment to respiration. An examination by a physician readily disclosed the presence of a mucous polypus. Various remedies were administered during a long period without 270 THE QUESTION OF THE DOSE. perceptible effect. Neither Mercurius dulcis, used as a snuff, nor Corrosive sublimate in solution, to be inhaled, had a noteworthy or enduring effect. The patient thought the slight changes noticed were rather to be ascribed to the weather, and especially to the dryness or moistuce of the atmosphere than to the remedies used. Under these circumstances, the operation being proposed, I was asked whether a cure was possible without operative procedures. I declared that a cure by means of internal remedies not only might succeed, but that it would have a much more enduring result than the mechanical removal of the growth could have; and furthermore, that an operation, in case it should prove necessary after an internal treatment, would be more certain and more lasting in its result than one without the previous use of corresponding remedies. Having seen from Calcarea carbonica in several similar cases a very striking and unmistakable curative action, I prescribed the fourth decimal trituration of this remedy and ordered at first one grain daily, and after eight days two grains daily to be taken. After two months, the patient appeared and reported that she had taken the remedy four weeks and then intermitted it for four weeks, and that no change in her condition was observable. And I could myself perceive neither increase nor decrease of the poly- pus excrescence. This determined me to give the second decimal trituration of Calcarea, one grain daily. After fourteen days, the nostril having become more permeable, and a diminution in the size of the polypus being percepti- ble, although very trifling in degree, I allowed a pause of four weeks in the use of the remedy. After this lapse of time, the tumor had regained its former size; the lady was more than ever inclined toward the operation. I concluded to wait upon her a few weeks longer, and gave her the officinal lime-water, a tea-spoonful twice daily in milk. Four weeks later the lady came again to me ; a most careful investigation revealed no traces of the polypus. She THE QUESTION OF THE DOSE. 271 informed me that there was amelioration after the very first doses of lime-water, and that after a fortnight the nose had ' felt entirely free, and since that time there had been no aggravation. The improvement has already lasted more than a year without any further administration of the remedy. Repeated examinations have failed to enable me to discover any trace of the polypus. THE BASIS OF TREATMENT.1 Hahnemann, throughout his works, takes every opportu- nity to urge the insufficiency of a pathological theory of the nature of a disease as the basis of the treatment. He every- where urges that the only sure indication for every case is to be found in the totality of the symptoms which the case presents. One would think that nothing could be more clear and convincing than his arguments on this subject. His opponents declared that his method ignored medical science, left no scope for pathology and diagnosis, and reduced therapeutics to a degrading mechanical comparison of symptoms. Very many homoeopathists have so far deviated from Hahnemann's method as to endeavor to blend with the use of his doses and remedies, an application of pathology as a basis of treatment. This endeavor can never be successful, inasmuch as the function of pathology is to furnish, not an indication for medical treatment, but simply a means of elucidating and collating the symptoms. The result has been a sad falling off from the standard of success in practice which was established by Hahnemann and his pupils. The points at issue are illustrated by the following case: Willie M., four years old, was brought to me December 3, 1863. He had been healthy since February, 1863, when he is reported to have had a long attack of gastric fever, from which he finally recovered with the affection about to be described. This was a dyspnoea and wheezing, distinctly perceptible at all times when the child was awake, and xRead before the Horn. Med. Society of Oneida County, N. Y., June 21 st, 1864. THE BASIS OF TREATMENT. 273 which, on making any exertion, were very much aggravated, and resulted in an attack of convulsive cough with difficult inhalation, the whole paroxysm resembling precisely what is described as Millar's asthma or Laryngismus stridulus. It was remarked that the child seemed to be free from dyspnoea when sleeping soundly, but at no other time. On waking in the morning he had always a hard fit of coughing, during which he sometimes raised a little tenacious mucus. His appetite was good, though somewhat capricious. He was considerably emaciated; his spirits were good, and he often attempted to join in the sports of other children, but was obliged soon to desist, because of the dyspnoea and cough which every physical exertion caused and which greatly fatigued him. On percussion and auscultation the lungs were found resonant; the respiratory murmur was, of course, masked by the loud wheezing. The child had been taken, in September, to Professor A. Clark, of New-York, who, after careful and repeated exami- nations, had given a written diagnosis—"Chronic Laryn- gismus." He gave a very unfavorable prognosis and the advice to avoid all medication, save only a dose of some antispasmodic during the violent attacks of dyspnoea. This advice had not been followed. The child had been, through- out his illness, under what I regard as very skillful homoe- opathic treatment. I had once seen him in consultation, but had not been able to suggest anything that proved of service to him. When now placed under my sole care, I well knew that the child had already taken, without benefit, every remedy which has symptoms at all resembling Millar's asthma or any spasmodic affection of the respiratory organs. And it was also evident, on even a cursory examination, that no one of these remedies was clearly indicated by the symptoms of the case. I therefore resolved to follow, as implicitly as I could, the advice given by Hahnemann for the examination of the 19 274 THE BASIS OF TREATMENT. patient and the selection of the remedy. Dismissing from my mind, then, every notion concerning the seat and prob- able pathological nature of the disease, I examined the patient and made the following record of the symptoms which he presented. i. Child emaciated, flesh soft, skin inclined to be yellow (naturally fair—a blonde) and dry. 2. Appetite very good; always calls for food as soon as a coughing fit begins in the morning or forenoon. 3. The right hypochondrium hard, distended, tender to the touch, painful on exertion and when he coughs. The right shoulder is elevated and the spinal column laterally curved; dullness on percussion on the right side, extending three fingers' breadth below the margin of the ribs. 4. Distension of the epigastrium which is tympanitic on percussion, and tender to the touch. 5. Much rumbling of flatus in the abdomen. 6. Frequent ineffectual desire for stool; stool scanty and dry, occurring once daily or once in two days. 7. Cough dry; sometimes in the morning a very little tenacious sputa; always a coughing fit in the morning on waking; he has to sit up to cough; cough excited by eating and drinking, by rapid motion, by exertion, by crying or talking. The cough hurts his right side. 8. Constant wheezing and dyspnoea aggravated by exer- tion and by lying down, relieved during sleep. The tender age of the patient rendered it impossible to obtain many subjective symptoms, such as usually facilitate the individualization of cases, and the determination of the appropriate remedy. Before proceeding further in the narration of the case, I desire to say a word upon its pathology. The symptoms are before us : what shall our diagnosis be ? Is the case one of spasmodic laryngeal disease, complicated by certain gastro-enteric and hepatic affections? Or, is it a chronic hepatitis, complicated by laryngismus ? Which affection is THE BASIS OF TREATMENT. 275 primary, and which secondary ? What relation do the groups of symptoms bear to each other? Professor Clark seems to have adopted the former view, regarding the gastro- hepatic troubles as secondary, if indeed he paid any atten- tion whatever to this complication. The homoeopathic physicians who preceded me probably adopted the same view and based their treatment upon it. Now if in so doing they had happened to take a correct pathological view, the result might have been favorable; or if they had adopted and acted upon the second hypothesis, and this had chanced to be the correct view, the result might have been favorable. But is it not obvious to every candid mind, that, in either case, success in the treatment based upon a pathological con- sideration of the case must depend on the correctness of the pathological hypothesis—a matter in which certainty can never be attained. On the other hand, if we throw aside, as irrelevant, the entire series of questions as to which is the primary disease and which the secondary—which the original malady and which the complication—if we say to ourselves: "Here is a sick child ; let us examine and record those points in which he differs from a healthy child," we get the series of symptoms above recited, which are facts, indisputable, unmistakable, .the result of pure observation. If now, with- out hypothesis or speculation, we seek to find and do find a remedy which presents a series of symptoms corresponding closely to those of the patient, experience justifies us in believing that we shall have reached the utmost possible certainty of correctly selecting the remedy. Comparing the symptoms with the Materia Medica, we perceive at once that the remedies whose names are usually associated with Millar's Asthma, Laryngismus, etc., viz.: Sambucus, Spongia, Cina, Lachesis, Hepar, Stannum, Chlo- rine, etc., etc., do not cover the case, having but little correspondence with groups 1, 2, 3, 4, 5, 6. 276 THE BASIS OF TREATMENT. Nux vomica, on the other hand, covers these groups very well, as will be seen by comparing Materia Medica. In addition, it has violent paroxysms of cough in the morning very early (676 and 677), excited by motion and exertion (670, 671, 672), producing pain in the epigastric zone (689), and accompanied by a desire to eat (my own observation). It has also a well-marked dyspnoea. The correspondence was so close that I had no hesitation in giving Nux vomica. Dec. 9, four powders of the 200th were given, one to be taken every night, and the patient to report in ten days. Dec. 21, the report was brought to me, that the child had no more wheezing nor dyspnoea; had been free from cough for five days, can play long and vigorously without incon- venience, is regular in his bowels, complains no longer of pain or tenderness in the hypochondrium—in fact seems to be perfectly well. He deranged the digestion by eating candy at Christmas, and had a slight return of pain in the hypochondrium, which a dose of Sulphur relieved. He has ever since been entirely free from dyspnoea and laryngeal spasm, and is in the enjoy- ment of robust and perfect health. If such a mode of practice as this be, as is charged, unscientific—if it ignore the sciences of pathology and diag- nosis as bases of treatment—thus much at least may be said in its favor, that it far surpasses every other method in the facilities it affords for the fulfillment of one not unimportant object of the physician—the cure of the patient. DIAGNOSIS IN HOMCEOPATHIC PRACTICE; With Compilations from Dr. Kaspar's Lectures. It is an objection often urged against Homoeopathy, that, as a system of therapeutics, it dispenses with the necessity for diagnosis. The objection is unfounded. For all pur- poses of prognosis and hygienic management, we have as great need of diagnosis as our brethren of the old practice. And so we have in prescribing. We profess to prescribe according to the " totality of the symptoms." But by this we are far from meaning to imply that each symptom is considered and prescribed for, independently of all the other symptoms. On the contrary, while on the one hand, every symptom must be taken into consideration as indispensable to a true " picture of the disease," and hence, in this view, no one symptom can be said to be less important than another; yet, on the other hand, the symptoms vary among themselves in rank. Some are primary or idiopathic, others are reflex or sympathetic. The latter are as important to a "picture of the disease" as the former, but they are important not simply as symptoms, but as sympathetic symptoms. Now, to form a diagnosis is to distinguish from among the whole number of symptoms, the idiopathic and sympathetic symp- toms, to attribute each symptom, whether idiopathic or sympathetic, to the organ or tissue which is in reality its seat, and to form a just notion of the pathological con- dition of that organ or tissue. That it is necessary for us to make such a diagnosis before prescribing, follows at once from the rationale of a homoeopathic prescription. The homoeopathic practitioner having got "a picture" of the disease he is about to treat, *'. e., having got the 278 DIAGNOSIS IN HOMOEOPATHIC PRACTICE. " totality of the symptoms," proceeds to compare this picture with the pathogeneses of various drugs. Now, these pathogeneses are themselves " pictures of disease;" they are symptoms of drug-disease. As such, they are divisible into idiopathic and sympathetic symptoms ; the organs, or tissues, in which they have their seat, and the pathological conditions of these organs, may be various. In seeking a drug whose symptoms shall correspond most nearly to those of the disease to be treated, it is evidently necessary to seek a drug, the idiopathic symptoms of which shall correspond to the idiopathic symptoms of the disease, and the sympathetic to the sympathetic ; a drug, too, whose symptoms of either variety shall have the same seat as the analogous symptoms of the disease, and shall result from a similar pathological condition. But we cannot select this drug without having previously formed a diagnosis, not merely of the disease to be treated, but also of the various drug-diseases or pathogeneses that constitute our Materia Medica. This necessity may be illustrated by a reference to errors into which a neglect of it leads us. Spontaneous vomiting of bile by a child may be an idiopathic symptom indicating abdominal derangement; or, it may be merely sympathetic of cerebral disturbance. Several drugs produce vomiting of bile ; some directly or idiopathically, by affect- ing the digestive organs; others, by a reflex or sympathetic action, their primary action being on the nervous centers. According to our diagnosis of the disease in the child, and of the drug-disease, we should give under the one view, Nux vomica, Ipecacuanha, or their analogues; or, under the other, Belladonna. Again, depraved appetite, convulsive movements, distorted vision, a peculiar aspect of distress, may be the idiopathic expression of disorder in the nervous centers, or may be "sympathetic with irritation produced by entozoa. In the one case we should select a remedy which affects the nervous centers idiopathically, as Belladonna or its analogues; and in the other a remedy which acts idio- DIAGNOSIS IN HOMOEOPATHIC PRACTICE. 279 pathically on the vegetative sphere, and affects the nervous centers sympathetically, as Cina. Neglect to distinguish between these varieties of symptoms has led compilers of manuals to recommend Cina in hydrocephalus. Moreover, it is requisite to determine the seat of the symptoms, both in the disease and in the pathogenesis. Pain and tenderness in the right iliac region, with local heat and fever, may have their seat in the cellular tissue, in the muscular or peritoneal layers, in the coecum, or even, at certain times, in the ovary. So might similar symptoms in a pathogenesis arise from a pathological condition of these various tissues. Evidently we cannot select our remedy with certainty of its adaptedness, unless we make a diagnosis both of the disease and of the pathogeneses of the drugs. Again, tenderness in the coxofemoral region, pain on moving the limb, and on pressing the great trochanter in toward the acetabulum, may have its seat in the tissues of the joint, or in the nerves that supply that region. And we have drugs that affect the tissues of the joint, and others that affect the nerves in question. We must select the former if the joint, and the latter if the nerves be affected; and in order to make the selection we must previously make the twofold diagnosis so often urged. Neglect of this has led to the erroneous recommendation of Colocynth in hip-joint disease. A twofold diagnosis, then, is a necessary pre- liminary to a properly conducted homoeopathic prescription. The diagnosis of the disease to be treated is to be made, of course, where the disease is encountered, at the bedside. But the diagnosis of the drug-diseases constitutes the syste- matic study of the Materia Medica. Our provings are a mass of symptoms, for the systematic study of which some feasible method has been long a desid- eratum. Their study and arrangement under the form of a diagnosis furnish a method well calculated to fix the characteristics of the drug in the memory, and at the same time, as we have shown, practically useful to the prescriber. 280 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. Dr. Watzke and Dr. Kaspar, resident physicians in Wurmb's Homoeopathic Hospital, in Vienna, have arranged a number of remedies in the form of a diagnosis, the expo- sition of which constituted the matter of lectures on Materia Medica, delivered by Dr. Kaspar at the Hospital, in the summer of 1851.x The substance of sixteen lectures by Dr. Kaspar follows, from which the scope and aim of the analysis will be evident; and it may not be amiss to sug- gest that these analyses are designed rather as aids in the study of Materia Medica than as direct guides for practice, and that, being greatly condensed, they require diligent study and constant comparison with the Hahnemannian pathogeneses. NO. I. HEPAR SULPHURIS CALCAREUM. Hepar has many close relations with Mercurius. The distinction between them is, in fact, rather negative than positive. Almost all the symptoms of Hepar are found under Mercurius, but not all those of Mercurius under Hepar. Hepar, like Mercurius, develops its effects in the vegeta- tive processes. Yet, whereas Mercurius increases to excess the whole secretive activity, and thereby produces emacia- tion (i. e., by excessive secretion, salivation, diarrhoea, diaphoresis), the same character belongs to Hepar in a much less degree. Hence Hepar produces no putrid collapse, makes no penetrating impression upon, and alteration of, the vital processes ; hence, too, it exerts no visible reflex action upon the nervous life, as Mercurius. While the reso- lutive, alterative action of Mercurius extends even to the formation of new secreting organs (abscess, secreting pus), Hepar possesses no such power. In the action of Hepar, appears, in a slighter degree, the tendency to abnormal 1 These lectures the author attended.— Ed. NO. I. HEPAR SULPHURIS CALCAREUM. 281 secretion, and the resulting symptoms have, for the most part, quite a different pathological foundation from that of analogous symptoms of Mercurius. The effects of Hepar appear most distinctly in the lymphatic system, the activity of which it excites in a high degree ; and hence it either, on the one hand, increases the absorptive activity of the lymphatic system, or else, on the other, causes a too abundant collection of lymph in the glands, and, in consequence, obstruction, inflammation, and suppuration of the glands. We find, therefore, among the symptoms of Hepar, a great number indicating this character, and we find the greatest number of symptoms in those parts of the body in which the lymphatic vessels are most abundant, neck, shoulder, bend of the elbow, dorsum of the foot, etc. On the increased resorption, on the other hand, depend a number of other symptoms in other organs, especially in those in which the lymphatic vascular system is highly developed. Although I have so strongly insisted on this, as the sphere of action of Hepar, I would not be understood to deny to it any farther action. The excitation of organic activity can never be circumscribed to a few determinate functions. If the resorptive activity of the lymphatic be increased, so will be also that of the venous system. The excretions will be altered in quantity and in quality. The action of Hepar is upon the periphery directly. Hence we find congestion of the skin and mucous mem- branes ; and, in consequence, redness, heat, swelling—in a word, an inflammatory condition shown by prickings, eleva- tions of the skin, rhagades; a slight degree of suppuration manifesting itself in rhagades, pustules, nodes, tubercles, ulcers, also flashes of heat, and dull redness of parts rich in blood—lips, cheeks, conjunctiva, etc. Partly in this way, and partly also by the fact of engorge- ment and obstruction of the lymphatic glands, we may explain the symptoms which appear in the skin. 282 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. Mucous Membranes. These are similarly excited. Their secretion is not greatly increased. Often, indeed, it is diminished ; and it is always thickened. The watery portion being immediately absorbed again, the secretion becomes viscous, even membranous. i. In the Intestinal Tract, Hepar must produce diminution of action; hence anorexia, nausea, vomiting, acid eructations, alienated taste, development of gas, etc., and, above all, enfeebled peristaltic action, and this, again, causes pain (meteorismus) and difficult evacuation even of soft faeces. Add to these considerations, the irritation of the mucous membrane consequent on the great number of lymphatic vessels in it, and we may explain the several sensations and pains in the alimentary tract, especially the frequent tenes- mus and aggravation after every stool. The stools are green, yellowish-brown, often mixed with blood. 2. In the Respiratory Organs we find a similar condition, various sensations indicating thickening of the secretions; hence, difficult respiration, laborious, dry cough. This con- dition, together with the puffy tumefaction of the mucous membrane, which usually accompanies such a condition, will explain to us the symptoms which we find especially in the larynx. 3. In the Urinary Mucous Membrane appears the same state of chemosis. Urine is scanty and dark, with abundant salts so that, when evacuated, it is already turbid, or else it soon becomes so. 4. The Salivary Glands are excited to a more abundant secretion. The action of Hepar on the Sanguine Vascular System may be easily determined; for if it excites one portion of this system, the remaining portions must of necessity be also excited, though in a less degree. Hence, febrile symptoms are not wanting. They are still more clearly pronounced when a somewhat violent inflammatory excitement has mani- fested itself, producing its reflex action on the organism. NO. I. HEPAR SULPHURIS CALCAREUM. 283 The general vascular excitement, however, can never assume the character of pure, intense synocha. The relations of Hepar to the Sexual System are unim- portant. The menses appear too early, and are too copious. Sensations. As every revulsion of the vegetative proc- esses provokes various sensations, so does that produced by Hepar. It is to be remarked, that pains,1 strictly speaking, are seldom excited by it. The more frequent sensations are itching, pricking, rending, and feeling as if beaten. (In inflamed parts, however, burning, sticking, and tearing pains are experienced.) Such sensations will be especially felt in parts where lymphatic vessels course in greatest numbers, the axilla, bend of the elbow, etc.: thus we have heat, redness, and pain from the fingers to the shoulders; needle stickings, itching in the fingers, swelling in the fingers, and the same condition in the thigh, ham, dorsum of the foot and the toes. Characteristic Symptoms. 1. Pains. Various. Especially pressing and general sensations. 2. Aggravation of Condition. At night, and by exposure to cold. 3. Thickening of the secretions, swelling, inflammation and suppuration of the glands. Indications for Administration. Hepar may be indi- cated— 1. In diseases of acute, sub-acute, and chronic form. 2. In diseases occurring in lymphatico-phlegmatic indi- viduals, with white delicate skin, blond hair, disposition to glandular swellings. 3. In all cases of glandular affection, as well for the collective chronic process as for the individual acute exacer- bations ; all scrofulous and tuberculous affections; enlarge- 1 The Germans distinguish between ing in the shoulder. Sensation is Pain (Schmerz) and Sensation (Ge- general, as to extent, and indefinite, fiihl). Pain is partial, as to extent, as to seat, e.g., oppression, lassitude, and determinate, as to seat, e.g., stick- itching. 284 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. ment, inflammation, and suppuration of all lymphatic glands, especially those of the neck; a similar condition of the cellular tissue. Hence it is indicated in mesenteric diseases of children; in frequently recurring angina; in inflammation of the salivary, cervical, and inguinal glands; panaris; inflammation of the eyelids ; discharge of prostatic fluid. 4. All kinds of inflammation which pass into suppuration; purulent exudations (pleuritis); abscess (for maturation, Mercurius is preferable); hip-joint disease (caries). 5. Inflammation terminating in solid, membranous exuda- tions ; acute catarrh; laryngeal croup (after use of Aconite); lymphangioitis, as well external as uterine; phlegmasia alba dolens; hooping-cough, after the stage of inflammation (?). 6. Abscesses and analogous formations. 7. The Mercurial Cachexy. Calvities after Mercury; salivary fistula. 8. Cutaneous Affections. Crusta lactea; Tinea; Erysipelas (after Belladonna) in scrofulous individuals. Generally in scrofulous skin-diseases. NO. II. CONIUM MACULATUM. Conium belongs to that class of remedies which alter the vegetative vital process in all its relations. Among the vegetative functions, that of resorption suffers the first and most marked alteration, being diminished in activity or completely arrested. The great representative of this func- tion is the lymphatic system, on which, therefore, Conium exerts its primary and most striking action. Next in degree, and of the same nature, is its action on the venous system. The diminution of the vitality of this system involves, on the one hand, diminished general absorption, and on the other, retarded circulation of the absorbed fluids. Hence, collections form in parenchymata and cavities, either in the form of fluid infiltration or exu- NO. II. CONIUM MACULATUM. 285 dation, or as hard tumors. In the lymphatics themselves depositions occur, which sometimes give rise to tumors. Such collections are hostile to the organism; they serve as excitants to the surrounding tissues ; hence, an inflammatory condition not unfrequently arises in these formations, which leads to their destruction. In some cases, however, the contrary takes place, and the organ attacked becomes altered. On these general pathological momenta depend the following Conium symptoms. Skin. Tuberculous eruption, passing over into Furun- culi; Petechiae ; Erysipelatous cutaneous inflammations; Gutta Rosacea ; Ulcers; Gangrenous ulcers. Glands. Various pains, generally sticking or cutting, especially in the mamma and mesenteric glands. Indura- tion, suppuration, and alteration of the same; hordeola; swelling of the tonsils. Pains in the liver. Inflammation of the prepuce. Pressing in prostate, and discharge of prostatic juice. Orchitis; pain and swelling of testes. The various symptoms in the breast and abdomen indicate that the glands are attacked; but the fact needs anatomical demonstration. The general disturbance of the resorptive function'probably depends on paralysis of the ganglionic system, in consequence of which all the vegetative functions must be more or less disturbed. Vascular System. The vascular system loses its energy. The circulation becomes irregular, universally retarded and enfeebled. Whatever excitation there may be depends rather upon local causes than. upon general stimulus. Hence, the general thermogenesis will be rather below the normal standard ; but it may be partially increased. Con- sequently, in the Conium fever, coldness predominates; the pulse is slow and small. (Still, the contrary may occur; the pulse may be quick and strong, and the heat partially increased.) The blood in the venous system, therefore, will be propelled slowly; hence, this system will be gorged ; this 286 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. will be especially manifest in the abdomen. The blood does not receive, on the one hand, the needed reparation, or, on the other, the necessary elaboration ; it consequently tends to fluidity and decomposition. Accordingly, cyanosis, ecchy- mosis, ulceration, and haemorrhage may easily and often be provoked. The results of every impediment of the circu- lation are manifested, rather in the periphery; hence, sev- eral inflammatory conditions produced by Conium. More frequently, however, the same cause favors the origin of infiltrations. By virtue of these tendencies we have inflam- mations of the eyes and eyelids, hordeola, inflammatory epistaxis, haemorrhage from swollen livid gums, irritable state of the throat, bleeding ulcers, haematuria, and inflam- matory symptoms in the urinary organs. From what has been said of the general primary action of Conium, its reflex effect on the individual functions of the vegetative sphere necessarily follow. We mention the con- ditions of its action in general terms and in specialties. The vegetation in general is depressed; this is shown by emaciation and change of color. The secretions are in general diminished, because inter- stitial absorption is diminished; for secretion must necessarily proceed pari passu with absorption ; and wherever this is not the case, the increase of secretion over absorption must be only in consequence of some local irritation, e. g, increase of salivary, lachrymal, and prostatic secretions. Hence, vomiting is rarely produced by Conium. And, since Conium furnishes scanty secretions, the stool is, for the most part, retained and scanty. Urine is scanty ; the mucous membrane of the urino-genital system is, for the most part, dry. The menses are retained or retarded. As specialty, it may be remarked that the intestines stand in nearer relation to Conium than the stomach does (probably because of their more intimate connection with the mesenteric glands), and that the most various symptoms are produced in them. The stool is generally scanty, with flatulence and NO. II. CONIUM MACULATUM. 287 pain before evacuation. If the stools are abundant and watery, so is the urine. The evacuation of urine is attended by violent pressing and by burning. The sweat is, for the most part, only partial, and is then accompanied by heat. Nervous System. The action of Conium on the nervous system is considerable, yet certainly of minor importance and often secondary, showing itself in spasms of various kinds; it centers in the sensorium, where depression predominates. Sexual System. The special relation of Conium to the sexual organs, especially the female, is very important. Its action is especially manifest in the breast and uterus, pro- ducing in these organs swelling, changes arrested, or abnor- mal secretion. Condition. The Conium symptoms are aggravated at night and early in the morning. ANALYSIS. 1. Alters the vegetative functions by altering or modify- ing resorption ; infiltrations or collections result, which tend to decomposition. Increased venosity, and finally depraved nutrition ; effects especially evident in the lymphatic system and in all glands, and among these, first, the mesenteric. 2. Glands. In closest relation with female sex and mamma. 3. Nervous System. Secondary Symptoms, manifested by spasms. 4. Secretions. In general diminished. 5. Pains. No particular character. 6. Aggravation. Night and early morning. Application. Conium corresponds to lymphatic, blond, pale individuals; to children, especially those with large, soft abdomens, and tendency to glandular enlargements and cutaneous eruptions; to women, especially in connection • with uterine diseases or with leucorrhoea ; to women in the climacteric period; to old women with collections in the 288 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. uterus; to pregnant women ; also to individuals who are easily excited ; to hypochondriacs. Diseases in general. All those dyscrasias whose develop- ment begins by deposition in the glandular system. Tuber- culosis and scrofulosis, especially when these dyscrasias concentrate in the mesenteric glands ; when, moreover, they evince rather a passive character, and do not run a rapid course, but gradually form deposits, and thereby give rise to partial congestions; in the first periods of such affections, so long as there is no especial colliquation, and while the secretions are in general diminished. (If, on the other hand, they show an active character, Hepar is indicated; when colliquation has set in, Mercurius?) i. Tuberculosis Meseraica. Tuberculosis glandularum maxillarum colli. Angina in tuberculoso without fever (Conium alternated with Hepar). 2. Scrofulous and Tuberculous Cutaneous Affections, especially lupus sub-cutaneus; tubercles of the skin ; papules with a white secretion. 3. Scrofulous and Sub-acute Ophthalmia, with great photophobia especially, affection and suppuration of the meibomian glands; formation of tubercles on the eyelids; conjunctivitis, with little or no mucous secretion; keratitis, especially when nebulae form; also chronic nebulae. 4. Scrofulous Affection of the Ears, with swelling of the parotids; albuminous, watery otorrhcea. 5. Scrofulous swelling of the nose. Ozaena. 6. Scrofulous Spinal Affection. Pott's curvature ; soft- ening of vertebral column; scrofulous coxalgia, which develops slowly ; scrofulous and tuberculous caries. 7. In Fibrous Scirrhus, in so far at least as at the begin- ning, it consists of albuminous infiltration, Conium may be of service ; but generally when an affection of this kind in the mammary or axillary gland is presented to our notice, it is too late for its removal. If, however, rational symptoms or hereditary taint give reason to anticipate or suspect the NO. II. CONIUM MACULATUM. 289 commencement of such an affection, Conium would certainly be among the most useful remedies, yet the symptoms of Conium have rather the character of those of infarctus than of developed fibroides, in which the knife alone avails.1 8. Induration in general of mamma and uterus (as well after reduction of inflammation as in chronic form), with discharge of mucus. All indurations; not so markedly indicated, however, in indurations resulting from inflam- mation. 9. For the Carcinomatous diathesis Conium can do noth- ing, even in the beginning. 10. In Atrophy of mamma and uterus, Conium may be useful; the conditions to which Conium corresponds often coinciding with atrophy; numerous observations show its especial applicability to affections of old women. 11. Results of Contusions ; hence, after difficult or instru- mental labor. 12. Since the conditions already named are mostly con- joined with discharge, Conium may be considered as anti- leucorrhceic. Chlorosis, amenorrhoea, and dysmenorrhoea, when they depend on the same cause, indicate Conium; yet these symptoms may be independent, and may still coin- cide with the symptoms of Conium. To the same category belong also sterility, milk-tumors, and affections caused by the sudden removal of the child from the breast. 1 The later English authors are tumor, and not to the malignant Can- disposed to confine the term Scirrhus cer in its first stage, that Conium is to the first stage of Cancer, before ul- applicable, and even in this, to benign ceration takes place. Scirrhus, then, fibroides only in the formative stage. is always a malignant affection. The During the year 1851, two patients in Germans apply the term, however, Dr. Wurmb's Hospital, in Vienna, in indifferently to such benign or malig- whom fibrous tumor of the uterus nant tumors as from their physical was clearly recognized, were treated character, hardness, merit the name. with Conium. In one, the tumor From this character, the benign fibrous disappeared; in the other, it had tumor (fibroides of Rokitansky) of the greatly diminished in size, when she uterus or mamma is often called refused further treatment. Scirrhus. It is to this species of C. D. 20 290 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 13. Affections of the Intestinal canal; seldom when these are primary,—chiefly when they are combined with, or rather are consequent upon, a general condition indicating Conium. Vomiting during pregnancy; diseases of the intestinal canal in tuberculous and scrofulous persons, espe- cially scrofulous children. 14. Dry, nightly, tickling cough, especially in scrofulous or aged persons; evening dyspnoea; pertussis, with much vomiting; asthma senile. 15. Feeble condition of old women and men; hysteria; hypochondriasis in chaste wedlock. NO. III. MERCURIUS. Mercurius has been well proved. Its symptoms are chiefly objective. 1. Its only primary effects are on the vegetative sphere, which it affects in the highest degree, both quantitively and qualitatively. It alters the vegetation so deeply and thor- oughly, that it assimilates itself, as it were, to the whole organism, decomposes and separates its organic constituents, and becomes itself a new element of the organism. Hence arises a new Mercurio-vital process, the natural vital process having given place to the operation of Mercurius. All other effects—viz., upon the nervous system—are sec- ondary. 2. In the vegetative sphere, Mercurius attacks, first of all, the secretive and resorptive processes. (The increased absorption is not a secondary result of increased secretion. Absorption, as well as secretion, is primarily affected, as is shown by the rapid absorption of Mercurius by the exter- nal skin.) It excites both of these processes to increased activity. The secretions are therefore increased in quantity. They are altered in quality. This alteration has reference both to consistence and to intimate chemical composition. NO. III. MERCURIUS. . 291 In consistence, they become thinner and more fluid; this effect distinguishes Mercurius from remedies otherwise anal- ogous, but which thicken the secretions. (Hepar, Conium.) As to chemical composition, they become acrid and exco- riating. This twofold alteration depends upon the peculiarity of Mercurius, already stated (1): in the first place, this plas- ticity of the secretions is diminished, and fluidation instead of coagulation is brought about; in the next, in the room of the displaced plastic materials, whose decomposition it effects, Mercurius insinuates and establishes itself. 3. Mercurius causes, first, a condition of excitation (even to inflammation and suppuration). This is to be explained, generally, by the stimulating action of Mercurius, and the reaction of the organism. Then follows a torpid collapse of the organic forces,—weakness even to exhaustion. This results from the commencing decomposition induced by Mercurius. 4. Mercurius penetrates the whole organism. No portion escapes its action. Before all other parts, however, in sus- ceptibility, stand: 1. All the membranes and the glands of the lymphatic system; 2. The parenchymatous organs; and 3. The muscular and nervous systems. EFFECTS IN GENERAL. I. Vegetation. The vegetative function depends upon the equality in activity of the secretive and absorptive processes. If one or both of these be abnormally affected, nutrition and assimilation (vegetation) will immediately sympathize. Since Mercurius affects these processes pri- marily, in a very high degree, vegetation must be deeply affected. The vegetative process is retarded, and at last entirely arrested, with the following phenomena: 1. As to Nutrition. General emaciation. Laxity; pale, earthy hue of the skin and mucous membranes; baldness. Sponginess of the tissues, especially of the gums; disposi- tion to haemorrhage; diseases of the bones, and, as a 292 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. natural consequence, great weakness, increased by every slight effort; great sensibility to all injurious influences; violent thirst, double vision. 2. Assimilation (i. e., with reference to vitality and con- stitution of the blood) is most deeply affected. On the one hand, the tone of the vessels is depressed; and on the other, the blood itself loses its plastic constituents, becoming altered in composition. Hence, in general, the pulse is increased in frequency, but is feeble (it may be also slow and soft). In the beginning, however, congestion and even inflammation occurs in individual organs ; but later, only hyperaemia and stases in these and in the periphery. Exu- dations often occur, partly because of the local inflammation in the hyperaemic parts, and partly because of the increased fluidity of the blood. Although, in consequence of the decomposition of the blood, the venosity threatens to pre- ponderate, this result is nevertheless obviated by the excessive secretion, and anaemia or hydraemia is everywhere manifest; or if venosity become manifest, it is of short duration, showing itself in ecchymosis. Secondary Symptoms. With the phenomena above-men- tioned, the whole vital energy succumbs. The thermogenesis will therefore be diminished. Thus, the chilliness, sensi- bility to cold air, and desire for the warmest possible temperature, are explicable. This is the general condition; there may be, however, temporary and partial excitement of the vascular system; and hence alternations of heat and cold occur, which appear so much the more frequently, as the erethistic condition is more highly developed. II. Nervous System. The effects on the nervous system spring from two causes: (i), a general cause,—the diminu- tion and decomposition of the fluids, and the reduction of the functions to an erethistic or even a torpid condition; and (2), a special cause,—the action of Mercurius upon the membranes, which extends to the neurilemma and the nervous centers. NO. III. MERCURIUS. 293 1. The nervous power is diminished; hence, as regards sensation, a feeling of great depression, as well as actual prostration, restlessness and general indisposition; and, as regards motion, a lack of power, the motions becoming tremulous, indirect, and scarcely obedient to the will: hence, mercurial trembling, loss of speech, dysphagia, cough, etc. 2. By virtue of the special cause, the neurilemma being attacked, true neuralgia occurs (prosopalgia mercurialis), especially when single nerve-twigs are involved. The pain is drawing and tearing, attacks generally but a single nerve ; often changes its location, but sometimes retains its seat for months ; is aggravated by hygrometric changes, and by changes of temperature. The left side is the most power- fully affected. 3. As a general rule, only the nerves of sensation and motion are attacked, the vegetative nerves suffering through the local conditions. 4. The sensorium is generally depressed (save during erethism) ; hence giddiness, irritability, mental disturbance, mania, melancholy, loss of memory, imbecility. III. Secretions in general. The secretions of every kind are altered and increased. They become acrid, and the quan- tity of some of their constituents is abnormally increased. 1. Sweat. Exceedingly copious, easily provoked, oily, sour, giving a yellow tinge to the linen. 2. Of Mucous Membranes in general. Acrid, causing therefore burning in the anus and tenesmus, tenesmus of the bladder, and burning, before and after micturition. The salivary secretion is characteristically increased. The pan- creatic secretion is increased; secretion of bile is increased; hence greenish-yellow stools. 3. Genital Organs. Glandular and urethral gonorrhoea ; increased discharge of semen. Menses increased in quantity. Leucorrhcea, sometimes mucous, sometimes purulent. 4. Respiratory Organs. The peculiarities of the secre- 294 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. tions induced by Mercurius are here less obvious. The normal secretion seems often even diminished. Frequent haemorrhage. Abnormal Secretions. To this category belong: (i.) The purulent decomposition of inflamed parts gen- erally. (2.) Formation of pustular eruptions. (3.) Ulcers in general, as combining these two character- istics. For, as to the former, the suppuration always pro- ceeds from an inflammatory process, and is hence preceded by signs of inflammation,— redness, heat, swelling,—especially when occurring in the glands and cellular tissue; hence swelling of the gums, fauces, tonsils, epiglottis, parotid and submaxillary glands and inflammation and suppuration of the cervical, inguinal, meibomian and mammary glands. Again, as to the latter, the eruptions caused by Mercurius have the complete character of inflammation, with a ten- dency to suppuration or to puriform collections. (The irritative character of Mercurius, and the consequent reaction of the organism, together with the tendency of Mercurius to cause fluidity, induce the suppuration.) The pustule formation is often incomplete; hence erythema, eczema, erysipelas, impetigo, rupia (large vesicles); or, in mucous membranes, aphthae, herpes praeputialis. The eruptions have this peculiarity, that on the spots originally occupied by them, sequelae form—e. g, scales. The mercurial ulcer originates in inflammation, removing the epidermis, and producing a discharge of pus and sanies. The ulcer rapidly increases in breadth and depth, soon becomes indolent and spongy, and finally bleeds. The circumference is red, the margins puffed. It most fre- quently occurs in mucous membranes, and in the mouth and on the genital organs. 5. Serous and Fibrous Tissues. These tissues become irritated. A secretion takes place in the capsules of joints and sheaths of muscles, fulfilling the conditions of rheu- NO. III. MERCURIUS. 295 matism. In the serous sacs, collections of water form (mercurial rheumatism), and also of pus. Inflammation of the periosteum occurs, with deposition of new products, e- <£"•» gummata. The bones become dry and brittle, through loss of fluidity. IV. Mercurius excites the lymphatic glandular system in general, even to inflammation and ulceration of the glands (axillary, cervical inguinal, etc.), and at the same time primarily stimulates in a very high degree, the absorption in the lymphatic vessels. N. B. It affects especially the salivary glands, increasing the secretion, inducing swelling, inflammation and suppuration. The Liver. Mercurius induces incomplete reproduction; hence the fatty diathesis. It is indicated, before all other remedies, in fatty disease of the liver, resulting from depressed vegetation. For the Spleen, Mercurius has little affinity. For the Lungs, more than for the spleen. ANALYSIS IN ANATOMICAL ORDER. Head. Various sensations and pains. Congestion. Eyes. Irritation, swelling sensation as of sand in the eye, lachrymation, conjunctival congestion, photophobia, ptosis, oedema of cellular tissue and conjunctiva, loss of brilliancy in cornea, nebulae, amblyopia, amaurosis, iritis. Ears. Inflammation with pustules, haemorrhage, deafness, illusion of the sense ; pains. Nose. Peculiar painfulness of nasal bones. Mercurius, above all remedies, is related to the nose, especially to the pharyngeal portion of it. Swelling and haemorrhage. Face. Collapse, paleness, blue rings around the eyes. CEdema, convulsive jerkings. Teeth. Swelling, redness, burning, bleeding of gums; looseness of teeth, aggravation of pain by cold applications, and at night. Mouth and Pharynx. At first, erythema; at the same 296 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. time oedema, vesicles, pustules, aphthae. The inflamed spots are very sensitive and bleed easily. Swelling and dryness of tongue, discharge of saliva. Difficulty in moving the tongue, even to paralysis. Throat, (Esophagus. Stiffness, swelling of pharynx, pressing pain, and excoriation. Dysphagia. The tonsils are first affected, then the gums. Digestive Organs. 1. Loss of appetite, nausea, bulimy, metallic taste, no thirst, save a desire to moisten the dry parts affected. 2. Digestion disturbed. Ructus, vomituritis, collection of water in the mouth ; nightly nausea. Mucous secretion increased and changed;, pancreatic juice altered. Stomach pains. 3. Abdomen. Fullness, oppression, meteor- ism, sensibility, sticking, cutting, pinching pains in liver. 4. Stools. Frequent, with little or no discharge of. solid or soft faeces; pappy, whitish-gray or green-yellow, sometimes bloody, acrid and excoriating; tenesmus, pinching and burning in anus, going on to inflammation, suppuration and haemorrhage. Dysentery. Mercurius has especial affinity for the two ends of the digestive canal. The stomach and upper intestine are but slightly affected; often not at all. Genital Organs. The mucous membrane is the part chiefly affected. 1. Male. Swelling; formation of scales, vesicles, pustules, ulcers, analogous to those of the mouth and pharynx; discharges, itching and burning; discharge of semen without pleasure; gonorrhoea. 2. Female. CEdema: Leucorrhcea purulent, acrid. Men- ses copious. Respiratory Organs. Expectoration streaked with blood. Mucous membrane light-colored; its substance little affected. Coryza, with acrid, purulent discharge. Trachea. Dry irritation; cough, with bloody sputa. Lungs, dyspnoea, asthma, sticking pains, oppression. Back and Limbs. In these parts are experienced all the NO. III. MERCURIUS. 297 symptoms relating to skin, serous and fibrous membranes and bones, e.g., itching, crawling, burning, lassitude, loss of power—tearing, sticking, and throbbing pain, cracking of the joints—cramps and trembling—oedema, exostosis. Characteristics. Aggravation by cold, and at night; from exposure to currents of air, and to change of weather; this applies to all the symptoms. Swelling and irritation of the parts attacked, suppuration, ulceration, pustular erup- tions. Increased and acrid secretions, salivation, diarrhoea, gonorrhoea. Menses too copious. Sweat; trembling and spasm, especially of the flexors. Osseous affections. Es- pecial relation to those mucous surfaces which are nearest the external skin. Application. 1. Generally. To individuals of a depressed vegetation, of a tendency to mucous and bloody discharge, to suppuration with hydraemia, to affections of the lymphatic and glandular systems. To children in the period of denti- tion ; to youths of feeble and leucophlegmatic temperament, but not torpid, on the contrary, rather erethistic. In both acute and chronic diseases; in the former, however, not until the general excitement has somewhat abated, and the inflammatory condition has become localized. In simple inflammations as well as in formation of deposits. 2. As to erases. In all erases characterized by slow depression of the plastic life, by increased and altered secre- tions, and still more, by a tendency to suppuration or to purulent exudation. All erases in which Mercurius is indi- cated are characterized by erethism and never by torpor, hence, Mercurius does not stand high on the list of antiscor- butics, because in scorbutus there is mere collapse, and no tendency to suppuration. Still in cases of scorbutus, with manifest excitement combined with phlebitis, it is often available. In other cases, Carbo vegetabilis, Arsenicum, China, Arnica, Lachesis, are preferable. Mercurius is more strongly indicated in the tuberculous and scrofulous erases when the parts attacked threaten to inflame and suppurate, 298 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. and where erethism is present and ulceration threatens. As to special erases: 1. In Tuberculosis. In the second stage, with tuberculous ulceration and copious purulent expectoration, with fever and gradual emaciation, Mercurius should never oe employed. It is indicated only in an erethistic condition of the lungs— hence not in pneumonia, rather in hectic fever in consequence of pyaemia. In tuberculous affections of the bones with tendency to caries. In necrosis. 2. In Scrofulosis, with ulceration or swelling of the glands, otherwise Calcarea is preferable. Scrofulous affections of the bones. Scrofulous ophthalmia. In rachitis, as distinct from scrofula, probably not so appropriate as Calcarea. 3. In Syphilis, especially when the mucous membrane and glands are affected—especially when ulcerated. Mercurius has less affinity for the eruptions unless they be pustular (Rupia). Not so well adapted to the syphilitic osseous affections. 4. In Pyamia, from absorption of purulent matters. Except Arsenic, no better remedy is known for this crasis. Also in erases that present similar symptoms to those of pyaemia. 5. In the Inflammatory crasis, with mild fever with tendency to localization, and inflammatory exudations in the cellular tissue and glands. Pleuritis, meningitis, peritonitis. Inflammation of the capsules of joints and sheaths of muscles, with purulent, plastic exudations. 6. In the Typhoid crasis, Mercurius is scarcely indicated unless in typhoid parotitis. But in puerperal fever it is a most precious remedy against both the local affection and the general condition. In metritis puerperalis,— affections of the joints, and puerperal deposits (metastatic), because of the general tendency to pyaemia. 7. In the Rheumatic crasis, seldom indicated, rather where the periosteum is affected with aggravation by change of weather. NO. III. MERCURIUS. 299 8. In the CEdematic crasis, contra-indicated in anasarca or ascites. 9. Mercurius is indicated in Icterus, with irritation of the liver—febris biliosa. 10. In Exanthemata, vesicular, and pustular (seldom the papular), both acute and chronic. In variola, when pyaemia is established after the repercussion of the eruption. In salivation; in herpes zoster Mercurius vivus is a specific. In benign furunculus (not in malignant), impetigo, miliaria, eczema, crusta lactea. INDICA TIONS IN ANA TOMICAL ORDER. 1. Head. Hydrocephalus acutus; abscesses in the scalp; caries; syphilis. 2. Ophthalmia scrofulosa, and catarrhalis with purulent secretion ; inflamed cellular tissue. 3. Otitis with purulent discharge. 4. Angina with tendency to suppuration. Tonsillitis. Aphthae. 5. Swelling, inflammation and suppuration of the gums. 6. Glossitis; inflammation of cellular tissue and glands, with irritation of all surrounding parts; suppuration, ulcera- tion, salivation, toothache, with ulcers from caries, stomacace (compare Iodine). 7. Hepatitis, acute and chronic. Bilious derangements. 8. Enteritis, acute and chronic, when actual pus is formed after the first stage. 9. Diarrhoea generally, with muco-purulent stools, green and bloody, tenesmus, scanty stools, much tormina, burning in rectum, no pains in the abdomen. 10. Proctitis, and proctalgia, with discharge of pus and blood. 11. Dysentery in high grades, with purulent secretions, tenesmus, scanty stool. 12. Inflammation of kidneys (and irritation after inflam- mation), with irritation and purulent urine. 300 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 13. Inflammation of the bladder and urethra. 14. Gonorrhoea, ulceration of the genitals; oedema praeputialis (especially in children, with slight erysipelas); orchitis; leucorrhoea excoriating. 15. Metritis, especially lymphangioitis, leading to pyaemia. 16. Oophoritis (after Belladonna, and succeeded by Platina). Hydrops ovarii. (Graphites ?) 17. Catarrh; not indicated unless there be purulent dis- charge. 18. Myelitis. 19. Panaritis. (Mercurius yields only to Hepar in efficacy.) 20. Psoitis; scrofulous coxalgia in incipience. When suppuration already exists, Mercurius does not remove it. Phlegmasia alba dolens. 21. Arthritis. White swelling. 22. Trembling, twitching of the features, as a secondary phenomenon. Neuralgia. NO. IV. ACONITE. Aconite is the general representative of antiphlogistics. Effects in general. 1. Vascular System. It operates power- fully as a direct excitant of the vessels, and produces, there- fore, true synocha. 2. Aconite produces no crasis, and has, therefore, no tendency to product-formation. Its action is purely dynamic, viz.: the pulse is much accelerated, hard and strong; thermogenesis is increased; thirst great; general sensation abnormal. 3. It has a greater action on the more vascular organs — hence above all, on the lungs, giving rise to various degrees of excitement; next to the lungs it affects the periphery, and, last of all, the intestines. Hence congestion of blood to these parts, and haemorrhages. NO. IV. ACONITE. 301 4. It has no especial relations to the fibrous and mucous tissues, although it exerts an inflammatory action on all organs and tissues of the body. (Bryonia also has this specific action, although it. excites the vascular system less intensely than Aconite.) 5. Its action on the Nervous System is secondary. 1. The sensorium is either excited in consequence of the vascular excitement,—hence delirium,—or, 2. It is depressed by reason of the vascular congestion ; hence sopor. 6. Aconite has characteristic morning and evening exacer- bations; the majority of the pains are sticking; other pains occur according to the nature of the organ attacked. General Indications. Aconite is generally indicated, 1. In all inflammations in the beginning, against the vascular excitement which always prevails, before the disease is fully developed. Its action is brief, and does not interfere with that . of subsequent prescriptions. 2. As an alternating remedy after the development of the disease, when the vascular excitement continues. Special Indications. 