B 477462
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LIBRARY
1837
Tammi
PRSATI
VERITAS
UNIVERSITY OF MICHIGAN
-E PLURIBUS UNUM
DEBUR
SCIENTIA
OF THE
SI-QUAERIS PENINSULAM AMOENAME
CIRCUMSPICE
GAJATKINJAGUNG.
LỢI
CHINITAT

Panoblets. Homoeopathic. Practice v. 1:
Contents.
Allen. J. Dr. Allen's cure for the alcoholic baoit.
2. Allen, J. Phthisis oulmonalis.
3. Arcularius. P. E. Parasitic diseases of the skin.
4. Avery. H. N. Hand-oook for consuno tives.
5. Bojenus.3. Uro-lithiasis in Russia.
6. Bartlett.. Malingering and its detection.
7. Bayes. W. Treatment of cholere & eoidenic diarrhoea.
E. Beebe, A. Therapeutics of benign tumors.
9. Beebe, C. E. Prinary cancer of the trachea.
10. Bender.P. Relaosing or remittent oneumonia,
11. Bender. P. The obysiology & pathology of diabetes.
12. Bender. ?. Aetiology of Asiatic cholera.
prostate
13. Bessey, W. E. Non-surgical tratuent of enlarged land.
14. Boobook. R. A case of elephantiasis arabun,
15. Bredford. T.. A monograoh on arouo.
16. Bryson, H. B. Orificial pbilosooby soolied to the resoir
atory orifices.
17. Clarke. W. B. Vaccination no safeguard against snelloox
18. Couch. A. S. Soecial pathology & diagnosis.
19. Dowling. B. W.
20. Dowling, B. W.
21. Dowling. J. W.
The so byonograph.
Nature of malaria..
Alcohol on the circulatory & respiratory
organs.
22. Dowling, J. W.
Lithaends.
23. Dowling. J. Is the American heart wearing out?
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H. McCRACKEN,
2016 Memphis St, Phila

Dr. Allen's Cure
FOR THE
80948
Alcoholic Mabit.
Discovered and Prepared by
*
JOSHUA ALLEN, M. D.,
PHILADELPHIA, PA., U. S. A.
1
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DR. ALLEN'S CURE
FOR THE
ALCOHOLIC HABIT.
It is very generally admitted at the present day, that Alco-
hol has no uses whatever in the human system, that its effects
are always hurtful, never beneficial; while it appears to generate
heat, and impart strength, it is really using up the reserve stock
of vitality, which nature has stored away to be used for emergen-
cies, such as the crises of serious diseases, periods when it is im-
possible for one to get sufficient sleep, and times of great men-
tal strain, anxiety, and impending disaster. Yes, this great
power, with which the Creator, through the operation of natural
laws, has endowed man, and with which he intended him to
withstand the shock of the world's collision, is stolen away by an
enemy, the most insidious, the most cunning, the most implaca-
ble, that ever downed a victiin.
EFFECTS OF ALCOHOL ON THE BODY.
The first effect of an Alcoholic stimulant is that of exhila-
ration, and apparent increase in bodily strength, but, there is
another effect, that of depression, when the outraged body resents
the injury done it and in numerous aches and pains expresses its
agony, and the mind, conscious of the indignity imposed upon it,
rebels, and scourges the victim with the pangs of a remorseful
conscience. Re-action takes place, the strength of the body re-
asserts itself, and the man is himself once more, but, he yeilds
again to the tempter, he falls and the terrible agonies of his pre-
vious experience are gone over again, only ten times more
intensified; he rallies again, but, this time not to the same
degree as before, he feels a lack of confidence in himself, is
tremulous, and to quiet his shattered nerves, he again resorts to
a stimulant, and now he is in the serpent's power, he has forged
the chain of habit, strong drink has become a necessity, and
with every succeeding debauch, the serpentine coils are drawn
closer and tighter, till at last, they encircle his whole being so
completely that with a shriek, blood curdling in its horrible in-
tensity, he passes out from this earthly life. This pen picture of
a drunkard's career is not overdrawn, in fact, words are inade-
1
2-
quate to express the wailings and bemoanings of the unhappy
victims of strong drink, when, in their lucid moments, memory
goes back and recalls the once happy homes wrecked, the lives
of their sweet little children blighted, and they themselves, mis-
erable outcasts from society, anxious, but unable to go back to
manhood's estate, they march, a great army of them, every
year, down to the dishonored graves, yawning open to receive
them.
Besides the effects noted above the imbibing of Alcoholic
beverages produces a great variety of diseases, principally
among which are the following; Delirium Tremens, Drunkards'
Consumption, Diseases of the Liver, and Dropsy arising there-
from, Enlargement of the Heart, Epilepsy, Paralysis and a great
variety of Kidney Diseases, but, the most pitiful thing to relate,
is the fact, that the tendency to these diseases, as well as a love
for liquor, is transmitted by parents who drink Alcoholic stimu-
lants, to their innocent offspring.
THE CURE FOR THE ALCOHOLIC HABIT.
Deliberating upon the sad state of affairs just described, and
realizing the almost universal desire, and I might say necessity,
of the human race, for some kind of a stimulant, I reasoned within
myself, saying, if in Alcohol we find an agent capable of produ-
cing such terrible results on the human organism, is it not possi-
ble to find another one equally powerful, or still more powerful,
which will produce effects of an opposite character, or in other
words, overcome the weak, enfeebled and diseased conditions pro-
duced by this poison, and in its place give health, strength and
perfect self-possession by creating a vigorous state of the nervous
system? The answer to my reasoning was, yes; somewhere in
the realm of nature such a remedy exists, and I believe I can
find it, and I did find it, and now I say to all mankind who have
become slaves to the Alcoholic habit, the day of deliverance is at
hand, if you wish to be liberated from your prison walls, take
this remedy; deal honestly by it, faithfully carry out the direc-
tion accompanying it, and in a very few days, new hopes, new joys,
new life will be yours, and with your old enemy under your feet,
you will once more be able to take the position in life, which na-
ture fitted you to adorn.
EARLY EXPERIENCES WITH THE CURE.
After fully satisfying myself, that I had instituted an effec-
tual cure for the drink habit, I anxiously awaited my first case,
on which to try it; some weeks went by before it presented, but
when it did I prescribed the remedy with every confidence that
it would do its work well. My patient did not give me the par-
-3-
ticulars of his case at the time of consultation, but, three months
afterwards he returned and gave in detail all the facts; he said
to me: "Doctor, I thank you for saving me from a suicide's
grave; when I called on you I had determined to take my life.
I had fallen so low from drink that I could not look my fellow-
men in the face any longer, and had your treatment failed I
would have died by my own hand. But, thank God, your cure
for the Alcoholic habit enabled me to stop drinking immediately,
and after the first dose I lost all craving for liquor, although I
inherited a love of it, and had been drinking since I was a boy.
I feel better now than I ever felt before, and have had no return
of the old appetite."
My second case was that of a woman, who had acquired a
love of whiskey by taking a little now and then to keep up her
strength; at the end of three years she was a common drunk-
ard, so she expressed herself. I was sent for to visit her at her
own home, she was in agonies, and crying out constantly for me
to save her; for six days and nights she had not slept nor tasted
food of any kind, drinking nothing but whiskey. I prescribed
The Cure for the Alcoholic Habit, the next day she still wanted
whiskey, the following day she did not crave for it so much, and
on the third day I found her with sleeves rolled up going about
her housework and declaring she never felt better, and rejoicing
in her new found liberty. Months after she still abstains from
liquor, and has had no desire for it.
My third case was that of a moderate drinker, who had
heard of the marvelous effects of the new treatment and desired
to test it in his own case. He had been drinking because he felt
the necessity of taking something to brace him up, suffice it to
say the new medicine was a revelation to him, and to-day he is a
new man indeed.
My fourth case was brought by the gentleman whose case
has just been cited, it was a hard one, the man himself said:
"Doctor, I am a hard case, I have just filled up with five or six
drinks before coming to see you, my friend assures me you can
cure me, I am going to give you the chance, for I realize this
habit is injurious to me, and a disgrace to my family, but, I tell
you before you begin you cannot do it." I gave him the medi-
cine and requested him to return in four days, which he did.
Looking me in the face, he said: "Doctor, what was in that
medicine?" I said: "
I said: "My friend, I really cannot think of telling
you that." Correcting himself, he said: "I do not mean that, of
course you will not tell me, but, I am puzzled, that medicine is
not bad to take and I expected to be laid up in bed to get cured
instead of which I am feeling glorious, in fact I never felt better
P
-4-
but, I will not say anything more about it, give me more medi-
cine, and I will come back in a week." He did so, looking
more puzzled than ever, as he remarked: "Well, this beats
everything! Doctor, you do not know what a heavy drinker I
have been. I have been in the habit of going on a drunk regu-
larly every Saturday and Sunday, and what is more I loved the
cursed stuff, and to think that after the first dose of your Cure
for the Alcoholic Habit, I should stop drinking, and lose my old
love for liquor, which I have been taking regularly for a quarter
of a century; well, it beats all creation." Some weeks later he
reported all right, and no desire for drink.
And still another interesting case was that of a man of whom
it is believed that he had not been sober more than four months
during the last fourteen years. His wife had to wait seven weeks
after hearing of the Cure for the Alcoholic Habit before she
found him in a condition to come and see me, suffice it to say, he
was cured immediately, and the wife declares that she has been
in Heaven ever since.
I might go on enumerating case after case similar to those
above, but, I think it is unnecessary, and will now refer you to
testimonials which have been given me by grateful patients or
their friends, with the privilege of referring to them privately,
They nearly all reside in Philadelphia.
TESTIMONIALS.
PHILADELPHIA, October 18th, 1890.
Dr. J. Allen,
Dear Sir-About the year 1884, I called to see you in reference to a remedy
for over-mental work, explaining that the nature of my business was such as to prevent
my taking the necessary rest. In order to perform the duties required of me by my
employer, I found it necessary to get a stimulant for the brain.
For want of a proper
one, I tried whiskey, which enabled me to get through, but debilitated the system very
much. At that time, if you will remember, I explained all this to you in conversation
on the subject. You then stated that several cases of the same character had come
under your observation, and that while no remedy had yet been discovered to take the
place of alcohol, you still hoped and believed that such remedy must soon be found,
as the alcohol was doing such terrible work. Recently my employers exacted duties.
from me which could not be performed, with such assistance given me, by any one
in the world. I never whilst in employ cried, can't; and set about doing it as best I
could, depending on stimulants to carry me through. Finding that my system would
not sustain sufficient to pull me through without unfitting me physically, I lost my
head, as it is called, was taken sick in mind, and called on you for medical advice.
You prescribed for me your Cure for the Alcoholic Habit, which I took, and found
that the taste for the former stimulant was entirely removed and that under its influ-
—5—
I
ence I could attend to more business than I ever could before,-in fact, I began to
build up in body and mind, and am better in health than I have been for years.
can conscientiously recommend your treatment to men or women who may be suffering
from effects of over-work, and particularly to any one who has heretofore depended
on alcohol for assistance. Congratulating you on your great discovery, and feeling
grateful for the benefit I have derived from it, I am,
Yours truly,
-
[The above is from the son of one of our Philadelphia physicians, lately
deceased. I have the privilege of referring any one to him for confirmation of the
facts stated in his testimonial.]
PHILADELPHIA, September 20th, 1890.
Joshua Allen, M. D.,
Dear Sir-As a friend of suffering humanity, I feel it my duty to give my
testimony in regard to the efficacy of your Cure for the Alcoholic Habit. I obtained a
bottle and used it according to directions, and before I had taken all of it I found it
gave me new life, and I confidently reccommend it to all in need of such a medicine.
Since taking the medicine I have lost all taste for liquor, to which I have been
addicted for some years.
Yours respectfully,
[The above case is that of a woman, who, although in a respectable position in
life, had become, as she expressed it, a common drunkard. She was cured in three
days.]
PHILADELPHIA, October 24th, 1890.
Dr. Joshua Allen,
Dear Sir:-I have taken your new medicine, the Cure for the Alcoholic Habit,
and it has destroyed all desire for any stimulants whatever. With pleasure I recom-
mend it to any person desiring to be cured of the alcoholic habit. I am satisfied thou-
sands will avail themselves of the opportunity to destroy the appetite for strong drink
by taking it. In my own case it has not only taken away the desire for alcoholic stim-
ulants, but has invigorated and built up my system, and made me feel strong and able
to attend to business with pleasure. Send doubters to me; I will be glad to spread the
news of the greatest discovery of the age. Wishing you God speed, I remain,
Yours respectfully,
PHILADELPHIA, October 8th, 1890.
Dr. J Allen,
Dear Sir-Please publish the following testimonial for the good of suffering
mankind, and refer anybody to me for confirmation of it. I have been accustomed to
drinking alcoholic stimulants since I was a boy. The habit grew, and then mastered
me. I was in a terrible state,-my nerves all shattered, and I was afraid of my own
shadow. I suffered everything, until I was cured in four days' time by taking your
Cure for the Alcoholic Habit, and I solemnly state since that time I have not touched
liquors, and what is more surprising, I have had no desire for them, although the love
for them was inherited.
Yours truly,
[The father of the writer of the above died from the effects of alcohol under my
treatment, before I had discovered this new treatment, so there is no doubt about the
love of liquor being hereditary.]
-6—
PHILADELPHIA, July 2d, 1890.
Dr. J. Allen,
I have never,
Dear Sir-I find, after taking the Cure for the Alcoholic Habit, which you
prescribed for me, that I have almost entirely recovered from the nervous condition
which I have been in for the past ten or twelve years. In that time, and prior thereto,
I had been addicted to the use of alcoholic drink, which I firmly believe was the cause
of my condition. I also believe my appetite to have been inherited, as it was the love
for the taste of liquor which induced me to indulge to the extent I did.
until now, had the real and unqualified desire and determination to abstain from it
forever. I am absolutely sure that it is owing to nothing else but that your medicine
renewed the nerve force, enabling me to overcome that appetite which was leading to
destruction, both physical and mental. I wish you would send any skeptical person to
me, and I will personally convince them of the benefits I have received from taking
your remedy. I hope you will prescribe it, not only in your private practice, but make
it known to all the world,-to the millions who suffer as I have suffered. Hoping my
testimony may aid in making it more generally known,
I am yours very gratefully,
**
PHILADELPHIA, October 13th, 1890.
Dr. J. Allen.
"
Dear Sir:-I, above all others, most gladly testify to the marvelous effects of
your medicine in curing alcoholism. I was reduced to a most pitiable state indeed ;
I was almost living on stimulants, was compelled some nights to take six and eight
drinks before I could quiet down sufficiently to get a little sleep, and then up and
drinking again before daylight in the morning. In two days after commencing to take
your Cure for the Alcoholic Habit I lost all desire for liquor. I suffered little or noth-
ing in being cured, and health and happiness was soon restored to me.
Yours gratefully,
[Having been for a long time physician to the writer of the above, I certify
from personal knowledge, to the correctness of the statements made.]
MCCAULLEY BROTHERS, COAL, Depot, Lehigh and Trenton Avenues.
PHILADELPHIA, November 4th, 1890.
Dr. Joshua Allen, 2136 E. Cumberland Street, Philadelphia.
Dear Sir:-Knowing a man, who had occasionally worked for us a few days
at a time, during the past fifteen years, was so addicted to excessive use of liquor that
it seemed utterly impossible for him to remain sober longer than a couple of days at a
time, being frequently sent to the House of Correction in consequence of his inebriety,
thought him a good subject to profit by the use of your Cure for the Alcoholic Habit.
I employed him with the understanding that he tried it. He did so. Immediately he
started taking the medicine there was a marked change,—his distaste for liquor was so
great, he found it impossible to swallow a drink he had bought. The use of several
bottles has completely cured him, and he has worked steadily for us the last three
months, being perfectly sober. Previous to this time for about fifteen years he had
never remained so three consecutive days, unless under the restraint of the law.
Yours truly,
EDWARD V. MCCAULLEY,
-7-
TO THE PUBLIC.
What Mr. McCaulley has written about me is true, every word of it, and it is
also true, that nearly four years have gone by since I was cured of the drinking habit
by taking Dr. Allen's Treatment, and from the day I was cured, up to the present time,
I have not touched any stimulants, nor have I had any desire for them, whatever.
My name and address is at Dr. Allen's office, and I have given him the privilege of
furnishing it to any one, who desires to interview me on the subject.
Respectfully,
A.
E Lehigh avenue.
McD.
REV. NOBLE FRAMES' TESTIMONY.
PHILADELPHIA, August 2nd, 1893.
Dr. Joshua Allen,
Dear Sir :-It gives me great pleasure to add my testimony, to the virtue of
your medicine for the restoration of inebriates, particularly its beneficial effects in re-
storing to sobriety, some of the worst cases. One case was that of a man, who had
been a hard drinker for nearly thirty years, and was induced by a friend to try your
remedy. He purchased two bottles of the medicine and took it according to direc-
tions, and although associating necessarily with his former companions and fellow-
workmen, he has entirely abstained from, has had no desire for, and actually abhors
the smell of liquor. Two years have gone by since he was cured, and all who know
him, and have watched him attentively, believe he is entirely cured.
Another case is that of a young man, who lives about thirty miles from here,
who had beendrinking hard for several years; about nine months ago he came to his
sisters' in Philadelphia, having been from his home on a spree, for more than two
weeks. He was bordering on mania-potu. His sister was alarmed at his condition
and by my advice, she procured a bottle of your Cure for the Alcoholic Habit. He
reluctantly began to take it, but, in four days time he seemed entirely changed in ap-
pearance, and was changed in his feelings. One week later he returned to his home,
taking a bottle of the medicine with him, and since that time he has remained sober,
has had no desire for liquor and has worked every day at his trade, as a printer. His
physical condition has wonderfully improved, as well as his mental faculties. I write
these short accounts of the two cases,that have come under my own observation during
the past year or more, for the special benefit of my fellow-men, who unfortunately have
fallen victims of intemperance.
Yours truly,
NOBLE FRAME,
Pastor of Snyder Avenue M. E. Church
I have selected the above testimonials for publication, be-
cause they represent typical cases of Alcoholism. I can hardly
understand how there could be worse ones, and I now offer the
Cure for the Alcoholic Habit to the public, fervently hoping and
praying that it may prove to be a blessing to humanity at large,
and that through its influence joy and sunshine may reign in
homes where now, through strong drink, there is naught but
sorrow and despair.
Sincerely,
JOSHUA ALLEN, M. D.
→
8-
Dr. Allen's Cure for the Alcoholic Habit possesses the
power to restore the nervous organization of an individual to its
normal condition, no matter how long it has been abused by the
action of Alcohol; it does this by operating in accordance with
the natural law, which governs the growth and development of a
healthy, human body, hence its wonderful efficacy. Usually
within three or four days after commencing its use, (provided
stimulants have not been taken during this time,) all desire for
liquors cease, and the feeling of nervousness, is replaced by that
of buoyancy, hope and confidence. Six bottles of this prepara-
tion, taken consecutively, will eradicate all the evil effects on the
body, of a life-time of dissipation, and it is absolutely necessary
that this quantity should be taken in order to effect a thorough
cure.
DIRECTIONS.
Take one tablespoonful after each meal: Use a measuring
glass. Keep the bottle tightly corked, and in a cool place. Do
not try any tapering off process, but, immediately stop the use
of all liquors, and trust yourself to this medicine, which is easily
taken, and does not sicken in order to cure. Only when the
stomach is highly inflamed, will it ever be rejected, and then it
will only be necessary to dilute it with water, in order to be re-
tained.
Ask for Dr. Allen's Cure for the Alcoholic Habit. It is
on sale at the drug stores, and retails for $1.00 per bottle. Per-
sons unable to procure the preparation from their local druggist,
can by forwarding three or six dollars have half or all of the
treatment sent to them by express.
Address,
JOSHUA ALLEN, M. D.,
2136 East Cumberland St.,
Philadelphia, Pa.

Do
J. H. McCRACKEN,
2015 Memphis St,, Phila.
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2
Compliments of the Author.
Phthisis Pulmonalis,
(Consumption of the Lungs)
Its Cause, Prevention and Cure,
Discovered by
JOSHUA ALLEN, M. D.,
PHILADELPHIA, PA.
P
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141
}
INTRODUCTORY.
'HIS book has been written for the people. In it I
have avoided as much as possible the use of tech
nical terms, and have endeavored to make its meaning.
so plain, that all who can read can understand it.
Precipitancy in making a discovery known before
demonstrating its truth, has been the pitfall into which
many of my predecessors in the field of original re-
search have fallen. I have reversed it, and proved
the truth of my own discovery, beyond the peradven-
ture of a doubt, before making it generally known,
having devoted nearly three years in private practice
to doing so. Read the following pages carefully,
catch their meaning, remember the nearer you get to
nature the more harmony, the greater perfection, the
greater wonder, and then remember, that only the
subtle forces of nature, which I have learned to artifi-
cally produce are brought into play, in curing you of
that dread disease Consumption of the Lungs.
PHTHISIS PULMONALIS
(CONSUMPTION OF THE LUNGS,)
ITS CAUSE, PREVENTION AND CURE.
DISCOVERED BY
JOSHUA ALLEN, M. D.
PHILADELPHIA.
We live in a progressive age, an age characterized by the
greatest developments in the arts and sciences, but of all the
sciences, medicine has been the most backward, and is the
least deserving of the name, for all medical men will admit,
that the administration of a remedy, although well chosen, is
but seldom followed by exact and uniform results, and so long
as such is the existing state of affairs, the term science strictly
speaking, as applied to medicine is a misnomer. Wherein lies
the difficulty? My answer is, that in all ages medical men have
been following an Ignis-fatuus, instead of studying up the
principles underlying the Automatic action of the nervous
system, which is the real source of life and power, of health
and disease, and ascertaining the means by which nature vita-
lizes this system, they have been treating diseases pretty much
on the same principles as those adopted in the tale that is told
of a man who went out in a boat to save a sinking ship; he
cut down the flag of distress, and coming back to land cried
out exultingly, behold the flag of distress is down, all danger
is over, but he did not stop the leak, and the ship went down.
in the storm. An exhausted condition of the nervous system
is shown by the presence of diseases, which are but flags of
distress, telling us in unmistakable language that the Vital
forces evolved through the wondrous action of the great nerve
centres, are not in sufficient supply for the demands of the
organism, and countless millions of the human race, go through
4
life, half dazed, more dead than alive, for want of this vitaliz-
ing principle. Now while nature in her economy, makes use
of a number of agencies to assist in maintaining life in our
bodies, yet, standing out preeminently above all the others,
like the Pyramids of Egypt, to endure for all time, is one
which besides making use of in her own way,she has, as if antic-
ipating the future needs of her children, kindly and most boun-
tifully stored up in a vegetable product, and which when it is lib-
erated by man's ingenuity, and introduced into the system, there
is evolved a force which quickens and sustains life, acting in
harmony with nature's grandest Physiological law; and I claim
that this force is made use of in health and in disease, by a
conservative intelligence within us, which presides over all
the organs of the body, regulating them, and ever on guard
to preserve the integrity of the same, and ever constant in
efforts to restore the body to health when diseased, and the
proof of this is found in the facts, that when diseases do ap-
pear, that many of them are cured without any assistance
whatever, and that all acute diseases have a tendency to get
well of themselves, and this demonstrates the truth that inter-
nal forces, or forces resident within the body are at work, and
are sufficient in themselves to bring around such results; and
this is literally true in regard to Phthisis Pulmonalis, for the
lungs of great numbers of people who have died from other
diseases, have been examined, and there has been found un-
mistakable evidences of Consumption having once been active
therein and that natural forces operating in the body, had ar-
rested the disease in its course, healed the lungs and restored
the patients to health. So instead of trying to cut down these
flags of distress known as diseases, I contend that the rational
treatment is, and will be in the future, to supply the vitalizing
principle, and if the elements of which the body is composed.
are supplied in sufficient quantities in the way of properly se-
lected foods, nature will then do the rebuilding of the organism
herself, as in the instances noted above, and also in her ability
to heal great wounds of the body unaided. Every human
being has a reserve stock of vitality which is thus made use
of, but when the drain on this reserve force is continued too
5
long, or the sudden demand is in excess of the supply, then
death must inevitably result, unless we can step in and render
timely aid, by supplying the means for developing anew this
Vital Force. The method of generating that force in the hu-
man body I claim to have discovered. In a work published
by Professor S. Pancoast in the year 1873, he writes the fol-
lowing. "Indeed if we contemplate the simplicity of Nature's
laws, it is not unreasonable to suppose, that the nature and
treatment of diseases are capable of being written on a single
page of a volume like the present. The time is no doubt
rapidly approaching when this will be done. The day cannot
be far off, when some progressive mind, will dispel the mys-
teries of medical science, and from the accumulated rubbish
that environs it, pluck the jewel secret of nature, and hold it
up for the regeneration of man, and the healing of nations of
their many maladies." Doctor Pancoast was a prophet, and
I believe my discovery, to be the fulfillment of his prophecy,
and while not prepared to say as yet for want of experience,
that it will or will not cure all diseases, yet from the unparal
lelled success attending the application of this new method, I
have no doubt, but that the nature and treatment of all dis-
eases, except those due to mechanical causes, can indeed be
written on a single page of a small volume like the present,
and that the jewel-secret of nature is the method by which she
originally built up and continues to vitalize her most wondrous
creation man. While applying this treatment to a great vari-
ety of diseases, yet my thoughts and attention quite naturally
focused on the great scourge of the human race, Consumption
of the lungs, and now after nearly three years experience in
treating a great number of such cases, I claim, openly, broadly,
conscious of the integrity of the assertion, that my discovery
solves the problem of the ages, viz: The cause, prevention
and cure of this dread disease.
phy
In the month of February in the year 1890, as a result of
long continued study and observation of nervous phenomena,
as a factor in the production and cure of diseases, I came to
the conclusion that Consumption of the Lungs was of ner-
vous origin, and without going into the detail of the various.
6
steps by which I arrived at this opinion, I will briefly state
that the best evidence of the truth of the position I have taken
is the fact, that in the employment of a remedy, the force of
which is expended almost entirely on the nervous organization,
cures of this terrible disease take place with such a celerity
and thoroughness as to astonish all observers. In the year
1891 a congress of Physicians met in Paris for the sole pur
pose of discussing the question, "How to cure Consumption"
and while nothing new of any importance was presented, yet
as the result of their deliberations, they arrived at this conclu-
sion. "That the present trend of the day is to make use of
the methods which nature employs against Consumptive pro-
cesses, the treatment of the future, seems to be taking that
form, the production artificially of nature's methods of preven-
tion and elimination," this is my discovery, for what they hinted
at, I had practically put in operation eighteen months before
The curing of Consumption by nature's methods artificially
produced.
THE MEDULLA OBLONGATA.
Acting as a bond of nervous communication between the
brain and spinal cord, is a highly organized mass of nerve
substance known as the Medulla Oblongata. Now it is quite
possible to remove the larger and the smaller brains from the
cranium, and yet the heart will still continue to circulate the
blood, and the lungs to keep up the movements in respira-
tion, but, injure the Medulla, and the action of the lungs ceases
immediately, and death shortly follows. Exhaust, by dissipation
or otherwise, the nervous energy stored up in it, and the lungs
collapse slowly, but death comes as surely. The human body
from the largest organ in it down to the tissues which are mi-
croscopic in size, are absolutely under the direction and con-
trol of the nervous system, there is no such thing as health of
any part of the body, unless the nerves distributed thereto, re-
ceive a full supply of nerve force, and are perfectly strong and
able to carry it, and I believe the solution of the cure of all
diseases to which flesh is heir, is in restoring the entire ner-
vous organization to its normal standard of strength and har-
monious action, and the key to which I hold in my discovery,
→
J
-
7
and need only time to perfectly adapt it to the wants of each
individual sufferer.
THE CAUSE OF CONSUMPTION.
Phthisis Pulmonalis is a disease due to an exhausted con-
dition of the nervous system generally, but particularly so of
the Medulla Oblongata and the nerve centre in it, in which origi-
nates the great Pneumogastric nerve, the most important one
in the body, and which in connection with branches of other
nerves is distributed to the throat, lungs, heart, stomach and
liver, and it is through this great nerve and its accessories, that
the vital current is sent, which is necessary to keep these or-
gans performing their duty, and upon which the health of the
whole body depends, and if they become injured or weakened
diseases of various kinds will follow, according to the Seat of
injury or weakness, and if they as a whole, or that part alone
distributed to the lungs becomes exhausted, Consumption,
will sooner or later inevitably follow. The causes operating
to bring about the debility of the nervous system which in
turn produces this disease, are almost too numerous to men-
tion; anything which weakens the body is an active factor in
its production. Overwork, worry, fret, melancholy, grief,
loss of rest, insufficient or poor quality of food, inherent
weakness, the use of alcohol, neglected colds, catarrh, various
occupations and climates are some of them, there are many
others which could be mentioned.
PROFESSOR KOCH'S THEORY.
As to Prof. Koch's Bacilli being the cause of Consump-
tion, and the announcement of which has caused consternation
in the minds of so many timid people, I would say, not yet
proven, it is like the problem of which was first the chicken or
the egg, and if he or any other scientist has a telescope, through
which they can look way back into the beginning of time, and an-
tedating the period when man was created, and demonstrate
to me a lonely Bacillus hovering in space, and watching for
the advent of his victim, then I am a convert to his theory,
but, not until then, why, because the facts are against him.
There is quite an army of Physicians, of equal intelligence
8
with Dr. Koch, who will bear me out in the statement, that
great numbers of people, ill with this disease, have submitted
their sputa, time and time again, for examination, by the best
experts and under the most scrutinizing tests, and without the
slightest evidence of the presence of the Bacilli being found,
and yet they died with Consumption. This is true, and being
true, is it not more than probable, that the presence of the
Bacilli in the sputa of some Consumptives, and not in others, is
due to conditions favorable to their development in the one
case and not in the other, and that they are present in these
cases, only under these certain conditions, as the result, and
not the cause of the disease, otherwise they would be univer-
sally present. Professor Koch's experiments on lower animals,
prove one thing only, the effects of the Bacilli on lower ani-
mals, and that too, under the most unnatural conditions, nothing
more; it does not prove their effects on human beings. There
is but one way to test his theory, and but one way in which
the people who are interested desire to have it tested, and that
is according to the conditions under which they are compelled
to live, all other tests are of no practical value in settling this
question; and now again I shall call upon the intelligent physi-
cians throughout the land to bear me out in another truth
calculated to disprove the Baccilli infection theory. How
often it has happened in their experience and in mine, that a
mother with the seeds of inherited consumption in her own
system has faithfully attended a loved child ill with this dis-
ease, and for a period of time covering many months, has
scarcely been known to leave the sick room, and consequently
was continuously breathing the air filled with these parasites,
and must have inhaled countless numbers of them, and yet
she did not develop Consumption, which she most assuredly
would have done, had the Bacilli the power to infect her sys-
tem.
Taking these cases in the aggregate from the practices of
all the Physicians in the world, and in the course of an ordi-
nary life-time, they would run into the millions, all of them
irrefutable evidences of the non-contagiousness of the disease,
as opposed to the few cases which could be adduced, which
9
U
seem to prove the contrary. There is but one conclusion to
be arrived at, the cause of Consumption of the Lungs, is not
found in the Bacilli, but, in the habits of the people and the
causes enumerated above.
HOW CONSUMPTION DEVELOPS.
Fully ninety-five out of every one hundred cases of Con-
sumption commence in the upper parts of the lungs which col-
lapse or fall in, and solidify. How is this condition brought
about? This you can readily understand, if you will recall the
statement made above, that the action of the lungs is depend-
ent upon a proper supply of nerve force distributed to them.
And now, when any of the causative agencies enumerated
above, weaken or exhaust this force, then the lungs cannot ex-
pand fully in breathing, and as their apices are least used they
collapse first. The influences operating to produce this initial
breakdown, are as a rule continued with the result of causing
them to collapse still more, and at this stage of the disease you
will observe just under the collar-bones, quite a hollow on
one or both sides, as it happens, that one or both lungs might
be diseased. As a result of the breathing space being thus
lessened, an insufficient supply of air is taken in, and conse-
quently the blood is not relieved of its accumulated impurities
and cannot properly nourish the nerves centres, which in turn
become debilitated still more and send out a still feebler sup-
ply of force, still greater collapsing of the lung tissue takes
place, and with this is associated adhesions and structural
changes, and now we have the anxious countenance, the hur-
ried breathing, the debility more marked than ever, and finally
complete exhaustion ending in death. The remaining five per
cent of cases due to the results following Pneumonia, and
other causes, are equally amenable to treatment. The cough,
expectoration, fever, night sweats, and other conditions inciden-
tal to this disease, in the curable cases all disappear, and the
patient recovers his former health and strength as the collapsed
air cells dilate, and as every organ does its duty again, in re-
sponse to the stimulus of natural forces artifically produced.
If the health of the body is to be maintained it is essential
that three thousand gallons of air should come in contact
IO
every twenty-four hours with the blood as it is passing through
the lungs in order to purify it; failure to mect this condition,
is the reason why a Consumptive wastes away, even though
he eat enormously, and makes plenty of blood in doing so.
CAN CONSUMPTION BE PREVENTED?
ease.
Yes, I believe my treatment stands as an impassible barrier
between the expectant victim, and the development of the dis-
Even though it be hereditary, even though the grand-
parents, the parents and every member of the immediate family,
except one, have in turn developed and died of it, let that one
be presented to me, before the disease has actually commenced
its ravages in his system and if he will give me his faithful co-
operation, I feel perfectly safe in saying that he may bid defi-
ances to the grim monster, which has laid low so many of his
loved ones. This disease comes on so insidiously, that before
one is aware of it, he is in a dangerous if not a hopeless con-
dition; this cannot occur under my plan of preventive treat-
ment, for the patient will be made familiar with, and have use
of the means for detecting the very first inroads of the disease.
CAN CONSUMPTION BE CURED?
Yes, positively yes. Can all cases be cured? No, there is a
limit, and ever will be. My experience has been, that if a little
more than one half of the breathing space is left intact, which
practically amounts to one whole lung, and if structural
changes of too serious a character have not already taken
place, such cases as a rule are curable, beyond this with very
few exceptions, although life may be prolonged and made com-
fortable, death must inevitably fellow sooner or later. Let
me give you one of my cases from practice illustrating this
point. A young man whose brother and sister had died with
consumption, came to me suffering with the same disease; his
normal breathing capacity was one hundred and ninety-eight
cubic inches of air at each deep inhalation; at the time he pre-
sented himself he could only breathe one hundred and ten
cubic inches, or nearly a loss of one half; he had been com-
pelled to relinquish his position, had all the characteristic symp-
toms of Consumption, and would have died in a short time. In
-
I I
a few weeks under treatment, his cough and expectoration had
ceased entirely; he was stronger and heavier than at any time
in his life before, and his breathing capacity was fully restored
to the normal again, in fact, he was perfectly cured, and will
ever remain so, he can never, I repeat it, he can never suffer
again with this disease if he will follow out some simple rules
I have given him to live by. Had his breathing power fallen
to ninety (90) cubic inches instead of one hundred and ten
(110) cubic inches he would in all probability in a very short
time have succumbed to the disease.
TO PARENTS.
How often it has happened, perhaps in your own family, if
not, then in the family of a friend, that a promising boy or a
lovely daughter, about budding into life, has been stricken
down by this fell destroyer Consumption, and you have groaned
in spirit, as you watched them day after day literally fade out
of existence, and as you realized the hopelessness of their con-
dition, you have bowed your head in humble submission to
what appeared to be the stroke of fate. But fate had nothing
to do with it, it was because no one had taught you the means
of detecting the first inroads of the disease, and no
discovered the means for curing it when it had started.
one had
This cannot truthfully be said any longer, for a new era
in medicine is about dawning upon humanity, the all powerful
medicine of natural forces artificially produced. Would you
save your children from such a direful fate, then bring them
to me, bring them when they are from twelve to fifteen years
of
age, for as a rule at this time the disease is not developed.
even though it be slumbering in the system and I believe not
one of them faithfully carrying out my instruction will ever
die of Consumption of the Lungs. If the disease has already
started, bring them, and if they have not passed the limitations
noted above, and circumstances favoring, a recovery may be
expected.
I2
The office is located at No. 2136 East Cumberland Street
Philadelphia.
All patients will be required to present themselves during
office hours only, which commence
In the morning at 7.30 and end at 9 o'clock;
In the afternoon at 2, and end at 4 o'clock;
In the evening at 7, and end at 8 o'clock.
Thursday evenings excepted. No Sunday Office Hours.
During the months of June, July and August, the after-
noon office hour will be from 2 to 3 o'clock; the other hours
remaining as above.
Patients will not be admitted after the expiration of the
office hours except by special arrangement.
FEES.
Ten Dollars for the first office consultation, including
treatment for one week, the subsequent cost being about two
dollars per week.
Charges for visiting patients at their homes will be regula-
ted according to the distance and the time consumed.
All services are to be settled for at the time they are ren-
dered, except in the case of worthy poor people, who will
as usual, be treated gratuitously.

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ANOMALOUS FORMS
M
GETABLE PARASITIC DISEASES OF THE SKIN
Mader
HOME
Reprin
PHILIPE ARCUDARIUS, AM, MD
NEW YORK
01
MONTHLY, October 189

ANOMALOUS FORMS OF VEGETABLE
PARASITIC DISEASES OF THE SKIN.
BY
PHILIP E. ARCULARIUS, A.M., M.D.,
NEW YORK CITY.
(C
THOUGH there are many forms of eczema, which in its varying
phases has been said to comprise almost one-half of all the diseases
of the skin, still there are patches of eruption which are scaly
throughout their course, and whose margin, unlike that of eczema
proper, is well defined. We all remember the old term, eczema
marginatum," given to an ostensible form of eczema occurring about
the fork upon the inner and upper surface of the thighs, whose
margin was characteristic and well defined, with an intervening
streak of healthy skin between it and the main patch of the disease.
But since the introduction of the microscope, this, and many other of
the so-called patches of eczema have yielded, upon investigation of
their scales, the evidence of the vegetable parasite in one or another
of its elementary forms. Tilbury Fox many years ago contributed
valuable information upon the tines or vegetable parasitic diseases,
and showed that the fungus existed under four forms: Stroma;
conidia or spores; chains of the same, and mycelia. The stroma he
mentioned as an element often overlooked, but "very potent for
evil." It is this form of the fungus*-the stroma-which it is the
object of this paper to emphasize; for it is the opinion of the writer,
after many years of careful microscopic investigation, that much that
is termed chronic eczema may in truth be so, though rather a derma-
* Tilbury Fox defined the stroma as follows: "It consists of an infinite number
of minute cells, which are probably derived from the multiplication of granules in
the interior of cells and filaments, and is the early condition and nuclear form of
the fully developed fungus. It accompanies all fungi in a state of active growth,
is generally overlooked, and requires a high power for its detection." Crocker,
also, in his new work upon Diseases of the Skin, discusses the fungus, and mentions
an authority who describes a small spore variety, without mycelium, and that pro-
duces the most obstinate cases."
:.
!
- 2 —
titis with an added parasitic nature. This will account for the
peculiar characteristics of certain chronic circumscribed patches of
scaly eruption, with a well defined margin upon a surrounding
healthy surface; their obstinacy in yielding to remedies, their ten-
dency to relapse, so common in ordinary ringworm in children-due
doubtless to the fact that after the vegetable parasite has insinuated
itself into the tissues of the skin and there set up an inflammation,
it becomes very difficult of dislodgement. This will explain the
very long periods through which these scaly patches have existed—
possibly years—and the consequent tedious results under treatment;
for the parasite of tinea versicolor, one that has the least hold upon
the skin, has been known to last from fifteen to twenty years. Thus
many forms of so-called localized eczema are accounted for, existing
anywhere upon the surface, though more especially upon the face,
the neck, the scalp, the armpits, the flexure of the elbows, the backs
of the hands, the fold under the female breasts, the groins, the
popliteal spaces, about the fork, the anal region between the nates,
and the palms and soles. All these are favorable localities where.
the skin is either rich in fatty secretions of the sebaceous glands,
which stand closely together and are well developed, or where sur-
faces oppose each other, affording thus an appropriate soil.
It has been the experience of the writer to see many cases in per-
sons of various ages, but all adults, and differently circumstanced in
life. The disease has presented itself in one or more of the above
locations, or elsewhere, under favorable conditions; or by the exten-
sion of the eruption, as an old patch of months or years duration ;
possibly, at times, moist; but, in the main, if not almost always,
dry and scaly, with a well defined margin, and with or without
itching. A few of the scales placed under the microscope and treated
with the proper reagents have brought into prominence the vegetable
parasite, as stroma or fine particles, scattered throughout the field in
the substance of the scale, and giving it thus a minutely granular
appearance. Occasionally may be found the spore, or exceptionally
the interlacing mycelia, so typical of the vegetable fungus; but the
cases to which the writer refers invariably presented the stroma like
fine granules, this, and nothing more, as the sole feature for micro-
scopic investigation. And it is upon this particular element of the
fungus that the whole substance of this paper rests upon which to
base the diagnosis, that the so-called eczema is nothing more than a
vegetable parasitic disease of the skin of a chronic nature.
A case well-remembered by the writer, occurring in a physician

—
-3-
—
attendant upon his lectures in the year 1877 at the New York
Homœopathic Medical College, and who consulted him at his office,
was one of the original sources of investigation on this particular
subject. The patient had suffered more or less with his trouble
ever since the occupation of an abandoned Confederate camp during
the Civil War, and when he presented himself, showed the general
surface liberally supplied with sundry patches of a dry scaly erup-
tion which in certain regions, as the scalp, manifested the charac-
teristic circular form of ringworm, with dry and twisted hair readily
falling out. Even the finger-nails were affected, and so too, the
fold of the nates. The eruption had existed thus for a long time,
and no diagnosis had seemingly been made until the writer placed
some of the scales from the patches under the microscope, when,
with the aid of the proper reagents, the characteristic stroma, like
fine granules, became visible and well pronounced.
A second case, occurring in a young man in the year 1888, had
been styled by a specialist, psoriasis, and appeared as a dry scaly
eruption, dotting the surface generally in spots the size of a small
coin. The microscope again revealed the stroma, like fine granules;
and the disease, determined thus to be parasitic, a favorable prog-
nosis was given which under appropriate treatment was duly con-
firmed, for the vegetable parasitic diseases are all curable.
ga
· 4 —
-$
A third case of more recent years was that of a missionary returned
from Japan who presented spots about the face, one upon the tem-
poral region being prominent, round, scaly and marginate, while to
these were added quite general alopecia, though the scalp seemed
free from scales. The patient gave no history of special contagion,
though in a general way was narrated the interesting fact, that as
the heads of children in Japan are shaved it is the custom of the
instructor, by way of commendation, to stroke the bare head with
the hand, and that thus skin disease is transferred from child to
child, and many have sore heads. In the present instance the patient
said this habit had been avoided, and that contact with the children's
heads had been shunned. However, this general history, with the
special condition of the skin, led the writer to make a differential
diagnosis by the aid of the microscope, only to detect the presence
of the stroma, like fine granules, in the microscopic field throughout
the scales. Under suitable treatment a favorable result ensued.
The three foregoing cases have been cited among many others;
two with a history of contagion, as typical ones by way of proof of
what has already been laid down by the writer, and are only a few
of a long series of cases, extending over a term of fifteen years, and
yielding invariably the same results under microscopic investigation,
and leading up to the title of this paper, and all yielding to appro-
priate parasitic treatment; for, as already stated, all the vegetable
parasitic diseases are curable, though remedial measures must some-
times be persevered in for a long time.
66
Since the above facts were written, the writer finds that Unna
defines eczema as a chronic parasitic catarrh of the skin with des-
quamation, itching and a tendency, when irritated, to result in exu-
dation and marked inflammation." Also, that Eichhoff makes men-
tion of the parasitic theory of eczema, and would confine the name
eczema to non-parasitic cases, while parasitic forms might be termed
"dermatitis parasitaria," saying, that the latter "commence in the
form of hyperemia and slight infiltration, soon going on to superfi
cial desquamation; that the progress is in circles or rings of increas-
ing size or gyrate; and that when the parasite penetrates more
deeply into the skin, the slight scaliness gives way to a more marked
irritation, exudation, swelling and vesiculation, or pustulation."
Eichhoff considers chronic eczema of the face and scalp in children
as a parasitic dermatitis, the parasite arousing extreme inflammatory
action; so, too, forms of eczema closely resembling psoriasis in the
appearance and distribution of lesions as to be differentiated in some
C
– 5 —
cases with great difficulty. Jonathan Hutchinson holds that "Ec-
zema is not a substantive disease, but simply one of the commonest
forms of local dermatitis, and may be evoked by a great variety of
kinds of local irritation. However evoked, it originates, in the act
of inflammation, a material which is more or less infectious to the tis-
sues of the patient, and thus scratching is one of the chief causes of
extension. In this way anything which makes the skin itch may
aggravate eczema. For the most part it shows no tendency to spread
from the patient to those about him, yet in some cases, especially
when in hot weather many elderly people occupy the same ward,
eczema may prevail as an epidemic." Besuier says that the "term
eczema represents neither a lesion nor a disease, but designates a most
complex and confused dermatological germs." Crocker, in his recent.
work upon the skin, says: "My own view is this: that while a
limited number of local eczemas are parasitic, in most the dermatitis.
however caused, only opens the door to parasites whose presence
keeps up local irritation, so that their destruction is au important
step in the restoration of the skin ad integrum."
With this last exception, the writer has quoted largely from Sa-
jou's Annual, of recent dates, where the foregoing facts are very
tersely stated by Van Harlingen; and, to say the least, he was sur-
prised to find that along his own original lines of investigation, pur-
sued alone by himself for so many years, and leading him to find by
the microscope so many so-called patches of eczema and psoriasis
parasitic in their real nature, that authorities so well known as those
just given had arrived at similar results.
To the writer it seems that the truth lies somewhere between the
two extremes, and that while all inflamed, chronic, scaly patches are
not necessarily parasitic, but may be forms of uncomplicated eczema
or psoriasis, still that this is the exception and not the rule, and that
in the vast majority of cases of irregular circular type, with distinct
margin, but fine scaling, and only a moderate amount of itching and
moisture, and usually dry; that these invariably call for microscopic
investigation to determine their true nature, and usually yield evi-
dence of the stroma, like fine granules, and thus of a parasite. This
blending of the characteristics of eczema and psoriasis in these
patches of a parasitic nature may also explain the opinion some hold
that these two diseases may sometimes coexist on the same patient at
the same time.
II.
In view of what has been already written upon the parasitic na-
*
- 6 -
ture of so many so-called cases of eczema, and for which the more
appropriate appellation should be dermatitis parasitaria, it behooves
the skillful practitioner, in order to meet the requirements of the
case and satisfy the real needs of his patient, and just so soon as he
has determined by a proper microscopic examination the elements of
a parasitic growth, to proceed in the use of such measures, both gen-
eral and local, as will insure the best and most speedy results. This
is most assuredly his bounden duty, which no one will dispute, but
how shall it be accomplished?
This leads to a general consideration of the treatment of these
forms of skin disease and all it implies. It cannot be denied that
usually there exists a certain dyscrasia, a blood, nerve or tissue con-
dition, involving the general health, and calling for the proper hom-
œopathic remedy such as the pathogenesis of each case may suggest.
This is all-important with every one, particularly with those who
hold that these diseases are not essentially local, but rather general
in their nature, and not dependent upon the introduction of the
vegetable spore from without. Thus, among school children or
members of the same family we know there exists an immunity from
contagion on the part of certain individuals, yet this is the exception
and not the rule, for the fungus may be diffused through the medium
of the air. This certainly suggests the fact that contagion, coupled
with predisposition, rules, and accounts for the generality of the
vegetable parasitic affections, emphasized by their occurrence upon
regions exposed to contact, as the skin of the face, neck and scalp in
children.
-
In a former paper, published in the North American Journal of
Homœopathy, in 1876, upon the general treatment of skin diseases,
the writer there relegated the vegetable parasitic diseases to a dis-
tinct class for local treatment with parasiticides, while, in the main,
pressing the importance of internal medication alone with the single.
homœopathic remedy according to the similimum, and that too, in
the case of single discrete local lesions !
Again, in a paper read before the American Institute of Homœo-
pathy, in 1887, upon local treatment in eczema infantile, the writer
urged the importance of local applications as dressings to the dis-
eased surface, whether the lesion involved a solution of continuity, or
threatened, from irritation and scratching, secondary conditions;
thus to facilitate the prompt and proper action of the internal ho-
mœopathic remedy. But here, again, the vegetable parasitic dis-
eases were alluded to apart as an unique class, demanding for their
7-
cure parasiticides. Not at this time, but since then, authorities al-
ready quoted have arisen who denominated eczema infantile as one
of the many forms of dermatitis parasitaria; so that the writer in
discussing this subject under the title of eczema, and recommending
local measures as dressings, builded better than he knew, though em-
phasizing their vast importance to allay the great irritability and
suffering on the part of the child.
Unna, one of the principal authorities espousing the parasitic na-
ture of eczema, cites, by way of proof, how the chronic scaly patch
will readily respond to the action of the local parasiticide; and
doubtless the daily practitioner, enthusiastic though he be in the law
of similars, and honestly groping after the proper internal remedy-
will recall to mind his occasional failure therewith, while, in other
hands the case which has dragged along with him has speedily, as
if by magic, been cured by the proper local dressing, parasiticidal it
may be.
-
All this does not detract from the superior advantages of homœo-
pathy in the internal treatment of diseases of the skin, but it con-
vinces the rank and file of the profession that homoeopathy has its
limitations, and that what does good and cures is at all times the
proper treatment, and that surgery-chirurgery-handwork—is
called for in dealing with skin diseases quite as much as where
manual interference is needed in the management of affections of
the eye, ear and throat, let alone instrumental operative procedures
where the conditions are, from the nature of the case, beyond the
reach of internal remedies. The case is thus presented none too
strongly, for it goes without saying, and the truth must be acknowl-
edged by every one, whether he be greatest enthusiast in homœo-
pathy, or the most brilliant student of our materia medica, or the
learned professor in therapeutics, professing all things.
"So far
shalt thou go and no farther," will be the verdict placed upon him
who tries and tries and fails with the unaided internal remedy, for
though many conditions may be remedied, and many diseased states
modified, still, where the vegetable parasite has gained a foothold
in the tissues of the skin, and thrives and grows luxuriantly under
an existent dermatitis, however important and well advised may be
the internal medication, no case will be cured without the proper
parasiticidal measures locally applied.
splad
Any one conversant with the true nature of parasitic troubles, in-
volving hairy surfaces, endowed richly with sebaceous and hair fol-
licles, knows the exceeding difficulty and complexity of treatment,
sta
- 8-
and how stubborn is the resistance to remedies, and how prone to
relapse are these conditions, and that, with the internal remedy un-
aided, failure will be the rule. Besides, Vidal has shown that the
fungus is aërobic, and the principle of excluding air is the one now
extensively adopted. And then, too, something is due the commu-
nity in which the patient lives; and it is certainly incumbent upon
the physician to see that the fine spores of the parasite are not wafted,
like any other vegetable pollen, through the air, thus to propagate
the species upon some new individual. Thus, a thorough and speedy
cure is to be desired, not only for the patient, but also for society at
large. Long ago, Tilbury Fox suggested, that, in school children,
and in institutions where large bodies of children are thrown to-
gether, that, as in the case of contagious eye diseases, so in parasitic
skin diseases, there should be systematic inspection from time to time
by way of prophylaxis.
It alone remains to note some of the special measures demanded
in dealing with these so-called cases of chronic scaly eczema, or
rather, "dermatitis parasitaria," confined as they are to special local-
ities, as one, two, or a few individual spots. We may, in truth, test
the efficacy of rhus, apis, arsenicum and mercurius; or, graphites,
calcarea, lycopodium, sepia, silica or sulphur; or any other remedy
that the pathogenesis of the case may suggest, and to our entire
satisfaction. However, after all these indications for internal rem-
edies have been complied with, many practitioners find to their
chagrin, that something yet remains to be done; for the case reaches.
a condition of stasis, and the action of the remedy is at a stand-
still, while the itching and scratching go bravely on, and the disease
thus kept up, tends to relapse into its initial state. It is just at this
juncture that local applications avail, and lead on royally to a cure,
by allaying irritation, and destroying the element of parasitic growth;
for, by the action of the finger-nails, and the renewed trouble thus
set up, the results of internal medication are rapidly reversed, while
by their medium of communication the disease is spread from spot
to spot.
<
To specify, the milder the application the better the effect, and
the less the interference with the internal remedy. But, where the
nature of the case warrants in point of chronicity and obstinacy,
nothing should be omitted in the way of a local dressing to insure
the best results. Nothing is so uncertain as the action of local ap-
plications upon the diseased skin; for what will aid in one individual,
will fail in another, so that a patient who has been the rounds of
— 9 —
the physicians will be speedily helped by something new in his
case, though old in the catalogue of drugs. It is the experience of
the writer, after twenty-five years' practice in diseases of the skin, to
see cases relegated to his care by the general practitioner, where
faithful and scientific internal medication had seemingly failed, get
well rapidly, as if by magic, when wisely and judiciously, the
proper local dressing has been applied; and this has been the history
many cases, oft repeated, so that the writer knows whereof he
speaks. Invariably, in all cases where the scales have been exam-
ined under the microscope, and the vegetable parasite, as stroma in
the form of minute granules has been discovered, the inevitable
prognosis holds good; and, sooner or later-though possibly after
much perseverance, though none the less surely--can be promised, a
cure.
104 W. 44TH STREET, NEW YORK CITY.
1
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HAND-BOOK
*
FOR
·
CONSUMPTIVES.
DR. H. N. AVERY.
Price Fifty Cents.
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340
{
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་
1
I
HAND -
BOOK
FOR
CONSUMPTIVES,
A PRACTICAL GUIDE FOR THE INVALID AND STUDENT,
EMBRACING ALL THE RECENT DISCOVERIES APPLICABLE TO
THE CONSUMPTIVE IN
CLIMATE, HYGIENE, FOOD AND TREATMENT.
BY
HENRY N. AVERY, A. M., M. D.,
Formerly Chemist to the Custom House, Port of New York. Late United States
Examining Surgeon for Pensions.
Professar Physiology. New Fack Hom
medied bollege
T869-70
New-York:
S. P. HEERMANCE & SON.
1869.
↑
[Entered according to Act of Congress, in the year 1869, by HENRY N. AVERY, In the Clerk's Office of the
District Court of the United States, for the Southern District of New York.]
TO MY FATHER
CHARLES AVERY, LL.D.,
For the past thirty-five years
PROFESSOR OF CHEMISTRY AND NATURAL PHILCSOPHY
IN HAMILTON COLLEGE,
FHIS SMALL TRIBUTE IS MOST AFFECTIONATELY
DEDICATED.
{
་
1
+
!
Appreciating the wants of invalids who are enfeebled by the destructive
tendency to consumption, and believing the disease can be controlled by
resorting to proper care and treatment, I have consented to prepare a brief,
concise, and practical HAND-BOOK.
PREFACE.
The object will be to condense what is known upon the subject, and
place before the patient all that is necessary for him to understand, in absence
of a physician. Many times invalids are far away from home, deprived of
the social circle and home comforts, as well as the advice of the family
physician: it is then that this Guide is expected to step in and offer its
suggestions, and endeavor to lead the invalid to a proper understanding
of his case
If persons inclined to hereditary consumption would but take early steps
in the treatment of this disease, many cases would recover that now have
to succumb to its ravaging influences.
If the sufferer finds any relief from the suggestions offered in these few
pages, it will repay me for the time and labor spent in their preparation.
NEW YORK,
10 East 28th Street
}
1
CHAPTER I.
WHERE SHALL THE INVALID GO?
Is one of the most difficult questions for the physician to
answer. The different temperaments of invalids and the
degree to which the disease has progressed, have to be taken
into consideration. Some have experienced the most benefit
in the cold, bracing air of the northwest; while others have
been greatly improved by the uniform temperature of some of
the southern states.
If the cause of Tuberculosis is owing to defective nutrition,
itself the result of a vitiated vitality, then a dry, cool, stimu-
lating climate, and not a moist, warm air, will be most likely to
bring into action the languishing vital powers. The great
object to accomplish, under all circumstances, is to strengthen
and invigorate, not to soothe and calm. Warm weather
produces languor, disinclines to exercise, destroys appetite,
and engenders disgust for meat and oleaginous food.
Consumptive soldiers of the East and the West Indies,
belonging to the French and English armies, are sent home to
a temperate climate.
The extremes of cold and heat are not conducive to longevity.
A temperate, climate is the most desirable; where the
temperature ranges from 55 deg. to 70 deg. Fahr. in the
day, and from 45 deg. to 55 deg. in the night. This invig-
orates the system, stimulates to exercise, improves the appetite,
strengthens the digestive organs, and rouses vitality.
A cold, moist air arrests the action of the skin, obliges the
lungs to perform extra work, and is apt to cause influenzas,
pleurisy, pneumonia, and bronchitis. It also deprives one of
out-door exercise, which is so important in restoring lost
strength.
8
When patients have made a change of climate, an important
point should be borne in mind: that is, to keep the body uni-
formly and constantly covered with warm clothing. Even in a
southern climate the sudden changes cannot otherwise be guarded
against. Exposure to night, and early morning, air should be
avoided.
In noting the advantages and disadvantages of various sec-
tions, I will point out different localities in the United States
and Europe, that have been found to possess the most beneficial
influence.
Dakota Territory and the region of the Rocky Mountains
will suit a class of patients that expectorate freely and are of a
relaxed condition. The air is bracing and dry, though the
high winds and poor water make it somewhat objectionable.
The section is not entirely free from consumption, as the
Indians are known to die with the disease frequently.
* *
The southwestern part of Texas possesses a very uniform
climate; a mean winter temperature of 53.9 deg, and is free
from swamps. The air is dry, cool, and invigorating. A medical
writer says of this region: "Here is a country of perpetual
summer.”
* * * * * * "Are not all the climatic
wants of the phthisical patient here fully met? Indeed, there
is nothing on this continent or in Europe that can compare with
it, even far-famed Italy must yield the palm to the 'Lone Star."
The difficulty of reaching this section, and the impracticability
of residing in cities, as the invalid would be obliged to do at
present, are its objections.
Minnesota, and the region about Lake Superior, have many
advocates. The climate of Minnesota has undergone a change
within the past few years; more rain has fallen, and the air
contains more moisture. The intense cold of winter makes it
objectionable. A summer residence there is generally attended
with great benefit.
East Tennessee possesses a very equitable climate. The
region is elevated and mountainous; the winters are mild and
the summers cool; the air is dry; and the thermometer seldom
reaches 85 deg. in summer. The native population exhibit
9
great physical development. The mortality from consumption
is 6 cent., while that of Michigan is 15
cent.
The valley of Western North Carolina is another very desir-
able locality. For instance, Ashville, a convenient spot,
situated some 2,250 feet above tide-water. The winters are
mild and summers cool. The maximum heat for Ashville, for
the past ten years has been 88 deg., and the mean temperature
70 deg. This section is praised very highly by those who have
visited it. The mortality from consumption is very small,-
some 3 cent. of the entire deaths.
The soil is good and the water excellent. The advantages of
this locality are, that it is situated in a valley, and is at a high
elevation.
Aiken, South Carolina, may be said to possess all the advan-
tages that many consumptives require: mild climate, easy of
access, good society, comfortable accommodations, and fair
board. The air is exhilarating, easily breathed, and permeated
with pitch-pine odor.
Ag
No locality possesses so many advantages, and will suit the
majority of invalids as well as Aiken. Out-of-door exercise can
be taken most of the winter, without danger of contracting
colds. The soil is sandy, and the ground is generally in good
condition for walking and horse-back exercise.
Those invalids that require the sea air, will find no place equal
to St. Augustine, Fla. This is the most desirable place on the
sea-shore, in the United States.
Another winter resort in the United States, may be men-
tioned the Hot Springs of Arkansas. The mild winters, and
the medicinal waters, make it a valuable resort for invalids,
who have phthisis complicated with gout, rheumatism, or
syphilis.
Among the many desirable, elevated localities, may be men-
tioned Anahuac, Mexico, 9,000 feet above the sea; the Alps, in
Switzerland; and the village Juja, (called Huha,) situated
among the Andes in Peru.
10
As a summer resort in the United States, no place possesses
as many advantages as Saratoga Springs. The great number
of medicinal springs gives the invalid a choice of remedial agents.
The air is bracing and stimulationg, being highly charged with
ozone and permeated with the virtues of the pine forests on
the north. The drives and walks are excellent; the society
pleasant, and fine accommodations with excellent board can
always be obtained at reasonable prices.
For a sea-side resort during summer, Long Branch is desir-
able. Easy of access, good bathing, pleasant drives, and fine
accommodations, render it very attractive.
Newport, and the islands off the coast of Maine, are pleasant
and desirable retreats.
Nassau, N. P., is a winter resort of great value, when a sea-
air is desired. The mild climate and bracing air are exceed-
ingly desirable for those who require strengthening, and can
bear the tonic effect of the sea-air.
Good accommodations and excellent board can frequently be
obtained in the families of some of the government officers.
EUROPE.
Europe presents many points of interest to the consumptive.
Baden-Baden, Weisbaden, Meran, and Botzen, in Germany,
may be resorted to, in the winter months.
Mentone, Nice, Rome, Naples, Malaga, and Madeira, are all
favorable spots. Mentone and Madeira are localities that will
suit the majority of invalids, and are to be recommended in
preferance to the others.
For invalids that can spare the time and means, Upper Egypt
offers decided advantages, as a permanent residence. The dry,
stimulating air agrees with many invalids.
Next in importance for a winter residence is Madeira, with a
mean temperature of 64 deg. It offers many inducements in
the first stage of consumption, and in cases of chronic bron-
chitis with a dry cough; also in cases of gout and nervous
affections. The winters are pleasant, and springs mild.
11
As a preventive of consumption, and where a sea-air is
required, Nice is a favorite spot.
When patients are troubled with looseness of bowels, and
when a strong sea-air is necessary, Mentone is a desirable
resort; but the invalid should leave there by the middle of
March, to avoid the strong winds, for some inland residence,
such as Rome, Pisa, or Pau.
Rome is a pleasant and desirable location for the spring
months. It is here that care should be exercised by sight-
seeing invalids, for the damp churches and other buildings are
prolific sources of colds and disease.
For a summer residence Pau, situated near the Pyrenean
watering places, is attractive, as the summers are cool and
bracing.
If a trip across the ocean is contemplated, the invalid should
exercise all possible care not to become too greatly reduced by
sea-sickness.
Preventive means and remedies will be given to suit such
as are thus annoyed, under the head of TREATMENT.
To sum up in brief; the points to be sought for, and objects
to be obtained, are stated below :
1. A temperature moderately high, and of slight varia-
bleness.
2. Elevated localities, or valleys in mountainous regions,
are the most desirable.
3. The air should be moderately moist, which is better
than very dry.
4. The locality should be protected by mountains, so that
the atmosphere will not be disturbed by violent agitations.
5. The sky should be clear a greater portion of the time.
12
6. Good walks and drives are requisite, and society should
be agreeable, so as to stimulate the patient.
7. The mind should have occupation, and amusements.
be afforded.
8. It is when the powers of the patient have not been too
much reduced, that a change of climate is advisable.
9. A change of climate, without remedial agents to over-
come the diseased tendency, will produce but little benefit.
10. A change of climate should never be made without the
advice of a physician.
13
CHAPTER II.
HYGIENE.
The subject of Hygiene includes all the conditions, physical
and mental, which are the most favorable for the development
of the human system.
Mental hygiene consists of quietude, suspension of business
duties, and freedom from the cares and perplexities of life.
Physical hygiene embraces good and abundant nourishment,
proper rest and exercise, a clean skin, and pure air.
When we consider that pulmonary consumption is the effect
of defective nutrition, either hereditary or acquired, the im-
portance of observing proper hygienic rules becomes manifest.
The importance to consumptives of breathing pure air, can-
not be over-estimated. A large amount of oxygen is required,
both day and night, to preserve vitality.
It is now conceded by many physiologists, that the amount
of oxygen inhaled during sleep exceeds the quantity breathed
in during the waking hours.
Each night the system stores up oxygen as fuel, to sustain
the vital powers during the activity of the succeeding day.
All patients, at whatever stage of the disease, should have a
plentiful supply of fresh air constantly passing through the
room during sleep-themselves protected from the draft.
Dr. Bennett says, "Consumptive invalids stand ventilating
as well as persons in health, and are no more liable to contract
colds or influenzas." We are all aware that plants under glass,
too crowded and not well supplied with air, soon sicken and
die.
The oppression for breath, or dyspnoea, that many experience,
arises from an insufficiency of pure air. I would earnestly
14
recommend all consumptive invalids to throw open the win-
dows, and breathe plenty of pure, fresh air.
Perfumes of all kinds should be avoided. The habit of using
cologne, camphor, ammonia, etc., is very injurious to persons
with weak lungs.
The
The skin is an important agent in regulating the conditions
of life. Through the pores, to a certain extent, the used-up
carbonaceous and nitrogenous elements are thrown off.
strong odor of the cutaneous secretions, shows this. The lungs
and skin perform a large share of the excretory functions of
the body. If the skin is dirty and the pores closed, the lungs
have to do more work in eliminating the waste material of the
body; then the lungs are overworked, and disease is the result.
The best mode of preventing winter colds, is to keep the pores
of the skin open by cold or tepid water baths, followed by fric-
tion over the surface.
I would confidently recommend consumptive patients, if
strong enough, to use a sponge-bath, at a temperature of from
62 deg. to 68 deg. every morning.
The water may excite expectoration of the mucus collected
in the bronchial tubes, during the night; but it need not be
attended with any alarm.
The question of exercise is one of the most important points
we have to settle.. I believe many patients are "walked to
death." Moderate, rational exercise is all that is necessary.
How often it is, that the invalid is seen at some favorite re-
sort, "striking out" for dear life, over a rough, hilly road, only
to return exhausted, and at a loss of a large per centage of
strength.
The consumptive invalid is often, during the existence of
active disease, possessed of an abnormal amount of strength.
As the excited brain of a fevered patient causes an undue
amount of strength, so the phthisical invalid is stimulated by
an excited and diseased condition of the system.
As the patient recovers from the influences of pulmonary
consumption, it is nothing unusual to find him losing some of
his unnatural strength that is, a change takes place, from an
15
artificial, excited state, to a natural condition. In the curative
stage the false strength is gone; the true condition of the pa-
tient is exhibited.
Moderate exercise should be the rule. It should combine
pleasure with duty and may embrace slow riding on horse-
back or in an open carriage; being rowed in a boat or mod-
erate walking. The principal things to combine are, to remain
in the open air and save muscular strength; for most of the
strength of the system is required to perform the processes of
digestion and assimilation of food.
Dr. Bodell comments upon this subject as follows:
1
Experience has taught me that in coming to a decision on
this vital question, the physician ought to be entirely guided by
physiological reasoning; and that his advice will be right or
wrong just in proportion as he is shrewd and discriminating in
measuring the exact condition of his patient, in each particular
case, and in the application of his physiological knowledge. The
following leading facts must be borne in mind:
CC
1. That the labor of walking one mile (if the weight be 150
pounds) equals 17.678 foot-tons, equivalent to 51.295 British
units of heat, the evolution of which requires the oxidation of
0.0566 oz. of carbon.
2. That every 1 oz. of oxygen will combine with 0.375 oz. of
carbon, the combination being accompanied by the evolution of
339.84 British units of heat, equivalent to 117.12 foot-tons of
mechanical force.
3. That fat is essential to histogenesis and to the protection
of the tissues from oxidation, that increased muscular exertion
necessitates increased oxidation, and requires increased histo-
genesis.
If the patient has lost enough fat to make an impression.
upon his strength, that is to say, if heat is being generated by
the combustion of materials which ought to be available for
mechanical force and histogenesis, it is madness to make any
16
1
avoidable demand upon either mechanical force or histogenesis
until all and more than the deficit fat has been restored; and it
is equally wrong to increase the supply of oxygen to the blood
beyond the smallest quantity consistent with life. If, while
pouring fat into the blood, we could actually stop the supply of
oxygen and stop the demand for renovation of tissue, mechan-
ical force, and sensible heat, without arresting those phenomena
upon which the maintenance of life and nutrition depend, we
should have the patient as much under our control as we have
the lamp, which we blow out while recharging it with oil, and
thus save its wick from combustion.
But although we cannot do this in the case of the patient,
our object should be to approach as nearly to this condition as
is consistent with the maintenance of life and nutrition."
"Dr. Pollock gives the following graphic description of what
is usually called the 'Premonitory Stage' of ordinary consump-
tion: We have now to consider the value of the earliest symp-
toms. When any physical signs of established deposit in the
lungs are present, the disorder has ceased to be premonitory,
and a certified lung disease is present. Stethoscopic evidence
must, then, be excluded.'
'
ant.
The earliest symptoms are the coincidence of emaciation
and the febrile condition, and wasting is in almost all instances
the first. Its earliest manifestation is an absorption of the adi-
pose tissue, and a thinning of the muscles. Its diagnostic char-
acter depends on the absence of sufficient cause. The appetite
may be good, the secretions regular, the supply of food abund-
There may be no drain on the system, yet emaciation be-
yond the lowest average of the individual steadily proceeds.
This emaciation is more marked in individuals of middle life in
whom the processes of nutrition have long been impaired; but
it is also, as we believe, present in all cases of phthisis, except-
ing those of the most acute form. It is more marked in those
who have been previously stout, and more perilous. It is pro-
gressive and not recovered from; and it is thus distinguishable
from the transient alterations in weight dependent on seasons
of the year, variations in diet and exercise, etc., which many
17
undergo harmlessly. The sensation of weakness is also greater
than in these latter. The absence of any preceding acute dis-
ease should of course be ascertained. Dyspepsia, in its various
forms, may reduce the weight, and it will be necessary to dis-
tinguish the functional gastric disorder from that which so
commonly attends all stages of acute phthisis.
Wasting alone is not sufficient to alarm. It is the coinci-
dence of this symptom with the febrile state which indicates
organic mischief. Dry heat, chills in the afternoon, and occa-
sional intermitting perspirations, with an accelerated pulse,
uniformly too high, but increased towards evening, form a
group of characteristic symptoms.
If to the foregoing we add a general feeling of malaise, of
depressed nervous power, and of insufficiency for the require-
ments of business or the daily occupations of the patient, we
shall have a sum of vital phenomena, inconclusive it is true as
regards the actual seat of the organic mischief, but indicative of
blood changes of a serious character.
Some local symptoms may at this time exist, as cough.
dyspnoea, pain in the sub-clavicular regions, and hæmoptysis:
but they are rarely present unless the physical signs of deposit
in the lung are sufficiently established to be recognizable by a
skilled observer. They do not, therefore, enter into our pre-
sent considerations.
་
Dr. Edward Smith sees in the lessened respiration attending
the earliest stages of consumption, the cause of tubercle. He
says: It has been proved that the essential feature of phthisis
is lessened action of the lungs in general, and of the air vesicles
in particular.' He speaks of tubercle and lessened vital pro-
cesses due to lessened inspiratory action of the air vesicles of
the lung.' And he sees the cure in all means by which respira-
tion is increased. The essential treatment is to increase respi-
ration.' While fully admitting with Dr. Smith that in early
phthisis respiration is diminished, I believe that he is totally
wrong in his interpretation of its meaning. It is a law of ani-
¿
18
aral nature to save a tender part. And I see in the attempt at
lessened respiration in early phthisis an example of the opera-
tion of this law. The blood in the pulmonary circulation is
deficient in the materials which the inhaled air seeks-the deli-
cate texture of the lungs is exposed to injury by the air, through
deficiency in its usual protection of fatty blood-and Nature
comes to the rescue by attempting to diminish the quantity of
air that is brought into the unprotected lungs; just as she cuts
off the access of light from the inflamed retina of the eye by
closing the iris or the lid.
My recent experiments upon myself have proved that walk-
ing in health at one mile per hour increases the respiration
from 500 cubic inches to 800 cubic inches per minute; at two
miles per hour, to 1,000 cubic inches; at three miles per hour,
to 1,600 cubic inches; and at four miles per hour, to 2,300 cubic
inches per minute. The depth of inspiration is likewise in-
creased from 35 cubic inches to 100 cubic inches per respiration;
and hence both the mechanical distension of the lung, and the
chemical and physical changes of respiration, are greatly in-
creased.
Riding in a carriage increases respiration, but the degree
varies with the oscillation of the carriage. In an omnibus the
increase is fully half of the original quantity. On horseback,
at a walking pace, the increase is more than half; in trotting,
three-and-a-half times; and cantering, three times the original
quantity.
Of all the modes whereby the respiration is increased there
are but two which do not, at the same time, increase the rate of
pulsation, viz., the voluntary deep inspiration aud cold bath-
ing.
Walking at the rate of four miles per hour will increase the
rate of pulsation to about 130 per minute, and even in gentle
exercise there is some increase in the rate of pulsation."
19
CHAPTER III,
FOOD.
In studying the nature of the human system, we find there
are two classes of individuals, so far as relates to the powers of
the digestive functions.
One class, whose vitality endows them with strong, rapid di-
gestive organs. Another class, whose nutritive system is defec-
tive, and whose powers of digestion are slow and weak. The
former are capable of digesting rapidly a large proportion of
vegetable and animal food; while the latter can dispose of only
a small supply of either the one or the other, and digest slowly,
This fact shows the importance of limiting the supply to the
capabilities of each individual case.
As the nourishment and strength of the body, as well as the
power of resisting the inroad of disease, depend upon the food
digested, it will be seen what a vast amount of importance
should be attached to the proper condition of the organs of
digestion.
Some require food three times a day; others more frequently.
The individual should be the guide.
I find many females suffering from pulmonary difficulties
who are also suffering from some uterine derangement. Under
such circumstances, the pulmonary troubles are relieved gener-
ally by curing the uterine disease.
As no specific has yet been discovered that will cure con-
sumption, it remains for the invalid to adopt hygienic rules and
therapeutical agents, if any relief is expected. There is one
remedy, however, which, par excellence, is adapted to all cases
20
of consumption, and that is Cod-Liver Oil. Upon this, the
hopes of the patient must rest. Combined with proper medi-
cines, it holds out flattering inducements for the sufferer. Many
cases are now cured that formerly would have been lost.
As cod-liver oil is more of a nutriment, and should not be
classed as a medicine, I give place to it under this head.
As to the value of this article, I will give the opinion of Dr.
Bennet, of London :
•
The question naturally presents itself, if cod-liver oil un-
doubtedly exercises a beneficial and even curative influence on
pulmonary tuberculosis, why and how does it produce this
effect? Chemical analysis of fish-oil does not give a clue, for
the amount of iodine and bromine discovered is so infinitesimal
that we can hardly admit that theirs is the potent influence;
especially when we find that, administered alone, the therapeu-
tical effect is not produced. To discover the clue, we must fall
back upon physiology.
It is now generally admitted by physiologists that fatty sub-
stances, if not absolutely essential to digestion and nutrition,
exercise a most beneficial influence over these processes; indeed,
nature appears to have placed fats within the reach of man all
over the world, and to have implanted an instinctive craving
for them in mankind. In northern climates, the natives con-
sume largely fish-oils alone, or with their food; in temperate
climates, butter and neat-fats take their place; while in sub-
tropical regions vegetable oils, such as olive-oil, form an im-
portant element of the food. Even in the tropics there is the
palm-oil, and gee, or butter, to satisfy the absolute want of fatty
substances. From physiological requirements to those of the
morbid condition of nutrition which constitutes tuberculosis
there is only a step, which observation has made. It has been
long remarked that in these morbid conditions of the human
economy a larger amount of fatty nutritive elements than is
usually required becomes a means of restoring nutrition to a
more healthy state, and that these fatty elements become, posi-
tively, therapeutical agencies.
21
If this view of the action of cod-liver oil is the correct one,
if in giving it we are merely ministering, in an exaggerated de-
gree for therapeutical purposes, to a natural health require-
ment, any fatty substance would have the same result. Within
certain limits I believe that such is the case-cream, fat meat,
vegetable oils, bacon, butter, all answer the physiological con-
dition, and I invariably give them, if possible, when the pa-
tient's stomach cannot bear the fish-oil. But I also believe
with the rest of the profession, that the fish-oil is the best, is
the easiest digested and assimilated, and is the fat to which the
stomach gets the soonest reconciled, and which it can take the
longest. I myself took an ounce and a half a day for five years
without intermission, at last with pleasure, and always with
benefit to the digestive processes. A medical friend of mine,
well known to the profession, who has, like myself, saved his
life by the combined influence of hygiene, climate and physic,
could never take cod-liver oil; 'but then,' says he, 'I took fabu-
lous quantities of butter with my meals.'
It is a known and admitted fact, that the greater number of
those who now recover from phthisis are persons who have
taken cod-liver oil. This fact certainly redounds to the credit
of the remedy, but it must be remembered that those only can
take it in whom the digestive organs are in a sound condition
naturally, or in whom they have been restored to a sound con-
dition by proper medical treatment. Women in whom uterine
disease sympathetical produces nausea and sickness, those who
are suffering from chronic dyspepsia, or from chronic liver or
kidney disease, generally speaking, cannot take the fish-oil; it
nauseates them, makes them sick, and destroys their appetite,
as often do all other fatty substances. Thus, the recovery of
those who can, and do, take cod-liver oil, may be not so much
because they take it, as that their digestive system is sound,
and that they can take and digest fat and plenty of good nour-
ishing food besides. On the other hand, those who cannot take
the oil, and die, may die not so much because they do not take
the oil remedy as that their digestive system is bad, and cannot
be restored to a healthy state, so as to admit of the food-cure.
mada
22
The undoubted improvement of the majority of the con-
sumptive patients who can take cod-liver oil or other fats, in
health, in strength, and in condition, has received additional
and most valuable explanation and confirmation from some re-
cent interesting physiological experiments. These experiments
have been made during the last year by Dr. E. Smith, the Rev.
Prof. Haughton, Dr. Frankland, and Professors Fick and Wis-
licenus, of Zurich, with a view to arrive at a clearer notion than
we had before respecting the origin of the power shown or
spent by animated beings. They have been carried on under
the influence of modern views respecting the correlation of phy-
sical forces, and the doctrine of the conservation of force and
of the equivalency of heat and mechanical force. The generally
received physiological idea of nutrition is, that nitrogenous or
albuminous food, by the process of assimilation, is transformed
into muscle and force; whereas carbonaceous, fatty, amylaceous
food, is burnt, and generates animal heat. The experimental-
ists whom I have quoted appear to have satisfactorily establish-
ed that the production of the muscular power spent by animals
and man is not so much to be attributed to the assimilation of
nitrogenous food as to the slow combustion of carbonaceous
food. According to this theory, the formation of animal heat
by the combustion of carbon is attended with the development
of "force," of which the muscles may possibly be only the in-
struments, not the producers.
This view may be familiarly explained by the steam-engine;
the latter, in burning coal, does not only produce heat, but
power-the power that drags the train along. In a more ob-
scure, but equally evident manner, the slow combustion of food
in the processes of nutrition is attended with the development
not only of heat, but of power, force. If the above views are
correct, it would follow, singular as the statement appears, that
more power or strength is to be got out of fat than out of meat
or muscular tissue; and this really seems to be the case. Ty-
rolese chamois hunters find that they can endure greater fa-
tigue on beef-fat than on the same weight of lean meat; and
accordingly, when about to absent themselves for several days
23
in the mountains, they take beef-fat with them instead of meat.
Thus is explained the craving of mankind for fatty food, and
for carbonaceous food generally. Thus is illustrated the gener-
ally acknowledged physiological principle, that man is omnivo-
rous, and is also explained the strength of the rice-eating Hin-
doo, and of the potato-eating Irishman. A rational dietary is
evidently the one in which nitrogenous and carbonaceous food
are mingled in due proportion.
Lastly, we may safely conclude that fats are not 'bilious,"
bile producers, as popularly believed, but that the inability to
digest them is merely an evidence of defective, or of weak and
easily-disturbed digestive powers. The great majority of those
whose digestive system is in good order digest fats with the
greatest ease, and that in large quantities. The dislike so often
shown to fat by persons in good health is often merely a result
of education-of mothers most foolishly and erroneously pick-
ing out the fat from their children's food in early life" as un-
wholesome and bilious.'
15
C
The best quality of cod-liver oil should be selected. The high
price affords many temptations for adulteration. That which is
known as the de-odorized oil is preferable, as some of the dis-
agreeable odor is removed.
The quantity should be a teaspoonful twice a day, to com-
mence with, and gradually increased to a tablespoonful. The
quantity may be confined to a teaspoonful for several months.
The continuance of the oil should be persevered in, even
months and years, or otherwise no beneficial effects can be ex-
pected.
It is taken with the best results after breakfast and tea.
As the oleaginous substances taken into the system are di-
gested by the secretions of the pancreas, the necessity of a proper
amount of pancreatic fluid will be obvious.
Frequently it occurs that the supply of pancreatic fluid is
24
deficient, from a deranged condition of the system. Then it is
necessary to give some agent that will assist in the proper as-
similation of the oil. For that purpose a small amount of a
mixture of one.part sulphuric ether and ten parts water may
be taken.
For convenience, a preparation known as ETHERIZED COD-
LIVER OIL has been prepared; if of reliable manufacture, it
may be used.
From the fact that cod-liver oil nauseates many invalids, it is
necessary frequently to devise some means whereby that objec-
tion may be removed.
For the use of such persons, we would suggest the following.
For most cases, any of the agreeable bitter tinctures or aro-
matics will suffice as tincture of gentian, ginger, orange-peel,
&c., or infusion of quasia, cinchona, wild-cherry bark, or an
emulsion with sugar and gum arabic or eggs.
Some pour a
little porter in a glass and then add oil, covering with the froth.
The essential oil of bitter almonds, in the proportion of one
part to two hundred of cod-liver oil, will disguise the latter.
With isinglass, it has been added as a jelly.
The whole dose of oil and vehicle should not exceed a table-
spoonful at a time.
In connection with the oil and vehicle, it is found advisable,
frequently, to administer some of the mineral acids.
If they
prove too acid for the stomach, a little soda may be given.
In inflammatory cases the nitric acid answers the best pur-
pose. It is liable to injure the teeth; therefore it should be
used in small quantities.
In case the invalid should be suffering from profuse night
sweats, the sulphuric acid is preferable.
There is still another acid that will suit the majority of cases,
and will be found very efficacious, the phosphoric acid.
25
Either of these acids may be prepared by adding one part
acid to fifty parts water. Five to ten drops of this mixture
may be added to the vehicle, or be taken immediately after the
oil.
In case of peculiar weakness of stomach, and when vomiting
sets in, two drops of tincture nux vomica may be added. Sali-
cine may be substituted.
If a light diet is required from the nature of the case, arrow
root and milk, with a little wine, may be given.
The following should be the diet for consumptive invalids :
Fresh meat, fish, fowl, game, eggs, milk and bread, with a fair
proportion of vegetables and a little fruit. A small amount of
wine may be given with the earlier meals; it stimulates the ac-
tion of the stomach, and assists digestion.
In case a nourishing injection should be required, the follow-
ing will be found to answer a good purpose: strong meat broth,
yolk of eggs, and soups; to either of which may be added a
small quantity of brandy.
All pastry and rich stuffing should be avoided.
Fat meat and much butter will not answer for all invalids,
while taking oil. The latter will supply all the oleaginous pro-
perties required.
Malt liquors and milk are found too heavy for some. They
are liable to prove "bilious," and are therefore objectionable.
26
CHAPTER IV.
TREATMENT.
It is satisfactorily established that Consumption is ameliorated
by proper treatment, and that the rate of mortality from the
disease for the past few years has greatly decreased.
These facts should encourage predisposed persons to renewed
energy in fortifying themselves against the enemy that may be
lurking, to bring about their destruction.
The invalid should not feel that he is deriving the greatest
amount of good, when he is striving to concentrate the largest
amount of medicine in his system.
The least amount of medicine that can be taken and secure
the object, the better. It should be the aim to build up and
strengthen, not to reduce and debilitate.
For the invalid to derive any benefit from treatment, a proper
observance of hygienic laws should be earnestly enforced, (see
Chapter on Hygiene,) and the importance of close attention to
food cannot be over-estimated.
All the hygienic regulations should be strictly observed.
otherwise little benefit will result from medicine.
Those who believe in the infalibility of specific remedies for
the cure of consumption, will discover their error too late for
human agency to render any assistance. No medicine, alone,
will eradicate the disease; while an observance of other require-
27
ments, combined with proper medication, might cure many
otherwise hopeless cases.
In entering upon the treatment of Consumption, these several
objects should be borne in mind, viz:
I. To use agencies that will prevent the progress of the dis-
ease, by checking the tuberculous deposit.
II. To overcome congestion and inflammation of pulmonary
tissue.
III. To combat local or general symptoms that may arise.
COD-LIVER OIL AS A MEANS OF CURE.
It has been seen (Chapter on Food) that cod-liver oil is an
essential agent in the treatment of this disease. Although not
strictly a medicine, it must be regarded as a means of cure in
all cases.
I should hesitate to commence treatment without its use.
The number of cases treated, where its beneficial effects have
been seen, in my own practice and in that of others, has thor-
oughly convinced me of its importance.
There are those who cannot take the oil with any degree of
comfort. For such, directions have been given in a previous
Chapter. Then there are those who can take the oil in a cold
climate, that find it impossible to do so in a warm one. Such
should remain in a cool, temperate climate. The digestive or-
gans will then comply with the demand of the system. Cold
increases the combustion of fat, and has a tendency to rouse
the digestive organs to proper action. On this account a warm
climate should be shunned by many consumptives. A proper
digestion of oil in this disease is of the highest importance.
In those cases of depraved vitality, where the tone of the sys-
tem is low, digestion and assimilation are deranged, and this
causes a deficiency in the chyle, of oily matters, which are ne-
cessary to a true nutritive material.
If a "bilious" attack should set in by the use of too large a
28
quantity of oil, indicated by headache, nausea, furred tongue,
high-colored urine, and sour eructations, then the diet must be
lightened and the quantity of oil reduced.
ARSENIC AS AN AGENT IN TREATING PHTHISIS.
It has been found that this agent exerts a beneficial influence
over diseased pulmonary tissue. M. Martin, of Paris, has been
making a series of experiments-and subsequent trials by my-
self and others prove their value-with arsenic as a remedy in
consumption. He sums up as follows:
"I. The action of the substance is undeniable. II. It is par-
ticularly efficacious when phthisis assumes a slow and torpid
course. III. Acute tuberculosis is not greatly modified by its
employment. IV. In a great number of cases, even when the
disease is far advanced and attended with hectic fever, the gen-
eral condition of the patient is favorably modified. V. Local
lesions are modified more slowly. VI. There would be a greater
number of successful cases, if the patient persevered in the
employment of arsenic. VII. In order to be efficacious, the
treatment must be protracted. VIII. The dose must be small.
IX. Arsenic especially exercises a reconstructing action, and
modifies secondarily the pulmonary lesion, and that possesses
a direct action over the respiratory functions."
When the digestive organs are greatly impaired and diarrhoea
sets in, the dose must be very small; and in all cases it should
be omitted for a few days, at intervals of five or six weeks.
THE HYPOSULPHITES OF LIME AND SODA.
These agents have been used by many with decided advan-
tage. They possess the power of preventing metamorphosis of
tissue, and, in many cases complicated with scrofula, they will
be found of service.
They also possess the power of increasing the circulation and
respiration. Therefore, the importance of using them with
caution, where there is a tendency to hemorrhage; as an undue
amount of blood in the lungs might rupture a blood-vessel.
29
THE PHOSPHATE AND CARBONATE OP LIME.
These are essential agents in many constitutions, when the
osseous system is deranged.
They should be used in small doses, and persevered in for a
great length of time.
The phosphates supply the waste from the brain, and thus
strengthen vitality.
These agents, and others previously mentioned, are what the
invalid must carefully select from.
THE FIRST SIGNS OF PHTHISIS.
Frequently the first signs of consumption manifest them-
selves by some local lesion, or are accompanied by some morbid
alteration of structure. The parts most subject to such changes
are the Pharynx, Larynx, and Trachea. In such cases, local
and general treatment should be adopted, to cover the different
conditions of the disease.
Much more frequently consumption manifests itself by wast-
ing away. The victim perceives, perhaps, that his weight is
growing less, from day to day, without regard to the general
effect of cold and warm weather. At the same time his circu-
lation may be disturbed. He may every day or two have flushes
of heat, which last only a few minutes. These symptoms pre-
cede the cough.
Under all circumstances, the first sign of any disease in those
predisposed, should be met with prompt treatment. A little
timely advice from your physician may save much suffering.
UTERINE DISEASES ACCOMPANY PHTHISIS IN FEMALES.
Many cases of consumption in females are accompanied with
diseases of the organs of generation. Some are sympathetic,
while others are organic.
All uterine diseases must necessarily affect the general health;
and, as it is expedient to save the strength of the patient, the
importance of early treatment for the uterine disturbance will
be manifest.
30
WHAT BREAD SHOULD BE EATEN.
As a curative agent, bread may be mentioned.
White wheat bread, made from superfine flour, possesses the
carbonates, or heat and fat producers, while bread made from
the inside and outside of the wheat, possesses the phosphates
and nitrates, combined with the carbonates. Therefore, to de-
rive all the advantages of the wheat, it is necessary to eat
brown as well as white bread. The Nitrates and Phosphates
go toward making up the muscles, brain and nerves.
Bread made of rye flour or corn meal may be used for a
change, with good advantage.
MEAT AS A CURATIVE AGENT.
Raw meat, chopped into a salad, has been used with good
advantage in some cases.
The great disadvantage of visiting some localities, is the in-
ability of procuring fresh meat for the invalid. In such cases
Liebig's Extract, or the concentrated beef of some reliable
manufacturer, may be used.
DIARRHEA OF PHTHISIS.
The intermittent diarrhoea of consumptives, is owing to in-
flammation and ulceration of the small intestines, dependent
upon tubercular disorganization. The intestines are very sen-
sitive, and great care should be exercised not to use anything
that will act as an irritant. The diarrhoea should be checked
by attention to diet and hygienic rules; opium and astringents
should not be used under any circumstances.
If the irritation be owing to indigestible food, and it should
be necessary to remove it, the simplest and most effectual agent
is castor oil. The taste of the oil may be disguised, by adding
to it a mixture of orange or lemon juice, and water; or float
the oil on the top of water in a wine glass, and pour over the
oil a little brandy; care being taken not to allow the oil to touch
the sides of the glass.
If vomiting should set in, the dose may be immediately re-
peated, the patient lying down for half an hour.
31
WHAT CLOTHING IS REQUIRED.
The body should be well protected throughout with thick
flannel during winter, and with a lighter quality during the
Never allow yourself to sleep in your ordinary under
garments. They should be well aired during the night.
summer.
VESSELS FOR RECEIVING THE SPUTA.
Do not use the ordinary spittoons for receiving the expecto-
ration; they soon become foul, and constantly emit an offensive
odor. The best receiver is a box filled with fine, dry earth,
which may be refilled daily.
WHAT MAY BE EXPECTED FROM TREATMENT.
In baffling the evil influences of pulmonary disease, the pa-
tient must bear in mind that there is no panacea he can resort
to and expect to be cured. A proper hygienic observance must
be combined with the use of cod-liver oil, arsenic, the phos-
phates and carbonates; and remedies to cover symptoms as they
arise. By a proper observance of this course, many cases of
consumption may be cured.
SUBORDINATE AGENTS IN TREATING PHTHISIS.
Under this head will be given those remedies and suggestions.
that have been found of service in combatting symptoms. Only
those recommended by the highest authorities will be given.
Individual cases require different remedies, and in different
quantities. The smallest dose, compatible with the case, should
be given in all cases. When practicable, a physician's advice
should be sought.
ALCOHOL AS A LOCAL AGENT.
It has been recommended to wear woolen or flannel cloths,
saturated with alcohol, over the chest. The whole may be cor-
ered with oiled silk, to prevent evaporation.
In incipient phthisis, this may be adopted with benefit.
EXPANDING THE CHEST, A MEANS OF CURE,
Benefit has been derived from expanding the chest and filling
the lungs with air, several times a day.
To derive any benefit from this, the lungs must be expanded
to their full extent several times, at every trial. Three or four
trials a day will be sufficient. The chest should be exercised,
32
❤
by throwing the arms and shoulders backward and forward.
This exercise should be continued many months.
ARRESTING PULMONARY HEMORRHAGE.
In absence of a physician, the invalid should have control of
agents that will arrest this dangerous symptom; and, in case a
change of residence is desired, the medicines mentioned below
should be procured.
When hemorrhage has taken place, rest and quiet should be
sought. The temperature of the surrounding air should be
low. Small pieces of ice may be swallowed frequently.
Tincture Erigeron Canadense is serviceable in many cases.
Dose Ten drops in ten teaspoonfuls of water; one teaspoon-
ful every two minutes.
:
Tincture Hamomelis (Pond's Extract) is another remedy
of value.
Dose: Fifteen drops in half a glass of water; a teaspoonful
every two or three minutes.
Fluid Extract of Ergot has been recommended highly by
some.
Dose: Five drops every ten minutes, until the discharge of
blood appears to decrease.
If the pulse is quick, Tincture of Aconite may be used.
Dose: Five drops in a glass of water; a teaspoonful every
half hour.
WEAKNESS OF HEART.
If weakness of heart is present, denoted by inequality and
rapidity of pulse, and occasional faintness, Tincture Digitalis
may be given in small doses.
This remedy ought to be continued for a long time, to ac-
complish any good. It should also be omitted a few days, at
intervals of two or three weeks.
GENERAL DEBILITY.
In case of general debility, and when a tonic is required, a
few drops of Tincture Cinchona may be taken, three or four
times a day.
33
CARBONIC ACID GAS, AS A LOCAL AGENT.
For consumption, preceded or accompanied by throat affec-
tions, carbonic acid gas has been used with much service, by
inhalation.
In syphilitic or scrofulous ulcerations of the throat, it has
done good service. It should be inhaled moderately at first,
and gradually increased.
MEDICINES FOR INHALING.
It has been proposed to administer different drugs by inha-
lation. The following have been used for that purpose: Car-
bolic Acid, Creosote, Chloroform, Iodine, Oil of Turpentine,
and Extract or Juice of Hemlock.
For this purpose, to save the expense of an inhaling appara-
tus, a jug may be used, by wrapping a towel around the jug
and extending it to the nose or mouth. To prepare the mixture
for the purpose, fill the jug with hot water, and add from one
to thirty drops, according to circumstances, of either one or
more of the different medicines. An inhalation of ten minutes
may be repeated two or three times a day.
In convulsive coughs, add chloroform: when the expectora-
tions are offensive, add creosote, or carbolic acid; and, to de-
rive the alterative effect, use iodine, turpentine, or hemlock.
OTHER AGENTS IN PHTHISIS.
A few other agents have been recommended, supposing that
they possess some specific virtue in curing consumption.
Coal Oil, in teaspoonful doses: Tincture Cimicifuga, with
Fusil Oil, in small doses.
Iodized Syrup of Horse-radish has been proposed as a sub-
stitute for Cod-liver Oil.
TO PREVENT SEA-SICKNESS.
The following rules should be carefully observed :
1. The strength should be preserved, and the mind compos-
ed. This can be accomplished best by having every preparation
made at least twenty-four hours before sailing.
34
2. Eat an early breakfast; and, if the vessel sails at 12 M.,
eat a hearty meal just before going aboard.
3. All things that are required for the first ten days, should
be arranged as soon as you are aboard. Undress and go to
bed before the vessel starts. Neglect of this may cost many
days of sickness.
4. Eat, at regular meal hours, good, plain, substantial food,
and as much as required.
5. Continue in bed at least two days, without raising the
head from the pillow. In this manner the strength is saved,
digestion continues, and a habit of accustoming oneself to the
change of equilibrium, is established.
6. No corrective, as magnesia or sedlitz powders, should be
taken in the morning. They aggravate the tendency to sea-
sickness.
7. As sea-sickness is liable to produce constipation, care
should be taken to prevent it, by attention to regular stools. If
necessary, injections may be resorted to.
8. In the course of two or three days, after having become
habituated to the sea, you can venture to take your meals at
the table.
9. Never rise in the morning until you eat something; as
oat-meal porridge, a little toast, or sea-biscuit. Those in the
habit of drinking coffee, may take a small quantity.
10. If at any time you should experience a tendency to sick-
ness, immediately go to bed, and remain upon the back.
These rules should be strictly observed and faithfully carried
out, if sickness is to be avoided. Females should especially
observe this.
P
ज्ञ
URO-LITHIASIS IN RUSSIA,
(Nishny-Novgorod)
A Contribution to Operative Surgery, Etiology, Statistics and Therapeutics
By Dr. C. Bojanus, Moscow, 1876.
[This Essay is illustrated by 72 Vesical Calculi (the "second series" of which the author
speaks) sent by the author to the World's Homeopathic Convention of 1876.]
TO HIS HONORED FRIEND, THE EMINENT PROMOTER OF SCIENCE,
E. VON GRAUWOGL, THIS ESSAY IS DEDICATED AS A FEEBLE TOKEN
OF RESPECT AND LOVE BY THE AUTHOR.
DR.
PREFACE. It is in the nature of mankind to seek to explain what is
obscure, by searching for the causes of phenomena. And where could such
irvestigations be more in place than in the natural sciences, the advancement
of which redounds at once to the personal advantage of man himself? These
two lines of work, however, observation and explanation, converging to one
result, never advance at equal rates; observation outstrips explanation. An
attempt has been made in the following pages to explain phenomena, the
causes of which have not hitherto been fully recognized; how successfully,
let competent but impartial judges determine.
¿
The observations which are the basis of this treatise were confined to a
single province of the Russian Empire, the other provinces offering too few
and indefinite data for positive conclusions.
May this effort tend to the advancement and general recognition of the
truth-the sole object which has animated and guided
Moscow, February, 1876.
THE AUTHOR.
ܐ
7.
*
*
WORLD'S HOMEOPATHIC CONVENTION.
[2
THE period during which the Hospital of Nishny-Nov-
gorod was under my charge embraces about nine years
(from September, 1854, to July 1, 1863). During this
time the operation of Lithotomy was performed in the hos-
pital 143 times.
The report of a portion of this period was published at
Dorpat in 1863, and this report was translated and pub-
lished under the following title: Application de la M decine
Homeopathique aux Traitements Chirurgicaux. Bruxelles,
1864. We refer to this work for that portion of the service.
During the second period (subsequent to the preparation
of the above report) there were 72 lithotomy cases, one of
which was in a female; an evidence that males are much
more liable to this disease than females. Of at least 200
cases that have come uuder my observation, only three were
in women, one of whom was operated upon. All of these
three women had passed their fortieth year. I have never seen
unmarried women, young or old, afflicted with stone in the
bladder. The rate of mortality for the second period (1859
to 1863) was more favorable than for the previous period;
of the 72 cases, one in 6 died, about 15.27 per cent.
The mortality in the 143 cases, comprising both periods of
operations, with homoeopathic treatment, was one in 5%,
or 19.58 per cent., which is at least not worse than the ex-
perience of other surgeons. If the report serve no other
purpose, it will at least prove the fruitlessness of the treat-
ment hitherto employed after the surgical operation; and,
if it did nothing more, Homœopathy would, for this, merit
a favorable recognition.
100
1
The duration of treatment during the second period
was, on an average, 270 days shorter than during the
previous period, being an average of 42% instead of
45 days for each patient. The total of 143 lithot-
omy cases gives us, therefore, 115 cured; the average
38
3]
URO-LITHIASIS IN RUSSIA.
treatment lasting 43% days. If we deduct from the 72
cases five in which the recto-vesical operation was per-
formed, and one in which the horizontal was resorted to,
the rate of mortality for the 67 cases of bilateral operation
is 14.92 per cent., or as one to 67%; the average duration
of treatment, 41180 days. Whatever may be the bearing
on the question of the preference previously, and now again,
expressed by us for the bilateral over the lateral operation,
more numerous observations are necessary for a positive
settlement of the question. Certainly, the results hitherto
obtained are not unfavorable to the views we have expressed.
The sequelæ of the operations and the mortality in re-
lation to the age of the patients are given in the accom-
panying tables. [See Appendix A.]
The variety of the sequelæ is less than that of the pre-
vious period. We do not find cysto-renitis, hæmorrhage,
abscess and fistulæ, phlebitis, pyænia, tetanus and eclamp-
sia. On the other hand, we find among the sequelæ of the
second period, intermittent and pneumonia; in how direct
a relation to the operation these diseases stand, we cannot
with certainty determine.
Of 61 cases which recovered, 19 had no sequelæ and 23
had simple traumatic fever; while, in the previous period,
only eight were exempt from sequelæ, and 28 had traumatic
fever. Whether, and to what extent these favorable results
are due to the mode of operation we cannot determine, but
think the question deserves investigation; for we think that
the bilateral operation, a method which presents no special
technical difficulties, has been unjustly neglected by many
surgeons.
The accompanying table [See Appendix B.], embracing all
the cases (143) of both periods, shows the frequency of the
various sequelæ, and their relation to age and mortality.
The accompanying table [See Appendix C.] shows the
relative frequency and mortality.
The number of these observations is too small to justify
a conclusion respecting the frequency of sequelæ, especially
WORLD'S HOMOEOPATHIC CONVENTION.
[4
1
T
if we take into acccunt the fact that these sequelæ result.
not simply from the operation, but likewise from many local
endemic, epidemic, climatic and nosocomial influences to
which the individual patients have been subjected; and
that, moreover, the more or less favorable results may
depend in part on the individual luck of the surgeon,* and
in part upon the fact that, as already stated, I operated
under most unfavorable circumstances, which many surgeons
will not do.
It appears that traumatic fever and cysto-peritonitis were
the most frequent sequelæ; the former occurring once in
2.8 of the 143 cases, and the latter once in 6.5; while cys-
titis occurred once in 13 cases.
The prognosis can be numerically determined for only
two forms of disease; for the others, which occurred less
frequently, it depends on the pathological character of the
disease. It is favorable for traumatic fever without local-
ization; in cystitis it is as one to eleven; in peritonitis as
one to four; in cysto-peritonitis as one to two; in cysto-
peritouitis, with acute purulent oedema, as one to two; in
acute purulent oedema, without complication, as one to 1.5.
The relation of the mortality to the age of the patient is,
for the second period, as follows:
Age, 1 to 5 years, 22 cases, no deaths.
66
،،
6
"12 66
27 66 4
12
17 46
13
21
10
66 58 66
For both periods, embracing 143 cases:
Age, 1 to 5 years, 43 cases, 4 deaths,
66
،،
CC
66
• 12 66
6
17
9.3 per cent.
12.96
37.5
= 36.36
12
54
24
22
66 19
9
21
"658
8
The important influence of the size of the calculus upon
the mortality is shown, for the second as well as for both
periods together, by the following tables:
66
((
(6
66
66
(6
(6
66
66
66
4
3
،،
66
66
(6
= 14.81 per cent.
= 30.76
C6
(6
= 30
* Piragoff: Clinical Surgery, page 22.
† Application du trait. Hom., etc., pp. 23, 24.
(6
66
66
66
، ،
5]
URO-LITHIASIS IN RUSSIA.
cases.
I dr.
Second period, 1859 to 1863. 72
Stones weighing less than
Age, 3
22
66
1/2
<<
<<
(6
***
3
4
6, 4, 7
2 2
years. Grains, 2
+6
64
Age, 4
(4
<<
<<
((
CC
CL
(C
years.
(6
*C
46
པ༷
<<
CC
235
23
33
38
46
53
Cases.
Stones weighing just 1 dr.
I
2 HH Jank
2
I
I
I
در
I
I
II
Cases
TABLE I.

I
Deaths.
O
Deaths.
Both periods together.
143 cases.
Stones weighing less than I dr.
O
Age, 3
2½
C
1½
แ
CC
(+
"C
6 C
*K
66
KE
(c
(C
(C
<<
TABLE II.
CC
21
4322 +
2/2,3
4
7
2
years.
CC
13/4
6
2
Co
(6
Age, 12, 4,
"C
6+
4
6,4,7,8
<<
CC
(*
C6
CC
CC
6.
LC
Grains, 2
66
<:
8 years.
<<
*C
<<
**
cc
<<
،،
46
،،
(C
rt
<<
2 Min
5
18
23
~ ~ Co Cm
25 1000
29
33
35
40
46
48
52
53
Stones weighing just 1 dr.
Cases.
I
2
I
I
4
I
20
Cases.
3
Deaths.
I
I
Deaths.
O
+
Stones weighing more than I dr.
Age, 40 yrs. I dr. 7 gr.
8 **
CC
I
21
(C
I
22
30
35
""
**
,,
..
6.
By
31
""
""
""
"
""
. .
6.
""
""
:
21
CC
533 5000 2 4
Age, 6 yrs.
""
13
15
3,9
LOSO
I I
46
CC
5
06
13
39 13
""
པ
""
CC
CC
""
""
""
""
(6
""
WORLD'S HOMEOPATHIC CONVENTION.
TABLE III.
""
""
4
10, 8"
I
I
I
I
I
Stones weighing more than 2 drs.
I
2 2 2 ~ ~ ~ N
2
2
2
11
2
"
2 2 2
(C
*
""
2 dr.
""
CC
(C
66
19
tr
..
""
པ
3
CC
""
""
43
46
48
52
>>
12
""
""
42
(.
46
50
..
<<
""
o gr.
<<
""
13
(C
15
18 "
19
CC
40
CC
>>
">
??
Cases.
པ
I
I
I
I
I
9
Çases.
I
2
I
I
I
I
I
2
I
1 2
Deaths.
2
13
0
Deaths.
Stones weighing more than I dr.
I
Age, 40 yrs
4
3
4
ΙΟ
2
""
CC
""
66
""
""
""
66
""
""
TABLE IV.
""
""
""
""
CE
CC.
>>
"",
""
""
""
.6
"3
>>
((
""
""
ΟΙ
ic
""
21
(C
8
13
5
3
15
II
LONDON ~ +
6
46
5
22
8
گانه
22
2
4
I Age, 6 yrs.
5
3,7,9"
66
8
""
("
CC
.،
""
""
5, 14
5
3, 13"
3, 13 “
4
IO,
25
<<
>>
""
در
""
""
""
""
""
>"
CC
""
""
(6
""
""
34
34
""
""
CC
X
I dr.
CC
I
I
I
I
I
I
I
I
I
band
I
I
I
18
20
21
22
30
31
1 33
I
35
I
43
I
45
46
I
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 2
2
2
2
2
2
2
2
2
2
39
2
""
2
2
((
2
(6
""
<<
2 dr.
པ
>>
C6
rr
30
"}
35
2
Stones weighing more than 2 drs.
CC
CC
པ
""
""
""
=
<<
THE
"
""
*
"1
CC
:
66
tr
C6
༤
>>
7 gr. I
I
78 9LOX
CC
6
15
445
78 2
47
48
52
I I
2 c +1000
12
13
14
15
19
35
39
40
""
42
""
46
",
50
51
CC
"C
66
པ
">
o gr.
་་
(6
""
❤
J
C.
6.
""
(:
**
186
""
""
>"
tr
""
3
CC
C.
"
6.
""
Cases.
""
""
I
I
I
I
I
I
I
I
I
I
I
I
I
Janet
I
I
2
19
Cases.
2 1
I
33
HH
H
I
2 - 2 2 - 2 -
I
I
[6
I
Deaths.
I
I
2

Deaths.
I
I
I
22 3
1
77
URO-LITHIASIS IN RUSSIA.
▸
Age, 14 yrs.
>>
""
""
CC
"
,,
""
(6
<<
,,
66
""
66
315
"
<<
HH
"
Stones weighing over 3 drs.
3
6213
II
CC 8
13
IO
5
28 9
I IW
6
32
17
>>
7436
tr
14
<<
CC
124
""
་
>>
354
""
'
"
">
Co
3 dr.
CC
3
3
3
(C
3
>>
دن در د
3
3
3
'
66
✦✦✦✦44444
""
""
CC
Age, 12 yrs. 4 dr. 14 gr.
(C IS "
66
>>
CC
>>
CC
CC
>>
2 gr.
17
2 2 COM
22
29
26 " I
32
Stones weighing over 4 drs.
37
4I
47
51
>>
""
*
པ
""
""
..
42
50
52"
<<
*
23
30
40"
"
*
>>
(C
Cases.
>>
TABLE V.
I
I
I
I
I
6
Cases.
I
I
8
Deaths.
Со
O
Deaths.
2
Age, 14 yrs.
""
""
ور
"7
•
**
""
>>
""
CC
""
""
""
X
(C
*C
>>
"}
,.
25
CC
TABLE VI.
>>
>>
(C
Stones weighing over 3 drs.
>>
"
+0000
*
5
30
8
3402
14
6
II
ΟΙ
3
12
13
ΟΙ
5
5
27
17
2 400 0.00 2
8
32
17
430
.་
14
८८
6
CC
30
CC
CC
""
223
در
'
tr
*
CC
>>
tr
3340
CC
(C
354
>>
<<
**
,,
CC
.
>>
3 dr.
CC
3 cm co co co co co co co ♡♡♡♡ M CO M M
21
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
+++++
4
4
4
C6
4
>>
4
""
2
******
'
6.
CC
CC
>>
>>
>>
CC
CC
CC
CC
**
"
CC
Age, 12 yrs. 4 dr. 14 gr.
<+
4
16
݂ܕ
*?
12
THE
เ
3
**
嫂
​*?
2 gr
6 6
", 91
17
26 76 7∞ 762
345
74
18
27
29
32
Stones weighing over 4 drs.
33
37
40
41
47
51
5 in
53
56
59
IS
2 2 7+
400 I
23
24
30
""
40
42
6.
50
52
46
6C
(C
""
""
-
*
:>
CC
""
در
(.
*
Co
??
>>
66
>>
>>
66
Cases.
..
I
I
I
I
I
I
I
I
-
18
Cases.
I
121f
I
2
I
II
Deaths.
I
I

Deaths.
I
I
ta
2
WORLD'S HOMEOPATHIC CONVENTION.
[8
""
"",
Age, 8 yrs. 5 dr. 5 gr.
6
CC
.6
12
58
28 "
48
CC
""
""
۱۰
""
Stones weighing 5 drs.
CC
6
ΟΙ
12
(6
، ،
""
""
CC
""
""
""
>>
7
7
7
""
""
CC
Age, 10 yrs. 6 dr. 18 gr.
C.
(C
<C
6
7
II
12
17
ვი
1
""
""
49
53
CC
""
""
Stones weighing 6-8 drs.
24
31
43
""
""
""
،،
TABLE VII.
""
I
I
I
I
I
I
6
I
I
I
I
I
I
5
I
Age, 8
6
22
1Ο
14, 58“
9
""
CC
""
>>
""
66
""
TABLE VIII.
>>
""
Age,
""
>>
tr
<<
66
""
""
""
Stones weighing 5 drs.