1. (1.) Inflammatory Fever. (2.) In all inflammations, a. While the vascular excitement is great, and before any product has yet formed, b. When the product is already forming, if the vascular storm has not abated. (3.) Especially in inflammations of the serous and fibrous tissues; Aconite is preferable to all other remedies in these cases—when the vascular excitement is great, and a plastic exudation threatens (for less intense vascular excitement and a threatened serous exudation, Bryonia); hence in meningitis, pleuritis, peritonitis, under these con- ditions. 2. In Ophthalmia,—acute, with febrile excitement,—a sovereign remedy. 3. In the periods of dentition and menstruation with vascular excitement. It does not disturb the menstrual function. 4. Acute Rheumatism. 302 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 5. Acute Catarrh. 6. Tuberculosis with febrile excitement. 7. Vascular affections. Arteritis, pericarditis, and endo- carditis. In organic heart disease, for the periodical excite- ment. (Aconite is preferable to Digitalis, which sometimes leaves injurious sequelae.) 8. Violent dynamic congestions, depending on no organic cause. NO. V. CALCAREA CARBONICA. Calcarea affects exclusively the vegetative system; all other action is secondary. The secretive and resorptive functions are immediately stimulated to increased activity, and a condition of irritation ensues. All organs and sys- tems are affected, the nutrition of all being altered. The lymphatic system is affected in a special degree; and, in the mode of this affection, the Calcarea symptoms resemble the scrofulous process in its lower grades. Calcarea is a chronic remedy, because it alters the erases; also a sub- acute, because the products of the altered erases provoke a state of irritation. Its action is not stormy, but mild and slow. 1. Nervous System. Not specifically affected; the iso- lated spasms that occur are secondary. Pains corresponding to the nature of the organs attacked. Sticking pains, and a sensation of rigidity, predominate. 2. Vegetation in General. A cachectic habit is induced ; decrease of temperature; puffiness of the soft parts; laxity and general debility, with increased sensibility to external influences,—as changes of weather. 3. Vascular System. Moderate degree of fever; chill and heat quickly alternating; fugitive heats; chilliness predom- inates. Sweat breaks out easily, especially in the palms and soles ; evening exacerbation. Thus, a fever resembling that of Tuberculosis. The composition of the blood is not primarily altered; secondarily it is altered. NO. V. CALCAREA CARBONICA. 303 4. Lymphatic System. Excitement and irritation. Re- sorption is deranged, and its activity is increased; the glands are swollen, irritated, become the seat of a deposit, and even pass into a state of inflammation. The glands of the neck and mesentery are especially attacked. 5. Skin. Irritation, evinced by erythema, erysipelas, papules, vesicles, pustules, bleeding ulcers, and scaling off of the epidermis, especially on the head ; the skin ulcerates easily, especially at tender points,— e. g., lips and margins of eyelids, the inner surface of the arms, and the anterior surface of the thigh, dorsum of the foot, and outer surface of the ear, etc. 6. Mucous Membrane and Glands. Irritation. Secretion rather diminished than increased. ANAL YSIS IN ANA TOMICAL ORDER. 1. Head. No especial symptom of cerebral disturbance. Frequent congestion in consequence of the general irritation. 2. Eyes. Irritation and rigidity of the lids. Conjunctiva reddened ; feeling as of sand in the eye ; photophobia ; the secretion of the meibomian glands is thick and glutinous. Lachrymal secretion increased. 3. Ears. Increased secretion of cerumen. Purulent discharge; deafness. 4. Nose. Ulceration of the alae; purulent, foetid dis- charge. Dry obstruction. 5. Mouth. Gums red and swollen. Also the whole mouth to the uvula. Salivation. Tonsils and palate swollen. Deg- lutition difficult. 6. Intestinal Tract. In stomach and abdominal canal great sensibility to pressure ; burning and pinching pains. Loss of appetite. Repugnance especially to meat, which passes away undigested. Rancid, sour eructations. Faeces long retained; hence, tormina. Stools solid and dry, with straining. Sometimes also diarrhoea (secretion being abnor- mal in quality), watery and pappy, always scanty. The 304 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. intestinal secretion being abnormal, induces irritation; hence, spasm of stomach and intestine. 7. Liver. Irritation, especially in the biliary passages. 8. Urinary Organs. Pressing and sticking in the kid- neys and bladder ; burning, dysuria, enuresis. Urine diminished in quantity, and for the most part saturated with saline constituents, and hence dark or turbid. 9. Genitals. Congestion and swelling. As to sexual functions, erethism ; and, as an alternate effect, diminished instinct. Sweating of the labia and scrotum (in gonorrhoea and onanism, compare Sepia and Selenium, Boenninghausen). It is a most important remedy in connection with early and too copious menstruation; so much so, that it acts favorably only when these conditions are present. 10. Respiratory Organs. Mucous secretion altered,—either increased or diminished. Tenacious, thick mucus. Dryness of throat; dry cough, constriction of chest, with hoarseness and roughness. 11. Muscles. Stiffness; pains in the joints, causing diffi- culty of motion. (Calcarea favors the secretion of chalky deposits in the synovial sac.) 12. Bone-pains from head to feet. Characteristics. Calcarea affects primarily only the vege- tative sphere; from this its operation extends over the whole organism, exciting moderately, producing irritation, and appearing to favor a deposit of the earthy salts. The lymphatic system of vessels and glands is first and most deeply affected, being the seat of irritation, swelling, depos- its, and their consequences. The skin and mucous mem- branes are next affected; the secretions are often diminished, and often increased (when increased, only relatively), and are generally acrid and sour. The whole nutrition suffers very greatly. Menstruation is too early and too copious. The pains are various ; chiefly a feeling of stiffness, with or without sticking pains. Aggravation by change of temper- ature, especially by cold, and at night. (Boenninghausen NO. V. CALCAREA CARBONICA. 305 designates many important symptoms, which are aggravated in the morning, in contradistinction to corresponding symp- toms of Causticum, which have evening aggravation.— C. D.) Application. To youthful persons and females; to those who are badly nourished, pale, with affections, of the skin and mucous membranes ; to all, in short, who present the scrofulous diathesis, or one like it; especially at the period of development; dentition and puberty (menses too copi- ous) ; moreover, for children generally. The symptoms of Calcarea present a striking picture of erethistic scrofula, for which diathesis it is eminently appropriate. (For the cancerous diathesis, Arsenic ; for the chlorotic, Pulsatilla.) Tuberculosis and Rachitis, with excitement and irritation. 1. Children who do not walk until after the usual age, who manifest great irritability, have large, distended abdo- mens, and scrofulous inflammations of the skin,— i. e., gen- erally little vesicles producing crusts, chiefly on the head and face, lips, nose, and eyes,— subjects to scrofulous ophthal- mia, scrofulous ozoena, scrofulous affections of the ears,— especially with a purulent discharge. In atrophia infantum, without suppuration, Calcarea is better than Arsenic. In osteomalacia ; swelling of the glands. Indigestion, with acid- ity, in scrofulous subjects. Acid, pappy diarrhoea; also constipation. Helminthiasis in a scrofulous diathesis. What is true of scrofula in general, is true also of tuberculosis. 2. Adults also; in tuberculosis, with colliquative sweats. Ophthalmia, with thick blennorrhcea. Ophthalmia which has left behind it opacity of the cornea. Blennorrhcea nasalis. 3. Rheumatism, acute or chronic. Tendency to vesical calculus. 4. Tonsillitis frequently recurring; general irritation of tonsils. 5. Gastritis. Chronic, especially with acid formations. Gastromalacia chronica, with evacuation of undigested faeces. Disposition to catarrh, chronic catarrh, catarrh of bladder and vagina. 21 306 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. NO. VI. BRYONIA ALBA. Bryonia is in every respect closely allied to Aconite, as well in its general relation to the vascular system as in its special affinities. i. Vegetation. It operates directly on the vegetation, affecting especially the secretive process, producing a high degree of irritation, sometimes even inflammation. First of all, however, it increases the activity of the resorptive appa- ratus ; that of the secretive function is a consequence. (Compare Mercurius.) Bryonia induces the formation of products, viz.: infiltration into the cellular tissue, and serous exudations into the serous sacs. It produces no plastic exudations (as Hepar and Mercurius do). The blood is affected, as in the milder forms of typhus. By virtue of its action on the resorptive and secretive functions, Bryonia has especial affinities for the abdomen, where abound those organs and tissues on which it especially acts, viz., serous, fibrous, and mucous tissues. 2. Vascular System. The vascular system is excited in a less degree than by Aconite. Its action is partial, i. e., is exerted upon single organs. During the paroxysm of fever, the chill predominates, occurring often in the midst of the heat. Thirst is very intense (because of the increased resorption); sweat very copious. 3. Nervous System. On the nervous system it acts, 1. probably directly, attacking the serous envelopes, the men- inges and neurilemma; 2. mechanically, the excretions which it induces, producing, by compression, a depressing effect. 4. Skin. No especial relation. Irritation, oedema, and vesicles, characteristic. No pustules. 5. Eyes. Irritation, serous secretion, especially attacks the sero-fibrous tissues (keratitis, sclerotitis, iritis). The secretions are at first watery; later, they are purulent, thick and tenacious. NO. VI. BRYONIA ALBA. 307 6. Ears. A mild form of periostitis—watery discharge, sticking pains, illusions and dullness of hearing. 7. Face. Generally paleness; frequently, however, fugi- tive heat, swelling, with slight redness. 8. Digestive Apparatus. Irritation. Secretion of the mucous membrane is at first thinned, then thickened, and then altogether suppressed. Burning in the mouth and throat; difficult deglutition. The fibrous coats of the muscles are especially affected, hence pain on turning the head, swallow- ing, etc. (different in seat from pain of Belladonna). (Edema of the gums, and of the whole cavity of the mouth. Perios- teum alveolorum affected; excessive sticking pains through the entire row of teeth, accompanied by oedema of the gums, even to the roots of the teeth. Salivary secretion increased and thin. Stomach. Digestion disturbed, in con- sequence ructus, vomituritio, vomitus post pastum. Intes- tine. Similar irritation; constipation as well as diarrhoea (serous); rather, however, an alternation of the two; pinching and burning pains. Peritoneum. Irritation. Sticking pain, great sensibility. Hence, symptoms from the liver, kidneys, bladder, and uterus (their peritoneal coats being affected). The secretion of the liver is increased. The stools are thin and green, from intermixed bile; frequent vomiting of bile. The kidneys more deeply affected, secretion diminished, urine clear. For the sexual organs it has no affinity, except in so far as the serous envelopes of the organs are concerned. CEdematous and painful swellings of the testes. 9. Respiration. Irritation. Secretion, for the most part, increased, thin and serous. Dyspnoea. Pleuritic inflamma- tions, with exudation. 10. Rheumatismus Acutus. Pain, swelling, increased temperature, redness, sensibility to changes of the weather, inability to move the parts. Inflammation of the perios- teum, especially of the head and face, with the characteristic sticking pains. 308 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. The symptoms occur chiefly in the serous and fibrous tis- sues. Application. Bryonia is indicated in a condition between synocha and typhus, resembling the former as respects the vascular system, and the latter as respects the nervous (com- pare Arnica). It is suitable for nervous and bilious tem- peraments, persons of dry and spare habit, dark complexion, excitable character, and predisposition to inflammation of the membranous tissues; for women and children in whom excitability is great, but energy and stability of reaction only moderate, who are inclined to lymphatic exudations and accumulations, and to nervous diseases, and at the same time, in an equal degree, to active congestions. It is appropriate in all varieties of rheumatism, and in all conditions in which catarrhal and rheumatic characters are combined. i. Typhus. The efficacy of Bryonia in the commence- ment of typhus is attested by all homoeopathic writers; but, as in its very commencement typhus is not easily recognized, the claims of Bryonia remain sub-dubio. In typhus versa- tilis, however, with rheumatic pains, it is efficacious in all stages. Also in complications of typhus, with meningitis or pleuritis. In localized typhus, attacking the peritoneum or pleura, it is a sovereign remedy. 2. Intermittent Fever. Only in those cases in which the disease acts directly upon the ganglionic system, in which the cold predominates, and thirst and pain in the limbs are great, with accessory symptoms, e. g., serous diarrhoea and sticking pains. 3. Skin. Urticaria. Morbilli with oedema, especially with a vesicular eruption. Miliaria (copious sweat). Sweating of the feet, not offensive. If offensive, Carbo-vegetabilis is preferable. 4. Nervous Affections, of various kinds, having their seat in the meninges and neurilemma. Oppression, dizziness, staggering, etc. NO. VI. BRYONIA ALBA. 309 5. Rheumatism. Acute, with serous exudations and general vascular excitement. 6. Membranes. Inflammation of serous membranes, with serous exudations containing plastic flocculi. Irritation of meninges (in actual inflammation Belladonna is better). Con- junctivitis. Hydrops oculi acutus. CEdema palpebrarum. Otitis. Ozaena. Swelling of the face, with sticking pain or without pain. Toothache, sticking pain, with extensive swelling, increased by cold, alleviated by warmth. Periton- itis, and hence hepatitis and enteritis serosae. 7. Gastric phenomena, especially serous diarrhoea. Also renowned as a remedy for constipation. (The irritated con- dition of the membranes induces diarrhoea, and probably, at a later period, dryness of the membranes, and hence con- stipation.) 8. Icterus, depending on chagrin, anger, excessive physical efforts, and a sedentary mode of life. 9. Mastitis, in nurses, especially when the mamma is somewhat oedematous with sticking pains, and the inflamma- tion is slight (for violent inflammation, with hardness, redness, and pressing pain, Belladonna; — Phosphorus, Boen- ninghausen). 10. Respiratory Organs. Pleuritis. Bronchitis with dimin- ished secretion, much irritation, exciting a cough, and scanty serous expectoration, raised with difficulty. In pneumonia it is less frequently indicated; only in pleuro-pneumonia, and in pneumonia with great oedema. In bilious pneumonia (of the right lower lobe). Bryonia has in general great affinity to the biliary apparatus. 11. General. Pericarditis, endocarditis, hydrocele (Rhodo- dendron). CEdematous glandular swelling. Sclereme. Anasarca, especially acute oedema pedum. In phlegmone colli experience has shown Bryonia to be a most valuable remedy (Wurmb). 310 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. NO. VII. RHUS TOXICODENDRON. GENERAL EFFECTS. Rhus acts primarily on the vegetative system, affecting especially the functions of resorption and secretion. All other symptoms are reflex from these effects. I. Its primary action is excitation (irritation). 2. It has especial relations to the membranes; and especially to the mucous membranes and external skin, producing irritation and even inflammation. SPECIAL ACTION. I. Vascular System. Irritation, even to fever. The pulse is hard, full, and frequent, and the heart impulse strong; but the peripheral vascular system is more particularly affected, and sometimes this alone. Hence the external heat exceeds the internal; both, however, are abnormally increased; thirst is very great. Vascular torpor is only a secondary condition, and is, hence, no indication for Rhus. 2. Nervous System. Secondarily affected. In case of moderate vascular irritation, the nervous system is excited ; in case of very great vascular irritation, it is depressed. Hence, in the former case, great mental excitement, anxiety, irritation, sleeplessness, or restless sleep with anxious dreams; and, in the latter case, sinking of the powers, weakness even to syncope, trembling, and convulsive jerkings. 3. Cerebral System. Specifically affected. Symptoms of incipient typhus: headache, diminished mental activity, uncertainty of movement, roaring in the ears, long apparent pondering before answering a question. These cerebral symptoms are present in every case of Rhus intoxication, and are hence characteristic. Hence the applicability of Rhus in typhus. 4. Nutrition. Depressed, but not in a very marked degree. NO. VII. RHUS TOXICODENDRON. 311 5. Secretions. 1. In the higher grades of excitement, all the secretions are diminished in quantity and thickened. 2. In the lower grades of excitement, they are increased in quantity and thickened, or else they become serous. 3. The Rhus irritation, unless it proceed to inflammation, is always accompanied by serous discharges, in the form of evacua- tions or of oedema. TISSUES. 1. Skin. Especially affected. Even contact of the leaves of the plant, or proximity to them, produces an eruption, varying in intensity from the slightest erythema to the gravest form of vesicular erysipelas. Vesicular formations are characteristic of Rhus. 2. Mucous Membranes. 1. Aphtha, swelling of the tongue; oedema and swelling of tonsils, and vesicular angina ; phimosis and paraphimosis, vesicular formations on the whole penis, scrotum, and perineum, with oedematus swelling of the neighboring parts. This Rhus oedema is everywhere hot. 2. Dryness of the mucous membranes, and, in consequence, difficult deglutition, tickling in the larynx, dry tongtfe, hoarse- ness, dry and painful cough, burning in the chest, burning pain in the stomach, nausea, repugnance to stimulating food, as flesh, wine, etc.1 Intestinal Canal. Tardy action. Tenesmus; painful evacuation of dry, friable faeces, often light-colored; also, but less frequently, from the tendency to serous depositions, thin serous stools. (See note.) Urine. Diminished; evacuation painful; tenesmus, with burning; emission by drops; also, involuntary evacuation. Urine turbid and scanty, with copious white sediment; also, increased in quantity and pale. (See note!) Region of the bladder, sensitive. 1 These different conditions of the by different grades of intoxication. mucous membrane depend on the Vide supra, Secretions, 1 and 2. different degrees of irritation induced C. D. 312 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. Sexual System. Excited ; a condition of erethism. 3. Serous Membranes. Secretion diminished; dryness, cracking in the joints; feeling of roughness and stiffness; sticking pains. 4. Sero-fibrous Tissues. Secretion diminished ; sensation of stiffness in the sheaths of the muscles, causing pain and difficulty of motion. 5. Osseous System. Periosteum is attacked; boring and deep sticking pains in the malar and maxillary bones. Characteristics. Aggravation during repose ; amelioration by motion ; action often confined to one side, more frequently the left side. APPLICA TION. General. 1. To acute and sub-acute cases ; less frequently to chronic. 2. In affections of the membranes, especially if accompanied by an evident dyscrasia, and attended by nervous phenomena. 3. In affections resulting from expos- ure to rain while perspiring. (Boenninghausen.) Special. I. Vesicular Cutaneous Diseases of all Varieties. Erythema and erysipelas bullosum; scarlatina miliaris; miliaria; carbuncle ; and, generally, all cutaneous eruptions that tend to gangrene. Herpes acutus; crusta lactea; hydrargyrosis; variola, with highly developed oedema and great cutaneous irritation; acute pemphigus ; oedema after acute eruptions, with redness, heat and fever; acute oedema per se (Morbus Brightii ?). II. Sero-fibrous Membranes. Acute and sub-acute rheu- matism affecting the joints and muscles, characterized by considerable swelling, redness, heat of the joint, pain diminished by motion, increased by repose, with miliaria and pustules around the joint; rheumatism of the fascia lata. III. Rheumatic Odontalgia. Tearing, boring pain over the whole chin ; swelling, redness of the gums ; erysipelatous swelling of the cheeks and region of the lower jaw, even to the eyes and forehead. NO. VII. RHUS TOXICODENDRON. 313 IV. Mucous Membranes. Acute catarrhs and inflamma- tions; laryngitis, bronchitis, gastritis, enteritis, etc., of mild degree, attended by nervous phenomena. I. Conjunctivitis, with oedema, vesicles and pustules; great pain, dryness, photophobia; gluing together of the eyelids ; pain on opening the eyelids, especially in scrofulous subjects. 2. Otitis and pharyngitis. 3. Inflammation of prepuce and scrotum, with vesicles and oedema. 4. Mucous diarrhoea, with great tenesmus; first stage of dysentery, scanty, frequent and painful stool. V. Typhus and other Maladies, with Nervous Phenomena. In the lower grade of typhus, in the first stage, everything indicates Rhus; predominant excitement; constipation, or frequent serous, greenish-yellow stools, especially if attended by miliary eruption. 1. Miliaria puerperalis ; purpura haemorrhagia febrilis. 2. Catarrhal fever, when the nervous system is especially involved. 3. Puerperal fever in the lower grades; peritoneal irrita- tion without exudation, rather of a rheumatic character; exudation scanty, and not plastic. 4. Pleuritis of the same character as peritonitis, nervous phenomena accompanying. 5. Pneumonia; difficult, thick, tenacious expectoration, with slow and tedious resolution (Pneumonia notha). 6. Heart diseases, especially of the pericardium, attended by nervous phenomena. 7. Lumbago ; paralysis in lumbar region.1 8. Intermittent fever. Nervous symptoms predominate. During the paroxysm a rheumatic condition comes on. Thirst and heat are very great. During the sweat, miliaria make their appearance. 1 Among the records of his large of the lumbar muscles in cows, after veterinary experience, Boenninghausen calving, cured by Rhus, followed by has many cases noted of paralysis Nux vomica.— C. D. 314 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 9. All diseases bearing a resemblance to rheumatism, which, however, one hesitates whether or not to pronounce typhus. NO. VIII. COLCHICUM AUTUMNALE. Colchicum ranks, in almost all respects, next to Bryonia. It acts especially on the serous and fibrous tissues. Its characteristic pains are sticking. 1. Differences. 1. Bryonia is adapted rather to acute diseases; Colchicum to sub-acute and chronic. 2. Bryonia affects the vascular system more deeply than Colchicum, exciting fever. 3. Bryonia attacks the larger serous sur- faces ; Colchicum rather the smaller ones (articular serous surfaces), and the sheaths of the muscles, rather the fibrous and fibro-serous, than the purely serous tissues; hence the periosteum and muscular sheaths are especially attacked. 2. Mucous Membrane. The action of Colchicum resem- bles that of Bryonia; the secretions are diminished in quantity, and thickened ; but Colchicum produces a far less degree of irritation than Bryonia does; hence its applica- bility in chronic catarrh, with a moderately copious tenacious mucous secretion (catarrh of old people). 3. Nervous System. No especial primary action. 4. Adaptation. Colchicum corresponds to the venous constitution, the phlegmatic, melancholic temperament; Bryonia rather to the nervous, erethistic temperament. The pains of Colchicum, like those of Bryonia, are aggra- vated by touch and by motion; those of Colchicum, how- ever, are worse in the evening and during the night; while, generally, the symptoms of Bryonia are aggravated in the morning on awaking. Colchicum, like Bryonia, produces tearing, sticking pains; but those of Colchicum appear as tearing or sticking jerkings through the periosteum, while the pains of Bryonia are NO. IX. LEDUM PALUSTRE. 315 accompanied by the general feeling, as if beaten (zerschla- genheitschmerz) throughout the muscular system. Colchicum, then, is more suitable when the excitation is slight,—when the disease inclines rather to a torpid char- acter, therefore to diseases of torpid, phlegmatic individuals. 5. Chief Sphere of Action. Rheumatism (sub-acute and chronic, but not of very ancient date), chronic gout, with thickened secretions, especially if characterized not so much by pain as by impediments to the free motion of the parts (semi-paralysis, quasi-paralysis). In the latter stages of acute rheumatism Colchicum is often indicated. (Kaspar appears to find frequently appropriate in acute rheumatism, 1st, Aconite; 2d, Bryonia; 3d, Colchicum.) In dropsy, conjoined with a general torpid condition, with little or no irritation,—dropsy after exanthematous diseases, —also, but less frequently, in dropsical affections of the synovial sacs, and of the thoracic cavities,— Colchicum is indicated. In diarrhoea, with plastic excretion and rheumatic com- plication, characterized by great flatulence,— in a low grade of autumnal dysentery, or rather in sanguineous diarrhoea than in real dysentery,— Colchicum is appropriate. In hydrops oculi, diseases of the sclerotica and cornea, and especially opacity of the cornea,—and among affections of the chest, in chronic catarrh, with scanty plastic secre- tion, and great sensibility to changes of temperature, espe- cially to cold air,—Colchicum shows itself efficacious. NO. IX. LEDUM PALUSTRE. Ledum ranks next to Colchicum in its action on the serous, fibrous, and mucous membranes. Its action is more power- ful than that of Colchicum, producing not only irritation and an increased thickened secretion, but also a deposit of solid, earthy masses. 3l6 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. Vascular System. In their relations to this system are found the true distinctions between Bryonia, Colchicum, and Ledum. Ledum affects the blood distinctly, producing a definite crasis, viz.: a tendency to exudation of blood; hence we find it producing haemorrhages (which are not induced by Bryonia and Colchicum). The blood has a special tendency to the periphery. Moreover, Ledum has far greater rela- tions to the periosteum and mucous membrane than either Colchicum or Bryonia (of these two, Colchicum has the greater affinity for mucous membranes and periosteum). The pains of Ledum are, to a greater extent, sticking and tear- ing, sticking as if caused by needles, as well in internal as in superficial parts. A characteristic of Ledum is a deficiency of vital heat, inducing a predominant coldness and ehilliness. As in the case with Bryonia and Colchicum, the sticking and tearing pains, and also the symptoms that occur at night, are aggravated by motion and by warmth. Like Bryonia, Ledum produces a hot swelling, but it has an especial affinity for the hip and shoulder. Application, i. In chronic rheumatism Ledum is espe- cially indicated when the secretion is scanty and thick, and is no longer absorbed, but concretions begin to form, residua in periosteal and cartilaginous envelopes, pain greatly increased by motion. Ledum has a special affinity for the regions of the hip and shoulder. The affection must not be entirely chronic; in such a case the mineral remedies are rather indicated, Calcarea, Mercurius, Iodine, etc. To be consulted in coxalgia, lumbago, arthrocace. In affections of the bones, especially in the formation of nodes. 2. Chronic Cutaneous Affections. Transformations of the epidermis. Ecchymoses (rather in chronic cases, such as chronic morbus maculosus). Bleeding ulcers on the fore- head. Tuberculous eruptions in drunkards. 3. Intermittent Fever. When the cold stage is of long duration, with violent thirst. Neglected typhus, with 1, NO. X. SEPIA. 317 important anaemia, or 2, visible alteration of the blood crasis (inducing, for instance, ecchymosis), or 3, affections of the mucous membranes especially (nasal haemorrhage or bloody expectoration without irritation). 4. Headache. Especially in the sequelae of syphilis, and in mercurial poisoning. 5. Ophthalmia Chronica. A renowned remedy, espe- cially in affections of the mucous membranes, with copious secretion from the meibomian glands and opacity of the cornea. 6. Dropsy, viz., Ascites. Ledum, like Colchicum, has a great affinity for the abdominal organs, probably because of their great venosity. 7. Chronic Pulmonary Catarrh. Even in pneumonia, if the symptoms correspond, especially if the cough is accom- panied by bloody expectoration, and threatens to become chronic. Tuberculosis with haemoptysis. 8. Tubercular disease of the bones. Ulcers of skin and gangrenous ulcers. (Hartmann.) 9. Gout. According to Rau's experience, one of the chief remedies, even for maladies complicated with gout. NO. X. SEPIA. GENERAL EFFECTS. Sepia is essentially a remedy affecting the vegetative sphere. Its other effects are only secondary. 1. It has a transforming action, altering the erases. Its action is slow, but deep and prolonged. 2. It diminishes the reproductive energy of the vegetable sphere. This is made manifest— a. Through the sluggish performance of the functions. b. Through the deficient general nutrition. 3. Pains and isolated' symptoms are but feebly pro- nounced. 318 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 4. It has special relations to the portal system, and to the female sexual system. SPECIAL EFFECTS. A. Primary. 1. Digestion is impaired, acidity predominat- ing; sour and foul eructations; tormina and meteorismus; chilliness after meals; neither copious diarrhoea nor obstinate constipation; frequent tenesmus. Haemorrhoidal tumors; excoriation between the nates (corresponding to the acrid character of the discharge). 2. On the Portal System and the Liver, a. Functions of the Liver. In degree these are not greatly disturbed. In kind the bile is altered ; it acquires a sour or foul character (hence vomiting and diarrhoea) with too little alkali. b. It induces also a change of texture in the liver, as is manifested by the disturbed state of the circulation (numer- ous stases). c. The complexion is altered. The skin becomes yellow and earthy-colored—like the wax of old church candles. Puffiness of the soft parts; there is no emaciation; this appears later—first, an increase of the fatty tissue, then laxity and flaccidity, lastly, emaciation. Also, irritations of the skin, showing itself in red spots with yellow areolae. d. Mental depression; sadness, inclination to anger. 3. Sexual System, a. Enfeebled condition, manifested by erethism (sexual instinct without energy),— rapid emissions, followed by great exhaustion and apathy after coitus. b. Profuse perspiration about the genital organs, especially of females ; excoriation and itching. c. Sepia has more relation to the female sex, yet is not to be overlooked in reference to the male. Menses scanty or suppressed, or else occurring too early. During the sup- pression of the menses mental depression and apathy. B. Secondary. 1. Nervous System. a. The nervous system, especially in the female sex, standing in the closest NO. X. SEPIA. 319 relation to the sexual system, shows a tendency to erethism, in consequence of which hysteric phenomena present them- selves, which may increase even to spasms. b. The sensations and pains of Sepia are indistinct in character, and are, generally, feelings of weakness, apathy and lassitude; sometimes, however, they are more distinct, occurring as burning, sticking or cutting pains—especially in the loins (corresponding to the liver and sexual system). 2. Vascular System, a. Participates slightly in the effects of Sepia, except in the easily provoked orgasms of blood to the head and chest. The symptoms chiefly unimportant and secondary. b. Vascular energy is diminished—so, consequently, is the thermogenesis. Subjective and objective venosity; passive congestions, perspiration; palpitation, pulsations felt over the whole body. These occur, but may well be regarded as phenomena belonging to the nervous rather than to the vascular system. 3. Secretive System. Only in so far generally affected, as that the secretions and excretions present an abnormal character, having a tendency to become sour and foul. They are sometimes increased, sometimes diminished. The increase of perspiration is most marked. 4. Respiratory System. A tendency to furnish a counter- poise to the general condition; hence, not unfrequently, a condition of irritation, catarrh with even bloody expectora- tion, cough, sometimes dry, sometimes moist—irritation of the pleura. 5. Sexual System. The physiological connection between uterus and mamma is here manifested by the emaciation and flaccidity of the mammae, and the swelling and ulceration of the nipples. CHAR A CTERISTICS. 1. The pains are dull; pain like paralysis is predominant. Amelioration from wannth and violent motion. Aggravation by repose and at night. 320 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. 2. A peculiar cachectic aspect; enfeebling of the vegeta- tion. Predominant affections of the portal, hepatic and sexual systems. Especially applicable to females. Gener- ally menstruation scanty, suppressed, or precocious. APPLICA TION. A. General. I. Age. Sepia is especially adapted to affections occurring at the climacteric period, in women who were formerly excitable ; after long-continued depress- ing mental affections, or great bodily or mental labor. 2. Aspect. An unmistakable aspect; a peculiar yellow- ish puffy complexion, rather fat. The tissues are soft and flaccid; they easily and quickly collapse and soon recover. 3. Temperament. Good-natured, yet easily excitable. 4. The affections complained of are not violent, often disappearing altogether, and are concentrated in the digestive and sexual sphere. A special indication, in addition to the above, is a very slight acrid and excoriating discharge ex genitalibus. 5. Although especially adapted to females, Sepia is also applicable, variatis variandis, to the male sex, especially to woman-like, soft-tissued men, who were formerly of a fiery temperament, but have settled down into a sedentary, medi- tative mode of life. B. Special. 1. Affections of the Digestive apparatus and the Liver indicate Sepia, a. By sour and putrid formations, manifested by eructations and habitual flatulence, and dis- turbed digestion. Inveterate sub-acute pyrosis (in acute, not appropriate,—compare Ipecacuanha, etc.). Pains in the stom- ach, and cramps of the stomach and intestines after eating. b. Pains in the hepatic and iliac region, excited by touch- ing those regions; hence, applicable in corresponding affections of the liver generally; in degeneration of the liver and intestines, Sepia is applicable, at most, only in the beginning; later, other remedies come into play. (Ascites as secondary to hepatic affection.) NO. XL GRAPHITES. 321 2. Sexual System, a. Uterus. Chronic infarctus; indu- ration. Acrid discharge ; laxity of the neighboring parts ; blennorrhcea, prolapsus. Amenorrhcea and dysmenorrhcea (menses being either too early or too late, and too weak). Sterility, abortion, displacement of the uterus. Mucous polypus. b. Male Sex. Increase of sexual instinct, and at the same time loss of sexual power. Erethism (in both sexes); hence, frequent nocturnal pollutions, followed by great exhaustion. Chronic, very profuse, corrosive gonorrhoea. 3. Nervous Affections. Nervous affection of the abdom- inal organs and uterus; hence, melancholia and actual hysteria ; megrim easily induced. Nervous toothache during pregnancy and at the climacteric period. Irritatio spinalis ; and, in consequence, paralysis of the lower part of the trunk. 4. Cutaneous Affections. Herpes circinatus ; stinking perspiration of the feet (not stinking, Bryonia). Psoriasis. 5. Affections of Eyes, Ears, and Nose. (As far as the vascular system is concerned). Chronic ophthalmia, with acrid secretion (abdominal ophthalmia, according to Pro- fessor Rosas, of Vienna), and yellow sclerotica. Deafness, in affections of the liver and abdominal organs. In Ozcena, a very important remedy. Ulceration and eruption about the mouth, with simultaneous disturbance of the digestion. 6. Excretions. Constipation/with much tenesmus. Mucous diarrhoea ; stinking cold sweat of the extremities. 7. Thoracic Affections. Tuberculosis. Affections of the heart depending on abdominal disease. Palpitation. Inter- mittent fever, cold predominating. Ulceration of the feet. Varices. NO. XL GRAPHITES. Graphites resembles, in many respects, its chemical sis- ters, the Carbons; less, however, in its general character, 22 322 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. than with reference to certain peculiar symptoms. Its action is very extensive and energetic, affecting, in a marked degree, the entire vegetative sphere. We find, in the effects of Graphites, all the phenomena of a depressed vegetative life, and a diminished assimilative activity, and can only remark, as a specialty, the peculiar tendency to the formation of pus. This specialty will be noted here- after. i. Vegetative Life. Almost no remedy attacks this sys- tem with so great energy in proportion to the degree of reaction which it excites. In this respect, Graphites stands between Arsenic and the Carbons. The phenomena of general and local excitement induced by it are pretty clear, yet are only to be explained as secondary; and they pro- ceed only from the vascular system, and, in a very slight degree, from the nervous system. 2. Secretions. In general, the secretions are diminished and thickened. The character of decomposition is manifest in a greater or less degree; hence, the secretions are offensive, of unnatural color and repulsive taste. As is always the case when the character of decomposition pre- vails, the serous secretions are increased. 3. Skin. Here we see, strongly developed, the phenom- ena furnished by every disease which manifests a tendency to morbid secretions,—viz.: itching, formation of pimples; irritation, with bluish-red papules of various size, having an erysipelatous aspect. There is, however, a special tendency to erythema, suppuration, ulceration ; hence, serous vesicles, ulcers discharging pus and sanies, moist eruptions, rhagades, scaly ulcers on all parts of the skin, and on its transitions to mucous membrane, especially about the mouth. 4. Mucous Membranes. In the mucous membranes, this character of Graphites is still more distinctly manifested. Their secretion is, for the most part, diminished; hence, they become dry. The secretions assume a thick, tenacious NO. XL GRAPHITES. 323 character, are difficult of solution (or excretion), and have a foul, saltish taste. (1.) The Eye becomes turbid and dry, the lids cohere; they burn and are irritated. (2.) In the Ear, a similar condition is manifested; buzzing in the ear, and deafness. (3.) Dryness of the Nose, inclination to sneeze, loss of smell, or a foul odor constantly in the nose. (4.) Mouth and Throat. Coated tongue; sensation as of something fixed in the throat; frequent endeavors to hawk up something ; dryness of throat, hoarseness, tickling, burn- ing, rawness; dyspnoea, anxiety, dry laborious cough. (5.) Intestinal Tract. Diminished stools; dryness and burning in the urethra and vagina; difficult and painful micturition. The tendency to ulceration appears most distinctly in those mucous membranes which are in more immediate contact with the atmosphere; hence ulcerative pain, with vesicles, pustules and ulcers, and corresponding discharges from nose and mouth. 5. The Urinary Secretion is either diminished or increased; more frequently diminished. 6. Menstruation. Diminished, retarded, enfeebled (Hahne- mann). 7. The Seminal Secretion is likewise scanty, or fails entirely; hence diminished sexual instinct, and imperfect ejaculation of semen. 8. Assimilation. Graphites diminishes the assimilative action, inasmuch as the part destroyed by its primary, decomposing action is not perfectly restored; while at the same time it enlarges it, inasmuch as it induces abnormal deposits and secretions. The altered blood-crasis does not permit a sufficient ^generation of the removed portions; hence the vital turgor sinks, the tissues lose their elasticity; while the new tissues do not arrive at textual completeness. Hence ensue collapse, flabbiness, discoloration of skin and 324 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. mucous membranes, loss of epidermis, falling out of the hair. Circulation is generally, at first, in a state of excitement; hence sometimes a general storm, but more frequently partial congestions present themselves. Soon, however, the circulation loses energy, becomes slow, idle, weak. As everywhere, under such circumstances, so here also appear soon an increased venosity, and then stases in the capillary vascular system, which lead to exudations in the form of oedema, ecchymosis, vesicles, etc. In the lymphatic system, the same process goes on ; hence swelling of the glands, induration, and irritation. In this condition, a corresponding fever is evident, in which the cold predominates, the heat being less general and less violent; coldness of greater part of the body, and heat only here and there. Sweat and thirst, especially thirst, are often violent, and, as in all enfeebled conditions, are easily and speedily provoked by slight causes. The nervous system partakes very little in the action of Graphites, since this action is not excessive, rapid, nor violent. The phenomena that do occur are chiefly those of depression ; hence the cerebral activity is markedly impaired. The general sensation, according as it does with the condition of the vegetative life, is depressed; hence gen- eral weakness, lassitude, relaxation of the tissues. Syncope is easily induced, together with great anxiety. On this account the feeling of lassitude is altogether the predominant general sensation; the other varieties of pain not being constantly produced by Graphites, but being due to the local conditions induced by it. The activity of the motory functions is impaired; these functions lack energy, but their debility never amounts to more than a very slight degree of paralysis; while, on the other hand, convulsive jerkings, tremblings, and spasmodic phenomena are not unfrequently present. Particular Functions. I. Digestion is impaired. Graphites NO. XI. GRAPHITES. 325 has an especial relation to this process; for several symp- toms are peculiar to Graphites, viz.: salt, sour, foul taste in the mouth, aversion, especially to meat and salt food, and disinclination to other articles of food ; unpleasant sensation before eating; during a meal, immediate unpleasant effects, especially abdominal distension, borborygmi; after eating, many sufferings, burning, sticking, and stomach cramp, singultus, nausea; many marked secondary symptoms. 2. Intestinal Canal. At the same time with above digest- ive phenomena, great meteorismus, discharges of flatus, and cramps. Liver and Spleen. Pain; bilious vomiting. Stool gen- erally retained solid, of a horribly offensive character; seldom watery. Anus. Burning and pinching. Prolapsus, discharges of blood; haemorrhoidal tumors. Urine. The urinary and genital systems are markedly affected. APPLICA TION. Graphites is applicable, according to special indications, in both acute and chronic diseases; more frequently in chronic. The acute conditions in which it is indicated cannot be strictly and purely such, but rather be conditions growing out of a chronic diseased state, corresponding in general character to Graphites. Its province is the more highly developed affections of the vegetative sphere, and we might in this view call Graphites a high potency of sulphur; for no small number of symptoms is common to both remedies; in Graphites, however, they reach a higher grade of develop- ment. This intermediate position of Graphites between Sulphur and Arsenic and Carbon, indicates its very extended sphere of action, which, however, is distinct from that of the others, inasmuch as Graphites has so marked a tendency to the ulcerative and corresponding processes. Diseases in General. 1. Cutaneous Affections. Those 326 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. which are disposed to suppuration. Ulceration with a peculiar scanty discharge, and formation of fungous granu- lations (hence panaritis). This ulcer is not easily healed — presents, however, a certain degree of vitality, even of irritation; hence granulations form, or at least there is an evident tendency to their formation. Scrofula and tubercle do not generally correspond to Graphites, yet may do so in individual forms, which are not infrequent. Arthritis. Graphites is one of the very first remedies, especially where there is no deposit, or a very slight one, when it is probable that the sero-fibrous tissues, by their dryness, aggravate the condition. Diseases in particular. I. Skin is especially the province of Graphites. Its distinctive character is this: a product forms, the epidermis is removed, pustules and vesicles form and re-form, or disappear, and are succeeded by scales; the pustules or scales fall away, and leave a raw place, difficult to heal, and generally covered by a certain amount of secretion, which, in the air, dries to a scab, scale, or mem- brane, and covers the spot. Moreover, cutaneous secretions are produced, which thicken and elevate the epidermis, and form granulations of various kinds (horny, panaritic fungi). Finally, to Graphites belong those skin diseases which are followed by successive crops of little vesicles, which scab over and so gradually cover large surfaces. In this category belong eczema, herpes, impetigo, lichen (?), in the lower grades; psoriasis, pityriasis, ichthyosis, scaly eruption on the head, and falling out of the hair. Among the maladies not herein included, and in which Graphites is indicated, is erysipelas, which frequently returns, or has so slow a migra- tion that gradually almost the whole body is covered by it. 2. Eyes. Often recurring inflammation, especially with formation of ulcers. Scrofulous ophthalmia, with cohesions of the lids and photophobia, especially in conjunction with crusta lactea. Dryness of the conjunctiva. 3. Ears. Deafness, buzzing in the ears, when in a gouty NO. XII. IPECACUANHA. 327 constitution, but especially when there is reason to suspect dryness of the mucous lining of the ear, as, for example, simultaneous dry catarrh of the nose, pharynx, etc. Toothache, with swelling and ulceration of the gums. Ulcers of the Mouth. Especially with offensive swellings of the glands of the throat; frequent angina, with conse- quent ulceration. Dyspepsia. Chronic Gastritis (Ulcus perforans). Flatulence very great. Constipation, with occasional diarrhoea; chronic colic. Genitalia. Swelling of prepuce, especially in children. Herpes Prceputialis. Burning on micturition. Want of semen and lack of sexual instinct; swelling and induration of testes. Hydrocele. Enlarged ovaries; amenorrhcea; Menses scanty, delayed, and painful. Respiratory Organs. Dryness of mucous membrane; hence chronic catarrh in many cases of tuberculosis; great roughness and hoarseness of the voice ; sensibility of larynx or quick respiration, and on change of temperature, inducing a tickling and spasmodic cough. N. B. Applicable to the pyaemic and uraemic processes; to affections of the liver without degenerations. NO. XII. IPECACUANHA. Belongs to that class of remedies which act chiefly on the nervous system. Its action is very moderate in degree; hence not very striking. Its exciting action is exerted chiefly on the thoracic plexus; it stands therefore in a kind of opposition to Nux vomica, which affects rather the subdiaphragmatic ganglia. 1. Nervous System. The brain and spinal system are scarcely affected; at most they are affected only by a reflex action. Still less is the sensorium acted upon. Little or no 328 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. pain is induced ; at most it is secondary. The symptoms of spasm are more numerous and better marked. Character. The symptoms reveal a distinctly intermittent character, in which they are rivaled only by Nux and Pulsatilla. The pains suddenly appear and suddenly disappear. They are aggravated at night (because the vegetative sphere is especially affected). For the same reasons, similar symptoms occur at the same time in various parts of the body. Gastric phenomena are always present; and organic sensation, i. e., consciousness of defined organic conditions, in a high degree; e. g., nausea, constant constriction of the chest, premonitions of spasms, constrictive sensations in the salivary ducts, in the urinary and sexual organs. 2. Vascular System. Great analogy to Nux. Ipecac- uanha has little effect on the great vessels and the heart (Nux affects the capillary system and the great vessels at the same time); it has more especial affinity to the capillary vascular system alone ; hence external coldness, and internal heat, and vice versa, objective heat, but subjective coldness of the skin, and vice versa. 3. Vegetation. Ipecacuanha excites and alters the vege- tation. The secretions are in general diminished in quantity; in quality they are scarcely altered. There seems to be no connection or mutual dependence between objective and Subjective phenomena. Sweat, urine, saliva, are for the most part increased; other secretions, which require a greater elaboration, for example, those of mucous membranes, are diminished. Bile is generally increased. Haemorrhages are frequent (because of the action of Ipecacuanha on the capillary system), yet no profuse discharge of undecomposed blood, threatening the organism. Ipecacuanha affects the stomach and chest, but acts less strongly on the intestines. Nausea, inflation, constrictive sensation, vomiting (scanty), without giving relief, and the matters vomited not qualita- tively altered. Foul taste, scratched feeling in the throat, yet the tongue not foul, etc. The peristaltic action of the NO. XII. IPECACUANHA. 329 bowels is diminished ; the antiperistaltic increased; constipa- tion, also watery diarrhoea. Lungs. More important action, constriction, dyspnoea, irritation inducing cough, increased sensibility, spasm' diminished secretion. Application. To pale, blonde individuals, women and children. Disturbance of the vegetative nervous system, of the stomach and lungs at the same time. Special. 1. Disorder of the stomach after an excess, if the disturbance continue some time (for the more transient disorders, Nux vomica, Pulsatilla, etc.). After typhus and intermittent fever, for the remaining stomach affections, chronic nausea, and vomiting. Indisposition after eating, yet without loss of appetite. In particular the gastric phenomena of pregnancy. All these ailments are generally conjoined with chest affections, anxiety, constriction, etc. 2. Acute affections. Variola, morbilli, catarrh, in its last stages. 3. Intermittent fever. It ranks with Nux vomica Pulsatilla, and China, as one of the best remedies. The fever in which it is indicated is characterized by gastric phenomena of low intensity; the chill predominates, and the chest also, is affected; the patient feels as if a hoop were placed around the body. 4. Nervous fever in the beginning; cholera in the begin- ning ; and in the sequelae of cholera. 5 Haemorrhage, from partial over-excitements, especially in incipient tuberculosis in young girls; also in haemorrhage from paralysis of the capillary vascular system, but never in haemorrhage arising from general crasis, or decomposition. Seldom in haemorrhage from the stomach and intestines; oftener in that from the lungs and nose. 6. After the violence of acute pulmonary affections has abated, when irritation remains. In chronic catarrh with physical symptoms of a very low grade; when the irritation inducing cough, and the dyspnoea are great at periodic DIAGNOSIS IN HOMCEOPATHIC PRACTICE. intervals; hence, in all asthmatic cases. In all coughs with a tendency to vomiting, if not violent, even in a slight degree. Spasms during pregnancy. Abuse of China. NO. XIII. CHINA. China has much in common with Arsenic and Carbo vegetabilis. It develops its effects on the vitality of the blood ; debility ensues, like that induced by venesection, in which the quantity and quality of the blood are altered, and, in consequence, various functional disturbances mani- fest themselves. The entire vegetation suffers, the tone of the organism becomes enfeebled, the blood becomes thin and watery, and the circulation lacks energy; hence ensue stases, haemorrhage, watery diarrhoea, abundant sweat and urine. Circulation. The energy of the circulation is diminished; the pulse becomes small and weak in consequence of the anaemia; hence, erethism and debility. (Carbo induces debility, with torpor; Arsenic, debility, with excitation, presenting, therefore, a closer analogy to China.) The veins become varicose ; the arteries, however, retain their tone. Nervous System. Erethistically affected. Greatly in- creased sensibility to all external influences. (China induces greater sensitiveness of the scalp to external touch than any other remedy does.) The affection of the nervous system exercises a reflex action on the blood; hence, also, excitation alternating with depression. (Belladonna induces a continuous, enduring excitation.) Vegetation. The whole vegetation appears depressed, the vital turgor diminished. The skin is pale and earthy, the vessels being visible through it. The digestive function is modified. For the liver, China has a special affinity, as well as for the spleen, in enlargement of which a small dose of China effects a speedy diminution of volume. NO. XIII. CHINA. 331 China induces hyperaemia of both of these organs; the diminution is therefore a secondary effect. (Piorry's experi- ments.) To the Stomach, China bears important relations (espe- cially to the solar plexus), enfeebling its activity, inducing loss of appetite, without vitiating the taste. Nausea, and disinclination for certain articles of ordinary diet, result from the altered digestive activity and the altered secretions; in particular, water-brash, in consequence of the watery secre- tions. The rest of the digestive canal is but little affected; watery stools, however, occur, in consequence of intestinal paralysis ; hence, also, Lienteria. To the Lungs and Genital Organs, China has no special relations. The secretions of the mucous membranes are watery and thin (oedema pulmonum). It is not specifically indicated in anasarca, and it induces vesicles (miliaria) only by inducing a general debility. To the uterus, no especial affinity. The menstrual flow is increased in quantity and in fluidity, with general weakness and anaemia. Characteristic Symptoms. 1. Pains. Sticking, tearing, drawing, in particular lassitude, with a peculiar restlessness, impelling to constant motion. Pain, as if after a journey on foot. 2. Aggravation. By touch, motion, and by every kind of physical or mental effort. 3. Very great sensitiveness to external influences, espe- cially of the skin and the head, to the external touch. 4. Yellow, earthy hue of the skin. 5. Fever, chill predominating; heat and cold but par- tially distributed. Thirst during the cold, and between it and the heat. 6. Pulse generally quick, small, and soft. 7. Thirst during the cold stage. 8. Gastric affection ; water-brash. 9. Swelling and pain of liver and spleen. 10. Diarrhoea, watery and soft: slowly expelled. 332 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. II. Menses generally increased, but thin and watery. 12. Symptoms periodic in character. 13. Feeble condition after loss of vital juices, after haemor- rhages, sweat, pollutions, onanism, etc. SPECIAL INDICA TIONS. 1. After all enfeebling maladies (intermittent and nervous fever, etc.). 2. After great loss of fluids. 3. After mental exertions, night watchings, etc. (1.) In atrophia infantilis and senilis. (2.) In haemorrhages, only when they depend on debility, on torpor of the vessels, and fluidity of the blood. 4. In chlorosis, China compares with Pulsatilla and Fer- rum. (1.) Pulsatilla is indicated when paleness predominates, where emaciation is not yet marked, and where the turgor vitalis is still present. Fluor Albus. (2.) China, where there is a yellowish hue, gastric symp- toms are conjoined, and the turgor vitalis is going or quite gone. (3.) Ferrum, where there are vascular erethism, fugitive flashes of heat, diminished menstrual flow, but the blood of a bright red color. 5. Hydrops from atony and anaemia. 6. Sequelae of liver disease. Ascites. 7. Sequelae of cutaneous disease. (Edema, cyanosis. 9. Typhus seldom, and only when accompanied by their bilious diarrhoea. 9. Sequelae of cholera. 10. Intermittent fever. The experience of allopaths shows that in this disease we should not neglect China. Dr. Kaspar says he gives China in all cases of intermittent fever, in which no other remedy is clearly indicated, even though the indication be not very clear for China. The enlarged spleen diminishes in a short time and permanently. NO. XIV. PHOSPHORUS. 333 II. Gastric and bilious, according to their form. Gas- tralgia. 12. Affections of liver and spleen. Enlargement of the liver. 13. Lienteria, a cardinal remedy. (Weakness of the intestinal canal — a too thin gastric secretion.) 