CC
""
ΟΙ
II
12
22
10
15
6
yrs. 5 dr.
14
6
12
17
17
ور
30
25
""
""
""
CC
tr
6
yrs.
66
ઃઃ
""
""
""
،،
""
""
""
(C
(C
5
5
CC
""
""
7
>"
""
เ
>>
(4
(C
،،
Stones weighing 6-8 drs.
6 dr.
6
6
6
6
""
CC
،،
CC
CC
""
""
""
"?
5 gr.
(.
CC
I 2
17
23
2866
48
49
50
53
59
ΟΙ
13
22
40
""
II
""
4 gr.
،،
24
25
31
43
50
เส
6.
• 6
<<
66
"
">
""
>>
""
CC
Cases.
CC
I
I
I
I
2
2
I
12
Cases.
I
I
I
I
I
I
I
I
I
II
•
Deaths.
1
I
I
3
Deaths.
I
ι
2
9]
URO-LITHIASIS IN RUSSIA.
""
4C
=
Age, 23 yrs. I oz. I dr. 46 gr. I
66
6
(6
I
21
I
I
38
I
40"
""
""
Stones weighing more than I oz.
242
"28
""
21
47
ΟΙ
14
CC
"?
6.
""
CC
I
I
66
I
I
??
""
،،
""
CC
(C
12 22 347
در
""
,,
O
134
>>
S
CC
>>
37
42
I2
,,
""
Age, 17 yrs. 2 oz. o dr. 55 gr.
CC
(C
CC
CC
13
2
7 37
13
4
IO
>>
""
""
""
Stones weighing over 2 oz.
Cases.
""
TABLE IX.
I
I
I
7
Cases.
I
نما
Deaths.
I
3
Deaths.
I
I
I
3
Age, 9, 21 yrs. I oz. o dr.
66
66
""
""
6.
Stones weighing more than I oz.
•
>>
*C
པ
3
"}
<<
*
""
>>
,,
*
31
>>
>>
++
CC
""
(
****
>>
>>
66
25
20 10
TABLE X.
28
1030
10
19
O aço 1
I I
23
S
- 10
31+6J
1+
II
21
24
17
28
ΟΙ
I I
10
14
13
9
33
13
>>
>>
*
**
""
CC
<.
34
""
**
เ
"
+ C
CC
""
་
CC
""
לי
35
CA
CC
<<
*
3
པ
""
tr
I
~~ ~~24
I
I
2
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
13
,,
>>
་་
(C
..
CC
查看
​..
C6
BEST SE
6.
+6
>>
66
21
""
""
CC
""
*
>>
>>
>>
OH 337O
O 27
38
O 45
O
I
O
I
I
INN 2 2 MM ++
47
4
I
33
I 46
3
4
5
47
2 17
7
CC
""
<<
."
****
2 21
CC
>>
CC
>>
CC
<.
,,
>>
6.
3 12
""
6.
6.
cr
9gr.
66
(C
>>
??
38
34
40
37
42
36
48
12
Age, 17 yrs. 2 oz. o dr. 55 gr. I
47
I
13
I
22
I
I
Pour ou
Stones weighing over 2 oz.
ΟΙ
5
י,
46
""
37
>>
CC
""
6.
Ci
C6
,,
CC
>>
CC
CC
,,
CC
tr
CC
>>
$333
CC
Cases
>>
2 -
" OI
I
I
2
I
H
Sed
bad
>
Cases.
I
I
I
21
S
Deaths.
I
I
I

I
I
I
I
I
8

Deaths.
I
I
I
I
H
6 6
WORLD'S HOMEOPATHIC CONVENTION.
[10
Important as is the size of the stone in its bearing upon
the mortality and the sequelae, and hence upon the prog-
nosis, it bears no so direct relation to the age of the patient
as to admit of any positive conclusions. On the contrary,
we find the same class of stones in patients of the most
diverse ages; consequently, the size of the stone must de-
pend rather upon the duration of the case, upon the chem-
ical composition of the stone (it is well known that calculi
of the phosphate of ammonia and magnesia form rapidly and
become very large), and also perhaps upon individual dia-
thesis. If the conclusion that the size of the stone is
directly in proportion to the age of the patient is theo-
retically plausible, the conclusion that it is in direct relation
to the duration of the disease is both theoretically and prac-
tically true beyond question; and this is more important
than all the other elements of the question. The condition
of the entire urinary apparatus and of the whole organism,
as well as the prognosis, depends upon it. The character
and frequency of the sequela, and therefore the results of
the case, are governed by this element. It is to be regretted
that I am not able to state more exactly the duration of the
cases operated upon. They all belonged to the peasantry,
who lacked intelligence necessary to give an accurate, or
indeed any, history of their cases. This much is certain,
that many of them came into the world with a stone already
in the bladder, and that in many the duration of the disease
was five to thirty years.
From the preceding tables, based on the size of the stone,
we see that in
Table I. Stones less than 1 dr.
Between 13 and 8 years, 20 cases, 1 death,
Table II. Just 1 dr.
Between 1 and 8 years, 3 cases, 0 death,
Table III. Over 1 dr.
Between 2 and 40 years, 19 cases, 2 deaths,
Table IV. Over 2 drs.
Between 3 and 25 years, 22 cases, 3 deaths,
G
1:20
1:9.5
1:7
11]
URO-LITHIASIS IN RUSSIA.
Table V. Over 3 drs.
Between 21 and 30 years, 18 cases, 1 death,
Table VI. Over 4 drs.
Between 2 and 32 years, 11 cases, 2 deaths,
Table VII. Over 5 drs.
Adults,
Between 6 and 22 years, 12 cases, 3 deaths, =1:3.66
Table VIII. 6 to 8 drs.
Between 6 and 30 years, 11 cases, 2 deaths, 1:5.5
Table IX. 1 to 2 oz.
Between 6 and 28 years, 21 cases, S deaths. =
Table X. From 2 to over 4 oz.
CC
Between 13 and 58 years, 6 cases, 6 deaths, =
Of the 143 cases, with a total mortality of one in 5.1, or
19.58 per cent., there were in
Children, from 1 to 10 years, 86 cases, 9 deaths.
"C
((
(6
66
،،
11
66 15
11
66 58
17
28
29
S
(C
1:17
66
1:5
46
1:3
The proportion of children from 1 to 15 years to adults.
is as 114 to 29, or as 3.09 to 1. The relative mortality of
the former was as 1 to 5 or 17.54 per cent.; of the latter
as 1 to 3.62 or 27.58 per cent. But if we consider the size
of the stone without taking further account of the age of
the patient, we find the mortality much more dependent on
the former than on the latter; for we find in the first five
tables (not over 4 drs. weight) 7 deaths in 82 cases, or 1 in
11.71, or 8.53 per cent.; while in the three following tables
(VI., VII., VIII.) there are 7 deaths in 34 cases, or 1 in 4.85
or 20.58 per cent.—that is, more than twice as many. If,
still disregarding the age, we consider the last two tables
(IX., X.), the dependence of mortality on the size of the stone
is evident with a weight of from 1 to over 4 oz., we find
14 deaths in 27 cases-more than twice as many as in the
three preceding tables, and six times as many as in the first
five; that is, 1 in 1.92, or 51.85 per cent.
In all discussions, therefore, respecting the mortality of
the operation of lithotomy, the size of the stone must be
WORLD'S HOMEOPATHIC CONVENTION.
[12
taken into account as one of the most important of the
elements that determine the result of the operation.
The accompanying table [See Appendix D.] shows the
influence of the size of the stone on the mortality, with
the cause of this influence, by showing the relation of the
size of the stone to the sequelæ.
As regards the occurrence of sequelæ, this table shows
that tables I., III., IV., V., VI., VII., VIII. give the best
proportions, although the size of the stone is very different,
varying from less than 1 to 8 drs. in weight. In these
seven tables, of 113 cases there were sequelæ in 85, or 1 in
1.32, or 75.2 per cent. In the remaining three tables (II.,
IX., X.), on the other hand, there were 30 sequelæ in 30
cases, or 100 per cent. This apparent contradiction ceases
to be such, as soon as we take into account the character of
the sequelæ in the respective cases.
To make this more
evident, we show in the following arrangement the relative
frequency of the sequelæ located in those organs which
are directly involved in the operation:
Table I. 20 cases, 15 sequelæ, 1 cystitis, = 1 to 20 cases
and 1 to 15 sequelæ.
:
66
.6
66
66
S2 cystitis,
III. 19 cases, 15 sequelæ,
1 cysto-peritonitis,
1 to 6.33 cases and 1 to 5 sequelæ.
IV. 22 cases, 14 sequela, {1 cysto-peritonitis,}
3
VI.
1 to 5.5 cases and 1 to 3.5 sequelæ.
S 5 cystitis,
{
2 cysto-peritonitis,
1 to 2.57 cases and 1 to 2.42 sequelæ.
11 cases, 9 sequela, {2 Cysto peritonitis,}
1
V. 18 cases, 17 sequelæ.
1 to 3.66 cases and 1 to 3 sequelæ.
"VII. 12 cases, 10 sequela, 5 cysto-peritonitis,
1 to 2.4 cases and 1 to 2 sequelæ.
I cystitis,
“VIII. 11 cases, 5 sequelæ,
I cysto-peritonitis,
1 to 5.5 cases and 1 to 2.5 sequeìæ.
13]
URO-LITHIASIS IN RUSSIA.
Here the few cases embraced in Table VIII. seem to con-
tradict our affirmations.
Table II.
66 IX.
*
66
In these three tables, therefore, no case was free from
sequelæ, and in one-half of the 30 cases the sequelæ were
severe inflammations. Deducting the 3 cases of traumatic
fever of Table II., there remain 14 localized inflammations
in 27 cases, or more than one-half. But, in Table II., the
stones weighed 1 dram, while in Tables IX. and X. they
weighed from 1 to more than 4 oz.
The cases without sequelæ likewise confirm the statement
that the size of the stone must be regarded as one of the
most important elements of the prognosis. For we have in
Table I. 20 cases, 15 with sequelæ, 5 without, = 1 to 4
cases, 1 to 3 sequelæ.
(6
((
،،
เ
"(
3 cases, 3 sequelæ, none inflammatory.
( 3 cystitis,
21 cases, 21 sequelæ,
7 cysto-peritonitis,
I to 2.1 cases and 1 to 2.1 sequelæ.
X. 6 cases, 6 sequelæ, 4 cysto-peritonitis,
1.5 cases and 1.5 sequelæ.
(6
II.
III.
IV.
V.
VI.
VII.
= 1 to
3 cases, 3 with sequelæ, 0 without.
19 cases, 16 with sequelæ, 3 without, I to 6.33
cases, 1 to 5 sequelæ.
22 cases, 14 with sequelæ, 8 without, = 1 to 2.75
cases, 1 to 1.75 sequelæ.
=
18 cases, 17 with sequelæ, 1 without, 1 to 18
cases, 1 to 17 sequelæ.
11 cases, 9 with sequelæ, 2 without, 1 to 1.55
cases, i to 4.5 sequelæ.
12 cases, 10 with sequela, 2 without, = 1 to 6
cases, 1 to 5 sequelæ.
IX. 21 cases. 21 with sequelæ, 0 without.
X.
6 cases, 6 with sequelæ, 0 without.
Here, in Table VIII., comprising cases which seem to
have been remarkably favorable, we observe a proportion
similar to that of the inflammatory sequelae. Let us now
+
WORLD'S HOMEOPATHIC CONVENTION.
[14
consider the frequency of traumatic fever without local-
ization :
Table I. 20 cases, 15 with sequelæ, 11 traumatic fever,=
1 to 1.81 cases, 1 to 1.35 sequelæ.
3 cases, 3 with sequelæ, 3 traumatic fever,
1 to 0 cases, 1 to 0 sequelæ.
19 cases, 15 with sequelæ, 9 traumatic fever,
1 to 2.11 cases, 1 to 1.66 sequelæ.
IV. 22 cases, 14 with sequelæ, 9 traumatic fever, =
1 to 2.44 cases, 1 to 1.55 sequelæ.
18 cases, 17 with sequelae, 5 traumatic fever, =
1 to 3.6 cases, 1 to 3.4 sequelæ.
VI. 11 cases, 9 with sequelae, 4 traumatic fever,
1 to 2.75 cases, 1 to 2.25 sequela.
12 cases, 10 with sequela, 2 traumatic fever,
1 to 6 cases, 1 to 5 sequelæ.
11 cases, 5 with sequela, 2 traumatic fever, =
1 to 5.5 cases, 1 to 2.5 sequela.
IX. 21 cases, 21 with sequela, 6 traumatic fever,
1 to 3.5 cases, 1 to 3.5 sequelæ.
X. 6 cases, 6 with sequelae, 0 traumatic fever.
The unprejudiced observer will notice, notwithstanding
all variations in the tables, that the proportion of sequelæ
to cases increases much more directly with the size of the
stone than with the age of the patient. He will remem-
ber, also, that when the numerical method is employed to
determine the relative advantages of any mode of treat-
ment, we must take into account not merely the naked
numbers, but likewise the individual and concomitant
circumstances.
، ، II.
66
66
66
III.
66 VII.
66
V.
.. VIII.
66
The very history of the operation of Lithotomy demon-
strates the important bearing of the size of the stone upon
the prognosis and the results. What led surgeons to the
discovery of the various operative methods? Obviously, it
was the desire to make as large a wound as possible, that
the stone might pass out freely without causing contusious
and lacerations, which, of course, when they occur, result
15]
URO-LITHIASIS IN RUSSIA.
from the size of the stone. In part, however, they depend
also upon the duration of the disease; for the more elastic
the organic tissues through which the stone must pass when
extracted, the less will be the laceration and contusion.
But the longer these tissues have been exposed to chronic
inflaminatory irritation, the more they are histologically
changed and hypertrophied. We may, therefore, assume
that the greater the duration of the disease the less is the
elasticity of the tissues; the greater the consequent proba-
bility of contusion and laceration, and, therefore, of sequelæ,
and the more unfavorable the prognosis. It is not, there-
fore, the size of the wound (of course, within the limits of
anatomical possibility), but it is contusion and laceration
which constitute the danger of the operation; but even the
largest (possible) wound will not completely obviate these
dangers, if the requisite elasticity of the tissues be lacking.
I have often seen with great astonishment the extent to
which the bladder, the membranous portion of the urethra,
and even the prostate, may become thickened; and I have
a specimen of a bladder the walls of which are almost one
inch thick.
To many of my readers the preceding tables and argu-
ments may appear fruitless and unnecessary, inasmuch as
all surgeons have recognized the size of the stone and the
duration of the disease as the chief factors of the prognosis
and result. I have given much space to the study of the
mortality and frequency of the sequelae and their relatious
to the number of cases, in order that no question might be
thrown upon my statement of results. The unprejudiced
reader must judge of my success.
Fully to master the question, however, we must compare
our results with those of the old school; although, in
truth, our scanty material shrinks out of sight when placed
beside the colossal statistics which our opponents have for
centuries been gathering.
Sir Astley Cooper says: "The proportion of deaths to
cases operated upon, including all ages, is 1 to 8 (12.5 per
WORLD'S HOMOEOPATHIC CONVENTION.
[16
cent.")* Mühryt quotes a statement of Roux that, "the
general mortality of Lithotomy cases may be assumed to be
1 in 5 or 6 adults and 1 in 20 children." Civialet laid be-
fore the Academy of Sciences, Oct. 5th, 1835, statistics of
Lithotrity collected from the largest hospitals of Europe, in
which he showed that of 5,713 cases of Lithotomy, 1,141
were fatal, that is, 1 in 5 or 19.97 per ceut. In the Norfolk
hospital, in the course of sixty years, there were 704 cases
of Lithotomy, 35 of them in women; 611 recovered, 93
died; a proportion of 1 to 7.56 or 13.21 per cent. Another
calculation makes the yearly average of Lithotomy cases in
London 47, and in the rest of Eugland and Wales 64; both
together 111. It is estimated that one-fifth of these cases.
are fatal, as in Paris. Günther¶ gives an extended state-
ment of the results of Lithotomy according to the different
methods of operating, and also without reference to the
method. Here we see a variation of the relative mortality,
from 1 in 1.2 to 1 in 100. Taking from this collection of
statistics data covering a cousiderable number of cases for
a somewhat extended time, we find that:
1. In the Austrian states, during a period of 10 years,
there were 1,263 operations and 314 deaths, a proportion of
1 to 4.02; with me the proportion was 1 to 5.5.
2. In the Paris hospitals, for 10 years, according to Du-
puytren, 97 boys from 3 to 15 years old were operated upon,
with 9 deaths, a proportion of 1 to 10.77; with me it was
1 to 6.18.
3. Wattman, during 35 years, shows a proportion in
children of 1 to 11.3.
4. In the hospital for incurables in Naples, according to
Renzi, during 13 years there were 401 Lithotomy cases and
60 deaths, a proportion of 1 to 6.58.
*Sir Astley Cooper's Lectures on Surgery, edited by Lee, 1856, I. 343.
| Mühry: Darstellungen und Ansichten zur Vergleichung der Medizın in
Frankreich, England und Deutschland, 1836, p. 172.
‡ Ibidem, page 173.
§ Muhry, loc. cit., page 405.
¶ Günther: Lehre von den blutigen Operationen am Menschlichen Körper,
IV., 316.
17]
URO-LITHIASIS IN RUSSIA.
5. In the Norwich hospital, according to Morel, in 44
years there were 506 operations and 70 deaths, a proportion
of 1 to 7.23.
6. According to Dupuytren, the general mortality is as
1 to 5 or 6.
7. According to Souberville, 1 to 6 or 8.
8. According to Oesterlin ("Handbuch der Medicinsichen
Statistik, page 651"), the mortality after Lithotomy is "about
15 per cent., subject to great variations, according to indi-
vidual and other conditions." In 15 London hospitals
(1854-57), it was 21.5 per cent.; in 29 English hospitals,
only 12.1 per cent. ; in Glasgow, 14.4 per cent.
The mor-
tality also increases, in general, with the patient's age; but
is greater in children under than over five years. In cases
of phosphatic calculus the mortality is greater than in other
cases; indeed, it is in general proportion to the size of the
stonc. Of 6,369 cases collected by Coulson from the
records of many hospitals and countries, 958 died, a pro-
portion of 1 to 6 or 15.4 per cent. (In England alone, the
proportion was 1 to 7 or 14.3 per cent.) And while the
mortality of patients from 1 to 10 years old was only 1 in
13, and of those from 11 to 20 years 1 in 10; in those from
41 to 50 years old, it was 1 in 4.6; in those from 51 to 70
years old, it was 1 in 3.4, and in those from 71 to 80 years
old, it was 1 in 2.7.”
Günther says (1. c., page 317): "In the latter, appar-
ently very favorable statistics, the unfavorable cases seemed
to have been passed over," and I must myself raise this
question, especially since Bassoff** states the mortality, after
the bilateral operation, to be 1 in 4.68, and that, after the
lateral operation, in a total of 2,893 cases, to be 1 in 10.71.
The weight and size of the stones are given in 69 cases only,
which were submitted to a chemical analysis; it never
exceeded 3 oz. and 20 grains. In all the other cases, the
* De lithiasi vesica urinariæ in genere et in specie de extractione calculi per sec-
tionem perinæi, dissertatio medico-chirurgica, 1841.
2
WORLD'S HOMEOPATHIC CONVENTION.
[18
reporters failed to mention the size of the stone, and this.
makes the statistics of much less value.
H. Thompson and Bryant* agree with the view which
has been above expressed and, so far as the scanty material
permitted, demonstrated. They say: "The duration of the
disease determines the prognosis, which, moreover, is in
direct relation to the size of the stone." Thompson col-
lates 1,002 cases with 136 deaths, according to age. The
mortality, without regard to age, is 1 in 7; in patients from
1 to 5 years old (225 cases) it was 1 in 11. With me under
similar circumstances (20 cases) it was 1 in 20.
was 1 in 20. In patients
from 6 to 10 years old (179 cases) it was 1 in 30; with me
in patients from 6 to 12 years old (26 cases) it was 1 in 6.5.
In all the other cases, his results are more favorable than
mine, which is very natural, considering that his total num-
ber was more than ten times mine.
According to the reports of the University Kasan, there
were in the course of 30 years 259 operations and 48 deaths,
a ratio of 1 to 5.39.
It appears then from these citations, which, I must repeat,
are imperfect, inasmuch as the weight of the stone is not
taken into account, that the results of Lithotomy under
homoeopathic treatment are at least no worse than those of
the old school. The number of cases hitherto treated is
too small and our clinical material too scanty, to justify
positive conclusions. We confidently expect, however, as
a result of further investigations in the unlimited field of
our therapeutics, a favorable result for the subjects of this
operation, similar to that which has been attained in other
diseases, e. g. in pneumonia.
The cause of the formation of vesical calculus has long
interested physicians. Many excellent works have appeared
on the subject, none of which, however, not even the most
recent by Ultzmann, explains the wherefore, though they do
* Medicinische Neuigkeiten, redigirt von Prof. Wintrich in Erlangen. Jahr-
gang XIII., No. 11, p. 83.
19]
URO-LITHIASIS IN RUSSIA.
explain the how, of the formation of stone in the bladder.
As an example of the views that have been put forth on
this subject, I mention that Prof. Telatschitsch, in Kasan,
has ascribed the formation of stone in the bladder to the
use of sour-krout and quass* among the Russians, and he
states that, in the course of his long practice, he has never
seen a case of stone among the Tartars, who use neither
of the above named articles.
Mühry says that, "We often seek the causes of peculiar
endemic diseases in the soil, the drinking-water, the habits
or the food of the people; and yet the peculiar cause of
most of these diseases remains unexplained." Although
this may not be disputed, yet it cannot be a matter of in-
difference whether the chief nutrition of the organism consists
of albuminates or albuminoids, and whether the atmosphere
contain much or little ozone or be laden with paludal or
other exhalations, etc. Moreover, in looking for the causes
we should not confine ourselves to isolated circumstances,
overlooking concomitant and modifying conditions; for it is
often these very conditions that reveal to us the cause,
where it was not at first apparent. The conditions under
which a phenomenon occurs may constitute it a cause,
whereas, apart from these conditions, it could not be so re-
garded. We have an analogy to this in our selection of
remedies, where our choice is determined by the phenomena
and conditions jointly.
We propose, then, to investigate as far as possible the
phenomena and their conditions by which the occurrence of
Lithiasis may be explained.
The Government Nishny-Novgorod (between 54.14° and .
56.080 N. Lat., and 60.45° and 63.4° E. Long.) has an area
*A beverage, quite palatable when well made, prepared by fermentation
(sometimes effervescent) from rye malt, or sometimes from crusts of
bread.
The Government Nishny-Novgorod, and all below it on the Volga, are
thickly peopled with Tartars, "Tscheremishen Tschuwaschen" and "Mord-
winen."
Muhry: Dic Geographischen Verhältnisse der Krankheiten, page 3.
WORLD'S HOMEOPATHIC CONVENTION.
[20
of 923 square miles and a population of 1,262,913, or 1,367
to the square mile.*
-
It lies about 560 English feet above the sea, and although
the climate is very temperate, yet in consequence of ex-
tensive forests and large bodies of water, consisting of lakes,
rivers and swamps, the average temperature of Nishny-
Novgorod is lower than that of many other places in the
same latitude.
O
The Volga, the largest river of Europe, rises in the district
Astaschkow of the Government Trver, 840 to 1000 feet
above the sea, about 57.1 N. Lat. Its source is in the
midst of an almost inaccessible swamp, which was, proba-
bly, once part of an immense inlaud sea, occupying the
great Sarmatian plain. At first an inconsiderable stream,
the Volga is soon swelled by tributaries from a number of
lakes until, before it receives the outlet of the Seliger Sea, it
has become a navigable and stately river, having run a
course of 35 versts. From this point, where it has a
breadth of 20 Fadeus, it flows south-eastward over a wide
plain through a formation of quartz and limestone. The
shores are high and sandy. From its source to its entrance
into the Caspian Sea, the Volga has a length of about 485
miles. The current is sluggish; there are many sand-bars
and islands in it. The water is turbid, of a dirty yellow-
green color, charged with salts of lime and with organic
matter, visible even to the naked eye. Without suitable
purification it is not fit to drink, but, from the lack of better
water, it is generally used.
In the spring, the river overflows its banks for a distance
of ten or twelve miles, filling all the hollows and converting
the whole region into a colossal swamp which, in fact, never
thoroughly dries up.
A second large river of the Government Nishny Novgorod,
a tributary of the Volga, with banks of sand and limestone,
*
Calendar of Academy of Sciences.
Seven versts = one German mile,
+ One Faden = seven feet.
St. Petersburgh, 1872.
about four English miles.
=
21]
URO-LITHIASIS IN RUSSIA.
has a still more sluggish current than the Volga; and its
annual overflow likewise converts the plains and hollows
into swamps and stagnant pools. Besides these and numer-
ous smaller tributary rivers, there are many lakes which are
shallow, not navigable, with swampy banks generally of
wide extent. The total area of the lakes and rivers is about
175,000 acres, and that of the swamps about 400,000.
According to monthly tables, the mean annual tempera-
ture is +5° R.; the mean state of the barometer 751.
There are in the year 78 perfectly clear days, 84 partially
clouded, 61 completely clouded, 86 variable, 56 of snow or
rain. Spring begins in April; at the end of May and begin-
ning of June every thing is in blossom; the harvest begins
in August. In September come cloudy, foggy days, with
rain and snow. In November heavy frosts begin, and the
winter is generally clearer, healthier, and more enjoyable
than the other seasons. The prevailing wind is from the
south-west; gales are frequent in March, April, May, and
October. The rain-fall is abundant in spring and autump,
scanty in summer; the fall of suow, which begins in Sep-
tember, is very considerable, and continues at intervals
until April and May. Hail storms, with thunder, come
occasionally during the summer. Fog prevails from the
beginning of August to the establishment of winter.
With such a climate and soil, the atmosphere must be
poor in ozone and rich in vapor of water and in the gases
resulting from decomposition.
There is no complete geological description of the Gov-
ernment of Nishny-Novgorod. In the southern part there
are coal formations, with limestone, gypsum and dolomite,
belonging to the permian and triassic systems. These are
covered with diluvial and alluvial formations, forming lay-
ers of sand, sometimes 140 feet thick. There are also large
turf deposits, and much bog iron ore in the southern part.
Most of the inhabitants are Russians, of Slavic origin, geu-
erally strongly built and robust, inured by their mode of
life to hardships and exposure. There are also
There are also among the
WORLD'S HOMOEOPATHIC CONVENTION.
[22
inhabitants, Mordwinen and Tschuwaschen, Finns and Tar-
tars, of Mongolian origin, and whose customs and mode of life
differ much from those of the Russians. The dwellings of
the Russians are log cabins, the crevices stopped with turf, in-
closing a space of about 450 square feet and seven to eight
feet high. An immense stove occupies much of the room,
the floor of which consists of the mother earth, or boards
ill-fitted and covered with a straw matting. This room is
the dwelling-place of the entire family, which includes in
winter the young domestic animals, e. g. sheep, calves,
swine, fowls, etc. The fire in the large stove is kept up
day and night; the heat is often intense and the air of the
cabin detestable, the small and infrequent windows being
only exceptionally opened. The house has no chimney, the
smoke escaping through the windows and door, which the
residents open when compelled to do so.
The upper por-
tions of the room are therefore constantly full of smoke;
when airing it, therefore, they crouch upon the floor, and,
in this position, after being in an intensely heated atmos-
phere, are exposed to currents of cold air.
The clothing of the Russian peasants is of their own
manufacture, and generally insufficient. It consists of a
coarse linen shirt, a woolen coat and a sheep-skin, which is
often worn in summer as well as in winter. The feet and
legs are covered in summer with linen, in winter with
woolen cloths wound around them, and the feet protected
by shoes of the Lindenbast-of course, not water-proof;
they rarely wear boots. The women, at the most, have a
woolen gown and sometimes a sheep-skin over a coarse
chemise; their feet are protected like those of the men.
The children wear a shirt and go barefoot
The exceedingly strict religious observances of the Rus-
sians allow them animal food (meat, milk, eggs, butter)
only 167 days in the year; on the remaining 198 days they
live on a vegetable diet prepared with hemp or linseed oil,
and occasionally have fish. The observance of these 198
fast days has been for centuries, and is still, strongly en-
23]
URO-LITHIASIS IN RUSSIA.
forced as the chief means of salvation by the priesthood,
who are generally of a low culture; and is so ingrained in
the mind of the Russian peasant, that there could be in his
view no greater crime than to neglect a fast day. More-
over, meat, being a luxury and not easily attainable, is sel-
dom eaten even on feast days; bad husbandry makes milk
and butter scarce, and, in fact, the Russian peasant lives
mostly on a vegetable diet, consisting of bad rye bread, bar-
ley, buckwheat, millet, cabbage, red-beets, potatoes, and the
oil of hemp, linseed, or sunflower. The commonest drink of
the Russians, besides water and quass, is brandy, generally a
bad fusel-corn-brandy. Every opportunity is taken to get
drunk, and fatal poisonings with this abominable brandy are
of almost daily occurrence. One must have lived in Russia
to have an idea what an enormous quantity of brandy one
man can consume. The results are, of course, very sad;
for besides the specific effects of the fusel-alcohol poison, it
happens that every winter many hundreds are frozen to
death, or so injured by the cold that they lose one or more
extremities, not to speak of single fingers and toes. The
effects of alcoholism upon the mental and moral nature are
known to everybody; I need only say that this plague
infests a people inferior in intelligence and capacity for
culture to none in Europe. Another favorite beverage,
used only on high festivals, and peculiar to Nishny-Nov-
gorod, is a very palatable and highly intoxicating beer, pre-
pared from rye or barley malt, with a large addition of hops,
called "Braga." When taken to the excess which is char-
acteristic of the Russian peasant, and during a debauch
lasting often several weeks, it produces swelling, followed
by stiffness of the extremities. I cannot explain this phe-
nomenon, but have often observed it, and it is well known
to the peasants. A third beverage consumed of late years
in large quantities is tea. The Russians do not neglect the
care of the skin; they are in the habit of taking a vapor-
bath at least once a week, the construction of which, how-
ever, and the abrupt changes of temperature which it
WORLD'S HOMEOPATHIC CONVENTION.
[24
involves, make it rather a source of illness than a hygienic
measure.
The nurture of the children is worse than that of the
adults. The peasant women, who, in every respect, share
the life of the men, all nurse their children; but as this
takes time and is difficult, especially in summer, when they
are at work in the fields, the "sucking-bag" is in constant
use for nurslings. This sucking-bag, in its influence on
nutrition, is the most abominable apparatus that buman
brutality has ever contrived for the misery of the race.
Imagine a cow or ox-horn perforated at the end, to which
is attached a nipple cut from the udder of a slaughtered
cow; used often for mouths, never washed, and finally
becoming a disgusting, putrid, offensive mass. In this
apparatus, which is rarely washed, a ferment forms, which
at once makes the milk sour that is poured into it, even if
it was not sour before. The unhappy child has this appar-
atus continually in its mouth to keep it from crying, and
sucks away at it whether it be full or empty; taking in, in
the former case, the sour milk; in the latter, the septic
poison of the decomposing nipple, and with it the seeds of
an early and painful death. The following statistics, cover-
ing a period of ten years, from 1838 to 1848, show that this
is no exaggerated statement :
Children born in Nishny-Novgorod, males,
females
60
Died, males,
66 females
66
22,778
25,607
Total
29,059
28,303
57,362
48,385
Remained alive
8,977
That is only 15.65 per cent.; while the immense propor-
tion of 84.35 per cent. perished. If the child survives the
period of dentition, often even earlier, it shares its parents'
fare, and must, nolens volens, keep the fast days which are
25]
URO-LITHIASIS IN RUSSIA,
obligatory at the age of 6 to 7 years, although before that
age milk is allowed.
The results of such a physical (not to say bestial) educa-
tion must be evident, as well as the impossibility of profes-
sional help under such circumstances; and so, among the
Russian peasants, diseases otherwise unimportant become
serious, and easily surpass the resources of art.
The most prevalent diseases in a ten years' experience in
Nishny-Novgorod, arranged in percentage, are as follows:
Arthritis and rheumatism,
S.61 per cent.
Catarrh of respiratory, digestive and urinary
organs,
Chronic dermatoses,
Chronic ulcers,
Intermittents,
Secondary syphilis and mercurialism,
Uro-lithiasis,
6.89
9.01
5.20
2.90
1.91
1.35
66
66
66
66
61
66
Here the carbo-nitrogenoid constitution has a contingent.
of 30 per cent. and the hydrogenoid ouly 4.81 per cent.;
for secondary syphilis belongs rather to the sycotic form.
Considering, however, that, for so large an area and popula-
tion, ten years is much too short a period of observation,
and considering the dread which the peasants feel of a phy-
sician, especially an official one, and which makes them
only exceptionally seek his aid, when their condition is
beyond the resources of the village quack, a fact which the
small number of intermittent fevers in the above table
clearly shows, it is plain that the above statistical ratio
should be greatly increased.
The intermittents of all types which prevail in Nishuy-
Novgorod are peculiarly obstinate; and those which occur
in the autumn are generally quartans, which, treated in the
usual way (if treated at all), by being suppressed, favor the
establishment of the carbo-nitrogenoid constitution.
The mode of life of the Tartars is, in obedience likewise
to the precepts of religion, very different from that of the
23
WORLD'S HOMOEOPATHIC CONVENTION.
[26
Russians. In their houses, built like those of the Russians,
but much more carefully, the greatest cleanliness prevails.
They all have floors; the kitchen is separated from the
dwelling by a vestibule; domestic animals do not share the
living-room with their owners.
The food of the Tartars consists chiefly of meat; they
have no fasts, in the sense in which the Russians observe
them; and, even though they do not strictly follow the
precepts of the Koran, they consume much less brandy,
and very rarely use braga. Their clothing is better aud
more carefully prepared. Their children do not live in the
dirt, like those of the Russiaus, nor is their food so damag-
ingly poor in protein.
Having considered the external relations of climate and
mode of life, of the regions in which Uro-lithiasis is so fre-
quent, we must now, in order to come at our final results,
turn our attention to chemistry, physiology, and the doctrine
of the constitutions in v. Grauvogl's sense. On the
first view of the chemical constituents of the nuclei,
which must necessarily be regarded as the foundation of
calculus, we see that, with few exceptions, all consist of the
products of retrograde tissue changes: uric and oxalic acids.
and their combinations with lime, etc. We must, therefore,
pay especial attention to the circumstances under which
these substances occur in the organism and the changes
they undergo, as well as to the organs to which they are
related.
Chemistry and physiology teach us that uric acid is a re-
sult of the retrograde metamorphosis of nitrogenous tissues,
and that, by a further oxidation, it is converted into urea;
that it is, therefore, to be regarded as representing a less
complete stage of oxidation than urea. Since, however, it
is, for this reason, capable of further oxidation, it must be
regarded as an intermediate stage in the retrograde meta-
morphosis. It is, however, far from being established
whether free uric acid in the organism is to be regarded as
27]
URO-LITHIASIS IN RUSSIA.
a normal or a pathological product or as a result of decom-
position. Free uric acid is found in fresh urine just evacu-
ated from the bladder, only when there is formation of stone
or gravel; it is found also in the blood, in arthritis and
leucæmia.
By the action of a high temperature and ozone, uric acid
is converted into urea and we are justified in concluding
that when these two conditions fail, the further oxidation of
uric acid into urea does not take place.
There is an excess of uric acid in the urine when respira-
tion or pulmonary circulation is impeded, and when there
is any disturbance of interchange of elements in the organ-
ism, especially if it retard oxidation. The quantity of uric
acid, then, is inversely proportioned to oxidation. Accord-
ing to Barthez, in febrile conditions there is decrease of urea
and proportional increase of uric acid only when, with the
fever, there is disturbance of respiration.
According to Ranke, the spleen is to be regarded as the
organ in which uric acid is formed; and his observations
show that in Leutamia and enlargement of the spleen, the
daily formation of uric acid is absolutely, and relatively,
much increased. We know that, under normal conditions, the
uric acid in the organism undergoes a change by which its
nitrogen leaves the body as a constituent of urea, and a
part of its carbon as carbonic oxide and carbonic acid. The
experiments of Frerichs and Wöhler show that uric acid,
taken into the organism, is discharged as urea and oxalic
acid, but not as uric acid; and this is confirmed by another
experiment, viz., that, in the blood of dogs poisoned with
alcohol, oxalic acid is found toward the end of the intoxi-
cation.
Oxalic acid occurs in genetic connection with uric acid,
as a result of retrograde tissue metamorphoses. Its genetic
connection with uric acid consists in the fact that they oc-
cur together in the urine, and in its concretions; and that
the physiological conditions under which oxalate of lime
(the only form in which oxalic acid appears in the organ-
WORLD'S HOMOEOPATHIC CONVENTION.
[28
ism) appears in excess in the urine, are the same as those
which induce an increase of the uric acid, viz., a disturb-
ance of the material exchanges of the organism, and of the
respiration. It may be assumed, then, that oxalic acid, like
uric acid, appears in the urine because it has not been
further oxidized. The experiments of Frerichs and Wöhler
(injections of urates into the veins of animals) have shown
that an excess, not only of oxalate of lime, but also of urea,
in the urine results; from which we may assume that ox-
alic acid is one of the by-products of the formation of urea
from uric acid.
Excess of carbonic acid in the blood increases the oxalate.
of lime in the urine, which proves the origin of formed ox-
alic acid from diminished or impeded oxidation.
If we are justified in assuming that, within the normal
organism, the further oxidation of uric acid by its separation.
into urea, oxalic acid and allantoin (just as this takes place
under the action of ozone and hydrogen di-oxide), it is by no
means impossible that in abnormal conditions, this process
may be imperfectly performed and the oxidation of the uric
acid may not take place (Gorup Besanez).
What has been said forbids a doubt that the origin of
calcalous concretions is to be sought within the organism,
not in individual organs which simply co-operate in the
process, but in the blood which, under the influence of
internal and external conditions, undergoes a change of
quality. This view is confirmed by the fact that uric acid
is found not only in the blood, but also in many organs;
that the kidneys, therefore, are not the only organs in which
it is formed; that, indeed, it is not proved that it is formed
in the kidneys at all; for Strahl, Lieberkühn, Zalesky and
Garrod found that, after extirpation of the kidneys in
snakes, abnormal urinary deposits took place; and, still
more, after ligation of the urethra, which, however, is far
from proving the exclusive formation of uric acid in the
kidneys.
Moreover, with a few exceptions, of which we shall speak
29]
URO-LITHIASIS IN RUSSIA.
hereafter, the primitive formation of stone must necessarily
begin in the kidneys, which are the filters and organs of
diffusion for the separation of the urine from the blood.
This view is confirmed by the fact that, as is well known,
in early childhood the urine is very rich in uric acid, and
that the vasa recta of sucklings are often found full of urates,
which explains the prevalence of urinary calculus in chil-
dren; it likewise explains why small concretions not larger
than the lumen of the ureters are sometimes retained and
sometimes evacuated, and why, in some cases, there is a
formation of sand (gravel).
It is not to be assumed that exchange of elements and
the process of oxidation go on continually in the same di-
rection in unchanged progression, but rather that the energy
of these processes suffers oscillations of more or less, depend-
ing on external and internal vital influences, which likewise
experience various oscillations. An evidence of this is found
in the fact that the analysis of the urine serves as a physio-
logical criterion of relative nutrition and exchange of ele-
ments, and, therefore, of increased or diminished oxidation;
and likewise in the fact that the concentric layers of a
urinary calculus, while they may differ from each other in
composition, nevertheless must constitute a record of the
changes which have taken place within the organism.
Supposing, now, that, with a given plus of depression of
oxidation, and a similar plus of disturbance in exchange of
elements, a concretion is formed, at first necessarily small;
it is not impossible that, with a minus of the above-named
disturbance of oxidation and exchange of elements, the con-
cretion would be eliminated, or, at least, would not increase
in volume. For, with such a minus, the tension and energy
of the organism would increase; and the quality of the
layers of the calculus proves to us that these minus periods
may be very long.
If, under the above circumstances (depression and disturb-
ance of oxidation and element-exchange), a small renal con-
cretion has formed, and if these circumstances continue in
A
WORLD'S HOMEOPATHIC CONVENTION.
[30
the same direction, the concretion grows in the place where
it was formed and becomes a renal calculus. If, on the
contrary, oxidation increases, and the disturbance of element-
exchange ceases (of course, within reasonable limits), as,
e. g. in consequence of exchanging an atmosphere contain-
ing but little ozone for one rich in ozone, or of adopting a
diet rich in protein, the energy and tension of the organism
increase, the concretion leaves the place in which it is
formed,—the kidneys,-passes into the bladder, and, if there
be no mechanical hindrance, leaves this organ or may be
retained in it, or more rarely in the urethra, until, under a
recurring depression of oxidation, it becomes larger in con-
sequence of simple juxtaposition with the substances con-
tained in the urine. In this way the presence of several
stones in the bladder, or, what is often enough observed,
of stones occurring simultaneously in the bladder and kidney,
is explained. The current names of calculi, according to the
place in which they are found, are, therefore, strictly, of no
value; and although it is now generally believed that concre-
tions may form in various parts of the body, yet, wherever
formed, the process is, as we shall see, essentially the same.
We have hitherto considered the manner and locality of
the formation of stone; let us now consider the cause.
There are, says v. Grauvogl, diseases which are actually
accompanied by diminished excretion of carbon and nitro-
gen, such as pulmonary catarrh, exanthems, etc. We know
that such sicknesses are sometimes inherited, sometimes
occur as sequelæ, and sometimes result directly from exter-
nal causes, such as frequent use of alcoholic drinks, insuffi-
cient diet, residence in bad air (poor in ozone), suppressed
intermittent fevers, etc., etc. These causes retard the oxi-
dation of the blood and produce an accumulation of carbon
and nitrogen; a result of this deficient oxidation is that the
nitrogenous tissues are no longer oxidized so as to form
urea, but are excreted as uric acid. The chronic diseases
which make this constitution (the carbo-nitrogenoid) possi-
ble are processes of retention.
31]
URO-LITHIASIS IN RUSSIA.
If we now recur to what has been said of the mode of life
of the Russiaus and the Tartars, and of the substances which
form the diet of these two races, we find no difficulty in
understanding why the Tartars are free from Uro-lithiasis.
We shall also see the correctness of the conditions which v.
Grauvogl states to be the chief factors of the carbo-nitro-
genoid constitution.
Dr. R. Arnoldoff, of Simbirsk* on the Volga, who is not
a Homœopathist, and can therefore have no notion of v.
Grauvogl's "text-book," speaking of diet as a cause of
Lithiasis, says: "On the one side, we see a great accumu-
lation of vegetable acids in the organism; on the other, in
consequence of febrile conditions, of affectious of the respi-
ratory and digestive organs, of inhalation of bad air-a defi-
cient oxidation of the blood; that is, we see on the one
hand every thing which would increase the quantity of
vegetable acids in the organism, and on the other hand
every thing that could favor the excretion of uric acid."
When the observations of men unknown to each other,
living in different quarters of the globe, lead them to the
same conclusions, both observations and conclusions are of
great value.
It is hardly necessary to call attention to what is so
clear the agreement between the chemico-vital processes
of the carbo-nitrogenoid constitution and those of the for-
mation of stone; we simply remind the reader that the reten-
tion-processes involve retention-products. If acid fermen-
tation of urine stands in causal relation to stone-genesis,
and if, as Scherer has shown, the fermentation of urine
(outside of the body) depends upon the formation of a fun-
gus similar to that of yeast, it may not be too bold to
assume that in this constitution a similar process within
the organism—that is, in the blood-precedes the formation
of urinary concretions, inducing a low form of pyelitis
catarrhalis. The fact that, according to Ultzmann, of seve-
* Journal of the Society of Homeopathic Physicians, St. Petersburgh, III., 6,
171.
WORLD'S HOMEOPATHIC CONVENTION.
[32
ral hundred urinary concretions, spontaneously discharged,
not one consisted of earthy phosphates, leads to the neces-
sary conclusion that only such concretions form in the kid-
neys as are composed of the constituents of acid urine;
and the views above expressed make this observation more
thau probable.
Inasmuch, moreover, as uric acid must be regarded as an
intermediate step in retrograde tissue metamorphosis, or as
an arrested formation, we can understand that, under favor-
able internal and external conditions, retention-processes,
and consequently retention-products, may easily occur. Dr.
Arnoldoff (/. c.) recognizes in the lime (especially the phos-
phate) contained in the soil and drinking-water, and like-
wise in the diet, overcharged with vegetable and lactic acids,
of the Russian peasants, and particularly of their children,
the chief conditions of the formation of stone. Without
denying that these conditions may contribute to the forma-
tion of stone, we can concede to them only a subordinate
value as favoring elements. For, the mode of life of Rus-
sian peasants, and especially of their children, is pretty
much the same everywhere; many provinces of Russia, as
for example Orel and Kursk, have extensive deposits of
phosphate of lime; and yet, in these provinces, Lithiasis is
very rare. We must, therefore, accept without doubt the
view that the formation of stone begins only when, by vir-
tue of all conditions depending upon diet, regimen, climate,
and atmosphere, the carbo-nitro-hydrogenoid constitution
has perverted the normal vital chemistry of the organism.
It is known that Thein is converted, in the organism, into
uric acid, and it would be equally reasonable to regard ex-
cessive use of tea as one of the causes of the formation of
stone.
We must here mention a noteworthy circumstance, that
the constitution of human urine, during Uro-lithiasis, most
resembles that of birds and serpents. The latter is well-
known to be rich in uric acid and urates; that of birds con-
sisting chiefly of acid urate of ammonia, urate of lime and
33]
URO-LITHIASIS IN RUSSIA.
free uric acid. Human urine contains free uric acid only
in Lithiasis.
We have seen that uric acid is found, and is said by
Ranke to be formed, in the spleen; and we have observed
that in Leucæmia, with enlargement of the spleen, the daily
average of uric acid is absolutely and relatively increased.
Whether this observation would justify the conclusion that
the formation of uric acid is a physiological function of the
spleen, or whether this is to be regarded as a pathological
process, we shall not undertake to determine; the fact suf-
fices for our purpose. We know that splenic as well as
lymphatic Leucemia belongs to that form of sycotic dis-
eases which v. Grauvogl has included in the hydrogenoid
constitution, characterized by hygroscopic blood, or by an
undue proportion of water in the blood, and by mucous
formations.
When, says v. Grauvogl, we are seeking the causes of
chronic diseases, we must not forget that these are not to
be found in a something absolutely foreign to the organism,
but rather in a plus or minus of those elements which
furnish the material for building up the organism; that this
material depends not only upon an inborn inherited dispo-
sition, but also upon the mode of life, and especially upon
the character of the atmosphere and its changes; and that
a special consideration of these circumstances is of the
greatest importance in the construction of a truly rational
pathology and therapeutics.
If we now go back a little and consider the circumstances
-mode of life, climatic and atmospheric conditions and in-
herited disposition-in which the patients of whom we are
speaking live, we must confess that they favor the produc-
tion of the hydrogenoid constitution; and we are justified
in concluding that the origin of urinary concretions must be
referred to a complex pathological condition such as v.
Grauvogl has described as the carbo-nitrogenoid and the
hydrogenoid constitutions.
If, as is generally admitted, urinary concretions are formed
3
WORLD'S HOMEOPATHIC CONVENTION.
[34
by the cohesion of their smaller particles, through some
connective matter, the hydrogenoid constitution furnishes
us this connective material in the mucus-like substance to
which it gives rise; we might almost then say that urinary
concretions—perhaps concretious in general-occur only
when external and internal conditions have produced a
combined carbo - nitrogenoid and hydrogenoid constitu-
tion. If, on the other hand, the predisposing conditions—
diet, mode of life, climate, and atmosphere-do not favor
such a combination, we have a formation, not of stone, but of
gravel; the latter being a purely carbo-uitrogenoid process,
the former a carbo-nitro-hydrogenoid. The fact that, during
a ten years' (in this direction) pretty active practice, in a
region in which urinary calculus is very common, I saw, lit-
erally, not a single patient suffering with gravel, may
be re-
garded as confirming these views. It is true, I operated on
only 143 patients; but I examined more than double that
number, for not every one consents to the operation, and
the Russian peasants have a great dread of the knife.
Moreover, the chemical constituents of urinary calculi are
essentially the same as those of the urinary deposits excreted
in fever, inflammation, rheumatism, gout, etc.; and fevers,
especially intermittents, in which there are always urinary
deposits, occur in precisely those constitutions which are
distinguished by enlargement of the spleen and hygroscopic
blood. Intermittents, moreover, are particularly apt to
occur under such climatic and atmospheric conditions as are
characteristic of regions in which urinary calculi are common,
viz., frequent sudden changes of temperature, prevailing
cold weather, moist marsh-air poor in ozone, and, in con-
sequence of all these, depressed activity of the skin. In
consideration of all these facts, the co-operation of this
constitution in Lithiasis is easily understood.
graphical distribution of Lithiasis confirms what has been
said. The localities which most abound in swamps have
furnished us the greatest number of patients with stone; for
example, the district Balachna, and in it the villages Maloje
The geo-
35]
URO-LITHIASIS IN RUSSIA.
and Bolschoje, (little and great) Kasino, both of which lie
in and are surrounded by swamps; also the district Gorba-
tew, and in it the village Pawlowo, close on the shore of the
Oka, and surrounded by a marsh.
The question now presents itself: Do these investigations
bring us any nearer to our object, the prevention and cure
of Lithiasis? for we do not call an operation a cure. We
reply, unhesitatingly, Yes! The problem is simply to
choose among the remedies, which, mutatis mutandis, corre-
spond to the constitution in question, that which, according
to the law of similarity, best suits the individual case; and
to remove injurious predisposing causes which play
portant a part in Lithiasis. We know therefore, positively,
where to look for curative and prophylactic remedies,
and we know what injurious elements must be avoided.
Whether all this is attainable is another question; for cli-
mate and atmosphere cannot be changed by magic, nor a
population of several millions removed nor improved in
morals and culture. It is enough, for the present, to
have indicated the way to attain our object, and to have
proved its possibility. Whether a urinary calculus already
formed can be removed from the organism by therapeutic
means is a question which, for the present at least, must be
postponed, but by no means regarded as beyond the hope
and possibility of realization—a statement which, to those
who are familiar with the present position of Homœopathy,
will not appear too sanguine.
According to Ultzmann's researches, it appears, as he
himself says, that the formation of stone begins in the kid-
neys. For 93.8 per cent. of the 886 calculi examined by
him belonged to this category; and his classification of
calculi according to their chief constituents must be re-
garded as a very rational one. He assumes, and correctly
(until the contrary be proved), that calculi resulting from
alkaline fermentation of urine are formed in the bladder.
According to his classification, all calculi are divided into
two categories, viz., those composed of the constituents of
WORLD'S HOMEOPATHIC CONVENTION.
[36
acid urine, and those composed of the constituents of alka-
line urine. There must, therefore, be calculi which are
formed in the bladder, when, by some pathological process,
the urine becomes decomposed and the alkaline fermenta-
tion is established; and we must regard as a subdivision of
this category such stones as form upon a foreign body as a
nucleus, such as a fragment of a catheter, a needle, or a
mass of mucus or blood.
These facts in no way contradict our proposed explana-
tion, based on constitutional conditions. We often observe
chronic catarrhal and inflammatory diseases of the bladder,
as well as such as result from spinal affections, in which
quantities of mucus are secreted, and there is long-continued
retention, or scanty and difficult emission of urine, and con-
sequent alkaline fermentation, as, for example, in stricture
and enlarged prostate. Moreover, hæmorrhages of the
bladder and the kidneys are not infrequent. Now, if these
affections were really a chief element in the formation of
vesical calculus, then Uro-lithiasis ought to be a ubiquitous
disease. It is not so, however; for Mulry says, in his
Elements of Noso-Geography," There are some special dys-
crasias which occur in every zone, not distributed, however,
over the whole area, but occurring in scattered groups, as,
for example, Strumosis and Uro-lithiasis; the latter has nests
here and there, and we are not able to explain the reason of
this." (Pages 79 and 113.) It is more than probable that
if we investigate all the circumstances and conditions of
these "nests," we should come upou just such conditions as
we have heretofore pointed out, and should thus attain the
desired explanation. Touching the size of these "nests,
it should be said that the region in Russia where we know
that Lithiasis abounds, covers a very considerable area, and
could not properly be called a "nest."
The provinces
Nishny-Novgorod, Kostroma, Wladimir, Taraslow and
Kazau, in all of which Lithiasis abounds, cover an area of
at least 6,000 square miles; and they are not the only ones
in which it prevails.
37]
URO-LITHIASIS IN RUSSIA.
Without wishing to deny the prevailing view of the
formation of stone in the bladder, we must say that it is
evident that there must be something besides the hitherto
recognized conditions necessary to the formation of stone;
and this something we believe we have found in the "consti-
tutions" described by v. Granvogl, and in the conditions and
circumstances which produce these constitutions. In this
connection we must mention that Virchow has found urate
of ammonia in the renal pyramids of new-born children, and
that, in one class of calculi, the nucleus of which is urate of
ammonia. 84 per cent. of the cases were children. Finally,
according to our observations, the formation of concretions
in the kidneys begins in fetal life, dependent, therefore,
certainly upon the constitution of the mother.
Experiments upon animals, such as are subject to Uro-
lithiasis, might inform us how the formation of stone occurs
in the bladder after the introduction of foreign bodies, and
whether it always occurs. It is a wonder that such experi-
ments have not already been made.
The female sex enjoys a relatively great immunity as re-
gards Uro-lithiasis. Of 143 cases operated on by me, three
were in females. One reason of this difference between the
sexes may be the anatomical diversity of the urinary organs,
but this is certainly not the only reason. This immunity, like
Lithiasis itself, may depend on many conditions; menstrua-
tion, pregnancy, lactation, and probably also upon a some-
what modified vital chemistry. This is a field of research
uncultivated, promising, and which belongs to the future.
I need not say that what has here been offered to the reader
does not claim to be an exhaustive treatise on the subject.
Such a work would far surpass our object and our limits.
It will suffice if we have given an outline of the subject,
and we should rejoice if it furnish an impulse to continued
and more thorough research.
WORLD'S HOMEOPATHIC CONVENTION.
[38
72
21
2
22
H
6
II
2
Janeļ
I
3
2
I l
40-58
28-32
21-23
2
I
I
I
H
Awww Aw aw Nuwan - Dow55
I
I
17
15
I
2
I
14
13
I
I
2
I
O
I
2
2
I 2
I
I
I
11
I
I
ΟΙ
NO C
I
I
I
I
2345O DR
I
2
2
2
3
I
6
2
I
I
1½
I
I
Age.
Number of cases.
Without reaction.
With't reaction; sub-
sequent intermittent.
Traumatic fever.
Traumatic fever and
erysipelas.
Traumatic fever and
pneumonia.
Cystitis.
Cysto-peritonitis.
Cysto-perit. and
œdema.
Cysto-entero-perit.
Peritonitis.
Acute purulent
oedema.
Typhus.
Died.
APPENDIX A.

39]
URO-LITHIASIS IN RUSSIA.
143 27
2 52
I
I
II
4
22 4
=
6
در
I
N
I 2
I
228
17
15
14
13
40-58
28-32
19-27 13
I
I
N
2
2
دی
1
2
2
2
12
دا
5 I
mtio Noo ooo
I
2 3× 12
2
II
2
5 2
JOJON N
II
I
4
12
Jak
I
3
NGWA
8 2
WNN US
II 2
II 3
I
I
ไ
2-2 10
3 I
I
J
I-FI
-
2
Age.
Number of cases.
No reaction.
No reaction; intermittent.
Traumatic fever.
Traumatic fever and erysipelas.
Traumatic fever and pneumonia.
Cystitis.
Peritonitis.
Cysto-peritonitis.
Cysto-perit. and acute purulent ædema.
Cysto-entero-peritonitis.
Acute purulent ædema.
Typhus.
Cysto-renitis.
Abscess and fistula.
Marasmus.
Phlebitis and pyæmia.
Tetanus.
Eclampsia.
Hæmorrhage.
Died.
APPENDIX B.




WORLD'S HOMEOPATHIC CONVENTION.
[40
No reaction; subsequent intermittent.
Traumatic fever; no localization.”.
Traumatic fever; subsequent erysipelas.
Traumatic fever; subsequent pneumonia.
Cystitis.
Peritonitis
Cysto-peritonitis.
Cysto-peritonitis, with acute purulent œdema
Cysto-entero peritonitis
Acute purulent oedema
Typhus
Cystorchitis.
Abscess and fistula.
Marasmus
Phlebitis and pyæmia.
Tetanus
•
•
Eclampsia.
Hæmorrhage.
•
•
APPENDIX C.
•
•
Cases.
"
22
+
2
51 51
I
I
I
I
!ï
I I
3
II
2
I
639
Recovered.
2
I
2
I
I
2
21
2
2
I
2
I
116 SS
Died.
I
II
2
3
I
2
I
I
I
28
WORLD'S HOMEOPATHIC CONVENTION.
[42
Age.
2
1½ I
1½
I
I 3/4
I
2
I
2 2 2 2
2
2/2
22 233
22
22
NTN
3
3333
Male.
I
I
I
1
I
Sex.
1
I
I
I
I
1
I
1
I
Female.
TABLE OF OPERATIONS, ARRANGED ACCORDING TO THE AGES OF PATIENTS.
No. of stones.
I
-
I
I
I
I
I
I
I
1
LH H
I
I
I
I
I
I
I
2
Ounces.
Weight.
Drams.
I
I
3 29
46
2
Grains.
I
5
43
29
43
23
I 47
I
☺ fooww
53
45
5
40
31
18
50
37
23
Operation.
Lateral.
Bilateral..
66
66
"C
(C
66
(6
"6
64
<<
Lateral.
66
"
66
Bilateral..
66
66
<<
Days.
27
21
784
18
2 4
21
22
90
23
WONN
35000 m
~~~~~ 2 14 3 3 0 0 0 A
25
38
29
24
45
30
28
Recovered.
Sequelæ.
Traum. fever; no localization.
No sequelæ..
raum.
Traum. fever; no local
"6
(6
CC
(6
Cysto-peritonitis, superficial
gangrene of wound, long
suppuration, slow conval.
No sequelæ..
Traum. fever; no local
"
"C
C
"C
(C
66
.
£6
CC
Trm. fever; erysipelas penis,
scroti et pedis dextri.
Traum. fever; no local.
66
"C
46
Hæmorrhage, 6th day.
· ·
↓
•
•
·
•
• ·
U
•
•
O •
No sequelæ
Cysto-peritonitis and super-
ficial gangrene of wound.
Traum. fever; no local.
No sequelæ.
67 Traum. fever and pneumonia.
66
66
no local.
•
·
Days.
انه
Died.
Cause of Death,
and
Autopsy.
Tetanus
REMARKS.
Broken during extraction.

43]
URO-LITHIASIS IN RUSSIA.
33
3
3
4
4
4
4
4
4
4
4
4
in in nunoo
6
I
Ι
I
I
I
I
I
1
I
I
I
I
I
I
I
I
Ι
I
I
Ι
I
I
I
I
I
I
I
2
I
2
I
I
I
I
I
I
I
I
1 2
I
I
2 2
2
3
121||
I
T
در
232 ~ ~ ~NO
2 2
12
I 52
42
17
4
I 8
15
30
2
38
6
46
52
33
16
51
18
6
2 II
39
2 35
3 53
Bilateral...
4
54
"C
<<
38 Lateral.
16
<<
*
66
66
<<
..
CC
"C
(6
(C
Bilateral..
Recto-
› vesical
Bilateral.
Lateral.
(6
66
-
Bilateral..
"
"
66
Lateral.
•
•
36 | No sequelæ
cs of co
47
38
36
N N N we co
56
32
28
21
29
60
18
74
70
29
28
34
36
22
29
72
28
21
29
Traum. fever;
no local.
Cysto-peritonitis and partial
gangrene of the wound.
Traum. fever; no local
No sequelæ.
Traum. fever; no local
CC
<<
CC
CC
{
CC
"C
(6
"C
CL
(C
(C
CC
(C
(6
Acute pur. oedema; partial
sphacelus of scrotum and
wound
No sequelæ.
Cystitis, abscess of scrotum,
and fistulæ
Cystitis, phimosis, and abscess
of scrotum
No equelæ
No sequelæ; tertian inter-
mittent during convales'ce
Traum. fever; no local.
(C
CC
<<
(C
(C
•
66
·
•
No sequelæ
Cystitis; erysipelas of scrotum
Traum. fever; no local.
No sequelæ.
Peritonitis
33
Cysto - perit.
& marasmus.
2½ Eclampsia.
6
Cysto-perit.
Stone flat, tabular, strongly
adhering to bladder.
Crumbled during extraction.
Stone wedged fast in neck
of bladder.
Complicated with stricture
of urethra,which delayed
recovery; treated with
bougies and completely
removed.
Almost in agony when
brought to hospital; op-
erated only at urgent re-
quest of parents.
WORLD'S HOMEOPATHIC CONVENTION.
[44
Age.
6
6
6
6
6
6
6
6
6
~~~~∞∞
7
Male.
Sex.
I
I
I
I
I
I
I
TABLE OF OPERATIONS, ARRANGED ACCORDING TO THE AGES OF PATIENTS—Continued.
I
-
Female.
No. of stones.
I
I
I
I
3
I
I
I
I
I
I
I
Ounces.
I
I
Weight.
Drams.
2 14 Lateral.
5
2 19
4 52
3
Grains.
2
2 21 Bilateral... 76
7
2
12
26
38
I I
38
12
am too
40
Operation.
33
I 4
CC
"C
"
Recto-
vesical
Bilateral..
46
"C
66
Lateral.
..
66
Bilateral..
38 Lateral
·
}
Days.
•
32 Traum. fever; no local.
Cysto-peritonitis; superficial
gangrene of wound; long
suppuration;
slow conva-
lescence; great debility
Traum. fever; cysto-peritoni-
tis; superficial gangrene of
wound
No sequelæ
Cysto-peritonitis; superficial
gangrene of wound; slow
convalescence.
No sequelæ.
39
57
66
14
23
233 23
36∞
36
38
27
32
31
50
121
Recovered.
66
Sequelæ.
Traum. fever; no local
(6
"C
<<
66
• ·
No sequelæ.
Traum. fever; no local.
66
66
"C
CC
• •
"C
.
hæm'ge 5th day.
no local.
"6
Abscess of scrotum, and fistula.
Days.
10
{
Died.
Cause of Death,
and
Autopsy.
Acute
œdema.
pur.
REMARKS.
Stone wedged in neck of
bladder; crmbl'd on extrac.


45].
URO-LITHIASIS IN RUSSIA.
1
∞
8
8
8
8
8
∞ ∞ ∞
8 I
9
9
9
9
9
10
IO
10
10
IO
IO
10
IO
IO
10
I
I
10
Ι
Ι
I
I
I
I
1
I
I
I
I
I
I
1
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
32
I
I
I
I
I
HH
I
4H
I
3 16
5 48
2
HH 452 46
Ι
24
5
I 46
50
LONDON 22
5 48
526 +mind
I
12
23
23
523
I 20
20
9
5 48
50
IO
42
49
Bilateral..
CC
CC
CC
66
(6
(C
(6
CC
KE
<<
66
CC
66
*C
66
Lateral.
"
Bilateral..
(6
(C
66
3 33 Lateral
18
66
3 47 Bilateral..
30
23
29
35
25
int : coco
38
32
71
28
29
34
44
30
27
45
23
90
Traum. fever; no local..
"C
(C
66
Cystitis and superficial gan-
grene of wound.
Cysto-peritonitis.
Traum. fever, and light cysto-
peritonitis.
Traum. fever; no local..
No sequelæ..
Traum. fever; no local
No sequelæ.
Traum. fever; no local
No sequelæ.
Traum. fever; no local
No sequelæ.
Traum. fever; no local
"C
CC
<<
Traum. fever; no local
No sequelæ.
n..
❤
• • •
.
D
•
▸
•
•
•
• •
·
·
❤
·
→
•
►
•
•
No sequelæ.
Traum. fever; no local.
66
(6
(C
Traum. fever, cystitis, super-
ficial gangrene of wound,
long suppuration, very scrof-
ulous subject.
2
↓
+
•
►
∞
Cysto-perit.;
gangrene of
genitals to
above sym-
physis..
7 Cysto-perit
19 Marasmus
4
Perit. & gangr..
Stone crumbled on extract'n.
Almost in agony when
brought; a small stone
had closed the urethra ;
urine retained four days;
bladder distended above
symphysis. To remove
stone enlarged orifice of
urethra; much bloody
urine. In one week a
second stone removed by
operation. No febrile re-
action; rapid marasmus.
WORLD'S HOMEOPATHIC CONVENTION.
[46
Age.
II
II
I I
II
II
= 22
II
12
12
12
13
333
13
13
*[LI[
Sex.
I
I
I
Ι
I
I
I
I
Ι
I
I
TABLE OF OPERATIONS, ARRANGED ACCORDING TO THE
ACCORDING TO THE AGES OF PATIENTS-Continued.
I
I
Female.
No. of stones.
1
I
2
I
2
I
I
I
I
I
I
Ounces.
I
4
Weight.
Drams.
232 IN
I
5
536
43
Grains.
4
13
2 7
2
7 24
32
17 Lateral.
33
553
30
39
40
Operation.
14
42
35
IO
Bilateral.
66
Bilateral..
66
"C
66
Lateral.
Bilateral...
C
""
((
((
Recto-ves.
·
1
Days.
28
24
85
49
55
42
45
ma
Recovered.
66
No sequelæ.
Traum. fever; no local
CC
66
66
Sequelæ.
66
66
No sequelæ.
Peritonitis
Traum. fever; cysto-peritonitis
and superficial gangrene of
wound.
30
44
35
29 No sequelæ...
No sequela; tertian intermit-
tent in convalescence.
Acute pur. ædema; gangrene
of wound
Cystitis; traum. fever
}
}
Days.
13
3
25 1
Died.
Cause of Death,
and
Autopsy.
Cysto-perit.
{
Acute purul't
oedema....
Cysto-perit. and en-
teritis, ending in
-
REMARKS.
marasmus.
AUTOPSY. -Exu-
dation on serous Stone crumbled.
coat of small in-
testines, causing
them to cohere ;
walls of the blad-]
der thick as the
finger and cartila-
ginous; kidneys
dilated, saccu
lent; the cortical]
substance gone;
the calices disor-
ganized, full of
fine sand.
•
Stone crumbled.
(AUTOPSY. - Inflamed, en-
larged liver; hypostatic
pneumonia, with fluent
tubercles very abundant;
yellow serum in right
pleural cavity; much per-
itonitis; kidneys much
hypertrophied and dilat-
ed; Bright's disease; ure-
ters as large as finger;
bladder callous and car-
tilaginous.
One-half the stone engaged
in the bladder and adher-
ent; at this spot two deep
furrows; the stone one-
third as thick.
47]
URO-LITHIASIS IN RUSSIA.
13
13
13
13
14
14
14
14
14
14
14
450107
14
15
15
17
17
}
I
ι
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
2
Ι
40
7 37
3
I
2
4
2 3 5 Lateral.
5 28
3
18
I
6 40
47
4 42
2
35
7
3-67
2
43
13
Bilateral..
M
"C
7 25
I 3 32
Recto-ves..
(C
CC
((
12 Recto-ves
Bilateral..
૬
(6
+
Bilateral..
(6
CC
፡፡
Lateral
• ❤
·
21
61
61
56
55
142
wow.co
48
37
90
32
No sequelæ..
Cystitis and traum. fever.
Cysto-peritonitis and superfi-
cial gangrene of the wound.
Peritonitis
Traum. fever; no local.
Cysto-peritonitis; acute pur-
ulent oedema; slow con-
valescence
Traum. fever; no local.
(6
"
"C
(6
No sequelæ.
...
66
.6
2
3
2
2
2
33
1
Acute pur.
œdema.
Cysto - perit.
and paraly-
sis of lungs.
Cystitis &
acute pur.
oedema...
do.
Cysto-perit
and gangr. S
Cystitis, per-
itonitis, ma-
rasmus.
Stone crumbled.
Stone wedged fast in neck
of bladder; crumbled.
AUTOPSY.-Kidneys dilat-
ed and sacculated;
Bright's disease; cortical
substance much inflam-
ed; peritonitis and acute
purulent oedema in the
pelvis.
-
AUTOPSY.-Sacculated, di-
lated, softened kidneys;
bladder thickened; acute
pur. œdema in the pel-
vis.
Stone entangled in false
membrane and crumbled.
Stone smooth and so im-
bedded in the bladder-
though not adherent-as
to be more easily found
through the rectum than
with the sound.
Stone crumbled.
A
WORLD'S HOMECPATHIC CONVENTION.
[48
Age.
17
17
17
17
19
21
21
21
22
Male.
I
I
I
I
I
I
1
TABLE OF OPERATIONS, ARRANGED ACCORDING TO THE AGES OF PATIENTS-Continued.
Sex.
}
Female.
No. of stones.
I
I
I
Ι
I
T
Ounces.
2
I
2
Weight.
Drams.
Grains.
3 59
7 3
55
4 40
45
2
9
I 12
38
346
Operation.
Lateral
Bilateral..
66
66
Lateral..
CC
Bilateral..
66
CC
·
Days.
35
50
Recovered.
38 No sequelæ
39
Sequelæ.
Traum. fever; no local
66
(C
66
Traum. fever; no local.
Days.
42
3
∞
17
7
Died.
Cause of Death,
and
Autopsy.
Cystitis, per-
itonitis, ma-
rasmus..
Cysto-perito-
nitis and
gangrene.
•
Gang., phle-
bitis, pyæ-
mia.
Cysto-perit.;
gangrene of
wound; pa-
tient reduc-
ed by long
suffering...
Hæmorr❜ge,
cystitis, per.
itonitis, and
pulmonary
apoplexy.
REMARKS.
Stone crumbled.
{
Stone mulberry, but soft;
crumbled.

49]
URO-LITHIASIS IN RUSSIA.
22
22
23
24
NNNM
25
25
25 I
27
28
28
30
30
32
40
46
I
I
1
I
I
I
I
I
I
I
I
Ι
I
I
I
2 -
I
I
I
Jand
I
I
I
I
I
I
I
I
I
I
I
46
2 40
50
52
27
56
38
I 3 37
I
i7 67
I
5 57
2
w
17 | Bilateral..
66
ro
7 43
I
4 30
2
"C
Lateral.
CC
CC
66
Bilateral..
Lateral
Bilateral... 120
38
30
60
69
(6
18
7 Lateral 104
O
Bilateral...
7❘ Bilateral..
54
•
64
77
63
Traum. fever; no local.
Cystitis, gangrene of wound,
long convalescence.
Traum. fever; no local.
Traum. fever; no local.
Hæmorrhage and traum. fever.
Cystitis..
Cystitis and orchitis.
Traum. fever, cystitis, and su-
perficial gangrene of the
wound.
No sequelæ.
Abscess; partial gangrene of
scrotum; five vesico-scrotal
fistulæ.
Cystitis; long suppuration
of wound, slow convales-
cence.
15 Dbl.-horiz... 17 No sequelæ.
22
16
Typhus, with
great pros-
tration
Gang., phle-
bitis, pyæ-
mia
23 { Typhus dur-
ANOMALY OF THE ART-
ERIES.--The transverse
perineal ran 6'' above
the orifice of the anus,
and the right external
pudic a few lines from
the raphe. Both were
severed; the pudic was
tied; the transverse
could not be. No sec-
ondary hæmorrhage.
• •
Five years before had a
stone weighing 1 oz. 27
grs. removed by lateral
operation. This time
stone crumbled.
ing conval..All four stones entangled
close under the symphy-
sis pubis, making not
only the discovery but
the extraction very diffi-
cult.
(The operation was per-
formed with the double
lithotome caché from the
urethra. Stone crum-
bled.


a
MALINGERING AND ITS DETECTION.
BY
Compliments of the Author.
A
CLARENCE BARTLETT, M.D.,
PHILADELPHIA,
Reprinted from the HAHNEMANNIAN MONTHLY, March, 1893.
SHERMAN & Cα PRS. PHRA.
138