14. Nocturnal pollutions too frequent. Amenorrhcea; abortion; delayed parturition; chlorotic palpitation of the heart. With reference to general sensibility; compare China with Cocculus and Ignatia. NO. XIV. PHOSPHORUS. Phosphorus acts directly upon the blood-life, modifying it in a remarkable manner, producing a tendency to decom- position, and causing ecchymosis, haemorrhage and depositions in the parenchymatous organs. The pus of which it induces the formation is intermediate between true pus and sanies. Phosphorus induces, in particular, a violent erethistic con- dition of the whole vital process, acting first, upon the nervous system, then by a reflex action upon the vascular and the remaining system, and causing in its subsequent action, apathy, torpor, and paralytic conditions. 1. Vascular System. Erethism is distinctly marked. Sometimes it is general; sometimes partial, affecting especially the head and chest; chills predominate, but excessive heat is often induced, and these sensations alter- nate quickly with each other. Sensations resulting from a partial erethistic condition in the head and chest accompany almost all other symptoms. Throbbing of the vessels of the head (also Belladonna). The general temperature is much elevated. Thirst may be increased or absent. Sweat is much increased. 2. Nervous System. Much excited. This excitement is manifested in gayety and levity, in diminished sleep without consequent suffering; in restlessness and dreamful sleep, in DIAGNOSIS IN HOMCEOPATHIC PRACTICE. entire sleeplessness, even in delirium. The fantasy is exalted. In the further action of Phosphorus apathy is induced; the mental activity and ability are diminished; trembling and jerking of the muscles are frequent, especially of the muscles of the head, face and neck. 3. Nutrition. Impaired—as shown by the earthy com- plexion, with the peculiar yellow tint, recognized in the Phosphorus degeneration. The turgor vitalis is at first increased, then depressed, emaciation resulting. The Secre- tions are in general diminished, even to dryness. (Sweat and urine are (mechanically ?) increased). 4. Skin. Phosphorus has little affinity for the skin. It induces the formation of papules and of ulcers, especially on the points of transition between the mucous membrane and the skin, and in the hollows of the joints (this is very characteristic). Ecchymoses. 5. Eyes. Irritation, swelling, the conjunctiva is reddened, and the cornea is rendered opaque; the globe of the eye enlarges, and vesicles form in and around the eyes; in con- sequence, sensations as of clouds and sparks before the eyes are induced, with a sensation as of sand in the eye, and twitching of the eyelids. 6. Ears. Dryness. 7. Nose. Dryness, ulceration, sticking, efflorescence around the nose. 8. Mouth. Dryness, furred tongue, vesicles, aphtha, difficult deglutition (because of the dryness). The pharynx is irritated and inflamed. 9. Digestion. Disturbed, as is shown by loss of appetite, disgust, nausea, scanty vomiting, acrid eructations. 10. Excretions. Sensation of heat through the whole intestinal track, even to burning, relieved by Coffee. Various pains. Great development of gas (meteorismus tympanitis). Stools are scanty, of a pappy nature, green, also gray, thin and frequent. Sometimes they are difficult and painful, attended by tenesmus and burning in the anus. NO. XIV. PHOSPHORUS. 335 ii. Respiratory Organs. A Specific Action. Phosphorus induces great dryness, roughness, hoarseness, laborious cough, with a scanty, tenacious, muco-purulent and bloody expectoration. The respiration is accelerated, with a feeling of constriction, heat, congestion and sticking pain. 12. Genito- Urinary Organs. Inflammation of the kid- neys (?). Diminution or increase of the urine; burning in the urethra, or involuntary micturition. The sexual instinct is increased, showing itself in priapism, nymphomania, pollution, powerless coitus, etc. Menstruation is too early and too copious. 13. Bones. Phosphorus exerts a specific action, especially on the jaw-bones, inducing inflammation and suppuration, with a simultaneous formation of callus. APPLICATION. Phosphorus is indicated as well in acute as in chronic cases, —rather in acute diseases. In all conditions of nervous and vascular irritation with debility,—hence in erethistic con- ditions it stands before all other remedies. In the diseases in which it is applicable, the transition is always easy to torpor; there is always a dyscrasia, approaching in character the Typhoid dyscrasia. Special Application. 1. In typhus. The Phosphorus pathogenesis is a perfect picture of erethistic typhus (cerebral and abdominal). It is to be compared with Arsenicum, which produces collapse, decubitus, and colliquative diarrhoea, and is thereby distinguished from Phosphorus, which has no diarrhoea. In pneumo-typhus, where the diagnosis hesitates between tuberculosis and typhus. In all cases in which inflamma- tion takes on a nervous character, e. g., dysentery, pyaemia, acute catarrh, with nervous symptoms. 2. To inflammation of mucous membranes Phosphorus has a peculiar affinity, with a scanty muco-purulent secretion. Hence, in ophthalmia with general vascular excitement; in 336 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. pneumonia tuberculosa (frequent in Phosphorus factories), in gastritis, enteritis, nephritis, and haematuria, with dark, scanty, turbid urine. 3. Ostitis and necrosis, especially of maxillary bones. 4. Rheumatism. In bone diseases depending on rheuma- tism. In diseases assuming a chronic form. 1. Day-blindness; photophobia, with spots and sparks before the eyes. Otitis, with deafness after nervous fevers. Polypus nasi. Dental caries. 2. Priapism, impotence; amenorrhoea. NO. XV. CHAMOMILLA. Chamomilla affects directly both the animal and vegetable nervous systems,—the latter in a greater degree. It acts more decidedly on the sensitive than on the motory sphere. Like Ignatia, it has no violent, long-enduring, or deep-felt action. Nevertheless, by a long use of it, the vegetation is seriously affected. GENERAL ACTION. 1. In the animal nervous system. Motory sphere. Slight spasms, or rather tremblings and twitchings, of short dura- tion. The parts among which the middle spinal nerves are distributed appear most strongly affected. 2. Vegetation.—The sensitive sphere is more affected than the motory. 1. Spasm occurs also in the vegetative muscular system; but of a very feeble character. 2. Pain in stomach and intestines is very considerable. When spasm occurs, pain is always present predominating over the spasm (colic), and very often pain occurs without spasm. First the gastro-intestinal sphere is affected,—then the thoracic. 1. Stomach. Dull sensations, pain, often also spasm. Violent nausea interfering with appetite. Singultus when NO. XV. CHAMOMILLA. 337 eating, ructus, vomituritio, vomitus,—all this being attended by more or less pain. Sensation of fullness when the stomach is empty, and vice versa. Anxiety in the epigas- trium after eating ; drawing pains in the loins and hypochon- dria ; accumulation of saliva in the mouth; alienated taste; sometimes even vertigo; loss of sense. Hence, in general, aggravation after eating. 2. Intestine. Pain, flatulence, peristaltic motion increased, anti-peristaltic motion induced. 3. Chest. Increased irritability of the lungs; hence tickling, constriction, and anxiety. 4. Brain. Irritability, anger, chagrin, restlessness, anxiety, weeping, groaning, fright, crying out, speaking during sleep, and sudden starting, especially in children. 5. Vascular System. Easily excited ; hence frequent con- gestions of short duration. Contradiction of the objective and subjective symptoms, e. g., external cold, and internal heat, as in the case of Ignatia; Chamomilla, however, has pain and greater disturbance of sensation than Ignatia, and its vascular excitement is greater, amounting to a considerable de- gree of fever, even to delirium, and attended by violent thirst. 6. Blood. Little affected, unless by a long use of Chamo- milla, which renders the blood less plastic and induces chlorosis. 7. Secretions. Not altered, only increased, especially those of the intestines and liver; in consequence of the latter effect, the excretions are more green in appearance, and increased in quantity. Development of flatus. 8. Female Sexual System. Although this system is not specifically affected, yet the menses and sexual instinct are increased. 9. Aggravation of the pains by rest and warmth. APPLICATION. Chamomilla is applicable in erethism of the sensitive nervous spheres; hence, peculiarly appropriate for children, 23 338 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. and for women, especially during pregnancy; for persons of irritable temperament, prone to congestion, after chagrin and anger. Among children's diseases, it is especially appropriate for such as result from the use of milk either always bad or rendered so temporarily by a fit of anger on the part of the nurse,—inducing vomiting, cuttings in the abdomen, etc. Chamomilla may be used, when indicated, in all diseases, except in conditions of torpor and synocha, or of great excitation; hence, in sub-acute conditions, hysteria, certain odontalgias, with jerkings and distortion of the face, aggravated by warmth ; in sub-acute rheumatism; in mastitis. In erysipelas faciei it is renowned. In inter- mittent fever, with abdominal symptoms characteristic of Chamomilla. In diarrhoea, with violent pains; abdominal spasms before the evacuation; stools pappy, watery, acid and bilious. In gastric affections, especially after chagrin and anger, with much thirst and heat. Icterus, conse- quent on a fit of anger, with great excitability. Important in the period of dentition; in the menstrual period, for menstrual colic; metrorrhagia with the characteristic symp- toms of Chamomilla—false pains; in several varieties of asthma, with great sensibility. Ischias, cramp of the calves. NO. XVI. NUX VOMICA. The primary action of Nux Vomica is exerted exclusively upon the Nervous System, inducing, first, variation in the intensity of action of that system, viz., excitation, soon followed by torpidity, and secondly, alteration in its mode of action. The Motory or Centrifugal factor of the nervous system is especially affected. The Central portions (the ganglia and the spinal cord themselves) are more affected than the peripheric, and above all the abdominal ganglia and those NO. XVI. NUX VOMICA. 339 parts of the spinal cord in immediate connection with the diaphragm. i. Spinal Cord. The action of Nux is chiefly on the motory or centrifugal factor, producing spasm, especially in the abdomen and lower extremities, rather tonic than clonic, induced by very slight exciting causes, even by change of weather. Individual Symptoms. Jerkings, stiffness, cramp, spasm of the pharynx, and of the anus, erection of the penis, spasm of the bladder, in a word, of all the half voluntary muscles, spasmodic distortion of the face and mouth. Tris- mus, spasm of the tongue (followed by partial paralysis) of the oesophagus and rectum. All of these symptoms are followed by torpidity and temporary partial paralysis. 2. Vegetative System, Motory Factor. Dilatation and contraction of the iris, spasm of the stomach and intestine. The chief malady of this system, bearing close relation to the symptoms of Nux is cardialgia, both presenting us eructations, nausea, vomiting, constriction and protrusion of the intestine, painful anti-peristaltic motion, palpitation, pulse momentarily irregular. 3. Cerebral System. The character of the phenomena induced by Nux in this system is similar to that above depicted, but the phenomena are less strongly pronounced. They are the reflex of those induced in the spinal and vege- tative system. The Organs of Sense are strongly influenced, but those functions which are peculiarly cerebral (i. e.} sensorial functions, phantasy, etc.) are but slightly affected. Susceptibility to mental and sensuous impressions is greatly increased; this condition is soon followed by one of apathy, in which, however, consciousness is preserved. (N. B. Under the action of Stramonium and Hyoscyamus, in a corresponding condition, consciousness is lost.) 4. The Pains and Sensations excited by Nux are such as usually accompany spasm—cramp-pains, jerkings, etc. A feeling of exhaustion, a sensation as if beaten, is very constantly observed. 340 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. Phenomena of the Vegetative Life generally. I. Vascular System. Increased activity, soon followed by exhaustion, hence Nux rather retards than accelerates the circulation (causing congestions). The general effects of Nux in this respect resemble those of Cocculus and Ignatia. The frequently observed phenomenon of external cold with internal heat (and vice versa) is important, as showing this state of partial excitation and partial torpidity. Character of the Fever. Violent chill, external heat with internal cold, and vice versa. The thirst is slight, or there is great thirst at the period of greatest coldness (showing that the latter is a consequence of alteration of nervous functions, and not of an immediate vascular excitement; this is shown, too, by the fact that drinking rather aggra- vates than relieves the thirst). 2. Assimilation. The effects of Nux are very complex, its especial action being upon the abdominal ganglionic system. A habitus gastricus is the chief indication for its administration; a skin yellowish or earthy, eyes yellow or dirty-looking, tongue coated, teeth yellow, irritability of temper, hypochondriasis, hysteria. 3. Gastric Phenomena. These depend on alteration in the mode of action of the nerves. The gastric secretion is modified, the odor of the breath is unpleasant, the taste is salt or bitter. These phenomena depend on the condition of the stomach, and not upon any altered state of the mouth (as appears from the fact that the sense of taste retains its full power of distinguishing different articles and qualities of food, a characteristic of Nux), bulimy or anorexia. While eating, nausea, headache, tormina; after eating, these symptoms are aggravated, eructations, vomit- ing, which is never profuse, but is generally sour or bitter mucus. Thirst, yet drinks are not well endured. Although these symptoms occur after eating, they are also manifested at other times—an evidence of the alteration of nervous action. NO. XVI. NUX VOMICA. 341 Morning Vomiting. The secretion of the stomach and intestines, especially of the latter, is diminished in quantity (hence constipation), as well as altered in quality (hence irritation and tenesmus). Faeces are diminished in quantity, hard, dark, and compact. Hepatic System. On this system Nux acts powerfully. Its effects are rather dynamic than organic. The secretion of bile is markedly increased. Genital System. Erethism, manifested by pollution, and too rapid emission ; or again, as the result of over-excite- ment, by loss of erectile power. Menstruation too early and too copious. Respiratory System. Spasmodic action. The secretion of the mucous membranes is diminished ; they are irritable, hence a cough is easily produced ; a dry, tickling cough, with scanty, thick, tenacious expectoration. A frequent sensation of constriction, arising partly from spasm, and partly from congestion. Characteristics. 1. High excitement of the whole nervous system, especially, however, of those parts of the spinal and ganglionic system which lie below the diaphragm ; especial relation to the motory sphere; hence spasm, both tonic and clonic. 2. Vascular System. Excitation and impediment, each of these phenomena having the character of partiality. 3. Powerful effects upon the vegetation, especially in the digestive canal; hence gastric affections predominate. In general, diminished secretions (hence constipation) ; irrita- tion of the thoracic organs; sexual erethism; too early menstruation. Seldom pain, with the exception of headache; rather, sensations axe produced. Administration. Nux is especially appropriate to diseases of men, lean, of strong fiber, who take rich food, are given to spirituous drink, and to mental labor; in following dis- eased conditions. 1. Nervous Affections. Spasm, general or partial, especially 342 DIAGNOSIS IN HOMCEOPATHIC PRACTICE. of the lower part of the body,—especially those which involve, at the same time, the muscles of both the animal and vege- tative spheres; in all cases where Nux is indicated, conscious- ness must be retained; cases in which pressure or warmth applied to the vertebral column provokes the spasms. Tonic spasm, in the forms of tetanus, trismus, eclampsia infantum, etc. Nux is a very important remedy in cases of trembling induced by metallic poisoning,1 and in saturnine colic. Spasms of the pharynx and larynx, and of the diaphragm ; angina pectoris. Spasm of the stomach; spasmodic vom- iting, with scanty evacuation; vomiting during pregnancy. Hernia. Flatulent and menstrual colic. Over-excitability of the senses. Irritation of the spinal cord. 2. Intermittent Fever. Nux is probably indicated in nine cases out of every ten.2 These cases are distinguished by cer- tain gastric phenomena; the complexion is of a light icteric hue; there is obstinate constipation, with violent pain in the loins. The cold predominates. Thirst is present, yet drinking aggravates the symptoms. 3. In Typhus, Nux is only sympathetically indicated, when there is continued constipation, or in the mild form of typhus, attended by the peculiar gastric symptoms of Nux. 4. Sub-acute and chronic muscular rheumatism; certain forms of delirium tremens ; nervous vertigo, depending on abnormal affections. Morning vomitus after a debauch. Headache after meals; the cephalic congestion always, if conjoined with gastric phenomena. 5. In gastric derangements from use of coffee; dynamic affections of the liver. In hernia, both free and incarcerated. In haemorrhoids. In neuralgia. In catarrh, with dry, labo- rious, tickling cough ; with spasm, and even vomiting. 1 For poisoning by Arsenic, with 2 It will be remembered that these trembling of the hands, in hat-makers, lectures were delivered in a suburb they give, in the General Hospital of Vienna, in which a peculiar form (Allopathic) of Vienna, sulphur, in of Intermittent Fever is endemic- drachm doses, and relieve the patient C. D. generally in about four days.— C. D. BELLADONNA.1 Belladonna excites simultaneously the nervous and vas- cular systems, and is hence indicated neither in pure inflam- matory fever, nor in pure nervous fever, but as a kind of amphibious remedy in that condition in which the symptoms of both appear,—in the " neurophlogosen" of Schonlein, in the "febris inflammatoria nervosa" of Vogt,—hence not in pure phlegmonous inflammation nor in pure spasm but in inflammatory spasm. I. Vascular System. Strongly excited; most of all the capillary system, in which the effects of Belladonna are especially manifest in the skin, throat, head and lungs, con- stituting an affection very similar to scarlatina. (According to Schonlein, the scarlatina pulse is present.) Belladonna is the Aconite of the capillary vascular system. II. Vegetation. Skin and mucous membranes, are attacked; hence, dryness of the throat and constriction, increased thirst, diminished secretions, burning and spasms of the stomach. III. Although Belladonna affects powerfully the GLAND- ULAR SYSTEM, yet it gives no especial characteristic indi- cation. IV. NERVOUS System. Exaltation, alienation, and depres- sion, the last only from large doses (bad provings), and affording no special indication. This affection of the nervous system depends not only upon the encephalon but also upon the spinal cord; and the sensitive as well as the motor nerves are affected; hence pains, convulsions, and tonic 1 Report of a Clinical Lecture by Dr. Wurmb, in the Second Homoeopathic Hospital, Vienna. 344 BELLADONNA. spasms, are first induced, and finally paralysis. Upon the ganglionic system Belladonna acts as a depressing agent. Characteristics. i. Pain. Oppression, pressing from within outward and vice versa, also throbbing. The pain comes on suddenly, rises quickly to its greatest intensity, and suddenly vanishes or changes its seat. It is aggravated in the evening and at night by coffee, wine, vinegar (hence vinegar is no antidote); ameliorated by pressure and com- pression. Indications. I. Inflammation of the ear, erysipelatous; ditto of the throat and fauces with constriction, which serves to distinguish Belladonna from Mercurius and from Nitric Acid, which last is indicated where aphthae appear on the tonsils. Also in malignant angina. 2. In pneumonia, typhus, and acute catarrh, with cerebral complications. Tussis convulsiva more frequently requires other remedies, as Hyoscyamus, Sulphur, Veratrum and Cuprum. 3. Abdominal affections. Flatulent colic, sausage-like inflation of the colon with pain in the umbilical region. Hernia, in inflammatory condition. Hepatic congestion. Icterus inflammatorius. Haemorrhoids with constriction of the sphincter. 4. Nervous affections. Melancholy during pregnancy and the puerperal state. Spasm with consciousness (peculiar to Belladonna). Mania. Delirium tremens. Hydrophobia (Wurmb has no experience; would incline to expect more from the animal poisons). 5. Nervous accidents. 1. Clonic spasms in the upper part of the body. Epilepsy. Chorea (with reference always to the genius of the remedy). 1. Congestio ad caput. Dis- turbed menstruation. Raphania. 2. Pain. a. Prosopalgia Fothergillii (also Ferrum Carbonicum) in cases in which there is simultaneous vascular excitement. In purely nervous cases it is not indicated. (Spigelia preferable.) b. Toothache ; gums inflamed; aggravated by cold. c. Sleep- BELLADONNA. 345 lessness, especially of plethoric children. From nervous over-excitement. (Coffea.) d. Certain particular nervous maladies. I. Febris nervosa versatilis of the ancients, or typhus in which the abdominal ulcers are wanting; 2. Typhus cerebralis; 3. Febris intermittens apoplectica. 6. Vascular diseases. 1. Congestion. Pain in sinciput; great sensibility to air and noise ; roaring in the head, sparks before the eyes, especially in amenorrhcea and dysmenorrhoea; apo- plexy and its prodromena. In short, in every case in which the allopath would resort to venesection. An antidote to Hyoscyamus. 2. Inflammation, a. Of the brain and mem- branes, especially in metastasis from scarlatina; delirium ferox, dilated pupils, red face, spasms. In children during dentition (when the irritation is too great for Chamomilla); when tonic spasms occur (compare Hyoscyamus and Stra- monium). The large cerebrum of children disposes them to this affection; hence Belladonna is appropriate as prophy- lactic, b. Ophthalmia?. 1. Scrofulous ophthalmia, as an intercurrent remedy in case of photophobia with vascular injection {without this, Conium) and dryness of the eyes. 2. Catarrhal ophthalmia, with dryness of throat and cough. 3. Arthritic ophthalmia. 4. Internal ophthalmia, amblyopia and recent amaurosis. 7. Sexual diseases. Metrophlebitis even in metastasis to the parotid, the joints, etc. Mania puerperalis. Orgasm to the uterus. Menses copious, black, clotted. A pressing outward. Cutting lumbar pains extending round to hypo- gastrium. Sensibility of the uterus. Affections before and after menstruation. Labor-pains deficient from non- dilatation (rigidity) of the os uteri. 8. Skin. 1. Scarlatina,— the smooth variety, not the mili- ary. In ordinary scarlatina Aconite and Belladonna alter- nately. Also the same as prophylactics. Wurmb always succeeds giving them in small doses (30) one remedy each day in a single dose. Measles with affection of the head and throat. Erysipelas, smooth form (the vesicular, Rhus). 346 BELLADONNA. External erysipelatous inflammation of the ears. 2. Glands. Inflammation of the salivary glands with affection of the head. For the inguinal glands and testes slight affinity. Inflammation of axillary glands during the climacteric period, and when the swelling remains stationary and resembles scirrhus and is worse during menstruation. Degen- eration of the mamma, and erysipelatoid inflammation, but not traumatic inflammation, in which Arnica in small doses is indicated. Inflammation of the uterus with great haemor- rhage, pressing outward. A WEAK SPOT IN OUR MATERIA MEDICA. The Homoeopathic Materia Medica is constructed upon the results of provings on healthy subjects. Every day's experience, in its application at the bedside, shows us that the more accurate the prover's observation of the symptoms which the drug produces in him, the more certainly can we determine whether the drug is appropriate for our case. We call certain drugs "well proved" because the state- ments of symptoms are so clear, the discriminations, especially of subjective symptoms, are so sharp and well defined, as regards character, locality, direction and conditions, that we get, by study of the proving, a vivid realization of the patho- genesis, and can be sure whether a similarity exists between it and our patient's array of symptoms. And, moreover, the symptomatology of some of our "well proved" drugs is so full and precise that we are able, particularly if we borrow a little from the toxicologist, to construct a very complete pathological theory of the drug-action, with which we may compare our theory of the pathology of the patient's disease ; and thus we may have the double satisfaction of a patho- logical and a symptomatological correspondence between patient and drug. A reference to our Materia Medica, in so far as the symp- toms of the respiratory organs are concerned, will illustrate this point. How sharply defined, for example, are the indi- cations for Aconite, Bryonia, Squilla, Phosphorus, Sulphur, Chelidonium, Antimonium tartaricum, Spongia, Veratrum, Bromine, and many other drugs! In other words, how clearly do the symptoms reveal to us what part of the apparatus is affected, and how it is affected, down to the 348 A WEAK SPOT IN OUR MATERIA MEDICA. finest shades of difference ! And with what remarkable precision and certainty, as compared with former medical experience, are we enabled to prescribe in affections of the respiratory organs ! A strong contrast with this precision and certainty is presented by the indefinite indications we possess for pre- scriptions in diseases of the sexual organs of women. Even our " best proved " drugs furnish comparatively few symp- toms referable to these organs; and, of these few, the language is generally so vague that we are at a loss to determine what part of the apparatus may have been the seat of the sensation described. Even the descriptions of objective symptoms are often most unsatisfactory and indef- inite. Compare, in evidence of this, the relative clearness and fullness with which discharges, for instance, from the respiratory, and from the female sexual organs have been described by provers. Here, then, is a weak spot in our Materia Medica; and, practically, it is one that we must greatly deplore. Women's diseases constitute a large majority of our cases. For, at least half of the community are women ; and, what with the s enforced illnesses contingent on maternity; upon evolution and involution, which are often attended with serious dis- eases ; because of our modes of living, which bear so hardly upon woman; upon the unequal struggle which, as yet, women are forced to maintain, who wage alone the hard battle of life,—this half of the community, as the records of all of us must show, call for professional aid at least twice as often as the other. And yet, in reference to their peculiar diseases, our Materia Medica is weakest. The reason and the remedy are not far to seek. We have comparatively few symptoms of drug-action upon women, because comparatively few women have been provers of drugs. And the symptoms we have are lacking in precision, because our women-provers, as a rule, have been deficient in definite knowledge of the structure and A WEAK SPOT IN OUR MATERIA MEDICA. 349 physiology of the organs distinctive of their sex, and have, therefore, been, to some extent, incompetent observers. They have often better described the symptoms of the respiratory organs which they possess in common with men, than of their own characteristic sexual organs; a fact not surprising, perhaps, but certainly, from the stand-point of the Materia Medica, deplorable. This want in our Materia Medica can be supplied only by the voluntary labors of women as provers of drugs. And that their provings may possess the requisite definiteness and precision, the provers must have acquired such a degree, at least, of professional knowledge as to understand the anatomy, physiology and relations of the apparatus peculiar to their sex. In other words, they must be, for this object, at least, and to this extent, physicians. More especially is this neces- sary as regards the symptoms produced upon the sexual apparatus of women, since, in the work of defining and com- prehending these symptoms, at least, they can receive no aid from professional men. None but women can do this work. None but women educated in medical science can do it worthily and well, so that our Materia Medica may be an efficient means for the treatment of women's diseases. If this fact furnish an argument for the medical education of women, the fault lies in nature! And if, engaged in the execution of such a work as is here indicated,—so sorely needed, and which they alone can perform,—women physicians should seek admission to the privileges of our profession, I, for one, could not imagine a more complete, nor a more beneficent vindication of their right, than such a contribution to human knowledge would be. DIRECTIONS FOR DRUG-PROVERS, Given to the Women who Proved Lilium Tigrinum. The object in proving a drug is to ascertain the changes which the drug is capable of producing in the functions and organs of the healthy body. It is very important that each prover should know and be able to recognize the various sensations and variations of function to which she may, by peculiarity of consti- tution, be subject when in average health ; so that she may not, while proving a drug, mistake such natural variations for effects of a drug. The prover should have at hand, at all times, a note- book, in which to record the times of taking the drug and the doses, as well as the symptoms as they occur. The record should be made as soon as the symptom is per- ceived, and the time of its occurrence and the circumstances of the prover at the time should be recorded. Before beginning the record of a proving, the prover should inscribe in the note-book a statement of her age, temperament, the sicknesses which she has had, and those to which she has an inherited or acquired tendency; also whatever pains or sensations she may be habitually subject to; also any peculiar susceptibilities she may possess to external influences of any kind, or to mental or moral or emotional excitements, depressions, or perversions. Her constitutional peculiarities respecting the menstrual function should be carefully recorded ; regarding frequency, quantity, character, and whatever inconveniences or sufferings pre- cede, accompany, or follow menstruation; such as headache, DIRECTIONS FOR DRUG-PROVERS. 351 backache, colic, leucorrhcea, etc., together with peculiar states of mind or emotion. In describing sensations or pains which may occur during a proving, it is not sufficiently definite to say " pain in the head," " pain in the back," etc. The character and locality of the pain must be exactly described in graphic language, —stating, for example, that the pain is "cutting," "burning," " sticking," etc.,— and specifying its location, and, if it move, its course. The prover should find out by experiment, and should carefully state, what circumstances aggravate or ameliorate the pain (or other symptom), and note its periodical recur- rence, because periodicity is a very important element in the history of the action of drugs. For example: is the pain worse when the prover stands, or sits or lies down, worse during exercise and better during rest, worse on first waking, worse in the cold and relieved by heat, worse or better from touch or pressure, etc., etc. All such condi- tions of aggravation or amelioration should be carefully recorded. If the pain move from one part of the body to another, the fact and the course of the pain should be recorded. The sides of the body on which symptoms occur should always be stated. The times of occurrence, aggravation, and amelioration are very important elements ; as, in the morning or after- noon ; at night, before or after midnight, or waking from sleep ; just before or after eating, etc., etc. Changes in the quantity, quality, and appearance of the natural secretions should be carefully described. The urine, for instance, should be measured, and the quantity per day recorded ; it should be tested for acid and albu- men, and whatever sediment it may deposit should be carefully described. Modifications of the menstrual func- tions should be most carefully recorded ; such as its greater or less frequency or quantity ; alterations of color and con- 352 DIRECTIONS FOR DRUG-PROVERS. sistency; whether acrid or not; pains and discomforts of body or mind which precede, accompany, or follow it. Secretions not observed by the prover when in health— such as leucorrhcea, unusual perspirations, etc.— should be described, as to color, consistency, odor, nature ; whether bland or acrid, times of occurrence, and circumstances which increase or diminish them, and symptoms which accompany them. If organic symptoms occur, such as eruptions or sus- pected enlargements or displacements of organs, it is well to consult a physician in order to ascertain the exact condi- tion, which should be carefully described. The records should be full and minute. It is better to be obliged to erase something afterward, than to risk the loss of an important symptom by aiming at brevity. The dose should be taken at a time when the prover can rest, in mind and body, for a half hour after taking it. The early morning is the best time, for then the prover will have a chance to observe the action of the drug for fifteen to eighteen hours without interruption by sleep. It is better to begin with a small dose, gradually increasing it until effects are recognized, and then to cease taking the drug until these effects have ceased. It may then be repeated in a somewhat larger dose. No danger of per- manent illness is incurred by this mode of proving drugs. During a proving, the prover should abstain from the use of medicines, cosmetics and perfumes, but should make no marked deviation from her usual diet and regimen. Habits of so long standing as to have become " second nature " should be continued in moderation, since to break them off suddenly is to institute at once a morbid state. LILIUM TIGRINUM. A SUMMARY OF A FEW PROVINGS UPON WOMEN. My studies have, for years past, shown me the weakness of the Homoeopathic Materia Medica in respect of the physi- ological effects of drugs upon the peculiar organism of women. This is due to the fact that but few of the provers to whose observation we owe our Materia Medica were women. I have not been able to imagine any method by which this deficiency in the Materia Medica could be sup- plied, except by the voluntary acts of women, who should undertake to prove drugs. And it has seemed to me improbable that this work could be performed with the requisite accuracy and intelligence unless the women who should undertake it were educated in the medical sciences. Finally, it appeared to me that women who had become by education and acquirements members of the medical pro- fession, would not be likely to take a hearty and efficient part with us in the great work of perfecting the vital element of our science,—the Materia Medica,— unless they were recognized and received by us as fellow-workers on an equal footing in every respect, for a similar reason to that which led Mr. Dickens to decline the Queen's invitation to give a reading at Windsor Castle, saying, " I will not appear as an artist where I should not be received as a man;" and, conversely, I thought that if so received they would respond cordially and generously to an invitation to engage in the work for the promotion of medical science, and in a department in which they alone could work, and the com- pleteness of which would be forever a monument of their ability and devotion. 24 354 LILIUM tigrinum. When, therefore, at the session of the Institute in 1869 a resolution was pending which declared the eligibility of properly qualified women to membership, I determined to invite women who had joined the medical profession to engage in the labor of proving drugs, feeling confident that the results of their work would demonstrate how valuable and indispensable it is to the completion and perfection of our Materia Medica. The results even thus far have justi- fied this confidence. More than thirty women, most of them members of the profession, responded cordially to my invitation, and entered upon the work of drug-proving. One-third of the number have already reported results of a satisfactory nature, and of which I here present a sum- mary. The drug selected for proving was the Lilium tigrinum— the tiger-lily—which was introduced into the Materia Medica by Dr. W. E. Payne, of Bath, Me., who had communicated to us just enough to show that it had a powerful specific action upon the female organism. The symptoms were known, however, only to members of the Institute. I thought that by engaging a number of provers in different parts of the country, in a simultaneous proving of this drug, utterly unknown to most, if not all of them, I should receive reports which, if they should corroborate each other, would be very conclusive as to the action of the drug. Inasmuch as this drug belongs by right of discovery to Dr. W. E. Payne, I have turned over to him the verbatim reports received from my provers, that he might incorporate them with his own, and prepare the whole for publication in the Transactions of the Institute. The first proving, and which I shall give in greatest detail, was made under my own observation and direction, by a lady of 30 years, unmarried, a practicing physician, and who had always enjoyed good health, although quite susceptible to the action of drugs. No. 1. She began her proving Oct. 1, 1869, by taking LILIUM TIGRINUM. 355 three drops of the 30 centesimal dilution of Lilium tigrinum thrice daily. She reports as follows: " I first noticed that I was more active; things went easily. There was no other effect for four days, unless it was increased sexual instinct; then a sweetish nausea, with fullness of the abdomen, particularly after eating—even after eating small quantities. But food does not increase the nausea ; no desire to vomit. " On the 6th day moral symptoms were developed. I do not want to be pleased ; don't care to talk; desire to sleep. Slept well all night, with unpleasant dreams. Omitted medicine two days, during which the nausea and full feeling subsided. At intervals the skin of the abdomen felt stiff and stretched. On the 7th day took five drops of the 30, and in a few hours the nausea was much increased, with the same bloated sensation in the abdomen, par- ticularly across the hips and in the region of the uterus; darting pains in different parts of the head, some tearing pain in the lower part of the abdomen from the region of the ovary down both sides. I ate as much as usual, but felt no appetite for it; was restless, with a desire to do something, but no ambition. A sensation of pressure in the vagina, and a pain at the top of the sacrum extending to the hips. " 8th Day. Worse on going to bed; can't go to sleep; wild feeling in the head, as though I should go crazy and no one would take care of me; thoughts of suicide; how much opium would put me to sleep forever, and who would find my body, and who would care; nausea constant. " 10th Day. Pain in the right iliac region, better during motion; the head grows wild after I have been quiet for a short time. At 2 P. M. of the 10th day (Oct. 10), took five drops of the 30. Increased depressing weight over the pubes; worse in the evening. The knees ache." No more medicine was taken by this prover. Eight days afterward (Oct. 20th), she came to me to state 356 LILIUM TIGRINUM. her symptoms, her mind being in such a state that she could not herself record them. The following symptoms had come on on the 20th (ten days after last dose), and steadily increased: A sensation in the pelvis as though everything was coming into the world through the vagina. Last night it was very distressing, and not relieved by change of position. The dragging downward toward the pelvis is felt as high as the stomach and even the shoulders; not relieved by lying down, though worse when standing; a disposition to place the hand upon the hypogastrium and press upward in order to relieve the dragging sensation. Likewise an aching and pressure across the lumbo-sacral region, and some pressure upon the rectum. Likewise pressure and a crazy feeling upon the vertex, so that she cannot write her symptoms. To-day (22d), when walking, a sensation as if everything were pressing down in the pelvis and into the vagina, so that she inhales forcibly in order to draw up the thorax and clear the pelvis. She wants somebody to talk to her and entertain her. Feels quite nervous; wants to cry from a feeling of irritation and of something wrong in the abdomen and pelvis. Feels hurried and yet incapable, as if she had a great deal to do and cannot do it; much thirst; drinks often, and much at a time. Bowels generally regular. Now she has alternately a solid and a loose stool, several during the day, and a constant feeling as though she must have a stool; this feeling result- ing from a sensation as if something were pressing against the anterior wall of the rectum at the anus and about one to three inches above it. She is conscious of feeling nervous and irritable, and yet says she feels jolly. Grumbling pain in right side of head and teeth. Yesterday, when walking, pain in both ovaries, worse in the left, extending down the anterior and inner aspect of the left thigh, as if it would be impossible to take another step; LILIUM TIGRINUM. 357 as soon as she extended the limb she must immediatly flex it again, and then, because of a restless discomfort, must again extend it. At length she went to sleep on the back with knees and thighs flexed. She cannot tell which pelvic pain is the worse, that in the back or that in the pubic region. The whole contents of the pelvis seem to drag downward and forward and quite from the epigastric region. She cannot record her symptoms. Don't want to com- plain, and yet don't avoid people. Feels bloated, but is not so. Somewhat tender on pressure in the region of the ovaries, especially the right. Oct. 23. Aching in the pelvis between promontory of sacrum and the pubes. It feels to her as if the aching were not in the uterus but around it. She feels constantly the two spots corresponding to the ovaries, and which ache and feel like little coals of fire. In the pelvis, a feeling like a dragging out, as if the whole contents were pushing down into a funnel, the outlet of which coincided with the vagina. Oct. 25. For the last 36 hours constant desire for stool from pressure on the rectum ; a stool every half hour, lumpy, diarrhoeic, with flatus; constant tenesmus, and burning in the urethra. These symptoms continued, along with those before described, for several days. The pain in the right ovary increased, until on the 16th she described it as if a knife were inserted into the ovary and ripped down the groin and the anterior part of the thigh ; the pain extended over the lumbo-sacral region, and she must cry herself to sleep. Somewhat relieved by pressure on the ovarian region. Diarrhoea and pressure on bladder continue without relief until the 27th. She remarks that her symptoms are all worse when she gives up active resistance to them and con- trol over herself, as for example, when she sits down to rest or tries to go to sleep. 358 LILIUM TIGRINUM. Oct. 28. Menses occurred at the regular day and normal, but only while she keeps moving. The flow ceases when she becomes quiet. She feels much hurried and driven, but knows not why; walks fast and constantly, but aimlessly; is much confused in mind. Oct. 29. She noticed some heart symptoms, not very definite. On the 30th, after walking, a sudden fluttering sensation in the heart. This, like all other symptoms, is less felt if she can busy herself much. A hurried feeling about the heart with faintness and fluttering as though she could make no exertion but must sit still. The seat of pain is the apex of the heart. Twice she had a sharp pain there. Feels hurried as though she must breathe quickly, yet does not. The prover feels that her whole system has been pro- foundly affected by the drug. " She is not the person she once was;" feels hurried but incapable; no heart nor strength for business; discouraged and despondent. Nov. 1. A dry, single cough; heart symptoms very troublesome; short of breath, especially on going upstairs. Appetite very much increased, especially for meat, and the more so the more pronounced the symptoms were. The mental symptoms are striking ; she is averse to being alone, which formerly she liked (but does not dread it). Her sexual instincts, formerly dormant, are now quite strong; wits and intuitions dull and languid. Nov. 10. The prover reports: She had been quite well since the 4th, and supposed the action of the drug exhausted, but on the 7th the bearing down sensation in the pelvis returned; everything seemed to be pressing out of the vagina. This continued on the 8th like light labor pains. Leucorrhoea also occurred (a thin acrid discharge, leaving a brown stain). She had never before had it. All these symptoms worse afternoon and evening till midnight. On the 9th leucorrhcea had ceased, but in the afternoon it returned worse than ever, and she could not sleep for the pelvic distress. LILIUM TIGRINUM. 359 Nov. n. She feels depression; has pressure on bladder and rectum; is inert, yet restless and peevish; leucorrhcea continues. With these symptoms comes the desire again for meat. Burning pain across the hypogastrium from groin to groin. In short, the symptoms first experienced repeat themselves. She had not taken any more of the Lilium tigrinum. In addition she notices a peculiar mental con- dition ; a desire for fine things of every kind. She is dis- satisfied with what she has, and envious of others. Nov. 12. While attending a lecture, much irritation in the womb and a singular state of mind—desire to strike the lecturer, and in the evening a disposition to swear at every- body and everything, and to think and speak of obscene things; as these feelings came, the uterine pains passed away. To-day the leucorrhcea ceased. Nov. 13. She has been languid, dull, and forgetful since the last report. Menses recurred (14th) after an interval of only two weeks; a slight, dark, thick, and offensive dis- charge. Dec. 1. It is eight weeks since she took Lilium tigrinum. Yesterday, great hunger, and she ate largely, yet felt as if she should starve. Felt the old hurry and incapacity; the old pains in head and teeth relieved by motion and occupa- tion, followed by the diarrhoea and the pressure on the bladder. Dec. 4. She is now passing this, the third series of symptoms produced by the Lilium tigrinum; the passionate excitement, the aching and burning pain in the ovaries (in the right), which organs are distinctly defined to her sensa- tion; then despondency with aggravation at night and diarrhoea in the morning; then pressing down in the pelvis and burning all around the pubes and genitals, worse from 3 to 5 P. M., and passing away from 8 P. M., accompanied by pressure on the bladder. The symptoms on this occasion were so severe and dis- tressing—physical no less than mental—that I could not 36o LILIUM TIGRINUM. allow the prover to continue to endure them, and gave Platina200 repeatedly, under which she gained speedy relief. No. 2. To compare with the above, 1 will give an abstract of a proving made under the supervision of Dr. W. E. Payne, at about the same time, the provers having no com- munication : Mrs. P., aged 55, has ceased to menstruate. Jan. 26, 1870, took a drop of the 30 centesimal. In the evening, after griping pain, had free, faecal stool, followed by acrid feeling in anus and rectum, a very rare thing for this prover. During the night, a feeling in all the extremities as if the blood were pushed outward ; restlessness; heat and pain in forehead and brow. Next day a free stool, followed by acrid sensation at the anus. Frequent desire to urinate during the day, with scanty discharge and followed by an acrid sensation in the urethra. These symptoms recurred daily with marked' aggravation about 5 P. M. till February 2. Diarrhoeic stool every morning, followed by acrid irritation at anus, con- tinuing about an hour. Same symptoms with urine. Feb. 2. Repeated medicine. Increase of the above symptoms; burning in palms and soles all night, with con- stant desire to find a cool place for them; some cutting pain in the left mammary gland, with aching, beginning below the nipple, deep in the breast, as though between the gland and the ribs and extending around that side to the spine, seeming to pass under the lower end of scapula, coming on after retiring and worse when lying on the affected side. These symptoms continued and recurred daily; she repeated the medicine, which was followed by a severe blind- ing headache in the anterior part of the head, the peculiarity of which was a sensation as if all the blood were pressing outward through every aperture. The medicine was repeated every third or fourth day. About the 9th and 10th, in the left side of the abdomen (ovarian region) soreness to press- LILIUM TIGRINUM. 361 ure; darting pains at times in this region, extending to the groin and pubes in front; frequent desire to urinate. On the 12th, the head being clearer and better, great heaviness and pressure in the region of the womb, with stinging and darting pain in the ovarian region. 14th. The ovarian pains become more decided and ex- tend down the left thigh. This series of symptoms continued until the 21st, when the ovarian pain continuing, there was also a bearing down in the uterine region, with a desire to sustain the parts by pressing upward with the hand against the vulva; symp- toms which continued and are described on the 25th as a " pressing and bearing down sensation " in the whole of the sexual organs, with a feeling as if the internal parts were being pulled outward and downward from the mammary and umbilical region through the vagina; irresistible desire to press the hands against the vulva to prevent the internal organs from escaping. These symptoms continued to recur for a full month after the last dose of Lilium, and the morning diarrhoea for more than six weeks. No. 3. This prover took Lilium3 in one dose a quarter ounce. No symptoms were observed for two weeks. Then, of which the most striking were those last in order, pain in the lumbar region as though the back would break; bearing down pain in the pelvis, especially when walking; pressure and weight low down in the vagina. She reports, also, a headache, as if the head were too full of blood—as if the blood would issue from nose and ears. No. 4. This prover, who had suffered from astigmatism, and was hypermetropic, experienced from Lilium3, heart symptoms, pain through the heart to the back, and a feeling as if the heart were squeezed in a vice. She cannot walk straight by going into a warm room, the symptoms having occurred while walking in cold air. Also, her eyesight became very dim. She took no more 362 LILIUM TIGRINUM. medicine, and in about a month her eyesight was restored. She then found that the astigmatism no longer existed. No. 5. This prover describes the same headache as the previous prover—pressure from within outward; the same nervous prostration, and a morning diarrhoea with much tenesmus. She states the symptoms persisted for a month after the last dose. No. 6. This prover reports nervous tremulousness and inability to apply the mind; aggravation in the afternoon, and a headache similar to the preceding. Also, menses diminished in quantity, but occurring too soon. Likewise, severe pains in the uterus; could not bear the weight of clothing on the pelvis; profuse acrid leucorrhoea. While the pain in the pelvis was so severe, a vaginal examination disclosed the fact that the uterus was anteverted; a state of things that had never before existed. During the pains hysterical paroxysms. Nos. 7. and 8. The same series of symptoms as above. From this resume we may gather some of the chief charac- teristics of Lilium. When taken in moderate doses the effects are not immediate. Days elapse before unmistak- able symptoms of the drug-action appear. But the effects are very persistent, as the record of every prover shows. They tend, moreover, to recur at longer or shorter intervals, and in groups which preserve a definite order. Thus, prover No. 1, whose record I have given at greater length, reports a third recurrence of a group of symptoms nearly two months after the dose of Lilium. In male provers the same recur- rence of symptoms in definite groups has been observed, with an interval of comparative freedom from symptoms. The simultaneous observation of these peculiarities in provers residing far from each other, and not known to each other, precludes any doubt of its genuineness. Of the symptoms observed by women, as well as men, the effects on the mind are noteworthy, and are of two varieties. First, as noticed by Dr. Payne, anxiety and apprehension LILIUM TIGRINUM. 363 that an incurable disease exists or is impending, and this produces despondency. Second, as exhibited most decidedly in prover No. 1, and clearly, though less pronounced, in several others, a consciousness of an unnatural state of mind and feeling, which at last develops into an exalted condition in which the prover is disposed to find fault with persons and things, to exaggerate her own importance and excellence, and look down upon others; conjoined with this is an exal- tation of the sexual instinct. In several provers this state of things has resulted in hysterical paroxysms. In prover No. 1 it assumed such marked proportions that I was constrained to put an end to it by administering Platina, the indications for which are evident from the mental symptoms. Intel- lectual activity is impaired in both men and women. Both have complained of the feeling of hurry and restlessness, which is so well described by prover No. 1. Menstruation is accelerated, in some cases recurring in two weeks. The flow is very scanty. An acrid, thin, brownish leucorrhcea was, to several prov- ers, a troublesome symptom. But the most striking symptoms, and those most widely observed, relate to the pelvic organs. They did not gener- ally present themselves until a number of days after the proving was begun. They consist of a dragging or pulling or forcing down sensation in the pelvis, as though the entire contents of the pelvis were pulled down through the vagina, or would issue from the vulva. This sensation is not con- fined to the back or hips,—nor again to the hypogastric region,— but is described as pervading the entire pelvis. And the two provers in whom this symptom was most marked describe the dragging as coming even from the thorax, the mammary region, and the shoulders. So marked is the sensation of downward and outward pressure that the provers place the hand on the hypogastrium or the vulva as though to prevent protrusion. In three provers, physical inspection revealed the existence of anteversio 364 LILIUM TIGRINUM. uteri, a trouble which none of them had ever before experienced. In this train of symptoms belong also the tenesmus of bladder and rectum, and the diarrhoea and frequent micturi- tion. There is agreement of the provers respecting pains, burn- ing or cutting, and tenderness in the region of the ovaries, especially of the right ovary. The symptoms generally are worse in the afternoon and before midnight, except the diarrhoea, which seems to be a morning diarrhoea. If now, with the light which these provings afford us, we seek to place Lilium tigrinum in its appropriate niche in our Materia Medica, and to estimate its value by comparison with other drugs, we observe, first: The uniform occurrence, in so many provers, of pelvic symptoms, as well as the demonstration, by physical examination, of the uterine dis- placement, establish its a priori claim to rank among the remedies for prolapsus and displacement of the uterus, for catarrh of vagina and uterus, and for inflammation of the ovary. And if we run a parallel with the symptoms of other remedies, we find marked peculiarities which characterize Lilium. In the morning diarrhoea, coming suddenly and with tenesmus, it resembles Podophyllum, and Podophyllum has, likewise, a general bearing down in the pelvis—con- fined, however, to the lumbo-sacral region, while the mental and moral symptoms produced by Podophyllum bear no resemblance to those of Lilium. Moreover, in so far as my own observation goes, Podophyllum both produces and removes these pelvic symptoms only when they occur in connection with certain symptoms of the digestive tract, such as Lilium has no relation with. Sepia produces, certainly, a bearing down sensation upon the lumbar region, together with dragging and even sharp pains from the region of the ovaries extending downward to the pudenda, but besides that, Sepia presents us no symp- LILIUM TIGRINUM. 