;
!
1
L
T
2
MALINGERING AND ITS DETECTION.
BY
CLARENCE BARTLETT, M.D.,
PHILADELPHIA.
TEXT-BOOKS bearing on practice of medicine, and even special
treatises pertaining to most branches of medical science, have but
little of any importance to say concerning malingering, and yet
this subject is one of great practical interest. True it is that in-
stances of simulated disease are not frequently observed in general
medical practice, still they do occur, and then if the physician is
caught in the trap set for him, the mortification that ensues is, to say
the least, decidedly uncomfortable. Unmindful of the deceived
practitioner's many successful battles with genuine disease, his error
is utilized by neighboring gossips to hold him up to ridicule. The
necessity of being on the watch for feigned disease is therefore evi-
dent, for no one knows at what moment such cases will come to
him.
When disease is simulated, the culprit always has some object in
view. Even children are known to practice deception, usually to
avoid irksome tasks at home or at school. How often do we hear of
headaches conveniently appearing at about 8.30 A.M., and disappear-
ing with still greater convenience at 9.15 A.M.! Even blindness may
be assumed by the more precocious youngsters. I can recall such a
case coming to the eye department of the Hahnemann College Dis-
pensary in 1880, and who stated that he was blind in one eye, a
blindness that was at once shown to be assumed by Dr. William H.
Bigler, whom it was my pleasure and profit to assist at that time.
Among adults, symptoms are assumed for the purpose of calling
forth sympathy, to secure support while living a life of idleness, to
gain entrance to hospitals, to avoid punishment, and last but not
least, to secure damages for alleged injuries.
This latter class of cases is of especial importance to the profession.
In our dealings with them we owe a two-fold duty, one to ourselves
and the other to the general public. We owe a duty to ourselves,
2-
because under no circumstances should we connive at fraud; because
the malingerer will never entertain the slightest respect for the sci-
entific attainments of the physician he deceives; and because if the
malingerer is unprincipled enough to take money for fictitious dam-
ages, he will not hesitate to defraud the physician whom he has de-
ceived. We owe a duty to the general public to do all in our power
to aid and not to defeat justice. Every man who seeks damages for
injuries received must prove the extent of the alleged injuries. His
physician should put him through every possible test to prove that
they are genuine. If this is done, and the facts stated are borne out
by the examination, then the plaintiff's case is only made stronger;
if, on the other hand, the case is so weak as not to bear rigid scrutiny,
the sooner all concerned are rid of it the better. An illustration of
the flimsy pretexts on which lawsuits may be based was instanced a
few years ago when one of our prominent physicians was sued for
an enormous sum of money by his driver on account of alleged inju-
ries received in a runaway accident. It so happened that this driver
applied for treatment to me some time before beginning suit at the
dispensary of the Hahnemann Medical College. The symptoms
disappeared promptly, and finally he reported himself as cured. But
one week later he secured the services of a lawyer, and entered suit
as above stated. Although the suit was lost, the defendant physi-
cian was put to an expense of over one thousand dollars in lawyers'
fees and loss of practice, to say nothing of anxiety and annoyance,
and all because of a pettifogging lawyer and a worthless vagabond.
In this case expert medical testimony was brought forward to show
the extreme probability of a future epilepsy; in fact, I am not sure
but that the expert(?) swore that an incurable epilepsy was certain to
appear.
The extent to which malingerers will go to gain a point is ofttimes
wonderful. When a student at the Hahnemann Medical College
in the season of 1878-79, a remarkable case was brought before the
class by Prof. B. F. Betts. It was that of a young woman who
alleged that she was a confirmed masturbator. Disgusted with her-
self, she had determined to reform. To aid her in this determination
she had placed a number of pieces of glass in the vagina, believing
that titillation of the parts would thus be made to occasion pain in-
stead of pleasure and force her to desist from the pernicious practice.
I remember the surprise of the class at the large quantity and the
rough angles of the glass removed by Prof. Betts. The following
week we were informed that the girl was an arrant fraud; that she
-
1
3-
was what is technically known as a "hospital bummer;" that she had
been practicing successfully at other hospitals the same scheme that
she had tried with us; and that she had interested a large number
of sympathetic women who had been doing considerable for her
welfare.
Medical literature contains numerous other instances more remark-
able, to the extent of being well nigh incredible. In the Medical
Record, vol. xlii., p. 726, is reported the case of a hysterical (?)
patient who underwent laparotomy for the fourth time. The reputa-
tion of the physician reporting the case, Dr. J. D. Bryant, is a suf-
ficient voucher for the authenticity of the facts presented.
S
P
The patient was a young women of 22 years, who stated that she
had had inflammation of the bowels three times. Each of these
attacks began with pain in the left iliac region, was followed by
chill, fever, and vomiting of blood, and attended with bloody stool.
Each attack led to laparotomy. About two months before her
admission to Bellevue Hospital, the pain began again in the same
situation, and was attended with chill, fever, vomiting of dark
colored blood, and the passage of bloody stools. Examination on
admission disclosed general abdominal pain and tenderness, attended
with fæcal vomiting, and bloody and mucous stools. On the evening
of her transfer to the surgical wards it was reported that she had
vomited a portion of a glycerine enema eighteen seconds after its
administration. In order to be certain of the identity of the vomited
matter, the resident surgeon had given a second enema which con-
tained methyl violet. A portion of this was vomited in fifteen or
twenty seconds after administration. "As the expulsion by the
mouth so soon after administration could not be accounted for ration-
ally at that time except on the theory of the presence of a large
fistulous communication between the sigmoid flexure and the stomach
or the colon and stomach, directions were given to prepare the patient.
for operation to be done the following day." The operation was
accordingly performed at the earnest solicitation of the patient.
General adhesions were found, but no fistulous communication any-
where could be discovered. To make assurance doubly sure, the
stomach was opened and examined carefully by every possible
method. The patient recovered from the operation, though with a
fecal fistula. During convalescence she developed hysterical
symp-
toms, as great excitement, attended by violent crying, complete
ptosis. Finally on May 9th she complained of great abdominal
pain, continuous retching attended with fæcal vomiting.
"For the
ensuing six days she was nourished entirely by the bowel. On the
first of these days, the vomited matter had the odor of whisky, and
possessed other characteristics strongly suggestive of the nature of
the nutritious enemata that were being administered every few
hours. On May 12th at 5 P.M., her temperature was normal by
4
the mouth, while by the rectum it was 113°." On the following
day the rectal temperature was 108°; but after dilatation of the
sphincter ani and carrying the thermometer well up into the bowel,
it was but 99°. During the six days of rectal alimentation, continu-
ous fæcal vomiting, and the occasional high temperature by the
rectum, the patient's general condition, pulse, and the temperature
elsewhere than in the bowel were normal, and for this reason it was
believed that the patient was obtaining food surreptitiously else-
where. "As she still continued the vomiting of matters resembling
the enemata, an enema of eosin solution flavored with oil of cloves
was given by the house surgeon, and fourteen minutes later was ex-
pelled by the mouth an ounce of the mixture. Still it was fifteen
hours after the giving of this enema before any evidence of it ap-
peared at the fistulous opening in the abdomen. On the following
day she was stripped while in bed and removed to the corner of a
neighboring ward, and there placed in another bed, her hands tied,
and continuous watch placed over her. She was then given as before
methyl blue flavored with oil of cloves." No more fæcal vomiting
occurred notwithstanding her efforts at retching, which were soon
discontinued. The nutritious enemata were continued as before. She
soon begged for food, which was given her and the enema discon-
tinued. From this time she made a continuous and prompt recov-
The following statement regarding the deception was then
obtained from the patient: "1. She knew that she was doing wrong,
but the impulse to do so was irresistible. 2. That in the first in-
stance (glycerine enema) she fooled the nurse by removing some of
the enema from the rectum with the finger and placed it in the
mouth, then while being observed, retched and expelled it from the
mouth with apparently great effort and suffering. 3. She obtained
the methyl violet while it was in a dish placed on the stand by her
bedside, when the nurse was stooping down to place a vessel on the
floor. Therefore she had it in her mouth ready for exhibition before
the injection was given. 4. During the six days of continuous fecal
vomiting and the phenomenal high temperatures and rectal alimenta-
tion (all of which caused no well-marked physical change), she was
well fed with milk by a patient of the ward during the absence of
the nurse.
The fæcal supply of the vomit was taken from the ab-
dominal fistula, put in the mouth by herself, and kept there to be
expelled while under observation. 5. Portions of the clove-scented
eosin solutions used as an enema were removed from the rectum by
the patient with her index finger, put in the mouth, and expelled
when necessary for the purpose of deception. 6. She refused to
account for the high registration of the thermometer, saying, 'I do
not know."
ery.
Sta
Dr. Bryant's paper closed with the report of another case of re-
markable deception practiced by a patient of Dr. J. M. Leslie, who
removed from her hand over three hundred fragments of bone, ap-
parently of chicken-bone that had been boiled. The pieces ranged
i
- 5 —
from seven-eighths to two inches in length. Some few had been
whittled down to facilitate introduction.
In the Medical Press and Circular, September 17, 1890, appears
a short article entitled "Curious Malingering," from which I take
the following:
One of the plans to which prisoners in the gaols of India resort for
the purpose of securing their release is that of causing a fictitious
form of dysentery. The symptoms are kept up by the convict tak-
ing surreptitiously an irritant of some kind, which has the effect of
producing dysenteric symptoms. It is said that this habit is per-
sisted in occasionally until death ensues. Another curious habit has
been revealed; namely, that of lowering a leaden bullet to the level
of the epiglottis and leaving it there for a short time daily. It is
said that the effect of this is that a pouch is sometimes deliberately
formed in the pharynx, and this pouch often becomes large enough,
at the end of six months, to hold several rupees. A secret receptacle
of money is then at the disposal of the enterprising individual.
the gaol of the Presidency of Calcutta is a bullet measuring three-
quarters of an inch, which is known to have been used for this pur-
pose.
In
This report certainly tries the credulity of the reader.
In the Medical Record, vol. xxii., p. 277, Dr. Thomas F. Hous-
ton reports a case of malingering ending in a very serious surgical
operation :
The patient was a colored man accused of stealing a watch, who
became apparently insane. He was convicted and sentenced. On
being returned to jail, he jumped up, struck his heels together, and
remarked: “Well, I am guilty; but I would have fooled the law
but for that d d doctor." In one hour he had torn off his clothes,
thrown them out the window, and was acting wildly again. After
this he did not speak nor get out of his bed, which emitted a horri-
ble odor from the excretions he had passed into it. An examination
then made found four large blisters, two on each ankle, about two
inches in diameter, occupying the site of some old shackle-marks.
These were evidently the effect of two cold nights which had occurred
during the time that he was attempting to play the madman. The
prison authorities could not induce him, by threats or persuasion, to
show the slightest sign of human intelligence, so they had to let him
lie in his filth. One week later gangrene of both extremities had
set in; temperature, 103°; pulse, 120. Both feet had to be ampu-
tated. The patient recovered. He afterwards expressed gratitude
to his physician for the attention, and admitted that he had been
malingering.
- 6 -
I now proceed to consider the various symptoms frequently simu-
lated, and the means for their detection :
I. Paralysis.—Paralysis may be feigned as a means of proving
the existence of an incurable spinal or nerve lesion. One is first led
to a suspicion of malingering in these cases by a process of exclu-
sion; that is to say, the symptoms present are not consistent with
those of any possible lesion. The distribution of the paralysis does
not accord with certain other phenomena; the various reflexes are
normal; muscular rigidity or atrophy is absent; electrical reactions
are unaltered. I believe that the study of the deep and superficial
reflexes in these cases is of the utmost importance, for in the vast
majority of cases of paralysis, perhaps in all, these will show some
departures from the normal standard. The presence of normal elec-
trical reactions is not of much value, as many forms of paralysis may
exist with this condition.
When one of the legs is said to be paralyzed, careful observation
of the way in which the patient uses his stick should be made. It
will be found that he does not always use it so as to relieve the in-
jured member.
When one member is alleged to be completely paralyzed, anæs-
thesia is probably the best means of detection. While going under
the influence of the ether, the patient will more than likely struggle,
and the movements will involve the paralyzed (?) as well as the
normal extremities.
II. Epilepsy is frequently simulated, generally, however, to
secure the sympathy of bystanders. Skilled malingerers have been
known to deceive the most expert diagnostician. Fagge, in his
work on the Practice of Medicine (vol. i., p. 710), relates that
Esquirol, who did not believe that an attack could be simulated so
as to deceive, was once talking with Calmeil over the possibility of
this deception, when the latter fell on the floor in violent convul-
sions. Esquirol examined him for a moment and then said: “Poor
fellow, he is epileptic." Thereupon Calmeil got up and asked him
whether he still retained his opinion. This shows the possibility of
perfect simulation..
-
During the convulsive seizures themselves, certain tests may be
applied. During convulsions the pupils are dilated, and do not re-
spond to light. This symptom is usually regarded as conclusive
evidence of the nature of the attack. Care must be observed,
however, in looking for it. The great muscular exertion required
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in simulating a convulsive seizure will likewise cause dilatation
of the pupils. In the latter case, however, they respond to light.
Fagge has suggested a very efficient means of exposing impostors
who choose to simulate epilepsy, namely, the blowing of snuff into
the nostrils. This will produce irresistible inclination to sneeze if
the attack be a feigned one.
Supraorbital pressure is likewise a good means of detecting ma-
lingering.
The character of the convulsive movements, their times of occur-
rence and modes of onset, afford important diagnostic aids. About
six months ago a man, aged 26 years, who had once been examined
in the Department for Nervous Diseases, Hahnemann College Dis-
pensary, subponed me to testify in his behalf. He had committed
forgery, and it was his intention to prove that the crime was com-
mitted in a post-epileptic trance. His case was called for trial on
several successive days, but he always succeeded in getting a convul-
sion at some convenient moment. The seizures consisted of tremu-
lous or clonic movements on one side, and hysteroid movements on
the other. They were not preceded by any tonic stage. Evidence
of their oncoming was discernible for quite a period beforehand, and
his falling was gradual, so as not to hurt himself. He had had
convulsions at very convenient moments for the accomplishment of
his nefarious purposes. He did not bite his tongue. His defence
availed him nothing, and he was convicted and sentenced to three
years' imprisonment. It was a plain case of malingering.
III. Pain, rheumatic, neuralgic, etc.—Pain is frequently made
the basis of damage suits. The inference on the part of the ma-
lingerer is that the symptom, being a purely subjective one, is capa-
ble of perfect simulation. Associated symptoms will ofttimes be of
great avail in exposing the correct nature of the case. In simulated
pain we have, however, some important objective tests. When the
patient complains of sensitiveness to touch over the painful part, it
is usually sufficient to distract attention while pressure is made.
This method was successfully employed in the case of Nora G., to
be described shortly, and by Dr. C. M. Thomas, in a hospital case
seen by me when acting resident physician in the Philadelphia
Homœopathic Hospital in 1879. The latter patient had been ad-
mitted for the treatment of sciatica. Her sufferings were excruciat-
ing. She kept all the other patients awake by her cries. Treatment
was unavailing. Distracting her attention by examining her spine
and then making pressure over the sensitive spot showed that the
<
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pain was assumed. The object in practicing deception was to gain
a shelter, for the constable had just seized the entire household goods
and put her out of her home.
Observation of the pulse during a paroxysm of pain will furnish
some aid. The pulse should be quickened at such times if the
sufferings be genuine. When sensitiveness to touch is a symptom,
then increase in the pulse-rate at the time of making pressure will
be noted.
Genuine pain, if at all severe and long continued, influences nu-
trition and sleep; simulated pain rarely exerts that effect, unless
accompanied by persistent efforts on the part of the patient to bring
on a state of malnutrition by improper living.
In many cases in which pain is the source of complaint, and in
which the pain is aggravated by any movement, it will be ob-
served, when the facts stated are true, that the muscles about the
painful part exhibit a certain amount of rigidity. This was exem-
plified in a case recently examined by me, in which there was every
incentive to dissimulate. The pain was in the lower portion of the
back and followed a railroad injury. On stooping it was observed
that the back muscles became rigid, and this rigidity was accompa-
nied by a clonic movement of the back muscles.
IV. Anæsthesia.-One of the most commonly given reasons for
believing that a patient has lost sensation is that he is able to stand
having a needle run through his flesh without giving any evidence
of pain. This is a fallacy, for almost any one can, with very little
training, accustom himself to such a procedure. As positive evi-
dence of genuine anesthesia, as a means of detecting malingering,
it is worthless. I have heard it said by a prominent surgeon that
there is no reliable test for simulated anesthesia. With this state-
ment I disagree. Probably the best course to pursue in examining
such cases is to first examine the condition of sensibility after the
various methods employed in regular practice. This over, various
control tests may be made to confirm the first observations. Blind-
fold the patient. Test the sense of touch by bringing the test object
first from the periphery to the centre. Mark with an aniline pencil
the point where it is first felt. Then repeat the experiment by bring-
ing the object from the centre to the periphery, and then mark the
point where sensation is lost. Notice if the two observations agree.
I doubt very much the possibility of any malingerer being able to
deceive with this test.
Electricity may be called into service when there is a fairly well-
E
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defined line of demarcation between the areas of sensibility and an-
æsthesia. Having determined this line, place a plate electrode (it
must be a perfectly flexible one) immediately over the line. Of
course the patient then feels the current. Then, without the knowl-
edge of the patient, raises that portion of the electrode from the side
which covers the sensitive area. If he still feels the current his
anæsthesia is simulated.
-
A study of the pulse may be made for the purpose of detecting the
genuineness of the loss of sensation. Apply a faradic brush to the
affected part, making the current up to the endurance of the patient.
Having determined this point, take the patient's pulse, first while
no current is being passed and while the electrodes are in position;
and then, again, when the current is suddenly turned on. If he
complains that he does not feel the current and yet at the moment
it is turned on his pulse quickens, I think one is safe in declaring
the patient a fraud.
V. Aphonia. Loss of voice is sometimes simulated. The only
reliable means of detection with which I am acquainted is anæs-
thesia.
VI. Blindness. When monocular blindness is assumed, detec-
tion is as a rule an easy matter. Placing a prism before one eye
produces double vision. A modification of the old prism test is the
use of the Maddux prism. This, if blindness is simulated, produces
treble vision. Still another modification is the rod and stenopaic.
test. With this over one eye, and the patient looking at a flame,
there is formed an image consisting of the normal flame with a line.
of light running through it. Some patients may be too shrewd to
be caught by the above schemes. Then the old color test may be
employed. I cannot better explain this test than by quoting a case
reported in the Medical Record, vol. xxxi., p. 424.
In a large factory a workman wielding a hammer carelessly
allowed it to slip from his hand. It flew across the room, striking
a workman in the left eye. The man brought suit in the courts,
and although an eminent oculist after an examination declared that
no apparent injury could be detected, claimed that his eyesight was
destroyed and refused all offers of compromise. On the day of the
trial a further test was made. The oculist for the defence had a
pair of glasses made, the right eye being of red, and the left of ordi-
nary glass. He brought also a black card with a sentence written
on it in green ink. The plaintiff was ordered to put the glasses on
and read the sentence, which he readily did, thus proving himself a
perjurer, as the sound right eye being fitted with a red glass, could
not distinguish the writing.
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For the 'successful application of this test it is absolutely essential
that complementary shades of red and green be used.
When absolute blindness of both eyes is complained of, detection
is not always an easy matter. In such cases one is obliged to rely
upon the conditions associated with the blindness as its mode of
onset, state of the pupils, ophthalmoscopic appearances, condition of
the deep reflexes, and the presence or absence of other symptoms.
Possibly the best test of the blindness is that suggested by Dr. H. I.
Jessup, and is as follows: Have the patient face the physician, with
his eyes wide open. Then slowly approach one eye with a sharp-
pointed instrument. Do this very slowly indeed. When the point
comes within a quarter of an inch of the cornea there is an irresisti-
ble inclination on the part of the patient to draw the head away.
This will not be the case, if the patient is blind. This test I put to
successful application at the hypnotic performance given before the
World's Convention at Atlantic City in 1891. I with others was
invited to the stage to attest the genuineness of the phenomena dis-
played. The patient having been hypnotized I was invited to
plunge a long sharp needle into his flesh. This I declined to do,
but instead made use of the above test. The patient gave evidence.
of seeing it. He stood the ordeal for a time, and then moved the
head back. The operator declared the test an unreasonable one as it
was too severe.
Two years ago, I was invited by Dr. G. M. Christine to see Minnie,
æt. 16 years. She was a bright looking rather prepossessing girl.
Two days before she had fallen down a few steps, shortly after
which she became absolutely blind. Ophthalmoscopic appearances
were normal. Her pupils reacted to light. Knee-jerks were nor-
mal. There was no paralysis or pain of any kind present. Aside
from the blindness she was without a symptom. Although there
was no apparent incentive to deceive I gave the opinion that the
patient was malingering. The case was subsequently brought to the
Hahnemann College Dispensary where she was seen by Drs. C. M.
Thomas, H. I. Jessup, and others, all of whom concurred in my
opinion, though unable to conclusively trap the girl. A few days
later, I brought her before the class, and then applied the knife test,
which caused her to move her head, she claimed (though incor-
rectly) because I touched her cornea. In taking her from the clini-
cal amphitheatre over to the eyeroom, Dr. George P. Stubbs (then
a resident physician), who was leading her observed that when she
came to a step, she lifted her foot properly as if her vision was per-
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fect. In a few days vision began to return, fortunately for the phy-
sicians in one eye first. The prism test gave double vision. At five
feet she read 5-200; bringing the test-type nearer vision increased
to 3-20. When leaving my office she without the slightest hesita-
tion put forth her hand to take hold of the door-knob. From this
time on improvement was rapid, and sight was entirely restored.
Recent investigations into the history of this case have revealed
the fact that the above incident was apparently the beginning of a
downward career. The girl stole things from her home, ran away
a couple of times and went on the stage, became pregnant and had a
miscarriage. She still claims that her blindness was genuine. It
seems that her vicious conduct began two years before the attack of
assumed blindness. In the opinion of all connected with her, her
malingering was for the purpose of escaping punishment for some
wrong-doing in which she had been detected.
-
toms.
One of the most interesting cases of malingering ever my lot to
witness was that of Nora. The interest centres in the variety of
phenomena simulated, the persistence with which she carried them
out, and the trouble to which they gave rise. On December 10,
1889, this patient presented herself to my department in the Hahne-
mann College Dispensary. She brought a note from Dr. Charles
M. Thomas stating that she had eye symptoms which were fraudu-
lent, and requesting an opinion concerning certain nervous symp-
The history she gave was as follows: Some time before, she
had been struck on the forehead over the left eye by a screw-eye of
a swinging door at one of our railroad depots. The wound did not
heal rapidly, but suppurated. Shortly before coming to us for
treatment, the vision of the left eye was completely lost. She
claimed to be unable to see anything. She also suffered from fright-
ful neuralgic pains over the seat of injury. The affected spot was
so sensitive to touch that she could not tolerate even light pressure.
While in the eye-department her eyes were examined thoroughly.
Ophthalmoscopic examination gave negative results. The pupils
reacted normally. A Maddux prism placed before one eye, made
her see three objects; a prism before the right eye and a red glass
before the left gave two images, one red and the other white. She
was then sent to me for examination. Directing her attention to
the spine and making a feint of examining the same, I then made
pressure over the sensitive point on the forehead. She did not then
wince a particle. Saccharum lactis was prescribed. She returned
for treatment from time to time. On one of her visits, I had her
- 12 -
sit in a position where she could see me examine a case of locomotor
ataxia; on examining her later, she had instability when her eyes
were closed. On February 3, 1890, she reported to Dr. Weston D.
Bayley that she had been obliged to leave Sunday-school the pre-
ceding afternoon at 3 o'clock, and that she went home and went to
bed, and was unable to get up until the following morning. By a
singular coincidence, Dr. Bayley had seen her enter her home at 9
o'clock that same evening, thus exposing the falsity of her state-
ments.
December 30, 1890, she turned up again, this time in the Hahne-
mann Hospital. That evening she was attending a Christmas festi-
val when she was taken in convulsions. Two physicians who hap-
pened to be present brought her to the hospital, when she was placed
on the couch in the receiving ward. While the attention of Dr.
Stubbs, one of the resident physicians, was diverted she came out of
her spasm and began to inspect her new quarters. While thus en-
gaged he turned suddenly and detected her. She went into convul-
sions again. From these she was aroused by the application of
supraorbital pressure.
On my visit to the hospital the next morning, the admission of
the patient was reported to me. It was then arranged between Dr.
L. L. Lazear (one of the resident physicians) and myself that I
should give an order that her spine should be cauterized and that
Dr. Lazear should make a feint to carry it out. I found the patient
in bed, apparently in a stupor. The genuineness of this stupor was
made very doubtful by constant blinking of the eyes. The order
for actual cautery to the spine was given. After I left, she gradu-
ally came to, and then sent for the supervising nurse, whom she asked
whether or not she had been dreaming; it seemed to her that she
had heard some one order her to be burnt. On being told that it
was a reality, that she was to be burned, she ordered that a message
be taken to the doctors to the effect that she was better, and would
like to go home. She was accordingly dismissed. I heard nothing
more from her until one morning I saw in the papers that a sympa-
thetic jury had given her $5000 damages. The above evidence
later coming out, the defendant was given the privilege of a new
trial.
As I write this, I am made acquainted by Dr. Charles M. Thomas
of another very simple test for simulated monocular blindness.
Direct the patient to read aloud. While he is doing this hold a pen-
holder or pencil before the eye which he claims to be sound. If the
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blindness be genuine, vision will be interfered with, If vision exists
in both eyes, the patient will be able to read perfectly,
VII. Deafness. The detection of complete deafness of both ears
is a very difficult matter. So far as I know there is no reliable test.
One is obliged to rely entirely upon general observation of the pa-
tient's doing.
When deafness is alleged to exist in one ear only, the test proposed
by Dr. Coggens is available. This consists in plugging the ear
piece corresponding to the normal ear, of a binaural stethoscope.
The instrument is then put on the patient, and his power of hearing
tested. If he hears through the instrument, it can only be by his
alleged deaf ear.
VIII. Skin diseases have been simulated. Duhring and Fagge
refer to this point in their works. Mustard oil, nitric acid, can-
tharides, croton oil, turpentine and other agents have been employed
for the purpose of deception by their ability to produce local redness
and vesication.*
IX. Tumors may be simulated. In the Medical Record, xxxiv.,
p. 307, is reported the case of a girl who applied for the treatment
of a tumor of one cheek. One surgeon had pronounced it incurable;
another had advised operation. Still another, making a more
thorough examination found a ball of yarn which she had stuffed in
her mouth to cause the trouble. No cause for the malingering was
discovered.
I have in the above outlined some of the conditions which un-
principled parties may simulate for selfish purposes. If this narra-
tion shall be the means of preventing any one from being dragged
into legal cases, my labor shall not have been in vain.
* Papers on feigned diseases of the skin will be found as follows: By Mr.
Startin, British Medical Journal, January 8, 1870; by Dr. Fagge, British Medical
Journal, February 12th and March 26, 1870; by Tilbury Fox, Lancet, October 30,
1875.
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7
PLAIN DIRECTIONS
FOR THE
TREATMENT OF CHOLERA
AND
EPIDEMIC DIARRHEA,
AND
FOR THEIR PREVENTION.
BY
WILLIAM BAYES, M.D. (HON.),
EXTRA-LICentiate, ROYAL COLLEGE OF PHYSICIANS, LONDON; MEMBER, ROYAL
COLLEGE OF SURGEONS, ENGLAND; MEMBER OF THE BRITISH
HOMEOPATHIC SOCIETY; PHYSICIAN TO CAMBRIDGESHIRE DISPENSARY;
FORMERLY PHYSICIAN TO THE BRIGHTON DISPENSARY.
ENLARGED AND IMPROVED EDITION.
NEW-YORK:
WM. RADDE, 550 PEARL-STREET.
1866.
+
INTRODUCTION.
THE intention of the following pages is to impart general infor-
mation on the means best calculated to prevent an outbreak of
epidemic cholera in a family; and, further, to afford such know-
ledge of the means of cure as shall enable the head of a family
to meet the first symptoms of the disease, if it should invade his
household. An attack of cholera is sometimes so sudden, and
its progress so rapid, that the time which must necessarily elapse
between sending for medical aid and its arrival often includes
the only period during which the disease may be curable; at all
events, time is extremely important in the treatment of a disease
of such malignant force as cholera.
The following instructions on the treatment of the disease will
enable the friends of the patient to inaugurate the curative
treatment, so that when the medical adviser arrives, he will find
that the patient's powers of life have been sustained and pre-
served, thus giving such other treatment as he may see needful
to adopt a fair chance of completing the cure.
While, therefore, we have endeavored to place the best general
instructions for the treatment of cholera before our readers, let
us not be misunderstood as pretending to include the whole treat-
ment of cholera in our few pages. Where homoeopathic profes-
sional aid is to be procured, it should be obtained without delay,
as the perfection of the subsequent recovery and the avoidance
or control of the secondary fever, which so frequently follows
cholera, depends much on the management of the reaction after
the more urgent symptoms have been subdued.
CHR. HOFFMANN's Cholera Preventive, $1.
Also Homoeopathic Pocket Cases at $3, with Family Guide
and 27 remedies. With 13 remedies and Guide, $2.
PLAIN DIRECTIONS
FOR THE
TREATMENT OF CHOLERA AND EPIDEMIC
DIARRHEA,
•AND FOR THEIR PREVENTION.
PREMONITORY DIARRHEA.
WHEN CHOLERA is epidemic in a neighborhood every attack of
DIARRHEA should be checked as speedily as possible. CHOLERA
(in this country) is usually preceded by a premonitory diarrhæa,
and as this choleraic diarrhoea in its early stage differs, in no
respect, from ordinary diarrhoea, it is clear that we ought not to
neglect even the simplest form of relaxation of the bowels when
CHOLERA is known to be epidemic.
We have found Veratrum the most reliable remedy at any
stage of the disease, whether EARLY or LATE, when diarrhoea sets
in with pain.
The DIARRHEA which precedes (TOLERA usually presents the
appearance of bilious diarhæa, with greenish or yellowish evacu-
ations. At its first onset a few doses of Mercurius-corrosiv.-sub.*
(3d dec. dilution) will be indicated. Phosphoricum-acidum has
proved a specific for frequent painless diarrhoea with flatulence.
But if the diarrhoea increases, if it loses its bilious character, and
if it becomes watery, profuse, and debilitating, then ARSENICUM
must be given in place of MERCURIUS.
The diet should be nutritious and easy of digestion. Beef-tea,
thickened with pearl-barley, or with flour, gruels, sago, or some
other light farinacea; arrowroot, made with milk; arrowroot,
made with water; boiled rice with milk; these or some other
light food as may be made of the best crackers, should be given
in small quantities, frequently repeated. To allay thirst, toast-
water, gum-water (made by pouring boiling water on a little gum,
and allowing it to cool), iced-water, and barley-water, may be
given. The patient should be kept warm in bed if the diarrhoea
is at all profuse.
*For dose and mode of administration see Appendix.
3
4
If, in spite of these means, the disease progresses, cholera is
imminent. In this case, tincture of camphor should be given in
5-drop doses every five or ten minutes, either on a lump of sugar
or in a little water.
CHOLERA.
SYMPTOMS.-When a patient is seized with Asiatic cholera he
is suddenly prostrated; he becomes cold; his hands and feet icy;
his face pale, or leaden-colored; the eyes sunken, and surrounded
with deep blue or dark circles; the fingers and hands, the toes
and feet, become shrunken, and are affected with cramps; the
pulse is scarcely to be felt at the wrist; the skin feels cold and
harsh, often moist, like damp leather, and even the breath, the
tongue, and the mouth are cold; the face changes its expression,
so that we fail to recognise even the best-known features.
-
At the next stage, purging and often vomiting set in; the dis-
charges are enormous in quantity; they look like water in which
some grains of rice are floating. Sometimes these discharges
from the bowels and the vomiting are simultaneously expelled
with tremendous force, as if from a syringe, sometimes they flow
away rapidly and quietly; cramps set in with violence, extending
from the limbs to the trunk, so that at times the symptoms resemble
tetanus or lock-jaw; the cramps end in violent convulsions; there
is intense thirst; the urine is suppressed. If the disease pro-
ceeds to a favorable termination, warmth gradually returns, the
vomitings and purgings cease, bile is again found in the evacua-
tions; the urine is passed. Then comes another danger, that of
the disease running into the third stage, and ending in secondary
fever, of a typhoid type. This danger is greatly lessened where
the disease has been treated homoeopathically. Where death
ensues it may occur during the first stage, i. e. that of the invasion
of the disease, destroying life at once, even before there has been
either vomiting or purging. This suddenly fatal issue is rare in
this country, (as in nearly every case the painless watery diarrhoea
has been running on many hours before the patient became
alarmed;) but it is not unfrequent in hot climates. Death more
usually occurs during the second stage, from the exhaustion
induced by the rapid draining away of the fluids. Death,
also, is not infrequent in the third stage-that of the consecutive
fever.
The mind of the cholera patient generally remains perfectly
clear to the last, and the mental condition is characterised by
extreme anxiety and great alarm. The voice, in cholera, is peculiar
and characteristic.
None but those who have seen Asiatic cholera can realise, from
Hotel B
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any description, the characteristic voice and features of the cholera
patient, but, once seen, these will be recognised in all future cases
at the first glance.
THE MORTALITY from cholera varies in different epidemics; it
varies also at different periods during the same epidemics. It is
most fatal at the outbreak and the relative mortality decreases
towards the subsidence of the epidemic. Broadly stated, we may
affirm that the mortality under ALLOPATHIC treatment is about or
above one-half of the cases attacked, while under HOMEOPATHIC
treatment the mortality is about or below one-fourth of the cases
attacked.
THE CAUSES.-The disease is probably owing to some peculiar
constitution of the air of the infected districts. It spreads in the
direction of prevailing winds; in still weather it remains in a
district; it leaves the district when a high wind springs up.
Opinions are divided as to whether the disease is contagious. It
has been asserted that the development of the cholera is most
active when there is a deficiency of ozone in the air: this theory
requires the confirmation of extended experimental observation.
The best opinion appears to be that Cholera is not contagious,
but that it may be carried from one place to another. The germs
of the poison propagate themselves rapidly in an atmosphere of
filth. In pure air it is not so likely to spread.
TREATMENT.—When a patient is seized with cholera he should
at once be placed in bed, between blankets, not sheets. The air
of the room and of the house should be made as pure as possible.
CARBOLIC ACID,* should be sprinkled about the rooms and
passages. Chloride of lime should be thrown down the water-
closets and sinks. The windows should be thrown open, and, if
the weather be damp, fires should be lighted in the groundfloor
rooms. Every evacuation should be received into vessels con-
taining some carbolic-acid water, and be immediately removed
from the room. ICE should be procured, and a piece of ice
swallowed frequently by the patient, who should drink iced-water
in very small quantities at a time to allay his thirst. His limbs
should be rubbed with iced-water, and afterwards covered with
flannel, or woollens. Warm flannels should be applied to the
abdomen, and fomentations, with a solution of sulphate of copper,
should be applied to the spine and to the abdomen.
*
DIET.-Till the purgings and vomitings cease iced-water is the
only diet admissible. It is questionable whether stimulants do
any good in the first two stages of cholera, it is even probable
that they are hurtful.
* For the mode of preparation see Appendix.
}
6
Specific Treatment.
During the early stage of cholera, viz., that of the invasion of
the disease, tincture of camphor should be given, in doses of five
drops, every five or ten minutes. If the purgings and vomitings
set in with violence (in spite of the camphor) give VERATRUM
and ARSENICUM,* in alternation, every ten minutes or quarter of
an hour.
When the disease takes a favorable turn, reaction comes on
gradually, the color of the patient improves, the skin gets
warmer, the convulsions and cramps cease, the voice recovers its
natural tone, the pulse returns, the breath gets warm, the dejec-
tions contain bile, and the urine is passed again. The expression
of extreme care and anxiety passes from the face, which resumes
its natural appearance.
Watching the patient anxiously, if the attendant notes these,
or any of these, changes in the patient, the interval between each
dose of medicine may be lengthened to twenty minutes, then to
half an hour, one hour, or two hours.
If the attack of cholera is marked by cramps and convulsions,
whose severity is more marked than that of the vomitings and
purgings, then give CUPRUM-ACETICUM* in place of ARSENICUM.
When the disease takes an unfavorable turn, all the worst
symptoms are intensified, and exhaustion or insensibility may
supervene.
In this case, if the blue color and the coldness of surface in-
crease, CARBO-VEGETABILIS may be given in alternation with VERA
TRUM. As we said in the introduction to these pages, we do not
profess to lay down a complete scheme for the whole treatment
of cholera; to do this would require a volume. All we profess
to do, is to point out those means which are indicated in by far
the majority of cases. We recommend that these should be adopted
in the absence of Homœopathic medical aid, or until such aid can
be obtained. There are many points in which one case differs
from another, and where some special plan of treatment may be
indicated. These indications are too numerous to be detailed here
without introducing confusion and doing away with that simpli-
city at which we aim. Our object is to lay down such general
rules as are easy of adoption, are within the reach of every one,
and may be employed without danger and with every chance of
success in by far the majority of cases during the epidemic of
Asiatic cholera.
There is one other remedy to which we must draw attention—
* For the mode of administration of this and the other medicines see Ap
pendix.
7
IPECACUANHA. This is to be given when symptoms of cholera
set in after the patient has eaten freely of some indigestible food.
In this case give a tumblerful of warm water to freely favor the
vomiting of the offending matter, and then give IPECACUANHA
every ten minutes or quarter of an hour. If this fail to relieve
the purgings and vomitings then treat the case as one of ordinary
cholera.
Prevention.
During the epidemic of cholera, carefully protect the abdomen
from cold. Wear a flannel belt or, better still, an anti-cholera
belt, which contains a copper plate to be adjusted so as to cover
the pit of the stomach.
SULPHUR is one of the best remedies in the beginning of
cholera, when there is little sickness of stomach, with tumid
abdomen; scrofulous constitution, &c.
Avoid a chill, and in damp or cool weather have fires.
Keep the air in and around the house pure.
Pour down the drains and water-closets some disinfectant fluid
daily.
Don't sleep on the ground-floor.
If you get a chill, warm yourself at once, by friction with a hot
towel, or by applying hot flannels.
Be careful in diet.
Don't eat pork, rich dishes, raw fruit or raw vegetables, cucum-
bers, melons, pine apples, &c.
Eat and drink in strict moderation.
Take stimulants if you feel low and weak, and then in small
quantity; avoid them if you feel heated and feverish.
Be very careful to eat no tainted meat nor game long killed.
Beef is better than game or poultry of any kind.
Filter the water you drink, through a charcoal filter.
The best medicine as a preventive is undoubtedly Cuprum
(copper.) Workmen in copper factories are reported to have had
an immunity from cholera during previous epidemics.
APPENDIX.
1. DOSE OR MODE OF ADMINISTRATION.
We recommend that, in each case, there should be uniformity
of strength used in the preparation of these medicines.
Three drops of the mother tincture, of the selected remedy may
be will mixed in a tumbler of pure cold water (better distilled
water if on hand, or filtered water, or water which has been boiled
and allowed to grow cold) by pouring it from one tumbler into
another, for seven or nine times, and a tablespoonful taken at a
8
.
dose; or a powder, of the trituration; about as much as could
be taken up by the point of a pen-knife, should be placed on the
tongue, and left there until dissolved;-or six globules may be
taken dry on the tongue. In violent cases a dose may be repeated
every ten, twenty or thirty minutes, until three or four doses have
been given; then, if indicated other remedies may be selected;
or those given in longer intervals, varying from one to three hours.
-Repeat the dose, in diarrhoea, after each relaxed evacuation.
As a preventive, give one powder of CUPRUM-ACET. (1) night
and morning.
The SOLUTION OF SULPHATE OF COPPER, for external appli-
cation.-Dissolve two drachms of the sulphate of copper in two
quarts of hot water, and use the solution as a fomentation, apply-
ing it on flannels to the abdomen and spine. The temperature of
the fomentation must depend on that of the body; it should be
only a few degrees hotter than the heat of the skin.
2. DISINFECTANTS RECOMMENDED.
CARBOLIC (OR PHENIC) ACID.-Mix one table-spoonful of the
acid with three table-spoonfuls of acetic acid, or vinegar. Of this
mixture, add a teaspoonful to half a pint of water, and sprinkle
it freely about the rooms and passages. Also put a little into the
bed-pans, commodes, and chamber-vessels.
7 +
CHLORIDE of LIME.-A table-spoonful of the powdered chloride
of lime may be thrown down each water-closet, two or three times
a day.
3. MEDICINES RECOMMENDED.
TINCTURE OF CAMPHOR.
TINCTURE OF ARSENICUM, 3d decimal. TRITURATION OF CUPRUM-
MET. OR CUPRUM-ACETICUM, 1st centesimal. TINCTURE OF IPECA-
CUANHA, 1st centesimal. MERCURIUS-CORROS., 3d decimal.
TINCTURE OF VERATRUM, 1st centesimal.
点
​To these may be added, though less often used TRITURATION
OF CARBO-VEGETABILIS, 3d decimal, and TINCTURE OF IRIS-VER-
SICOLOR, 1st centesimal. (This medicine is highly spoken of in
Dr. Hale's book on new remedies, as checking the vomitings and
purgings, and relieving the intense gastric pains in cholera. Our
experience, hitherto, has satisfied us that the remedies above indi-
cated are worthy of every reliance, and should therefore be first
resorted to but the IRIS may be worth a trial, if other means fail.)
HOMEOPATHIC CHOLERA MEDICINES, in all their different prepa-
rations, either by the single vial, or put up in cases; also Homoeo-
pathic books on Cholera in the English, French, German and
Spanish languages; and all other articles used in the Homoeo-
pathic practice; also ANTI-CHOLERA BELTS, for sale.
1
8
THERAPEUTICS OF BENIGN TUMORS.
BEEBE, M. D., CHICAGO.
BY ALBERT GAY
Gar
Whether our remedies are able, generally, to remove tumors,
even when benign in character, is a question not yet satisfac-
torily answered. While a very large majority, even of homoeo-
pathic practitioners, are probably skeptical as to such results
there are not a few who assert positively that such growths
are curable by potentized drugs, and report cases in which
they fully believe this has been done.
;
In support of this belief, it has been asserted that tumors
are not to be regarded as constituting the disease or as, in
their nature, local, but merely as the symptoms or local
manifestations of some constitutional dyscrasia, on the erad-
ication of which, by appropriate medication, the effects will
necessarily disappear. This assertion, like many others, can
neither be positively proved nor disproved in the present
state of our knowledge. It may, however, be accepted as
probably true of certain growths, and probably false of certain
others; though where the dividing line should be drawn it
would be impossible to determine. Even if this theory be
conceded as universally true it does not follow that, the cause
being removed, the effects must cease. On the contrary, the
fact is too well recognized to require illustration, that a train
of events may continue its progression indefinitely, long after
the initial force has ceased to be operative. If we suppose a
morbid growth to be developing under the direct influence of
some morbific force, we may reasonably expect to arrest its
progress if we can remove the cause; but it does not follow
1
WORLD'S HOMEOPATHIC CONVENTION.
[2
that this alone would produce that retrograde metamorphosis
necessary for the removal of the growth already present.
Neither are we warranted in assuming that the conservative
forces of nature can, unaided, accomplish such removal. On the
other hand there is reason to believe that morbid growths are
not infrequently sustained and fed through a purely local stim-
ulation, resulting from mechanical irritation by the growths
themselves; or from some accidental extraneous circumstance.
1. We will assume then that, of the entire number, a con-
siderable proportion of the benign tumors we meet with arise
from purely local or mechanical causes; and for these med-
ication offers the least promise of success.
2. Of the remainder, or those which originated in some
constitutional cachexia, a portion have already ceased to feel
the influence of the original cause; are sustained in a kind of
independent existence by local or mechanical causes; and are
therefore essentially in the same category as those of the pre-
ceding class, and subject to the same principles of treatment.
3. Including all growths developing under the continued
influence of a systemic dyscrasia. These should be most
readily controlled by constitutional treatment. Supposing
such treatment to be adopted as will eradicate the dyscrasia,
we may expect one of two results. If the growth has pro-
gressed sufficiently far to enable it to maintain an existence
independent of the primary cause, we shall find it assuming the
characteristic of class two; while, if taken at an earlier period,
the growth may disappear with the removal of the cause.
Since the sole province of homœopathic remedies is to secure
the normal performance of the vital functions, we conclude
that if the conservative forces of nature are not able to elimi-
nate a morbid growth, when the constitutional disturbing
cause has been removed, we can expect nothing further from
medication. The reason is that a continued mechanical irri-
tation or stimulation of a part or tissue would naturally be
followed by increased activity or perversion of growth, the
natural result of a perfectly normal performance of the organic
functions. A mechanical cause should and must be mechan-
ically removed.
31
THERAPEUTICS OF BENIGN TUMORS.
We conclude, then, that only in a limited number of cases.
can we reasonably expect medicinal measures to accomplish
the removal of tumors.
The selection of remedies for this purpose is attended with
considerable difficulty. The pathogenesis of very few, if any,
of our drugs exhibit any well-defined tumors, resulting from
our provings; and since there are generally no other constant
or essential symptoms found in these cases, we have no guide
in the selection of remedies but occasional concomitant, disas-
sociated symptoms; and frequently there are none of any kind.
These concomitant symptoms, being, for the most part, purely
accidental or entirely independent of the disease we are seek-
ing to cure, are evidently unreliable as a basis of treatment.
The etiology of most tumors, of constitutional origin at least,
is involved in such obscurity that we are left without even the
clue which such knowledge would, perhaps, afford; so that, up
to this time, it must be conceded our medical treatment of this
class of affections has been generally empirical, and its suc-
cesses can not be fairly claimed for Homœopathy, even though
they may have been accomplished by potentized drugs.
Prescribing homœopathically is one thing; using drugs em
pirically, even when prepared in the form usually employed
by homoeopathic physicians, is quite another: and if we would
be honest, we have no right to claim for Homœopathy the
results of any prescription not based upon the similarity of
the symptoms of the case to the pathogenesis of the remedy.
Whatever of value our literature affords upon this subject
is, therefore, of the character of clinical experience. Numer-
ous cases have, no doubt, been reported from the time of
Hahnemann down to the present; some of them of practical
value. But as neither the time nor the facilities for making
a complete digest of these reports have been available to the
writer, we must content ourselves with a brief resume of what
seem to be the most tangible results in the clinical experience
of practitioners of our school. Undoubtedly tenfold more,
and riper, experience lies buried in the memories or note-
books of busy physicians throughout the world, than all that
has as yet been published; and if this paper shall fortunately
WORLD'S HOMOEOPATHIC CONVENTION.
[4
provoke the divulgence of some of this knowledge, it will
surely have subserved a useful purpose.
Q
In a considerable proportion of the cases reported as cured
by remedies, the cure has been accomplished either through
the elimination of the tumor en masse, as in the expulsion of
uterine fibroids, or of polypi of the uterus, vagina or nares;
or else through the rupture and discharge of the contents of
cystic growths and subsequent obliteration of the cyst by sup-
purative inflammation. It may well be doubted whether such
cases can be fairly considered legitimate cures by remedies;
whether the drugs given had any thing to do with the result.
Probably a large majority of physicians and surgeons of both
schools, whose credulity has not given them over entirely to
the fallacy of post hoc, ergo propter hoc, will continue to con-
sider such results as due solely to the spontaneous efforts of
Nature, and their relation to the treatment as a simple coin-
cidence, nothing more.
SEBACEOUS CYSTS.
Belladonna cured several cases of wens of the scalp.'
Kali brom. "Great advantage from the internal adminis-
tration, given in two grain doses three times a day.":
"Calcarea carb. is recommended by Professor Dunham for
encysted tumors of the head and neck, with fluid or semi-fluid
contents." 3
30
Staphysagria has been successful in removing sebaceous
tumors of upper eyelid (after styes), and
Thuja, when arising from meibomian glands."
Graphites2000, rapid cure of cystic tumors of eyelids."
Silicea". Cystic tumor of lower eyelid, existing one year,
was cured by one dose every night in fourteen days.*
SYNOVIAL CYSTS--BURSAE--GANGLION.
Silicia. Chronic bursitis had generally yielded to it."
Kali iod. "In my experience the Iodide of potash is more
1. New York State Transactions, 1864. John Hornby. M d.
2. Helmuth's Surgery, p. 180.
3. Helmuth's Surgery, p. 180,
4. Prof. W. H. Woodyatt.
5. Amer. Hom. Obs, 1874, p. 45.
6. Steus Sr. Allgem. Hom. Zeit., Vol. LXXXIX, p. 156.
}
5]
THERAPEUTICS OF BENIGN TUMORS.
effectual in chronic bursitis than any other medicine which I
have employed."
8
Silicea, followed by Calcarea carb., cured ganglion of wrist,
size of hazlenut, in four months."
OVARIAN TUMORS (CYSTIC AND OTHERWISE).
200 1000 100000
Colocynth200 cured (fibrous ?) ovarian tumor.'
Colocynth,200 cured cystic tumor of ovary."
Podophyllum 200 twice cured a tumor of the right ovary in
the same patient, with an intervening period of health of
fourteen years.
30
Lachesis also removed enlargement of left ovary in the
same patient."
Graphites¹ cured tumors of both ovaries simultaneously."
Platina. Ovarian tumors diminished."
Kali brom. (crude) cured ovarian cyst.
Apis mel. and Arsenic. cured one case.
In allopathic practice, bromide and iodide of potassium,
chlorate of potassa and oxide of gold have cured quite a num-
ber of cases.
15
The difficulty of arriving at a positive diagnosis in many
cases of ovarian tumor leaves, naturally, some uncertainty as
to the accuracy of many of the reported cures.
LIPOMA (ADIPOSE OR FATTY TUMORS).
Crocus 200 cured fatty tumor of scalp with hemorrhage of
dark stringy blood, with feeling as something were alive in the
tumor."
Baryta carb.200 It has been my good fortune to treat quite
a number of cases. I have uniformly used Baryta carb.200,
and have not yet failed to cure a single case.
7 Mr. Pope, Discussion in British Hom. Congress, 1871,
8. Helmuth's Surgery, p. 506.
9. Hermann Welsch, Allg. Hom. Zeit., No. 24, 1874.
10. Carroll Dunham, N. Eng. Med. Gazette, 1869, p 211.
11 J G Gilchrist, Med. Investigator, 1873, p. 632
12 Wm. Gallupe, American Institute Transactions, 1869, p 328.
13. Dudgeon, Brit. Jour. Hom., 1873, p. 183,
14. M. B. Jackson, N. A. Jour. Hom., Vol. XXII, p. 93.
15. T. Black, Brit. Jour. Hom., January, 1859.
16. Helmuth's Surgery, p 1181.
17. J. C. Morgan-see Helmuth's Surgery. p. 183.
18. T. S. Hoyne, U. S. Med and Surg. Jour. July, 1873, p. 425.
WORLD'S HOMEOPATHIC CONVENTION.
[6
Prof. Chus. Adams reports having as uniformly failed with
Baryta in several cases, upon which he has tried both the car-
bonate and the iodide.
FIBROUS TUMORS.
This class, undoubtedly, includes a large number of cases
diagnosed as scirrhus, especially of the breast, and reported
cured by remedies, or operated upon as cancer. Probably few
physicians of experience have failed to see several such cases.
A smooth, rounded, dense tumor, from the size of an almond
upward, is found in the breast. It is usually movable, not
very sensitive, enlarges slowly, with some slight lancinating
pain, often aggravated before the menses.
300
Conium m.³ Hard, round, movable tumor of the breast cured."
Conium cured, in two months, a tumor of the breast, size
of a walnut, resulting from a bruise.20
Silicea". Hard, nodular tumor of breast ("scirrhus"?)
cured in two month's."
Conium". Same kind of tumor as the preceding, size of
hen's egg. Silicea" had no effect.22
Conium 1000. Hard and painful lumps in the mammæ re-
duced.23
Conium³ cured a small painless tumor in the breast, near
the nipple."
Belladonna (plaster) relieved a painful, indurated tumor of
the breast.'
25
Silicea200 co cured a tumor of the breast (in a man) 13 inches
in diameter and inch thick.26
Silicea 200 600. Scirrhus (?) of breast improving."
•
Conium and Calc. carb. I have found the most efficient
remedies for fibrous tumors.*
28
19. W T. IIclmuth, New York State Transactions, 1870.
20. J. G. Gilchrist, Med. Inv., Vol. VIII., p. 3.
21. Zeit. f. H. Kl., No. 12, p. 91.
27
22. Zeit. f. II. Kl., No, 12, p. 91.
23. North Amer. Jour. Iom., Vol. XXI, p. 553.
24. J. H. Nankivell. Ilom. World, Vol. VI11, p. 79.
25. New York State Transactions, 1861, p. 112, Dr. B. F. Bowers.
26. J. B. Bell, New Eng Med. Guzette, 1869
27. J. B. Bell, New Eng. Med. Gazette, 1809.
28. Helmuth's Surgery, p. 189.
រ
7]
THERAPEUTICS OF BENIGN TUMORS.
- Conium dec. To the above 1 can add my own testimony as
to the efficacy of this remedy, having three times used it suc-
cessfully for tumors of this class. The testimony seems abun-
dant to prove the value of Conium in fibrous tumors of the
breast and other glands, especially in lymphatic subjects, and
connected with menstrual disorders. This simply corresponds
to the pathogenesis of the remedy.
UTERINE FIBROIDS.
Ustilago madis. Sub-serous or interstitial fibroid much
diminished under use of this remedy."
Ustilago madis." Similar case, similar result."
30
Kali hyd. 200 cured several cases of intra mural uterire
fibroids.
Kali hyd.200 removed thickening of posterior wall of uterus."
Calcar. iod. has, in at least one instance in my own hands,
greatly reduced and relieved a large intra-mural fibroid of the
uterus; the influence of the remedy being most marked in re-
lieving the severe menorrhagia, for which it was originally
selected. In several other cases it has been used, in conjunc-
tion with other remedies, with excellent results; sufficient, at
least, to warrant careful trial in similar cases. I have usually
used Nichol's preparation, putting about five to ten grains of
the crude into four ounces of hot water and giving a teaspoon-
ful of the clear, supernatant fluid, three or four times a day.
I have not used the medicine in triturations because it is very
unstable; decomposing very readily on exposure to light
and air.
POLYPOID GROWTHIS.
The reports of cases of various kinds of polypi have gener-
ally been so vague as to make it impossible to determine the
precise character of the growths-whether mucous, fibrous or
fibro-cellular.
Sanguinaria. A decoction used as an injection, per va-
ginam, removed two uterine polypi by absorption."
29. W. H. Burt on Ustilago madis.
30. E. M. Hale, American Institute Tran-actions, 1870, p 475.
31. Professor Charles Adams
32. Professor Charles Adams.
33. H. C. Spaulding, New Eng. Med. Gazette, March, 1873, p. 126.
WORLD'S HOMEOPATHIC CONVENTION.
[8
I
6 16 90
Conium® was followed by expulsion of five polypi of va-
rious sizes with uterine contractions and profuse hemorrhage."
3
Calcarea carb. was followed after fifteen days by the
expulsion of two fibrous polypi of the upper portion of the
vagina. Thuja' had first been given to check profuse serous
discharge."
Thuja¹. In a case mentioned by Dr. Petroz, caused in
eleven days, the detachment of a large and very distressing
fibroid-polypus."
Calcarra carb.200. Eight doses cured a severe case of polypi
of both nostrils, of two years duration, after the failure of
Teucrium200 during six weeks."
Calcarea phos. cured large polypus of left nostril (in-
ternally and topically) after it had first been considerably
reduced by local use of Sanguinaria.”
3
Calcarea carb. dec. and Phosphorus dec., alternately, pre-
vented redevelopment of frequently recurring cysto-mucous
polypi of nose."
Phosphorus, Sulphur and Calcarea" at long intervals,
cured nasal polypi."
Calcarea carb. had reduced polypus of the velum fully
two thirds when last examined."
Teucrium³ dec. cured mucous polypi of both nares in about
four months, hoy aged eleven.""
Teucrium" cured mucous polypi hanging out of the nose,
a year or more, boy aged fifteen.“³
"The best medicines are undoubtedly Calcarea carb., Teu-
crium, Phosphorus and Sulphur."
99 44
“Dr. John E. James speaks highly of freshly powdered
Sanguinaria canadensis root, blown through quill or other
34. North Amer Jour. Hom, Vol. XXII., p 62.
35. S. M Alvarez, N. A. J. H v XXII, page 62.
36. J. H. Woodbury, American Institute Transactions, 1870, p. 474.
37. W. P. Wesselhoeft, N. E. M. G, February 1873, p 49.
38. W. F. Hocking, O. M. and S. R., 1873.
39. Med. Advance, September 1873, p. 401.
40. S. M. Alvarez, N. A. Jour. Hom., Vol. XXII, p.*350.
41. Prof. J. S. Mitchell.
42. William Gallupe, American Institute Transactions, 1870, p. 451.
43 William Gallupe, American Institute Transactions, 1870, p. 452.
44. W. T Helmuth-see Surgery, p. 864.
9]
THERAPEUTICS OF BENIGN TUMORS.
cylindrical tube over the whole polypus. In many, if not in
most cases, three applications, at intervals of from three to
seven days are sufficient, to effect a radical cure; and should
the polypus be so large as to necessitate forcible removal, the
application once or twice will make a temporary relief a certain
cure. Dr. Thos. Bryant, after an experience of three or four
years, also speaks highly of the use of Tannin, in a similar
1
manner.” 45
"Dr John Pattison, has used successfully a snuff of
powdered rad. Sanguinaria canadensis. Professor Dunham
reports cases cured with Calcarea carb., Teucrium and Staphy
sagria."
48
Sanguinaria' dec. I can also testify to the efficacy of this
remedy, having several times cured mucous polypi of the
nares, one case being of a very obstinate character under other
treatment, by the internal use of the 2d. dec. trituration of
this drug, conjoined with the insufflation of the 1 dec. trit-
turation.
Teucrium, Sanguinaria and Calcarea iod. have been found
useful in aural polypus.
47
Lycopodium, has cured conjunctival polypus."
Lycopodium and Calcarea for polypus of the conjunctiva.
"The remedies have been given at long intervals and in high
potencies, and the result is thus far very satisfactory.
49
TUMOR OF THE GUM.
Nitric acid and Silicca cured a case (probably one form
of epulis)."⁰
200
ADENOID TUMORS.
Bronchocele is so generally amenable to our treatment that
it seems hardly necessary to quote examples. Most practi-
tioners could probably give reports from their own experience
as to the efficacy of Iodine and the iodides; also of the prepara-
tions of lime. From my own experience I should say, that
45 W. T. Helmuth-see Surgery, p. 864.
16. W. T. Helmuth-see Surgery, p. 185.
47. Prof W. H. Woodyatt.
48. Prof. W H. Woodyatt.
49. T. F. Allen, American Institute Transactions, 1871, p. 412.
50. C. C. Slocomb, N. E. M. G., Vol. 5. No. 10.
WORLD'S HOMEOPATHIC CONVENTION.
[10
I
30
nearly all cases, if taken early, can be controlled by Iodine" to ".
Occasionally Spongia, Calcarea, Calcarea iod. or Mercurius iod.
may prove more serviceable.
Egg shell (Calcarea carb.) "A man who had been afflicted
many years with a goitre and had taken Gastein water for five
years, and also Iodine without success, had been advised by a
neighbor to take the shell of an egg, cleanse it well of the
skin within, and pulverize it. Then take of this powder every
morning as much as there lies upon the point of a knife,
during the decreasing moon for fourteen days. This he had
done and the goitre was gone."
Iodine cured a case of very long standing in a man of 58,
after the ineffectual use of Spongia.
Calcarea carb. Goitre, sanguine temperament, etc.“
Salix niger. "I cured one case of goitre in October 1874,
of a Miss, twenty years old, in eight weeks with Salix niger.
The goitre was large, standing out as far as the chin, was
heavy and caused pain when swallowing. I gave in all sixteen
ounces of the first decimal attenuation of Salix niger." “
64
Silicea" to "cured cystic goitre (right lobe) in about three
months, girl aged seventeen.'
Helmuth credits Natrum carb., Calcarea carb., Staphysagria,
Lycopodium and Spongia with curative powers; also the
iodides of mercury, both internally and as an ointment; but
says Iodine" is the principal remedy in the treatment of this
disease."
66
30
61
Generally, we may feel confident of removing all recent
cases of this kind, especially of the simple or adenoid variety.
Pulsatilla" and Conium cured a case of recent sarcocele."7
Mercurius biniod of course removed syphilitic sarcocele."
We have but little to add to these reports except to refer to
the almost absolute control which our remedies exercise over
}
51. G. Proell A. H. Z. vol. 89, p. 176.
52. Dr. Schepens, Rev. Hom., 1874, p. 143.
53. A Elblein, Proc. H. M. S. Pa., 1873.
54 J. S. Wright, Med. Inv., April, 1875, p. 326.
55. Dr. H. Welsch, Allg. II. Z. No 24, 1874.
56. See Surgery, p. 940.
57. Jno Hornby, N. Y. St. Trans., 1864, p. 122.
58
A. Cricca, W. H. Obs. Vol. VII, No 10.
52
68
F
11]
vascular tumors of the rectum. Hemorrhoids should very
seldom require surgical treatment with such remedies as
Esculus hip., Hamamelis and Nux vomica within our reach.
There is no doubt, that with added experience and skill in the
selection of remedies, conjoined with greater care in diagnosis.
and a more scientific pathology, the operating case will be
more frequently put aside in favor of the medicine chest.
However, it seems at least questionable, if science, humanity,
or the true interests of our patients, will always be best sub
served by occupying weeks or months, and perhaps years,
(subjecting the patient meanwhile to lingering suspense and
inconvenience, if not pain) to accomplish by drugs what might
be safely and painlessly accomplished by surgical measures in
a few moments, and probably at much less expense.
THERAPEUTICS OF BENIGN TUMORS.
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PRIMARY CANCER OF THE TRACHEA.
BY
CLARENCE E. BEEBE, A.M., M.D.,
1
NEW YORK.
REPRINTED FROM THE HAHNEMANNIAN MONTHLY,
SEPTEMBER, 1885.
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PRIMARY CANCER OF THE TRACHEA.
BY CLARENCE E. BEEBE, A.M., M.D., NEW YORK.
(Illustrated.)
MR. JOHN W. C., æt. 54 years, private watchman in the
N. Y. Stock Exchange, consulted me on December 19th, 1881,
with reference to a difficulty in breathing, from which he had
been suffering for a long time. Prior to November 7th, 1880,
he had always enjoyed perfect health. On that date, in conse-
quence of undue exposure, he contracted a severe cold, to which
he paid little or no attention, allowing it to take its own course,
until after the lapse of two weeks, when the voice became ex-
tinet. He then consulted his family physician, who prescribed
for him on several occasions, but without benefit.
During the five weeks that followed, patent medicines were
taken by the patient on his own responsibility, but without
inducing any amelioration in his condition. From this time
until May, 1881, the only remedy taken was quinine in com-
bination with whiskey. During May, he came under the care
of a prominent laryngologist, who pronounced the case to be
one of paralysis of the right vocal cord, complicating chronic
laryngeal inflammation. The pulmonary structures were de-
clared to be perfectly normal. At the end of two months, he
was examined by another eminent specialist, who rendered a
diagnosis of paralysis of the right cord, and tracheal stenosis due
to an intra-thoracic tumor, probably aneurismal.
On August 7th, Mr. C. put on a complete suit of "Wilsonia"
garments, and declared he experienced relief to his dyspnoea
within forty-eight hours. The voice gained in strength very
perceptibly. Nine days later, he commenced to raise from the
trachea large quantities of mucus admixed with blood, and at
intervals, varying from two to four weeks, small hard sub-
stances, apparently composed of organized matter. Six of
these bodies were expectorated, and just prior to their discharge,
the dyspnoea became so excessive that complete suffocation
appeared to be impending. The relief following their expul-
sion was very marked.
1
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On October 24th, 1881, his family physician again pre-
scribed for his so-called bronchial trouble, and continued to do
so until November 25th, the patient becoming worse each day.
Finally a thorough examination of the lungs was again insti-
tuted, and the statement made that the lower posterior portion
of the left lung was infiltrated, that the blood expectorated was
derived from said infiltration, and finally that the patient must
be confined in bed for some time, while under treatment.
Three weeks elapsed, however, without relief having been
obtained, and Mr. C. finally fell into my hands on December
19th, 1881, as already noted.
He was then suffering from considerable dyspnoea, accom-
panied by cough, intensely aggravated by motion. Expecto-
ration was very scanty, and at times altogether absent. Both
inspiration and respiration were markedly prolonged and
stridulous in character. There was no pain in any locality:
voice hoarse, though not in any pronounced degree; never
entirely lost, except at the beginning of the attack. Nothing
noticeable with reference to facial appearance, excepting possibly
some slight cyanosis, and an expression of anxiety referable to
a recent aggravation of the disease; body well nourished, and
presenting an unusual muscular development.
Inspection of the narcs elicited the presence of a pronounced
hypertrophy of the membrane covering the anterior extremity
of the inferior turbinated bone on the left side with inner de-
flection of the cartilaginous septum on the same side. Mem-
brane on both sides otherwise normal. Pharynx normal.
Larynx normal in color. Paralysis of abduction and adduc-
tion of the right vocal cord was easily detected. The left cord
was normal. Lining membrane of the trachea was somewhat
hyperemic in the upper third, the injection becoming more
prominent over the middle third. A little lower down, a nar-
rowing of the calibre of the tube was noted, due to bulging
inwards of the walls on the posterior and lateral aspects. This
feature became more and more marked, the further the eye
could reach. One small excrescence was plainly discovered
at the most prominent part of the swelling. This nodule dis-
appeared about January 16th, when the first attack of chok-
ing was induced, after the patient came under my observa-
tion.
-
The facts, derived from physical examination of the chest,
were exceedingly meagre and unsatisfactory. The chest-walls
were somewhat prominent in the infra-clavicular region, said
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prominence continuing downwards as far as the mammary,
but not in so marked a degree as is found in the barrel-shaped
chest of the emphysematous. During the act of respiration,
there was complete rigidity of the chest-walls. In fact, the
only movement noticeable on inspection was in the epigastric
region, where during inspiration there was a very pronounced
depression. A like condition existed at the supra-sternal notch.
During the acts of deglutition and respiration, the trachea and
surmounting structures were absolutely stationary. On the
right side, at the sterno-clavicular articulation, a well-marked
protuberance was discovered.
It was impossible, for some reason, to determine the exact
location of the apex beat. Palpation revealed nothing abnor-
mal, except a peculiar thrill, on phonation, differing in many
respects from the customary fremitus. Auscultation elicited
nothing definite, probably in consequence of the above noted
rigidity of the chest-walls, and also because of the fact that
the loud and stridulous sounds, originating in the trachea at
the point of stricture, obscured everything else. The percus-
sion note was one simply of increased resonance on both sides.
I have omitted mentioning the presence of considerable indu-
ration and swelling of the external aspect of the trachea which
was insensitive to pressure.
A consideration of the above enumerated points shows very
clearly 1st. That there was tracheal stenosis at the middle
and lower thirds, due to narrowing of the tube calibre, in con-
sequence of the presence of some abnormity, which exerted
pressure from without or within. 2d. That the paresis of the
right vocal cord was probably dependent upon said abnormity,
through implication of the right recurrent laryngeal nerve;
and 3d. That it was impossible to arrive at any definite con-
clusions as to the condition of the intra-thoracic structures.
In view of the fact that Mr. C. had passed through the
hands of many physicians, some of them prominent specialists,
before coming under my care, who had in nearly every in-
stance pronounced the case to be one of intra-thoracic tumor,
probably aneurismal in character, my attention was naturally
directed to this supposed condition. Repeated and exhaustive
examinations, however, failed to satisfy my mind on this point,
as it was very strongly my belief that the lesion was located
in the structure of the trachea itself, and was probably cancer-
ous in character.
Said opinion was stated to the family of the patient, and
4
P
the difficulty of arriving at a definite conclusion fully ex-
plained.
As the diagnosis at this period was a doubtful one at best,
by my advice Mr. C. consulted one more well-known laryn-
gologist, who unfortunately pronounced the same opinion as his
predecessors. Still this did not convince me, and it was
deemed the wisest plan to watch the case and await further
developments. This, fortunately, I was enabled to do, until
death came to Mr. C.'s relief on the 1st of April, 1882.
It is unnecessary to particularize the different phases
through which the patient passed except with reference to a
few points of marked interest. Four attacks of extreme dys-
pnoea occurred during the time he was under observation,
viz. on January 16th, February 10th, March 6th, and March
24th, the last continuing with little abatement until April 1st,
when the end came. The paroxysms were the most intense it
has ever been my lot to witness, and would obtain for about two
hours with the exception of the last. The only measures,
among the many employed, which would afford the slightest
relief, was the inhalation of steam impregnated with the com-
pound tincture of benzoin, and this was efficient only through
its power to relieve in a certain degree the irritated condition
of the membrane, and, by moistening it and the superimposed
secretions that had accumulated below the point of constric-
tion, to assist in dislodging and expelling the latter.
-
The symptoms, so urgent and distressing during the earlier
paroxysms, determined me to send for assistance with a view
to the introduction of a tube into the trachea (a measure, by
the way, which had been advocated in the strongest terms by
all the physicians whom the patient had previously consulted);
Ithough, if my original opinion were correct as to the nature
and location of the growth, everything contra-indicated such a
procedure. If the neoplasm were in the tracheal walls, and
by its presence and protrusion produced the narrowing of the
tube, and if it were located, as the laryngeal mirror certainly
evidenced it to be, in the middle and lower thirds of the
trachea, and there induced a stenosis so pronounced as to
hardly admit of the passage of the smallest current of air, no
tube of a calibre sufficiently large to increase the breathing
space, or of a length sufficient to pass the point of obstruction,
could with safety and propriety be introduced. On the other
hand, were the growth higher up, such operation would, of
course, be feasible, no matter what may have been its nature.
·
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But, in order to avoid assuming the entire responsibility of
deciding against tracheotomy, at my request Dr. F. E. Doughty
was summoned in consultation. After a most rigid examina-
tion on his part the verdict was strongly against operative in-
terference.
Difficulty and pain in deglutition are so often concomitant
with tracheal stenosis, from implication of the oesophagus by
the disease, or from external pressure upon the tube, one would
naturally anticipate such a condition to exist in the present
instance. There never was pain, and difficulty in swallowing
only occurred when the secretions, etc., had accumulated below
the point of tracheal constriction, and by their presence exerted
undue pressure upon the oesophagus. Then, too, the fear of
impending suffocation unquestionably constituted a very im-
portant factor in inducing the difficulty.
The walls of the trachea, as has already been noted, upon
external examination appeared to be considerably thickened
as far down as the suprasternal notch, beginning a little below
the cricoid cartilage. There was no pain on pressure, and only
a slight degree of sensitiveness, when the patient was recover-
ing from one of the acute attacks of suffocation.
The digestive functions, as well as those of every other
portion of the body, were performed with the utmost regularity
throughout his sickness.
There was one peculiar feature about the circulatory ap-
paratus which excited my apprehension, and appeared to be
the one symptom which forcibly pointed to the correctness of
the aneurism theory. This was the marked difference between
the radial pulses of the two sides. Several sphygmographic
tracings were taken on different occasions, but without deter-
mining anything definite. It will be remembered, that in the
examination of the chest it was impossible to ascertain the exact
position of the apex impulse. The noisy respiration totally
obscured even the normal heart sounds. This uncertainty
about the cardiac condition, and the discrepancy between the
radials, certainly augmented very greatly the difficulty in
making a differential diagnosis.
During the latter part of January, and before the second
suffocative attack, which, it will be remembered, occurred on
the 10th of February, the superficies began to assume a pecu-
liar yellowish hue, which soon became one of the positive
evidences of the presence of a cachexia. The breath began
to be offensive, the odor becoming more and more disagree-
6
FIG. 1.
able and penetrating as the disease progressed. The diagnosis
of tracheal cancer was then posi-
tively made, and the next par-
oxysm with the subsequent ejec-
tion of the tracheal accumulations
awaited with interest, in the hope
that a thorough microscopic exami-
nation of the latter would be con-
firmatory of the malignancy of the
growth. February 10th came, and
with it the attack. The materials
expelled were most rigidly inves-
tigated, but unfortunately with
only negative results, and for some
reason or other, each subsequent
examination was attended by the
same unsatisfactory issue. During
the afternoon of March 24th, the
final paroxysm of suffocation was
induced, and continued with slight
intermission until death.

<<
The autopsy, made twenty hours
after death by Dr. Doughty,
elicited the following facts, in
brief: Extreme emaciation. Con-
siderable superficial hypostatic in-
jection. First ribs, particularly
the right, together with the right
clavicle, at the sternal articulations,
much thicker than normal. Fluid
in pericardium slightly in excess.
About two ounces of bloody fluid
in right pleural sac. About five
ounces of the same in left. Lower
lobe of right lung hypostatically
congested. (The patient invaria-
bly assumed the right decubitus.)
Left lung normal, except at two
points, where minute foci of calei-
fication were discovered. Heart and large vessels normal.
No adhesions anywhere. The only lesion of importance was
found in tracheal walls at middle and lower thirds, cancerous
deposit being plainly seen infiltrating the walls themselves on
i
7
their external portion, and also upon the internal right
lateral and posterior aspects. The calibre of the tube was
narrowed to the size of the finest silver probe, and at first ap-
peared to be absolutely impermeable. Esophagus normal. No
perforations. No cancerous deposit was detected in any other
organ than the one mentioned. As there had never been dis-
turbances of any description in the abdominal or pelvic viscera,
and because of the urgent request of the family, no further
examination was made.
The trachea was removed from the thyroid to a point below
the bifurcation, and the specimen sent to Heitzmann for draw-
ing and microscopic examination. Dr. Heitzmann on June
1st. 1882, wrote me a note embodying the subjoined opinion:
"The tumor of the trachea is a medullary cancer; the lymph
FIG. 2.
-

ganglion beneath the neoplasm is not invaded by the disease."
Fig. 1 represents the trachea, with growth in situ, and Fig. 2
the microscopic image of a section.
There are very few pathological conditions in the history of
medicine that present so meagre a literature as the one under
consideration. Fully cognizant of this fact I determined, for
many reasons, to investigate the subject as thoroughly as
possible, and must confess to a feeling of astonishment at the
rarity of the lesion and the little that has been said about it.
The authorities consulted comprised all the more recent text-
books which would naturally refer to the lesion, several systems
of medicine, encylopædias; all periodicals published during the
last fifty years, American, English, German, French, Italian,
8
and Spanish; in fact every possible source of information ob-
tainable.
Some idea of the paucity of facts regarding our subject,
to be derived from the literature of the day and the past, may
be gained when the statement is advanced that in all the fore-
going mass of authority, mention of the lesion is made in only
six instances, and only nine authenticated cases have been
placed on record, viz.: one each by Mackenzie, Langhans,†
Sabourin, Oulmont,§ Morra,|| and Koch,¶ two by Schrötter,**
and one by Fischer.†† My own case makes the tenth.
*
Other cases, it is true, have been cited as instances of pri-
mary tracheal cancer, and reference will be made to a few of
them further on, but investigation has shown, that they were
either not of a cancerous nature, or, if they were, were not
primary, but secondary, either by extension from adjacent struc-
tures, or to lesions of the same character situated in organs more
or less remote from the trachea.
The literature on the subject will occupy so little space, it
is deemed advisable to reproduce it here for the purpose of ren-
dering the study of tracheal cancer in its primary form as
complete as possible. And in this connection I desire to ex-
press my deep obligations to Drs. Malcolm Leal and E. C.
M. Hall for their valuable assistance in the preparation of the
necessary translations.
MACKENZIE.-DISEASES OF THE PHARYNX, LARYNX,
AND TRACHEA.-Definition. Primary cancer of the trachea
gives rise to dyspnoea, and, if not relieved by surgical treat-
ment, to fatal apnoea.
This disease is so rare that it does not require to be treated
with the same detail as most of the other tracheal diseases.
The origin of cancer is probably always to be found in an ab-
normal formative property with which the tissues are prima-
rily endowed; but it would appear. that the perverted energy
is, as a rule, only called forth by some local irritation. The
remarkable relative immunity which the trachea enjoys may
be explained by its freedom from functional excess and acci-
dental injury. The principal symptom of the affection is
Mackenzie.-Diseases of the Pharynx, Larynx, and Trachea, p. 386.
Virchow's Archiv., 53, p. 470.
Annales de Maladies de l'Orielle et du Larynx, vol. x. 1879.
2 Bulletin de la Soc. Anat. de Paris, p. 137. 1875.
|| Giorno. Intern. dell. Scien. Med.
¶ Schmidt's Jahrbücher, vol. 146, p. 90.
1870.
** Laryngologische Mittheilungen, p. 86. 1871.
† Annales de Maladies de l'Orielle et du Larnyx. March, 1883.
!
9
tracheal stenosis, but an accurate diagnosis can only be made
with the aid of the laryngoscope. As regards the pathology
of the only two cases with which I am acquainted, one was
described as a soft cancer, and the other as an example of
epithelioma. In the case reported by Langhans,* the only
example hitherto published, the patient was a man, aged forty,
who suffered for one year from symptoms of stenosis of the
bronchi, especially of the right bronchus, and died from suffo-
cation. The post-mortem examination revealed carcinoma-
tous degeneration of the mucous membrane of the trachea,
above the bifurcation, and the bronchi just below that spot.
The microscope showed that the neoplasm was a soft carcinoma
which took its origin in the glandulæ of the mucous mem-
brane. There was no disease in any other organ.
The prognosis, it need scarcely be said, is most unfavorable,
the patient being unlikely to live more than a year or two at
the most.
Treatment.-Soothing inhalations and sedative medicine may
be administered, and when the growth is high in the trachea,
tracheotomy may be performed with advantage. Extirpation
of the trachea with a view to eradicating the morbid growth
will probably be attempted in future cases.
MACKENZIE'S CASE.-Jane E., et. 57, an unmarried
woman who had led a dissolute life, came under his care at the
Hospital for Diseases of the Throat, in April, 1864, suffering
from shortness of breath, which had lasted for six months.
Diagnosis.-Tracheal stenosis probably syphilitic, but no
evidence of constitutional syphilis, congestion of the larynx
with narrowing. Dysphagia subsequently came on, and the
patient died, January, 1865.
On post-mortem examination, an ulcerated growth was dis-
covered occupying the middle third of the trachea, and origi-
nating from the sides of the tube; the largest portion of the
base of the growth, however, was on the posterior wall, which
was thickened and projected backwards into the œsophagus.
The lining membrane of the esophagus was perfectly smooth,
and the vertical extent of the projection and its canal was only
a centimetre. The trachea, on the other hand, was contracted
at its narrowest portion to such an extent, that a probe four
millimetres in diameter could only be passed with difficulty.
The growth extended to within half an inch of the cricoid
cartilage above. A portion of the morbid structure was
* Virchow's Archiv., 53, p. 470.
10
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examined by Dr. Andrew Clark, and pronounced to be typical
epithelial cancer, containing numerous nested cells. The tis-
sues around the trachea were slightly thickened, and two of
the bronchial glands were somewhat enlarged.
COHEN. DISEASES OF THE THROAT AND NASAL PAS-
SAGES.-Carcinoma of the trachea is very rare. Primitive
cancer has been observed. It is sometimes associated with
K
primitive cancer of the bronchi. It usually commences in
the soft tissues in the interior of the tube, beginning near the
cricoid cartilage, or near the bifurcation, and eventually in-
volves the cartilaginous framework. Asexamined post-mortem,
the appearances are similar to those described in connection
with cancer of the larynx.
Symptoms. There would be but few symptoms until the
cancerous mass became large enough to obstruct respiration,
when the symptoms would be those of tracheal stenosis.
Previous to this, cough, expectoration, and occasional dyspnoca
occur, according to the location, condition, and size of the mass.
If the cancer invades the larynx or œsophagus, the symptoms
referable to involvement of those structures become super-
added.
Diagnosis. Symptoms of stenosis in connection with mani-
festations of cachexia, might lead to a correct surmise as to the
existence of cancer of the trachea; but unless so located as to
be accessible to laryngoscopic inspection, only the microscopic
examination of expectorated fragments could establish the
diagnosis with certainty.
Prognosis. The discase is necessarily fatal. Death may
occur from hæmorrhage, perforation, asthenia, or asphyxia.
Treatment.—Palliative measures by inhalation and otherwise
are all that can be attempted, the usual efforts being made to
keep the general health in as good a condition as is possible.
Surgical relief is out of the question.
The only reference of importance, I have been able to dis-
cover in Ziemssen's Cyclopædia, may be found in vol. iv.,
p. 480, under "Diseases of the Trachea and Bronchi," by
Riegel.
Carcinomas most often afflict the air-passages secondarily.
According to Förster, primary cancer of the trachea and
bronchi has not yet been observed. Rokitansky describes a
cancerous formation, extending from a bronchial stem to its
branches, by which the walls of the bronchi were thickened,
rendered rigid, and diminished in calibre, and their inner sur-
face made uneven. He remarks, however, that carcinoma of
11
the bronchial glands, and extensive carcinoma of the costal
pleura were present, and that the disease in question probably
arose from this. So, likewise, the cases of carcinoma of the
trachea reported by Türck were only secondary cancer. On
the other hand, the case recently reported by Langhans in
Virchow's Archiv., 53, p. 470, shows that the bronchi and
trachea may serve as a point of origin for primary cancer.
This case, therefore, is not only of interest because it is the
only one of primary cancer of the trachea and bronchi demon-
strated to a certainty, but because it reveals, with exactitude,
the mucous glands as the point of origin of the entire cancerous
formation.
SABOURIN'S CASE.*-Mrs. B., æt 40, came under the care of
Dr. Raynend, at Lariboisiere, in St. Mathilde's, Ward No. 23,
October 1st, 1878. At that time she complained of attacks of
dyspnea, from which she had suffered for a month prior to
her entrance into the hospital. These attacks would occur as
the result of the slightest effort, and for the past five or six
days they had been much more severe, and for 24 hours had
been continuous. She said she had never, to her knowledge,
suffered before this from any disease of the respiratory organs;
had never had cough or hoarseness. There is no history of
syphilis.
At the time of examination, her dyspnoea was rather in-
tense, and associated with stridulous respiration-worse in
the inspiratory act. The dyspnoea is more marked when the
patient sits up, diminishing again as soon as she assumes the
horizontal position. Examination of the throat reveals nothing
abnormal. ` Digital exploration of the pharynx and superior
orifice of the larynx, discovers nothing in the ary-epiglottidean
folds or on the epiglottis which might explain the dyspnoea.
Auscultation of the chest demonstrated only a feeble respi-
ratory murmur on both sides. External examination of the cer-
vical region reveals nothing abnormal in the line of the trachea.
Percussion of the sternal region elicits nothing to prove the
existence of a superficial intra-thoracic tumor. Auscultation
of the heart and larger arterial trunks eliminated the possibility
of an aneurism; in general appearance, her condition was
good, without the slightest manifestation of cachexia. The
laryngoscopic examination was deferred to the following day.
As the dyspnoea was lessened by rest, and as nothing indicated
immediate danger, the result of the laryngoscopic examination
was awaited in order to arrive at a correct diagnosis.
* Annales de Maladies de l'Oreille et du Larynx, vol. x. 1879.
12
The same evening the woman died in one of her paroxysms
of dyspnoea.
Autopsy. The external manifestations of the tumor were so
slight it was not discovered until after the entire respiratory
tract had been removed, en masse. Larynx perfectly normal.
The middle portion of the trachea was slightly curved forward,
and to the left; in every other respect, the cartilaginous portion
was normal. On the posterior aspect, from the 4th to the 10th
ring, the lining membrane was covered by a solid tumor, closely
adherent; the upper tissues were flattened and slipped over
the vertebræ by means of the cellular strictures. The tumor
was spindle-shaped, nodulated with ganglia on either side.
The oesophagus at the point of structure was deflected to
the left side of the trachea, and in other respects was nor-
mal internally and externally. In order to study the rela-
tions of the tumor, a transverse section of the specimen was
made at the level of the 7th tracheal ring. The tumor pre-
sented a white appearance, was finely granular, somewhat dry,
and resembled a cutaneous epithelioma. The centre of the
mass corresponded exactly to the posterior portion of the tra-
chea, was softer in consistence, slightly yellow in color, and
hence must have been the oldest portion of the neoplasm.
Anteriorly, the growth penetrated the cavity of the trachea.
There it formed a toadstool-shaped body covered by the mu-
cous lining in the form of a thin, reddish envelope. At the
level of the section, the protuberance obstructed at least two-
thirds of the calibre of the trachea, and left simply a narrow
semilunar opening for the passage of air. The fibrous ex-
ternal sheath of the trachea seemed to have been dissected
from the surface of the rings so as to form a sac for the tumor.
Posteriorly, the growth was still broader, and its median por-
tion was continuous with the anterior part described above;
there were also two lateral portions separated from the re-
mainder by a thick septum. The centre of the one on the right
was soft, while the left presented the white appearance already
noted. The esophagus was overlying the latter. The trachea
was then divided anteriorly, and the posterior wall was found
to be occupied, at its median portion, and two-thirds of its
length, by the fusiform growth. These sections demonstrated
that the cartilaginous rings were nowhere destroyed, but simply
pushed aside. There was no ulceration in any portion of the
growth. Lungs were perfectly normal. The other viscera
showed no structural changes to the naked eye.
Microscopic examination.—The nature of the various parts
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13
of the tumor was found to be identical. The two ganglia
had degenerated into cancerous tissue. The neoplasm was a
lobulated epithelioma. The fibrous net-work was scanty. The
epithelial elements were generally in the form of long and
ramified trunks, solid and somewhat similar to the external
appearance of racemose lobulated glands. Among them, were
found irregular, round epithelial masses separated by a con-
nective stroma whose alveole they appeared to occupy. The
epithelial cells varied greatly in configuration, and were re-
markable on account of their size. In regard to the point of
origin, the neoplasm was found to be wholly independent of
the esophagus. It may have been in one of the ganglia,
which was one of its constituent parts; but this does not appear
probable, for the reason that such a ganglionic epithelial neo-
plasm is rare; and if such had been the origin we must admit
that the extra-ganglionic tumor had developed by contiguity.
This is possible, but the well-marked limits, the ganglia on
the body of the tumor, their isolation in a fibrous envelope
without any solution of continuity must eliminate also this in-
terpretation.
Still, it would be very easy to admit that the intra-tracheal
tumor was only a bulging out of the membranous wall of the
canal. The integrity of the mucous membrane would appear
to add weight to this opinion. But another origin is possible,
and the microscopic examination strongly indicates it.
The
membranous wall of the trachea contains a great many com-
pound racemose glands, some of which are in the mucous mem-
brane, others underlying it, and those situated most deeply are
found in the smooth muscular layer of that wall, and are sepa-
rated from the preceding by well-developed fibro-elastic bands.
In these glands then of the posterior wall of the trachea must
we expect to find the points of origin of the tumor. A section
through its entire anterior portion demonstrates the integrity
of the mucous membrane on the circumference of the cartilages.
On a level with the excrescence, it is somewhat thin and filled
with dilated vessels. Most of the superficial glands are intact
and their locale sharply defined in the cancerous side by elastic
fibrous sheaths. The deeper glands, however, have undergone
metamorphosis, and all degrees of degeneration may be ob-
served. Those adjoining the cartilages may still be recognized,
and long epithelial trunks arise from them and are lost in the
tumor. On a level with the median portion, there is nothing
in their place but a mass of epithelial detritus which gradually
blends with the more recent portions of the tumor. These
14
destroyed glands correspond exactly with the central and
softened portion of the neoplasm. On either side, the cancer-
ous tissue is more recent, and the ends of the cartilages pene-
trate its thickness without noteworthy alteration. The epithe-
lioma surrounds them externally, dissecting the tracheal sheath
to form its own external envelope.
The results of this investigation lead us to conclude that the
neoplasm is an epithelioma originating in the deeply seated
glands of the tracheal membrane. There is reason to believe
that the alteration of tissue, at first limited to the subsequently
softened portion of the tumor, had after an indefinite period
caused a neighboring ganglionic enlargement on the right side,
whose stage of degeneration indicated its less recent formation.
The lesion remained local for a time; then, as in cancers, a
sudden period of growth caused the formation of the greater
part of the tumor, and the subsequent ganglionic enlargement
on the left side whose structure evidences more recent changes.
It is certainly strange that the mucous membrane had pre-
served its integrity to such a degree, when the extent of the
tumor is taken into consideration. An explanation may per-
haps be found in the study of the already noted elastic sheath
of the trachea. These tough bands of fibrous tissue probably
opposed to some degree the extension of the disease. Especially
so, if, as we have reason to believe, the tumor was evolved by
what may be termed a sudden outburst.
Clinically, a few details, regarding the case, are of consid-
erable interest. There was in this patient some difficulty in
diagnosis. The laryngoscopic examination was not made.
Had it been, possibly the mirror would have revealed the
intra-tracheal growth. On the other hand, the position of the
tumor on the posterior wall of the trachea, and the depth at
which its most prominent part was located, would have made
such a supposition improbable. At any rate, the laryngoscope
would have demonstrated the integrity of the larynx, and by
exclusion the diagnosis of tracheal obstruction would have been
reached. This conclusion would have been materially aided
by an examination of the neck, especially with the precon-
ceived idea that there was an obstacle situated below the
larynx. There was no pain in the region of the trachea; there
was no cachexia; the adipose tissue of the neck concealed the
existing curvature of the trachea, and also rendered palpation
of deeper structures more difficult. In fact, everything ne
cessitated a guarded diagnosis.
Equally interesting is the fact of the increase of dyspnea in
1
15
the sitting posture, and its diminution in the dorsal. This cir-
cumstance was so characteristic, it might possibly become of
diagnostic importance in a similar case. It is apparently ex-
plained by a mechanical emptying of some of the vessels of the
tumor, favored by the horizontal position, with the head on a
level with the trunk.
We shall not advert to the inadequacy of any treatment that
might have been adopted. The cancer killed the patient me-
chanically, before the appearance of the characteristic cachexia.
Had tracheotomy been performed, the result may be easily
conceived. The knife would have cut through the tumor and
thus induced a hemorrhage which probably would have been
fatal.
Remark. In reviewing my own case, it will be remembered
that the peculiar relief to the dyspnoea, referable to the recum-
bent position noted by Sabourin, was very marked. It is a
question in my mind whether his explanation of the phenome-
non is altogether satisfactory.
OULMONT'S CASE.*-Eugene Canchon, t. 70 years, a cook,
entered the Lariboisiere IIospital, St. Laudry Ward, January
28th. His health had been excellent until about two months
prior to his presentation. On December 1st, a chill was fol-
lowed by a severe cold, associated with cough, constant, violent,
and fatiguing, with expectoration, white, frothy and at times
markedly sanguinolent. Fifteen days later, the voice became
hoarse, and was occasionally entirely extinct; respiration diffi-
cult and noisy, particularly during the inspiratory act.
The
dyspnoca at times amounted to orthopnoea. The patient is
large, obese, and anæmic. Voice completely gone. Respira-
tion rapid. At time of examination, he was in the dorsal de-
cubitus. Respiration is accompanied by considerable wheez-
ing. More marked in inspiration, sonorous in expiration, and
loud enough to be heard throughout the ward. The dyspnoea
is paroxysmal, with complete intermissions. The paroxysms
last from one to several hours, and are induced by emotion,
movement and fatigue. He complains of no illness. In the
intervals he has violent and prolonged attacks of coughing,
with abundant expectoration, frothy and tinged with brownish
blood. Deglutition easy for liquids, difficult at times for sol-
ids. After the attacks all the functions become normal.
Palpation of neck gives absolutely no result. No deviation
of trachea, no tumor, no engorgement of hyoidean or subcla-
vicular ganglia. The carotids are not swollen, and there is no
*Bulletin de la Soc. Anat. de Paris, p. 137. 1875.
.
16
trace of encephalic stasis. Palpation of the chest anteriorly is
also unfruitful. No substernal dulness, indicating a medias-
tinal tumor. Heart action regular, sounds normal; pulse well
marked, frequent, without a trace of atheroma, uniform and
simultaneous on both sides. Posteriorly there is no manifes-
tation of growth or ganglionic enlargement. Resonance every-
where, but respiration feeble, although heard in all portions of
the pulmonary region.
On the 29th, the patient was examined laryngoscopically.
No tumor appears in the glottis, but when the patient is told
to enunciate ah!, the right vocal cord remains almost immova-
ble, and appears paralyzed.
The above-noted symptoms, and the absence of other phys-
ical signs, point to compression of the right recurrent laryngeal
nerve by a tumor, probably aneurismal, located on a level
with the arch of the aorta, or the brachio-cephalic trunk.
Prescribed potassium iodide, lobelia inflata, combined with
dry cupping.
The symptoms above noted persisted until February 4th,
and on that day the patient was bled. There was some amelio-
ration on the 5th. The voice is, at times, more distinct, the
wheezing less pronounced in the intervals between the par-
oxysms. No dyspnoea.
No dyspnoea. This condition lasted until the 8th,
when the patient became worse, and on the 10th an intense
suffocative attack occurred. The stridulous breathing reap-
peared; the pulse became small and frequent. No pulmonary
lesion could be discovered. The patient died that night.
Autopsy.—Liver normal. Lungs emphysematous, anteri-
orly and at their apices. The trachea shows no trace of mal-
formation or deviation. On its lateral wall are situated some
enlarged ganglia; and posteriorly, as far as the first ring, is
seated a tumor about as large as a hen's egg, projecting slightly
on the right lateral wall. The tumor exerts pressure posteriorly
upon the œsophagus, contracting its canal to such a degree that
the walls appear to lie in contact. The growth is blended,
by its right lateral prolongation, with the thyroid body, whose
right lobe presents at its base an induration as large as a me-
dium-sized nut. Dividing the trachea on its anterior face, we
find a tumor whose summit corresponds with the base of the
cricoid cartilage, narrowing the tracheal canal so as to give it
the form of a crescent, with posterior convexity. The mucous
surface is healthy. This growth blends with the large extra-
tracheal neoplasm, and is hard and resistant to the knife. On
section, an abundant milky fluid exudes, in which, under the
J
g
i
}
17
microscope, is seen a throng of large cells, irregularly formed
and with one or more nuclei. Its tissue is white, gristly,
slightly granular, and rasps under the scalpel. Posteriorly,
the growth blends completely with the anterior esophageal
wall. The lining membrane of the oesophagus is intact. Finally,
on a level with the nodule found in the thyroid body, the
neoplasm has invaded the gland. On dissection, we find the
right recurrent laryngeal nerve underneath the crico-aryte-
noideus posticus, and evidencing close union with the tumor
at its superior border. The left also unites with a ganglion
whose tissue shows structural metamorphoses analogous to
those observed in the tumor itself. Koch* gives an account of
an encephaloid which was formed in the trachea of a servant,
æt. 37 years, who died of suffocation after a long illness, char
acterized by cachexia; from the fifth to the tenth ring, the
diameter of the trachea was reduced to that of a pencil.
Schrötter cites a case of primary cancer of the trachea,
situated between the third and fifth rings, in which the diag-
nosis was made prior to death by means of the laryngoscope.
In 1877, Schrötter‡ presented before the Medical Society of
Vienna an epithelioma which formed in the trachea of a
woman 52 years old, completely obliterating its cavity.
Fischers narrates the history of a patient, 33 years of age,
a baker by trade. He was ill for one year, and suffered prin-
cipally from dyspnoea, which gradually became very intense
and frequent. The yellow color of the skin, the extreme
fecbleness and emaciation showed the man to be in a pro-
foundly critical condition. Under the laryngoscope, the vocal
apparatus evidenced simply signs of chronic catarrh. The
trachea, on the contrary, was found reduced to a chink at the
site of the first ring, by tumors attached to its side and pro-
jecting into the lumen. Nothing abnormal was found in the
thoracic organs. There existed no syphilitic antecedents. The
tumors which produced the contraction were therefore, accord-
ing to all appearances, of a cancerous nature. Tracheotomy
produced no appreciable amelioration in the patient's condition,
as he steadily grew worse until death from intercurrent pneu-
monia took place.
The autopsy confirmed the diagnosis. The tracheal canal
* Schmidt's Jahrbücher, 1870, vol. 146, p. 90.
Laryngologische Mittheilungen, 1871,
p. 86.
Annales de Maladies de l'Oreille et du Larynx, March, 1883.
Annales de Maladies de l'Oreille et du Larynx, March, 1883.
2
18
was transformed into a cleft, seven cm. long, by a carcinoma-
tous degeneration of the mucous membrane.
Morra's* case is the only one left unconsidered. This ap-
parent omission is due to the fact of my being unable to gain
access to the original description.
In conclusion, it might be well to note the fact that Fried-
rich,† Eppinger,‡ Schrötter,§ and Fischer,|| also cite additional
cases of tracheal growth; but in all of them, with the exception
of Fischer's, the cancerous nature of the neoplasm was not
definitely determined. Fischer's second case was undoubtedly
cancerous, but the growth had its origin external to the tra-
chea, in the thyroid, and although it eventually implicated the
trachea itself, it must, for manifest reasons, be necessarily
omitted from our list.
* Loc. cit.
Virchow's Manuel de Pathologie Speciale, 5, 486.
Handbuch der Pathologischen Anatomie, 1880.
Laryngologische Mittheilungen, 1875, p. 103.
Annales de Maladies de l'Oreille et du Larynx, March, 1883.
S
Wellt
compello