365 toms of diarrhoea and irritation of rectum and anus, and no such leucorrhcea as Lilium ; the conditions are very different. The Lilium pains are aggravated in the afternoon, and before midnight. They grow worse during repose and when one's mind is passive; worse, therefore, on lying down and trying to compose one's self to sleep. Whereas, on the other hand, the Sepia pains are worse from 9 A.M. to noon, and are relieved by repose; being aggravated by motion and occupation. The state of mind produced by the two drugs is very different. Almost the same differences exist between Lilium and Pulsatilla. Belladonna resembles Lilium in the bearing down sensa- tion, both in the back and in the pubic region, and in the fact that there is not immediate relief from repose. But, on the other hand, Lilium gives no evidence of that general affection of the organism, especially of the circulation, which accompanies every well pronounced group of Bella- donna symptoms. On the contrary, under Lilium, when the patient suffered most, nutrition and appetite were not impaired. They were even improved. It is probable that further provings of Helonias dioica will show a strong analogy between it and Lilium as regards their action on the female organism. We know enough already to recognize a difference in the mental symptoms. Lilium dulls the intellect, produces a sensation of hurry with inability, and a distress based on a clearly defined apprehension of having some fatal or serious malady. Helonias produces profound melancholy, deep, undefined depression, with sensation of soreness and weight in the womb, a "consciousness of a womb." Platina seems to me to present the strongest features of resemblance to Lilium, both in the pelvic symptoms and in at least one phase of mental symptoms, and the result of my trials with prover No. 1 shows its power to antidote Lilium. But Platina does not present any of the symp- toms of the intestinal tract which are so prominent under 366 LILIUM tigrinum. Lilium nor are its effects on the function of menstruation similar. It will be observed that I have said nothing'of the action of Lilium upon the heart. This is because my provers were not very markedly affected in that way (except one of them), but chiefly because my purpose was to show the action of the drug on the organs and functions peculiar to women, and to demonstrate how valuable additions may in a short time be made to Materia Medica in its weakest part by the labors of professionally educated women heartily engaged in this work, which none but such as they can perform. MUREX PURPUREA. This substance was first introduced into the Materia Medica by Dr. Petroz, of Paris, in some observations published in the Revue Critique et Retrospective de la Matiere Medicale, vol. iii., 1841. Dr. Petroz does not state from what variety of the mollusk which furnishes the purple coloring matter the specimen employed by him in the proving was obtained. A coloring substance, to all appearance identical, is found in various genera of the family Muricidae as well as in the genus purpura of the family Buccinidae. Weber, of Paris, in his Codex des Medicaments Homoeo- pathiques ou pharmacopee pratique et raisonee, has the following remarks: "MUREX PURPUREA. Coquille a pourpre. It belongs to the class of mollusks and to the family of Purpurifera. There are several varieties which may have the same value in Homoeopathy, inasmuch as up to the present day the only part used for experimentation has been the coloring matter which furnishes the purple, and even this experimen- tation has been made not upon the healthy subject, but upon the sick. "The ancients derived their purple dye from several different mollusks, from the Biccinum, a variety found upon the rocks, as well as from the Purpurea, which is the "Coquille a pourpre," properly so-called, and which is found not only upon the Phoenician coast, but also through- out the Mediterranean. Recently a juice, analogous to the purple dye, has been found in several conchiferae belonging to the family of the Limacidae. This juice, which is viscous, 368 MUREX PURPUREA. and, when first obtained, colorless, is found in a distinct little sac which in the majority of these mollusks is situated between the heart and the liver. When brought into contact with the atmosphere this juice becomes successively yellow, green, blue and finally a reddish purple. " It is insoluble in water, alcohol or ether ; consequently, for homoeopathic use, the first three attenuations should be prepared by trituration." Jahr and Catellan, in their Pharmacopeia, Paris, 1853, say : " MUREX PURPUREA, purpura patula, cochlea veram pur- puram fundens; pourpre antique; Purpurschnecke. An oval shell furrowed transversely, studded with tubercles, especially when young; with a somewhat short helix, the aperture bell-mouthed. Color, a blackish russet externally. The columella of a russet yellow. The straight margin white. This variety of shell inhabits the Mediterranean, where it is pretty common. Its juice, which is the true purple dye, is contained in a large fold in the form of a pocket upon the back near the neck. It requires a good deal of adroitness to collect this juice, for it is quickly thrown out by the animal. The juice, after being taken from the animal, is at first blue, and then of a beautiful green, finally of a magnificent purplish red. Cloth dyed with it always preserves its color." The provings recorded by Dr. Petroz, and which are the only ones that we possess, are, it must be confessed, frag- mentary. So are the contributions of every individual prover of every drug. So are the single stones, of which when they are duly placed together, a stately mansion is constructed. If the stones were neglected, because, when regarded separately, they are nothing like a house, how could they ever be brought together and built up, forming the house ? If the results of each individual prover's or experi- menter's labors are to be withheld on the ground that they are fragmentary, how shall matter be accumulated for a complete and exhaustive proving ? MUREX PURPUREA. 369 It has been further objected that Dr. Petroz's proving is not a pure one, because his subjects had, two of them a slight leucorrhcea, and the third a cutting uterine pain at the time of the menstrual flow. Some, chief among them Dr. Roth, of Paris, would rigorously exclude from the Materia Medica Pura everything which does not rest upon exact observation of the effect of drugs upon exclusively arid strictly healthy persons. Etymologically, he is quite correct. A pure Materia Medica has no business with a single symptom obtained from observation on the sick, however slightly sick, or sick in a way however foreign to the nature of the symptom in question. But in good part, the criticism of Dr. Roth is sheer pedantry, not practical sagacity. An ideal Materia Medica Pura should contain only symp- toms obtained upon the absolutely healthy. Ages will elapse before we can have a complete Materia Medica of this kind. It is certainly an object worthy of unceasing labor. The Materia Medica which we possess while made up in good part of pure symptoms (symptoms observed upon the absolutely healthy), contains also symptoms observed upon1 those who are not absolutely healthy. The symptoms we possess of certain medicines are wholly of the latter char- acter. Cases occur in practice to which no remedy of which we have pure symptoms corresponds, but which nevertheless finds its simile and its individual specific in one of these drugs of which we have no knowledge except the symptoms it has produced upon the sick. Now, the pedantry of the critic in his closet may exclude from a pure Materia Medica every proving that is, so to speak, impure, but the question for the practical man is this: Shall any proving, however fragmentary, however impure, which yet puts it in the power of the physician to cure even a single case of disease, be cast out from the Materia Medica ? The answer must be, let it remain for the sake of 25 370 MUREX PURPUREA. these rare cases as a stimulus to pure and complete provings, as a contribution to the clinical, if not, in pedantic literal- ness, to the pathogenetic history of the drug! The point of greatest importance in relation to the frag- mentary provings, which are published from time to time, and from a collection of which an exhaustive knowledge of the drug is ultimately to be obtained, seems to us to be this, that the name and condition of the prover should be attached to each symptom, and that thus the student may be enabled to judge for himself of the pureness and authenticity of the symptoms. The observations of Dr. Petroz are given in the following with but little abbreviation. They are followed by some clinical observations by Dr. Constantine Hering and other practitioners. All together, these remarks should serve to draw attention to Murex purpurea as a substance promising rich returns to the careful prover. MUREX PURPUREA, by Dr. Petroz, of Paris, from La Revue Critique et Retrospective de la Matiere Medicate : The entire scope of the action of therapeutic agents is not easily recognized, even by those who have a profound understanding of the Materia Medica based on experimenta- tion on the healthy subject. This difficulty explains the astonishment of practitioners when they meet with unexpected results, the products of some particular condition different from that which consti- tutes the physiological state. The observations of these effects in conditions very similar to each other, if collected with care, should, after a time, constitute the second part of the Materia Medica, which we might call the clinical, in contradistinction to the pure or experimental part. The latter, however, the fundamental basis of the art of curing, should be regarded as an inviolable law, the point of departure of every positive notion, the sacred volum£ to which we faithfully recur on every occasion on which we may have been led away, by a sort of involuntary impulse as MUREX PURPUREA. 371 it were, to that empiric method which has, up to the present time, characterized the successively prevailing doctrines. Experimentation on the healthy subject, while it produces symptoms analogous to the majority of those observed in the sick, has not been able to go so far as to produce those disorders, whether functional or material, so serious, and yet so common, which appall the most practiced and hardened observer. That the proving of a medicinal substance upon the healthy subject should make known all the effects which it is capable of developing, it must be repeated not only under different conditions of age, sex, etc., but also under variable conditions of susceptibility. But even if one succeed in finding healthy individuals of very unusual susceptibility, this is but trifling, compared with the susceptibility which characterizes certain pathological conditions. Furthermore, where is the physician, who, whatever his devotion to science, would assume the right of pushing his proving to the extent of endangering the life of the prover. This difficulty of pushing experimentation far enough to discover every medicinal property which a substance may possess is relative, as I have said above, to the susceptibility of the prover. Thus a young woman, very impressible and courageous, presented to me, when under the influence of Lycoperdon Bovista, symptoms which were the very image of asphyxia from the fumes of charcoal. * * * In proving a mimosa asperata she experienced several epilep- tiform nervous symptoms. But it is a rare thing to find individuals so well adapted to this work. In default of them we must interrogate the path- ological susceptibility, which, in its turn, may prove a fruitful source of positive knowledge. PATHOGENESY. No. 1. A woman, 46 years old, of nervous tempera- ment, very impressible, but in good health. 372 MUREX PURPUREA. One dose of Murex, fourth, was taken in six spoonfuls of water. The first spoonful was taken January 5th, in the evening. Twelve hours after taking the medicine, acute pain in the right side of the uterus, which crossed the entire body and extended upward to the left breast; extreme feebleness of all voluntary motions, the legs bend under her; irresistible necessity of remaining seated; confusion of ideas, repug- nance to conversation, deep sadness. At six P. M., palpitations of the heart, and throbbings of the arteries in the neck. In the evening, excessive fatigue, somnolence, heat of the hands; pulse 80. Pains in the knees; pains in the loins, sensation of excoriation and of burning pain, as if broken, in the chest. The night was good. January 7th. The second spoonful, in the evening. Sharp burning pain under the false ribs of the left flank, toward the vertebral column, in paroxysms; somnolence and sad- ness ; difficult evacuation of faeces, stool requiring an enema of tepid water. The stitch in the side has lasted the whole day. In the evening, painful tension in the right hypochondrium. Dry, infrequent cough. Dyspnoea. Voice is changed and hoarse. The heaviness is much diminished. No leucorrhcea since the first spoonful. The third spoonful on the evening of the seventh. 8th. The night good. On awaking, feels well. The stitch in the side has disappeared. Sensation of dryness and of con- striction in the uterus. The heaviness has disappeared. No leucorrhcea. The fourth spoonful was taken on the evening of the eighth. 9th. A good day. Natural stool. Fifth spoonful, eve- ning. 10th. Very good day. Sixth spoonful. nth. In the morning, a sensation of heaviness and of dilation in the labia majora. The urine has a white deposit. MUREX PURPUREA. 373 Expulsion of a small quantity of bloody mucus, after passing water. 12th. A good day. In the evening the menses appeared abundantly. Stool natural. 13th. Pain in the uterus, as if wounded by a cutting instrument. This sensation has been habitual during the menstrual flow for many years. No. 2. A woman, aged 38 years, of a sanguine tempera- ment, sound mind, judicious powers of observation, good health. First day. The leucorrhcea having disappeared entirely, pain in the occiput toward midday, pain in the arms below the elbow. Second day. On awaking, headache, which disappears on getting up. During the day pains in the left temple, com- ing and going. * * Toward the close of the day, tightness in the occiput; I involuntarily raise my hand to the part affected, when the tightness passes from left to right; I raise to the head the hand of the opposite side to that which is the seat of the pain; I bend my head backward because it seems to me that this motion relaxes the nerves of the occiput and of the neck; constant desire to urinate during the day; at three o'clock in the afternoon, great desire to sleep. Third day. Headache as the evening before, and relieved in the same way; sleep with troublesome dreams; I fled from a troubled sea and found myself again in a meadow with water; during the day momentary heaviness of the head; at five o'clock my right cheek was burning; in the evening, twice, I had a very violent stitch on the left side of the abdomen, downward; it ascended perpendicularly and lasted one minute; at nine o'clock, violent sleepiness. During the day,.pains in the legs from time to time, tight- ness in the head on each side above the ears; pains in the breasts. Fourth day. Painful dreams, headache on waking * * 374 MUREX PURPUREA. pretty severe colic; hunger during the day; appetite pretty good in the morning, but not at dinner; pains in the breasts. Fifth day. I will explain to you. The prover has not dared write all that she has felt in the region of the genital organs; excessive sexual desire, an excitement which will and reasoa could hardly control. Sixth day. The left cheek burning. Hunger during the day; in the evening, headache with pain, lasting about an hour. Seventh day. Troublesome dreams; waked with a start, in fear; in the morning, leucorrhoea, very scanty, but green- ish ; in the evening, flatulent colic. This is the seventh day of medication, and since the second day I have been very much constipated; to-day I could not go to stool; in the evening I had headache in front of the forehead. I have forgotten to say that, during the first days, in the morning before breakfast, I coughed several times. In the evening, when breathing, I had wheezing in the chest; for several days, I experience, during the day, paroxysms of anguish, of fear and dread. No. 3. A woman, aged 39 years, of sanguine-lymphatic temperament. First day. At two o'clock and at four, I have had sharp but transient pains above the cerebellum. Less of leucor- rhoea, but always mixed with blood. Second day, Friday. Since noon, the head embarrassed and a little heavy; little disposition to work; at half-past two o'clock, buzzing in the ears, and increased heaviness in the head, relieved about four o'clock; about half-past six, I was taken with a sharp pain in the abdomen on the left side. It was acute and extended over the whole abdomen; not equally intense, but felt in different spots, like a sharp point; the left side of the abdomen remained sore the whole even- ing. The leucorrhcea scanty and not mixed with blood. In bed, pains in the renal and lumbar regions, and a decided heat above the thighs persistent. MUREX PURPUREA. 375 Third day, Saturday. Less heaviness of the head ; but little leucorrhcea, but it is thicker; not mixed with blood; the sore spots of the left side of the abdomen are less sensi- tive, but are still occasionally felt; some lancinating pains; the heat of the thighs has disappeared, but that of the hip region continues even when not recumbent. Fourth day, Sunday. This morning, on going to stool, the blood had disappeared, and up to one o'clock, blood was mingled with leucorrhcea; about three o'clock I experienced a severe pain above the right temple; a little pain in the thighs; I have remarked that since taking the medicine the pains in the loins and hips are greater. In the evening, on going to stool, the blood flowed copiously; this day, but little leucorrhcea. For two days, pains in the breasts. Fifth day, Monday. No blood to-day; but little leucor- rhcea ; but, on rising, pains under the left thigh, very sensi- ble on touching the part. This continued throughout the day. Some lancinating pains in the womb; the hips are painful; no heat of the thighs, either in bed or when up. Sixth day, Tuesday. No blood; but little leucorrhcea. The pain below the thigh is less severe, but the part is always sensitive to the touch. The breasts have been very painful, and in bed I have had sharp and painful lancinations in them. The pains of the thighs and of the loins have almost disappeared. Seventh day, Wednesday. During the night I waked with a start, and a violent desire to urinate. Urinated very copiously. No blood nor leucorrhcea during the night, a good deal during the day. Heaviness of the head and even dizziness, but since taking the medicine, and even before, I have not had so good a day. I have observed that since taking the medicine I lose my memory, and even find my words with difficulty. Eighth day, Thursday. Ceased to take the medicine. The day has been a very bad one. Very severe pains in the breasts, loins and thighs. Distress in the abdomen, 376 MUREX PURPUREA. resembling that which I feel at the approach of the menses; and we are now at the 20th of August,—they should not come until the 5th of September. Desire to sleep, dullness of head; labor is irksome. This evening, no more pains except in the thighs, always below and toward the middle. When urinating during the day blood appeared slightly; scarcely any leucorrhcea, but very thick and yellow. I have remarked that I suffer more when sitting than when walking, and the pains, which I cease to feel when walking to and fro, return almost immediately when I resume the sitting posture. Good sleep and appetite. Ninth day, Friday. Good night; yet on first waking, and also several times during the night on waking, I had pretty severe pains, such as attend the menses ; anguish. The breasts, to-day, have been less painful; no more blood in the leucorrhoea, and at stool scarce any leucorrhcea ; no pain in loins but extreme lassitude and pains in the legs and knees. No lancinations. A good day. Headache, however, and frequent transient sharp pain in the right temple. My headache, which continues this evening is more on the right side than on the left. Clinical Observations. No. 1. Madame J., mother of several children whom she nursed, enjoyed very good health up to her forty-fifth year. At this period she began to have irregularity of the menses and soon to complain of painful weariness in the loins, of a sensation of weight in the hypogastrium and more particularly in the rectum, all of which gave her great concern; deep sadness at the approach of the menses, which were very abundant for several days, and were attended with great pain caused by the expulsion of large coagula. Subsequently, the flow, which lasted ten or twelve days, became russet-colored and finally serous. The interval from one period to the next was only about ten days, during which the above symptoms diminished without entirely ceasing, and at the recurrence of the menstrual flow re-appeared with their original severity. MUREX PURPUREA. 377 Exploration, by means of the speculum, revealed the pres- ence of a soft, violet-colored enlargement of the neck of the uterus; a large excoriation on its anterior aspect, which was caused to bleed by a slight touch, induced recourse to cauterization, after which the patient was enjoined to observe absolute repose and a light not very abundant diet. The menses subsequent to the operation were less abundant, without coagula and consequently less painful and of shorter duration; the secondary symptoms were also less marked. This improvement did not last longer than a few months, when the symptoms returned with increased violence. Walking, or standing for a long time became almost impossi- ble ; the pain at the appearance of the menses became again violent, for the expulsion of large coagula; during the periods of suffering, the pulse was small and frequent; emission of urine was impossible; a copious sweat covered the patient's body. Sabina ^, in 120 grammes of water, given in spoonful doses, every half hour, moderated the severity of the symptoms without much abridging their duration. Eight days afterward the patient took Murex purpurea4, five centigrammes in 180 grammes of water (a spoonful morning and evening). Under the influence of this remedy, the painful weariness of the loins, of the thighs, the weight upon the rectum, the leucorrhcea, the itching occasioned by it and the pains in the hypogastrium diminished and then disappeared. The menstrual epoch, which was retarded several days, occurred as before the sickness, except that there was the weakness resulting from the antecedent sufferings. A second dose, like the first, was given, immediately after the cessation of the menses. From that time she was restored to perfect health. Eighteen months have elapsed, during which she has led an active and sometimes a fatiguing life, without her health being at all impaired. No. 2. Madame F., 30 years of age, of a sanguine-lymphatic temperament, mother of two children, was subject, in infancy, 378 MUREX PURPUREA. to violent attacks of cough, caused by congestion of the lungs, the results of a psoric taint (retrocession of itch). These attacks ceased to appear about the time of her first preg- nancy, another organ becoming then the center of the con- gestion and the seat of disorders of another character. The patient began by experiencing a sensation of pressure toward the genital organs; some months after her first con- finement, a heavy weight pressing upon the rectum, swelling of the haemorrhoids, greenish yellow leucorrhaea, sometimes bloody, and discharge of pure blood by the vulva at stool. Thrilling pains in the lower extremities. Painful weariness in the loins, in the nates ; very great debility which rendered walking very difficult, often impossible, at the period of the menses. To these symptoms, which kept growing more intense, there was added a painful aching in the whole hypogastrium; it caused an inexpressible anguish and fre- quent syncope, which ceased when the menses began to appear; soon these became excessive, accompanied by spasms in the abdomen, together with sharp lancinations in the uterus. Several cauterizations had been made, the operator having been induced to resort to them (as he is reported to have said) by the tumefaction of the cervix, in which there were several deep fissures. The body of the uterus, more volu- minous than natural, was very much inclined forward, the cervix resting upon the posterior wall of the pelvis. This' position must, no doubt, have aggravated the pains. The cauterization, although often repeated, did but little good. It was given up, and for several months longer the sufferings were the same. Immediately after the menstrual period, five centigrammes of Murex4 were given in 120 grammes of water; the patient took a spoonful every morn- ing. The symptoms perceptibly diminished before the ensuing menstrual period. The latter was attended with but little suffering, and the flow was less than usual. Above all, the leucorrhoea was decidedly diminished. A second MUREX PURPUREA. 379 dose, given in the same way, as soon as the flow had ceased, was sufficient to re-establish the health of the patient, who for the last year has continued to be well. From these two observations and others analogous to them, one may deduce principles of a useful application. They will find their place hereafter. Resume of the Pathogenetic Symptoms of Murex purpurea, by Dr. Petroz. Head. i. Confusion of ideas, repugnance to conversation, deep sadness in the evening; first day. 2. Pain in the occiput toward midday; first day. 3. Headache on awaking, which disappears on rising; first day. 4. During the day, pain in the left temple, which goes and comes. 5. Heaviness of the head from time to time, which leaves at intervals great clearness in the ideas; second and third day. 6. At the end of the day, tightness behind the head, which causes her to raise the hand involuntarily to the seat of the pain; when the pain is on the left side she raises the right hand, and vice versa. Desire to bend the head back- ward ; this motion relieves the head and neck ; second day. 7. The head is heavy for short periods of time; third day. 8. The right cheek burns toward evening ; third day. 9. Tightness of the head behind the ears; third day. 10. The left cheek burns in the morning; sixth day. 11. Headache (heaviness) lasting one hour; sixth day. 12. Pressive frontal headache; seventh day. 13. Confusion in the head, sleepiness ; labor is irksome; eighth day. 14. Pressive pain in the right temple ; ninth day. 15. Pain in the occiput, very acute, but of short duration ; first day. 38o MUREX PURPUREA. 16. Head confused, heavy; indisposition to work ; second day. 17. Buzzing in the ears and increased heaviness in the head; second day. 18. Diminution of memory, difficulty in finding words. 19. Heaviness of the head as when the atmosphere is close. 20. The nose is cold all day so that she is much incom- moded thereby; third day. Thorax. 21. Palpitation of the heart, throbbing of the arteries of the neck; first day. 22. Pain in the thorax as if broken. 23. Incisive burning pain under the false ribs (left side), and toward the spine ; second day. 24. Dry infrequent cough, oppression ; second day. 25. The voice is changed, hoarseness; second day. 26. Pain in the mammae; third and fourth days. 27. Cough in the morning before breakfast; first day. 28. Wheezing in the chest in the evening when breathing; seventh day. 29. Severe pains in the mammae; eighth day. 30. Sharp lancinations in the mammae. Stomach. 31. Hunger during the day, in the morning; none at dinner. 32. Hunger the sixth day. Abdomen. 33. Evacuation difficult; second day. 34. Painful tension in the right hypochondrium; second day. 35. Colic; fourth day. Colic in the evening; seventh day. Constipation which lasts five days and more. Uneasi- MUREX PURPUREA. 381 ness in the abdomen like that which is caused by the approach of the menses; their appearance is retarded fifteen days; eighth day. 36. Acute pain like a sharp point in the left side of the abdomen extends and is felt in different isolated spots; the left side of the abdomen remained painful the whole evening; second day. 37. The same symptoms less severe; third day. 38. Pressure upon the anus like painful points; first day. Genital Organs. 39. Acute pain in the right side of the uterus which crosses the body and ascends to the left mamma; first day. 40. Sensation of dryness and of constriction in the uterus; second day. 41. Sensation of weight and of dilation in the labia majora; seventh day. 42. Pain as if wounded by a cutting instrument in the uterus; seventh day. 43. In the evening (third day), two violent lancinations, lasting one minute, in the left side of the abdomen in an upward direction. 44. Excitement of the genital organs; desire so violent as to fatigue the reason. 45. Greenish thick leucorrhcea; seventh day. The same (third day) diminished but thicker; eighth day. 46. The leucorrhcea becomes bloody; ninth day. 47. Return of bloody discharge from the vulva on going to stool (fourth day) a part of the day; it ceases and re-appears. 48. Venereal desire renewed by the slightest touch; sec- ond day. 49. Heaviness in the vagina during the existence of the pain in the abdomen. 50. Throbbings in the uterus; fifth day. 382 MUREX PURPUREA. 51. Watery leucorrhcea lasting only a half day; second day. Urinary Organs. 52. Urine with white sediment. Discharge of a small quantity of bloody mucus after the passage of urine; fifth day. 53. Frequent call to urinate during the day; second day. 54. When urinating slight bloody discharge; eighth day. 55- Frequent need to urinate during the night, urine colorless; third day. 56. Urine foetid ; the odor much resembling that of Vale- rian ; this odor soon diminishes and disappears; third day. Trunk. 57. Pain in the loins. Sensation of burning, of excoria- tion ; first day. 58. Pain in the loins; eighth day. 59. Pain in the loins when lying down, pain in the hips (second to third day) especially in bed. 60. Pain around the pelvis; third day. Extremities. 61. Extreme feebleness in the voluntary movements. The limbs give way and there is irresistible desire to remain seated; first day. 62. Pain in the knees; first day. 63. Heat in the hands ; first day. 64. Pain in the arms below the elbows (first day); simple pain in the legs from time to time; third day. 65. Pains of very great weariness in the thighs (eighth day); pain of contusion in the front and middle of the thighs. 66. Extreme lassitude, pains in the legs and knees; ninth day. 67. Sharp heat in the anterior part of the thighs; second day. MUREX PURPUREA. 383 68. On rising, acute pain in the middle anterior portion of the left thigh; she cannot bear to have it touched; it lasts the whole day ; fifth day. 69. Sensation of throbbing in the anterior part of the thigh. Sleep. 70. Drowsiness ; first day. ' 71. Drowsiness and sadness; second day. 72. At 9 P. M. great desire to sleep. 73. Sleep with troublesome dreams; fleeing from a tur- bulent ocean she found herself in a plain full of water; third day. 74. Troublesome dreams (fourth day); ditto (seventh day), waking with fright. 75. Sleep interrupted by pains altogether similar to those which sometimes accompany the menses (third day); anguish. 76. Wakes with a start and a violent desire to urinate; urine abundant. General Symptoms. 77. Excessive fatigue; first day. 78. Sensation of anguish during the day, feeling of fear, of indefinite fright; for several days the sufferings are greater when sitting than when walking; when walking they cease, and re-appear on sitting down. 79. Sensation of dryness in the skin, as if it would crack. Provings on Patients, by M. de B., furnished by Dr. C. Hering. January 12th, 1852. Taken by a lady, aged 38 years, of sanguine-nervous temperament. She has been ill eight years of prolapsus uteri. For more than a year she was unable to stand. For several years she has suffered excru- ciating pain. Her mind is in a very gloomy state. 384 MUREX PURPUREA. She has been under my care about three years, and has constantly but slowly regained health. She can now ride about ten miles and rest in an hour afterward; can sew about eight hours in a day, but must rest frequently, and has never passed a day without lying down. Her mind has gradually recovered its cheerfulness, and she has been for several months desirous of society, which even one year since she could not at all endure. I directed her not to take any other medicine for ten days before the Murex. She has taken three doses at intervals of ten days. The symptoms have been the same each time, only much more intense than the first dose. I gave her the two hundredth dilution; she took it in the morning as soon as she had risen. For the first four hours she felt nothing. Then she felt a debility of the entire muscular system; a sinking of the stomach; an enlargement of the bowels; a distinct feeling of the womb; and great sensitiveness of the bowels, with sharp pain running up from the groin to the socket of the right hip. A sensation as of the creeping of a snake over the entire region of the short ribs, upon the left side; great depression of spirits; it seemed to her that she was hopelessly ill. She was obliged to go to bed and lie there. These symptoms continued for nearly a week, with- out abatement, and at the end of a week she felt about as usual, except that she was rather gloomy in mind. The second and third doses produced the same symptoms, but less intense. No. 2. A lady, aged about 30 years, of sanguine-nervous temperament, had been for five years subject almost con- stantly to pain in her right hip, and a feeling of sinking at the stomach, which incapacitated her for sewing or knitting. She took but one dose and said, " It made me miserable. I was so low-spirited that I gave up everything. I had no strength left. My stomach seemed gone, and an intolerable creeping pain in my right hip kept me from getting any ease in any position." I ought to add that this lady had MUREX PURPUREA. 385 been so well for the last eight months that I had not been in attendance upon her. The duration of the effect of the medicine in her case was about five days. No. 3. A lady, aged 23 years, of sanguine-nervous tem- perament. I had treated her during the year past for pro- lapsus uteri, with the ordinary debility in the lumbar region, palpitation of the heart, sinking at the stomach, etc., that usually accompany that affection. She recovered rapidly and seemed to be in sound health for the last six months. She took three doses of Murex at intervals of ten days, and perceived no effect whatever. The following case, which occurred under my own. observa- tion, presents some points of interest: Mrs. C, aged 28 years. Seven years ago, about four months after her marriage, she had a miscarriage and subse- quently a prolapsus uteri and so-called ulceration of the cervix, for which she was under local (allopathic) treatment for a period of eighteen months. Three years ago, after unusual exercise under circumstances of great emotional excitement, she had a recurrence of the prolapsus, under which she suffered for some time. June 30th. After taking unusually violent exercise, the patient was suddenly subjected to terrible mental excite- ment. July 1st. She applied for medical treatment. She has bearing down sensations ; a feeling as if the internal genitals were being pushed out, with great nausea and faintness, and a peculiarly distressed sinking sensation in the epigastrium. A vaginal examination reveals a slight prolapsus, a very long cervix, but no ulcerations. There was utter loss of appetite and great despondency. In consequence of the great faintness and " sinking at the stomach" (which, Dr. Lippe says, is a strong characteristic of Murex), in addition to the other symptoms which indi- cated this remedy, Murex purpurea6 was prescribed, a 26 386 MUREX PURPUREA. powder every four hours (no higher potency being at hand). July 3d. The patient reports that in fifteen minutes after taking the first powder, she felt very hungry and ate some- thing. After the second powder, a still greater degree of hunger; she again took food. After the third powder, she expressed herself as "half starved" and had to have a hearty meal prepared, which she ate. She slept well. July 4th. After the first powder, this morning, the same sensation of hunger, though in a less degree than yesterday. In the region of the uterus she felt much better. July 6th. Has gained in every way. Felt quite well as regards the uterine symptoms and the sinking at the stomach, until this evening, having been frightened by a dog, she fainted. This brought back the symptoms of July 1st, which, however, were soon relieved by Murex, and have not since returned. PLATINA.1 Preparations for medicinal use. Chemically pure Platina, which is soft, and may be cut Avith a knife, is dissolved in aqua regia by the aid of heat, the resultant golden yellow solution diluted to a sufficient extent, and a clean smooth rod of steel suspended in it, on which the Platina precipitates, forming a crystalline coating. This precipitate, which may be easily rubbed off the rod, is several times washed in distilled water (until free from acid), and then well dried between layers of bibulous paper. One grain of this pre- cipitate, triturated for two hours with ninety-nine grains of milk sugar, forms the first centesimal trituration of Platina. The further dynamizations are prepared in the usual manner. Literature. Stapf and Gross, Archiv. i., I : Hahnemann, Chronic Diseases, v. Action. Platina develops its effects as well in the province of the brain as in that of the spinal cord, and of the great nervous branches proceeding from it. The great splanchnic nerves, distributed in the abdomen, and, in particular, the nerves of the uterine system given off from the hypogastric plexus, are especially affected by Platina. From this specific action, no inconsiderable number of symptoms seem to result which are quite peculiar to this remedy, as well moral affections as many aches and pains. Hence this remedy, as will be seen, is especially appropriate for diseases of females, such as we often meet in women and maidens. Whether Platina is suitable only for irritable, excitable females, with predominant activity of the sexual functions, as the majority of writers assume, and among them Stapf and •Adapted from the German of Dr. Veit Meyer. 388 PLATINA. Gross, the provers of it, who, by the way, made their provings on a very excitable 'young woman, I shall leave undetermined. For myself, I have had frequent occasion to administer Platina, and have obtained the very best curative results in appropriate diseased conditions, occurring in phlegmatic women of lax fiber. This observation, too, appears to me to stand by no means in opposition to the totality of the Platina symptoms, but rather to accord most clearly with them. For, on a critical review of what has been made known concerning the action of the remedy, we find that all or by far the greater part of its symptoms bear the character of depression, but not that of erethism. A lack of energy, a lack of electric tension of the nerves, if I may so express myself, seems to me more clearly manifest in Platina than in any other remedy. And although we find, it is true, isolated phenomena which seem to indicate a contrary action, yet we regard these only as reflex or alternate effects; and, indeed, they occur in so isolated a manner as almost to disappear before the mass of symptoms which justify the view I have taken. It may be that a farther proving of this drug, which, by the way, is very desirable, would disprove our assumption : for the present, however, we can only hold to that proving of which we are already in possession. In this proving we find, in every system on which Platina acts, the stamp of relaxation, of diminished energy, of depression, of torpor. As well in the psychical and sensuous, as in the sensitive, motor, and* vegetative nervous systems, we see this character manifested by the trembling, the sensations of chilliness, the coldness and paralysis which are so frequently present. The assertion will be demonstrated when we come to consider the passive and negative relation of Platina to the sympathetic system as the regulator of the entire vascular system in the human body. But Platina presents no phenomena of hyperaemia, no independent or primary inflammation, no strikingly accelerated circulation. Hence, we find no alterations in the pulse, such as the PLATINA. 389 learned and careful provers would certainly have signal- ized had they occurred during the proving. We have gained, then, several general positions with reference to the sphere of action of Platina. 1. A negative position, viz. : that it does not directly affect the blood life. 2. That it exerts its greatest power upon the brain and spinal cord, and especially in several particular provinces of these nervous centers; and, finally, 3. That it depotentizes and depresses the nervous life. Let us now seek to determine these characteristic qualities in the individual phenomena of the drug, and inquire, first, how and how far the action of Platina is manifest on the brain and spinal cord, and what changes this drug is able to effect in the individual spheres of these central organs. But, in giving a true picture of the action of Platina, I cannot be expected to adhere closely to the organic order of the individual parts of the nervous system. I shall rather bring first to view those phenomena which stand forth most strikingly among the symptoms of Platina, and arrange the others subsequently in the order of their importance. Thus, then, in surveying the isolated Platina symptoms, we encounter a pathological picture which we have not unfre- quently occasion to meet in women—I mean hysteria. In the delineation of this picture, we begin by the recital of those symptoms which relate to the proximate cause of this affection: I. DISTURBANCES IN THE UTERINE SYSTEM. The following symptoms clearly indicate this: In both groins, painful drawing, as if the menses were about to set in. Pressing in the hypogastrium, with a feeling of weakness, as before the menses. Painful pressing down toward the genitals, as if the 390 PLATINA. menses were commencing; sometimes with tenesmus, draw- ing through the groins over the hips to the sacrum, where the pain continues longer. Painful sensibility and constant pressure in the pubic region and in the genitals, with almost constant internal chilliness and external objective coldness (except in the face). In the evening, in bed, the painful pressure as if from the menses commencing ceases immediately, but is felt again in the morning, after rising. Cutting in the hypogastrium, as if before the menses, with drawing headache. On the second day of the menses, cutting in the abdo- men ; then, pressing down in the groin, alternating with pressure in the genitals, with increased congestion and dis- charge of blood. Pressing in the abdomen, and depression of spirits, with copious menstrual flow. Menses six days too early, with diarrhoea. Menses fourteen days too early, and very copious. Menses six days too early, and lasting eight days, with drawing pain in the abdomen the first day. The first day of the menses, discharge of much clotted blood. Voluptuous tingling in the genitals and in the abdo- men, with oppressive anxiety and palpitation; thereupon, painful pressure low in the genitals, with relaxed feeling and sticking in the sinciput. Leucorrhoea like white of egg, without sensation, only by day, sometimes after urinating, sometimes after rising from her seat. If we consider these symptoms connectedly, we see that the disturbances excited in the uterine system by Platina consist chiefly in certain spasmodic affections and pains, and in the too early appearance of the menstrual discharge. This anticipation of the menses, however, does not result from an abnormal, congestive overloading of the uterus with PLATINA. 391 blood, as we have heretofore seen to be the case with Aconite, and as others have observed of Pulsatilla and Crocus, in the case of which remedies the clearly marked alternations in the character of the blood discharged, in addition to many other phenomena indicative of hyperaemia, are evidence of such a condition. The too early and too long-continued menstruation of Platina depend not so much on sanguineous congestion as, rather, on atony of the nerves . and vessels of the uterus, whereby a condition resembling anaemia is induced, which is indicated in the symptoms "pale and sunken face; pale, wretched aspect for several days." (The heat and redness of face are alternate effects.) This atonic condition is evidenced, too, by the already men- tioned symptom, " painful sensibility, etc., with almost con- stant internal chilliness and external objective coldness;" since, indeed, as we shall soon see, chilliness and coldness are peculiar to Platina. Proceeding with the further delineation of the Platina hysteria, to which we have a good clue in the symptoms, " pressing in abdomen, with ill-humor, attending the copious menses," we shall see what is the nature of the psychical affection. II. DISTURBANCES IN THE PSYCHICAL SPHERE OF THE NERVOUS SYSTEM. Depression, despondency, taciturnity. She thinks she is neglected, and stands alone in the world. Anxiety, with flushes of heat and trembling of the hands. Great anxiety, with violent palpitation of the heart, when- ever she would speak in company, so that speaking becomes irksome to her. Anxiety as though she should die or lose consciousness, with trembling in every limb, oppressed breathing, and violent palpitation of the heart. 392 PLATINA. Anxiety in region of the heart, and apprehensiveness, as if she must soon die, with disposition to weep, and actual weeping. Great restlessness of disposition,—she can rest quietly nowhere, — with melancholy which renders even the most joyous objects disagreeable to her. She thinks she is not fit for the world, is tired of life, but has the greatest dread of death, which she believes is at hand. Morose and ill-content. Discontent with the whole world; everything is a con- straint ; with inclination to weep. Sad and morose, she sits alone, without speaking, and cannot resist sleep; then, inconsolable weeping, especially when spoken to. Silence and involuntary weeping, even after being addressed in the most friendly manner, so that she is angry at herself for it. Disposition to weep, and weeping after receiving a mild reproof. Ill-humored, and disposed to weep; often obliged to weep involuntarily, which relieves her. Disposition to weep, and melancholy; worse in her cham- ber, better in the open air. Sad and morose the first morning; the next, indescribably happy, especially in the open air, so that she could have embraced everything, and made merry over the saddest objects. Very lachrymose, and easily touched by causes quite too trivial. Very earnest and silent the first day; the next day, everything presents itself to her in a ridiculous aspect. Chilliness and shuddering, mingled with fugitive heat, with ill-humored taciturnity in the open air; later, pleasant warmth throughout whole body, with return of cheerfulness. Great cheerfulness, so that she could dance, a half hour after weeping. PLATINA. 393 Great cheerfulness for two days; everything seems joyous, she could laugh at the saddest object; third day, great melan- choly in the morning and evening, with weeping, even over joyous or ridiculous objects, and also when spoken to. Involuntary disposition to whistle and sing. Very fretful and irritable, even at things and words that are quite innocent, so that she could sometimes strike at herself and her friends. No remedy gives us so striking a picture of the hysteric perversion of the disposition as Platina. The depression and anxiety which often increase in intensity, even up to actual apprehension of death, so that, as I have sometimes experienced at the bedside, patients make every provision and arrangement for the disposition of their affairs after death, are characteristic indications of hysteria as well as of the Platina disease. Platina, however, is most especially appropriate in that form of hysteria in which the disposition to weep, and the fear of death, which is thought to be at hand, accompany all the other morbid phenomena. I remember a case in which a mother was compelled, on account of debility, to wean her child earlier than she had wished to do so. Several days after I was called to her, and on entering the chamber found her friends wringing their hands as they surrounded her bed; for the patient, who never ceased weeping, spoke amid anxiety and apprehension, of nothing but her death, and how fearful it was to have to die so young. She had already made all testamentary arrangements. The most careful investigation could discover nothing morbid in the mammae, which were still distended with milk, but not hard; even the pulse had not varied from its normal condition. My exhortation to dismiss these thoughts of death, for which there existed, I assured my patient, not the slightest ground, was gently rejected, as was also at first the medicine I ordered for her; and she told me with tears, that she had merely sent for me that she might see me once again before her death. Finally, I succeeded 394 PLATINA. in getting her to take a grain of the third trituration of Platina. When I saw the patient again in the evening, the fear of death and the weeping had vanished, and the depres- sion which still remained yielded the following day to her accustomed cheerfulness. She became healthy, and remained so. Moreover, we find in the just enumerated moral symptoms of Platina, the alternations of cheerfulness and sadness, of laughing and weeping, which are peculiar to hysteria,— just as, generally in nature, exaltation so often follows depression or alternates with it. The same condition of depression we observe, too, in the perceptive faculty, as is shown by the following symptoms: Illusion of fancy upon entering the room after a walk of one hour, as if everything around her were very small, and everybody inferior to her, both in regard to body and mind, and as if she herself were tall and elevated; the room appears gloomy and disagreeable to her, accompanied with slight anguish, sad and vexed mood, vertigo, and uncomfort- able feeling in the midst of a society that she was generally fond of; all this passes off in the open air when the sun shines. Looking down contemptuously and pitifully upon people, whom at other times she respects, against her will, in paroxysms. During her contemptuous turns she is suddenly attacked with canine hunger, and eats in a greedy, hasty, manner; when the regular meal-time arrived she had lost all her appetite. Proud feeling. Cold, absent, indifferent in company of friends ; she only answers when she must, and is only half conscious of what she says; after having answered, she reflects whether her answer had been suitable; she is constantly absent without knowing where her thoughts are roaming. She imagines she does not belong to her family; after a short absence all things appear changed to her; absence of mind; she listens to conversations around her, but after they are terminated she has forgotten what she heard. Great absence of mind ; she hears not PLATINA. 395 what is said to her, even when addressed with great emphasis. Not disposed to intellectual labor; dull, stretching sensation, as of a board before the forehead, passing attacks of vertigo in quick succession, in the evening when standing, as if she would lose her consciousness; violent vertigo, she dares not move her eyes ; more in day-time than at night; generally when she is attacked with palpitation of the heart. The characteristic feature of these Platina illusions is the proud exaltation of one's self above other persons, who are regarded as contemptible. This circumstance also has its origin in a depressed moral activity, as is shown by the related symptoms, " the chamber seems gloomy and un- pleasant," "anxious apprehension," "ill-humor, vertigo, and discomfort," etc., and the "alleviation in the open air." Hence, too, Stapf and Gross recommended Platina as "a very welcome specific remedy for a not infrequent kind of melancholy." The sleep, too, gives a clear indication of disturbance in the psychic nervous system. In this relation we are to con- sider the following symptoms: Excessive weakness and drowsiness in the evening; falls asleep after midnight, with tearing in the ball of the toe; she wakes in the night in a sort of stupor, and is unable to col- lect her senses; wakes about midnight; ideas which she is unable to repel crowding upon her mind, no sleep until morning; anxious dreams, and gloomy thoughts, and sad visions when waking suddenly; anxious, confused dreams of war and bloodshed. She dreams of fires, wants to go there, but cannot get ready, with her preparations of toilet, etc. He wakes in the morning with a peevish and anxious mood as if he had suffered injury during his sleep. I might continue to describe hysteria in the words of the Platina symptoms; for many more alterations of functions induced by this remedy might easily be made to contribute to the completion of the picture. I shall mention, however, in this relation, only the digestive disturbances, the spasmodic affections, and the pains induced by Platina. But I fear to 396 PLATINA. lead, by this course, to the erroneous supposition that all the other phenomena of Platina belong also to hysteria, and thus to the false conclusion that Platina is only and exclu- sively a remedy for hysteria; whereas, on the one hand, not every form of hysteria finds its remedy in Platina, and on the other, Platina is a remedy for several other morbid con- ditions, not only of women, but also of men. To guard against this error, I must forbear to cite further the Platina symp- toms resembling hysteria, but would not wish to deter others from studying and estimating their relations and correspond- ence. First, however, I must call attention to a few other symptoms of Platina, nearly related to hysteria, less important than those already cited, but still characteristic. It not unfrequently happens in hysteria, that a feeling of indescribable anxiety, with respiratory embarrassment, or a spasmodic constriction of the oesophagus, is experienced. This condition, generally denominated "hysteric asthma," is depicted in the following symptoms of Platina: Sudden arrest of breathing in the throat, as takes place when walking against the wind. Oppressed breathing, with warm rising from the pit of the stomach to the pit of the throat; she has to take deep breath; accompanied with a hoarse voice, going off again with the oppression. Impeded respiration from weakness of the chest; deep breathing, as if a load were oppressing the chest; frequent deep breathing without oppression of the chest; asthma, as if laced too tightly, with heavy, slow breathing. Another trouble frequently attendant on hysteria is the so-called clavus hystericus, a peculiar, ■ tense, pressing, squeezing headache, appearing in paroxysms, and confined to a small spot. The following symptoms may be referred to this con- dition: cramp-pain in the right temple in the afternoon; cramp-pain in the forehead, as if between screws; cramp- like tension in the temples, as if between screws; com- pression in the forehead, in paroxysms; sudden and short PLATINA. 397 pressing from without, inward in the vertex; pressure under the right frontal eminence, increasing and decreasing in paroxysms; sudden attack of contusive pain in a small spot of the left parietal bone; dull pressure in the right parietal bone, as of a plug being lodged in it; violent boring in the center of the forehead, decreasing gradually, and finally disappearing. Let us now leave the subject of hysteria, and consider the farther action of Platina on the healthy body ; and, first: III. THE DISTURBANCES IN THE VEGETATIVE NERVOUS SYSTEM. Viscid and slimy in the mouth the whole day, especially after a meal, also in the morning, with very bad humor; occasional conflux of water in the mouth; sensation in the upper part of the tongue as if burnt, increased by rubbing the teeth over it; scraping sensation in the throat, as if raw, in the evening after lying down, and on the day following, sometimes accompanied with an irritation resulting in short cough; sweet taste on the tip of the tongue; no appetite; she relishes the first mouthfuls, but she is soon replete; she is speedily satisfied at supper owing to great sadness, later she eats; pinching in the umbilical region after a meal, as if diarrhoea would come on; empty eructations in the morning; loud eructations in the morning, and after dinner; sudden gulping up of a bitter sour fluid, inducing cough and a scrap- ing sensation in the throat; nauseous feeling in the region of the stomach; qualmishness in the region of the stomach in the morning; continual nausea, with great faintness, anxious- ness, and a trembling sensation through the whole body in the forenoon; desire to vomit, without vomiting, coming and going increasingly accompanied with great qualmish- ness and uneasiness in the limbs. Stomach. Pressure in the pit of the stomach, also when touching it; pressure in the pit of the stomach after eating 398 PLATINA. bread and butter, as if he had eaten something that had not been digested; repletion in the stomach and abdomen, as if overloaded, in the morning before breakfast, with a good deal of empty eructation; distension of the pit of the stomach and the stomach itself, with a scratching and tear- ing sensation in the stomach; drawing pain, with pressure under the pit of the stomach, as if occasioned by a strain ; contractive pain around the pit of the stomach, as if she had laced herself too tightly, with a suffocative sensation ; pain- ful sensation around the pit of the stomach, as if she had laced herself too tightly, with sensation as if it would go off by eating; oppression around the pit of the stomach, independent of breathing; pinching in the region of the scrobiculus cordis, and shortly after sensation as if press- ing into the hypogastrium, as if flatulence were crowding down; the sensation went off when a desire for emission of flatulence made its appearance, which, however, took place with great difficulty, the sensation in the groin returned all the time, with distension of the abdomen; creeping in the pit of the stomach, rising into the throat, as if she had swallowed little particles of a feather, vomiturition ensued; itching in the region of the stomach going off by friction; fermenting sensation in the region of the stomach; dull beating as with a hammer in and near the pit of the stomach, in the region of one of the cartilages of the ribs (immediately); violent stitches on the right side near the pit of the stomach; dull shocks in the pit of the stomach; violent dull stitching shocks in the pit of the stomach, slowly going and coming; gnawing and writhing sensation in the stomach early in the morning, with canine hunger and accu- mulation of water in the mouth, not relieved by eating. Abdomen. Colic toward evening increased by raising one's self in the bed, and then ceasing gradually; great dis- tension of the abdomen in the evening; spasmodic disten- sion of the abdomen in several places, causing elevations and depressions on the surface; sensation in the whole of PLATINA. 399 the abdomen, as if she had laced herself too tightly; sensa- tion in the whole abdomen, as of being pinched together from the umbilicus to the back ; painful pinching under the left short ribs; jerking pinching in various parts of the abdomen; jerking drawing in the right side of the abdomen, with some arrest of breathing; a darting pain through the abdomen, succeeded by weariness of the knees; drawing through the abdomen, from the chest toward both groins, this drawing terminates in the genital organs, where it causes a pain; a writhing sensation around the umbilicus, with oppressed breathing, and a tremulous sensation through the whole body; very painful stitch deep in the abdomen above the umbilicus, when suddenly raising one's self after cowering; dull stitches in the middle of the umbilicus; dull shocks in the abdomen, at intervals, below the short ribs; stitches in the abdomen in the morning; fine stinging in the right side of the abdomen, moving in the umbilical region when lying upon the affected side, but increasing when lying on the left side; anxiety in the whole abdomen, succeeded by a pain in the abdomen as after fright, accompanied by a desire as if diarrhoea would come on; slight burning around the umbilicus; sudden burning darting from above downward in the right side of the abdomen ; burning sensa- tion in a small spot of the left side of the abdomen, in parox- ysms ; sudden jerking, resembling a dull shock in a small spot in the abdominal integuments; dull contusive pain below the umbilicus in the integuments; dull shocks, a sort of beating in the region of a true lower rib; motion in the abdomen as of flatulence; rumbling in the epigastrium before breakfast; rubbing sensation in the abdomen, before breakfast, with a pinching anxiety in the intestines; emission of short, interrupted flatus, sometimes difficult; copious emission of flatulence. Constipation, lasting several days. Constant tenesmus. Frequent ineffectual desire for stool, or with scanty stool, 400 PLATINA. which passes only part at a time, with violent straining and painful sensation of weakness and tension in the abdominal muscles. Difficult stool, with cutting, burning, and protrusion of the varices. Stool hard, as if burned, with slight tenesmus before and after it. Scanty, tenacious stool, cohering like clay, with long press- ing and straining of the abdominal muscles. Papescent stool in the morning, half digested and some- what bloody ; afterward, increased tension in the left hypo- chondrium and loins. Papescent stool in the evening, with ascarides. Tenesmus, with evacuation of a piece of tape-worm. Violent, noisy evacuation after dinner, first thin, then solid, expelled in fragments almost pulverulent, with great straining; after the expulsion he feels a shaking and shud- dering, especially in the upper part of the body; and after rising from stool he feels a slight pain and weakness about the umbilicus; considerable tenesmus, even when the stool is not hardj and after every stool a violent stitch in the anus, with subsequent cramp-like contraction of the nates, extend- ing toward the small of the back. Shuddering after stool and urination. Much discharge of blood from the anus. Tingling tenesmus in the anus, as if diarrhoea would set in, every evening before going to sleep, at the same hour each day. Burning in the rectum during stool, and, afterward, violent itching. Violent, dull stitches in front part of the rectum, so that she could cry out. Urine pale yellow in the morning, clear as water in the afternoon. Very red urine, with white clouds. Urine becomes turbid, and leaves a red stain on the sides of the vessel. PLATINA. 401 If we cast a glance over all these symptoms, we find here torpor of the intestinal canal distinctly pronounced. The flatulent colic, which is clearly depicted in the symptoms, depends, here, on a paralytic weakness of the whole intesti- nal tract. The peristaltic action is diminished ; hence an inordinate development or retention of intestinal gas, and manifold digestive disorders, as consequences. Eructations, nausea, anorexia, partial or complete, oppression at the stomach, fullness, distension of the stomach and abdomen, distension of an isolated part of the abdomen and drawing in of the rest, cutting, gnawing, wrenching, gurgling, finally, discharge of flatus, sometimes very troublesome; constipa- tion, very dry or papescent stools, containing half-digested matter,—all these phenomena furnish clear evidence of the torpidity of the muscular fiber, or, rather, of the diminished activity of the intestinal motor nerves. Homceopathists are acquainted with several remedies which develop in a high degree the signs of flatulence and its attendant difficulties. I mention only for example Colocynth, which is sure to occur to the mind of every homceopathist when flatulence is mentioned. But the flatulence of Colocynth depends rather on an abnormal composition of the gastric juices, and a vicious bilious secretion; hence the bitter taste, the green vomiting, the abdominal pain after anger, the altered color of the stools. The Platina symptoms, on the other hand, indicate by no means an altered composition of the fluids necessary to digestion; and nothing is left to which to attribute the flatus and other abnormal symptoms of the intestinal canal, save a diminished activity of the intestinal muscular fiber. IV. AFFECTIONS OF THE MOTORY NERVOUS APPARATUS. SPASMODIC PHENOMENA. Cramp-like feeling of contraction darts suddenly through the head from the right temple to the left; then, feeling of 27 402 PLATINA. dullness, as if too tightly bound, with trembling, both sides of the head. Cramp in the cervical muscles, as if from lying on too hard a pillow; worse on motion. Cramp in the hand on exerting it. The finger is drawn crooked, with painful drawing up in the arm on bending the arm. At night, after rising, cramp and contraction of the soles of the feet. Great inclination to violent, almost spasmodic, yawning. Yawning, afternoon, without sleepiness. Frequent yawning, afternoon, so violent, her eyes overflow. Violent yawning after a meal, so that the cervical muscles become painful. A chill runs over the whole body after yawning. Jerking of the muscles in the legs after walking a little. Cramp-like jerking here and there in the limbs, like throbbing. Painful trembling of the whole body, with throbbing in the vessels. Trembling sensation, at times, through the whole body. First, a trembling sensation in the hands and feet, then chilliness and violent trembling of the whole body, as if in the most violent chill, with chattering of the teeth, the face at the same time being warm and the hands cold. The trembling, which, standing midway between spasm and paralysis, is often met with in the pathogenesis of Platina, and is associated in it with many other morbid phenomena, leads us very naturally to disturbances of another nature in the province of the motory nervous system. PARALYTIC PHENOMENA. Weakness in the nape of the neck; the head sinks for- ward. Weakness in the nape; she cannot hold up the head. PLATINA. 403 Relaxed feeling in both arms, as if they had held up something heavy; diminished by moving them to and fro, but returning immediately when they are at rest, with draw- ing, as on a thread, from the shoulder to the hand. Sudden paralysis, as after an apoplectic fit, in a small spot, now of the right, now of the left arm. Heaviness of the arms. Feeling as if paralyzed in the left arm; she has to let it sink down; much worse when resting the arm on the chair, when sitting, even when leaning the shoulder against the chair. Weariness and weakness of the left arm, with drawing in it. Paralytic feeling in the right fore-arm, drawing from above downward. Weakness, with trembling disquiet in the thighs, especially toward the knees, as when tired by walking, felt only when sitting. Weakness in thighs (and whole limbs), as if beaten, with tremulous uneasiness in them, when sitting and standing. Great weakness in the knee-joints and their neighborhood, more when standing than when walking, worst when going upstairs. Weakness in the knees when walking, also in the thighs when sitting, as if fatigued by walking. Tottering when walking, as if the limbs had no firm footing. Weakness, especially when sitting; the feet feel as if over- fatigued, and are full of trembling uneasiness. The phenomena resembling paralysis are much more clearly defined than are the spasmodic affections. The whole muscular system appears dormant, and seems to have lost its tone. Even in sitting and leaning the body against a solid object, this weakness and laxity of fiber are significant enough to warrant the conclusion that many forms of disease resembling paralysis must find a remedy in Platina. Thus, 404 PLATINA. on the motor nerves, our remedy acts as a depressing agent, taking from them their wonted energy and only here and there, through its inroad upon their activity, provoking spasmodic phenomena of slight importance. Let us now go farther, and see whether the distinctive characteristic of Platina displays itself in any other nervous system subject to the control of the brain. V. AFFECTIONS OF THE SENSITIVE NERVOUS SYSTEM. We have here phenomena of two kinds to consider,— Anaesthesia and Pain. A.—A N^ESTHESIA. Tensive, numb feeling in the whole sinciput, as after a blow, extending as far as the nasal bone; numb feeling in the sinciput, as if constricted, in a warm room full of persons, increased after a short time to a violent pressing together, with a sensation as of a dull digging up, with impatience and ill-humor, and heat on the upper part of the body, especially in the head, as if the sweat of anguish would break out; in the evening, when in the cool air, he feels an unusual heat, and, when beginning to walk, a painful shaking of the brain, as if a ball were knocking against the skull; afterward the same sensation is felt when lying in bed, accompanied with a slight roaring in the ears; when the pain abates he falls asleep. Feeling of coldness, creeping, and numbness in the whole right side of the face. Cramp-like painful feeling of numbness in the left side of the zygoma. Tensive feeling of numbness in the zygomata and mastoid processes, as if the head were compressed by screws. Feeling of numbness in coccyx, as if after a blow when sitting. PLATINA. 405 Tensive feeling of numbness in the nape of the neck, just at the occiput, as if bound together. Sensitive feeling of numbness and trembling of the right thumb, in the morning, as if contused. Trembling feeling of numbness in the knees, and extend- ing to the feet, as if too tightly bound. Feeling of numbness, and weakness, and dull pressure on the inner side of the bend of the left knee, when sitting. Cramp-like jerking of the legs from above downward, with a feeling of stiffness, which is also felt in the feet when sitting, especially in the evening. Tremulous, creeping uneasiness in the legs when sitting, with feeling of numbness and stiffness, especially increased in the evening, and also in bed. Feeling of numbness and weariness, in the feeling only, when sitting, as if after standing a long time. B.—PAINS AND SENSATIONS. The true character of Platina is clearly depicted in the feelings of dullness and numbness. Now, even if we assume, with the majority of physiologists, that pain consists in an exalted activity of the sensitive nerve, then, notwithstanding, Platina produces, as we shall see, no small number of pain- ful sensations, still, paradoxical as this may at first view appear, the general character of Platina, viz., that of depres- sion, is clearly manifested in the form which the Platina pains assume. No substance which acts on the human body leaves unaffected the sensitive nerves so easily and quickly excitable. Hence, we find, that in all provings of drugs on the healthy body, a greater or less number of pains occur. But for the very reason that pain so frequently accompanies the pathological modifications of the organism, it is incapable of serving, in its generality as pain, as an index for the dis- covery of the peculiar character of a drug. If we received it as our guide, we should always, of necessity, infer an 406 PLATINA. increased activity. It is necessary, therefore, to examine the determining conditions in which the pains originate, in order to form an opinion as to whether the pains are induced by congestion or anaemia, by inflammation, or by a condition of paralysis, etc., etc. In determining the character of a drug, then, the pains and sensations, inasmuch as they occur almost universally, are to be subordinated and accommodated to the other phenomena. Perhaps the kind of pain, whether more of a sticking or squeezing, more of a tearing or con- tracting, more of a pressing or pinching pain, stands in some relation to the nature of the drug which produces the pain, and so may contribute somewhat to the unfolding of the latter. We shall lay no greater stress, however, on this assumption, which is quite hypothetical, than on this, that the kind of pain depends on the tissue in which it originates. I will enumerate briefly the various pains and sensa- tions which Platina excites, naming, at the same time, the parts in which they especially occur ; and I have endeavored to indicate, by the order of succession, what kinds of pain occur most frequently, and what kind less often. Cramp-pain (head, forehead, temples, orbital margins, ears, nose, zygoma, lower maxilla, teeth, fauces, chest, nape, throat, fore-arm, hand, fingers, hips, limbs, thighs, legs, calf, tarsus, heel, toes). Oppression (head, eyes, nose, zygoma, epigastrium, ribs, genitals, chest, back, shoulders, fore-arm, ham, sole of foot, toes). Oppression, wave-like, over the right orbit. Pressing (forehead, rectum, Genitals). Pressing together (forehead). Pressing inward, cramp-like (temples, vertex). Tension (temples, orbital margins, globe of the eye, chin, nape, hips, thighs, ham, calf, dorsum of the foot, toes). Drawing (head, ears, teeth, gullet, epigastrium, abdomen, scapula, hand, finger, thigh, knee, calf, heel). Drawing together (head, temples, epigastrium, abdomen). PLATINA. 407 Tenesmus (anus). Jerking (nose, soles of the feet). Sticking (head, meatus auditorius, cheeks, gullet, gastric region, abdomen, rectum, praecordia, back, axilla, hand, cruro-tarsal joint, ball of the foot, toes). Crawling, itching, prickling, tickling (temples, lower maxilla, corners of the eyes, face, nose, tongue, epigastrium, arms, genitals, chest, thyroid region, hand, fingers, thumbs, limbs, knees, ankle-bones, soles of feet, toes). Chafing (orbital margins, tips of ears, nose, cheeks, parts about the mouth, chin, genitals, scrotum, hand, feet, and soles). Burning (head, eyes, ears, tongue, region of umbilicus, abdomen, rectum, chest, arm, elbow, hand, knee, toes). Pain as from a blow or thrust (head, temples, arch of eyebrow, abdomen, coccyx, shoulder, arm, limbs, thighs, knee). Numbness and feeling as of paralysis (head, cheeks, lips, nose, face, zygoma, chin, coccyx, nape, arm, fore-arm, hand, thumb, limbs, thighs, knees, hollow of the knee, feet). Feeling of coldness (head, eyes, cheeks, lips, face, chin, scapula, hand). Throbbing and throbbing pain (teeth, region of stomach, ribs, fore-arm, legs, toes). Soreness (eyes, lips, palate, back, legs, ankle-joints, and bones). Tearing (ears, thigh, dorsum of foot, toes). Shocks and blows (chin, epigastrium, chest, back, skin, calf). Startings (ears, chin, legs). Jerking and jerking pain (upper lip, gastric region (visible), abdomen, fore-arm, limbs). Feeling as if burned (upper lip, tongue). Feeling as if beaten (arm, thigh). Feeling as if dislocated (knee, ankle). Feeling as if contused (head, mastoid process, elbow, thumb, knee). 408 PLATINA. Pain of excoriation (back, scapula). Pinching (umbilical region, epigastrium, abdomen). Dull pains (head, teeth, arm, thigh). Cutting (abdomen, dorsum of foot). Digging (forehead, ears, teeth). Boring (forehead). Scratching (gullet). The pain most frequently encountered in Platina provings is cramp-pain. We meet with this in almost every part of the body. The following symptoms, for example, present modifications of it. "Tensive pain in both upper orbital margins, extending to the globe of the eye itself; they are, as it were, com- pressed. " In the left ala nasi cramp-like jerkings at regular inter- vals ; cramp-like jerkings at regular intervals in a small spot below the external knuckle of the right hand." The sensation of pressing inward, too, is a very frequent symptom of Platina. In addition to the instances in which this is distinctly expressed, the following, among other symptoms, seem to belong to this sensation: " In the left side of the forehead, a sudden, fugitive pressing inward, as by a dull body. " Fugitive pain in the middle of the vertex, a pressing inward. " Dull pain in the right parietal bone, as if a plug were forced there. " In the middle of the back, on the right, near the spine, violent pain, as if a sharp plug were fixed; on pressing upon it, pain like a sore wound, continuing a long time. " Behind, on the left mastoid process, pressing pain, as if by a dull instrument; on pressure, pain as from a con- tusion. " On a small spot, above, on the thorax, painful sensa- tion, as if one pressed powerfully on it, with a dull body." Just as frequent as the cramp-pain is in the muscular PLATINA. .409 tissue, is the feeling of itching in the skin. We find it under various forms, e. g. : " On the upper margin of the orbit a kind of sore, eating sensation, as if caused by excoriation. " On the scrotum a frequent sore, corrosive sensation, as if from excoriation by woolen cloth, so that he must change his position frequently, especially when sitting, also when lying in bed; many days, above and around the ankle-joint and bones, a smarting and sore gnawing sensation; if, when walking, the clothes strike against the uncovered foot, the part pains as if raw and excoriated ; sticking, gnawing in a small spot on the left sole, compelling him to scratch the part. " Tingling in the nose, as from snuff, or as before epistaxis, compelling him to rub the nose, causing the eyes to water, and inducing a vain desire to sneeze. " On the knuckles and finger, a burning prickling, as if he had touched stinging nettles, compelling him to scratch vigorously. " On the left elbow, a kind of sore burning, as if scraped, or abraded by woolen cloth. " On the right temple, formication, passing down the right side of the cheek and lower jaw, with a sensation of cold. " Formication and sensation as of a cold breeze in the left hand. " At a little spot on the left parietal bone, at intervals, a kind of dull, corrosive sticking." A peculiarity of the itching, burning, prickling, etc., is, that the scratching and rubbing, to which they usually compel the patient, afford only a very brief amelioration. Nearly related to the cramp-pain of Platina, is the sensa- tion of contraction and constriction, to be found in the following symptoms : " The head seems to him, as it were, compressed in a frame ; a dull, painful sensation. " Cramp-pain in the forehead, as if between screws. 4io PLATINA. " In a somewhat warm room (with many persons), first a feeling of dullness in the sinciput, as if contracted; this increases more and more to a violent headache, first, in the right temple, later, in the whole head, but always worst in the forehead; a dull, sometimes dizzy compression, with very cross and impatient humor; at the same time heat in the upper part of the body, especially the head; an anxious sweat seems about to break out; every minute, a flash of heat runs over him; nothing relieves this condition, which, if it moderate for an instant, returns quickly with violence. In the evening, when standing in the cool air, he is uncom- monly warm (no thirst). When beginning to walk, after a short rest, the brain is painful, as if shaken, or, as if a sensi- tive ball, lying loose in the head, struck against the cranial walls. In the evening, in bed, in addition to the dull feeling in the forehead, a roaring in the ears; then, when the pains abate, he sleeps. " Tensive, dull feeling in the nape of the neck, just on the occiput, as if tightly bound together. " A kind of spasmodic contractive sensation darts quickly and suddenly from the right temple, through the head, to the left temple; later, the head feels numb and trembling on both sides, as if a cloth were wound tightly about it. " In the left great toe, a painful sensation, as if tightly bandaged." It is characteristic of the morbid phenomena induced by Platina, that they often appear at regular rhythmical inter- vals, and, beginning feebly, become more violent, and then again diminish in intensity. " In the epigastrium, to the left, a few violent, dull stitches like shocks, at long intervals. " In the left ulna, two inches from the wrist, at intervals, pain in every position, like a kind of jerking, especially in the tendons. " Below the knee, from the right tibia down, painful shocks at irregular intervals, as from a dull instrument. PLATINA. 411 " A pressing cramp-pain in the left temple, beginning moderately, and rising and falling in severity. " In left side of thorax, a cramp-like pain, moderate at first, gradually increasing, and then decreasing. " On top of the right shoulder, a pain as from a blow, moderate at first, then gradually increasing, and then decreasing." A farther peculiarity of the Platina symptoms is that they become aggravated by sitting and standing, and are alleviated by walking,—a feature agreeing exactly with the general character of the drug. The following symptoms come under this head: " When sitting and standing, a painful feeling of weakness in the whole right limb, especially in the superficial muscles of both thighs, as if beaten, with a tremulous uneasiness. " When sitting, a dull pain, as from a fall, in the head of the left thigh. " Great weakness in the knee-joints and surrounding parts, even when sitting, but especially when standing, making him sway back and forth involuntarily. " When walking, he feels but little weakness; but, so soon as he sits, the feet are as if tired, trembling, and full of uneasiness." Another characteristic of the Platina symptoms is the evening exacerbation. " Spasmodic jerkings down the left thigh, and feeling of numbness in the legs and feet when sitting, especially in the evening. " Feeling of fatigue in the soles, with a sensation as if they were swollen around the ankles. When sitting, the fatigue ascends gradually into the calves, with a sensation as if they were stretched, in the evening. "In the afternoon and evening she feels in her worst humor." A farther peculiarity of Platina, which should not be over- looked, is that strikingly prominent sensation of cold and 412 PLATINA. chilliness which, as already stated, attends many phenomena, and often appears independently. We shall be less likely to regard this chilliness and feeling of coldness as a febrile symptom, or a disturbance in the sphere of the Sympathetic, inasmuch as we perceive no reaction of any kind,—heat, sweat, or change of pulse. These phenomena of chill and coldness are, here, rather a reflex action on the sensitive nervous system, dependent on the torpor peculiar to this drug. I do not therefore hesitate to cite here the following symptoms: " Chill, with chattering of the teeth, in the evening, when undressing. " Constant feeling as if he should freeze, with frequent shuddering down the limbs, especially in the open air, even when it is warm. " Cold, with shivering over the whole body, down to the feet. " Cold chill running over the back. " Shivering from cold, evening. " Constant shuddering through the whole body, especially the limbs. "Frequent shuddering from above, down the arm and the whole body, with horripilation. "A shiver runs over her when she steps from her chamber into the open air. " Sudden shiver on head, chest, and arms, after entering a warm room. " Shivering in the forenoon, with drowsiness. " She becomes suddenly quite warm, and fancies she looks very red, although her complexion is as usual." I have dwelt at somewhat greater length on the functional affections of the sensitive nerves, because it is in just these effects that many peculiarities and characteristic features of Platina are most strikingly prominent; for phenomena present themselves here, as we have seen, which serve as important points in the general indications of the remedy. PLATINA. 413 It only remains, for the sake of completeness, to cite a few symptoms, which, even if of no great importance, yet serve to fill out the picture of the Platina disease. These symp- toms relate to the organs of special sense: VI. AFFECTIONS OF THE SENSORIAL NERVOUS SYSTEM. " Painful drawing around the left ^ye, seeing as if through gauze, and sensation as of the eyes being agglutinated. The eyes are painful when using them in the evening, at candle- light, and when exerting them ; they first itch, obliging her to rub them; then they suppurate, are very painful, see a tremulous and twinkling light, obliging her to close them, and making it impossible for her to see any object. " Tingling of the ears; tingling of the ears, afterward tearing in the same; whizzing in the ears, with stitches in the head ; noise in the ears, as of the wind blowing into them, increased by the least noise to such an extent that she has great difficulty in hearing others; roaring in the right ear; noise in the right ear, as of the wing of a large bird; dull roaring and rolling in the ear every morning, and afterward every evening after lying down, at the same hour for several weeks; dull roaring in the right ear, with obtusion of the head from a sort of cramp-like pressure; jerks in the right ear like distant thunder." Finally, a few symptoms belonging to the male genital system remain to be cited: "Erections toward morning. " Constant erections during sleep, with amorous dreams. "Constant erections at night without seminal emission, and without many dreams. "Embrace with little pleasure, and very brief." These symptoms agree with the general character of Platina. The erections are, if I may use the expression, passive, and are attended by no desire; hence, erections 414 PLATINA. without emission and embrace of short duration with very little pleasure. Having thus taken a survey of the general and special sphere of action of Platina, I shall now consider several remedies that are related to it, and briefly refer to the diagnostic difference between them and Platina. First of all I name Asafcetida. This remedy, as well as Platina, exhibits many of the phenomena of hysteria, but of an altogether different form of that disease. Menstruation, too, is rendered more frequent by Asafcetida; still, however, it remains scanty. The hysteric perversion of the disposition and morale are clearly induced, it is true, by Asafcetida, and even the globus hystericus is present; but then Asafcetida fails to induce the disposition to weep, the fear of death, the absent-mindedness, the self-exaltation above others, which are so peculiar to Platina. The affections of the vegetative nervous system induced by Asafcetida are eminently of a spasmodic nature, as well as those induced by Platina; but they seem to depend partly upon a peculiar gastric condition and partly on obstructions in the portal system. Asafcetida affects the periosteum, for which Platina has no affinity at all. On the other hand, Asafcetida has the trembling, the cramp-like sensations, ceasing and re-appearing at regular intervals, aggravated by sitting, and ameliorated by walking, in com- mon with Platina, although with various modifications and under different conditions. The paralytic condition is not so clearly developed in the action of Asafcetida. But the phenomena which most strikingly distinguish Asafcetida from Platina are the symptoms of congestion and fever, which, as we have seen, are altogether wanting to the latter. Hence it follows, that torpor and inactivity, and prostration of the functions, do not make up the character of Asafcetida; but, as a rule, most of its effects upon the brain and spinal cord appear to be reflex effects from affections of the vegeta- tive nervous system, whereas the action of Platina upon these central organs is independent and primary. PLATINA. 415 Crocus, although far more widely different than Asafcetida from Platina, may yet be reckoned among the related remedies, because, perhaps, of its affinity for the female organism, and of its action on the morale and the disposition. The too early and too copious menstruation and the metrorrhagia which Crocus induces depend, however, on an overloading of the uterine vessels with blood; hence, the blood is black and clotted; and, hence, the haemorrhages which occur also in other organs are easily provoked by motion or exertion. The moral effects are directly opposed to those of Platina. In the case of the latter we have weep- ing and fear of death; in that of the former, laughing and unrestrained merriment; but the frequent alternation of cheerfulness and sadness is a feature common to both remedies. When I add, in conclusion, that the majority of the morbid phenomena of Crocus are induced by congestions, venosity, and other abnormal states of the vascular system, we at once perceive the distinctions between the remedies. Pulsatilla is in several aspects similar and related to Platina. But, from the very fact that it is a polychrest,— that is, that it acts in very many ways, and exerts its healing power in a great number of acute as well as chronic diseases, — the difference of its character from that of Platina may, notwithstanding their similarity, be clearly seen. It would lead me too far to unfold this difference in all its aspects; this may be done with greater propriety when treating of Pulsatilla. Only this much I may say: that the similarity of Pulsatilla to Platina is shown most clearly in their respective moral effects, and in their action on the female sexual system. But even in these symptoms there are important differences, the psychical effects of Pulsatilla con- sisting chiefly in fretfulness, complaint, and lamentation, and the disposition to weep which belongs to this remedy, arising rather out of these conditions ; whereas, the weeping induced by Platina is a result of apprehensiveness and of weakness of disposition. 4i6 PLATINA. With regard to menstruation, Pulsatilla induces a number of abnormal symptoms, retards the menses, and causes a discharge of black clotted blood. Hence, Pulsatilla is not improperly regarded as antidote to Platina. Last of all, it remains to mention Plumbum aceticum, which shows much resemblance to Platina in its spasmodic and paralytic symptoms; but whereas in the case of Platina these are primary, in that of Plumbum they are secondary. On this account, too, Platina is the remedy for certain cases of lead-colic. These two metals stand almost in the same relation that Arsenic and Carbo vegetabilis hold. The tendency to decompose everything of an organic nature is common to these two remedies; but Arsenic induces this decomposition after a previous over-excitement and too strong impression upon the organism, while the peculiarity of inducing decomposition is a part of the primary action of Carbo. The dose in which Platina may be given is various. I have generally given the second or third trituration, with the best results; but I doubt not that it is active in higher potencies, this being attested by the experience of competent physi- cians. REMARKS ON RUMEX CRISPUS. My clinical experience of the last two years has given me a feeling of great gratitude to Dr. Joslin, for his introduction of Rumex Crispus to the profession by his excellent proving. The value of the published proving is much enhanced by the publication of the daily records of each prover, which enable the student to appreciate the consecutive action of the drug much more perfectly than the Hahnemannian scheme allows, while the latter, again, is indispensable to the prescriber. I have used Rumex chiefly in acute catarrhal affections of the larynx, trachea and bronchi. In these cases it seems to me to present a close analogy in its action, to Belladonna, Lachesis, Phosphorus and Causticum. Without assuming to present an exhaustive analysis of the action of Rumex on the respiratory organs, I proceed to state the indica- tions for its use to which my studies of it thus far have led me. Rumex diminishes the secretions, and at the same time exalts in a very marked manner the sensibility of the mucous membrane of the larynx and trachea, exceeding in the extent of this exaltation any remedy known to us. The cough therefore is frequent and continuous to an extent quite out of proportion to the degree of organic affection of the mucous membrane. It is dry, occurs in long paroxysms, or, under certain circumstances, is almost uninterrupted. It is induced or greatly aggravated by any irregularity of respira- tion such as an inspiration a little deeper or more rapid than usual, by the inspiration of air a little colder than that previously inhaled, by irregularity of respiration and 28 418 REMARKS ON RUMEX CRISPUS. irregular motion of the larynx and trachea such as are involved in the act of speech and by external pressure upon the trachea, in the region of the supra-sternal fossa. These phenomena show a very great morbid irritability of the mucous membrane of the larynx and trachea. The subjective symptoms are rawness and soreness in the trachea, extending a short distance below the supra-sternal fossa and laterally into the bronchi, chiefly to the left; and tickling in the supra-sternal fossa and behind the sternum, provoking the cough; this tickling is very annoying and very persistent, and is often but momentarily, and sometimes only partially, relieved by coughing. The cough occurs chiefly, or is much worse in the evening, after retiring, and at that time the membrane of the trachea is particularly sensitive to cold air and to any irregularity in the flow of air over its surface, so that the patient often covers the head with the bedclothes to avoid the cold air of the apartment, and refuses to speak or even to listen to conversation, lest his attention should be withdrawn from the supervision of his respiratory acts, which he performs with the most careful uniformity and deliberation,—and all in the hope of pre- venting the distressing tickling and the harassing cough which would ensue from a neglect of these precautions. I have frequently witnessed this state of things during the last three years, and have invariably given prompt relief with Rumex. In the group of remedies in which I have placed Rumex (along with Belladonna, Lachesis, Phosphorus, Causticum), it stands pre-eminent in respect to the extreme sensibility of the tracheal mucous membrane. All of these remedies produce symptoms identical in kind. The characteristic of each is to be found in the relative degree in which each symptom is pronounced in the different remedies, quite as much as in the possession by any one of them of symptoms not produced by the others. Thus Belladonna, Lachesis and Rumex, produce each, a dry cough, induced by tickling in the larynx or trachea and REMARKS ON RUMEX CRISPUS. 419 provoked by deep inspiration, by speaking, and by external pressure on the larynx or trachea. Each produces soreness or rawness of the larynx or trachea. The cough of each is spasmodic and long-continued, and is worse at night after retiring. But, apart from the fact that Belladonna and Lachesis act more upon the larynx, and Rumex more upon the lower part of the trachea, we observe that, in the case of Lachesis, the slightest external pressure on the larynx or trachea produces violent and long-continued spasmodic cough; the patient cannot endure the least constriction in that region, not even the ordinary contact of his clothing. There is, moreover, a sense of fullness in the trachea and a very painful aching in the whole extent of the os hyoides. In the case of Belladonna not only is cough produced to a moderate extent by pressing upon the larynx, but soreness and pain are experienced with a sense of internal fullness and soreness which at once suggest the presence of acute laryngitis submucosa. In Rumex, on the other hand, there is no sensibility, strictly speaking, of the trachea, but simply such an irritability of the mucous membrane that cough is produced by the change of position induced in that membrane by external pressure on the trachea. As regards the extent and intensity of this symptom, Rumex holds a lower rank than the other remedies named. But the irritability of mucous membrane by virtue of which cough is induced by hurried or deep inspiration or by speaking, while it is common to Belladonna, Lachesis, Rumex and Phosphorus, is produced in the most exalted degree, as we have already seen, by Rumex, which, as regards this symptom, takes first rank. A sensation of rawness or roughness in the larynx, trachea and bronchi is produced by each of the four remedies above named, but the locality and the degree in which it is produced vary in such a manner as to serve in some measure as a character- istic of each. It is most marked in Phosphorus and Bella- donna, less prominent in Rumex, and least of all in Lachesis! 420 REMARKS ON RUMEX CRISPUS. In Belladonna and Lachesis it is most marked in the larynx; indeed it is almost confined to that region. Rumex pro- duces it in the trachea and upper part of the bronchi, while Phosphorus induces it in the whole mucous tract from the larynx to the smaller bronchi; and, moreover, in the Phos- phorus proving this "rawness" of the air-passages is accom- panied by a no less characteristic sense of weight and constriction across the upper part of the thorax, which indicates an affection of the finer air-tubes and of the air- vesicles of such a character as seriously to impede the func- tion of respiration. In considering this last symptom we must mention Causticum also, which produces "rawness" extending the whole length of the sternum. All five remedies, again, produce hoarseness ; Phosphorus, Causticum and Belladonna most eminently, Rumex less decidedly, and Lachesis in a still less degree. As regards complications, Belladonna and Lachesis apply especially to those which involve the fauces and pharynx, and are acute, the one of a sthenic, the other of an asthenic character; Phosphorus to those of the pulmonary tissues of a definite inflammatory character, and Rumex to certain affections of the lungs and their envelopes of which the nature is not clearly defined in the proving. They are indicated by pains, generally sub-acute, in the upper part of the lung near the clavicle and axilla, and more frequent in the left than in the right lung. In addition to these observations on the respiratory organs, I have noticed, in one case, the cessation of a brown watery diarrhoea after the administration of Rumex. A boy of five years had brown watery diarrhoea, chiefly in the morning, having five stools from five to nine A. M., attended with moderate griping pain in the lower part of the abdo- men. This continued several days, notwithstanding two prescriptions which I made for it. Observing that the boy had a cough which presented the characteristic features of the Rumex cough, I gave that remedy, and both diarrhoea REMARKS ON RUMEX CRISPUS. 421 and cough were speedily cured. The symptom " brown watery diarrhoea" occurs once in the provings. In relating this case I cannot forbear remarking that had I been more careful to collect and consider the totality of the symptoms, embracing cough as well as diarrhoea, I should have given Rumex at first, instead of making two blundering prescrip- tions on the basis of a partial view of the symptoms which embraced the diarrhoea alone. The following case from my clinical record will illustrate the character of the Rumex cough : M., aged twenty-two, of feeble constitution, strumous, subject for several years to sub-acute rheumatism; has had a severe cold for several days, and is now confined to the bed. The pulse is quick, not hard, 110, skin moderately hot and dry, face somewhat flushed. Respiration embarrassed not so much by any constriction of the chest as by the violent and long-continued cough which follows any attempt to make a full inspiration. A physical examination of the chest reveals no abnormal condition. The patient complains of roughness and soreness in the lower part of the trachea and behind the upper third of the sternum, much more per- ceptible when she coughs. The cough is dry, slightly hoarse, very violent and fatiguing to the patient. It is pro- voked by a tickling in the supra-sternal fossa; is induced by pressure upon the trachea in that region, and especially by talking and by deep inspiration or by the inspiration of cool air. This irritability of the trachea increases very markedly after 7 P. M., so that the patient suffers exceedingly from the constant tickling and violent cough. She can pre- vent them only by respiring with very great caution and deliberation, by avoiding all distractions of speech and con- versation, and finally she draws the bedclothes over the head in order to avoid inhaling the cool air of the chamber. This patient states that she has frequently had such coughs as this, and they have proved very obstinate although under skillful homoeopathic treatment. I gave Rumex12 in solution, 422 REMARKS ON RUMEX CRISPUS. a tea-spoonful every two hours. After the second dose there was complete relief. The next evening, a very slight dispo- sition to cough. No further symptoms. I supplied the patient with Rumex30, and advised her to use it at once on the occurrence of such a cough, and I am informed that she has always succeeded in subduing the cough within twelve hours. REMARKS ON GUAO.1 The Guao is undoubtedly the " Comocladia dentata," belonging to the same family as the Rhus toxicodendron and venenata, and the Anacardium occidentale or Cashew- tree. Lindley describes it as follows :2 " Anacardiacea. Comocladia dentata (Guao). St. Domingo and Cuba. A tree. Stem erect, not much branched. Leaves pinnated, shining and green above ; with a round rachis six inches long; leaflets six to ten on each side, with an odd one, oblong, acuminate, spring-toothed, veiny and somewhat downy at the back. Juice milky, glutinous, becoming black by exposure to the air, staining the linen or the skin of the same color, only coming off with the skin itself, and not removable from linen by washing even if repeated for many years successively. It is supposed by the natives of Cuba, that it is death to sleep beneath its shade, especially for persons of a sanguine or fat habit of body. This is firmly believed, and there can be no doubt that it is the most dangerous plant upon the island." An interesting article upon the " Comocladia dentata (Guao)," by J. G. Houard, M. D., Philadelphia, comprising contributions toward a proving of this plant, and some symptoms removed by its administration, was published in the Philadelphia Journal of Homoeopathy ? It seems not irrelevant to call attention to the fact that the Guao (Comocladia dentata) may possibly, from the similarity of the names, be confounded with the Guaco (Mikania guaco), a totally different plant. 1 Notes appended to a Paper on 2 Flora Medica, page 289, $ 598. Guao, written by Dr. Jose" J. Navarro, 8 Vol. iv. (No. 2), page 73 el sea., of Cuba. American Homoeopathic Re- May, 1854. view, vol. iii., March. 424 REMARKS ON GUAO. The Guaco (Mikania guaco) is a climbing plant used in Central and South America as an antidote to the poison of serpents. It is incidentally alluded to by Humboldt:1 "The liana, called vefuco de guaco (Mikania), which M. Mutro has rendered so celebrated, and which is the most certain remedy for the bite of venomous serpents." " Forster, Schomburgh, Poppig and Tschudi, agree that in South America the Mikania guaco is the best remedy for the bite of venomous serpents, and that it has in innumer- able instances demonstrated its specific curative power. The freshly expressed juice of this creeping plant is dropped into the somewhat dilated wound, the surrounding parts are repeatedly rubbed and covered with the bruised leaves, and the juice at the same time also internally taken. It is effica- cious against the bites of the most venomous serpents. It is also used as a prophylactic."2 Turchetti states that Guaco locally applied destroys the specific property of the pus from a chancre, and prevents the production of a second chancre by inoculation. He also claims for it positive curative powers in syphilis.3 Lindley speaks of the Guaco as follows4: " Aristolochiaceae (Guaco). The Guaco of the Caraccas, reported to be a powerful remedy for the bites of serpents, is said by Dr. Hancock to be some plant of this genus." In the A llgemeine Homoeopathische Zeitung? in a letter from Bordeaux it is stated, "A Mexican physician has sent hither a plant, Houacou" (evidently the same as Guaco), "which has proved very curative, in Mexico, in certain very severe mal- adies possessing great similarity to cholera. Our physicians have made successful experiments with it; out of eight patients to whom it was given, six were cured. * * A few drops administered on a lump of sugar restored a distinct pulse to a patient who had already become quite pulseless." 1 Travels, Bonn's edition, vol. ii., 3 Schmidt's Jahrbuch, Bd. 101, p. page 364. 168. 2 Homceopathische Vierteljahrschrift, * Flora Medica, page 344, § 915. 4» 39I_392« s Vol. i., page 128, December, 1832. REMARKS ON GUAO. 425 In the Allgemeine Homceopathische Zeitungf reference is made to an article by Dr. J. G. Houard, of Philadelphia, in the North American Journal of Homoeopathy? This article is a translation of a Spanish pamphlet on Guaco in cholera. It gives no other name than Guaco to the remedy used and no description of the plant from which it was derived, but refers to an article on the subject by Dr. Chalmers, an allopathist, in the Diario of Havana. In the Zeitschrift fur Homceopathische Klinik? it is stated that Guaco was recommended in cholera by Dr. W. Valentin. It had already been recommended in 1853 by Otto, of Copenhagen, for gout, asthma, rheuma; by Chabert, in Mexico, for cholera, and in 1836 had been used with good effect in cholera, by Czeterkyn, in Poland. In 1840, Jobst pub- lished a pamphlet on the subject giving communications from the then President of Venezuela, Dr. Vargas of Caraccas. According to the latter, Guaco (in form of tincture) is used in Caraccas in the following diseases: it cures the bites of poisonous snakes ; of the scorpions; prevents hydrophobia; antidotes poisons; is useful in relieving pain from wounds resulting from falls or floggings (it would be valuable in boarding-schools and on the plantation); favors menstrual flow and removes constipation; is efficacious against affec- tions of the liver, obstinate ulcers; is said to prevent and . cure cancer; has a happy effect in spasm of the stomach and consumption, when the latter depends upon menstrual dis- turbances ; cures asthma; cures tertian and all fevers com- plicated with chill; is a powerful anthelmintic; restores the functions of the stomach in feeble persons, and stimulates the circulation ; cures megrim radically; alleviates toothache4,— a goodly list of virtues ! We have no complete proving of Mikania guaco, although 1 Vol. liv., page 6, 1857. Materia Medica, i., ii.— Jobst "Ueber 2 Vol. ii., page 16. Guaco. Stuttgart, 1840. Wien. 3 Vol. iii., page 94, June, 1854. Wochenschrift, 44." *Dierback Neue Entdeckung, in 426 REMARKS ON GUAO. the editor of the Allgemeine Homceopathische Zeitung states that one has been made by Dr. Elb, of Dresden. Dr. Elb refers to this in an article on "Spinal Diseases"1 (of which we hope soon to present a notice to the reader)*in the course of which he gives the pathogenesis of Guaco in so far as it relates to symptoms of the spinal nervous system. 1 Allgemeine Homceopathische Zeitung, 61, 22 and 43. REMARKS ON SPIGELIA.1 To take a general view of the action of Spigelia upon the organism, it may be said to be manifested chiefly upon the nervous system of animal life. Spigelia is eminent among the remedies of our Materia Medica for the extent to which its action seems to be exerted upon the nerves themselves or their envelopes. Upon the substance of the nervous centers, however, its action is probably very slight. i. Spigelia excites the nerves of special sense in a marked degree, and this without any clearly defined inflammatory affection of the organs of special sense. In this regard, it differs from Belladonna, Rhus, and other remedies which excite particularly the nervous system of animal life. But there is an exception to this statement. In the tissues of the eye Spigelia excites inflammation, its symptoms giving a well-marked picture of rheumatic sclerotitis. Spigelia exerts a marked action on the trifacial nerve, producing prosopalgia, which involves the orbit, the zygoma and the superior maxilla; also upon the nerves of the tongue; perhaps also upon the portio dura. The prosopalgia of Spigelia is distinguished by sticking, burning pains with subsequent swelling and soreness of the parts affected. In 'Auburn, N. Y., March 26, 1877. Dr. Dunham was its author, and it * * * * In the fifth volume of should appear in any collection of his the American Homoeopathic Review, writings. Dr. Dunham's reasons for page 537, is an article on Spigelia wishing it to appear as mine were, that purporting to have been read by me he was writing so much for the in October, 1864. It is true that I Review, that he was glad to have read it, and by request of Dr. Dun- some other name appear occasionally. ham it went as my paper, although C. W. Boyce. I did not write a word of it. 428 REMARKS ON SPIGELIA. this respect it closely resembles the prosopalgia of Colchi- cum, from which, however, it is distinguished by the remark- able exaltation of the special senses and by the general nervous erethism and excitement and intolerance of pain which characterize Spigelia, whereas Colchicum on the other hand has an equally remarkable tolerance of pain, and patient, enduring disposition, with a general semi-paralyzed condition. 2. There is no evidence of any definite modification of the organic substance of any part of the body, unless such action upon the pericardium be inferred ex usu in morbis. 3. The sphere of action of Spigelia is not extensive. It embraces the nerves of animal life and of special sense, and the fibrous, and perhaps the muscular, tissues of the heart and of the smaller extremities. The effect of Spigelia upon the heart's action seems to be due to a morbid condition which the drug excites in the pericardium, and hence its value in pericarditis. 4. The pains of Spigelia are sticking, tearing, and burn- ing pressing. They are aggravated by motion and in the afternoon and at evening. They often prevent sleep. There is great lassitude and heaviness of the limbs. Great sen- sibility of the whole body to touch; the least touch on any part of the body sends a shudder through the whole frame. 5. There is no marked periodicity in the symptoms. Let us now examine more closely the different parts of the body chiefly affected. Head. There is vertigo when looking down and when walking. The memory is impaired, and mental effort is very irksome. The headache is very characteristic and presents a good picture of a form of so-called "nervous headache." In general, the sensations are dullness, heaviness and pain in the head; the pain is much increased by shaking or jarring the head, as by walking, especially if one make a misstep, REMARKS ON SPIGELIA. 429 or cough or sneeze; by moving the facial muscles; by speaking aloud or by any loud noise, as well as by touch or by a bright light. These things increase the pain so that it seems as though the head would burst; the patient is compelled to support it with the hand, or to bind it around. (Here we have headache with over-sensibility of the senses of sight, hearing and touch, with relief from binding the head. These symptoms resemble the headache of Silicea, which has likewise exaltation of the special senses and relief from binding up the head, but it is to be carefully noted, as characteristic, that the relief to the Spigelia headache comes from the pressure of the bandage, while to the Silicea headache, the relief is from the warmth; for warmth relieves the Silicea headache, while it rather aggravates the headache of Spigelia.) The pains are a heaviness and feeling as of a load or weight in the head; a pressing from without inward, aggra- vated by stooping forward, unless the forehead is supported by the hand; a sensation of swashing and surging of the brain within the cranium (compare China and Rhus and Apis) at every step, or on the least motion, or when speaking loudly, and very severe when a false step is made or the body is jarred; relieved by repose. This swashing sensation is often accompanied by a tearing, digging pain in some small well-defined portion of the head; generally, semi-lateral, as, for example, in the left parietal region, or the space extend- ing from the left occiput to the left forehead. As regards the localities affected, the pain is generally circumscribed and is often confined to one side; more frequently the left. The occiput is the seat of many pains which extend into the nape of the neck causing stiffness and at the same time restlessness. In the forehead and in the frontal protuber- ances we find pulsating stitches; pressure from without inward; boring and burning pains; the latter are probably superficial and seated in the supra-orbital nerve. In the 430 REMARKS ON SPIGELIA. frontal protuberances tearing pain extending into the eye and aggravated by motion of the globe of the eye. In the temporal region we find pulsating stitches, pressure inward and burning, extending into the zygoma. We pass now to the Eyes, which are acted upon not only as regards the tissues, especially the muscular and fibrous tissues, but also as regards the special sense of vision. In addition to the affections of the eye proper, we find in the left orbit pressing neuralgic pains extending down to the zygoma and leaving on the zygoma a tumor which is sensi- tive to the touch. The conjunctiva is moderately inflamed. There is moder- ate pain as if sand were in the eye, a slight secretion of muco-pus and bland lachrymation. The affection of the deeper tissues of the eyeball is shown by the dull and flat aspect of the eye, the supra-orbital pains, redness and inflammation of the sclerotic with ptosis, pain in eye and brow; the eyeball is painful when moved and feels tense as if too large for the orbit (Paris quadrifolia); sticking pain in the eye. The eye is painful when moved in any direction (Bryonia), an intolerable pressive pain, so great that, rather than endure it, the patient, when desirous of looking from side to side, moves the whole head, instead of merely the eyeball. Heat and burning in the eyes. Vision. The sensibility of the retina is increased, inducing photophobia. It is likewise perverted, causing illusions, as if hairs or feathers were on the lashes, and these illusions are increased by wiping the eyes; sparks and a sea of fire. The pupils are dilated. The sense of hearing is exalted in connection with the headache. • In the zygomatic region of the left side of the face, burn- ing or tearing pressive pains which leave a dull sensation of swelling as the pain abates. There are stitches from the upper maxilla to the vertex. We pass now to the symptoms of the thorax. REMARKS ON SPIGELIA. 431 There are stitches in the chest in various parts; and on both sides, most frequently the left. These stitches are gen- erally from within outward, and are aggravated by respira- tion (most by inspiration) and by motion. They occur under the nipple of either side, and, on the left side, are directed toward the scapula and left arm. The following symptoms: violent stitch in the left side just under the heart recurring periodically; stitch in the diaphragm on the left side, so violent as to arrest breathing ; dull stitches, synchronous with the pulse, in the region in which the heart's impulse is felt; stitches between this spot and the epigastrium ; — these symptoms, together with those which denote modified action of the heart, viz. : very violent pulsation, audible to the patient and visible to the by-stand- ers; violent palpitation and anxiety; tremulous motion of the heart; palpitation increased by sitting down and bend- ing forward, and by deep inspiration and retention of the breath; palpitation as soon as he sits down after rising in the morning, and, in the praecordial region, a heavy painful pressing load causing constriction and anxiety with cutting and griping as from wind in the abdomen ;—these symptoms all clearly point to an affection of the heart and pericardium, and, in such diseases, clinical experience has shown Spigelia to be of exceeding value. Clinical Indications. It is evident from our hasty and partial review of the symptoms, that Spigelia may be clearly indicated in cases that would come under the following groups: 1. Headaches; generally semi-lateral, so-called nervous; accompanied by great exaltation of the special senses (com- pare Silicea, Conium); aggravated by motion, noise, light and thought; involving generally the left eye and orbit without congestion of the head. In such affections (if attended, as frequently, by nausea and vomiting, they resemble "sick head- aches ") Spigelia compares with Silicea, Belladonna, Apis, Ignatia, Thuja, Sanguinaria. 