Regards,
2.13
RELAPSING OR REMITTENT PNEUMONIA, WITH RE-
MARKS ON THE ETIOLOGY OF PNEUMONIA GEN-
ERALLY!
BY PROSPER BENDER, M.D., BOSTON, MASS.
[Read before the Boston Homeopathic Medical Society.]
THE Social habits and conditions of life of this generation are
very different from those of the preceding age. The tendency
nowadays is to surround ourselves with every luxury and con-
venience, however detrimental to health. With the development
of elaborate social organizations, and the building-up of vast
civic communities, we encounter characteristic evils and perils
from which the plain-living, moral, and moderate-sized cities of
the olden time were almost free. As our circumstances change,
complications in the forms and operations of disease arise. The
wide diffusion of the sewer system, with its manifold dangers;
the adulteration of food and chemicals; the evils of over-crowd-
ing, imperfect ventilation, and accumulated filth, are all potent
factors in the causation of disease, which daily experience but
too painfully teaches. And the struggle for wealth and distinc-
tion, which is becoming greater every day, occasions a strain
upon the nervous system, hurtful and fatal to all but the robust.
These ills and errors account for the extension and aggravation
of diseases which were comparatively unknown under simpler
and more natural sanitary conditions.
How often do we hear middle-aged and elderly people, in town
as well as the country, make comparison of their health and
strength with that of their juniors, not favorable to the latter!
I have known myself, in Canada and elsewhere, men of the
"old stock" and "old time," who had worked hard till sixty
and seventy on the plainest fare, and not always enough of that,
endure hardships which would, to use a common phrase, “play
out" speedily multitudes of younger, better fed and cared-for
men of the present generation. Some of those veterans had
never been an hour ill, while frequently working all day in clothes.
wet from head to foot. This degeneracy has been attributed by
many to the evils consequent upon our modern ways of living.
It cannot fail to benefit the physician to make observations
and reflections respecting the present and the past, and to mark
clearly those differences which distinguish actual states of health
and disease from those of former times. Our profession is
intrusted with the noblest mission, the preservation of health;
the relief, under Divine guidance, of human suffering; and the
prolongation and improvement of life, morally no less than
physically. Every means, then, calculated to promote such
I Reprinted from the New-England Medical Gazette.
2
noble ends should be ascertained and made known for the
benefit of humanity.
The above general considerations have been suggested by the
increasing prevalence of pneumonia for years past, and its high
rate of mortality. In New York, during one week in March.
last, the deaths from that disease numbered twenty per cent of
the total mortality, or the alarming number of 149; in January,
486; and in February, 575. In Boston the number of cases and
the mortality give nearly the same ratio. In January the deaths
were 101; in February, 120; in March, 153; in April, 180; and
in May, 133: while in the same months of last year the deaths
were respectively 89, 80, 80, 80, and 46. The importance
of ascertaining the exciting causes of an epidemic decimating
our population with such frightful rapidity cannot be over-
estimated. If due, as many believe, to defects in our system of
sewerage and ventilation, it is our duty to point out the
facts to the public, who anxiously await the verdict of the pro-
fession.
I have had under my care, lately, several cases of pneumonia.
The most interesting I shall now describe. On the morning of
the 6th of March last, I was called to a single woman, aged
forty, who told the following story: She had not been well for
weeks, feeling languid and weak, with loss of appetite. Two
days previous, when overheated, she took cold. The night follow-
ing she woke out of her sleep suffering from severe pain in the
left side, and shortly afterwards experienced a chill. During
the next day she attended to her household duties, but com-
plained of stitches in the side. The objective symptoms, at the
time of my visit, were, decubitus on back, with inability to lie on
left side from pain; pulse 90; temperature 991°; respiration 25;
tongue coated; skin hot and dry; below left nipple, towards
side, friction sounds, during inspiration and expiration, noticeable
to touch and ear, and not affected by deep breathing; respiratory
murmur feeble; chest resonance normal: the subjective symp-
toms, chilliness and thirst, the least movement or deep inspira-
tion increasing pain in side.
2
A warm linseed-meal poultice over left lung was ordered, with
directions to renew as soon as cool. A half-glass of milk and
two tablespoons of beef-tea in alternation every second hour,
and sulphur³ every fourth hour until easier.
The next day, temperature, pulse, and respiration unchanged,
but a dry cough had set in, which increased chest pain, and jarred
the head; thirst for large quantities; nausea and vertigo on
sitting up in bed; pain in left side from the least motion; crepi-
tant râles; sibilant and sonorous rhonchi below left nipple, and
extending to posterior portion of lung; slight dulness on per-
cussing that region. One dose of bryonia200 was given. In the
afternoon, pain less severe, and patient could lie on left side:
other symptoms the same. During the night had a chill, which
Mnou
:
!
3
she thought was due to walking across a cold passage in her
bare feet to the closet.
In the morning (the 8th), pulse 100; temperature 1032°; respi-
ration 35; occasional cough, with viscid and scant expectora-
tion; small and large bubbling râles, front and back, at base of
left lung; prolonged expiration; tubular breathing; increased
dulness; bronchophony; apprehensive of motion on account
of pain, which was also aggravated by long breath or cough;
skin hot and dry, with chilly sensations; cough jarred head;
nausea and vertigo on motion; intense thirst. Another dose of
bryonia200. Twelve hours later a decided change for the better:
pulse decreased to 90; temperature 100°; no headache.
The next morning (9th) patient reported a good night's rest,
and said she was better; but the pulse was 106; temperature
1031°; respiration 40; râles over a larger area, with indications
of consolidation extending higher up; cough more troublesome,
with rusty-colored and viscous expectoration, and herpes on
lips. Bryonia³ was given, with orders to repeat in four hours if
not better. In the evening a favorable change was again wit
nessed; pulse-beats and temperature lower; much flatulence
and abdominal pain.
During the night, patient had five operations of the bowels,
of a light-yellow color, with coagula of undigested milk. The
bowels had previously operated regularly every day. The urine
was cloudless, and devoid of chlorides.
In the forenoon of the following day the pulse and tempera-
ture had risen, and respiration increased; face flushed, and cir
cumscribed redness of left cheek; skin bathed in perspiration,
but burning to the touch; physical condition of the lung the
same. Phosphorus³ every second hour. Granulated malt was
substituted for the milk, and roasted rice added to the beef-tea.
In the evening some improvement.
The patient did not "sleep a wink" all night. She lay with
her eyes wide open, incessantly talking, and making occasional
attempts to escape from her attendant. She refused to take food
and medicine, but was prevailed upon to do so after a while. One
of her hallucinations was that I wanted to perform some opera-
tion upon her. Temperature 102°; pulse 90; respiration 35;
pupils dilated; cough less; expectoration so tenacious that it
clung to the sides of the vessel. Hyoscyamus³ and phosphorus¹²
in alternation every second hour.
On the 12th she was still wandering in her mind, and talking
almost continually, but had slept some during the night; tem-
perature 1012; pulse 90; respiration 25; signs of resolution
setting in; dull sound lessening; and murmur of air-cells could
be heard returning here and there in affected lung. Medicine
continued, but less often.
On the 13th she was perfectly rational; temperature 99°;
pulse 85. Hyoscyamus discontinued. In the evening, at 6,
1
F
7
4
temperature 9810; pulse 80, regular, and equable; but not six
hours later a rigor set in, breathing became more difficult, mind
wandered, and food and medicine were refused. Owing to some
stupidity on the part of the nurse, I was not informed of this
change.
At II A.M., next day, her face was purple; respiration 50;
pulse 120 and irregular; temperature 10510; vesicular râles all
over left lung; blowing breathing; marked dulness on side,
and increased vocal fremitus; while the base of right lung
indicated pneumonic complication, which may, however, have
been hypostatic congestion; tracheal râles; general cold perspira-
tion; sordes on teeth; dry tongue, dark-brown coating in centre;
muttering delirium; picking at bed-clothes; involuntary stools
and urination; no expectoration, in fact, all the symptoms of
collapse. Phosphorus and antimonic tartrate³ in alternation
every hour; ordered face, hands, and feet sponged with cold
water; hot poultice to chest; malt, and beef-tea with rice, every
hour. At 2 P.M. some improvement, and at 10 P.M. it was still
more marked; expectoration returned; pulse 105; temperature
1032°; mixed bronchial and vesicular murmurs at base of left
lung, some blowing breathing in right, and less dulness: in
fact, defervescence had set in.
The following morning (the eighth day of the disease), tem-
perature 10210; respiration 30; pulse 90; little or no cough;
no expectoration; physical condition of lung rapidly improving;
pain in side almost gone; skin cool and mois t; and food readily
taken. Slept four hours that night. The chlorides had re-ap-
peared in the urine.
The improvement steadily continued until the night of the
17th, when patient complained of great internal heat of body;
burning hands and feet; moaning breathing; very nervous;
worse, particularly after sleep; pulse 90 and intermittent; tem-
perature 9910; some delirium; tongue red and glistening; in-
tense thirst. Lachesis³° soon corrected these symptoms. Two
days later, had retention of urine, which belladonna³ removed.
On the 5th of April she went out for a short walk, and has been
well since.
Now to an analysis of the case. I ascertained that my patient
had slept for months in an inner room, having a sink communi-
cating with the main drain, with no provision for the escape of
effluvia, or renewal of air, except by a corridor. There can be
no doubt that malaria, in its under sense of "bad air," was the
chief factor in the causation of this woman's illness. The patient,
having been weak and languid for weeks, while overheated took
cold, which ushered in the disease. Even if we had not a record
of previous exposure to a vitiated atmosphere, the course taken
by the disease would lead to such a conclusion. You will reflect
on the marked morning exacerbations, the relapses, the de-
lirium, the sudden cessation of cough and expectoration after
1
5
the eighth day, all of which indicate the action of a specific
morbific cause.
When I first saw the patient, I inclined to think I was dealing
with a simple case of pleuritis. The pleural friction was distinct
to the touch and ear, and heard during inspiration and expira-
tion; while the vesicular râles, which belong to pneumonia, are
only heard during inspiration. Of course, pleuritis existed, but
the vesicular sounds were drowned by the pleural. On the second
day the case was clear, continuing so to the end. My first pre-
scription was called for by the totality of the symptoms, and the
second likewise; but, as far as I can judge, they failed to affect
the case. I must here confess that it was with no ordinary
interest I watched the effect of the single dose of a high po-
tency, for I had never before tried it in this affection; and my
elation at my apparent success on the 8th, in bringing about
what I hoped was defervescence, was considerable. The change
was evidently, however, a mere coincidence, or, rather, a phase
in the course of the malady.
In the light of subsequent events, I now see that I erred in
persisting with bryonia, but I thought that perhaps the potency
was at fault. I believe, also, that I should have given phosphorus
sooner; but the indications for it (such as a dry, troublesome
cough; tickling in the trachea, aggravated by talking; pressure
over the chest) were not present. I think I could have dispensed
with the hyoscyamus on the 11th, and trusted to phosphorus and
increase of nourishment, but did not dare to. I am aware that
giving two medicines in alternation, on this occasion and on the
14th, will shock some physicians; but, where life and death are
at stake, all legitimate efforts are warranted. I do not believe,
like Molière's doctors, in letting people die at the hands of sci-
ence rather than cure them by means not strictly orthodox.
Perhaps I should have continued with the high potencies; but,
not having sufficient experience of them in acute diseases, I
desisted.
My experience of pneumonia has been considerable, and my
successes (I do not speak boastfully) numerous. For instance:
I have attended successfully seven cases in the third stage,
after distinguished allopathic physicians had given them up.
I must also confess to failures; but both kinds of experience.
enable me to say that I know of no class of serious cases which,
even at the most critical moment, I would more readily under-
take to treat, and with no small degree of confidence of success.
I have generally alternated the medicines, and given them low,
usually the third attenuation frequently repeated.
↑
Though jacket poultices generally act well, I often prefer cold-
water compresses. I usually order poultice first, and afterwards
cold water if the former do not relieve; and this may be done
with impunity. Sponging the face, hands, and feet with cold.
water simply, or alcohol or vinegar added, gives great relief.
6
Frequent cleansing of the mouth with alcohol and water is a
grateful proceeding to the patient.
Diet is a most important question in the treatment of pneu-
monia and kindred diseases, when the system has been previ-
ously debilitated. You must make provision for the renewal of
the waste going on in the tissues. Unless appropriate food be
selected, the patient will succumb before a cure can be effected.
While milk is an invaluable article of diet, it is not tolerated or
assimilated in some cases. Too much dependence must not be
put in the use of beef-tea, broths, etc., or death from inanition.
will happen. The carbo-hydrates are next in importance to milk.
They should, however, be thoroughly cooked, so as to convert
the starch granules into soluble dextrine. Such articles as rice,
barley, tapioca, or sago, slowly baked in an oven for over one hour,
taking care to avoid scorching, and added to beef-tea, bouillon,
or broth, are readily assimilated, and prove very nutritious.
If
mixed with milk, they are the more valuable as food. Granu-
lated malt I especially favor, dissolved in milk. Biscuits, pow-
dered, are also useful, and baby-foods likewise. Raw beef,
finely minced, well salted and peppered, administered if patient
complain of hunger, has often proved beneficial in my hands.
Many physicians of both schools advocate the use of stimu-
lants in this malady. In fact, some believe recovery almost
impossible without their aid; but I very seldom resort to them.
In the seven cases I was fortunate enough to save after they
had been pronounced "beyond recovery," I immediately ordered
their discontinuance, they having been freely administered by
previous medical attendants, and with results which justified
their withdrawal.
But I wish particularly to draw your attention to the fact
that for several days the patient was worse in the morning, a
condition not usual in this disease. As to the delirium, it is com-
mon, we know, with patients addicted to alcohol, or when the
upper lobe of the lung is affected; but my patient was abstemious,
and the lower lobe inflamed. High temperature may occasion
it, too, as well as blood or toxic causes. When defervescence
takes place very rapidly, acute cerebral anæmia often occurs,
and relapses such as those witnessed on the 11th and 14th are
occasionally caused by too rapid absorption into the system of
the resolving consolidation; but in the case under revision both
were due, I believe, to that complex condition known as septic.
influences.
The high temperature denoted great peril, especially in con-
nection with the other symptoms. Dr. Suckling, physician to
the Queen's Hospital, Birmingham, says on this point, "I have
only met with hyperpyrexia (a temperature of over 105° F.)
in two cases (pneumonia), and both proved fatal." He also
adds, in connection with the same disease, "Diarrhoea, unless.
critical, is a bad sign." You will remember, the tempera-
i
1
7
ture exceeded 105°, and she had involuntary stools and urina-
tion.
On the 10th, when told she had had five operations of the
bowels, I began to hope they were critical discharges, and that
defervescence had set in: but the temperature not having dimin-
ished, apart from the appearance of coagula in the stools, con-
vinced me it could not be so; that the change was due to the
milk disagreeing, which led me to alter the diet.
The tendency of pneumonia is towards recovery when left to
itself. Juergenson says, "Nature cures, and the only duty of the
physician is to maintain life until this cure is effected." But,
even so, I must say, that in the present case, on the morning of
the 14th, the prospect of recovery was very slim. The prompt
improvement subsequently, may have been due to the increased
nourishment, for the nurse did not insist upon the patient taking
her food during the night of the seventh day of the disease, be-
lieving it to be useless; but, for my own part, I cannot doubt
the specific action of the medicines then administered.
The profession has given much thought to the etiology of
pneumonia, without, as yet, reaching agreement or certainty.
To the vast literature of the question, I fear I cannot contribute
much that is new; but I may say I incline to the opinion that
in the great majority of cases it is a distinct and specific entity,
or, in the words of Swartz, “a general disease with local effects,"
and "not a local disease with general symptoms." The bulk of
the evidence tends to the belief that it belongs to the category
of malarial infections occasioned by defective sewerage and bad
ventilation. In rare instances, however, we meet with a genuine
inflammatory pneumonia, -a local disease with general symptoms,
brought on by a low temperature, in the case of people who were
before attacked in the enjoyment of perfect health. Dr. Sturgis,
an excellent authority, espouses the latter theory, and regards
pneumonia as the pattern and model of all inflammations. Sir
Andrew Clark, equally eminent, holds that the local pulmonary
affection is but a manifestation of the general specific disease.
Juergenson considers it "on all occasions an infectious disease."
A number in the profession, of late years express the opinion.
that it is contagious, and instances are cited which at first
sight appear to sustain this view; but a careful sifting of all the
evidence would doubtless show that there had been sanitary de-
fects in the surroundings. I have never observed any indication
of its contagiousness. I have had as many as three members of
one family ill with this disease within a few days of each other,
but have been able to trace the cause to vitiated air.
Drs. Friedlander and Frobenius have demonstrated the exist-
ence of microbes in pneumonia. Their experience has shown
that the inoculation of mice with those micro-organisms was inva-
riably followed by true lobar pneumonia, dogs being only occa-
sionally affected by it, while rabbits resisted attempts at infection.
-
8
L. Brieger recently inoculated mice and guinea-pigs with "cul-
tures" of cocci, and they manifested distinct pleuritic symp-
toms. The exudations were also found to contain cocci and
minute rods with their characteristic capsules. Surgeon Stern-
berg writes: "Pneumonia is simply the failure of the system to
resist the ravages of a micrococcus . . . that exists in every
healthy human saliva, but differs in numbers, being greatest
among the negroes." Emmerich has found at Munich the
pneumonia micrococcus beneath the floors of a barrack where
an epidemic had prevailed. I would like to pursue further this
attractive branch of my theme, but lack of time prevents my
dealing more minutely with this subject at present.
In over twenty years' practice I have met with many cases
of pneumonia, the type varying from the malignant to the
benign. In severe and protracted winters, like the last, with
low temperature, frequent high north-east winds, cases of a
severe and fatal character prevailed; but I have met with epi-
demics, though generally of a less severe form, in atmospheric
conditions the very opposite. The health records of different
countries show the mortality to be always greatest during
months of low temperature and considerable range, especially
March. I have noticed the prevalence of endemic diseases dur-
ing epidemics of pneumonia, and have generally considered that
there was a causal connection between them. In most cases I
have elicited the acknowledgment that the patients had not
been well for some time previous, suffering from lassitude, weari-
ness, chilliness, and anorexia; and there was generally the history
of a chill preceding the actual attack. In a few exceptional
instances no prodromic stage was known.
During cold weather, delicate people particularly remain much
in-doors. Under defective sanitary conditions, they become debili-
tated, and more sensitive to morbific influences. In cold weather,
too, structural defects in the sewers favor a determination of the
gases from adjacent sewers to warm apartments, by the greater
density of the outer air and up-draughts of fireplaces. What
more likely then that people exposed to such injurious influences
should readily fall a prey to this disease!
I fear I have detained you rather long; but, ere I conclude,
let me say, I think useful lessons may be gained sometimes in
reviewing such cases as the above. The examination and dis-
cussion of difficult cases, from opposite stand-points, should tend
to widen our views of the nature and operations of disease, as
well as the resources of the medical profession. I shall have
succeeded, then, in my object in describing this case, if I direct
for a short time the attention of my professional brethren to the
subject I have thus briefly treated; and should I elicit a com-
parison of views of a nature to further improve our habits of
observation, and add, however slightly, to our stock of useful
practical knowledge, I shall have another cause for satisfaction.
11
THE
t
Wute tratorial regards,
813

PHYSIOLOGY AND PATHOLOGY
OF
DIABETES.
Revised since its Publication in the New-England Medical Gazette.
BY PROSPER BENDER, M.D.
BOSTON, MASS.
266
:
*
}}
}
}
•
t
THE
PHYSIOLOGY AND PATHOLOGY
OF
DIABETES.
Revised since its Publication in the New-England Medical Gazette.
BY PROSPER BENDER, M.D.
BOSTON, MASS.
THERE can be little doubt as to the great interest attaching
at present to the subject I have undertaken to treat on this occa-
sion. The most advanced section of the profession on both
sides of the Atlantic has been giving, and is likely to continue
to give, particular attention to the physiology and pathology of
diabetes, upon the knowledge of which mainly depends our
competence to deal with the subject, in a manner creditable to
2
the profession and beneficial to the suffering community. It is
highly desirable to be acquainted with its indirect as well as
direct causes, in order to escape those errors in treatment so
injurious to humanity, as well as to the good name of the pro-
fession. Correct diagnosis leads to a salutary mental habit,
encouraging, as a rule, careful, intelligent examination, with
the deduction of accurate conclusions.
While some of our current diseases are as old as humanity,
undoubtedly others are of modern development, due to latter-day
habits of life, excessive self-indulgence, and inordinate ambitions.
of all sorts, peculiar to our time. In an exceptional age, with
its feverish excitements, its novel and insidious temptations, its
startling and appalling accidents, he would be a dull and
unreasoning physician, ignorant of both the physical and mental
elements of our race, who should not expect, in a frame-work so
susceptible, manifestations of disease unnoticed in the "good
old times," or the vast increase of others better known. In
addition to such conditions of derangement and factors of
disease, must be enumerated neglect of out-door exercise, over-
heating of houses, defective drainage and ventilation, and
systematic pampering of the appetite with dainties and luxuries.
Plain, wholesome diet is spurned by men and women whose
parents grew and throve upon it, reaching a ripe old age;
sweets, pastries, and stimulants of all sorts being now in vogue.
Diabetes was but little understood previous to Claude Ber-
nard's brilliant experiments in 1848, undertaken with the view
of ascertaining the causes of the formation of glucose in the
system, as well as the organ manufacturing it. In the course.
of his investigations, Bernard was first struck with the fact that
the portal vein contained no sugar, while the hepatic vein was
charged with sugar, and this even in the case of animals kept
fasting for a while. He showed the sugar-producing power of
the liver by removing this organ from the body of an animal,
"washing it out" by passing a current of water through its
vessels, then leaving it for a few hours, when sugar was again
found in the liver. His next experiment was the memorable
pricking of the floor of the fourth ventricle, in the neighborhood
3
of the pneumogastric nerves, which resulted in the produc-
tion of an artificial diabetes. He subsequently ascertained that
if he divided the pneumogastric nerve, the sugar-forming function
of the liver was suspended, while if the upper end of the severed
nerve were pricked sugar re-appeared. On the other hand,
irritation of its lower end did not cause the sugar to be formed
again. This satisfied Bernard that the sugar-producing power
did not originate in the brain, to be transmitted by the pneumo-
gastrics to the liver; on the contrary, the stimulus passed along
those nerves to the brain, and thence along the splanchnic
nerves to the liver, by reflex action. Dr. Harley's subsequent
experiments confirmed this conclusion, for he noticed that
after the injection of ammonia, ether, chloroform, alcohol, etc.,
into the portal vein, diabetes was artificially created.
Bernard, continuing his investigations, announced, in 1851,
that the liver in its normal state contained a substance resem-
bling starch in its elements, which, in contact with a ferment,
also secreted by the liver, was transformed into glucose. This
process he called the glycogenic function. This amyloid sub-
stance, or glycogen, he described as secreted by certain hepatic
cells, and the ferment the product of other hepatic cells: their
effect upon each other, the result of nervous influence. The
tissue of the liver, he says, "is impregnated with sugar, as that
of the testicle is with sperm, or that of the salivary glands with
saliva; therefore sugar is a product of hepatic secretion." The
amylaceous and saccharine principles of food, after subjection
to the diastase of the saliva and pancreas and to the intestinal
ferments, were converted into glucose, and entered the liver by
the portal vein, where they underwent a further or complement-
ary stage of assimilation, through the agency of the ferment.
He also ascertained, that while the quantity of glycogen
depends upon the amount of hydro-carbons and in some degree
upon the albuminoids ingested with the food, it was formed
independently likewise. For instance, glycogen continued to be
made, though the animal was kept fasting; this, while proving
the glycogenic theory, also showed that the necessary elements
for its formation were extracted from the blood. The glucose
4
of alimentation and of hepatic formation are poured together
into the blood, through the hepatic vein, carried into the general
circulation, and burned in the lungs. This theory he subse-
quently modified, stating that the sugar was consumed in the
peripheral capillaries, especially those of the muscles, yielding
heat and force to the system, through the production of carbonic
acid and water. Whatever glucose from the alimentary canal
is not needed, is stored in the liver and distributed according to
the requirements of the economy. In health the glucose from
both sources is rapidly consumed in the blood. Under certain
morbid conditions, however, it is not destroyed, but accumulates,
when glycemia and glycosuria are the outcome.
The next question that arose in Bernard's mind was, whether
the liver and intestines formed sugar in such abundance as to
overtax the oxidating faculties of the blood and cause a mischiev-
ous surplus, or whether the ordinary amount manufactured was
not consumed, owing to the liver not having exercised over the
sugar the necessary molecular change to permit of absorption.
He soon accepted the first theory, because the urine contained,
in some cases, more sugar than is formed by the liver in health;
but therein he was wrong, as I shall endeavor to prove.
In Bernard's experiment of puncture, the animal was fed upon
nitrogenous food alone, and yet, within a few hours, sugar
appeared in the blood. This could not have been occasioned by
excess of glucose, for it could hardly have been manufactured
in such quantity in so short a time. The only conclusion possi-
ble, then, is that the sugar accumulated in the blood not because
it was in excess, but that for some reason it could not be
utilized. A recent authority, Dr. G. Esbach, proved that this
was the case. He instanced a patient who, while he ate a hun-
dred and twenty-five grammes of bread, passed sugar in his
urine; but when the quantity was diminished to ninety grammes,
he ceased to excrete sugar. This trifling reduction of bread is
certainly too little to account for the accumulation.
Bernard also found that a temporary hyperæmia of the chylo-
poetic viscera followed traumatism of certain nervous centres,
resulting in paralysis of the vaso-motor nerves. This led to
T
E
5
increased action of the liver with its consequent excess of sugar,
which, not being consumed in the blood, outflowed with the urine.
In brief, according to this distinguished physiologist, diabetes is
a nerve lesion occasioning an excessive production of sugar, which
the blood is unable to consume, and therefore expels through the
urine.
The theory of Bernard was doubtless a beautiful and very
satisfactory one, giving a good working hypothesis. It was "a
new function of the liver." Diseases, grave lesions, suppressed
or suspended it. Brilliant experiments showed the influence
of the nervous system on this function by direct or reflex
excitation of the nerves of the liver. Puncture of the cord
above the origin of the phrenics stopped the production of sugar,
while pricking the floor of the fourth ventricle exaggerated it.
Hence, a plausible explanation was found for a disease hereto-
fore altogether obscure. The disease in question was only a
disturbance, an exaggeration, of a "new function."
At the same time both adversaries and advocates of the theory
seemed to have overlooked the fact, that not all the operations.
going on in an organ constitute for this organ so many special,
separate "functions;" that, in order to constitute a function,
there must be at the same time an element, a proper tissue, and
a special rôle in one of the great processes, either of animal or
organic life. At different times Bernard had, as we have seen,
thought that he had found in the liver two species of distinct
elements, the one destined for the secretion of bile, the other for
the secretion of sugar, but these hypotheses have never been
confirmed. Nor were his attempts any more successful to assign
to the "new function," a rôle worthy of the importance which he
attributed to it. Moreover, the demonstration of the presence
of sugar, and a "glycogenous matter" identical with that of the
liver in the muscles and lungs of the foetus, seemed to invalidate
the notion that organs as different from every point of view as
the liver, the muscles, and the lungs, could be agents of the
same functions.
Although the glycogenic theory was greatly shaken by the
observations of Ch. Rouget and others, proving that the glyco-
6
genic function is not peculiar to the liver, but belongs to entire
systems of organs (muscles of all animals, amnios and placenta,
cartilages, etc.), yet it met with general acceptance by the pro-
fession, until 1862, when a former pupil of Bernard's, Dr. Pavy,
of London, declared that the presence of sugar in the liver was
not due to the liver possessing a sugar-forming factory, but was
simply the result of either a post-mortem or pathological state ;
during life there is but little glycogen transformed into sugar.
Pavy believes that Bernard's experiments were defective, and he
thus accounts for the divergence of opinion between him and
his opponents. After a series of original and careful researches,
he failed to find sugar in any but the smallest quantity in the
liver of the living animal; but after death sugar was promptly
and freely formed. Flint and Tusk corroborate this statement,
yet differ from Pavy on the question of the glycogenic function
of the liver. Pavy detected minute quantities of sugar in the
general circulation, varying from 0.47, 0.58, and 0.73 parts per
1000' of blood, and in the urine 0.5 per 1000 grammes; but in
no larger quantity in the hepatic vein or in the circulation be-
tween the liver and lungs than elsewhere.
The fact, however, that sugar exists in all parts of the system
during health, is the strongest evidence of Pavy's mistake on the
question of the sugar-making power of the liver.
Senator says
that the glycogen producers like sugar, glycerine, gelatine, and
also the albuminates, are changed into glycogen in the hepatic
cells, and subsequently into sugar by re action with the blood
which bathes the cells. In truth, the majority of the authorities.
of the day espouse the theory that the liver is the sugar-factory.
And we have this further proof: remove the liver, or prevent it
from performing its functions by ligating the portal vein, and
no more sugar is found in the system, unless amylaceous or
saccharine food reaches it through the thoracic duct. The
experiments of Sackowsky and Luchsinger further establish
that when the functions of the hepatic cells are interrupted,
as in poisoning with arsenic, phosphorus, etc., no glycogen is
formed.
¹ Frerich gives 0.12 and 0.33 per cent.
7
Pavy's explanation of the changes undergone by the carbo-
hydrates in their progress towards assimilation, after their inges-
tion, varies greatly from Bernard's theory. He (Pavy) contends
that the glucose is detained in the liver, and converted, by the
selective action of the hepatic cells, into an animal dextrine or
amyloid substance, which is stored in the liver, and used in the
formation of bile and fat. He further states that owing to the
low diffusibility of the glycogen it circulates slowly in the liver,
while the glucose, which is much more diffusible, is promptly
carried off by the blood. The process of re-action between the
cells and blood may be hastened by rapid entero-hepatic circu-
lation to an extent sufficient to prevent the transformation
taking place, or to allow only of a partial conversion, when the
blood cannot consume the non-assimilated glucose. He adduces
reasons for believing that the amyloid substance did not easily
change into glucose under normal conditions. Under abnormal
ones, however, it was easily transformed; but it is not physiologi-
cally destined to be converted into sugar, as Bernard contends.
In his own words, "The liver, instead of being a sugar-forming,
is a sugar-accumulating organ." It is a moot question among
certain authorities, whether in diabetes the whole of the glycogen
is metamorphosed into sugar, or but a portion, the remainder
being utilized in nutrition or the formation of bile.
A morbid condition of the circulation, such as the presence
of much arterial blood in the liver, favors the formation of the
glucose ferment. The venous blood is inimical to the process.
Pavy observes: "Arterial blood in the liver gives a glucose fer-
ment; venous blood in the liver gives a maltose ferment.” In
fact, the venous hyperæmia not only hastens the liver's functions,
but causes the production of a glucose defective in quality and
unassimilable. The inhalation of oxygen or carbonic oxide,
the injection of defibrinated arterial blood into the portal vein,
occasion glycosuria by the increase of oxygen; and when
paralysis of the vaso-motor nerves of the liver exists, the
oxygen of the blood is also found increased.
Pavy's conclusions are, that diabetes is primarily a chemical
fault, due to an afflux of venous blood, produced by vaso-motor
+
8
paralysis, referable more to the sympathetic than to the cerebro-
spinal system, although it might also originate in the chylopoetic
viscera. The liver may be affected over a large or small extent.
If the area be limited, we have a mild type of glycosuria; if
extensive, severe and obstinate forms of the disease.
Recently Pavy's views on the changes the hydrocarbons un-
dergo in their progress towards assimilation have been consid-
erably modified, and are, indeed, quite a revelation. If accepted,
they must alter our theories of physiology and pathology as
relating to the functions of the liver. He now tells us that the
carbo-hydrate elements ingested are, in the alimentary canal,
changed into maltose and dextrine; and when in the liver, they
are, through the action of the hepatic cells, carried into a higher
group, and ultimately into glycogen, without being transformed
into glucose. However, in disease, these same substances are,
through the agency of a glucose ferment, changed into glucose,
and eliminated through the kidneys. Glucose may also be
derived from the albuminoids of food, by a twofold action of
the liver, which decomposes them into carbo-hydrates, urea, and
organic substances. The amount of glycogen formed depends
upon the quantity of sugar and starch partaken of. A small
amount is being constantly changed into sugar, and poured into
the circulation. If the quantity exceeds one part in a thousand
parts, it appears in the urine.
There are numerous other theories, all more or less directly
traceable to Bernard's or Pavy's. In fact, every medical man
of any originality or eminence has endeavored to think out a
theory of his own, and advocate it with more or less success.
It would, indeed, take a good-sized volume to present them all.
Some theories have been brought forward with an affectation of
superior knowledge, their authors scornfully disdaining all pop-
ular opinions; while, on the other hand, as is the case with all
evolutions and developments in medicine, as well as in other
sciences, there were not wanting critics who erred in the direc-
tion of exaggeration, making their theories fit so as to account
for complications with which the disease had no actual connec-
tion. The course of experience has thus furnished still another
7
;
9
exemplification of the value of caution, experiment, and careful
meditation in dealing with disease, which is not always to be
easily understood or grappled with, by even the most astute,
patient, and learned physicians. Indeed, it is the latter class
that evinces most circumspection in pronouncing upon this
subject, and most readiness to modify or surrender previous
opinions, at the faintest show of new light and genuine discovery.
But the limitation of space forbids giving more than the most
prominent theories.
Bouchardat's, which preceded Bernard's, has still many fol-
lowers, and is known as the gastro-intestinal theory. Accord-
ing to this theory (which, however, Bouchardat of late years
disclaimed as not completely expressing his view in fact,
the theory is more strictly Rollo's), the diabetes is primarily
caused either by an excessive consumption of saccharine or
amylaceous food, or by a disordered state of the digestion, with
defective assimilative functions, which often include over-active
digestive ferments. The result in the former case being that
the liver has suddenly thrust upon it more work than it can
perform; while in the latter the food is imperfectly converted
into chyle, and the sugar is not elaborated. Cases classifiable
under this head are many in appearance, and the frequent cures
from the exclusion of hydrocarbons from the dietary would
favor this theory. Most diabetics complain of some disturb-
ance of the digestive faculties, dyspeptic symptoms, morbid
appetites, too rapid action of the absorbents of stomach and
intestines. But how much of this is due to reflex causes, and
how much to the diabetes itself?
In most cases, if not all, neurotic troubles precede gastric
symptoms. They may not have been very marked, and perhaps.
only an observant patient would have noticed them; but they
have been present nevertheless. The stomach and liver receive.
their supply of nerves from the same sympathetic and cerebro-
spinal centres, and naturally their chemical affinities are freely
interwoven. It is consequently difficult for one to be affected
without the other suffering. In some subjects, functional dis-
orders of the nervous centres will occasion troubles of the
F
IO
digestive organs, or alterations in their tissues; and this is more
likely to be the case if the organs be previously modified in their
normal nutrition.
When the glucose of the intestinal canal is in excess of the
wants of the system, it is stored in the liver; when deficient,
the liver supplies its own sugar, manufactured out of the nitro-
genous elements of food. If any thing occur to disturb this
well-balanced condition, or to derange the functions of the liver,
diabetes ensues. When the sources from which emanates the
function of metabolism are intact, the hydrocarbons ingested
can be utilized, or, at any rate, would only produce temporary
glycosuria, a purely physiological process. This was also
Bernard's opinion, as well as Bouchardat's.
We all know the effect of moral, psychical, and physiological
causes upon the digestive organs, and the marked chemical
aberrations to which they may lead; how mental excitement,
grief or sorrow, and prolonged intellectual labor will retard and
even prevent digestion and assimilation. Every one acquainted
with Bernard's, Schiff's, Pavy's, and others experiments on the
cervico-spinal system, lower portion of cervical and upper por-
tion of thoracic ganglia, as well as the fibres of the sympathetic,
cannot doubt the important part the nervous system plays in
diabetes. Those nerves have vaso-motor fibres extending to
the organs which are affected when diabetes exists.
It is now generally admitted that the nervous system is at
fault in diabetes. Anything disturbing certain centres will
cause an increased flow of blood to the liver, which immediately
impairs its functions, giving us glycosuria as the result; and
this congestive condition of the liver may prove an abnormal
stimulus transmitted back to the nerve-centres, thus establishing
a vicious circle. The vaso-motors keep the blood-vessels in a
state of contraction; but if their centres or portions of their
tracts are diseased or suffer some lesion, an inhibitory effect
arises, which relaxes the muscular coat of the arteries, and
causes their dilatation. Authors are, however, divided as to
whether the hyperæmia is caused by paralytic dilatation of the
blood-vessels, or irritation of the nerves controlling the forma-
II
tion of glycogen; and some authorities attribute the vaso-motor
derangement to the poisoned condition of the blood acting upon
the nerve-centres. Of course, the nerve-centres may be affected
in a reflex manner without the existence of pathological changes
in them.
Lecorché, too, believes that diabetes is a neurosis, the glyco-
genic functions being increased by disturbances in the brain,
medulla oblongata, or by defects in the hepatic circulation, due
to respiratory affections; or, again, by a compressed condition
of the liver, in consequence of direct or reflex irritation of the
vaso-motor centres.
The advocates of the hepatic theory believe that the hepatic
cells may be so immoderately active as to allow the passage
of the glucose from both sources without sufficient revision of
either, and this whether sugar be introduced in excess or be
limited. Whether the liver be hyperæmic or anæmic, whether
an exalted condition or loss of tone exists, seems debatable
ground in the minds of certain upholders of this doctrine. The
trouble is attributed to cerebral or peripheral origin. This is
the theory of Bernard, which was treated of in the commence-
ment of the present paper.
Bouchard is the chief exponent of the theory of retarded
nutrition. He contends that whatever interferes with meta-
bolism in the tissues may cause glycosuria. Experiments and
clinical testimony both establish that the glycogenic power is
possessed by the muscles and tissues as well as the liver
(Rouget). Bouchard computes that the liver manufactures
sugar in a quantity equal to about two kilogrammes, -seven
hundred and ninety-eight grammes of which are consumed or
oxidized by the respiration, and the remaining twelve hundred
grammes appropriated by the tissues. If any thing occur to
prevent the tissues from performing this function, sugar will
overflow into the urine, and the system be deprived of so much.
nutrition. As in the case of the liver, the quantity of sugar in
the muscles is increased after meals, and decreased after exer-
cise. Constitutional diatheses, hereditary or acquired, are the
predisposing agents, and alcoholic and hygienic excesses the
12
1
I
exciting. Bouchard sums up the conditions which may cause
diabetes, as follows: 1. Every thing which will prevent the
glucose of alimentation from being transformed into glycogen;
2. Every thing which will considerably augment the formation
of sugar; and, 3. Every thing which will impede the destruction
or oxidation of sugar in the tissues. But I believe we shall
ultimately find the whole difficulty lies in the fact that the
sugar is not appropriated by the tissues, because it has not
previously undergone the requisite assimilation.
Lancereaux and others ascribe diabetes to some lesion of the
pancreas, contending that the diastase of the pancreatic juice
is necessary to the formation of glucose; and, when this fails,
diabetes ensues. Post-mortem evidence often conflicts with this
theory; atrophy and other changes in the pancreas are found.
without the existence of diabetes; but, on the other hand, the
pancreas is not seldom diseased. These anatomical changes
may possibly be due to concomitant alterations in the coeliac
plexus. (Klebs.)
Mialhes and Raynoso attribute the deficient combustion of
sugar to the interruption or delay of the passage of the blood to
the lungs, — to a deficient alkalinity of the blood, as the patho-
logical condition. The improvement following the adminis-
tration of alkalies in several cases gave some countenance to
this theory; but it is long exploded. Professor Lépine's case,
alluded to in the morbid anatomy portion of this paper, may
supply the possible cause of this mistaken theory. Schiff con-
cluded, from his experiments of pricking the sciatic nerve, that
the hyperemia produced developed a ferment which transformed
the glycogen into sugar. Cantani and Foster believe that some
cases are due to the formation of a paraglucose, which, unlike
the glucose of hepatic formation, cannot be oxygenated.
Since an irritation of the filaments of the nerves at their
origin will occasion diabetes, it may easily be supposed that
disease at these points may result in diabetes. This will readily
explain the modus operandi of injuries to the brain. As disease
may extend to several points or to several nerve-centres, it may
also explain why at one time we have several organs implicated
in the course of glycosuria.
13
Beyond the study of these different theories, there is still left
a large field for conjecture and query. Perhaps the most impor-
tant contribution of late on this subject is Dr. G. Esbach's work
entitled, "Le Diabète sucré, ou Névrose Assimilatrice du Foie."
His views are both original and ingenious, seeming, also, the
most plausible of any hitherto advanced. Esbach accepts the
glycogenic theory, but with several modifications. The glycogen
of Bernard, as we have seen, is formed from the carbohydrates
and nitrogenous substances of food; but Esbach believes it is
obtained from the latter exclusively. His principal reason for
this belief being the continuous production of sugar when all
outside starch and sugar are excluded, and only albuminoids.
given, and, in fact, even when they are withheld. A liberal diet
of amylaceous and saccharine substances may appear to cause
an increase of glycogen, but this is not the case. There is more
glycogen in the cells of the liver, for the reason that there is less
used or called for; the supply from the alimentary canal being
abundant, it is used instead.
Esbach cannot believe that Nature is such a bungler as
Bernard would make out. The latter states that the starch and
sugar of alimentation is first transformed in the intestines into
glucose, retrogrades into starch or dextrin when in the liver,
and subsequently, by contact with a ferment, resumes its original
conditions from the starting-point in the intestines. This Esbach
considers very unlikely: Nature's processes are simpler and
more to the point, he believes. The liver pours into the hepatic
vein glucose from both sources, to be promptly consumed, under
normal conditions, in the blood; but under the influence of
nervous shock, worry, sorrow, or injuries to cerebro-spinal axis,
a perversion of the assimilative power of the liver over starch
and sugar arises, which results in those substances not being
consumed in the blood.
The liver, the great reviser of assimilation, is composed of
a collection of lobules, each acting independently of the other.
They pour separately into the blood the products of their fabrica-
tion, sugar and bile. In health the glucose of food, which is
the more abundant, undergoes a revision in the lobules of the
14
I
!
liver that render it susceptible of utilization, or of being destroyed
in the blood; but when the lobules are diseased, the "glucose
enters the circulation in a non-utilizable or non-oxidizable state.
The more lobules affected, the more glucose escapes the neces-
sary revision or assimilation to pass out of the blood unconsumed;
the fewer lobules, the less, in relative proportion to the area of
liver involved.
In illustration of the above, let me cite the case of a diabetic
patient, who can eat with impunity six and one-half ounces of
gluten bread, with meat in abundance, but let him exceed the
saccharine or farinaceous substances by even one ounce, and
immediately sugar will appear in the urine. Let him, however,
return to the six and one-half ounces of gluten bread, and the
urine will again be free of sugar. Observe, if you will, the very
slight increase of bread, followed by accumulation. The differ-
ence of one ounce cannot explain such accumulation, nor can
there be overabundance of sugar. There is simply present in
the blood a substance which has failed to undergo the needed
revision for its oxidation. The capacity of assimilation of that
liver is for the time being just six and one-half ounces of bread,
but by and by, if the prescribed diet be carefully followed, it
will materially increase, and, in the course of time, become
normal.
Allow me to give one more instance: Another patient, who
easily assimilates ten ounces of gluten bread, indulges in a glass
of milk, or a lump or two of sugar in his coffee, and the next
day the urine contains sugar. This is another proof that the
fault is not the superabundance of sugar in the blood.
If most or the whole of the liver has lost its assimilating
powers, or is diabetized, as Esbach calls it, the glucose of both
origins will fail to be utilized; but if only a portion be thus
affected, and the use of amylaceous substances restricted, most
or all of the glucose will be disposed of. It is seldom that we
have so severe a case, - when both glucoses cannot be con-
sumed, as we find in traumatical diabetes.
You will occasionally meet a patient who has recovered his
health and yet passes a small quantity of sugar. This is an evi-
15
dence that a small portion of the liver has been left incurably
diabetic, just as a contracted limb in an hysterical patient
remains in that state after the patient has regained her usual
health. This partial condition of atrophy may or may not ulti-
mately disappear. It will if the original nervous influence
returns. Esbach has made interesting, ingenious experiments.
to demonstrate the limit of the diseased part, too lengthy for
notice here.
Bernard's theory of the existence of a ferment in the liver
which converts the glycogen into an assimilable condition is
untenable, says Esbach. In the following experiment he proves
his assertion: A diabetic whose urine contained two grammes of
sugar daily, under ordinary mixed diet, had it reduced to one
gramme under half the ordinary quantity of food; but when the
saccharine articles were considerably increased he passed but
one more additional gramme. Thus, the ferment first assimilated
all but two grammes of the glucose partaken of; when the food
is diminished by one-half, which ought to free a quantity equal
to the assimilation of one hundred grammes of sugar, still one
gramme escapes; and finally, when sweets are allowed in abun-
dance, only three grammes are found. This can only be ex-
plained on the theory that a certain number of lobules in the
liver are inactive or inoperative, which allow a proportional
amount of glucose to pass unrevised. Such a percentage of the
liver, if one may so express it, is affected, and consequently such
a percentage of glucose is not assimilated. This is certainly
plausible.
The failure of the blood to dispose of the glucose poured into
it is not due to the blood having lost its consuming or oxygen-
ating properties, since fats, lactates, tartrates, etc., continue to
be destroyed in that medium as the urine plainly shows. Where
diabetes persists, Esbach ascribes it to the fact that certain
articles of diet are persistently given which the patient's liver
cannot reduce to that special molecular condition necessary for
its absorption. Withdraw them from the dietary, substitute
meats and fats, and the patient will promptly regain health
The glucose of glycogen and that of the intestines possess
16
different molecular and physiological properties; the former is
much more easily destroyed in the blood. It would be only in
an extreme case of diabetized liver, that the first would not be
utilisable.
I
In short, when the liver fails to exercise its assimilating func-
tions, it is in a state of paresis. The whole is rarely in that
condition, a portion oftenest. The sugar which has traversed
that portion of the liver which is diabetized is non-utilisable;
that traversing the healthy portion is. This is the fundamental
point.
To repeat: there is no overabundance of sugar, nor difficulty
with the blood, lungs, or heart. While the patient eats freely,
he starves; because his diet consists mainly of hydrocarbons,
which he cannot appropriate, and which beside circulate in his
blood to his injury. In point of fact, the more he eats of these
articles, the worse is his condition.
Diabetes is not necessarily connected with a morbid condition
of the liver; but whether it be or not, is sometimes difficult to
determine. It is sometimes complicated with some lesion of
the brain or spine, meningitis, cerebral tumor, softening, etc.;
but it is usually an affection per se, a disorder of a functional
character, of the controlling nerve-centres. It is a neurosis, and
like other neurotic troubles - namely, migraine, gout, asthma,
etc. — it is often hereditary. The diabetic neurosis may extend
to other organs besides the liver; but such complications are
incidental, and do not belong to diabetes. Gouty patients often
have diabetic offspring.
Esbach maintains that the patient who does not eat starch or
sugar cannot pass sugar in his urine, after the reserve from pre-
vious alimentation is exhausted; and he is right. The whole
liver would have to be diabetic before one could witness such a
case, and, as already stated, that seldom occurs. As a rule,
if the diabetics be fed upon meats and fats, they will cease to
excrete sugar. If, on the other hand, injudicious dieting be
persisted in, atrophy of the cells of the liver will take place, and
I That diabetic sugar is molecularly different from glucose, is, in fact, no new proposition;
it has been taught by Cantani, Foster and Bouchard.-P. B.
}
"
17
the patient will become incurable. The patient who regains his
health after atrophy has existed for a while will assimilate but
a certain percentage of amylaceous and saccharine substances.
Without doubt the mind acts upon the body, mental distress
most obviously causing derangement of physical functions;
besides, the vital powers are limited, and too great a demand
upon one organ will impede the normal action of another. If a
person be subjected to much mental stress through loss by the
death of a friend, or through financial reverses, violent anger,
and regret, a neurosis like diabetes may be established; and
if, under these circumstances, the liver be inordinately taxed,
through unsuitable dieting, a purely functional affection may be
converted into an organic disease. It is, therefore, not surpris-
ing that the conditions of this malady are markedly influenced
by the mental state of the patient. If the provoking or deter-
mining cause, the mental worry, be removed, the patient will
recover, provided he is intelligently dieted.
On this subject, Dr. J. Milner Fothergill expresses himself as
follows: "Those who are giving special attention to the subject
are beginning to be strongly of the opinion that diabetes is
casually dependent very often upon 'carking care,' disturbing
the liver as regards its glycogenic function. If this view can
be substantiated, and I for one think it can, then the appear-
ance of sugar in the urine, even in small quantity and fitful as
to presence, is terribly suggestive."
reason.
Diabetes has been known to disappear without any assignable
It is also established that it may follow, alternate, or
appear simultaneously with, such neuroses as asthma, angina
pectoris, epilepsy, polyuria, boulimia, and so on. Functional
difficulty may give rise to atrophy of the cells, just as the disuse
of a part or member will lead to its loss of power, and of the
nerve-centres controlling it. And, as with other neuroses, it is
also affected favorably or otherwise by certain evolutions of the
system, such as the menstrual period, menopausis, etc.
It may be injudicious at present to come to any definite or
fixed conclusions on a subject which is perplexing the whole.
profession; and yet, admitting this, I am inclined to accept
18
Esbach's views. They appear to me the most rational of any
hitherto presented. His statements are plausible, although
some of them are hypothetical; the main facts, however, are
correct. My own experience so far corroborates his. The
treatment of three cases according to his principles resulted in
complete satisfaction. In all of them mental anxiety was the
etiological factor.
(Since writing the above, I have added two more cases to my
list of cured, and I attribute my success almost entirely to the
diet enforced. I have begun the treatment of another patient
where a fall on the head occasioned the trouble, but I can hardly
say at present what the result will be. I may report this case
later on.)
Out of place as it may seem to some, to allude, in a patho-
logical review of diabetes, to the subject of its treatment, I feel
compelled to state that unless Esbach's rules be strictly fol-
lowed, a failure will be the result. You must exercise a close
supervision of your patients; set down in writing their dietary,
and by frequent examination of the urine make sure that they
follow it. The least infringement will be detected in this way.
Require the patient, also, to tell you exactly what he has eaten
from day to day; in which way, only, can you make sure of
your injunctions being followed, or that errors, accounting for
your failures, have been committed. The mistake many medi-
cal men make is not to limit the amount of food to be taken.
I have found most practitioners place no restrictions on
the quantity of gluten bread which may be eaten. It must
be remembered that it contains starch, although in a less
quantity than ordinary bread or potatoes, and if much be eaten
it will act as injuriously as either of the other articles mentioned.
Therefore, limit the quantity to, say, four or five ounces daily to
begin with, gradually increasing the amount as the liver regains
its original power. And then the patients will often designedly
or unintentionally break through the rules laid down, and this
the physician must always keep in mind. Rest assured that
when sugar re-appears in the urine after its disappearance for a
while, the patient has transgressed. My patients have not
19
found it particularly trying to follow the dietary in question,
as they have a large list of articles of food from which to select ;
but, of course, amylaceous and saccharine food is allowed only
in very limited quantities.
THE MORBID ANATOMY OF DIABETES.
There are no positive or invariable changes found in the
cadaver of the diabetic victim. Structural lesions are observed,
sometimes in one organ and again in another, in varying degrees.
and stages; but whether the pathological condition be the result
or the cause of the initial disturbance, most pathologists fail to
state. However, some viscera are so often diseased as to acquire
significance and to justify an association with diabetes, the
kidneys and liver, for instance; and of late, reliable observers
contend that some parts of the cerebro-spinal system will always
be found affected. In short, the bulk of the evidence proves
that the morbid conditions are constantly varying, as we notice
in nervous disorders generally, to which this disease is undoubt
edly allied.
The strain of unusual activity imposed upon some organs, or
the irritation from the materies morbi circulating in the system,
may cause many of the pathological conditions witnessed;
hyperemia of the liver or kidney may be attributed to the
former, and affections of the cerebro-spinal centres to the latter.
According to Dr. W. H. Dickinson, a dilatation of the arteries.
and of the perivascular spaces of the brain, of the medulla ob-
longata and Pons Varolii, with an escape of the contents of the
blood-vessels, and consequent softening and destruction of nerve
substance, is peculiar to diabetes. Drs. W. Muller, Knelz, and
Hale White, who have closely studied the matter, contend that
those changes have been found in the cadaver of subjects not
suffering with diabetes. While Dr. Dickinson does not assert
that these changes are due to diabetes, he states that they were
constantly witnessed by him, and in varying places and degrees.
There was generally, with the perivascular changes, thickening
of the sheath, erosion or degeneration of the nerves, and the
presence of blood crystals in their neighborhood; but these
20
changes were often so minute as to be overlooked by the naked
eye. This latter fact might account for the discrepancies be-
tween him and his critics. Drs. Taylor and Goodhart challenge
the accuracy of Dr. Dickinson's views, but a very excellent au-
thority, Dr. Lockhart Clarke, corroborates them. Dr. Dickinson
("London Lancet," vol. i., 1878, p. 161) says: "The minute
morbid anatomy of the nervous system is but just coming out
of darkness into twilight, and it may be long before we get any
view of its finer lines. In diabetes, in tetanus, and in chorea,
there are certainly changes in nervous function, and possibly in
nervous structure, which precede and underlie the rough injuries,
which are all that have yet come under our notice. But these
are enough, at least, to show the place of the storm. The mis-
chief in diabetes, as in the other disorders I have mentioned in
juxtaposition with it, is seen in the altered relation of the blood-
vessels to the tissue, in the several shapes of hemorrhagic and
other exudation, perivascular injury, or erosion, and possibly the
spotted-gray disorganization which, when distinctly morbid, is
as distinctly related to changes of the same character. These
changes have different degrees and stages. None are exactly
repeated in every case, though there is evidence in each of
changes of the same nature. The changes may want in con-
stancy, but they do not want significance." There have also
been found in different portions of the brain, oftenest in the
neighborhood of the fourth ventricle, tumors, effusions, soften-
ing, wasting of gray substance, degeneration, and pigmentation
of the cells. In fine, Dr. Dickinson considers the brain the
primary seat of the disease, for he always observed it to be
affected. The changes may not have been peculiar to diabetes,
but they were always present.¹
The spinal cord is often congested, softened, and even in-
durated. Dr. Dickinson also avers that he has met with a dila-
tation of the central canal in the dorsal and lumbar regions,
and a proliferation of the lining epithelium. The sympathetic
system occasionally evidences changes, generally of a chronic
I London Lancet, vol. i., 1883, p. 775.
21
inflammatory nature, with an increase of the small cells; the
vessels of the thoracic sympathetic cord have been observed to
be engorged, and new growth of fibrous tissue formed; the
splanchnic nerves and semilunar ganglions have been similarly
diseased. Dickinson, however, states that he has usually found
the sympathetic system healthy; while Lubnoff (Virchow's
Archives, lxi. p. 145) detected sclerosis and atrophy of the
ganglionic cells, as well as an atrophied and pigmentary condi-
tion of the inferior ganglions of the trunk. The minute morbid
anatomy of the nervous system is a difficult one to trace; but
one may now look for new and important revelations, especially
as the use of the microscope is being better understood.
Ever since Claude Bernard's discovery of the glycogenic
functions of the liver, pathologists have been looking to that
viscus as likely to supply the key to the solution of the vexed
question of the seat of the disease causing diabetes. The liver
is generally observed to be altered, — in a condition of hyperæmia
or hypertrophy, with atrophy of the cells from pressure. But,
inasmuch as the weight and size of that organ vary much in
different individuals, this may have led to many errors. It is
likely that when pathology shall have progressed still further, it
will be demonstrated that the liver will always present some
morbid condition in the diabetic subject. As has already been
stated, the hyperæmia is owing to a paresis of the vaso-motor
nerves of the liver brought about by some nervous disturbance
of either the sympathetic or the cerebro-spinal system. Pavy
believes that there may be intrinsic conditions of the liver or
of the chylopoetic viscera provoking diabetes. MM. Hanot
and Chauffard report many cases with hypertrophic pigmentary
cirrhosis, and M. Letulle mentions two identical cases in No. 20
of the Bulletin et Mémoires de la Société Médicale des Hôpitaux.
Other observers cite cases with amyloid or fatty degenerative
changes, abscesses, and obliteration of the portal vein. In fact,
hypertrophy is so often present as to lead to the conclusion
that there is some connection between the two.
The kidneys are generally hyperamic, with an increase in
size of the cells of the convoluted tubules, and disintegration
22
of the renal epithelium (Dr. P. S. Inglessis: Le Rein dans ses
Rapports avec le Diabète, Paris). Renal hyperæmia is often
present in the earlier stages, and parenchymatous nephritis in
the advanced period. This is occasioned by the strain of
increased activity imposed upon the kidneys. In some cases
where albumen was detected in the urine during life, it led to
the supposition that Bright's disease existed; but the post-
mortem showed kidneys of a dull, pale yellow from infiltration
of fat. This, of course, is very different to that from diffused
nephritis occasioning contracted kidney, which is seldom seen
in diabetes. The pelvis of the kidneys and the ureters are
frequently in a catarrhal condition, due, doubtless, to the irrita-
tion caused by the sugar in the urine. Abscesses of this organ
have not been infrequent, and are the outcome of similar influ-
ences; and tuberculosis or amyloid degeneration has been
noticed when phthisis coincided with diabetes. In advanced
cases a granular metamorphosis of the renal epithelial cells may
occur, when uræmic symptoms are apt to arise, owing to the
non-elimination of the sugar.
The stomach and intestinal canal not seldom indicate chronic
catarrh, hyperæmia, thickening of mucous membrane, hæmor-
rhagic erosions, slaty pigmentation and hypertrophy of the mus-
cular coat of the stomach and upper part of intestine; but
whether they are due to primary conditions, or to the inevitable
outcome of the disease, is a matter for conjecture. The pancreas
is frequently the seat of morbid changes, either atrophy or fatty
degeneration. Those who claim that disease of the pancreas
is the cause of diabetes offer two theories in support of their
assumptions, one, that the disease originates with the pancreas,
and encroaches upon the plexus, destroying its ganglia; and
the other, that the coeliac plexus, being diseased in the first
instance, leads to circulatory disturbances in the parts supplied
by the coeliac artery, and hence atrophy or fatty degeneration.
The spleen is occasionally the seat of congestion, but we lack
data in respect to the condition of this organ in connection
with diabetes.
The blood varies in appearance. Sometimes it is unusually
I
23
thick and viscid, and then almost normal in consistency and
specific gravity; but generally it is as rich in hæmatin as in
the normal condition, except where anæmia has set in from
inanition. Glycogen has been found in the blood in vari-
able quantity, as well as in the brain, lungs, liver, pancreas,
kidneys, testicles, heart, voluntary muscles, and cerebro-spinal
fluid. When it exists in pus, it is significant, since it usually
promptly vanishes from the pus of the non-diabetic patient.
The coma which is so frequent a termination of diabetes is
doubtless due to alcoholic fermentation of the glucose in the
blood, resulting in the production of aceto-acetic acid, and not to
acetone, as formerly believed. The presence of this substance
in the blood would explain satisfactorily the acid state of the
urine generally noticed, the lactescent condition of the blood,
and the fatty degeneration observed in cases where diabetic.
coma has set in. Pavy dissents from this theory, believing that
the coma is due to exhaustion of the nerve-centres, such as
fatigue or unusual excitement would occasion; but then how are
we to account for the many sudden deaths which occur without
any particular previous fatigue, mental or physical?
Dr. Ralfe, on the occasion of the debate on diabetes at the
Pathological Society of London in 1883, expressed the opinion
that the coma was due to an acid poison, “an acid intoxication”
of the blood, which acid in the urine became decomposed into
acetone. Quite recently Professor Lépine publishes a case in
the Revue de Medecine which establishes conclusively that in
this state the blood loses its alkaline re-action. The professor's
experiments with intravenous injections of chloride of sodium
and bicarbonate of sodium were very interesting as well as in-
structive in this direction.
Fatty condition of the blood (lipæmia) is often observed, and
has led to the opinion that fatty emboli may be the cause of
diabetic coma. But it is now admitted that this is only a physi-
ological state due to excessive ingestion of fat or its deficient
elimination from the system. This condition of the blood has
also been met in disturbed functions of the liver, or in cases of
deficient de-oxidation of sugar.
1
24
It may be well to remember that the blood often contains
sugar in poisoning by curare, carbonic oxide, amyl nitrite, or
after large doses of morphia, chloral, hydrocyanic acid, and
alcohol, and also after certain infectious diseases, as cholera,
anthrax, diphtheria, typhoid fever, scarlatina, and malaria.
There are authors who state that a causal affinity exists be-
tween phthisis and diabetes; but in reality the impression has
originated with the fact that phthisis may supervene in the
course of diabetes, as it does in chronic and exhausting mala-
dies. The statistics of the Brompton Hospital, England, com-
piled by Dr. Douglas Powell, establish this fact conclusively.
It is, in reality, doubtful if these two diseases have any thing in
common. Chronic inflammatory processes, caseous pneumonia,
and pleuritic exudations, and even cavities, have been found;
but the lungs, when affected, are not so primarily.
There is often present a general alteration, a state of atrophy,
of the muscular fibres, leading to much weakness; and the
weakened or asthenic condition of the muscles of the heart
occasionally causes alarming syncope, with nausea, vomiting,
drowsiness, convulsions, temporary paralysis, and even loss of
consciousness. This must not be confounded with acetonæmia.
In the latter the attack is sudden, nausea and drowsiness are
present, but the pulse, instead of being weak and thready, is
regular and rapid, and we have, further, Cheyne-Stokes respira-
tion, fœtid odor of breath, and spasmodic abdominal pains, the
latter often rousing the patient from the state of somnolence.
The muscles look pale or reddish-brown, and, chemists state,
they contain an unusual amount of creatine.
Ehrlich's recent experiments are of the greatest interest.
By removing minute portions of the liver, by puncture, he as-
certained that, in the advanced stages of the disease, the forma-
tion of glycogen in the liver gradually declined, and the sugar,
entering the portal vein, passed directly into the systemic
circulation.
The mode of death varies greatly, as will be seen. The fatal
cases in the London Hospital, during eight years, terminating
in 1883, numbered 37. In 7 no disease could be detected in
..
}
25
the cadaver; in 3 there were no signs of pulmonary or other
visceral changes during life; in one, pulmonary disease was diag-
nosed before death; in 4 there were signs of recent pneumonia
or phthisis; and in 4, old pneumonias or phthisis existed. In
the 12 last-mentioned cases no necropsy was made. The
remaining 18 cases were as follows: cerebral hemorrhage in
one; cerebral tumor in one; spinal-cord disease and phthisis
in one; stricture of urethra, suppurative nephritis, and coma in
one; scrofulous nephritis and phthisis in one; pneumonic
phthisis in one; dermoid ovarian cyst, calcified mesenteric
glands, in one. In 20 out of 37 there were pneumonic or
phthisical changes.. The phthisical changes were found in two
organs only, -lungs and kidney. Coma was the determining
cause of death in 19 out of 37 cases. In 18 cases, where death
resulted from coma, no fat embolism, or fat in the blood-vessels,
was found. Fat embolism and acetonæmia accounted for the
coma in certain cases, but they were too inconstant to serve
for a general explanation. The sudden onset of the attack, as
well as other peculiar features, and also the absence of charac-
teristic lesions after death, point to some poison developing in
the body. There were no pathognomonic conditions; the most.
frequent, however, besides emaciation and phthisis, were a
slimy, homogenous state of liver and spleen, and enlarged,
congested kidneys.
Of 53 cases dying during a period of ten years, ending in
1883, at Guy's Hospital, London, 33 died comatose.
In 17
there were
no lesions of the viscera, in 3 the lesions were
unimportant, and in 10 the coma supervened in the course of
pneumonia or phthisis.
Frerich reports 250 fatal cases. Of these, 18 died from
exhaustion, 34 from phthisis, 7 from pneumonia (4 out of that
number of gangrene of the lungs), 8 from nephritis, 7 from car-
buncle, and 9 from complications (6 of these from cancer). In
all the other cases, some form of cerebral affection was present,
10 hemorrhage, 2 softening, 3 cerebro-spinal meningitis, and
the remainder presented symptoms of coma without any distinct
brain lesion. Upon 45 of his cases autopsies were performed.
26
The above statistics support, in the main, the theory I have
advocated, — that, in the majority of cases, some lesion of the
brain, spinal cord, or ganglionic system is present; and I think
it will be ascertained, ere long, that these lesions are oftener
the result than the cause of the initial disturbance. Further
research and experience will, I am satisfied, establish that
diabetes is a nervous, functional disease, presenting varied mor-
bid conditions as witnessed in all neurosis. Yet, it must be
confessed, there is sufficient uncertainty, if not mystery, still
involved in the question, to forbid dogmatism on the one hand,
and to encourage further research on the other, in the hope of
fresh and desirable additions to the domain of pathology and
physiology, as well as to the precious resources of the healing
art.
:
1
I
中
​12.
Welto
ист стрий
comptes of the
auchir,
A RESUME
OF THE
ETIOLOGY OF ASIATIC CHOLERA,
WITH COMMENTS THEREON.*
&B
BY PROSPER BENDER, M. D. BOSTON, MASS.
One of the most pleasing features of our present civiliza-
tion is the greatly increased care of the public health mani-
fested by the rulers and leading members of society. Now-
adays our social and political magnates have thoughts
beyond the gratification of their own whims and inclinations,
and the promotion of their own interests. The well-being
of the masses receives considerable attention from them.
While on the one hand the various influences of our high-
pressure civilization admittedly combine to damage health
and shorten life; on the other, our constantly increasing
sanitary improvements contribute much to warding off
disease, and particularly those old, common and violent
forms of it, which, frequently as epidemics in the by-gone
time slew the people by tens of thousands, terrifying and
impoverishing whole nations in a few weeks or months.
* Reprinted from the United States Medical Investigator, September. 1885.
-2-
·
This great change in the moral habits and tastes of the
leading classes is something to be thankful for, and well
calculated to cheer us in any forecast of the future. How
to pamper self and gratify private desires and pride, may
yet be a problem which will attract much attention; but
other questions compete with it vigorously for notice,
including the best means of contracting the power and
domain of disease, and involving the best methods of
increasing the forces of health and recuperation.
No subject now commands more prompt and earnest con-
sideration on the part of all concerned with public interests,
from the heads of the state to the humblest municipal
functionary, and from the most famous philanthropist, to
the youngest physician, than that of essaying the dissipation
of the most trifling ailment. Although all admit the
nobleness of the mission of fighting disease and pro-
longing life, the best means of pursuing it, of accomplish-
ing the largest results still constitutes the crowning difficulty
to be overcome.
The old experience in this matter continues more or less
familiar, the popular appreciation of it finding expression
now, as in past times, in a well known saying-" doctors
will differ." But while this habit must be recognized, it is
but fair to say as well as encouraging to know, that not-
withstanding such evidence of the weakness that one por-
tion of humanity is liable to, the subjects on which it is
agreed, affecting the physical and moral well-being of the
race, are more numerous than ever, with a constant progress
towards still greater harmony. And the evil of the differ-
ence among doctors, if it be an evil of the serious kind, is
largely compensated for by the wider and more exhaustive
discussion thus secured to questions possessing many sides,
with the natural result of attaining a larger measure of
truth, valuable in itself as well as advantageous to hu-
manity.
-3-
son.
The nature of cholera and its causes is one of those se-
rious questions with which both the medical profession and
statesmen are at this time occupied. Nor could anything be
more appropriate considering the ravages it has made hith-
erto, and is making at present in Spain. I shall in this
pa-
per present the principal views of the different schools on
this subject, as correctly as I can within the brief space at
my disposal, interspersing therewith such reflections as have
occurred to me in the task of condensation and compari-
While myself leaning to one theory, my controlling
desire is to witness the fullest and fairest discussion, with a
view to the triumph of the right, to the discovery and prac-
tice of all the truths important to science and valuable to
mankind. Above all things, I repeat, no matter whose the-
ories or crotchets suffer, let us have the truth, which is the
more valuable sometimes, in proportion to the difficulty of
its discovery. It must also be recognized that our science.
demands time and experiment, under all sorts of conditions
for the arrival at exact and reliable conclusions. And no
conclusions are so important to our race as those affecting
materially its health and life.
With regard to the etiology of the fell destroyer chol-
era, happily much more is now known than formerly, owing
to the wise and liberal action of the European governments
that have, during the last two or three years, sent commis-
sions, composed of able medical men, to Egypt, Italy,
France and Spain, as well as India, the unfortunate theatres
of its recent operations, to investigate its cause, pathology
and mode of propagation. As is natural enough, different
opinions have been expressed by the various commissions.
with regard to the theoretical or tentative problems con-
cerning the real origin of the disease and the methods of
its dissemination, and the results will doubtless ultimately
lead to the solution of the vital question of prevention,
comprehending the best sanitary measures for the different
races and regions afflicted. This is a great gain to humanity
-4-
at present, and one full of cheering promise for even the
early future.
I think in a general way I may conclude that, as respects
the real nature of cholera and its forms of development, the
bulk of the learned practical opinion endorses the germ the-
ory, which is now credited with the origin of many other
diseases. While many ascribe its cause to a minute
bacterium, others believe it to be due to the influence of a
living ferment, the representative of a parasitic organ-
ism. Certainly, from present appearances, the former
theory, which is the outcome of much patient and intelligent
experiment and research, appears the more influential and
the more likely to excel in the early struggle for converts.
-
These two rival theories at present dispute the field. They
will be better understood when the subjoined views of the
experts and savants mentioned are considered; one favors the
contagion theory, the other the local or effluvial. Among
the prominent advocates of the former are Koch, Surgeon
General DeRenzy, Macnamara, Watson-Cheyne and many
others. The "localists" count Pettenkofer, Surgeon General
J. D. Cunningham, Sir Joseph Fayer, Sir Geo. Hunter and
Drs. Klein and Gibbes.
But with regard to the interest of this subject for Amer-
icans-for all, indeed, who can spare a thought for one of
the greatest plagues which mankind is periodically afflicted
with, and particularly for the best means of fighting its ter-
rors-it is but right to observe here, that the recrudescence
of cholera in Spain justifies the apprehension that it will
soon spread to our shores. This scourge, as is well known,
follows the lines of human traffic, and the constant flow of
travel between both continents must inevitably bring us,
ere long, face to face with the dread disease. In view of the
possibility of such a visitation, it behooves us to understand
its causes, its mode of progression and diffusion, and its
pathology. Without such knowledge it will be impossible
-
—5—
to adopt effective measures to check its propagation or to as-
certain the best therapeutic expedients.
All who have studied the subject, no matter what ætio-
logical theory they may hold, believe that the most potent
factor in the spread of the disease, is the accumulation of
filth, which forms a breeding soil for the cholera germs and
a focus for their dissemination. In localities where cholera
prevails for any length of time, insanitary conditions must
exist. Places well drained and supplied with pure water are
seldom affected, and when they are they soon lose the suscep-
tibility to cholera. During the European epidemic of last
year, the number of cases and mortality were in direct pro-
portion to the insanitary state of the places.
The more
strict the hygienic regulations the fewer the cases and the
smaller the mortality. The general adoption of such pre-
cautionary measures will not only benefit the public health
but render the individual less susceptible to disease generally.
In the event of an attack of cholera, the malady will lose
much of its virulence and its fatality will be greatly les-
sened, which are matters of considerable moment.
Previous to last year very little comparatively was known
as to the exact nature of cholera. True, Hahnemann more
than half a century ago wrote that "the contagious matter
of cholera probably consisted of excessively minute, invisible,
living creatures," and his description of their propagation
was not unlike that subsequently given by Tyndall and Car-
penter. And Dr. A. H. Hassall in 1853 detected and de-
scribed a micro-organism similar to those which Koch now
says are an advanced stage in development of the comma
bacillus, and Pacini of Florence made a similar discovery the
year following; but it was reserved to Koch, who headed
the German expedition, to demonstrate the presence of a
characteristic and constant form of bacterial life in the intes-
tinal contents of the choleraic dead and to assert that it stood
in the relation of cause and effect to the disease. He describes
-6—
14
it as shaped like a comma (,) and belonging to the spiril-
lum rather than to the bacillus. It differs microscopically
and morphologically from any other form of bacteria ; it lives
and multiplies outside the body and thrives in damp and
soiled linen, but fortunately is short lived, is easily destroyed
by certain disinfectants and by dry heat. For the latter
reason he says the disease cannot be transmitted by mer-
chandise or by letter a statement, however, which facts
do not bear out. It multiplies rapidly in alkaline solution,
but acids are fatal to it. In healthy subjects the bacillus
does not reach the intestines owing to the acidity of the
gastric juices. The putrefactive bacteria are inimical to it,
and where they thrive the bacillus perishes. This assertion
seems extraordinary in view of the fact that we are told the
accumulation of filth favors the dissemination of cholera.
The bacillus is as harmless to the healthy subject as the
bacteria of decomposition and ferment. Special circum-
stances are necessary to its multiplication, but these have
not yet been fully elucidated. It may spread by human in-
tercourse, but its chief mode of propagation is by the water
we drink. It is found in abundance in the dejecta of the
patients, but seldom in the vomited matters. In no other
class of cases did Koch find this bacillus, and his followers
say that those who pretend differently did not submit the
bacillus to the several tests which he employs.
-
The 66 contagionists," whose theory has been greatly
strengthened by Koch's discovery, state that cholera is an
importation from India where it prevails endemically, es-
pecially in the delta of the Ganges. They attribute its cause
to numberless micro-organisms, which find entrance into the
circulation, through the air we breathe, or the food we eat,
but more particularly through the water we drink. They
believe that these mycetic germs abound in the dejecta of
the patient and by means of defective pipes and drains, priv-
ies and sewers, they find their way by filtration into drink-
ing water and are thus introduced into the human body.
}
-7-
Their dissemination is influenced by seasonal and local dis-
position; and the severity of the attack is incidental to the
individual susceptibility. When these germs gain access
into the circulation they cause irritation first, and then ne-
crotic changes in the mucous membrane of the intestines
with hemorrhage and putrefactive conditions, followed by
symptoms produced by the absorption of decomposing pro-
ducts, and known as cholera-typhoid.
The recent discovery by Dr. Emmerich, of Munich, of the
general distribution of a new cholera-microbe of a specific
character, with distinct pathogenetic properties throughout
the tissues of the body of the cholera patient, is another link
in the chain of evidence favorable to the views of the conta-
gionists. And since, Hans Buchner, one of Naegeli's prom-
inent pupils has ably advocated those views. Emmerich has
succeeded in isolating the choleraic microbe he claims to
have discovered, and its inoculation has caused symptoms re-
sembling cholera. Crookshank, however, says that it is
"nothing more nor less than a pyogenic or septicemic bac-
terium."
The Belgium government also sent a commission to Mar-
seilles last year, in the person of Dr. E. Van Ermengen, who
after a thorough investigation became convinced that Koch's
conclusions were correct. He expressed the opinion that the
“comma bacillus" possessed specific characters which satis-
fied him it was the causa causans of cholera.
The report of the English commissioner to Egypt, Sir
Wm.Hunter, was to the effect that cholera had prevailed epi-
demically in Egypt since 1865; the epidemic of 1883 was
but "a resuscitation" of the previous visitation in a more
violent form than that which existed in the interval, and was
classified by native practitioners as choleraic, cholerine or
even diarrhoea. This, he stated, explained the high rate of
mortality from that class of disease, which was ten per cent
-8-
of the total mortality.
He believed cholera was not
contagious, but due to local influences; and the malignity
of the disease depended upon the varying conditions of lo-
cality and climate.
Last year the British government despatched to India, Drs.
Klein and Gibbes, who reported that the dead body of chol-
eraic patients did not contain organisms which could be re-
garded as specific and pathogenetic. In all true infectious
diseases, mycetic germs are present in great numbers in the
morbid products of the disease, but such was not the case
with cholera patients. Water containing choleraic dischar-
ges did not produce the discase, but linen and clothes, not
even soiled, could convey the infection; the evacuations of
cholera were harmless from actual experiments. They be-
lieved the virus to be dependent upon locality, that it was a
chemical ferment, having its breeding ground in a suitable
soil, and when absorbed into the system was the real poison
at work, acting on the blood and nervous tissues and giving
rise to cholera. Persons not sick could convey the disease,
which proved that the dejecta were not necessarily the cause
of its propagation. In the different tanks and pools of Ben-
gal where the cholera patients' evacuations are constantly
draining into them, the water is drank with impunity. They
found Koch's "comma bacillus" occasionally, but not invaria-
bly; they therefore concluded it was not the infective agent.
They discovered small straight bacilli; but considered neither
possessed morbific element. They did not detect any organ-
isms in the tissues of the intestines, in the blood or elsewhere.
Might not this new bacillus as well as Emmerich's be the
same as Koch's in a different stage of transition or undergo-
ing changes with the varying external conditions? This is
the opinion of Watson-Cheyne, Crookshank and Koch too,
and seems to me a likely solution of the problem.
The believers in the Koch theory are positive as to the con--
سو
stant presence of the bacillus in cholera, and its cholerigenetic
power. Its mode of growth under artificial cultivation and
morphological pecularities is decided and unmistakable.
And Koch states there is "no analagous instance of a bacil-
lus being secondary to a disease with which it is solely asso-
ciated." Dr. Crookshank in the London Lancet, of the
13th June last, writes: "The last link in the chain of evi-
dence is afforded by the effect of the inoculation of a pure
culture of Koch's comma bacillus in animals. Nicati, Rietsch,
Koch, Ermengen and Babes have inoculated the bacilli with
success in the duodenum.”
The London Lancet in a recent issue when alluding to the
discovery of the German scientist says: * "the time will
surely come when we shall no longer be content with enforc-
ing the principles of sanitation, useful and fruitful as that.
labor is, but shall be possessed of measures aimed more di-
rectly against the causes of these diseases. To be sure, there
are many who doubt the significance of the micro-organisms
which appear to constitute the virus of so many of these dis-
eases, and who believe that the parasitic theory is being
pushed too far, blinding us to the broader features of epi-
demic influences. But evidence in support of that doctrine
accumulates on all sides and grows stronger day by day.
Mistakes, even grave errors, will often be made from lack of
sufficient care in observation and experiment, or from too
hasty generalization, but the main principle remains un-
shaken, the principle of zymosis."
Important as is this discovery, Pettenkofer believes it does
not supply a solution of the cholera question, but he admits
it is a very promising field for pathological not epidemiolog-
ical inquiry. It does not explain, he adds, "the dormant
conditions of the disease during winter, its recrudescence and
the influence of time and space."
The "localists" or "infectionists" who find in Dr. Klein a
IO
strong supporter say that cholera is non-contagious, non-
specific, owing its genesis to a living entity, a micro-organ-
ism generated and propagated independently of man, and
that it affects definite localities. They deny that cholera can
be conveyed from one place to another by air, water or any
other of the usual channels through which contagious dis-
eases spread. Cholera never shows itself outside of India in
a locality which had not been previously in communication
with an infected place; that the germs are short-lived unless
the necessary relation of time and space be favorable to its
development. How long the germs may remain latent in a
locality they have no evidence, but a whole year may elapse
before a recrudescence of the disease may occur. Outside of
India the germs die out, and they must be imported again.
The infection, they say, never outlives a long journey; Pet-
tenkofer states that neither the Cape of Good Hope nor Aus-
tralia has ever been visited by the cholera. Koch, however,
gives instances of ship epidemics of long duration. The "lo-
calists" are positive that the dejecta do not contain the patho-
genetic micro-organisms; if they did, they argue, physicians
and nurses would be more generally stricken with the dis-
ease, while it is generally admitted they are as exempt as
most classes. Surgeon General Irvine, principal medical
officer of the English troops in Egypt, however writes:
"Contrary to the general experience in cholera epidemics,
the attendants on the sick suffered in a much greater degree
than the rest of the troops, and this was also the case with
patients in hospital compared with the healthy men."
The incidence of cholera is always greatest in the most in-
sanitary regions. The similarity of cholera to ague, they
hold, is marked; the chill at the commencement and the
terminating fever are points of resemblance, and fur-
thermore like the zymotic diseases, its distinguishing
characteristics are not constant and invariable. Wherever
ague exists cholera finds a favorite locality for its dissem-
ination.
M
I I
The infection, they contend is located in certain districts;
remove a regiment or the prisoners from a jail or an infected
locality, and the disease will disappear, even if the sick ac-
company the party. The following instance is often cited
by the "localists" to illustrate this: During the Burmese
war, an English steam frigate (Moozuffer) was shipwrecked
at Pantano, India. Cholera existed on board at the time.
The crew was saved by that of another steamer. The next
day two of the men of the Moozuffer were stricken down
with cholera, no other cases happened, although the crews
of both freely commingled. Surgeon General Cunningham
says: "The whole practical action must be based on the
truth that measures should be directed not against the free-
dom of the person, but against the sanitary condition of
the place in which he lives." And yet the excellent au-
thority already quoted from, Surgeon General Irvine, says:
"Notwithstanding every precaution being adopted by evacu-
ating the barracks, encamping the troops and moving the
camps when requisite, the disease spread among them."
During some epidemics in India, cholera will follow a body of
pilgrims and soldiers for days and then suddenly disappear.
Virchow ably sums up the theory of the "localists" in the
subjoined brief words: "up to the present not a single case
was known where the existence of a cholera germ in the soil
had been proved." He "would not deny its possibility,
but he disputed the exclusiveness of the soil theory."
Drs. Strauss and Rouse of the Pasteur mission to Egypt
and Toulon found several kinds of micro-organisms in the
mucous membrane of the intestines and in its contents. In
very acute cases, however, they could not find them and,
therefore, they came to the conclusion that although bacilli
might play an important part in cholera, they had no ætio-
logical relation to the disease. They, however, discovered
organisms in the blood, due to special changes in hæmoglo-
bin, and which they believed, were the initial cause of chol-
-12-
era. Koch states that these germs have no causal
significance, and that they are present in the blood of typhus
and pneumonia patients.
Dr. Tommasi-Crudelli, the Italian cholera expert defines
cholera as a “contagio-miasma," a morbigenous germ, pro-
ceeding from a diseased human body, which never diffuses
itself epidemically except when the excrementa containing
it find in the soil conditions favorable to its multiplication.
Epidemiological influences must not be overlooked in study-
ing the cause of epidemics and the means of prophylaxis.
We all know that cholera is capricious in its movements.
One time it scourges one locality, skipping another not dis-
tant, and apparently more suitable for its operations, while
a second outbreak finds it acting wholly different. To give
but two instances; during the cholera last year, in France,
it raged in Marseilles and Paris, avoiding Lyons, midway
between them and on the same railway. In 1854 cholera
reached Berlin from Munich, while in 1866 the latter escaped
a visit, notwithstanding both cities are in constant communi-
cation. Koch believes that the atmospheric transmission of
cholera occasionally occurs, but generally it only affects an
epidemic to the extent that the power of the virus is longer
in force in moist air, while it is rapidly lost in the dry.
"Localists," moreover, lay great stress on the fact that
the epidemic always proceeds from the plains, in India,
up to the hills, and contrary to the course of the river. Hu-
midity of soil, particularly in the superficial layers wherein
organic matter is in active decomposition, favors the spread of
cholera, and also porous and clayey soils, but not stony and
compact ones. In high localities where drainage is good
cholera gains no foothold, while in low-lying regions it pre-
vails. The Himalayan mountains, those of Lebanon and
the Alps are generally free from cholera.
It is also generally acknowledged that there are cosmical
-13—
conditions which play an important part in the generation
and extension of epidemics. The share of these various influ-
ences it would be a beneficial achievement of science and
philanthropy to trace. The probability of their early and
approximately correct demonstration is hardly doubtful.
Science and honorable ambition continue marvellously ac-
tive, and their successes hitherto justify the hope of further
glorious conquests. Meteorological states and magnetic
forces like stillness of the atmosphere, a high temperature,
absence of ozone, mistiness and sultriness of aerial elements
have all been noted as immediate precursors of epidemics, or
steady accompaniments. In India when the atmosphere
clears and the sky is bright the mortality lessens. Who
does not know that when the air is still and oppressive
deaths are more numerous, corporeal susceptibility to dis-
ease and to its aggravation being thereby enhanced? Indi-
viduals sicken and die of the disease and communicate
it to others, but with relatively little spread of the epidemic,
unless they happen to be traveling in the direction and at
the rate in which some unknown epidemic influence is
itself proceeding-whatever the total effect of such influen-
ces, they greatly affect the patient and jeopardize his chances
of recovery. Pettenkofer does not deny
Pettenkofer does not deny "the influences of
human intercourse in the spread of cholera; but this alone
does not suffice to evoke an epidemic. Local and seasonal
influences must determine this."
The enormous influence of insanitary conditions, includ-
ing impure air and water, overcrowded tenements, and last
though not least, deficient nourishment of many of the
hardest workers, with distracting anxiety about circum-
stances occasioning great loss of needed sleep, all now admit.
Such mental states affect the brain and nervous system,
as well as the digestive and other organs.
And who can
adequately estimate, for example, the terrible, the conta-
gious, the weakening effects of fear, during epidemics or
times of public calamity?
14-
1
In pursuing our investigations in the causation of cholera,
there is danger in assuming the correctness of any theory
until it be proven, for it unwittingly gives a bias to our
methods of procedure. A careful and thorough examination
of the subject must be made before we reach or accept any
conclusion. We must remember that its prevention as well
as its limitation depends in a great measure upon the theo-
retical conception we form. It is generally conceded now
that a germ exists which is the active agent, but many con-
sider the question an open one, expectantly looking to scien-
tists for a solution of the question.
We must continue in the path of honest, patient investi-
gation, trusting to time and the clearer gaze of an ever-
growing intelligence to solve problems of vast concern to
humanity, which serve now to excite our intellects to higher
flights of honorable effort, and our hearts to nobler aims for
the general good.
1
•
1
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}
+
*

Compliments of the Author.
Ortesy
+
THE
NON-SURGICAL TREATMENT
OF
1
18
ENLARGED PROSTATE GLAND,
AND THE RADICAL CURE OF
PROSTATIC, CYSTIC, AND RENAL CALCULI,
AND CYSTIC SEDIMENTARY DEPOSITS,
BY A NEW SOLVENT.
BY
¿
W. E. BESSEY, M.D., C.M.,
TORONTO, CANADA.
Reprinted from the HAHNEMANNIAN MONTHLY, April and June, 1892.
GSM
ang mg
་་ཐོས་དགུང་པར་
པ༣༩