432 REMARKS ON SPIGELIA. 2. In Sclerotitis. Also in nasal catarrh when the dis- charge is chiefly from the posterior nares into the pharynx, and attended by neuralgic affections of the pharynx and region of the ear and lower jaw, provided always the general symptoms correspond. 3. Above all, in acute or sub-acute affections of the heart which present symptoms similar to those of Spigelia above quoted, it is an invaluable remedy; as for example, in acute pericarditis, with anxiety and weight in the praecordia, stitches through the heart arresting respiration, oppressed and accelerated palpitation so forcible as to be audible and visible, and excited or aggravated by change of position or by the slightest motion. In such cases, Spigelia compares with Aconite, Bryonia, Kalmia, Lachesis, Naja. And with the new remedy Cactus grandiflorus. Dr. HARLEY ON CONIUM MACULATUM. The idea of a Materia Medica Pura—a collection of the effects of drugs upon the healthy—did not originate with Hahnemann. He, himself, quotes several of his prede- cessors—notably Haller, who explained and urged the necessity of such a collection, as the only means of acquiring an exact knowledge of the relations of drugs to the human organism, and a possible key to their therapeutic use. But Hahnemann was the first physician who seriously devoted a large part of his life to the labor of ascertaining these effects, and making such a collection. Many a critic has, to his own satisfaction, demolished Hahnemann's work, and shown the fallacy of his demonstration of the value of prov- ing on the healthy. And, until very recently, the task of systematically developing the pure, that is the physiologi- cal, Materia Medica has been left to our own school of medicine. But the same mysterious mental and moral influences which have " drifted " the dominant school into admissions of the (at least partial) truth of the law, similia similibus curantur; into advocacy of the single remedy (in theory at least); and into the concession that the thera- peutic power of a drug is not necessarily in the direct ratio of the quantity, have recently overtaken prominent physi- cians, especially of England; and Sir Thomas Watson has distinctly pointed to a pure Materia Medica as a possible way to a therapeutic law, and an escape from the present chaos of therapeutics. And Dr. John Harley, of London, in the Gulstonian Lectures of 1868, on "The Old Vegetable Neurotics," has given us an installment of the "pure Materia Medica" of the future, as the allopathists understand and 29 434 DR- HARLEY ON CONIUM MACULATUM. propose to construct it. His work presents the physiologi- cal action and therapeutic use of Hemlock, Opium, Bella- donna and Henbane, alone and in combination. It is worthy of our most thoughtful study. We must not allow a pardonable feeling of satisfaction that the oppo- nents who would have overwhelmed with scorn our Materia Medica Pura, have now come to build such a structure for themselves after our plan; nor hug ourselves in self-suffi- ciency because they disdain to use the materials we have fathered. While we have labored in our departments of Materia Medica and Therapeutics, the allopaths on their side have not been idle. The sciences of physiology, pathology and organic chemistry have, through their industry, made won- derful advances, and now all the resources which these sciences afford them are brought to assist our opponents in their physiological provings of drugs. It behooves us, with minds devoid of prejudice and conceit, and with a teachable spirit, to scrutinize their labors and canvass their achievements, that we may profit by their contributions to useful knowledge, and avoid the errors into which, through an erroneous application of these auxiliary sciences, they may chance to fall. The first drug treated by Dr. Harley is the Conium mac- ulatum. We propose to give a summary of his pathogenesis, and his views of the therapeutic uses of this drug, and then to give a parallel summary of Hahnemann's provings and of our clinical experience, with reflections upon the similari- ties and differences. A similar treatment of the other remedies discussed by Dr. Harley will follow. Some remarks in the preface are worthy of quotation. Dr. Harley says: " My object throughout has been to ascertain, clearly and definitely, the action of the drugs employed on the healthy body in medicinal doses, from the smallest to the largest; to deduce simple practical conclusions from the facts observed; and then to apply the drug to the relief of the particular condi- tions to which its action appeared suitable." DR. HARLEY ON CONIUM MACULATUM. 435 A homceopathist might almost have written this, certainly the first section. But in the deduction "of simple practical conclusions from the facts observed," the door is opened to hypothesis and error; and how can one "apply the drug to the relief," etc., unless one possess a therapeutic law express- ing- the relation between such "conditions" and the patho- genetic " facts observed " ? Here are the weak points of Dr. Harley's system. Until he shall have a therapeutic law, other than the general rule, "causa sublata, lollitus effectus," he will be unable to apply the remedy therapeutically, except through the intervention of two hypotheses, one in pathology, to account for the symptoms of the patient, and the other in pathogenesy, to explain the phenomena pro- duced in the drug-proving; and the introduction of hypoth- eses into a scientific induction makes way for error. Dr. Harley devoted much time to an examination of the relative value of the different officinal preparations of Conium, most of which he regarded as destitute of medicinal power. Discarding the Tinctura conii fructus the Tinctura conii (dried leaf), and the Extractum conii, of the London Pharmacopoeia, as positively or comparatively inert, he describes the mode of making the Succus conii, which he regards as a uniform and very active preparation. We may say, briefly, that his process is substantially the same as that employed by Messrs. H. M. Smith & Brother, the well- known Homoeopathic Pharmaceutists of New-York. Pereira wrote in 1858: "In the present state of uncertainty with respect to the real physiological operations of Hemlock, it is obviously impossible to lay down indications for its use which can be much relied on." Dr. Harley proved Conium first on himself and says: " Having assured myself of the effects of Hemlock in my own person, I have thus been able to fully appreciate its operations in others, and proceed much more boldly than I could have done without such personal knowledge." It would be a satisfaction to add, "more intelligently " also. 436 DR. HARLEY ON CONIUM MACULATUM. " Physiological Action of Hemlock.—The first effect of Hemlock is a depres- sion of the motor function; and its last is the complete obliteration of all muscular motion derived from the cerebro-spinal motor tract. "After taking 3 iij. of the Succus conii, I set out walking; and three-fourths of an hour after the dose I felt a heavy, clogging sensation in my heels. There was a distinct impairment of motor power. I felt, so to speak, that 'the go ' was taken out of me. It was not that I felt fatigue just then, but it seems as if a drag was suddenly put upon me, and that it would have been impossible to walk fast if urged to do so. After walking about a mile up-hill this sensation was very decided, and on putting a foot on the scraper at the door the other leg was shaky, and felt almost too weak to support me. My movements appeared clumsy to myself, and it seemed necessary that I should make an effort to control them. At the same time there was a sluggishness of the adaptation of the eye. My vision was good for fixed objects; but when an uneven object was put in motion before the eyes, there was a haze and dimness of vision, producing a feeling of giddiness. The pulse and pupils were unaf- fected. These were the whole of the effects; and, after continuing for an hour, they rapidly disappeared and left me in the possession of my usual vigor. "2. If a strong, active individual take five or six drachms of the Succus on getting up in the morning, and start off for a long walk, he will be overtaken in the course of half or three-quarters of an hour with a feeling of general tired- ness, and a special weakness of the knees, as if he had been regularly tired out by walking all day to the full extent of his powers. If he be unusually active and strong he will not, perhaps, yield to the inclination to rest, but will proceed slowly on his way, feeling a strange lightness and powerlessness of the legs, with a tendency to drop forward on his knees. This will be associated with some giddiness, and a feeling of heaviness over the eyes. At first the feeling of languor will be most oppressive, but it will soon become more tolerable; and if he should continue the journey for an hour, he will find that the feeling of fatigue has by this time nearly passed off. In the course of another hour he will be as active as ever. " 3. The following were the effects produced in my own person during a period of rest, and they contrast well with the foregoing: " Three-quarters of an hour after taking five drachms and a half of Succus conii, on raising my eyes from the object on which they had been fixed to a more distant one, the vision was confused, and a feeling of giddiness suddenly came over me. That these symptoms were due to impairment of power in the muscular apparatus employed in the adaptation of the eye, was obvious to me; for, so long as my eyes were fixed on a given object, the giddiness disappeared, and the definition and capacity of vision for the minutest objects were unim- paired. But the instant that I directed the eyes to another object, all was haze and confusion, and I felt giddy; and in order to recover my vision and dismiss the sense of giddiness, it was necessary to lay hold upon some object, as it were, with my eyes, and rest them securely upon it. It was clear to me that the adjusting muscular apparatus of the eye was enfeebled, and its contractions so sluggishly performed that they could no longer keep pace with the more active movements of the external muscles of the eyeball. DR. HARLEY ON CONIUM MACULATUM. "Within ten minutes of the appearance of this disorder of vision a general muscular lethargy affected me, and the eyelids felt as heavy as if they were oppressed with the deepest drowsiness. The pupils were considerably dilated. I sat down to note these observations, but, being afraid to maintain this posture lest the rapidly increasing muscular lethargy should get the better of me, I rose up again and tried to shake it off. An hour and a quarter after taking the dose I first felt decided weakness in my legs. The giddiness and diminution of motor power continued to increase for the next fifteen minutes. An hour and a half after taking the dose these effects attained their maximum, and at this time I was cold, pale and tottering. The pulse, which had been emotionally excited by the sudden accession of the foregoing symptoms, was now sixty- eight, quite regular, and of undiminished force and volume. The legs felt as if they would soon be too weak to support me. There was a positive diminu- tion of voluntary power in every part of the muscular system, and this nearly amounted to complete paralysis as far as the hamstring and levator palpebrse muscles were concerned. At one time the greatest exertion was required to elevate the eyelids. The mind remained perfectly clear and calm, and the brain active throughout; but the body seemed heavy and well-nigh asleep. After continuing for about half an hour at their maximum, the symptoms began rapidly to decline, and within three hours and a half after taking the dose they had totally disappeared. ###**# "A delicate young woman, of inactive habits, took four drachms of the Succus. Twenty minutes afterward, and while attending to her usual duties, she experienced nausea and giddiness. She dropped an inkstand which she was holding in her hand, and was unable to walk, and she was placed in the recumbent posture. These symptoms came on with alarming swiftness, and the pulse went up to one hundred and twenty-six from emotional excitement (?) ; but, in a few minutes the heart regained its usual quietude, and she remained perfectly comfortable and calm, but without power to move the arms or legs. An hour after taking the medicine there was nearly complete muscular paraly- sis ; the eyelids were closed, the pupils widely dilated, and the mind clear, calm and active, and she expressed herself quite comfortable. She tried persever- ingly to raise the eyelids when I requested her to do so, but she was quite unable to separate their margins. The pulse and respiration were normal; the surface warm. At the end of an hour these symptoms passed off, and after three hours she had completely recovered her activity and resumed her duties. The next day she complained of slight wearisome pain in the muscles of the lees. * # ** * * * ** * "I proceed now," continues Dr. Harley, "to consider in detail the action of Conium upon the nervous system. The earliest indications of the operation of the medicine are invariably those that arise from the depression of the motor function of the third pair of nerves. They are giddiness, the sensation of a heavy weight, depressing the eyelids, or actual ptosis; a dull, lazy or fixed expressionless stare, like that of a drunken person; dilatation of the pupils. After moderate doses, the interference of vision is only such as results in haziness, as if a thin film of transparent vapor were floating between the eye and the object. * * * It occurs independently of any dilatation 438 DR. HARLEY ON CONIUM MACULATUM. of the pupils, and is compatible with good definition for fixed objects. It is due to imperfect adjustment of the refracting media of the eye from partial paralysis of the ciliary branches of the third nerve. It is through these minute branches that the individual first becomes conscious of the effects of the Hemlock, and if he should be reading at the time he will suddenly find the occupation fatiguing, and very soon afterward it may be impossible, and he will be glad to close the eyes to relieve himself of the symptom, and, as the muscular lethargy begins to be felt, content to lie perfectly still, as if asleep. " In full doses the depressing influence involves the other branches of the nerve, and the lazy movements of the eyeball, or dull, fixed and occasionally divergent stare, indicate the partially paralyzed condition of the external muscles of the eyeball; while more or less drooping of the upper lids expresses a similar condition of the levator palpebral. "Double vision, from inability to maintain the convergence of the optic axis, excepting as a very evanescent effect, is a comparatively rare result of the action of Hemlock. I have only observed it in a few persons. In one of these, a delicate invalid, confined by weakness and ovarian disease chiefly to the recumbent position, two drachms of the Succus conii produced full effects, accompanied by double vision. This was a constant symptom; it came on half an hour after taking the medicine, and lasted twenty minutes. "After having taken the Hemlock for six months, she told me, as often as I happened to see her during the operation of the medicine, that she saw each object in the room double, that my eyes were also doubled, and that she felt as if she were squinting. "Dilatation of the pupil occurs usually after only very large doses, and then it is often but slight, and only observable in a subdued light, the excitement of strong light overcoming the tendency to dilate, just as the exertion of a strong will strengthens for a time an enfeebled limb. " The absence of any preponderating action of the muscles, supplied by the fourth and sixth pairs of nerves, shows that they are equally affected with the third pair. "A proportionate diminution of power is also observed in the muscles supplied by the motor branches of faz fifth and seventh pairs. The contractile power of the m. orbicularis, in particular, is distinctly weakened. " Upon the eighth pair the action of Conium is not very apparent in a state of health; but in the spasmodic affections, arising from irritation of this nerve, its influence is very decided. " As to the hypoglossal nerve, I have never observed any decided loss of voluntary power in the tongue during the action of Conium, unless, as in chorea, some derangement of this center pre-existed. ***** " In the absence of irritation, functional or lesional, it is equally difficult to recognize any particular influence upon the spinal cord. Hemlock affects the motor function of this part of the nervous system last of all, and, short of a poisonous dose, it does not interfere with its motor activity, or reflex function as it is called, in any appreciable degree. * * * * # • * " When, however, there is a morbid excitability of the reflex function of the spinal cord, the influence of Conium in subduing it is powerful and direct. DR. HARLEY ON CONIUM MACULATUM. 439 " Conium, then, in a state of health, and in the fullest medicinal doses that we can venture to give, exerts its power chiefly, if not exclusively, upon the motor centers within the cranium. And of these the corpora striata, of course, are the parts principally affected. " Excepting, then, the reflex action of the cord, the whole motor function of an individual, under the full influence of Conium, is actually asleep; and this is the simplest view that we can take of the physiological action of Hemlock. It is to the corpora striata, to the smaller centers of motion, and to the whole of the motor tract, precisely what Opium is to the brain of a person readily influenced by its hypnotic action; and just as Opium tranquilizes and refreshes the over- excited and weary brain, so does Conium soothe and strengthen the unduly excited and exhausted centers of motor activity. ***** " The influence of Conium appears to be in proportion, not to the muscular strength of the individual, but to his motor activity. * * * A dull, inactive child requires, to produce a given effect, only half the quantity that a lively, active one does." This observation is in conformity with the law; the more similar the symptoms the smaller the dose. " Upon the cerebrum, Hemlock is powerless. I have never been able to recognize the least narcotic, nor directly hypnotic, effects. " Like the cerebrum, the sensory part of the nervous system is altogether unaffected directly by the action of Conium. Its anodyne power in certain diseases may be fairly attributed to muscular relaxation in the diseased parts rather than to a direct influence upon the sensory nerves. * * * Of its anodyne influence upon the facial branches of the fifth nervej I have been unable hitherto to obtain other than very doubtful evidence. * * I think that we may trace the anydone influence, which Hemlock undoubtedly exercises over the sensory branches of the fifth nerve, to the power that it possesses of calming the general irritability of the motor centers. * * Conium has no influence upon the circulating organs, upon the secretions or excretions, or directly upon nutrition. Its influence upon the sexual functions is traceable to a direct action upon the spinal cord." After thus describing the physiological action of Conium, Dr. Harley discusses its therapeutic value, giving examples which comprise ail the cases in which he has used Hemlock alone. He gives the following general conclusion : "Hemlock given in doses which fall far short of producing its proper physiological action, is useless in the treatment of diseases for which it is adpated." The homceopathist will perceive that Dr. Harley comes to this conclusion, because he regards 44O DR. HARLEY ON CONIUM MACULATUM. and uses Hemlock as "adapted" only to cases to which it is enantiopathic. " In selecting Hemlock as a remedy in the treatment of nervous diseases, * * * we must be guided by that simple view of its physiological action which I have now so fully stated; and then the only question to be pro- posed will be, is there irritation, direct or reflex, of the motor centers ? If there be, Conium is the appropriate and hopeful remedy." The homoeopathist will ask: May there not be many varieties of such irritation, varieties in kind, extent, and complication ? And again: May not the results of irrita- tion occurring in individuals of different idiosyncrasy be very various ? And are all such varieties to find their " appropriate and hopeful remedy " in Conium ? How con- stantly, then, will Conium be prescribed in our daily prac- tice ; for how few cases fail to present " irritation, direct or reflex, of the motor centers " ! Dr. Harley gives examples of the beneficial action of Conium in cases presenting tendencies to convulsions. A case of epilepsy was ameliorated. . Muscular tremor and chorea were cured; but the rapidity of the cure in the six cases of chorea is not such as a homoeopathic physician would consider creditable. Dr. Harley does not ascribe chorea to a perversion of the co-ordinating function. He doubts if there be such a function, and regards chorea as due to " an undue excitability of the motor centers, which throw off impressions so rapidly that the will is puzzled to control them." If this be all that chorea is, Conium according to Dr. Harley, should cure every case. As a matter of fact, we see a great variety of symptoms in differ- ent cases of chorea, and similarly we see great varieties in the modifications which different medftines produce in the motor functions. Dr. Harley's (the physiological) method takes no account of such varieties. It is not broad enough for the facts of nature with which it assumes to deal. He proposes to use Conium in tetanus, and has employed it in spasm of the oesophagus and stomach; in the globus DR. HARLEY ON CONIUM MACULATUM. hystericus; in spasmodic cough, laryngismus stridulus, and pertussis; in paraplegia, and in concussions of the spine, and in exhaustion and irritability of the sexual organs. ^ He speaks highly of Conium as a remedy in inflammatory diseases of the eye, and gives six cases of "strumous inflammation of the conjunctiva, more or less involving the cornea and iris, successfully treated by Conium alone and unaided by external applications. The speedy relief from the photophobia, lachrymation, and spasm of the orbicularis has often surprised me." He accounts for its action on the ground, that "in producing complete mus- cular relaxation it acts beneficially in relieving pain and tension, and thus removing irritation." It is difficult to believe that strumous ophthalmia (keratitis) depends on "spasm of the orbicularis and corrugator supercilii." Con- junctivitis palpebralis, at least, is well established, and, in most cases, destructive keratitis has set in before the spasm becomes a prominent symptom. Dr. Harley gives an excellent case of this disease cured in three months by two drachm doses of Conium every second day. I shall give the record of a severe case cured in one month by a few doses of Conium200. In cancer he considers Hemlock a palliative, in that it allays muscular spasm, and thus mitigates pain. In glandu- lar enlargements, and in cerebral diseases, he has found no benefit from Conium. In these citations we have given a fair and full view of Dr. Harley's provings of Conium, and experience in its therapeutic use. He admits its imperfectness, but seems to regard this as relating to extent rather than to method or principles. Let us now reflect a moment on this method of regarding and stating the physiological effects of a drug. How satis- factory it appears to have the entire action of a drug con- densed in one crisp generalization like this of Dr. Harley, instead of having to read page after page of symptoms 442 DR. HARLEY ON CONIUM MACULATUM. arranged in anatomical order! And how easy seems the application of such a generalization to therapeutics, possess- ing, as we do, the law. Let us not, however, be led astray by such fascinations ! Such generalizations are not possible in the present state of medical science. So long as there occur in the healthy body, phenomena physical, mental or psychical, which we cannot fully explain by known physio- logical processes—and there are thousands; so long as the sick present symptoms physical, mental or psychical, which we cannot account for by well-understood pathological proc- esses—and their name is legion,—so long will it be impos- sible to reduce phenomena and symptoms respectively to a general physiological or pathological formula. And, con- versely, whoever, in his therapeutic philosophy includes only such phenomena of symptoms as he can thus explain and account for, disregarding or overlooking all others, binds therapeutics to the slow chariot-wheels of physiology and pathology, and forbids that more rapid progress of this practical department of medicine which is possible under a therapeutic law that turns to account every phenomenon of pathogenesy, and every symptom of the patient. This will appear more clearly when we come to study the homoeo- pathic proving of Conium. CONIUM MACULATUM. The following remarks are based upon the proving pub- lished by Hahnemann in the "Chronic Diseases," volume iii., second edition: General Analysis. I. The action of Conium upon the vital power is very peculiar. It depresses the sensorium, weakening the memory, producing mental lassitude and dull- ness, with difficulty in expressing one's ideas; and yet, under its action, the special senses are abnormally acute, at least those of sight, smell and hearing. The pulse is enfeebled and irregular, but in no other way does the invol- untary muscular system appear to be affected. Power of locomotion is not impaired, but extreme lassitude and debility are manifest throughout the body, indisposing to physical exertion. Clonic spasms of the muscles of the face, arms and hands, have been observed. 2. There is not much in our proving of Conium that shows a marked action on the organic substance, never- theless Hahnemann's acute observation enabled him to per- ceive indications for a clinical application of it, which has demonstrated that it must possess the power to alter pro- foundly the structure of various parts of the body; as for example, the glandular substance, the substance of the cornea, the skin, and the uterus and its appendages. Among the symptoms of Conium, those of the disposition are very well marked and characteristic. The prover is much depressed and disposed to weep, yet easily aroused to anger, averse to companionship, and inclined to shun society, yet dreads to be alone. Sexual desire in the male is easily aroused, even by the mere presence of women, yet the 444 CONIUM MACULATUM. sexual organs appear so much enfeebled that seminal emis- sions take place under these circumstances, and sometimes without erection. In like manner in the female, the menses appear too early, but are scanty, the flow being accompanied by many accessory symptoms, among which extreme ten- derness of the mammary glands is very characteristic. The muscular lassitude is most marked in the early morn- ing ; the arms and legs feel tired and sore, the knees tremble, and after a short walk the prover is exhausted and must lie down. The symptoms generally are worse at night, espe- cially the cough, and the pains are worse during repose. With these general remarks, we pass to a more detailed consideration of the symptoms, in anatomical order. Conium produces the following effects upon the mind and disposition: Depression, sadness, under which tears come easily, excessive anxiety, or else unnatural indifference, with depression. The prover seems sunk in thought, and is apprehensive respecting the present or the future. Dislike of society, and yet a dread to be alone ;—this apparently incom- patible symptom reminds one of the incongruities of hysteria, and has been very often verified in practice. Hahnemann urges upon us the importance of attending to the symptoms of the mind. This is a characteristic mind-symptom of Conium. Upon the sensorium it produces vertigo, which is experienced when rising from the recumbent or sitting posture, when rising after stooping; or, on the other hand, when going down-stairs; and it is often worse when lying down—a symptom which is noteworthy in connection with Dr. Harley's speculations upon the physiological action of Conium. Memory seems to be enfeebled, as is likewise the power of comprehending what one reads, or of correctly expressing one's self. Nevertheless, Hahnemann remarks that the provers of Conium are unusually susceptible to the action of wine or alcohol, and we shall see that the special senses are abnormally acute under its influence. Of the head symptoms, we remark, first, as to the charac- CONIUM MACULATUM. 445 ter of the pains: an aching pain, which is sometimes confined to one side of the head, feels like a heavy downward press- ure, and is increased by motion of the eyes; sometimes in the occiput, like a heaviness when one sits leaning forward; sometimes in the temples and over the eyes, like a pressure from within outward. Second. Tearing pains, as a morning headache, as if the brain were torn. Third. A drawing pain in the forehead and temples, and a piercing pain from within outward. The headaches are generally worse during motion and from a sudden jar or shock, such as a false step, which sometimes produces a digging pain in the head; and the brain seems to be sensitive, speaking and noise producing an unpleasant concussion in it. In the eyes heat and burning; itching and piercing pains in the canthi, or a smarting as if some acrid substance had been introduced into the eye. In the eyeball, aching, increased by reading, and in the evening, by closing the eye. The white of the eye is sometimes red and inflamed; the tears are abundant, overflowing the lids, and are very acrid. The lids are thick and inflamed, pustules appearing upon them. The special sense is variously affected. Photophobia is among the symptoms. A short-sighted prover was enabled to see much farther than usual. Transient blind- ness, or dimness of vision, was noted by others; while others describe appearances as if threads or white clouds or luminous spots were moving in front of the eyes, and as if when reading, the lines upon the printed page moved up and down. These eye-symptoms, produced upon the healthy, afford us a more valid reason for using Conium in strumous ophthalmia than Dr. Harley's physiological explanation of its action could do. In the inner ear, sharp shocks from within outward were felt when swallowing, and piercing pains and aching; pain- ful tension behind the ear and piercing pains in the mastoid process. The cerumen was blood-red in color; the special sense abnormally acute, and painfully so, every noise caus- 446 CONIUM MACULATUM. ing the prover to start. The provers complained of rushing, roaring and ringing noises in the ear, with throbbing, as of the pulse; when blowing the nose the ears feel as if obstructed. The sense of smell is very acute, perhaps perverted; a prover stating that he seemed to smell tar, as though it were in the posterior nares. On the lips, vesicles appear near the vermilion border, and are very sore. Drawing pains and fine stitches in the gums and teeth. The toothache is aggravated by cold food ; the gums bleed easily, and the teeth feel as if they were loose; the tongue is dry and swollen; deglutition difficult and painful, from soreness of the throat. Speech is difficult, probably for the above reasons. Appetite is diminished; the taste is not blunted, but provers complain of a sour, foul or bitter taste, especially in the throat. Eructations occur, sometimes tasteless, some- times sour or offensive, or tasting'of the food; sometimes they are incomplete and produce pain in the stomach. Nausea and vomiting of mucus occur, sometimes early in the morning, sometimes after eating, sometimes toward evening. Digestion is much disordered, as we see by the symptoms which occur soon after eating; rapid distension of the abdo- men after eating only a little milk; distension in the epigas- tric zone after eating but little; it impedes respiration; nausea, vomiting and hiccough after eating; sour taste and eructations, and rising of sour liquid in the mouth after eating. Aching and pressing in the epigastrium. It extends from the epigastrium up to the pharynx, and feels as if a ball were rising to the throat. Other parts of the organism are affected at the same time. After eating, provers men- tion aching in the back of the neck, vertex and forehead, with nausea; a gentle heat seems to pass from the stomach through the arms to the fingers, and then the hands appear as if dead. CONIUM MACULATUM. 447 In the right hypochondrium an aching increased by inspiration ; in the left hypochondrium, an aching tension, extending lower down in the abdomen, with a sensation of heaviness throughout the abdomen. In the abdomen, a constrictive pain, with an involuntary drawing of the abdomen up toward the thorax, and a press- ing and aching pain. Cutting and piercing pains in the abdomen, with some degree of sensibility to pressure, are noted, along with the accumulation of flatus in the intestines. Pains in the groins as if swollen. As regards the stool, we find under Conium frequent desire for an evacuation, with scanty discharge or none at all; also liquid diarrhoeic stool with colic, discharge of flatus, and much mucus, or undigested food, or even blood. At night the evacuations are involuntary. The stools are preceded by cutting in the abdomen and accompanied by burning, pressing or cutting pains in the rectum ; and are followed, whether they are diarrhoeic or not, by a sensation of general weakness and trembling, or even faintness. The urine is high-colored, and there is frequent desire to pass it, and the stream is interrupted; there is a spasmodic pressure in the region of the neck of the bladder, and a sharp, piercing pain from without inward after urinating; severe cutting pains in the urethra during the act of passing water. Passing water does not relieve the desire to do so. In women, when passing water, pressure upon the uterus and cutting pains. In the male sexual organs, cutting pain through the scrotum to the root of the penis; pressing and tearing pains in the testes; frequent emissions of semen at night and even during the day, excited by the presence of women; on the other hand, deficient erections or complete impotence. In the female sexual organs, violent itching of the pudenda, and even within the vagina, day and night for a good while, most just after menstruation. The menses appear too soon, but are scanty; they are preceded by 448 CONIUM MACULATUM. dry heat over the whole body, anxious dreams, and a depressed and anxious state of mind, and by piercing pains in the region of the liver; worse when lying down at night, or on inspiration. Leucorrhoea occurs, of a white acrid mucus, which produces much burning, and is preceded by pain in the abdomen. In the respiratory organs, we notice a catarrhal condition; abundant discharge of mucus from the nose, with hoarse- ness, rawness of the throat and cough. The cough, which is forcible and frequent, appears to loosen some mucus in the chest, which, however, the patient cannot expectorate until some time has passed, when a slight cough brings it up. In the throat, a constant tickling and itching, provoking a dry, teasing cough. The cough becomes worse on lying down at night, and even threatens to end in vomiting; it produces shocks in the head and pain in the abdomen. These cough symptoms, especially the teasing, dry cough on lying down at night, have often been verified in practice. Respiration is short and labored, especially inspiration ; pains of various kinds are described, as cutting pains in both sides of the chest, increased by inspiration ; tension and weakness in the chest; palpitation of the heart, especially after drinking; it is visible to others as well as felt by the prover. The mammae are hard, very painful to the touch (espe- cially during menstruation), with stitching pains, at night, in them. The nipples itch, and when rubbed, burn. In the back are observed, in the sacral region and between the scapulas, stitches and tensive drawing pains, much increased by moving the arms upward; severe aching in the sacral region from walking a short distance, followed by nausea and lassitude; stitches in the sacrum when standing, with drawing through the lumbar vertebrae. In the extremities, lassitude and weakness, more marked in the lower extremities, with numbness of fingers and toes, CONIUM MACULATUM. 449 the former looking as if they were dead. There are also piercing and tearing pains throughout the extremities and in the joints, particularly in the elbow and hip joints. Conium appears to produce disposition to sleep, in the early morning and by day, so great as to be almost irresist- ible. The sleepiness continues in the evening, yet the prover does not get to sleep until late, and the sleep during the night is disturbed and interrupted, and attended by heat of the body and twitching of the arms and hands, and much depression, with disposition to weep, and by bad dreams. As before remarked, the sleep is prevented and interrupted by dry, teasing cough — a symptom which has received numberless clinical verifications. Of fever, no well-marked paroxysms are described. A coldness, without thirst, occurs in the morning, with vertigo and depression of spirits ; slight heat in the afternoon, with thirst, attended by relief of the head symptoms; sweat in the evening, quite abundant during the first sleep ; or dur- ing the night; sweat only of the legs ; or, again, sweat early in the morning on awaking, of the legs, although ^they are cold. The pulse is irregular, as regards both force and frequency. Upon the skin, Conium produces on various parts of the body a fine, hardly visible eruption, which itches considerably. Ulcers already existing in provers assume, under its action, a blackish color, discharge an offensive ichor, and bleed and pain. Swollen glands become the seat of piercing pains and soreness. Before we proceed to consider the therapeutic applications of Conium, it will be interesting to turn to Dr. Harley's statement of its physiological effects, as observed by him.1 He comprises its entire action in this brief statement: " Conium, then, in a state of health, and in the fullest medicinal doses that we can venture to give, exerts its power, chiefly, if not exclusively, upon the motor centers 1 See previous Article. 30 450 CONIUM MACULATUM. within the cranium. And, of these, the corpora striata, of course, are the parts chiefly affected." The peculiar symptoms of the mind and disposition, the abnormal acuteness of the special senses, the characteristic concomitant symptoms of the stool, are not mentioned in his record; perhaps because the doses which he used in proving were so large that the violent symptoms provoked by them masked such subjective phenomena as these; per- haps, and probably, because they were not susceptible of physiological explanation, and could, therefore, have no sig- nificance and no therapeutic value for him. We, fortunately, have a means of applying to therapeutic uses, symptoms to which we have not yet found the physiological key. Our therapeusis, therefore, is not held back by the short-comings of our pathology, however greatly it might be re-enforced by the perfection of that science. Therapeutic Applications. As might be inferred from the symptoms, Conium has been frequently and successfully used in mental affections. Elwert reports1 a case of insanity which had for two years been unsuccessfully treated allo- pathically. The peculiarity of the case was the regular alternation in the condition of the patient. For ten days he would be depressed, melancholy, taciturn, fearful, with rest- less nights; the succeeding ten days excited, violent, irri- table, mischievous. Conium8, a dose every fourth day. He seemed well after the second dose, but the remedy was continued, as a precautionary measure, for several months, in smaller and less frequent doses. Elwert reports2 another case of melancholy with enlarged spleen, cured by Conium. I have had occasion, more than once, to prescribe for cases in which, although there was evidently uterine disease exist- ing, yet no characteristic indications for treatment could be found in the uterine symptoms. ^Allgemeine Homotopathische Zeit- iAllgemeine Homceopathische Zeit- ung, ix., p. 196. ung, ix., p. 198. CONIUM MACULATUM. 451 The peculiar mental symptoms—depression, timidity, taciturnity, aversion to society, and at the same time a dread of being alone—induced me to give Conium, with very satisfactory results, as regards both mental and uterine symptoms. In affections of the eyes, Conium has been much and satisfactorily used. Tulff says,1 speaking of hordeola: " Conium will be useful where the trouble recurs; where several hordeola become indurated, and, on occasion, inflame again." He places Staphysagria beside Conium in this regard. Its chief application, however, has been in scrof- ulous ophthalmia. Knorre says:2 "Photophobia is either a symptom of inflammation of the eye, or an independent, purely nervous condition of the eye, without participation of the vascular system. In the latter case the photophobia is often con- joined with spasmodic closure of the lids. When it is impossible to open the lids, the inflammation of the lids is generally an index of inflammation existing within the eye. Usually, the scrofulous photophobia is conjoined with a pale reddish discoloration of the globe of the eye, which appears like a projecting seam around the cornea, or else there are visible only a few scattered blood-vessels in the conjunctiva. It is wonderful how quickly and certainly Conium relieves such cases; but where the inflammation predominates and the photophobia is not so marked, Conium is not so effica- cious. Knorre, Frank, Segin, Marschall and Thorer publish in the Allgemeine Homceopathische Zeitung, and in Hygea and Prakt- ische Beitrdge, cases illustrating the action of Conium in strumous ophthalmia. In all of these cases, the photophobia was the prominent symptom. In most of them, the flow of tears was excessive and the liquid acrid, producing much inflam- mation of the lids; ulcers and obscuration of the cornea 1 Homoeopathische Vierteljahrschrift, iAllgemeine Homceopathische Zeit- iii., p. 195. ung, v., p. 88. 452 CONIUM MACULATUM. were noticed in some cases. In this connection, the follow- ing case may be of interest: A girl of six years had been treated three months for "ulcer of the cornea," by applications of a crystal of sulphate of copper, and was brought to me in the following condition: The eyes were forcibly closed ; the head bent down and, when possible, buried in a pillow or in the mother's dress, to avoid the light. On any attempt to open the lids, a copious flow of tears gushed out, and the spasmodic closure was so firm that I could not get a view of the globe of the eye. If the lids were forcibly separated, the eye was rolled upward so as to hide the cornea. The sclerotic was not deeply colored; the conjunctiva palpebralis thick, dark-red and velvety. The edges of the lids were thickened, excori- ated and covered with light scabs. I had to accept the statement of my allopathic predecessor that there was a deep ulcer on each cornea. The general health was good. I gave Conium200, a dose every night. In one week the photophobia had so far diminished that I could get a view of the cornea. A large but not deep ulcer was visible on the right cornea, a smaller one on the left. Lachrymation much less; the lids less inflamed. The Conium was continued, but less frequently. In one month from the beginning of treatment, the photo- phobia had ceased ; the ulcers were healed, leaving a pearly opalescence in the right cornea, which, from observation of other cases, I think will disappear within a year or two. Had there been disorder of the digestion and constipation, such as clearly to indicate Nux vomica in this case, I should have given it, and expected, under its action, great amelioration of the photophobia; such having been my experience in cases of this kind. Rentsch reports1 two cases of deafness, in both of which the deafness had been preceded and was accompanied by symp- toms of disorder of the liver. The deafness seemed to depend 1 Allgemeine Homxopathische Zeitung, xxxviii., 92, and xxxviii., 90. CONIUM MACULATUM. 453 on accumulation of hardened and dark cerumen, which, being removed, and Conium administered, the deafness passed away. It would appear that the deafness depended on the accumulation of cerumen, and was cured by its removal; but it is noteworthy that the liver symptoms ceased under the action of Conium, and that the cerumen did not accumulate again. Kammerer reports 1 a case of " cancerous ulcer " of the lower lip, from pressure of tobacco-pipe, promptly healed, under the internal and external use of Conium first. Caspari relates2 a similar case—scirrhus of the lower lip of two years' standing, already ulcerated. Under Conium15 the ulcer healed and the tumor diminished. Six weeks after treatment began, however, the patient had the tumor removed by a surgeon. How far the favorable action of Conium could have availed in this case, we are, therefore, unable to know. In Gastralgia, Dr. Werber states3 that he has found Conium always an excellent remedy, where there was a tendency to constipation, the patient being of lymphatic constitution; and he relates a case cured by it, speedily, the symptoms being: painful spasm of the stomach, a feeling as if the stomach contracted, or of a heavy burden upon the stomach ; she could not bear tight clothing; the pain never entirely ceased, but was sometimes moderate, and then gradually became very severe ; tendency to constipation ; an obstinate, wearisome, spasmodic cough, which aggravated the gastralgia, the cough increased by talking, running, and by emotion. Dr. Gauwerky reports a cure of cancer in the stomach, and Dr. Stens of cancer on the lip, with Conium; the details not given.4 Drs. Burkner and Heil report5 cases of cancer of the 1 Archiv, viii., part 2, p. 70. * Archiv, iv., part 2, p. 24. 3 Hygea, vi., p. 321. * Allgemeine Homceopathische Zeit- ung, xliv., p. 7°- 6 Hirschel's Zeitschrift, iv., pp. 67; 58, 130. 454 CONIUM MACULATUM. stomach and perforating ulcer of the stomach respectively, in which the diagnosis can hardly be questioned, and which were ultimately fatal. Conium, however, caused such marked improvement in both cases, that we may suppose they might have been cured, had they come under treatment earlier. Dr. Battmann reports1 a case of enlargement of the mesenteric glands, ending in suppuration and a large abscess, which was opened near the umbilicus. The patient was terribly reduced, the abscess continued to discharge and the tumor to grow until Conium was administered, when improvement set in and the boy rapidly recovered. In enfeebled conditions of the male sexual organs, whether these result from self-abuse or from excessive venery, Conium has proved a valuable remedy. Lobethal, Ehrhardt, Marschall, Hartmann, bear witness to its value. I have used it successfully where, along with weakness, there also was much sexual erethism, amatory thoughts occurring and even emissions being provoked by the mere presence of women, to the great annoyance of the patient. In this regard, Conium belongs to the same group as Sepia, Selenium, and Gelseminum. Hahnemann 2 suggests that Conium would be an efficient remedy in that kind of hypochondriasis which befalls unmarried men of chaste habits. It is singular that Dr. Harley should have been led to hold similar views. (Or is it not?) Griesselich3 says that Conium relieves delayed and scanty menstruation, accompanied by symptoms which point to congestions in other organs, and especially when the mammae are lax and shrunken. Hartmann says:4 "Conium is an excellent remedy when menstruation fails to appear, but instead thereof, every four 1 Allgemeine Homceopathische Zeit- 3 Hygea, xxi., p. 195. ung, liv., p. 163. 4 Therapie, ii., p. 610. * Materia Medica Pura, iv., p. 238. CONIUM MACULATUM. 455 weeks, there is great sensitiveness of the outer and inner pudenda; constant dry heat of the body, without thirst; with anxious dreams and heaviness in all the limbs; disposi- tion to weep ; restlessness ; anxious care about every trifle ; and piercing pain in the region of the liver, often lasting several days, and much enfeebling the whole body." I would add to the above, tenderness of the mammae. Hartmann likewise says: " In the hysterical attacks and spasms no remedy is more suitable than Conium often is. Most of the symptoms in these cases originate in the sexual system. The patients often complain of itching in and about the pudenda, with pain like the downward pressure of the uterus, and stitches in the vagina; menses suppressed or deficient; leucorrhcea acrid, with frequent constricting pains in the abdomen; pressure in the oesophagus, as if a ball were rising from the stomach to the pharynx; depres- sion ; discontent; disposition to weep when alone. Palpita- tion and pain with every pulsation, as if a knife were thrust through the occiput, with irregular pulse. Clinical experience has shown the power of Conium to arrest the growth of fibrous tumors of the uterus, as I have had several occasions to observe. The indications must, in such cases, be derived from the concomitant symptoms. One which I have several times observed, and which has led me to the successful use of Conium, is this: " Symptom 441, after every stool, trembling weakness." Tumors of a suspicious nature in the mammae have been caused to disappear by the use of Conium. They are generally the seat of piercing pains, much worse at night. The rest of the gland is abnormally tender. I have had several such cases. Hartung reports* a " tumor of the right mamma, of a stony hardness, irregular surface, the seat of stitching pains; upon it a raw, irregular, moist elevation; swelling of the axillary glands. All disappearing under Conium. 1 Hygea, xxiii., 135, from Fragmenta der hinterlassenen Schriften Hahnemann's. 456 CONIUM MACULATUM. Caspari reports a scirrhus of the left breast following a blow, cured by Conium. In a case of mine in which Conium relieved the pains, but did nothing more, Clematis erecta caused the disappear- ance of the tumor. The action of Conium in curing spasmodic, dry cough, worse in the evening and at night, and greatly fatiguing the patient, is witnessed by many writers. Hartmann,1 Kase- mann,2 Hirsch,3 Mayrhofer,4 Hartmann.5 I have, myself, very often observed its happy action in such coughs. Like- wise, in whooping-cough, it has been frequently used with good effect; chiefly, I think, however, when, upon the spasmodic affection a sub-acute bronchitis had supervened, attended by a cough of the above character. Hirschel relates6 that a tuberculous youth had, for a long time, a tickling cough, dry, provoked by a spasmodic tick- ling in the larynx, which was not tender on pressure. The cough came on about six P. M., continued several hours, and was very wearisome. Conium2, one dose, cured the cough. Schwenke reports7 a singular case. In a lad of thirteen years, a noise, apparently from the larynx, like tha—h, tha—h, was heard, with respiration so loud and disturbing that he was dismissed from school. The muscles of the right side of the face were subject to spasmodic twitchings, which preceded an increase of the noise. He also com- plained of spasmodic pressure in the region of the glottis; swelling of the glands. Conium6 effected a permanent cure. Cures of eczema are reported by Hartlaub, Seidel and Schron. Enlargement and induration of the glands, in whatever locality, find in Conium, according to Hartmann, their most 1 Therapie, i., 115. 5 Allgemeine Homcepathische Zeit- * Hygea, x., 359. ung, ii., 109. 3 Allgemeine Homceopathische Zeit- 6 Zeitschrift, i., 77. ung, iv., 308. 7 Allgemeine Homceopathische Zeit- * Hygea, xviii.,495. ung, lx., 152. CONIUM MACULATUM. 457 frequently efficient remedy; a statement confirmed by much clinical testimony. These citations might be widely extended. What has been said will suffice, however, to show the application of Conium, according to the Homoeopathic law, and will suggest an interesting comparison with Dr. Harley's paper. REMARKS ON MEZEREUM. The late Dr. Wahle, of Rome, one of the most distin- guished of Hahnemann's own pupils, and well known by his acquirements in the science of Materia Medica, considered the proving of Mezereum, which was first published in the fourth volume of the Archiv, to be both erroneous and defective. It is no very uncommon thing to find a Homoeopath who considers a portion or the whole of our Materia Medica defective. But the peculiarity which distinguished Wahle was this: whenever he saw an error or a defect, he thought it his duty rather to go to work and correct the error or supply the defect, than simply to expose them and denounce the Materia Medica, taking credit meanwhile for his own acuteness. Accordingly, he instituted a new proving of Mezereum, of which a number of the symptoms are here given. They were given me by his son, the present Dr. Wahle, from whom we may expect a volume of his father's provings when peace and liberty shall prevail in the Papal States ! Scalp and Face. I. The head is covered with a thick, leather-like crust, under which thick and white pus collects here and there, and the hair is glued together. 2. On the head, great, elevated white scabs, under which ichor collects in quantity, and which begins to be offensive and to breed vermin. 3. The scabs on the head look chalky, and extend to the eyebrows and to the nape of the neck. REMARKS ON MEZEREUM. 459 4. Gray, earthy complexion. 5. The child scratches the face continually; it becomes covered with blood. The face and forehead are red and hot, with great restlessness and peevishness. In the night the child scratches its face so that the bed is covered with blood in the morning; and the face is covered with a scab which the child keeps constantly tearing off anew, and on the spots thus left, raw, large, " fat" pustules form. 6. The ichor from the scratched place excoriates other parts. 7. The skin of the face is of a deep inflammatory redness, and the eruption is " fat" and moist. (Impetigo.) 8. A honey-like scab around the mouth. Kidney. 9. Sticking in the kidney and pain as if torn. Menses. 10. Menses too frequent, and lasting too long. Larynx. 11. In the larynx a tickling as if with a feather, which causes coughing. When he has eaten anything he must cough until he vomits it up again. The vomited matter is sour or bitter. 12. Cough, with retching and scratching, or scraping in the pit of the throat, as if something sweet lay there which cannot be coughed up. 13. Between six and seven A. M. moderate cough—at no other time. 14. Dry cough day and night, with emaciation and loss of strength, with tensive pains across the thorax. 15. Sticking in the right side of the thorax. (Note by Dr. Wahle. Mezereum cures no small propor- tion of cases of whooping-cough.) 460 REMARKS ON MEZEREUM. Inferior Extremities. 16. Between the Glutaei, four large scabs surrounded by dark redness and on hardened bases. 17. Itching in the hollow of the right knee. 18. Pains in the periosteum of the long bones, especially the tibiae, worse at night and in bed; at this time the least touch is intolerable. 19. The whole shin is covered with elevated white scabs. General. 20. Itching and burning in the arms and legs, and, on scratching, violent stickings as with needles. 21. The fiery red inflammation of the knuckles of the left foot extends over the instep and calf, and hard tubercles form in the cellular tissue, which itch on the slightest touch, and violent burning pains ensue. Skin. 22. Blotches break out over the whole body. 23. Eruption—pale red, itching after scratching. The scabs are adherent and depressed in the center. 24. Ulcers, covered with thick, whitish, yellow scabs, under which thick yellow pus collects. 25. Throbbing around the ulcer, and, encircling it, a bright red areola with burning pain. 26. In the ulcers, burning pain in the evening in bed. 27. Around the ulcers, fiery red areolae, shining like a mirror. 28. Vesicles appear around the ulcers, itching violently and burning like fire. After eight days these vesicles dry up, leaving scabs, the tearing off of which causes great pain and retards the healing. 29. The parts affected feel, on being touched, as if swollen, which is not the case. 30. Linen or charpie sticks to the ulcers; when it is torn away they bleed. REMARKS ON MEZEREUM. 461 These symptoms suggest at once the applicability of Mezereum to Crusta lactea, to various forms of pure Impeti- go, and to some of those mercurial or mercurio-syphilitic ulcers on the lower extremities which often prove so difficult to cure. I have frequently had occasion to witness the prompt curative action of Mezereum in these affections, in which I have generally used the two hundredth potency. This has proved efficacious in cases in which the lower dilutions have been inert. The characteristics of the Mezereum skin-diseases are well defined in the above symptoms, viz.: Itching occurring in the evening when in bed, aggravated and changed to burning by touch or by scratching. Sensi- tiveness to touch. Ulcers with an areola, sensitive and easily bleeding, pain- ful at night; the pus tends to form an adherent scab, under which a quantity of pus collects. A close relationship is shown by these symptoms to exist between Mezereum and Arsenicum, Asafcetida and Mercurius. DEAFNESS CURED BY MEZEREUM. G. W. W., aged seventeen years, small, but well pro- portioned and of good constitution, healthy since his ninth year, has been deaf since he was four years old. When three years of age, he had an eruptive disease of the whole scalp, which, after resisting for a year all the milder methods of allopathic treatment, was finally caused to disap- pear, in the following manner: A tar-cap was placed upon the head, and when firmly adherent to the scabs, was violently torn off. The scabs came with it, leaving the whole scalp raw. This raw surface was moistened with a saturated solution of nitrate of silver. The eruption did not re- appear ; but from that time the child was deaf. "The condition of the youth now excites the earnest solicitude of his friends. His inability to move in society, or to get a situation in business, on account of his deafness, has produced a morbid state of mind. He broods over his infirmity, and secludes himself even from his own family." Under these circumstances, he applied to me to be cured of his deafness. His present condition .is as follows: He is quite unable to hear ordinary conversation, and has never heard a sermon in his life. A loud-ticking lever watch can be heard at a distance of three and a half inches from either ear. On application of the watch to his forehead, or to the teeth, he hears it distinctly. Occasional buzzing noises in front of the ears. A physical examination of his ears reveals the following condition : The external meatus is abundantly sup- plied with soft, normal wax. The membrana tympani is white, opaque, and evidently thickened. When the patient attempts to inflate the middle ear (which he accomplishes, with great DEAFNESS CURED BY MEZEREUM. 463 difficulty, by closing both mouth and nose and making a forcible expiration), the membrana tympani becomes but very slightly convex, and it is impossible to distinguish its distended blood-vessels. There has evidently been a deposit in the substance of the membrane. On examination of the throat, it appears that the orifice of the eustachian tube is free. Feb. 3, 1857. Patient received a powder containing three globules of Mezereum30, to be taken on retiring. Feb. 24. Thinks he hears better—"every sound seems much louder than before." Hears my watch at a distance of four and a half inches from the right ear, and four and a quarter from the left ear. Saccharum lactis. March 1. Has not improved during the last week. Meze- reum30, three globules. March 27. Hears my watch, with the right ear, six and a half inches, and with the left ear, seven inches. Saccha- rum lactis. April 20. Hears my watch, with the right ear, at a distance of ten inches, and with the left, at a distance of fourteen inches. Hears ordinary conversation easily, with attention. Saccharum lactis. Sept. 28. Has been steadily improving until three weeks ago, when he became more deaf again, without apparent cause. Mezereum30, three globules, on retiring. Jan. 26, 1858. Hears my watch at a distance of fourteen inches from the right ear, and twenty-four inches from the left ear. Deafness returns when he takes cold, but disappears with the cold. Mezereum30, three globules, on retiring. March 19. To his surprise, on going to church, although seated at the extreme end of a very large building, he dis- tinctly heard the whole sermon—for the first time in his life. On physical examination, the opacity of the membrana tym- pani is found to have disappeared, and its elasticity to have sensibly increased. 464 DEAFNESS CURED BY MEZEREUM. May 24. Patient writes me that he has obtained, with- out difficulty, a situation in a store, and that he is no longer conscious of being deaf. His sole difficulty is that, as he has the reputation of being deaf, everybody shouts at him. His father writes, that the son's hearing is "perfectly restored." Remarks. The success of the treatment resorted to in this case warrants a few remarks upon its rationale. Here was a case which presented to the practitioner apparently nothing on which to base a prescription. There was a thick- ened membrana tympani — nothing more. The work of thickening had probably been accomplished years ago. Here was a pathologico-anatomical condition, but no pathological process and, consequently, there were no abnormally per- formed functions—or, in other words, no symptoms of disease—from which to draw indications for the treatment. The pathologico-anatomical condition threw no certain light on the pathological process which had produced it—just as a knowledge of the town, at which a traveler has arrived, gives no certain clue to the road by which he reached it. But, as Hahnemann advised his disciples, the history of a case is often of the utmost importance in determining the treatment. In the case before us the coincidence between the violent removal of the tinea capitis by nitrate of silver, and the appearance of the deafness, was too marked to escape notice. It could not fail to occur to the practitioner that the scalp disease was one phase of a psoric affection, as Hahnemann would have called it, or of a dyscrasia, as the modern school of German pathologists would say (for the doctrine of the dyscrasias is but a rehash of Hahnemann's psora theory), and that this affection, disturbed in its locali- zation upon the scalp, had transferred itself to the tissues of the ear. It further occurred to me that, since in this latter localization there were no sufficient indications for a pre- scription, I might find such indications in the phenomena of deafness cured by mezereum. 465 the former localization upon the scalp. I accordingly addressed myself to the task of getting a complete picture of this affection, which had disappeared thirteen years before. By good fortune, the mother of the patient was possessed of a good memory, and of very excellent powers of descrip- tion, and from her I learned that " thick, whitish scabs, hard and almost horny, covered the whole scalp. There were fissures in the scales, through which, on pressure, there exuded a thick, yellowish pus, often very offensive. There was great itching, and a disposition to tear off the scabs with the finger-nails—especially troublesome at night." The remedy which corresponds most closely, in its patho- genesis, with the above group of symptoms, is undoubtedly Mezereum. In the introduction to the proving of that drug, in the Chronic Diseases, vol. iv., Hahnemann recommends it for moist eruptions of the scalp. In the proving, in the Archiv, vol. iv., many symptoms point to a similar erup- tion^itching, especially, at night; but the conclusive group of pathogenetic symptoms is the following, from a new proving of Mezereum, by the late Dr. Wahle, of Rome, of which the manuscript was shown me by his son, the present Dr. Wahle: " Head covered over with a thick leather-like crust, under which thick white pus collects here and there, and the hair is glued together; on the head, great, elevated, irregular, white scabs, under which pus collects in quantity, and becomes offensive and breeds vermin. The child keeps scratching its face and head at night, and continually tears off the scabs." The resemblance between these groups of symptoms was so striking that Mezereum was at once selected as the remedy for this case of deafness, just as if the scalp affection had been still in its original form, and had been the imme- diate object of the prescription. It not unfrequently occurs that we are called upon to prescribe for what seem rather results, of morbid actions, 31 466 deafness cured by mezereum. than active diseases. In such cases it would seem that we may often successfully base a prescription upon the symp- toms of a diseased condition which no longer exists, but which form in reality a part of the case. It may not be amiss to call attention to the completeness of the corrobora- tion which this case affords (were any needed) of Hahne- mann's psora theory. It is hardly necessary to say that Hahnemann had no idea of restricting the appellation psora to itch, as we understand that term, that is to the disease caused by the acarus. On the contrary, in his Chronic Diseases, vol. iv., he expressly includes under it various forms, as "Itch, Tinea Capitis, Herpes, etc." CROUP CURED BY BCENNINGHAUSEN'S POWDERS. On the evening of January 24th, I received a message to the effect that a little boy, aged eighteen months, fat and healthy, was slightly feverish, and somewhat hoarse. I was requested to send some medicine. I sent a powder of Aconite12, mentioning to the messenger that croup might perhaps be threatening, and requesting to be sent for on the first indications of that disease. The next morning I was told that the child was not much better, and was requested to visit it in the course of the day. I went immediately. As soon as the hall-door was opened, I heard the hoarse ringing respiration of the child, which was in the second story, and which I found sitting up in its crib, with an expression of great anguish, breathing at the rate of 35 in the minute and with great labor. There was but little cough; occasionally, an effort which resulted in a hoarse dry bark, but which was immediately suppressed, apparently because it interfered with respiration. The face was turgid and of a purple hue. The hands were frequently applied convul- sively to the larynx, but as a general thing the child was quiet, looking with pitiful appealing eyes to the by-stander as if for aid. The skin was hot and dry except on the fore- head, which was moist and cool, pulse hard, not full, 130. On saying to the mother, " The child is exceedingly ill," I was told, " He has been as bad if not worse all night." He had vomited once, about an hour before my arrival, bring- ing up a small piece of tough membrane. Here was a case of membranous croup of great severity, which had been in full blast at least twelve hours before I 468 CROUP CURED was called to it; in which the purple turgid face and the exhausted aspect of the child showed that the powers of life had already begun to fail under the imperfect decarboni- zation of the blood. Considering the gravity of the case, and its long duration before treatment was begun, I hesitated to give the powders recommended by Boenninghausen, but gave at once Bromine, first centesimal, in water, a tea- spoonful of the solution every fifteen minutes. At the end of two hours the child was in no respect better; the pulse was weaker and more frequent; there had been no relief for an instant to the labored character of the respiration, which numbered now 40 in the minute. I gave Hepar sulphuris, second trituration, alternately with the Bromine. At the end of two hours there was still no change for the better; the disease was steadily advancing, as it seemed, to a fatal termination. Already it had reached a point at which I have seen both Guersant and Trousseau at the Enfans Malades refuse to perform tracheotomy, on the ground that the disease had, by its long duration, so pre- vented oxygenation of the blood and consequent renovation of tissues that a favorable issue could not be hoped for. I determined now to give the Boenninghausen powders ; waiting therefore a half hour from the time at which the last dose of the Hepar was given, I gave a powder of Aconite200, to be followed at intervals of a half hour by Hepar200, Spongia200, and this series repeated (the method indicated in a foot-note to my translation of Bcenninghausen's article).1 It was now 5 P. M., a time of day after which croup gen- erally begins to be aggravated. At 7 o'clock the child was greatly relieved, respiration 30 in the minute, much less labored, the sound softer, cough rather more frequent and somewhat loose in sound. I left a second series of the pow- ders to be taken at intervals of one hour. The child slept at 11 P. M., and at intervals during the night, and the next morning was so much better that it seemed unnecessary 1 American Homeopathic Review, vol. ii., p. 212. BY BCENNINGHAUSEN'S POWDERS. 469 to give more medicine, although I left a series of the pow- ders to be given in case of a relapse. They were not given, however. The child recovered rapidly without relapse or sequelae of any kind, and on the fifth day was as well as usual. This was unquestionably the most severe case of croup that I have ever seen recover in this or any country. Judging from my experience with Bromine and Hepar in other cases, I have no hesitation in saying that, not acting more evidently and more promptly than they appeared to do in this case, nothing whatever was to be hoped for from them. In croup, if they act beneficially at all, they do so promptly. It seems impossible, therefore, to ascribe the recovery of this child in any degree to these remedies or to deny the curative action of the Boenninghausen powders. CHRONIC DIARRHOEA CURED BY A SINGLE DOSE OF A HIGH POTENCY. Charles C----, aged ten years, has had diarrhoea ever since he was four years old; has been subjected to various modes of treatment, including the Homoeopathic, but with- out any material benefit. He is of good height for his age, but is emaciated to an extraordinary degree;—not only are his tissues utterly devoid of fat, but the muscles are wonder- fully attenuated; — my thumb and finger meet with ease around the middle of his arm. Nevertheless, he is active and full of fun. His appetite is prodigious; thirst very greatj he complains of distress in the epigastric region, which is much greater just before a stool, compelling him to press his hand upon that region and bend forward; this is relieved to some extent by a movement of the bowels. The epigastrium is sensitive when touched. The abdomen is greatly distended; this is habitual; it is hard and tympa- nitic ; by forcible manipulation, one can detect hard ovoid bodies, deep in the abdomen, as large as a pigeon's egg. The number of stools in twenty-four hours varies from five to twenty. They are copious, pappy^ of a dark greenish- brown color, quite offensive. They occur chiefly during a period from 4 A. M. to noon—seldom after noon or before midnight. Though so copious, they do not produce faint- ness or a'sense of weakness, nor does the boy complain of debility, although aware that he is not so strong as other boys of his age. On the contrary, he is lively and full of mischief, his chief complaint being of the very frequent pain in the upper part of the abdomen, which he describes as a "grumbling pain," and sometimes, " a very sharp squeeze." Of the particulars of his previous treatment I could learn CHRONIC DIARRHCEA.CURED. 471 but little. During the summer preceding my first visit to him he had been under homoeopathic treatment (not in this village1), and I was told that he had taken a good deal of Arsenicum, which, however, to the great surprise of his phy- sician had done him no good. And, indeed, on a hasty review of the symptoms, it might seem extraordinary that Arsenicum should have failed to cure the_case. The dark, pappy, offensive stools, preceded by tolerably acute pain in the abdomen, with great and excessive emaciation, comprehend, to speak with the pathol- ogists of our school, the essential features of this present disease of the alimentary canal, and, moreover, present a fair simile to the Arsenicum disease. A carefuLex_amina- tion, however, will_show that some even of these symptoms vary in important aspects from the corresponding symptoms of Arsenicum, while other symptoms which betray the diathesis of the patient are quite at variance with those of Arsenicum. For example, in the first place, the thirst, although very great, is not satisfied by a small quantity of water, as in the Arsenicum disease; the stool, though similar in color, consistency and odor to that of Arsenicum, is copious, that of Arsenicum being, like all the secretions under that drug, scanty. It is not attended by as great a sense of exhaustion as one would expect to find. Indeed, the debility and muscular weakness are much less than one would suppose must result from a diarrhoea so copious and of so long duration, whereas in the Arsenicum disease, the general prostration is much greater than can be accounted for by the actual drain upon the system. In the second place, the aggravations occur in the mornings, while in the Arsenicum disease they occur almost exclusively in the evenings. The abdomen is distended and hard, making the child quite pot-bellied, whereas Arsenicum produces retrac- tion of the abdominal walls and concavity of the abdomen. The appetite is very great, a symptom which is not charac- teristic of Arsenicum. 1 Newburgh, N. Y. 472 CHRONIC DIARRHCEA CURED Then it appears, although the symptom to which my attention was first called, as being the symptom of chief importance, seemed to point to Arsenicum as its remedy, yet the conditions and concomitants of that symptom and the general symptoms of the patient did not at all demand, but decidedly contra-indicated, that remedy. But with what propriety can the diarrhoea, the frequent liquid stool, be regarded as the symptom of chief impor- tance, the primary symptom, so to speak ? It is that symp- tom which would first strike the observation of the patient's friends, because so decidedly objective in its character; but it is obviously a secondary phenomenon, depending on the diseased state of the alimentary canal and of the mesenteric glands; and this diseased state depended unquestionably upon a general depressed state of the vascular and nervous systems, or upon a modified vital action, which is mani- fested in those general symptoms, upon which we predicate distinctions of dyscrasia and diathesis. Taking this view of the case, it is evident that to assign the chief place in our scheme of symptoms to the diarrhoea, would be to prescribe for symptoms (and secondary ones at that) rather than for the whole morbid state of the patient. But if, in accordance with the view I have indicated, we give but a secondary place to the diarrhoea, it becomes easy to find a remedy for our case. The distended, prominent abdomen, the indurated and enlarged glands, the excessive appetite, the great thirst, demanding large draughts of water, the pain in the upper part of the abdomen just before the stool, the tender epigastrium, the copious and long-continued diarrhoea, without correspond- ing exhaustion,—all these symptoms combine to exhibit a_ crmditroTf' wrnvcK~rinds its exact simile in Calcarea carbonic^ Moreover, although Calcarea does not produce stools of the color met with in this case, yet the conditions of stool produced by Calcarea correspond to those of the case in hand. The aggravations of Calcarea are frequently in the morning, and the pain in the abdomen is relieved by warmth BY A SINGLE DOSE OF A HIGH POTENCY. 473 as in this case. Calcarea carbonica, therefore, was selected as^the appropriate remedy, and the propriety of giving it being so obvious that I could not suppose it had been over- looked by the physicians who had previously attended the lad, and there being every probability that, if they gave it at all, they gave it in low potencies, I concluded to give the two hundredth. Two globules were accordingly dissolved in four ounces of water, and a tea-spoonful of the solution ordered to be given every four hours. For the week pre- ceding this prescription the boy had had twenty stools daily, and very great pain. On the third day after the remedy was administered, I called again. The lad had had but one stool daily since the day after my visit; and during the ten months which have since elapsed, his bowels have moved regularly, but once daily, the stool being in all respects normal. In the space of one month the lad became so ruddy and plump — having gained twenty-two pounds in weight — that I should not have known him. As he gained flesh and strength, the rotundity of the abdomen disappeared, and at the end of the third month the indurated abdominal glands were no longer to be felt He received no medicine besides the single dose of Calcarea carbonica200, above mentioned. It may seem incredible, and I confess I cannot explain it, that a drain so long established and so copious could be instantaneously checked without producing at least tempo- rary disturbance of some other character. The fact, how- ever, does not admit of dispute. In a review of this case, two points seem worthy of notice. 1. The prompt and enduring action of the high potency. I would not venture to say that a low potency would not have acted as promptly; certainly, however, nothing better could be imagined or desired. 2. The great importance of paying careful regard, in the selection of a remedy, to the general symptoms of the patient, as denoting the dyscrasia, and to the conditions (time and character of aggravation, etc.) of every symptom. PTERYGIUM CRASSUM CURED BY A SINGLE REMEDY IN A HIGH POTENCY.1 The following case is thought worthy of special notice for several reasons. It presents an instance of a diseased con- dition which, being on the surface of the eye, may be made the subject of constant observation : Such a condition has never, so far as my knowledge goes, been produced by any remedy. It is not contained in any proving. A homoeopathic prescription for it must therefore be based upon the general characteristic symptoms which the patient may present, and to which corresponding symp- toms may be found in some drug-proving. The writer had never treated a case before, and does not recall any record of a cure made by homoeopathic remedies. He was not, consequently, influenced in the selection of a remedy by any knowledge ex usu in morbis. The patient was not encouraged to expect a cure, but looked forward' to a surgical operation as a matter of neces- sity. There can be no ground, then, for ascribing the cure to faith, the last resort of the credulous incredulous, to whom it is easier to believe that a grave and material disease can be cured by imagination, the intangible, than by a high potency, the imponderable ! The cure was effected by a single remedy, in a high potency, the two hundredth (prepared by myself). J. N. S., a farmer, aged fifty-five years,— generally in good health,—has had for three years a pterygium upon each eye. Starting from the inner angle of the eye, this morbid growth, 1 Read before the Homoeopathic Medical Society of Cayuga County, N. Y., June 22, 1864. PTERYGIUM CRASSUM CURED. 475 which was thick, opaque, and richly supplied with large blood-vessels, and much resembled a strong muscle, extended over the sclerotic, had invaded the cornea with a thick, broad extremity, and now covered more than one-half of the pupil, rendering the patient nearly blind. The conjunctiva of the remaining portion was deeply injected. The eyes were filled in the morning with a muco- purulent secretion. The patient was unable to endure artificial light, and com- pelled to carefully protect the eyes during the day-time. Reading was out of the question at all times. Within the last six months the growth of the pterygium had been very rapid. The eyes were very painful, especially in the evening and at night. The pain was in the inner angle of the eye, a pricking, smarting pain, seeming to be situated deep in the globe. Dust in the atmosphere greatly aggravated the pain. In addition there was a very severe pressure at the root of the nose and across the supra-orbital region. There was considerable lachrymation, especially in the evening. The effect of this disease was to entirely incapacitate the patient for every kind of business. In this condition the patient placed himself under my care about the 1st of July, 1863. He had been advised that an operation for the removal of the pterygium was the only thing to which he could look for relief, but had also been told that in the present inflamed condition of the eyes, and at the unfavorable season of midsummer, the operation would expose him to no inconsiderable danger of sequelae that might be very disastrous. He had been counseled to endure his present symptoms until the weather should become colder and more favorable for the operation. His motive, therefore, in coming to me was to get some palliation of his suffering, some temporary relief, that the summer months might be made more tolerable to him. I gave him no encouragement to believe that I could do 476 PTERYGIUM CRASSUM CURED more than slightly palliate his sufferings; for, as has been already remarked, I had never treated a pterygium, and never heard of a homoeopathic cure of one. Seeking a homoeopathic remedy for the case, as it has been stated, I could get no light from the objective symp- toms, since no proving contains anything like them. Nothing remained but the subjective symptoms. Of these the pain, smarting and pricking, and which was singularly confined to the inner angle of the eye and seemed deep- seated, the pushing pain at the root of the nose, the marked aggravation in the evening,— these symptoms together sug- gested Zincum metallicum. In the proving of Zincum we find (symptoms 194, 197, 205, 209), biting, pricking and soreness in the inner angle of the eyes ; lachrymation, especially in the evening ; inflam- mation and redness of the conjunctiva; suppuration of the inner angle with soreness,— many of these symptoms being aggravated in the evening; symptom 248, " Pressure on the root of the nose, as if it would be pressed into the head, almost intolerable," together with 249—251 of a like sig- nificance. The other symptoms of the patient being well covered by those of Zincum, I concluded to give this remedy. I felt the more hope of some benefit from it, from the fact that my (allopathic) preceptor, who had much experience and success in the treatment of diseases of the eye, had often said that Sulphate of zinc, applied externally, had a more beneficial effect in pterygium than any other astringent or caustic application. Now, as Sulphate of zinc is by no means so powerful an astringent or caustic as many other substances that are com- monly used as applications in such cases, certainly the supe- riority of Zinc could not be attributable to its mere posses- sion of those properties which it has in common with other collyria, as, for example, Nitrate of silver, Sulphate of copper, etc., etc. It must be due, then, to some specific BY A SINGLE REMEDY IN A HIGH POTENCY. 477 quality of the Zinc. In passing, let me venture the remark, that in clinical observations like the above, made by sagacious allopathic observers, we may often find valuable hints to supplement our pathogenetic knowledge of drugs. To return to the case, I determined to give the two hundredth potency of Zinc, the case being, as it seemed to me, a very fine one for experiment with a high potency. I gave four powders of sugar of milk, each containing three globules of Zincum metallicum200, and ten additional powders containing nothing but sugar of milk; a powder to be taken dry on the tongue, every night on retiring; the patient to report on the fourteenth day. No change to be made in diet, regimen, or occupation. No external applica- tions to be made. July 15. The patient presented himself and stated that on the third day after he began to take the powders he began to feel much better, and that now he was entirely free from pain and discomfort and from lachrymation. The morning secretion was much less. I thought the eye appeared less inflamed, but beyond this there was no change in its physi- cal condition. I gave sugar of milk and requested a report in a fortnight, or sooner, in case the pains should return. August 1. No return of pain. The pterygium has cer- tainly diminished in size; it is not so thick and luxuriant as formerly. Sugar of milk. August 10. The patient came to apprise me of a return of the pains to moderate extent. I gave three powders of Zincum metallicum200, to be taken every night on retiring. August 20. The pains disappeared after the first powder and have not returned. The pterygium is evidently de- creasing. Twice again the pains returned, and on each occasion I gave a powder of the Zincum200. By the end of October, the time fixed for the operation, the pterygium had dimin- ished so far that it was only a little colorless ridge in the extreme inner angle of the eye, the sight was entirely 478 PTERYGIUM CRASSUM CURED. restored, the patient could use his eyes freely both by day and in the evening; there was no longer any thought of the operation; in fact, it would have been hard to find anything to operate upon. At the present date there is no trace of the pterygium remaining upon the left eye. In the inner angle of the right eye there is a small speck yet visible. PANAMA FEVER CURED BY ARSENICUM. A. J., aged thirty, strong, muscular and hitherto healthy, sent for me. He had been exposed about eight weeks before, while on the isthmus of Panama, to unusual vicissi- tudes of weather, and three weeks after he left Panama had sickened with chill, fever, vomiting, etc., more or less severe, which, however, he succeeded in suppressing by large doses of quinine, so as to be able to travel for a few days at a time. Three days before I saw him he was taken with an unusually severe chill, followed by high fever and alternations of chill and fever, with severe constitutional symptoms, which continued, notwithstanding large and re- peated doses of quinine, until I found him in the following condition: Though still quite stout he had lost flesh greatly, having decreased in weight thirty pounds during the last month. His face was of a dusky red hue, hot and dry, eyes injected, dry and ferrety, the pupils contracted, with a very restless, anxious expression. The patient had constant thirst, though satisfied with a single swallow of water at a time. The stomach was excessively irritable—drink was rejected as soon as taken ; a profound disgust for food of all kinds. The tongue was covered with a thick, brownish coat, and felt to the patient dry, though not actually so. When protruded, the tongue trembled and was moved involuntarily back and forth, in spite of efforts to keep it still. The hands trembled excessively when held out, and the patient complained of indescribable weakness and prostration. Nevertheless, there was uncontrollable restlessness, it being literally impossible to remain for more than an instant in one position—the 480 PANAMA FEVER CURED BY ARSENICUM. recumbent posture was intolerable; alternations of chill and heat, partial and fugitive in character, were experienced, each lasting about fifteen minutes, the heat yielding for a few moments to a partial, clammy sweat, which was soon succeeded by chill again. There were dyspnoea and short, dry cough. The spleen was much enlarged and dull on percussion. During the last two nights the patient had been unable to sleep at all, but had been exceedingly rest- less and uncomfortable, tormented by thirst. The pulse was 140, very quick, small and wiry. The head was confused, and I found the sensorium much clouded, it being difficult to get definite answers to my questions; there was, how- ever, a constant effort to give expression to a sense of great uneasiness and vague apprehension of severe illness. No one who has been at all conversant with Panama Fever could fail to recognize the gravity of the above. I expected to have a long and perhaps a doubtful battle with the disease, and proceeded accordingly to make arrange- ments for an indefinite sojourn on the part of my patient, who was not a resident of this place.1 From the symptoms as detailed, there could be no doubt of the prescription required at the moment. The excessive prostration, con- joined with the great nervous and vascular erethism, the irritability of the stomach, the great thirst, satisfied for the moment by a small quantity of water,—the intermingled heat, chill and partial sweat, presenting at no time a definite paroxysm of intermittent,—along with the dyspnoea and anxiety, and the peculiar pulse, weak and yet excited, made it a matter of course that I should give Arsenicum, which as the indications were so clear that the selection of the remedy could not be a matter of doubt, I gave in the two hundredth potency, deeming this a very fair case, both as regards the clearness of indication and the severity of the disease, for the demonstration of the power of the high potencies. I gave at 4 P. M. a powder of Saccharum lactis 1 Newburgh, N. Y. PANAMA FEVER CURED BY ARSENICUM. 481 containing two globules of Arsenicum200, to be taken dry, and to be followed by a similar powder every four hours. The following day I found that my patient had slept three hours the night before; his stomach, no longer irritable, tolerated beef tea and toast, the chills and heat occurred about once in four hours, lasting for a few moments only; cough and dyspnoea had disappeared. Prostration still excessive, restlessness moderate, intelligence good, tongue and hands less tremulous. Arsenicum200 as before, every six hours. The third day. A better night, no chills or heat to-day, strength increasing; no restlessness. Arsenicum200 every eight hours. The fourth day. Slept well last night, feels like walking out; appetite good, tongue clean. Saccharum lactis. The fifth day. Feels quite well and strong. The next day he resumed his journey. In such a case, one would apprehend a relapse after the expiration of one, two or three weeks. I have made especial inquiries respect- ing my patient, and find that nothing of the kind has occurred. It is three months since I prescribed for him, and he has steadily gained strength and flesh, and is to all appearance well. 3-2 A CASE CURED BY MAGNESIA CARBONICA. Mrs. S., aged twenty-seven years, fair and stout, has been married six years, but never pregnant. Before marriage, menstruation was normal; soon after marriage, it became irregular, as follows : menses would appear at intervals of three or four months, and the flow would continue, with scarcely an intermission, for twelve or fourteen weeks. The discharge was generally dark and thick, accompanied by pain, more or less severe. During the flow the patient became quite feeble and anaemic, although not apparently emaciated. She applied to me, March 16, stating that she had been flowing since March 1st; the discharge being thick, dark and abundant, and attended by unusually severe, labor-like pains, night and day. She was already very feeble; and, judging from past experience that she would continue to flow in this way for at least two months, she apprehended a degree of prostration that would utterly disable her. I gave Platina200, a dose every night. The flow continued, although daily diminishing in quantity, for one week, and then ceased. The patient immediately began to regain strength. There was no re-appearance of menses until June 16, when they came on as before, but without pain, continued two days, ceased for twenty-four hours, re-appeared, and continued until July 4. During this time Platina200 was taken as before. July 18, menses re-appeared, the flow being very abundant, dark, and somewhat coagulated. The patient was weak, had no appetite, and complained of pain and much commotion in the abdomen. Platina having failed to produce a lasting effect, China, Crocus, and Hamamelis were A CASE CURED BY MAGNESIA CARBONICA. 483 given, but without satisfactory results. The flowing con- tinued from July 18 to September 12, when the patient's condition of debility was quite deplorable. I now found her symptoms to be as follows : the flow was not quite so dark, very profuse, but much more profuse during the night and on first rising than it was during the day. On rising in the morning, the patient experienced a contracting pain in the abdomen, and a sharp upward stitch in the rectum, followed by a discharge of coagula from the vagina. There was not much flowing during the day, while throughout the night it was abundant. She was very weak, and had much headache and no appetite. I gave Magnesia carbonica200, to be dissolved in water, a tea-spoonful every four hours until better. September 16, she reported that after taking Magnesia carbonica for two days the flowing at night ceased ; now, after four days, the flowing had entirely ceased. The improvement in general condition had been remarka- ble. From this time, the progress of the patient was all that could be desired. In five weeks menstruation re-appeared and pursued a normal course, and there has been no recur- rence of the former long-standing troubles. The prescription of Magnesia carbonica in this case was followed by very prompt and complete relief. The symp- tom which led to it was the "condition " of the flowing, viz.: "worse during the night." Shall we now, on the strength of this conformation of this unusual (we might say unphysi- ological) symptom, pronounce the latter a " characteristic," or a " key-note " of Magnesia carbonica ? It was certainly the symptom in the case which struck me as most remarka- ble (for I do not remember meeting it before in practice), and the fact that I found it in the proving of Magnesia car- bonica determined me to give that remedy. But would it be safe to rely on this symptom alone as a " key-note " and always give Magnesia carbonica when we meet the symp- tom in practice? No doubt we should sometimes brilliantly succeed, but I am sure we should often fail. At least one 484 A CASE CURED BY MAGNESIA CARBONICA. other remedy has the same symptom, flowing worse at night, viz., Bovista; and still others may have it. Between these two remedies, the distinction is easily found in the diversity of the other symptoms. Magnesia carbonica producesl too frequent and too profuse menstruation; the flow, which is dark and thick, being more profuse at night,2 corresponds with my case in every particular. Bovista, on the other hand,3 makes menstruation tardy and scanty ; the flow, which is watery, being most abundant at night.4 These remedies, so different, agree in this one symptom, "increase of flowing at night." We could avoid error in a prescription only by taking cognizance of the totality of the symptoms,— Hahnemann's approved method. Should we venture to base a prescription on this remarkable symptom alone, as a characteristic or "key-note," we should probably fail in half our cases. Ex uno disce omnes. There is no royal road to knowledge of the Materia Medica. 1 Chronic Diseases, Symptoms 500 to Medica, vol. iii., Bovista; Symptoms 525. 382 to 394. 2 Symptom 510. 4 Symptom 385. 3 Hartlaub and Trinks' Materia OVARIAN TUMOR CURED BY COLOCYNTH. On October 10, 1864, I was requested to visit Mrs. C. E. H., aged about thirty-eight years. She gave me the follow- ing history: She had been always in good health, married ten years, but never pregnant. While traveling in France in 1854, she was attacked with what was then called acute peritonitis. She was confined to her bed several years. Partially recovering, she consulted Trousseau, who discovered the right ovary inflamed and somewhat enlarged. From this time she was more or less unable to walk, and suffered much from a tumor, which gradually developed in the pelvis, between the uterus and the rectum, and which was pro- nounced by Trousseau to be an enlarged and prolapsed ovary. In 1863 she came to New-York, and placed herself under one of our most experienced gynecologists, who confirmed Trousseau's diagnosis, pronounced the case incurable, and advised a sparing resort to anodynes to mitigate severe suf- fering. I found Mrs. H. confined to her sofa; she had not left her room for a year. A firm, elastic tumor occupied the space between the uterus and vagina anteriorly, and the rectum posteriorly, completely occluding the vagina, and rendering defecation very difficult. It seemed not to be adherent to the walls of either passage. Attempts at walking induced paroxysms of acute pain across the hypo- gastrium, in the sacral region, and around the hip-joint; from here the pains extended down the groin and along the femoral nerve. The pain was relieved by flexing the thigh upon the pelvis; and always induced or aggravated by extending the thigh. Even without the provocation of 486 OVARIAN TUMOR CURED BY COLOCYNTH. motion there were frequent and severe paroxysms of pain, as above described. The appetite was not good, and digestion feeble; but the general condition of the patient was good. Nervous sensibility was very great. The pains had been ascribed to the pressure of the tumor upon the sacral nerves. The patient had a dread of taking opiates, and had used them sparingly. I was requested to mitigate the pains, if possible,— no hope being entertained of a cure. With no definite expectations of accomplishing a radical cure, I pre- scribed Colocynth200; a few pellets to be taken whenever a paroxysm of pain came on, and to be repeated every hour during the paroxysm. This prescription was based on the results of the Austrian proving of Colocynth, which confirm and amplify the provings of Hahnemann. November i. I learned that the paroxysms had been less frequent, much shorter, and milder; the remedy appearing to control them. March I, 1865. The patient walked half a mile to my office and reported that she had had no pain for a month. She could walk half a mile daily without fatigue or pain, and had resumed the charge of her household after an interval of nine years. She thought the tumor had become somewhat smaller. Being about to sail for Europe, she desired some more Colocynth, that she might be provided in case pain should return. June 9, 1869. Mrs. H. has just arrived from Europe. I find her perfectly well. There has been no return of pain since 1865. The tumor disappeared from its position between the vagina and rectum in the autumn of 1865, and was plainly perceptible in the abdomen, about as large as a Sicily orange. It has since disappeared entirely, and nothing of the kind can now be discovered. Was this really an ovarian tumor ? No doubt appeared to be entertained by the eminent physicians who preceded me in the case. Did the Colocynth cause its absorption ? The patient has no OVARIAN TUMOR CURED BY COLOCYNTH. 487 doubt on this point. Why should it not have done so ? Because we have no record of any action of Colocynth, except on the intestinal mucous membrane, and on certain plexus of nerves ? Fortunately, the action of remedies is not restricted to the measure of our imperfect a priori knowledge of them. A reviewer in the British Journal takes exception to a statement of mine, that a remedy, when indicated by a well-marked group of symptoms, will often remove, not merely those, but also other groups apparently unconnected, —in fact, the whole disease. This case is in point. And yet I can hardly doubt that, in such cases, a complete proving, were it possible, would show that the remedy does produce likewise these seemingly unconnected symptoms,—in fact, a picture of the whole disease, Indeed, on examining the Austrian proving, we find Frolich reports two brief prov- ings on women, both of which show the action of Colocynth on the ovaries. Had we well-instructed women-provers, how much more we should know of the action of drugs! BAPTISIA AS A HAIR-WASH. Miss A. S., forty-two years old, of light complexion, spare figure, very excitable, and prone to dwell upon her own ailments and disabilities, consulted me in December, 1864, for chronic constipation; to palliate which, she had been in the habit of taking daily, a pill of extract micis vomica and aloes. Under the use of sulphur200, followed by albumina200, she became able to dispense with her purgative pill, having a regular stool every day. On the 20th February, 1865, she applied to me again with the following symptoms: "The ,day before, her eyes began to smart and feel as though she had been exposed to wood-smoke. They felt full of dust; the conjunctiva of the globe was injected; there was a discharge of muco-purulent matter from the eyes this morning. " Fluent coryza, the discharge being thin, not acrid, a sore spot, feeling raw, internally on the left side of the pharynx; these symptoms are aggravated by exposure to damp, cool air. Headache, a pressure backward in the entire frontal region; severe pain from the right side of the occiput to the right frontal protuberance. " She feels ill, in an undefinable way; feels weak; half depressed in spirits, half apprehensive of some coming evil. Feels as though some unknown but irresistible influence had possession of her and she were about to be ill, or to meet with some misfortune." Her face was flushed, but there was no heat of skin; the pulse was about eighty, soft and slightly irregular. BAPTISIA AS A HAIR-WASH. 489 Something, I cannot tell what, struck me as incongruous in the patient's appearance and symptoms, and led me to doubt whether her condition were an idiopathic disease. I said to her, " You seem to me to be under the influence of some drug or poison. What have you taken ?" She pro- tested that she had taken no medicine. The similarity of her condition to my idea of the symptoms of Baptisia, came forcibly to my mind, and I asked, " Have you not taken or in some way used the tincture of the Baptisia ?" After some hesitation, she replied: " I have been using for several days a hair-wash, composed chiefly of the tincture of Wild Indigo. Could that have anything to do with my symp- toms?" I forbade the hair-wash, and gave nitric acid200. A week passed before the symptoms disappeared, those of the eyes lingering longest. New-York, Dec. 1, 1867. CHLORINE IN SPASMUS GLOTTIDIS. No. i. In the year 1850, after submitting to the manipulations of a dentist, I was advised to wash the mouth with a solution of Chlorine. A weak solution of Chlorine gas in cold water was accordingly prepared, and I proceeded to rinse the mouth with it. Scarcely had the liquid been received into my mouth, when I became sensible of a spasmodic action of some part of the respiratory organs of the following charac- ter : Inspiration was unimpeded, and could be effected in the natural manner, but expiration was absolutely impossible, and this impossibility arose, if I might trust my sensations, not from any inability of the muscles of expiration, but from a closure of the rima glottidis. Expiration being felt to be impossible, inspiration was again attempted, and was accom- plished, fully and easily, although the act was attended by a slight crowing noise. Expiration, which was again attempted, was impossible as before. By these successive operations, the lungs became inflated to a most painful degree, but, so firmly did the glottis appear to be closed, that it seemed as though air might pass through any part of the thoracic walls more readily than by the way of the larynx. This arrest of respiration having endured for about a minute, the face becoming turgid and livid, partial coma supervened, the spasm relaxed, and respiration became free again. In 1852, I had an opportunity of witnessing the effect of a strong accidental inhalation of chlorine gas by an adult. The same phenomena of comparatively free, but crowing inspiration, and of absolutely obstructed expiration presented themselves; the face became extremely livid, convulsive CHLORINE IN SPASMUS GLOTTIDIS. NO. I. 491 movements of the extremities began, and the patient became partially comatose. I administered ammonia by olfaction; the spasm relaxed, and consciousness returned along with normal respiration. These experiments show a power in chlorine to produce the following condition: Spasm of the glottis, which inter- feres but little with inspiration, giving to it a crowing sound, but which prevents expiration. During the continuance of the spasm, the respiratory acts consist of a succession of crowing inspirations, each followed by an ineffectual effort at expiration, the whole serving to inflate the chest to a most painful extent, and attended at last by turgescence of the face, and more or less complete coma, with or without con- vulsive movements of the extremities, and during which the spasm relaxes. In the Proving of Chlorine,1 a similar effect is indistinctly indicated. Pereira says: " If an attempt be made to inhale undiluted chlorine gas, it produces spasm of the glottis. Twice I have suffered severely from the accidental inhala- tion of it; and each time it gave the sensation of constric- tion of the air-tubes, such as might be produced by a spasmodic condition of the muscular fibers of the bronchial tubes." The peculiar nature of the chlorine spasm, viz., that it affects expiration almost exclusively, is not mentioned by Pereira. Bearing in mind the odium which has been attempted to be cast upon some of our colleagues for flooding our litera- ture with "fragmentary provings," which serve no purpose but to "cumber the Materia Medica," and to annoy our practitioners with an " embarras de richesses" x(as if it were not worth while to publish and to study anything, however " fragmentary," if it furnish us the means of curing, were it but a single case !), I might have abstained from publishing the above symptoms of Chlorine, had not the following case demonstrated their practical value. 1 In vol. ii. of the Neues Archiv. 492 CHLORINE IN SPASMUS GLOTTIDIS. NO. I. June 24th. A female infant, seven months old, well devel- oped and large, the fourth child of healthy parents, was brought to me with the following history: Having been previously in perfect health, she was seized three weeks ago, with a spasmodic affection of the respiratory organs. Suddenly and without any warning, she would make a long inspiration, with a slight crowing noise; an attempt to exhale would be made, but without success ; another crow- ing inspiration followed by a forcible, but ineffectual effort to exhale ; and this would be repeated until the child became blue around the mouth, and sank into partial uncons- ciousness, when free respiration would take place, and the child would generally sink into a deep sleep. Frequently toward the close of an attack, convulsive movements of the extremities would be noticed, and once, general spasm occurred. At first, these attacks came on only after some excitement, or on the child being startled. They frequently occurred during sleep, arousing the child suddenly, and they were most frequent from midnight to 7 A. M. Within the week before I saw her, they had become very frequent—as many as thirty to forty, occurring during the twenty-four hours. The child had begun to emaciate rapidly, had lost appetite, strength and playfulness, the face was pale and bloated, and the eyes had a dull and glassy expression. The child had been under most skillful homoeopathic treat- ment since the commencement of the attacks, and as she failed to improve, change of air was recommended, and she was brought to Newburgh. The climate failing to benefit her, the child was placed under my care. The case seemed all the more serious from the fact that, last year, the parents had lost an older child, a boy, with the same affection. In the fourth week of the disease, of which the course had been in every respect similar to that of the infant above narrated, convulsions supervened, and the child died at the end of the sixth week. This child was under enlightened allopathic care. It may be interesting to note, that the autopsy • CHLORINE IN SPASMUS GLOTTIDIS. NO. I. 493 revealed no malformation, and no organic lesion; simply emaciation and atrophy. On careful examination of my little patient, I could discover nothing abnormal in the condition of the heart or lungs, and no sign of disease that was not fairly attributed to the frequent recurrence of these spasms, with the venous congestion consequent upon them. It was evidently a case of spasmus glottidis (asthma thymicum, asthma millari, asthma laryngeum infantum, laryngismus stradulus), and had advanced almost to the second or convulsive stage in which the prognosis is decidedly unfavorable. The remedy which is recommended before all others for this disease, in our hand-books and repertories, is Sambucus. The symptom on which this recommendation is based is the following: " Slumber with half-open eyes and mouth; on awaking from it, he could not draw a breath, and was compelled to sit up, whereupon respiration was very hurried, with wheezing in the chest, as if he should suffocate; he lashed about with his hands; the head and face were bloated and bluish; he was hot, without thirst; weeping at the approach of a paroxysm,—all this without cough, and especially at night, from twelve to four o'clock." On com- paring this picture with the case under consideration, we find correspondences in the general characters of the affec- tion. The spasmodic embarrassment of respiration, the absence of fever and of cough, the occurrence of the paroxysms suddenly, chiefly at night, and on awaking, show a general appropriateness of Sambucus to spasms of the larynx and bronchial tubes. But we seek in vain for the unequal disturbance of the inspiratory and the expiratory acts, which are the individual, and therefore the characteristic, peculiarity of the case under consideration. And failing to find this, we should, as a matter of course, expect that Sambucus would fail to cure, or in any way to affect the case. And this had been the fact. So, too, of Lachesis and several other remedies which, as well as Sambucus, had 494 CHLORINE IN SPASMUS GLOTTIDIS. NO. I. already been tried before the case came under my care. In this very peculiarity, which was characteristic of the case, the similarity of Chlorine was most striking. And it was with the utmost confidence of a happy result, that I deter- mined, after a careful examination of the case, to administer Chlorine. I accordingly prepared a saturated solution of Chlorine gas in water at 6o° Fahrenheit, and made from this the first centesimal dilution, in which the odor of the Chlorine could be faintly perceived. Of this I ordered twenty drops to be dissolved in four table-spoonfuls of water, and a tea-spoonful to be given to the child every three hours. (A porcelain spoon was used.) I also directed a few drops to be placed in the child's mouth at the beginning of each paroxysm, if this should be possible. The first dose was given at four P. M., June 24th. During the preceding twenty-four hours the child had had forty paroxysms. During the succeeding twenty-four hours there occurred but four paroxysms, only one of which began with any severity, and this one was instantly arrested midway by a few drops of the solution placed upon the child's tongue. During the night of the 26th not a single paroxysm. Im- provement in the general condition of the patient now became apparent; appetite and playfulness returned; the bloated aspect of the face and the dullness of the eye dis- appeared. On the 27th the paroxysms increased in number and severity. On examining the solution, I found that it had changed in character, and no longer contained Chlorine. A fresh solution was prepared, and thenceforward it was prepared afresh every second day. From this time, July 1st, the remedy was continued; a dose every four hours, when, the spasms having wholly ceased, and the child appearing well, it was finally discontinued. On the 2d July a slight spasm occurred, and the child appeared feverish and excited, with greenish diarrhoea. I found a lower incisor pressing strongly upon the gum, which was hot and swollen, CHLORINE IN SPASMUS GLOTTIDIS. NO. I. 495 and which I forthwith lanced. In two hours the child had lost every trace of illness. Since this date she has continued in good health, with the exception of some trifling disorder attendant upon dentition.1 There has been no sign of a recurrence of the spasm of the glottis. I am aware that children who are subjects of this disease have occasionally periods of exemption from its attacks, though this is not the case when the attacks are so frequent and also violent as in the above case, and it is possible that this child may be again attacked under provocation of diffi- cult dentition or of some equally powerful exciting cause. As there can be no doubt, however, of the controlling power of chlorine over the first attack, I should have no misgivings about its success in subsequent attacks, should the condition be the same as before. In connection with the above remarks upon Chlorine, it may not be amiss to call attention to a kind of spasm of the glottis occasionally produced by chloroform, and which strikingly resembles the spasms produced by Chlorine. Now, by the presence of an alkaline solution, chloroform is readily decomposed, and Chlorine set free. The question at once suggests itself whether in these cases of spasms such a decomposition has been induced by the reaction of the alkaline saliva upon the vapor of chloroform, and whether the spasm is caused by the Chlorine thus set free. In this case, the spasm of the glottis constituted the whole of the morbid condition. But sometimes spasm of the glottis occurs as a complication of some affection of the throat or of the respiratory apparatus, and in such cases Chlorine may be of great service. In the winter of 1853, I visited in consultation a case of scarlatina, in which slough- ing of the pharynx to a great extent had taken place and in 1 Marshall Hall advises, that in this even daily scarifications, of the gums. disease special attention should be Until the 2d of July there was no sign paid to the state of the gums, if, as is of irritation of the gums, which had generally the case, it occur during been carefully examined by me every dentition, and he advises frequent, day. 496 CHLORINE IN SPASMUS GLOTTIDIS. NO. I. which spasm of the glottis had set in, threatening to.cause a speedily fatal termination. The attacks of spasm were almost constant, the child, a boy of eight years, scarcely rallying from one paroxysm before another came on. The character of the spasm was precisely such as I had seen produced by Chlorine. Chlorine water was administered, and the spasms ceased instantly, with but one or two very slight recurrences. CHLORINE IN SPASMUS GLOTTIDIS. No. 2. More than three years ago, I published1 an account of the effects of the inhalation of Chlorine gas in two instances, with the record of a case in which the symptoms of the disease were so similar to the effects which I had witnessed and experienced from the inhalation of Chlorine, that I was induced to administer a solution of Chlorine gas in water. The case was rapidly cured. The following case furnishes additional evidence of the value of Chlorine in certain spas- modic affections of the glottis : December 12th, 1862. J. S., aged fifty-two years, has suffered from follicular pharyngitis; has had the larynx and fauces swabbed, burned and penciled with nitrate of silver until he could endure it no longer. For two years he has not been under medical treatment. He now suffers much from pain in the throat, and has an habitual cough and expectoration of glairy mucus. Within three days the cough has assumed a spasmodic character, with the following peculiarities : The desire to cough results from a tickling and a sensation of rawness behind the thyroid cartilage. When the patient seeks to yield to this desire, he finds it impossible to expel the air from the chest, as is required in the act of coughing. The cough is therefore abortive, although the desire grows continually more and more intense. The obstruction to the free and sudden expulsion of air, which would constitute a cough, he describes as resulting from an apparent constriction just below the larynx. At the same time he can draw air into the lungs quite freely. 1 Vol. ii. of the American Homoeopathic Review, 1859: " Chlorine in Spasmus Glottidis. No. 1." 33 498 CHLORINE IN SPASMUS GLOTTIDIS. NO. 2. This freedom of inhalation and impeded exhalation, together with the constantly increasing tickling in the larynx which compelled the patient to make very energetic but unavailing efforts to cough, continue until he sinks, ex- hausted and covered with sweat, upon a couch, when the spasm seems to relax and he can cough and exhale with comparative freedom. These paroxysms recur about every two hours. 1 prepared immediately a weak solution of Chlorine gas in cool water, so weak that the odor of the gas could scarcely be detected, and when one of the paroxysms was at its height, administered a tea-spoonful. The effect was magical. The spasm relaxed immediately and the tickling was allayed. The dose was repeated every two or three hours, as the tickling recurred, and in the course of twenty-four hours the disposition to a recurrence of the paroxysms had ceased. Several days afterward the patient applied to me for a quantity of "that solution," stating that since he had taken it, his throat had been more comfortable and his voice better than they had been since the day when he was unhappily persuaded to allow caustic to be applied to his throat. CHLORINE IN SPASMUS GLOTTIDIS. No. 3. Several years since I published1 an accidental proving of Chlorine, with some cases of spasm of the glottis in which I had used it with advantage. Last month I was called to a child, two years and a half old, which had just been brought home from the country, and was supposed to be at the point of death. Five weeks before, it had sickened with scarlatina, which, according to the physicians in attendance,2 had become complicated by diphtheria, and this by inflammation of the right lung and deposit therein. An abscess had formed and discharged externally on the neck; leaving an ulcer about two inches long and one and a half broad, which exposed the cervical muscles, and showed no disposition to heal; copious and very offensive discharge from both ears; the throat seemed to be full of a thick, yellow matter, very offensive, which the child would occasionally eject, but seemed, for the most, to be unable to move either up or down. Any attempt to examine the throat, or, on the part of the child, to open the mouth to take food or drink, or any attempt to cough, produced a fearful spasm of the glottis, which seemed to admit the air well enough but to prevent its exit, and which lasted until the child became livid and sank exhausted. And this constituted, in the opinion of my predecessors, the insuperable obstacle to the child's recovery. The spasm prevented its tasting food. No food had been taken for a week, and very little during the entire illness. The child was now very feeble and greatly emaciated. Its death had been hourly looked for by the doctors. 1 American Hotnceopathic Review, 2 Allopaths of excellent professional vol. ii., pp. 18 and 448: "Spasmus standing. Glottidis. No. 1." 500 CHLORINE IN SPASMUS GLOTTIDIS. NO. 3. I prepared immediately some Chlorine water,1 diluted, until the gas was just perceptible, and gave to the child. He took a mouthful and began to choke with the spasm; I immediately placed near his face a handkerchief, wet with strong Chlorine water, so that he might inhale the gas. The spasm ceased instantly and he swallowed. I left orders for a similar procedure whenever, from any cause, whether coughing or swallowing, the spasm should be induced. It never failed to arrest the spasmodic action and enable the child to swallow, or to eject the matter from the throat. A number of days elapsed before the child could make an articulate sound, or any sound. The doctors had thought the diphtheria had induced paralysis of some of the pharyn- geal muscles, and perhaps others, and hence the spasm in the associate and neighboring muscles. And it may be so. They regarded the spasm an insuperable obstacle to recovery. It was evident to every attendant that the Chlorine relaxed the spasm and enabled the child to swallow. His subse- quent improvement was uniform and rapid under Carbo vegetabilis200. It may be, by and by, some esteemed friend will tell me2, " I have used Chlorine in a case presenting exactly these symptoms, and it failed," and may thence conclude that I am mistaken in ascribing the successful issue of my case to Chlorine. I suppose I shall reply: There are two possible fallacies. I have stated the symptoms which led me to give Chlorine, but they may not comprise the real symptoms which constituted the case a case for Chlorine, just as the judge may give a righteous judgment, but may base it, in his written opinion, on most erroneous prem- ises. So, on the other hand, you, in your case, may have found exactly the same symptoms which I described, but you may have overlooked something else in your case which constituted it an essentially different one from mine. The 1 American Homeopathic Review, 2 United States Medical and Sur- ii., 370. gical Journal, vol. iv., p. 408. CHLORINE IN SPASMUS GLOTTIDIS. NO. 3. 50I sciences of pathology and semeiology are too imperfect to admit of these back strokes of criticism overthrowing posi- tive evidence by negative. Why, they are not admitted in chemistry, and hardly, even in astronomy! I shall urge these considerations in reply, but feebly, doubtless, and to no purpose, and shall at last fall in with the current of the day, which, who can resist ? and shall read the old proverb, "Seeing is not believing;" and shall give in my adhesion to the scientific motto of our time: "Belief is human; but to doubt divine." ON THE ELIMINATION THEORY. My DEAR DOCTOR: Your favor of the nth inst. was received on the 12th. I should have been glad to send a few words of greeting to the Connecticut State Homoeopathic Society, if I had known earlier the date of your meeting. As it is, I have no more time than to call your attention in a few words to the importance which the " Elimination Theory" is now assuming, among the allopaths, in relation to disease and its treatment. For centuries back it has been suggested,. every now and then, by some wise man, that the secretions and excretions of patients are the results of efforts which nature is making to get rid of some poison- ous morbific matter; and that the true indication is to favor rather than to check these excretions. But, in general, the practice of allopaths has been to check and suppress them, as though they regarded the discharges themselves as being the disease. Now, as you must have noticed, Dr. George Johnson, of King's College Hospital, London, a very high authority, comes out with a statement and argument apply- ing the " Elimination Theory " to Cholera. He holds that the evacuations and vomited substances result from an effort of nature to get rid of a poison, and that they should be encouraged and not be checked. He opposes absolutely the sedative and astringent treat- ment by opium, tannin, kino, etc., and advises cathartics and emetics, and he says that applying this method, by treating cholera with castor-oil, in 1849 and 1854, he gained a very remarkable success. 1 Communication to the Secretary of the Connecticut State Homoeopathic Society. ON THE ELIMINATION THEORY. 503 Now, let it be observed that the treatment of such a disease as cholera by purgatives and emetics is, in a certain rude way, a homoeopathic treatment. The remedies which we find most successful, viz., Veratrum, Cuprum, Ipecacu- anha, are classed by allopaths as emetics and cathartics. This is another instance of the fact, which has been noticed in other departments of pathology and therapeutics, that the most advanced medical philosophy is slowly bringing allopaths round to the same practical position to which Hahnemann's practical sagacity and observation led him seventy years ago, before there was a possible basis for medical philosophy as it now exists. One other point: Dr. George Johnson, detailing his cases of cholera treated by castor-oil, says he would have been still more successful had he not erred by using excessive doses. He found he must use small doses. This was Hahne- mann's experience when he began to prescribe according to the homoeopathic law, and it has been the experience of every succeeding experimenter. And the more strictly the law is followed in all minutiae, the smaller must be the dose, if we would get all possible good, avoiding all unnecessary evil effects. It is in this way that homoeopaths have been gradually led to use, first attenuated medicines, and finally the higher potencies. CHOLERA.1 I. There can be no doubt that Asiatic Cholera, which has prevailed during the past summer in various parts of Europe, has been brought to our shores. Reasoning from analogy, we have good grounds for believing that it will be epidemic in the Atlantic states next summer. It is, therefore, the part of prudence in us to refresh our knowledge of the history and character of this terrible disease, and of the causes which seem to favor its propagation, in order that we maybe the better able to meet the great practical problems: HOW TO WARD IT OFF, AND HOW TO DEAL WITH IT. I. HISTORY. Like all invasions and all epidemics, cholera comes from the East, marching westward. It is known to have existed in the delta of the Ganges since 1629. But in 1817 it appeared in Hindostan, as a wide-spread and terribly fatal epidemic. From Calcutta and Jessore its progress was westward, although it spread also into China and the Indian Archipelago. In July, 1821, it had reached Muscat in Arabia, and in 1823 it touched the Georgian frontier of 10( the following paper, Sections i. to iv. were written for and published in a non-medical journal, the Independ- ent, in November and December, 1865. To avert any possible charge of presenting an ex parte case, the testi- mony to the superiority of homoeo- pathic treatment in Cholera was chiefly taken from the writings of impartial Government officers, or of hostile allopathic physicians; as, for example, Mr. Wilde, of Dublin, the distin- guished aural surgeon, and Dr. Mc- Laughlin, of London, Inspector of Cholera Hospitals for the Golden Square District, in 1854-55. To these sections a fifth is now added, on the Prevention and Treat- ment of Cholera.—C. D. New-York, April 20, 1866. CHOLERA. 505 Russia. Thence it spread northward through Russia, Poland and Austria, extending in July, 1831, to St. Petersburg and Cronstadt, and in October, to Berlin, Vienna and Hamburg. In October, 1831, it appeared in Sunderland, England, having been brought from Hamburg. It extended to Lon- don in February, 1832, appearing first in the immediate neighborhood of the shipping. From England it crossed to France, breaking out, March 23d, in Paris, where in one month it carried off 20,000 persons. It was conveyed in an emigrant vessel from London to Quebec, where it appeared June 8, 1832. A few weeks later it became epidemic in the city of New-York, where it pre- vailed with great fatality until late in the autumn. It re-appeared in 1834. In 1847 and 1848 cholera again invaded Europe from the East. December 8, 1848, the packet-ship "New-York" arrived at quarantine at Staten Island, N. Y., having on board a number of passengers sick with cholera. Several had died on the voyage. From this infection, cholera pre- vailed at quarantine for several weeks, and two or three cases, which were traced to this vessel, occurred in this city. Again, February 13, 1849, cholera broke out on board the packet-ship "Liverpool," on her way to this port. There were fifty cases, of which forty died. During the succeed- ing months of spring and early summer, several vessels suc- cessively brought the disease to the quarantine; but it did not become epidemic in the city of New-York until June, 1849. It prevailed until October. In the summer of 1854 it was again epidemic in New-York. In June, 1865, we heard of cholera as prevailing at Mecca, and on the route from Mecca to Alexandria. It was very fatal at Alexandria, Cairo and Constantinople. It extended to Jerusalem and along the shores of the Mediterranean and Adriatic. At Marseilles, we have reason to believe, it was and is still quite fatal, although no official reports have been allowed to be published. At the present time, November, 506 CHOLERA. 1865, ^ prevails extensively in Paris. The cases which recently arrived at our quarantine were from Paris, by way of Havre. A few cases have appeared at Southampton, England. We may hope that the influence of winter ' will prevent the malady spreading at present, but we should look for its re-appearance as an epidemic next summer. The characteristic features of an attack of Asiatic cholera are, in brief, as follows: In the chest and at the pit of the stomach, a distressing anxiety and sense of oppression. Gene- ral, and often extreme, prostration. Nausea, faintness, loud rumblings in the bowels. Sudden and forcible vomiting of a milky or watery fluid, in large quantities. Evacuations from the bowels, consisting of a similar watery substance, containing white floating grains. These vomitings and evacuations are attended and followed by spasms, tremors,. and very rapid loss of the heat of the body. The skin becomes cold, clammy, and shriveled. The fingers look like those of a washerwoman; the skin has lost its elasticity, and if pinched into a ridge it retains that form for a long time. There is often great thirst; but, in many cases, the liquid is no sooner swallowed than it is forcibly ejected from the stomach. The extremities are frequently the seat of very painful cramps. Severe cases pass on, in the course of eight to sixteen hours, to the stage of Collapse. Indeed, the most severe cases may almost be said to commence with collapse. In this condition the features are pinched and sunken; the skin is of a bluish color, icy cold, and clammy; the tongue is cold, and the hands are corrugated. The voice is husky and faint, and the breath is cold. The pulse is frequent, very small, and often imperceptible. The evacuations from the stomach and bowels become less and less frequent as this stage becomes more fully developed; and, in most cases, they entirely cease several hours before death. The secretion of urine is suspended. The thirst is intense. The external CHOLERA. 507 surface of the body is very cold, but the patients complain of an internal burning heat. During the whole course of the disease the mind is clear and composed. It is very remarkable that, although fully aware of their condition and danger, the majority of cholera patients manifest a singular apathy and indifference with regard to the result. The stage of collapse may last from two to twelve hours. In a majority of cases it ends in death. In the more fortunate minority, reaction sets in, marked by returning warmth and re-established secretions. It is to be noted that the more rapidly fatal the case, the earlier the collapse occurs, and the less abundant are the evacuations. In the most terribly rapid cases, which destroy life in a few hours, there are almost no evacuations. It is evident, therefore, that death, in cholera, does not come from the drain on the system resulting from the evacuations, and, consequently, mere astringent remedies will not cure cholera. During an epidemic of cholera, diarrhoea is very prevalent. It almost always precedes an attack, and doubtless predis- poses to it. Instant attention should therefore be paid to such premonitions. In like manner, slight cramps are often felt. They should be regarded as premonitions, and medi- cal advice should be sought at once. The mortality of cholera has been very uniform. In 1830-32, on the continent of Europe and in Great Britain, the deaths in private practice were about 39^ per cent. of the cases; in hospital practice they were about 57^ per cent. In Great Britain, there occurred, in 1831-33, i37>o8o cases of cholera, of which 52,547 died, or about 38^ per cent. In subsequent epidemics the figures have been about the same. From the official returns in the daily newspapers of New-York, in 1849, it appears, that in this city there occurred, in a period of fifty-two days, 2,631 cases, of which 915 died, or 34.78 per cent. The resident physician 508 CHOLERA. reported, as treated in the hospitals, 1,021 cases; of which 880, or 53.71 per cent, died. These facts are startling; but they are nevertheless facts. Instead of striving to avoid and ignore them, we should calmly accept them as incentives to our next topic : The study of the causes which favor the occurrence and increase the malignity of epidemic cholera. II. In coming to consider the causes which favor the occur- rence and spread of cholera, and increase its malignity, we are met by the questions: Is cholera contagious,—that is, does it spread by touch or contact? Or, on the other hand, does it exist in a community by virtue of some poison diffused through the atmosphere, and to which all persons in the community are alike exposed, and under the influence of which all who are predisposed to the disease sicken, whether they had been previously in the presence of cholera patients or not ? The ablest minds in the medical profession have sought to solve these questions and have come to different conclusions. In favor of the contagiousness of cholera, its general line of march has been urged as an argument. It followed established routes of travel: along the track of Eastern caravans; from Asia to Moscow ; thence to St. Petersburg; thence to Berlin and Hamburg; from Hamburg on board a vessel bound to England, and from this vessel to Sunder- land, the port at which she arrived; from Sunderland through- out England. Again: Professor Simpson, of Edinburgh, traced cholera from London, by a vessel, to Leith, where the sick of this vessel were placed in quarantine on a hospital-ship. The nurses of this hospital-ship were attacked with the disease, no other cases of it having as yet occurred in Scotland. On shore, it first assailed persons who had been in communi- CHOLERA. 509 cation with the sick in hospital. In this manner the first six cases that occurred in Scotland were traced to the ship which had arrived from London, where cholera was pre- vailing, and on which, during her voyage, passengers sick- ened of cholera. In the same way Professor Alison traced the first four cases in Edinburgh. And these two very eminent physi- cians had no doubt of the contagiousness of cholera in the epidemic in question. So, too, Mr. Moir, of Musselburg, showed that the first twenty-three cases of cholera in Prestonpans could be traced, by an unbroken chain of contact with the person or the clothing of cholera patients, back to a first case, which came, already ill, from a district in which cholera then existed. During the first epidemic in the United States, a vessel took some cases to Charleston, S. C. They were strictly quarantined under military guard. Many of the soldiers took the disease and died. So did some of the physicians and nurses who were sent from the city to take care of the sick. But not a case occurred in the city nor in any person who had not been in contact with the sick. Such facts as these can hardly be explained on any theory of chances. On the other side of the question, epidemics of cholera are authentically described, in which the spread of the disease could not be sufficiently accounted for by its mere con- tagiousness. An English commission, sent to investigate this very question, reported that in Asia, Turkey and Russia, the history of cholera precludes the idea of its having spread solely by contagion, or of its being an eminently contagious disease. Instances are adduced of its invading a large district or city, at several distant points simultaneously, and of its attacking so many persons within a short space of time that the doctrine of contagion alone would be inadequate to explain the facts. The strictest quarantine has not kept out the disease; as, 5io CHOLERA. for example, at Moscow, where, to no purpose, a large garrison preserved around the city a prohibitive cordon, kept with a strictness known only in the Russian army. At Charleston, although quarantine kept the cholera out in 1832, it was of no avail in 1833. Though it seemed to preserve New-York in December, 1848, yet cholera passed its barriers in June, 1849. Finally, it has been observed that, in some places and at some seasons, although cholera has been introduced and persons have been exposed to its infection, yet it does not extend—certainly not for a long time. This was the case in London in 1831, and in New-York in December, 1848. On other occasions it spreads like wild-fire, as at Paris, in 1832, where, in one month, it carried off 20,000 persons. But this last argument is not conclusive against the con- tagiousness of cholera; for the same apparent reluctance to extend itself was observed in the case of the plague (univer- sally regarded as contagious) in Cyprus, 1759. It has been observed of small-pox and of typhus on some occasions. From all the evidence on this subject we may conclude that, while in certain epidemics cholera has undoubtedly been introduced and propagated by contagion, yet the degree of contagiousness of the disease has greatly varied in different places, at different times and under different cir- cumstances. We think that "contagiousness is not an essen- tial attribute" of this (if of any) disease; "it is an accident, depending upon many modifying causes" (Russell); and that, in most cases of disease (cholera as well as other diseases), the question is not so much one of kind (contagious or not contagious) as rather one of degree {highly contagious or slightly so). It appears that, at all times, there have been requisite for the prevalence of cholera in a community a peculiar state of the atmosphere and peculiar local conditions. And, almost always, those who are attacked by cholera are found to have CHOLERA. 5H been previously subjected to the influence of certain predis- posing causes. Admitting, therefore, the importance of contagion as a means of conveying the seed of cholera, we perceive that there must be in the individual in whom the seed is planted a congenial soil; and there must be, likewise, in the gen- eral conditions of atmosphere and mode of life to which that individual is subjected a favorable climate. If these be lacking, the seed will not germinate and bear fruit after its kind. Let us inquire what conditions constitute this favorable climate and congenial soil; what are some of the predispos- ing causes of cholera. 1. Climate and Topography. Hot climates and the warm season of the year predispose to cholera. The epidemic of 1817 began in a hot summer in Hindostan. In all climates the disease has been temporarily checked, if not extinguished, by cold weather. The apparent exception in Russia is explained by the habits of the Russian people — the great heat and the extreme filth of their winter habita- tions. The epidemic of the past autumn in France seems to have been checked by the coming on of cool weather. Cholera has prevailed most severely, though not exclu- sively, along the sea-coast and in the course of large rivers,— more particularly where the land is low, flat and swampy, or imperfectly drained. The low " made land " of commercial cities is its favorite feeding-ground. In this cholera resem- bles typhus and diphtheria. 2. Hygienic Conditions. No fact is better established, and none is more important to be widely known, than this: That wherever FILTH abounds there cholera makes itself at home. The exhalations from an undrained soil, saturated with the washings of uncleaned streets; an atmosphere tainted by the effluvia from accumulated decaying garbage 512 CHOLERA. and from animal and human excretions — these furnish a climate in which the seed of cholera will rapidly develop and grow with rank luxuriance. This is demonstrated by both positive and negative evidence. In London, cholera was longest prevalent and was most deadly in the uncleansed and overcrowded tenement houses. In New-York, in 1832, it began in Cherry and Roosevelt streets, and then appeared in Reade, Duane and Washing- ton streets. It raged furiously at the Five Points, in the "rotten row" in Laurens street, and at Corlaer's Hook. In 1849 it first appeared in Baxter street, then in Mulberry street. It then broke out in Stanton and in Thompson streets. Whoever is familiar with these localities will recog- nize in their names the synonyms of vegetable decay and animal filth, and will also know them as the undrained sites of ancient swamps and ponds, the water of which still stands, sending up vapors through their oozy soil. See General Viele's recent pamphlet and map, "The Topography and Hydrology of New-York." On the other hand, it is stated on good authority that not a single case of cholera occurred in any of the new " Model Lodging Houses" of London, which are clean, dry, light and well ventilated, and which are not allowed to be over- crowded. In 1849, in Philadelphia, which, with the partial exception of two districts, was prepared for cholera by thorough cleansing, only 747 persons died of that disease, while in New-York 5,071 died of it. Boston was still more carefully purified, and the cholera confined itself to a few narrow lanes and crooked streets of the city. But the impure air that favors cholera is not found in filthy, narrow streets alone. It may exist in splendid houses, upon our cleanest and broadest avenues, if the sewers which drain the houses be defective, clogged, or not ventilated. It may exist in ANY sick-room, anywhere, if ventilation and cleanliness of person and of furniture be neglected. CHOLERA. 5U 3. Personal Habits. It is universally conceded that the free use of alcoholic drinks predisposes to cholera. It should be remembered, however, that habitual drunkards are also habitually filthy, and irregular in their habits, and are often destitute. Those who, having previously abstained from liquor, resort to its free use for the purpose of warding off cholera, thereby only increase their liability to the disease. On the other hand, those who are habituated to the moderate use of wine run a risk if they suddenly discontinue this habit. Excesses and extremes of all kinds predispose to cholera. Excessive filth does so. So does excessive bathing, with a view to extreme cleanliness; for it reduces the heat of the body, and debilitates the system. The inordinate use of either animal or vegetable food is a predisposing cause. But so, most emphatically, is fasting or abstinence, especially as regards animal food. The excessive mortality from cholera in Paris, which we have mentioned, occurred during the fastings of Lent. Nothing like it occurred at any other period. In a part of Louisiana, where nearly all the people are Papists, the mortality during a cholera epidemic was quadrupled during and after a three days' fast. Anything, in food or regimen, that irritates the bowels predisposes to cholera. So does fatigue or violent exercise. Reduction of the temperature of the body by exposure to night air or by excessive bathing has the same effect. But the most powerful of all predisposing causes are moral: fear, depressing dread—PANIC! We should strive against this in every way. And we shall be most likely to avoid panic this summer if we now faithfully employ every means to ward off the disease we dread. III. From a study of the history and the predisposing causes of the cholera, we turn to the practical questions: How may we ward off the disease ? Or how, if it come among 34 514 CHOLERA. us, may we circumscribe its extent and moderate its malig- nity ? Preventive measures may be collective, undertaken by the state, for the common good; or individual, set on foot by individuals, or single families, for their own benefit. Quarantine. Do its advantages compensate for the inconveniences and sufferings to individuals, and the great losses, by restrictions on commerce, which it involves ? It is not known that quarantine regulations have ever protected any community during the entire course of any epidemic. Yet, on the other hand, there is abundant evi- dence that a strict quarantine has interposed, for a time at least, an effectual bar to the advance of the disease, thus postponing its visitations, though it could not prevent them. To all who properly value human life above convenience in journeying and the uninterrupted flow of trade, this fact is a sufficient argument in favor of a strict quarantine. Indirectly, a quarantine may operate for good or for evil. For good, if, while it postpones the invasion of cholera for three or six months, it nevertheless warns us to prepare for its inevitable coming. For evil, if, by its temporary success in staying the pestilence, it deludes us into fancying that the destroyer will pass us by, and that we need take no care to set our houses and cities in order against his coming. For, it is probable that, by the aid of a rigid quarantine, we gain the advantage of ample warning and of time to adopt the necessary hygienic measures for mitigating the severity and circumscribing the extent of the disease. The chief of these measures is the removal of decaying organic matter from our houses and neighborhood. Epi- demics of cholera have been very aptly called "Providential admonitions to 'clean up.'" They come with the graduated severity characteristic of Providential warnings. We see them far off. Their approach is gradual. At last they come to our doors; and there their advance is stayed for a time CHOLERA. 515 by change of season or by our quarantine. During all this time, if we have understood the warning, we may have been diligently removing from our midst the predisposing causes of the disease. In proportion to our promptness in taking warning, and to our diligent faithfulness in preparing, will be the gentleness of the final visitation. When, last June, we heard of cholera in Egypt, we should have begun to clean our city. Now that it has knocked at our doors, we have still, in all likelihood, some weeks in which to make ready. Of course, our streets must be cleaned. And means should be taken to prevent garbage being thrown into the streets. Many families throw refuse into the streets, through ignorance and carelessness. A friendly word in explanation of the bad consequences that result from it would be more effective in preventing it than a city ordi- nance. Every citizen may make it his duty to make such representations and expostulations to his delinquent neigh- bors. In so doing he will subserve his own interests. But the greater part of the bad air of our houses comes from cess-pools and sewers. Cess-pools and privy-vaults should be emptied and cleansed during the cold winter months. Drains leading from houses to cess-pools or sewers should be carefully cleared, and all traps in such drains or in soil-pipes should be opened and cleansed. It will be found in many instances, that traps in waste and soil pipes, and under kitchen-sinks, although they allow water to pass, are, nevertheless, often clogged with considerable quantities of most offensive matter. DRAINAGE. Many houses in New-York and its suburbs stand upon "made ground," which is not properly drained. The cellars and surrounding grounds are damp. Such localities should, if possible, be well drained. If this be impossible, the cellars and lower stories must be kept thoroughly ventilated, and the walls and cellar floors fre- quently whitewashed, to destroy the fungi which dampness 5i6 CHOLERA. and confined air develop. It must not be forgotten that ventilation requires provision for both the entrance and egress of currents of air. VENTILATION. Wherever air stagnates, whether in cel- lars or elsewhere in houses, there dampness collects, and the lower forms of vegetation develop, and an atmosphere results which predisposes to disease. In apartments which are constantly occupied by human beings, the exhalations accumulate upon the walls and taint the atmosphere. Frequent applications of whitewash and abundant ventilation are suitable correctives. These remarks apply to all of our residences, and not merely to tenement houses and out- buildings. Drinking-Water is often made impure by decaying vegetable or animal matters, and is then a fruitful source of disease. Wells dug near privies or cess-pools, or near which drains are laid, should always be examined with reference to this fact. From some of the dangers thus far enumerated the resi- dents of New-York are exempt. But, to a greater extent than most other people, they are endangered by Unventilated SEWERS. The sewers receive the refuse from our houses. If the sewers were properly constructed, this refuse would never stagnate in them. But even so, decomposition of organic matter must continually go on in them, evolving noxious gases. To prevent these gases from flowing back into the houses through the waste and soil pipes, stench-traps are placed in these pipes. They consist of an elbow formed in the pipe, and in which water remains, constituting a barrier to the backward flow of the gases. But this is an effective barrier only so long as the gases are subjected to no upward pressure. If the gases be subjected to such pressure, they bubble up through the CHOLERA. 517 water in the trap, and pass into the house through the outlets of bath-tubs, wash-basins, and closets. Now, it is notorious that in but few of the sewers of New- York is the flow of matter unimpeded. No provision is made for the outlet of gases from the sewers. The gases accumulate, and, by this accumulation and by the heat evolved in their generation, they become subjected to press- ure. They bubble up through the stench-trap, and pervade the house. Thus Our Houses Ventilate our Sewers! Our refuse is discharged into the sewers, only that it may there be con- verted into poisonous gases, and be received again, in that form, into our houses. The more completely, under these circumstances, a house is provided with the " modern con- veniences," the more deadly a habitation it is! There are houses in Fifth avenue and in Twenty-third street which have illustrated these facts by the sad experience of their inmates. In many houses there are, besides the main stench-trap already described, secondary traps under each basin, closet, or sink. In these cases, the portion of pipe intervening between the main and the secondary traps becomes a "closed chamber," in which the poisonous gases forced up from the sewer are confined. Any increase of temperature, even the varying heat of the house, will expand these gases, and cause them to bubble up through the secondary traps, and into the house, as before. These most serious dangers may be obviated by ven- tilating the sewers or the waste-pipes. The latter can be done for himself by every householder. It is only necessary to connect with his waste or soil pipe, just below the uppermost trap, a small pipe, which shall be led up through the roof, and shall open into the atmosphere, allowing the gases to escape. This will prevent any pressure of gas below the traps. Personal observation and experience have convinced us of the great value of this ventilation of waste-pipes. On 5i8 CHOLERA. a large scale, ventilation of sewers in English towns has reduced the mortality from typhus to one-half its former amount. It should be noted that, as many of the predisposing causes of cholera are the same as those of typhus and of diphtheria, so preventives of the former are also preventives of the latter hardly less deadly maladies. It is a question of practical importance whether, in case it has been impossible to empty and clean cess-pools and vaults before the appearance of cholera, it would be safe to do so after the disease has begun to prevail. We think not. It would be better not to disturb the accumulation of organic matter. But we may intercept the gases which arise from these collections, and may hold them, employing for this purpose a mixture of substances which chemically unite with the gases and substances which mechanically absorb them; as, for example, a mixture of equal parts of ground plaster and of pulverized charcoal (or coal ashes) with the addition of one-eighth part of copperas (sulphate of iron). This should be spread upon the surface of the contents of the cess- pool or privy-vault. As regards the measures to be adopted by individuals to ward off cholera, they must consist mainly in the avoidance of those things which have been specified as predisposing causes of the disease. Excesses of all kinds are to be avoided—excesses of absti- nence as well as of use. The very free use of vegetable food, especially of the coarser kinds. Indulgence in alcoholic drinks. Exposure to night air ; to cold ; to undue fatigue of any kind; to mental depression. But it would be unwise to make, during the prevalence of an epidemic, sudden and violent changes in habits, which, though bad, are nevertheless long-established habits. "It is not safe to trade horses when crossing a stream." CHOLERA. 519 IV. If, in spite of the measures by which we had hoped to ward it off, cholera come among us as an epidemic, we shall find it to our advantage to have well considered beforehand, and determined, how we may best deal with it. This is a question for each individual to settle for himself, since the responsibility is his. The obvious answer, as indicating the wisest course, would be: "I will seek medical advice." But it is all important to know what are the earliest signs that medical advice is needed. Dr. Guerin, in his elaborate report on cholera to the French Academy, lays great stress on the "fact" that almost every case of decided cholera is preceded by, what he calls, a " curable stage ;" a period during which the patient suffers from a diarrhoea, or some other derangement of the digestive organs. This may last even for a week or ten days. It is often, apparently, so slight a deviation from health that, in ordinary times, one would think it hardly necessary to consult a physician or take remedies for it. But an experienced physician would at once recognize it as a choleraic diarrhoea—as, in fact, cholera in the preliminary, or, as Guerin calls it, the "curable stage." The patient should place himself under medical treatment as early as possible in this stage. This stage cannot be so described as to enable a non-medical person to distinguish it with cer- tainty from a common diarrhoea. Nor is it possible to give such directions for its treatment as would be proper for a large part of the community, without modification to suit the constitutional peculiarities of each individual. If " one man's meat is another man's poison," so, much more frequently, is his medicine. No faith should, there- fore, be placed in remedies or nostrums that are offered as " sure cures " for everybody, in every stage of cholera, etc. Each patient requires a treatment especially adapted to his particular constitution, and to his actual condition. 520 CHOLERA. Many persons are so fortunate as to have a medical adviser who commands their entire confidence ; who has attended them through dangerous illnesses, has studied and appreciated their constitutional peculiarities and tenden- cies, and to whose care they would, under any emergency, unhesitatingly intrust their lives. To such persons no better advice can be given than this: " Consult your physician ; be advised by him how to guard against cholera, how to meet its first advances, and then, resolving to follow his counsels implicitly, go about your business with an easy mind." But many are not thus happily situated. They have no trusted medical adviser. Even now, in anticipation of the coming of cholera, they are anxiously looking for the soundest medical counsel, and for that system of medical treatment which offers, in its statistics, the strongest guar- antees of success. For intelligent members of the com- munity well know that there are radical differences in the views of medical men as regards the proper and the most suc- cessful treatment of cholera as well as of all other diseases. It were a foolish affectation to ignore these differences. For the information, therefore, of those whose minds are not settled, but who are in quest of facts on the subject of these differences in modes of medical treatment, I will give in this section a summary of the statistics of the treat- ment of cholera under the two principal antagonistic systems of medicine. As might naturally be supposed, and for obvious reasons, the mortality of patients treated in hospitals is always much greater than that of patients treated at their own houses. From 1831 to 1848 the mortality of cholera patients treated by the ordinary, " regular," or allopathic treatment at their own houses, throughout Europe, was one in two and a half cases, or more than 39 per cent. In hospital practice, during the same period, and under the same method, the mortality was one in one and a half cases, or more than 57 per cent. CHOLERA. 521 During the same period the mortality of patients treated at their own houses, by homoeopathic physicians, was one death in eleven cases, or a little more than 9 per cent. In homoeopathic hospitals, the mortality was one in three and one-twelfth cases, or a little more than 33 per cent. In the city of New-York in 1832, the mortality under allopathic practice was: in hospitals, 50 per cent.; in private practice, 33 per cent. In 1849 the mortality under allopathic practice was: in hospitals, 53.7 per cent. ; in private practice, 34.7 per cent. During this epidemic in New-York, the aggregate mor- tality under homoeopathic treatment, under many disadvan- tages, was 15 per cent. Summing up the whole number of patients hitherto re- ported as treated homceopathically, in Europe and America, both in private and in hospital practice, we find a mortality of 9 per cent., while the most favorable statement of mor- tality under allopathic treatment is 32 per cent. But these reports of the results of homoeopathic treatment have, although most unjustly, been called in question. It is proper to authenticate them by citing the action of govern- ment officials, who are not interested in the disputes of physicians, and by quoting the words of distinguished medi- cal men who are not homoeopathists. Dr. Gerstel, of Vienna, and Dr. F. F. Quin, now a vener- able and distinguished practitioner in London, treated cholera in Tischnowitz, Moravia, in 1831. At the close of the epidemic, a report was made to the Austrian Government by the inspector. It concludes as follows : " The proportion of deaths, compared with other places in which the epidemic raged, was small. The homoeopathic treatment, which was carried out to a great extent by Dr. Gerstel, was the cause of this favorable result. (Signed) Dr. Victor Mekarsky von Merk, " K. K. Inspector." 522 CHOLERA. In 1836 cholera visited Vienna a second time. The prac- tice of Homoeopathy was at that time forbidden in Austria, but permission was obtained to open a Homoeopathic Cholera Hospital. I state the result in the words of Mr. Wilde, of Dublin, the distinguished aural and ophthalmic surgeon, who is no friend to Homoeopathy. He says:1 " Upon comparing the report made [by the government inspector, who visited the hospital daily] of the treatment of cholera in this hospital with that of the same epidemic in the other hospitals of Vienna at a similar time, it appeared that while two-thirds of those treated by Dr. Fleischmann (homoeopathic) recovered, two-thirds of those treated by the ordinary methods, in other hospitals, died. This very extra- ordinary result led Count Kolowrat, Minister of the Interior, to repeal the law relative to the practice of Homoeopathy." Thus the very fact that the practice of Homoeopathy has been sanctioned by law in Austria since 1836, is an eternal monument and testimony to the superior success of the homoeopathic treatment of cholera. In Paris, in 1848-50, Dr. Tessier, in the Hospital St. Marguerite (Hotel Dieu, annexe), treated cholera patients in his wards homceopathically. The general report, made, not by Tessier, but by allopathists, gives for his wards a mor- tality from cholera of 34^ per cent., while in the other wards and hospitals the mortality was 5 7 per cent. In 1854, in Great Britain, Government established a Medical Council to gather returns of the treatment and mortality of cholera under every method, and to report to Parliament. When the report was submitted to the House of Com- mons, it was noticed that the returns of the homoeopathic prac- titioners and of the London Homoeopathic Hospital were not included in it. The House of Commons thereupon called for these rejected returns, and they were presented in a sepa- rate report, entitled " Return to an Address of Hon. House 1 Austria and its Institutions, p. 275. CHOLERA. 523 of Commons, dated May 17, 1855; for copies of any letters; * * together with copies of any returns that have been rejected by the Medical Council." This return gives the statistics of the London Homoeo- pathic Hospital, attested by Dr. McLoughlin, an eminent allopathic physician, who was government inspector of cholera hospitals, by appointment of the same medical Council which rejected the returns ! The mortality of cholera in the Homoeopathic Hospital was 16.4 percent. Under allopathic treatment, during the same epidemic, the Medical Council's return to Parliament gives the mortality as 59.2 per cent. In a public letter contained in the report of the Homoeo- pathic Hospital, and addressed to one of the physicians of this hospital, Dr. McLoughlin, Government Inspector, says :x " You are aware that I went to your hospital prepossessed against the homoeopathic system ; that you had in me, in your camp, an enemy, rather than a friend. * * * That there may be no misapprehension about the cases I saw in your hospital, I will add that all I saw were true cases of cholera, in the various stages of the disease ; and that I saw several cases which did well under your treatment which I have no hesitation in saying would have sunk under any other. " In conclusion, I must repeat to you what I have already told you, and what I have told every one with whom I have conversed, that although an allopath by principle, education, and practice, yet, was it the will of Providence to afflict me with cholera, and to deprive me of the power of prescribing for myself, I would rather be in the hands of a homoeopathic than an allopathic prescriber. " I cannot suppose that anything I have said above can be of value to the homoeopathic system ; but, such as it is, you are at full liberty to make what use you please of this letter. "London, February 22, 1855." 1 See " Return to House of Commons." 524 CHOLERA. Let it be remembered, as a grand result of statistics hitherto, that in the cholera the homoeopathic treatment saves 91 in 100 cases; allopathy saves never more than 68 in 100 cases. These are facts, and they are re-assuring facts ! The wise will heed them. V. The homoeopathic treatment of cholera, as of every disease, requires, in order to the attainment of the greatest success, a strict individualization of cases, and a special modification of the treatment to meet the peculiarities of each case. This can be done only by a skillful and experi- enced homoeopathic physician; and no general directions for treatment can be published which will give the best possi- ble method for treating each person attacked with cholera. Those, therefore, who are within reach of a physician, should summon him at the earliest moment. The following memoranda are offered for the assistance of such as have no physician at hand. The subject divides itself into questions of: 1. Prophylaxis, or Prevention of Cholera. 2. Treatment of Cholerine, or Preliminary Diar- rhoea. 3. Treatment of Cholera Proper. 1. Prophylaxis. The fundamental principle of the homoeopathic practice of medicine is this: that a sick person is to be treated by the administration of a drug which has been found, by experience or observation, to produce upon healthy persons symptoms very similar to those which the sick person presents. CHOLERA. 525 In accordance with this great principle, it is clear that if the symptoms which a drug produces upon healthy persons are known, it is possible to foresee and to foretell what kinds of sickness that drug will cure. In this way, long before cholera had invaded Europe, on its first westward march, Hahnemann, having become ac- quainted with the action of these drugs upon the healthy, perceived and announced that Camphor, Veratrum album, and Cuprum metallicum, would be the most efficacious remedies for cholera, and so it proved. A similar application of the same law induced Hahne^ mann to recommend one or another of these remedies (according to circumstances), as prophylactics, or prevent- ives of cholera. The great weight of testimony compels us to believe that this use of prophylactic remedies has saved very many who would otherwise have been attacked. Dr. A. Cricca, of Smyrna, in a report dated September 28,. 1865, says of those who, under his directions, used the prophylactic remedies: " Out of the very considerable number of persons of all classes and conditions (600 families or about 3,000 individuals) not one (to our knowledge) has been attacked with real cholera. Their slight derangements of stomach have been easily cured by Veratrum album." The selection of the prophylactic remedy must, to some extent, be governed by the nature of the epidemic, and therefore the best preventive cannot always be determined until the epidemic has appeared, and its peculiar nature has been ascertained. Cuprum. But, as a general rule, both in Europe and in this country, Cuprum has been considered the most efficient preventive. A dose of Cuprum metallicum should be taken every third day, on rising in the morning. It was noticed that during the epidemic of 1849, *n Paris, workers in brass and copper escaped the disease. Sulphur. In some epidemics, Sulphur has been the best prophylactic. It will be suitable if the diarrhoea which 526 CHOLERA. prevails at the same time as the cholera, and the diarrhoea which precedes many cases of cholera, be of the character hereinafter described, as indicating Sulphur. It should be taken as directed for Cuprum. 2. Preliminary Diarrhoea. It has been stated that almost every attack of cholera is preceded by a diarrhoea, which may last from six hours to six days, and which, if promptly treated, is almost always easily cured. During the prevalence of an epidemic of cholera, every diarrhoea, however slight, should be regarded as being, possibly, a preliminary to an attack of cholera, and should at once receive careful attention. At the same time, it is all-important that the patient should not give himself up to fear and panic. Let him use his utmost self-control to keep his mind calm and his faculties clear, so that he may be able to observe his own condition and note its changes. Every- thing should be done quietly, and without precipitate haste. Prompt attention to the diarrhoea is advised, not so much because the patient's condition is already a perilous one, but rather that he may prevent it becoming such. As soon as diarrhoea occurs, the patient should go to bed and be warmly covered, but not so as to produce perspira- tion. He should keep the recumbent position as long as diarrhoea continues, using a bed-pan when the bowels move. If thirsty, he may drink cold water, but in moderate quanti- ties. The food should be light, but nutritious, and taken frequently in small quantities. The appropriate remedy should be taken without delay. If the diarrhoea come on in the night, no matter how slight it may be, the patient should immediately call assistance, or begin to treat it. He must on no account wait until morning, as many do, thereby losing precious time. The following remedies are likely to be suitable: Sulphur. If the diarrhoea comes on in the night, after CHOLERA. 527 midnight, the stools being yellow, pappy, and attended by great urgency, though the urging is often ineffectual; and if, at the same time, there are cramps in the soles of the feet, Sulphur should be taken, a dose every two hours, until relief is experienced. It is a general rule that doses of medicine should not be repeated after the patient has begun to improve, nor so long as improvement continues to progress. Phosphoric acid. If the evacuations are light-colored, liquid, copious, and not attended by pain; if the tongue is covered with a gluey mucus, and there are cramps in the arms, with a general sense of weakness, Phosphoric acid is the remedy. Take as above. Arsenicum. If the evacuations are frequent, small in quantity, liquid, dark-colored, and quite offensive; attended by sharp pain very low in the abdomen and by burning in the rectum, and followed by great prostration of strength; if, likewise, the patient has great thirst, drinking but little at a time, and is very restless in body and anxious in mind, he should take Arsenicum, as directed for Sulphur. Croton tiglium. If the evacuations are sudden and very copious, consisting of a large quantity of yellow water, which passes with a rush, and if an evacuation occurs every time the patient drinks, Croton tiglium is the remedy. Take as directed for Sulphur. Veratrum album. If the diarrhoea is watery, copious, and very painful, and is accompanied by copious vomiting, which is repeated every time the patient drinks, and by cold- ness and blueness of face and hands, and cold sweat on the forehead, Veratrum album must be taken, and repeated every fifteen minutes until warmth returns and water can be retained on the stomach. 3. CHOLERA. A case may pass gradually from choleraic diarrhoea into real cholera; or a neglected diarrhoea may apparently cease for a time, and then cholera may suddenly 528 CHOLERA. supervene; or cholera may come (it rarely does so) without warning. In the last two cases, symptoms resembling those already described as characterizing COLLAPSE are present. The patient suddenly loses strength, and looks pinched and blue. The skin becomes very cold; the voice husky and deep; the skin of the fingers shrivels. There are intense distress and anguish at the pit of the stomach and burning in the bowels. The patient tosses in agony. There are cramps in the calves, and sometimes nausea and vomiting, with cold sweat; but, generally, the evacuations, both up and down, are moderate and infrequent. Camphor. This is the form of the disease for which Camphor has been proved to be so excellent a remedy. In addition to the administration of Camphor, the patient's extremities should be vigorously rubbed, and bottles of hot water applied to them until the natural heat is restored. The room should be well ventilated, and cold water given freely if desired. Carbo vegetabilis. Sometimes the collapse is still more marked. Even at the outset, the tongue and very breath are cold. The voice is extinct. There is no vomiting, diarrhoea, spasm, or pain. The urine is suppressed. Give Carbo vegetabilis every five minutes, until warmth returns. Veratrum album. When the evacuations are profuse, both upward and downward, consisting of rice-water and frothy fluids, with great anguish in the abdomen, thirst for cold water, which is taken in large quantities, but is vomited as soon as swallowed; with contracted features, cold sweat on the fore- head, hands and feet, moderate cramps in hands, feet and calves; with suppression of urine,—Veratrum album should be given; a dose every five minutes until decided improvement is manifest. In cases requiring Camphor the COLLAPSE is the most prominent feature. In those which require Veratrum album, the EVACUATIONS and the COLDNESS are the most promi- CHOLERA. 529 nent symptoms. But in those cases which call for Cuprum, the SPASMS or CRAMPS are most prominent. Cuprum metallicum. When the evacuations are not very copious, but the spasms in the chest and stomach are very painful, with great tenderness to touch, the spasms coming on in paroxysms, both in the stomach and in the extremities; the thirst is moderate; the vomiting is allayed, for a time, by drinking water; the face is blue and cold; the respiration short and labored; the voice husky; and the urine sup- pressed, give Cuprum metallicum as directed for Veratrum. Administration of Remedies. Where medicines in liquid form are used, a drop of the liquid, on sugar or in water, may be used as a dose; where used in the form of powder, as much as would lie on a three-cent piece; where globules, three or four. Inconvenient results have been observed from the use of too large and too frequent doses of Camphor; and the pub- lic should be cautioned against using Camphor without a clear indication of its necessity. Where too much has been taken, it produces terrible anguish and burning at the pit of the stomach, so great as to drive the sufferer almost to despair. A few globules of Phosphorus will promptly anti- dote the Camphor and relieve the patient. 35 V; :-Vfi .•.;J .O. ,/j'- ■/ .'JTeW v .■-' '■"'■'''r'\ r,r,rfr,i-j ^■.■'...■;-:';---.-:;-; .-.■■'■:■■■ :7.-;;,::>* ■y^':..v.;i:!'>?'^;:^\V^ '■■'• ';,>"SSif .•'■-•"ii'Vafl %&» «?■. $ m ffl- '4 ■^fr^ •W'i .';•<. '^■^v;.:v '.:V;kli.:iftj.'. ..■;**$ '■''vVft ?F $£$^W -v$. &W