"
1
THE
**
!
NON-SURGICAL TREATMENT
OF
ENLARGED PROSTATE.
BY W. E. BESSEY, M.D., C.M.,
TORONTO, CANADA.
THERE are few more troublesome, distressing, or intractable dis-
eases that one may be called upon to treat than enlargement of the
prostatic gland; and few subjects more involved in pathological
obscurity or more resistant to therapeutic measures than prostatic,
renal and cystic calculi. Having had some satisfactory experience
recently in the treatment of prostatic affections-congestion and
chronic hypertrophy of the gland, and calcareous deposits, made up
of minute concretions of calcium phosphate, which forms within the
follicles of the gland, any or all of which give rise to a mechanical
obstruction to micturition in men who have passed middle life which
the profession generally have considered to be a permanent condi-
tion requiring operative interference, or mechanical means to over-
come, I have felt constrained to bring the subject before you for
consideration. It is hardly necessary to enumerate the many
operative proceedings that have been devised for the relief of this
condition, but I may refer to a few to show the serious manner in
which it is universally regarded.
your
A large number of patients with obstructive prostatic enlarge-
ment can be made comfortable by the use of a soft rubber, or a
Nelaton or Mercier catheter, if it be carefully sterilized, in a 1 to
2000 corrosive sublimate solution, both before and after use, and W.
Robertson, M.B. (British Medical Journal, May 17, 1884), origi-
nally suggested the use of injections of a corrosive sublimate solu-
tion (1 to 1000) in retention of urine from enlarged prostate, with
catarrh of the bladder, introduced through a large prostatic silver
- 2 -
Į
catheter to the extent of three to four ounces warmed, and allowed
to remain three or four minutes. This measure has been found to
ally irritation and reduce the swelling in cases of acute congestion
of the prostate. Free irrigation with hot water alone in acute cases
will do the same, while in chronic hypertrophy and calcareous en-
largement it has proved of no avail. To irrigate the prostatic inch
of the urethra or bladder successfully a suitable instrument for the
purpose is necessary, without which good effects are not obtained
and harm is done by the irritation of the interference. Of these,
devices the spirally grooved hard rubber catheter of Whitehead,
Manchester, England, is I think the most satisfactory and cheapest.
I have also used Linderschmidt's urethral and prostatic irrigator
with much satisfaction. It should be borne in mind that the irriga-
tion of the urethra with hot water, being regarded merely as a pre-
liminary measure to treatment for the relaxing of spasmodic con-
tractions of the urethral walls, and the cleaning away of foul secre-
tions, it should be followed immediately after the mucous membrane
has been thoroughly cleansed with an application of a weak solution
of salt water one grain to an ounce; or a solution of corrosive subli-
mate 1 to 30,000, or tincture calendula 1 to 1000.
Harrison's device for tapping, or puncture of the bladder for the
retention of urine from enlarged prostate, through the perinæum and
the enlarged gland by means of a trocar provided with a special
canula has been followed by satisfactory results in chronic cases, but
has not spread in popularity. Dr. Belfield's original operation, aud
McGill's admirable modifications of the work in the removal of por-
tions of the prostate in those cases in which catheterism had become
impossible, and in which cystitis had developed, and septicemia or
uræmic pressure seemed imminent, is an operation causing great
shock to the nervous system, and the risk of hæmorrhage, and of
septic troubles is too great for it to be anything more than a dernier
ressort at best.
Groves' modification of Harrison's prostatectomy is an operation
similar to an ordinary medium lithotomy opening of the membra-
nous portion of the urethra close to the prostate, and the splitting
up of the obstructing portion of the prostate with an ordinary lith-
otomy knife which is passed along a grooved staff. A large drainage-
tube is now inserted, through which a soft rubber catheter is passed
into the bladder allowing constant drainage; or a canula with a stop-
cock may be used; or the urine may be caught in a rubber urinal.
As the healing process goes on in the prostate, cicatricial tissue is
3 -
formed, which by its gradual contraction causes more or less atrophy
of the obstructing portion of the gland, making the improvement
progressive and permanent. This, although a formidable proceed-
ing, is among the best surgical measures that have been devised, if
we except the last but not least, supra-pubic puncture. This is easy
of performance, and should be done with a trocar having a No. 10
canula with a stop-cock attachment to screw into the end after re-
moval of the trocar to prevent leakage of urine. The canula should
have a shoulder outside the stop-cock for the attachment of a piece
of rubber tubing to facilitate the conducting of the urine into a
receptacle.
The best surgical device that has yet been introduced for opera-
tions upon the enlarged prostate is the dome-trocar catheter of Dr.
Fitch, Halifax, Nova Scotia, for tunnelling the intractably enlarged
prostate, by which means the bladder is relieved at the time, and
permanent release is secured for recurring retentions. This instru-
ment is a long dome-trocar, the terminal third curved less than a
common catheter or sound; the dome with its fenestra resembles the
end of a metal catheter, and is mounted upon a strong steel spring,
which adapts itself to the outer canula, and when this catheter end
is pushed out it occludes the point of the outer tube, which, for ad-
ditional security, has a slight dorsal protuberance, so that it cannot
catch or scratch the lining of the urethra; it is really a catheter within
a tubular trocar.
C
The mode of operating with it is as follows: the instrument with
the dome protruding is introduced into the urethra until it comes
against the obstruction and is arrested by the enlarged prostate, the
left forefinger being in the rectum to define and steady the parts con-
cerned, the pointed outer canula is advanced and passes easily through
the gland into the bladder; then the inside catheter is slid forward
and enters the bladder with certainty, again occluding the point, and
the urine is discharged as through an ordinary catheter; a thumb-
screw now fixes the protruded dome, and the instrument may be
retained in the bladder twenty-four hours, or until the perforation
is sufficiently patulous, as shown by the instrument moving easily in
it; it may then be withdrawn and a full-sized metal catheter intro-
duced twice a day or oftener, until the new channel is cicatrized and
permanently established.
These are some of the many surgical devices which have been re-
sorted to for the relief of this serious affection; to these must be added
Sir Henry Thompson's plan, which consists in making a perineal
·
· 4 -
incision into the membranous portion of the urethra just in front of
the anus and passing the index finger into the bladder; then having
withdrawn the grooved staff, insert in its place a large No. 20 vul-
canized catheter, just penetrating the bladder and retained for several
days; excellent results are claimed for this operation.
Notwithstanding the weight of the great names that have pro-
posed these several methods, they are only surgical, and, therefore,
expedients, such as should be resorted to as the dernier ressort, when
all remedial treatment has failed. I have something better, in my
opinion, to suggest, which, in my experience, relieves the condition
and renders surgical interference unnecessary.
An enlarged prostate is usually found to be about the most dis-
⚫tressing affection a patient can be afflicted with, and one of the most
troublesome and annoying; for, until very recently, the treatment
of it has been little better than palliation, and the remedies pro-
posed have come to be regarded as so unpromising and unsatisfactory
that it came to be looked upon as incurable, and the mechanical ob-
struction to micturition a permanent difficulty requiring surgical
measures to overcome. Now, if we give a little brief consideration
to the anatomical structure and the physiological functions of this
gland and the organ most affected-the bladder-and the pathologi-
cal changes which occur in this condition, it will furnish us with the
data necessary to guide us in our efforts to arrive at a rational plan
of treatment of enlarged prostate, with chronic cystitis, and thicken-
ing of the muscular walls of the bladder.
CC
The anatomical structure of the prostate gland is given by Gray
as a pale, firm, glandular body which surrounds the neck of the
bladder and commencement of the urethra." It is placed in the
pelvic cavity behind and below the symphysis pubis posterior to the
deep perineal fascia, and upon the rectum, through which it may be
distinctly felt, especially when enlarged. In shape and size it re-
sembles a chestnut. The prostate consists of two lateral and a middle
lobe. The two lateral lobes are of equal size, separated behind by a
deep notch. The third or middle lobe is a small transverse band,
occasionally a rounded or triangular prominence placed between the
two lateral lobes at the under and posterior part of the organ. It
lies immediately beneath the neck of the bladder, behind the com-
mencement of the urethra, and above and between the ejaculating
ducts. Its existence is not constant, but it is occasionally found at
an early period of life, as well as in adults and in old age. In ad-
vanced life this or some other portion of the prostate often becomes
- 5 —
considerably enlarged, and projects into the bladder, so as to impede
the passage of the urine. It consists of glandular substance and
muscular tissue. The muscular tissue according to Kolliker consti-
tutes the proper stroma of the prostate, the connective tissue being
very scanty and simply forming the trabecula between the muscu-
lar fibres in which the vessels and nerves of the gland ramify. The
muscular tissue is arranged as follows: Immediately beneath the
fibrous capsule is a dense layer which forms an investing sheath for
the gland; around the urethra, as it lies in the prostate, is another
dense layer of circular fibres, continuous behind with the internal
layer of the muscular coat of the bladder, and in front blending with
the fibres surrounding the membranous portion of the urethra. Be-
tween these two layers strong bands of muscular tissue which de-
cussate freely form meshes in which the glandular structure of the
organ is imbedded. In the part of the gland which is situated an-
terior to the urethra, the muscular tissue is specially dense, and in
this situation there is little or no gland tissue, while in that portion
which is behind the urethra the muscular tissue presents a wide-
meshed structure which is densest at the upper part of the gland,
that is, near the bladder; it becomes loose and sponge-like toward
the apex of the organ, directed forward to the deep perineal fascia.
The glandular substance is composed of membranous follicular
pouches opening into elongated canals. The follicles are connected
together by areolar tissue supported by prolongations from the
fibrous capsular and muscular stroma, and are enclosed in a delicate
capillary plexus,
Vischer says: "The prostate is a symmetrical body, composed of a
medium and two lateral lobes; the existence of the former, however,
is said by some never to be present in a urinal gland (Thompson,
Morgagni, Lantorini, etc.). Its structure consists of a dense stroma
of unstriped muscular tissue, in the meshes of which are found tubu-
lar glands lined with cylindrical epithelium."
Ellis says: "The prostate is essentially a muscular body, con-
sisting of circular or orbicular involuntary fibres—its circular fibres
are directly continuous behind, without any separation with the cir-
cular fibres of the bladder."
T
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Dewitt says: "The prostate is essentially a circular involuntary
sphincter to the neck of the bladder, and expeller of the seminal
fluid; but although it contains many mucous glands and follicles
intermixed with muscular fibres, it is by no means entitled to the
name of gland."
– 6 –
"Besides it contains a small vesicle, at the mouth of which the
ejaculating ducts open, which is believed to be the male homologue
of the female uterus." The involuntary muscular tissue which
enters into the composition of the prostate itself, and the vessels of
the gland also have in their coats unstriped or involuntary muscu-
lar fibres-and these exist in the coats of the bladder in a very
marked degree. Now these involuntary muscle fibres are more or
less extensible, and when normally stretched have an organic ten-
dency to contract. This is seen in the uterus, bladder, and diastole
of the blood vessels. But when abnormally distended they gradu-
ally lose their power to contract or become paralyzed and remain
permanently dilated or elongated as seen in varicose veins-dilata-
tion of the right side of heart, etc. Enlarged prostate consists essen-
tially in a hypertrophy or enlargement of the natural muscular
structure and incidentally by congestion of the glandular.
De Witt says of it: "The affection is peculiar to advanced life.
The increase may be but slightly above the ordinary chestnut size
of the gland, or it may render it as large as a man's fist or larger.
It may affect the whole organ, especially the lateral lobes, pretty
uniformly, in which case the posterior portion of the gland is
greatly lengthened, or it may affect one side more than the other, in
which case the canal will be twisted, or it may affect the postero-
median portion which lies between the ejaculating ducts, enlarging
it into what is commonly called the middle or third lobe."
Sir Henry Thompson says: "A middle or third lobe does not
exist in health; it is pathological anatomy and purely the result of
unnatural enlargement. In youth the prostate becomes enlarged
from interstitial plastic effusion-the result of inflammatory action.
In age there is an unnatural development of the prostatic tissue
itself."
Sales
S
De Witt further asserts: "The consequence of this enlargement of
the middle lobe is that there is a projection at the very orifice of the
urethra, causing a most serious impediment to the issue of the urine.
Hypertrophy and derangement of the muscular fibres and near the
trigone may produce a transverse bar at the neck of the bladder.
The enlargement may be due to an increase of the organ generally;
or to the development of one or many masses of fibrous tissue exactly
similar in structure to those concentric masses of muscular fibre
which are developed in the womb, and are commonly known as
fibrous tumors of the uterus.
“One or more of these masses, involving more or less glandular
1
L
- 7 -
T
tissue may be developed alone, and may project as a pedunculated
tumor, or it may be contained within the mass capable of enuclea-
tion, and may constitute the whole disease, or it may be combined
with general hypertrophy."
The causes of this hypertrophy appear to be clearly associated
with local irritation, congestion and disturbances of the circulation
of these parts as from masturbation, excessive intercourse, irritating
injections or urethritis. It may be the result of an old gonorrhoea
or gleet; according to Erand and Montagni one-half are gonorrhoeal;
the weakness or local paralysis following a long-continued or sharp
attack of gonorrhoea, forming a condition of chronic congestion of
the prostate gland and mucous-membrane lining of the ducts and
passages of the neighborhood. But any absolute positive knowledge
of the cause of this hypertrophy is as absent as that respecting tumors,
or enlargement of such other glandular structures, as, for example,
the tonsils or thyroid, cases of which are as common in early life as
this is in after life. It commences, says Sir B. Brodie, about the
time the hair begins to turn gray, and when the arterial coats begin
to become atheromatous, but this change is not universal, although
frequent. Persons not having a history of disease of the sexual or-
gans, masturbation, or sexual excess, are seldom affected with this
distressing complaint, and atrophy often takes its place.
Sir Henry Thompson regards this change in the prostate of old
men as abnormal and exceptional, and gives the following statistics :
Out of forty-three specimens from men of over fifty, two men atro-
phied or wasted, nine slightly enlarged, five seriously enlarged so as
to give rise to troublesome symptoms.
As to age, Sir B. Brodie thinks it begins at forty-five. Sir H.
Thompson believes the change rarely begins before fifty-five or after
seventy.
Symptomatology.-The symptoms are two-fold, viz., those of which
the patient complains, and those detected by physical examination.
Many writers have given special prominence fo special points in
diagnosis and treatment, but the following summary covers the
whole subject. By introducing the finger, well oiled, into the rectum,
and passing the bulb over the front wall, the sense of touch will
reveal the actual conditions present, viz., whether there is a tumor
of the right, left, or central lobes, or whether there is atrophy. In
using a catheter, if there be enlargement of the middle lobe, there
will be an obstruction at the neck of the bladder, or, after voiding
— 8 —
all the urine possible without a catheter, its use will show a residual
urine of some ounces.
According to the researches of Dr. Messers, conducted at Green-
wich hospital (see Medico-Chirurgical Transactions, vol. xliii., p. 152),
it would seem that such obstruction exists in 20 per cent. of all
prostates over sixty years of age. Such patients believe themselves
to be sufferers from internal piles, because of the sense of weight in
the perinæum, the tenesmus, slowness, and difficulty in making.
water. The bladder soon becomes irritable, with frequent calls to
urinate, and as it cannot be completely emptied on account of the
projection into the urethra formed by the tumor, the retained urine
becomes ammoniacal. A fit of complete retention may be brought
on by exposure to cold, or excessive venery, in fact, by anything ca-
pable of producing acute congestion of the part. As ordinarily no
treatment is attempted to arrest the progress of such cases, they being
looked upon as incurable, the enlargement goes on, the obstacle con-
tinues to increase, the bladder is constantly distended with ammoni-
acal urine; chronic cystitis increases, the ureters become dilated, the
kidneys affected, a state of chronic catarrhal inflammation of the
urinary apparatus is established, and finally, pyæmia or complete
retention ends in uræmic poisoning and death.
Now these are the anatomical, physiological, and pathological data
which lead to the conclusion that chronic hypertrophy of the prostate
gland need not be allowed to continue to exist in any case, and the
consequent retention and difficulty of voiding urine; the chronic
cystitis, misery, and death, can and should be prevented, and when
that is not done the life is lost, or the consequent misery and suffer-
ings is fairly chargeable to the blind negligence and voluntary ignor-
ance of the members of the profession having the case in charge.
It is upon the foregoing considerations, of the greatest import to
the surgeon, viz., anatomical and physiological facts, that the plan
of treatment I have been pursuing for the past three years in such
cases, with the greatest comfort to myself and satisfaction to my
patients, has been based. And in this connection I desire to state that
the merit of originating the plan of non-surgical treatment of en-
larged prostate gland is due, and is cheerfully accorded, to the late
Washington J. Atlee, M.D., of Philadelphia, who, in 1878, first an-
nounced the successful results of his experience with this method-
although his plan was only experimental, and lacked the complete-
ness and success which now attends this method of treatment.
Atlee's treatment was based upon the consideration that the pros-
-
i
9 -
tate is largely made up of involuntary muscle-fibres, and enlarge-
ment of the part was chiefly due to a condition of enlargement or
congestion, acute or chronic, of the capillary blood vessels, and that
we have in ergot an agent capable of acting upon unstriped muscle-
fibres and causing it to contract, and that "in all cases of relaxed or
stretched involuntary muscle-fibres this medicine will meet the re-
quirements as shown by its action upon the enlarged uterus, the
distended bladder, in hæmorrhage, in congestion of the capillaries,
etc." And he argued from this that, "it is calculated not only to
contract the muscular fibres of the prostate, but also primarily, the
capillary vessels, and secondly, as a consequence of muscular con-
traction, its follicles and mucous glands, and thus the size, as well
as the nutrition, of the gland would be diminished.”
As ergot is well known to be spasmodic in its action, and therefore
only temporary in its effects; and, as cohosh or cimicifuga possesses
the power of producing tonic or permanent contraction of involun-
tary muscle fibre, it suggested itself to my mind as the drug neces-
sary to complete the good effects of the ergot in such cases, and I
have been more than pleased with the results. My experience with
these two agents has gone to show that they will accomplish the de-
sired result, not only in mere hypertrophy of the gland, but also in
enlargement from myomatous growth, as in fibroid tumors of the
uterus. By the combination of the cohosh the weakness of the
sphincter, and muscular walls of the bladder, is greatly lessened, and
the power of the bladder to expel its contents greatly augmented, at
the same time that the mechanical obstruction to catheterism is re-
moved by the lessening of the size of the organ. My experience,
with the use of ergot alone, was not completely satisfactory, as the
symptoms after a time returned; but, since using the combination of
the two drugs, ergot and cohosh, I have had no complaints, and the
number of old men who have been able to drop the use of the cath-
eter, after having been constantly dependent upon its frequent use
for years, has been surprising, while the expressions of their grati-
tude is music to one's ears.
The late Dr. Atlee reduced his views to three propositions, which
I have extended to six; they are as follows:
1. The prostate and its vessels are supplied with unstriped (in-
voluntary) muscle-fibres.
2. The bladder is an organ having both voluntary and involun-
tary muscle-fibres in its coat.
3. The therapeutic action of ergot is known to be to contract un-
*
A
10-
F
striped, or involuntary muscle-fibres, and therefore, on the muscular
walls of the blood vessels, as seen in its action upon the uterus, and
in diminishing the calibre of the blood vessels.
4. That while the action of ergot upon unstriped muscle-fibre is
pronounced, its spasmodic character allows reaction to take place,
and it is therefore followed by a degree of relaxation or exhaustion.
which limits its usefulness.
5. That cohosh (cimicifuga rac.) is known to produce tonic or
persistent contractions of involuntary muscle-fibre through its action
upon the sympathetic nervous system, on which it produces a sooth-
ing effect (which in over-doses amounts to depression); that it re-
lieves muscle-pains and allays nervous irritability, as shown in its
action in relieving irritability and excitability of the heart, with
angina pectoris muscular rheumatism, chorea-and its admirable
action upon the uterus in the relaxed conditions following severe
labor; in menorrhagia by imparting tone to the muscular walls of
that organ; in its action upon the bladder in chronic cystitis, sooth-
ing pain and allaying irritability; while its administration is followed
by a true tonic effect upon the involuntary muscles, which seems to
be permanent and lasting.
6. That the use of cimicifuga racemosa (or its active principle,
cimicifugin), in conditions of relaxation or debility of the involun-
tury muscular system; in chronic congestion with pain, swelling,
and hypertrophy of the prostate gland in debility, with irritability
of the walls of the bladder, uterus, heart, urethra, etc., cannot be too
strongly recommended, especially in combination with ergot (1 part
c. to 2 parts e.), whereby a sharp, decided, energetic, and continuous
action is secured, with lasting benefit to the patient. Many remedies
have been tried for the purpose of producing absorption of the tumor
caused by enlarged prostate, such as potass. iodide, potass. bromide,
potass. sulph., potass. mur., etc., but no satisfactory results have fol-
lowed the use of any other remedy beside ergot or cohosh.
In complete retention of urine from enlargement of the prostate
from acute congestion or inflammatory action, a hot bath, fomenta-
tions, or leeches, etc., with aconite or ferrum phos., to arrest the in-
flammation, should be promptly resorted to. The first cardinal in-
dication is to relieve the patient's distress from the distended bladder,
and this can be almost always done by using a soft rubber catheter
of small size (No. 4), and injecting hot olive oil into the urethra be-
fore trying, either through the catheter to be inserted, or a larger one
carried up to the point of obstruction. The surgical principle is,
-
- 11 –
that the catheter should be passed per urethra, if possible; failing
this, the next resource is puncture of the bladder; and this should
always be by the rectum with a curved trocar, unless prevented by
rectal disease, in which case the puncture is to be made above the
pubes. Having succeeded in relieving the bladder, the next step in
the treatment of enlarged prostate is to irrigate the prostatic portion
of the urethra thoroughly with very hot water, to which sublimate
(perchloride of mercury) 1 part to 10,000 has been added. I then
order the patient to have injected into the rectum 10 drops of fld.
ext. ergot, with 5 of tinet. cimicifuga rac., every two hours, or 30 to
15 every six hours, as circumstances may indicate. This is per-
sisted with, and hot-water irrigations of the bladder with boracic
acid, 1 to 5 grs, to oz., are repeated every twelve hours until the
catheter can be readily introduced. I also direct my patients to
drink very freely of Buffalo lithia water (gallon in 24 hours)
when possible to procure it.
After that I began the use of steel sounds (a la Pratt) heated in
hot water and well oiled, introducing only such sizes, gradually in-
creased, as can be introduced without force. The medicine is con-
tinued, at first, every two hours, until the swelling has ceased to
prevent the use of the catheter; then, the frequency of the medicine
is diminished and the doses increased. For the first few days I in-
troduce the catheter every twelve hours, while necessary, to relieve
the bladder, usually until the third day, sometimes much less, or until
the obstruction to urination from the swelling of the prostate has
been removed, and, if the remedies be continued, the patient soon
recovers entire control of the bladder, and the use of a catheter
ceases to be a necessity. The cohosh will be found to have a sur-
prising effect in toning up the relaxed genital organs. The remedy,
however, must be persisted in, at longer intervals with larger doses
for a sufficient length of time to enable the patient to recover entire
and complete control over the bladder, after which a dose should be
taken at bed-time for several weeks, or months if necessary, to restore
the weakened bladder to a condition of usefulness. By this means,
prostate glands that have been chronically inflamed and enlarged for
years, may be effectually relieved, and comfortable health secured
into advanced life.
I have just heard from an ex-M. P., in the Canadian Nosthwest,
City of Winnipeg, who had been a sufferer from enlarged prostate,
with chronic cystitis or catarrh of the bladder, for nine years, or since
he had been treated for a severe attack of gonorrhoea. I now be-
S
12
came the twentieth practitioner into whose hands he had placed his
case, hitherto to no purpose. He was tired of spending money, had
lost confidence in the profession, and was fast becoming tired of life
also. He was obliged to make water very frequently, getting up
ten or twelve times a night. I succeeded in washing out the bladder
with Linderschmidt's Irrigator, and solution corrosv. sub., 1 to 4000,
after which I began passing steel sounds gradually, one of a larger
size each day, and gave him a dose of ergot and cohosh every two
hours. I dropped to every four hours, doubling the quantity of the
remedy, and in three days found him much relieved, and in three
weeks he had ceased to be obliged to get up to make water during
the night, and in three months-declaring himself cured-he left
Toronto for his home in the far West. Since his return, he has sent
me many cases in middle-aged men suffering from enlargement of the
prostate and other bladder troubles. I have learned that this
patient has had two or three attacks of irritation at the neck of the
bladder since, from drinking and exposure to cold, but these symp-
toms have readily yielded to hot douches, with boracic acid solution,
and a few injections of the E C mixture.
I have placed all like cases on the same treatment, with the same
beneficial results in every case-some sooner, some later, but all
being much relieved in a few days. In one old gentleman, who (for
want of faith) persisted in carrying and using his catheter, as he ad-
mitted, long after there was any real necessity remaining for its use;
persistent use of the remedy has not only cured the bladder difficulty,
but it has much improved the general tone of the system and ap-
pearance, enabling the old gentleman to do the town every day and
talk politics as a pastime.
In this connection, I wish to quote Dr. Atlee as saying, that he
mentions "a case in particular," because a post-mortem examination
proved that the prostate gland had been diminished in size by the
treatment. The patient was eighty-two, and had suffered from re-
tention from enlarged prostate; but his last few months had been
made more comfortable "by taking a dose of ergot every night.”
His urinary organs were kept in good condition, he was able to do
without a catheter, and he enjoyed much better health in consequence
until he finally died of old age." Surely, any plan of treatment, or
remedy, that will relieve the distresses of these suffering old gen-
tlemen is better than surgical torture, mangling, or murder.
C
13 —
THE TREATMENT OF PROSTATIC CALCULI AND CYSTIC SEDIMENTARY
DEPOSITS.
THE possibility of curing or removing prostatic, cystic or renal
calculi by medical agents, thus avoiding the necessity of resorting
to formidable and critical operations, is now a well established fact,
but like the cure of cataract by Compton Burnett, of England, or
Dr. Med. Schussler, of Oldenburg, Germany, it is so opposite to the
teachings and beliefs of the schools and the preconceived opinions.
of the profession on the subject, that to announce such a propositiou
is at once to excite the ridicule or derision of those who without
any special knowledge of the pros and cons of the subject and with-
out any experience in the matter, are ready, on the strength of old-
fashioned teachings, and medical dogmas, to condemn every such
undertaking as an absurdity.
At the risk of thus making myself appear, perhaps, ridiculous to
the minds of the "blind followers of the blind" in our profession,
I will here make the assertion that as certainly as cataract has been
made to disappear from the eye of the aged by the use of remedies
or medicinal agents, so also has a preparation been discovered (by a
homoeopathic physician) which when properly administered is capa-
ble of removing sedimentary deposits, gravel and stone, from the
bladder, kidneys or prostate of the male subject who may unfortu-
nately have been afflicted thereby-and as cystic and renal calculi
may be of varied chemical constituents and prostatic calculi of still
another chemical formation it is self-evident that the agent in ques-
tion does not and could not possibly do its beneficent work by any
chemical reaction upon the various elements of which calculi are
composed, but upon the agglutinatory elements entering into the
composition of all alike, whereby the the various particles are caused
to adhere to each other and are held in combination. In other
words, the cement which has been the active adhesive agent in the
formation of the various forms of calculi is amenable to, and capa-
ble of, being acted on by the remedy which my medical friend has
been able to discover.
$
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Sta
That this is a clinical fact he has been amply able to prove during
a number of years of critical observation, while his son (who is also
an M.D.) has fully corroborated the experience of his father in
every particular, and I, who through courtesy have been informed
of the facts, and furnished with the remedy, can also speak posi-
K
14-
tively of its efficacy in curing an obstinate case of gravel in the
aged.
}
As to the chemical nature of the various forms of calculi, a few
words will be in place just here. Indeed there are few medical
subjects involved in more obscurity than the nature and origin of
calculous diseases, and none of more interest to the surgeon, and
none more difficult to heal. "Renal and vesical calculi," says
Mastin, “have from the earliest history of our profession offered a
fertile field for pathological research, and those minute concretions
which form within the follicles of the prostate gland, although dif
fering in their chemical constituents and manner of formation from
urinary calculi, have proved especially interesting, since their true
cause has, as yet, not been thoroughly understood. These minute
concretions being at first almost microscopic in size, gradually in-
crease, yet rarely acquire any considerable dimensions, seldom be-
coming larger than an ordinary pea. Still, they aggregate in con-
siderable numbers, studding the follicles of the glands, or when
increasing in size they break down its parenchyma and collect in
distinct cysts. They are supposed to increase in size from concre-
tions upon their surfaces, and, unless escaping from the follicles (as)
they sometimes do), produce absorption of the intervening tissue by
direct pressure; thus considerable numbers are found collected to-
gether, in direct contact, in one or more distinct pouches. Generally,
several separate small calculi are found located in separate ducts;
these seldom give any trouble, are quiescent and may not give any*
evidence of their presence, but they frequently escape along their
ducts into the urethra and may find their way into the bladder, or be
expelled by the urine.
A much more serious condition is sometimes found consisting of
a collection of numerous growing concretions in a cyst; these in-
crease in size and may attain quite large dimensions, and set up
great irritation and local inflammation, with severe constitutional
disturbance, suppurative abscess, or ulcerative burrowing in the soft
tissues of the perinæum, until by lancing the contents are discharged
through the rectum or outward through the perinæum. It has been
conjectured that possibly when prostatic calculi find their way into
the bladder they may become the nuclei of true urinary calculi ; this
is not borne out by observation, for prostatic calculi, being phos-
phate of lime, we should-if this suggestion were true-find cystic
calculi, having a phosphatic nucleus encrusted with the lithates or
urates-this we seldom or never do. As to the causes which pro-
}
1
•
-15-
duce prostatic concretions it is now pretty well understood that instead
of being sedimentary, as in cystic calculi-or a deposit of earthy mat-
ter in a cavity, as in renal calculi-the deposition of their earthy
matter is the result of "a deranged action of the mucous membrane
-not a consequence of absolute disease-but the result of a de-
rangement in the secretory functions of the gland itself" (Mastin);
or, “a consequence of the dissolution of the elements of the pros-
tate, furnishing a fluid which by gradual formation of deposits pro-
duces these amyloid bodies, bodies closely analagous to the Corpora
Amylace of the nervous system" (Virchow).
0
The view most generally accepted with regard to the formation of
these small calcareous bodies in the prostate is that "they have their
origin in an oval vesicle, of a single wall of homogeneous membrane,
which is occupied by a colorless, finely-mottled substance, in the centre
of which a nuclear corpuscle occurs. They gradually increase in
size from 10 of an inch to zʊ, or more, by continuous concentric
layers; like so many repetitions of the original envelope—the inter-
vals between the layers being occupied by a finely-mottled, deep
yellow or red substance. In their interior is a central cavity which
corresponds to their external contour in form. There are numerous
variations in form which make them occupy an intermediate posi-
tion between inorganic concretions and organic growths. They
simulate inorganic substances in their shape, in their tendency to
become infiltrated with earthy matter, and in their disposition to pass
to the condition of a dead amorphous mass of a deep yellow or
almost black substance. But, like organic growths, they are vesicu-
lar in their origin, and their gradual growth, which seems to take
place chiefly from the dilatation of the vesicle and successive de-
position in its interior ” (Mastin).
"Their chemical composition," says Virchow, "is so widely differ-
ent from that of true urinary calculi (being chiefly phosphate of lime,
a substance which is never deposited in an unmixed state from the
urine) it is evident that we can always readily distinguish them from
those of urinary origin."
"Their chemical composition varies remarkably in the various
stages of their development, and is at all times widely different from
either renal or vesical calculi" (Barker).
"At first they consist," says Lassaigne, "of little less than animal
matter, gradually acquiring calcareous salts when in a state of de-
generation." They contain in 100 parts:
*
16 -
Basic phosphate of lime,
Carbonate of lime,
Animal matter,
•
•
·
84.5
0.5
15.0
100.
"Vesical calculi, on the other hand, have a distinct nuclei upon
which submorphous structures (crystalline and amorphous deposits)
settle and become embodied together in a colloid matrix, thus form-
ing calculous masses (Dr. Vandyke Carter).
""
According to Mastin and others, when we come to examine the
chemical constituents of different collections of renal and vesical cal-
culi, three-fifths of all calculi met with in adults of all ages, are
composed of uric acid or the urates; less than two-fifths are phos-
phates, while only about 4 per cent. of the whole number are oxalate
of lime; but all are held together by the same colloid matrix. (Note
this.)
J
J
Three-fifths are the product of urine abounding in an acid of
which they are the expression. Two-fifths are the product of urine
(generally alkaline, mostly ammoniacal), of which they are the re-
sult, ammonia, magnes-phosphates. It follows that the urates, the
oxalates, and a few of the phosphates (those formed within the kid-
ney) are the result of constitutional derangements, while the mixed
phosphates are produced solely within the bladder and are a conse-
quence of local disease only, and are found present in men with en-
larged prostate, who have passed the prime of life; a steadily pro-
gressive result or sequence of disease, pathological changes incident
to advanced life, which favors the formation of phosphatic deposits
within the bladder. When the outlet of the bladder is obstructed
and the urine retained, it rapidly passes into a state of decomposition
and eliminates free ammonia, which lights up a cystitis. Alkaline
pus is now secreted in abundance, which freely gives up its soda to
the phos. acid of the acid phosphates of ammonia and magnesia,
which were held in solution only because of an excess of phosphoric
acid, and are now precipitated as insoluble phosphates. Now note
what follows:
Mastin says:
"When the pus is changed by the action of the lib-
erated ammonia, it is, with the mucus of the bladder, converted into
an adhesive colloid medium, which cements together the insoluble
ammoniaco-magnesium-phosphates into a mass, and thus are formed
the ordinary phosphatic concretions formed in the bladder.”
According to Dr. Golding Brown, calculi of the prostate are com-
posed (like other concretions on mucous membrane) of phosphate of
17-
lime, mixed with triple phosphate, and may be deposited either in
the dilated urethral canal of an enlarged prostate, or in the ducts and
cells of the glands, or in both.
The symptoms produced are at first irritation at the neck of the
bladder and difficulty of micturition, as in other cases of enlarged
prostate; the calculi may be felt by the finger in the rectum, or with
the sound in the urethra. Keeping the urethra well dilated favors
their escape, and occasionally one may be removed by the forceps,
and it has been recommended to remove them by cutting down upon
them from the perinæum (which has been done successfully), but I
have a less formidable, and I think a better plan of treatment to
recommend, viz., the use of a remedy which acts as a solvent for the
calculus.
Now, as all calculi-no matter what their chemical constituents
may be or where situated-are held together by the same " adhesive
colloid medium,” it must follow, as a natural sequence, that any sub-
stance or remedy that will act upon this adhesive element, or cement
and dissolve it effectually, or disintegrate it, thus allowing the par-
ticles, of which the stone had originally been composed, to be carried
out by the urine, as in the case of gravel, must be a useful and es-
sential element in the treatment of stone, no matter where located,
and infinitely to be preferred to the operations of cutting or crushing
(lithotomy or lithotrity) with all their attendant evils.
That such a remedy has been discovered I am glad to believe,
although my own experience with it has as yet been comparatively
limited.
-
It is an anti-lithate, or solvent for calculus, wherever found, and
is the result of the study and experiments of a most scholarly mem-
ber of the medical profession of Toronto, now 76 years of age, and
its virtues have been tested by himself and his son, quietly, for
years; and his expression regarding it is, that "it never disap-
points," and I accept his statement. As to its chemical com-
position I know nothing. I only know of its therapeutic effects.
That it is a most valuable therapeutic remedy in all forms of calculus
or threatening calculus when symptoms of gravel are present, I am
more than satisfied, and would advise the members of the profession
to test it honestly in suitable cases.
The discoverer, Dr. D. S. Oliphant of Toronto, retains the for-
mula for the present for further tests and improvements. He des-
ignates it O. H. I have therefore concluded to call it "Oliphant's
Anti-lithate" for want of a more perfect or correct title; perhaps
18 -
some one will hit upon one better adapted to express its true char-
acteristics. I trust that the vast importance of the subject (many of
the most vital points of which have not been touched upon at all),
will be my justification for bringing this subject, with the new
method of cure, to the attention of the profession, and shall be fully
rewarded for the trouble I have had in connection therewith, if any
practitioner will thereby be aided in his efforts to relieve this most
miserable and distressing of affections in old men.
THE HISTORY OF DR. D. S. OLIPHANT'S FORMULA.
The history of my discovery is in brief as follows:
Pod
In August, 1882, I was called to attend Captain Winans, an
English gentleman who was suffering from ulceration of the stom-
ach, mainly in the vicinity of the pylorus. In the course of my ex-
amination of the case, I drew from him a long history of his pre-
vious suffering from gravel and stone, and that he was two years pre-
viously about to be operated upon by Drs. Hodder and Lizars for the
removal of two large stones by the knife; but that when already
placed on the table in the usual position for supra-pubic lithotomy,
he suddenly changed his mind and told his surgeons they might go
home again for he meant to die a "whole man." He accordingly
paid them their fee and dismissed them. Soon after he left Toronto
for the White and Blue Sulphur Springs in Virginia by way of
New York City.
By advice of a friend in New York he took with him a dozen
bottles of the genuine Haarlem Oil, manufactured by C. de Koning
Tilley, Haarlem, Holland. This firm have only one agent on the
Continent, a hardware house in New York. There are several imita-
tions on the market, very cheap and useless. As a result he came home
from the Blue Sulphur Springs free from pain, urinated freely, and
meeting Dr. Lizars one day told him of his cure and challenged an
examination. Both Dr. Lizars and Dr. Hodder made thorough search
of the bladder and agreed that neither stone or gravel existed. One
thing is certain, neither of these eminent surgeons was ever known
to perform an operation for stone afterward. My patient, the Cap-
tain, made one fatal mistake. He was in such terror of a return of
the disease that he continued the full dose (25 or 30 drops) of the
nauseous drug, nearly every day, until fatal ulceration commenced,
and he, shortly after my unfavorable prognosis, fell into the hands
of a popular member of the old school faculty, who was confident
allopathy alone was capable of saving him; ten days finished him
and the worthy surgeon declared he was called in too late.
1
19-
I saw clear and unmistakable evidence of the power of this com-
pound to dissolve the concretions of urates and lithates, but the drug
was so severe an irritant of the mucous coat of the stomach that it
was not safe to use in so large and continuous doses. Could it be
made successful as an attenuation?
""
I
For six months I experimented in every way to find a solvent that
would hold the drug in complete solution, and that would be harm-
less and also make a permanent solution at any temperature and un
influenced by light. One night I retired at a late hour after unu-
sual fatigue in making search for the desired solvent, and as I was
opening my book to have my customary luxury of a good "read'
the idea came into my head, "why have you never tried chloroform
as a primary solvent and reduce further with pure spirits?"
leaped from bed and ran down to my surgery and was delighted to
find that chloroform made a perfect solution of the entire drug, but
that the addition of alcohol (96 per cent.) could only be made to
a certain proportion without precipitation. I went to bed satis-
fied I had the key to the problem, and after a year's variable experi-
ment, I have arrived at the following result, viz.: A thorough 10 per
cent. solution of the drug preserving all its therapeutic value, with-
out any injury to vital tissues. The formula is in the hands of
well-known and honorable members of the medical profession, and
the preparation has been thoroughly tested, with satisfactory results.
Parties desiring to use this drug in their practice should obtain
the original and genuine preparation as put up by the inventor, Dr.
D. Soliphant, and thus secure themselves from the risk of deception
and disappointment in its use.
1
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OF
ELEPHANTIASIS ARABUM.
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A CASE
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BY
ROBERT BOOCOCK, M.D.
Reprinted with Additions from the HOMEOPATHIC RECORDER.
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A CASE
OF
ELEPHANTIASIS ARABUM.
BY ROBERT BOOCOCK, M.D.
ON November 21, 1890, I was called to see an elderly lady,
about sixty-five years of age, and short in stature, five feet. She
was blessed with a cheerful and hopeful disposition, bearing up
bravely, and making the best of all her troubles, while she was
compelled to drag around this very large limb. She has been
afflicted by it now for nearly four years.
The first sight of it was to me a very remarkable one; the
great size was eclipsed by its shining appearance. The crevices
or folds caused by the great weight of the upper upon the lower
parts were of a burnish silvery whiteness throughout the whole
length of the limb. When rubbed it was hard and dry, and large
scales, as like fish scales as possible in shape, or more like pieces
of pearl shell, for some were thicker than fish scales, would fall
off. On the under or back of the limb were hard, rough nodules.
or elevations, as large as little neck clams, rough and hard.
The size of the limb at the first measurement was: Around the
ankle, seventeen inches and a half; the calf, nineteen inches and
a half; the knee, twenty-two inches; three inches above the knee,
twenty-two and one-half inches, and the upper part of thigh,
twenty-four inches.
The lady comes from a long-lifed race of ancestry, some of
whom lived beyond their hundred years; her mother to over
ninety.
History. The probable cause of the trouble was as follows:
About five or six years ago she was a Sunday-school teacher in
a mission school. There being a fear of small-pox in the school,
she consented, for the sake of the family she lived with, to be
vaccinated by their family physician. He remarked, immediately
after, that the vaccine should take, as it was good, having just
2
1
been taken from a little negro baby. This information gave her
somewhat of a shock. She had a fearfully swollen, ulcerated
wound, with erysipelas condition, and it was a very long time
before she recovered, or rather, appeared to do so. About one
year after this she fell on any icy pavement, and hurt her knee
very much. Shortly after this she noticed a swelling of the knee
and lower limb, which kept on increasing in size and hardness,
notwithstanding the efforts of several physicians to arrest the
growth and cure the difficulty.
The great size and weight of the limb had almost made her a
house prisoner. She often attempted, but found she could not
lift the limb from the floor. The leg affected is the right one.
When I first saw her, the left leg was also very much swollen,
ankle measurement being thirteen, and the calf fifteen inches in
circumference. But this oedematous swelling was watery or
doughy; by pressure you could almost bury your fingers, and
leaving their imprint for some time afterwards.
The marks of contrast were great. The right leg was as hard
as wood; you could make no impression on it whatever, and there
was very little feeling caused by a very hard pinch. It had a
shining white silvery appearance: The left leg was soft, com-
pressable and tender; there was also an itching sensation, and it
was of a pinkish hue. The two limbs made a good diagnostic
contrast, and prevented any mistake in the above diagnosis.
There was also a very constipated condition, there being only
about three movements per month. If weekly, she would think
she was doing well. There was also some giddiness of the head,
causing a tendency to fall backward. These two symptoms sug-
gested Graphites as a remedy, which I gave. Five grains in half
a glass of water, of which she was to take a teaspoonful every
two hours for two days. On the 24th of November I found all
the symptoms better, and there was a decrease in size of nearly
two inches in the limb. It was at this visit that I took the
measurement of the other, or left leg, below the knee. This
improvement was more than I expected so soon. Keeping in
mind the (school) advice not to change a well-doing prescription,
I continued Graphites, giving about the fourth of a drachm of the
First Dec. Trit. in a tumbler of water, to be taken every two
hours, as at the first prescription. On November 26th there was
1
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3
a general improvement, and bowels moving easily every third
day; legs decreasing in size and becoming soft and smooth, the
scales disappearing.
The limb continued gradually to decrease up to December 17,
1890, when I bound it with a broad rubber bandage, from the
foot up to the body. She then remained in bed, with the most
gratifying result. I continued Graph. Ist. On December 20,
1890, the measurements were: Ankle, nine and one-half inches;
calf, sixteen inches; knec, fourteen and one-half inches; above
the knee, fifteen and one-half inches, and thigh, seventeen inches.
The left leg, the dropsy leg, had entirely recovered, except
some thick skin on the back of the limb, which made me think
that this leg would, in all probability, have soon become as bad
as the right one.
This made a reduction in a month of seven inches at the ankle
and upper part of thigh, and of five and six inches at the two
other measurements. At this time Dr. W. T. Helmuth very kindly
informed me of his remedy, Hydrocotyle, and I gave a one-drop
dose every three hours for one week. Under this medicine I lost
ground, there being an increase in the limb of one and a half
inches in each measurement. Having found this Asiatic medi-
cine to be unsuccessful, I then tried the highly recommended
medicine, Thuja, for a week, with no better results. I then gave
Sulph. for three days, to tone up the system, and returned to
Graphites 1, D. Trit., and am very happy to say at this writing
that my patient is in every way better, both in looks and in her
ability to get about and do some light work in her roon. Ankle
measurement, in both limbs, is now eight inches; calf, thirteen
inches; knee, fourteen inches, and thigh, sixteen and seventeen
inches. Skin smooth, but dry and wrinkled. When she is
standing upright the skin and tissues hang in folds like an empty
bag, and I fear would soon fill up again if not kept tight to
the bone by bandages. I shall endeavor to have this superfluous
skin or flesh contracted or absorbed in some way. I am now
trying to get a good perspiration or moisture on the limb surface
by Borax baths, and am also trying Rhus. T., at the kind sugges-
tion of Dr. Helmuth.
I described this case to our skillful Professor of Dermatology,
Dr. Archelarius, who gave it the name I have already done, thus
confirming my diagnosis.
4
March 26, 1891. Since writing the above, I am happy to
say, the cure is a good and perfect one. In every respect the
reduction remains; the last measurements were on March 17,
1891: Ankles, seven and a half inches; calves, twelve; knee,
thirteen inches; thigh, lower third, fourteen and a half; middle
third, sixteen and a half.
From these measurements it will be seen that there has been a
slight reduction, while the general health has been excellent,
appetite good, sleep sound and refreshing, bowels moving regu-
larly every day; she can get out on the street and visit as well as
ever.
In this disease, Elephantiasis, the fewness of the cases seen in
our climate, and no reported cures, the best that has been done
before this has been to relieve. All these things make one
additionally thankful for this remarkable cure, which I am sure
is the first on record in this country. I sincerely pray that many
more may be made as happy and as useful as this little lady has
been by the cure of this so-called incurable disease.
I shall be very glad if any who follow my plan of treatment will
kindly report to me, or send any who may be so suffering.
This is the third case of this kind that I have ever seen. One,
an old man of eighty years, with large lumps on various parts of
his body and limbs, rough and hard. He died at the age of
eighty-two, without any change. He went to sleep under Mor-
phine treatment, but not in my hands. The second case was that
of a young woman, who came from Rhode Island, before Dr.
Helmuth's clinic last year, with one or both legs of an enormous
size, and to whom the learned Professor prescribed Hydrocotyle.
There is a case photographed in Dr. Fox's book on Skin Dis-
A case reported by Dr. Charles Jewett, of Brooklyn, notes
furnished by Dr. P. L. Schenck, of the Kings County Hospital.
This was in many respects similar to the one that came before
Dr. Helmuth's clinic, being young, only nineteen years of age.
My case differs from the general description, being white and
shining, instead, as is usual, of being dark and discolored,
brownish or tanned.
cases.
Flatbush, N. Y., March 26, 1891.
15
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MONOGRAPH ON CROUP:
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PATHOLOGY, DIAGNOSIS AND TREATMENT.
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BY
LDFORD, M.D.,
OF PHILADELPHIA.
PHILADELPHIA:
SHERMAN & CO., PRINTERS.
1880.
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MONOGRAPH ON CROUP:
ITS
PATHOLOGY, DIAGNOSIS AND TREATMENT.
BY
T. L. BRADFORD, M.D.,
OF PHILADELPHIA,
PHILADELPHIA:
SHERMAN & CO., PRINTERS.
1880.
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A
CROUP:
ITS PATHOLOGY, DIAGNOSIS, AND TREATMENT.
In this article but little originality is claimed. Considerable care has
been taken to search our literature for important data, which have been
used when practicable.
Very many clinical cases have been rendered valueless from remedies
being used in alternation.
No treatment for the diphtheritic form has been given, that properly
belongs to the therapeutics of diphtheria.
In treating croup the following rules should be observed.
1. Decide carefully on the remedy and do not change it from mere
caprice, but stick to it and push it.
2. Always examine the throat, as in the first stages of croup the mem-
brane may be seen in the fauces or sometimes exudations may be seen
on the middle and edges of the tongue.
3. It should be borne in mind that every hour that is lost in hindering
the spread of the false membrane renders the case more difficult of cure.
4. Any hoarseness in children, especially if long continued, should be
looked upon with suspicion, as it often indicates impending membranous
croup.
5. Awaken the child to give the medicine, as too long-continued sleep
usually increases the suffocative paroxysms.
6. Do not expose the patient to draughts of air, but keep him in a room
of from 65 to 75 degrees Fahrenheit, with the extremities warm, the
throat and neck free. It is well to render the air moist by evaporating
water in the room, as this facilitates breathing.
7. Never give up a case as hopeless while life exists. The physician
will often be called when after the little sufferer has submitted to a course
of "heroic" treatment, but little hope seemingly exists; but it must be
remembered that oftentimes where the allopathic treatment has failed
homoeopathic remedies have proved successful. The author was once
called to a case which two allopathists had given up to die and upon which
they wished to perform, as a dernier ressort, tracheotomy; this was not al-
lowed, and they were dismissed. After watching for two long days and
nights expecting the child to die at any hour, on the third day the child
vomited a mass of softened membrane and made a good recovery, Kali
bich. 1 in water being the only remedy used.
8. Bear in mind that even if the membrane be discharged it may form
again.
4
9. Be careful not to confound the spasmodic or false croup with the
pseudo-membranous, which is a very rare disease.
10. Be firm, calm, and persevering, and insist upon taking the entire
charge of the case.
Adjuvants and Special Treatments.-Certain physicians of our school
have, from time to time, resorted to special treatments and the use of ad-
juvants.
Bonninghausen was accustomed to give five powders, with printed di-
rections for their use Of these, Nos. 1 and 2 were Aconite, Nos. 3 and 5
Hepar sulp., and No. 4 Spongia, all in the 200th potency. He claimed
that the true croup symptoms disappear after the first powder, if no other
treatment is resorted to. In any case, two hours should intervene be-
tween the dry administration of Nos. 1 and 2; and if improvement fol-
low No. 1, the space must be from 8 to 12 hours; No 3 then came in,
to remove the cough and prevent the return of the croup. Or, if need-
ful, all five powders are to be given at suitable intervals.
Kafka says that Aconite and Hepar sulp. will cure nineteen out of
twenty cases of croup.
Dr. C. S. Middleton, of Philadelphia, recommends the use of Iodine
almost exclusively.
Aconite and Spongia are used in alternation, by scores of physicians.
Dr. W. H. Holcombe applies a cold water compress to the throat, at an
early period, and insists on this course.
Dr. Bouchut, of Paris, passes an iron ring into the glottis in mem-
branous croup, allowing it to remain from one to four days, according
to the severity of the case. He claims that this dilates the glottis, and
is thus a substitute for tracheotomy.
Pounded ice, mixed with salt, placed in a muslin bag and applied to
the pomum Adamii, is said to be useful, in causing the membrane to de-
tach itself.
During the cough, a hot stone thrown into a bucket or tub of cold
water generates sudden steam, and will often relieve the paroxysm.
A sponge, saturated with lunar caustic (20 gr. to 2 dr. water), tied to
a bent whalebone, was passed into the larynx, in a case of membranous
croup, and was followed by vomiting of the membranes.
A German physician recommends the inhalation of pure glycerin,
by means of an atomizer. He says it moistens the cough, and relieves
the paroxysm. The inhalations should be repeated at intervals of from
half an hour to an hour and a half, and should continue about fifteen
minutes.
Dr. Dudgeon recommends compresses of hot water applied to the throat;
also a partial or complete warm bath.
Dr. Hering advises, in his Domestic Physician (Allentown edition,
1835), that water be poured upon Sulphuret of lime, and the steam be
inhaled.
He also advises, in extreme cases, where there are burning pains in the
windpipe, the application of leeches to the throat.
Dr. Attomyr considers Bromine as a specific, giving as a reason, that
Bromine is the only drug capable of producing a false membrane in the
healthy throat.
Gross asserts that he can cure all his cases, when taken in time, with
Hepar s. c., 1 to 3 trituration, followed by Acon. 3, and these followed
by Hepar. and Spongia, in alternation.
Teste claims that Bryonia and Ipecac., given alternately, are the most
important remedies.
5
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:
Sulphate of copper, in large doses, has been given in the last stages of
croup, followed by expulsion of the membrane.
Diet and Regimen.-During the attack, cold water will be most useful
and should be given, if desired, in small quantities, and frequently.
During convalescence, milk and water, arrowroot, gruel, etc., are useful.
When there is great weakness during the disease, beef-tea, wine and
water, or diluted whiskey, in small quantities, will be needed. Of course,
all draughts of air or exposure, must be avoided.
Pathology and Diagnosis.-Cynanche trachealis, or Croup, consists of an
inflammation or high vascular irritation of the laryngeal or laryngo-
tracheal mucous membrane, combined with spasm of the interior mus-
cles of the larynx, causing peculiar modifications in the voice, cough, and
respiration. The name croup is said to be of Scottish origin, and to be
derived from roup, a word designating the sound made by a chicken
having the pips.
Croup may be divided into the false or non-membranous, and true or
pseudo-membranous varieties.
The false croup has been again subdivided into the spasmodic and
catarrhal varieties.
SPASMODIC CROUP
Occurs very suddenly, with difficult breathing, noisy and wheezing in-
spirations, a short, dry, hoarse, infrequent cough; there is no fever. The
child may go to bed seemingly well and be roused from sleep with these
symptoms. The friends may be much alarmed and send for the doctor
in great haste But this variety is not dangerous, and under the appro-
priate remedy the attack is soon subdued.
CATARRHAL CROUP
Is much like the stridulous or spasmodic, except that there is at first a
prevalence of catarrhal symptoms, or the croupy symptoms; the sudden,
shrill cough, difficult respiration and dyspnoea wear off, leaving catarrhal
symptoms. The voice is more or less hoarse but seldom extinct. Should
the voice cease to be sonorous, even though occasionally suppressed, there is
great danger that the child has, not catarrhal but membranous croup; this
is an important diagnostic symptom, and should not be overlooked.
He
The distress may be great during the paroxysm; the child sits up or
tosses about in bed, supports himself on his hands and knees, or lies on
his back with his head extended in order to render the breathing easier.
He puts his hands up to his throat, as if to relieve the trouble there, or
implores aid with them. His countenance wears an alarmed look.
complains of tightness and pain in the throat, but his voice is often stifled
by the cough. The countenance is usually flushed, the skin warm, the
pulse frequent and febrile at first; but soon, unless the paroxysm speedily
subside, the lips become purplish or livid, the face pale, the limbs cold,
pulse feeble, frequent, and irregular, and an asphyxiated condition super-
venes when the spasm relaxes and air again enters the lungs. The child
now usually falls asleep. The paroxysm is rarely fatal, its duration
being from a few minutes to several hours.
The attack is more severe when occurring at night. The next morning
the little patient seems almost well save an occasional "croupy cough.'
The fauces, if examined, will appear somewhat reddened; the voice is
more or less hoarse. Under proper treatment the paroxysm may not
return. But, as is often the case, if the child receive improper treatment,
6
or none, the paroxysms continue at intervals for several days, when, if
the inflammation in the throat is moderate, the spasmodic symptoms dis-
appear, leaving a catarrhal cough and other symptoms which also soon
disappear.
Or the catarrhal variety may, through neglect, run into the mem-
branous form; but this is rare. There is exudation in catarrhal croup,
but it is of a thin mucus, unlike the tough exudation of true croup.
In
some cases catarrhal fever sets in with more or less inflamination about
the lungs, and this may prove fatal as capillary bronchitis. Dissection
reveals but little if any deposit of pseudo-membrane.
The mucous membrane of the larynx, trachea, and bronchia, appear
inflamed in patches, and there is more or less of a viscid, muco-purulent
mucus in the air-passages. In rare cases the mucous membrane is normal,
the patient dying probably from spasms.
The prognosis is usually favorable in this form of croup, the disease
being usually arrested in its first stages.
PSEUDO-MEMBRANOUS CROUP
Is, compared with the former variety, a very rare disease. There is
no doubt but that spasmodic croup is often confounded with it. The
writer remembers a case which had been given up to death by an allo-
pathic physician. Being called, it was noticed that the little fellow had
not lost his voice, that the croupy breathing was paroxysmal. Thechild
made a good recovery under the use of Aconite followed by Spongia.
The child had not membranous, but catarrhal croup. This form com-
mences variably; inflammation and exudation may occur simultaneously,
when the patient, without seeming very sick, may be beyond help; in such
cases the loss of voice is markedly to be noticed. In other cases, inflam-
mation precedes plastic exudation. The symptoms are like those of catar-
rhal croup; the child continues in this way for several days, and the first
intimation that there is a more serious disease is the failure of the tone of
the voice, and the change of the sonorous to a husky-sounding cough. A
hoarseness may continue for several days and then more serious symptoms
develop. Each effort to cough produces a whistling or sibilant sound during
inspiration; the cough is paroxysmal, and may be rare or frequent.
length the breathing becomes difficult; each inspiration has more or less of
the wheezing sound, and this sound becomes shriller and shriller as the dis-
ease advances, so that the efforts of the little sufferer to breathe may often
be heard for a considerable distance. There is more or less pain and
dyspnoea, the features are swollen and purplish, there is anxiety, great
restlessness, fever. The respiration is quickened. The patient sleeps
between the paroxysms. Sometimes the disease goes steadily on without
remission.
At
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*
If the case takes a favorable turn it may be known by the cough be-
coming looser and the sound in breathing not so shrill, some mucus may
also be expectorated. This exudation may be absorbed without any
expectoration, however.
The membrane may be thrown up in a complete cast of the trachea
and may not reform, or it may again reform and the case go on and on
to a fatal termination. It is in the last stage that the child's sufferings
become most severe; the utmost efforts are used to expand the chest; the
shoulders rise; the breast heaves; the nostrils expand and contract; the
head is thrown backward; the child is in agony; he throws himself about
in bed; gasps for air; implores with pitiful gestures for aid from friends
around him. At length the pulse becomes feeble, the skin cool and damp,
the cheeks pale and cold, the lips livid, and drowsiness and stupor super-
7
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vene. The child may sink away quietly, or may die in convulsions.
Sometimes death occurs earlier during a paroxysm. The disease lasts
from one day to one or two weeks.
If it commences in the bronchia, symptoms of bronchitis precede those
of croup.
The disease may be diagnosed by the loss of voice, hoarseness in coughing,
with lack of resonance, and by the expectoration of tubes of false mem-
brane.
Croup is caused by cold, dampness, by a sudden change from hot to
cold air, etc. Males have pseudo-membranous croup oftener than females;
and vigorous, blue-eyed, light-haired, fleshy children are especially sub-
ject to it.
It must be borne in mind that sometimes foreign bodies lodged in the
air-passages may simulate all the symptoms of croup, in which case of
course the treatment would be to remove them at once if possible.
It seldom attacks adults or aged people, although it is sometimes thus
seen.
Children after once having the disease are very liable to it again.
This predisposition can be remedied by the proper remedy given on the
least approach of the premonitory symptoms.
Tracheotomy.—Just how often or at what period this dernier ressort is
advisable is a mooted question. Dr. Talbot, of Boston, in a paper on
the subject, reports 51 cases in Boston with 10 recoveries. Trousseau,
the father of the operation, out of 222 operations, reported 127 recoveries.
That it should not be tried until all other means are exhausted is certain,
and it is equally certain then that it is advisable.
The following very complete directions for performing the operation
are quoted from Dr. Talbot's paper :
"I arrange three or four double canula tubes of various sizes; a com-
mon, a sharp-pointed, and a probe-pointed bistoury; a tenaculum, with
a long point at right angles with the shaft; a pair of dilating, curved
and straight forceps; a small probang or soft sponge firmly attached to
a flexible whalebone; several sponges and some tepid water. Having
etherized the patient, either on a bed or in a person's arms, let his body
be slightly inclined and his chin elevated, so as to render the trachea
tense. Carefully examining the position of the larynx, it is seized and
held firmly between the thumb and finger of the left hand, while, with
the right, the point of the tenaculum is passed into the trachea, just below
the cricoid cartilage. The tenaculum is then given to an assistant to be held
firmly in its position. An incision is then made through the skin, from
the tenaculum downward, an inch or an inch and a half, according to the
age of the child, and the depth at which the trachea lies. The adipose
tissue is then to be divided; and the areolar tissue may be separated
with the handle of the bistoury, with the finger, or, very carefully, with
the bistoury itself, as may also the sterno-hyoideus muscles, and the ten-
dinous intersection of the sterno-thyroideus. If the isthmus of the thy-
roid gland is broad, it may be necessary to divide it with the bistoury,
when care should he taken to ascertain if the occasional branch of the
arteria innominata is present; and if so, the greatest attention is requi-
site to avoid wounding it,-an accident which would probably prove fatal.
If there is much hemorrhage it must be arrested before the trachea is
opened. Then insert the point of the bistoury into the trachea next to
the tenaculum, and divide the upper tracheal ring; and afterwards, with
the probe-pointed bistoury passed into the trachea, divide from within
outwards two or more rings. The dilating forceps are then introduced
through the aperture and held in the right hand, and the tenaculum is
∞
removed. Violent efforts of coughing at this stage usually expel what-
ever of blood, mucus, or detached membrane may be in the trachea.
The incision should be sufficiently opened, and the light arranged so as
to allow the careful examination of the inner surface of the trachea, and
the removal with forceps of any partially detached pieces of membrane.
The tube is then inserted into the trachea between the blades of the for-
ceps, and the latter withdrawn. The tube is kept in its place by a ribbon.
tied around the neck.
"After the operation has been completed, and the trachea has become
accustomed to the presence of the tube, the child will breathe easily, and
will eat and drink freely. At this stage I have rarely found stimulants
necessary. The child will soon sink into a quiet sleep, which may con-
tinue uninterrupted for some hours. A small mass of thin gauze should
be laid over the opening to prevent the cold air from striking too directly
upon the lungs, thereby causing lobular inflammation. The inner tube
must be frequently removed and cleansed by means of a brush, of such
mucus as is forced into it in respiration; and whenever the child coughs,
this tube must be so held between the thumb and finger that it can be
withdrawn during the expiration. In this manner much mucus can be
extracted which would otherwise collect and impede respiration. During
the first twenty-four or thirty-six hours, the patient is comparatively
comfortable, but great care is required in attending to its wants; for, as
it is deprived of all power of articulation, it soon becomes annoyed and
excited in its efforts to speak, if its requests are not readily understood.
The tube must be frequently removed, cleansed, and moistened; and if
there is any tendency to dryness of the mucous membrane, which may
readily be detected by the cough, and character of the expectoration,
small drops of tepid water may be allowed to remain upon the inner tube
when it is returned. After the mucus has become thus softened, a drop
or two of water allowed to pass down the tube into the trachea will cause
coughing, and the expulsion of mucus. The system must be sustained by
nutritious diet; and Velpeau even goes so far as to insist on the child's
eating as much as can be forced down, whether it desires it or not.
"In from twenty-four to thirty-six hours after the operation, febrile
reaction commences; the skin becomes hotter; the pulse stronger and
more rapid; the cough more violent, with greater secretion of mucus.
This is the crisis of the disease. If the secretions become less abundant;
the skin dry; tongue and mouth parched; pulse wiry and rapid; cough
frequent and convulsive; the mucus thick, dry, tenacious, adhesive, and
of a yellowish-brown color, all that remains for us to do, is to relieve as
much as possible the wants of the little sufferer till death shall set it free.
If, on the other hand, the secretions increase; the skin continues moist;
tongue soft and covered with a white coating; pulse full and strong;
cough loose, with expectoration of shreds of membrane, and a whitish,
thin or clear mucus; the face, though pale, is animated; a free discharge
of urine, and occasional alvine evacuations occur,-there is very good
reason to hope for a favorable resolution. Great care will now be re-
quired; the tube must be kept free; and if pieces of membrane or tough
mucus are lodged in the trachea below the tube, they must be removed
by curved forceps or a piece of sponge attached to a flexible whalebone.
Frequently attacks of prostration will occur which must be promptly
met, either with beef tea, wine, to which sugar, egg, and a little milk is
added, brandy and water, or camphor tincture dissolved in water.
there is much heat of the chest with tendency to great inflammation,
great relief may be experienced by the external application of cold water
to the chest. The heat of the room should be kept considerably higher
If
2
9
after the operation than before, as the lungs do not now have the buccal
cavity, glottis, and larynx to increase the temperature of the air before
it reaches them The free generation of steam in the room has been fre-
quently resorted to; but I am not convinced of its utility. The evapo-
ration of water, so as to prevent too great dryness of the atmosphere, is
undoubtedly of service; while surcharging the air with steam is pros-
trating to the patient.
The occasional application through the tube, of a weak solution (1 to
40) of Nitrate of silver, is often of great service in two ways: 1st, it co-
agulates the mucus, and renders consistent what has been a thin, glairy,
or adhesive substance; and 2d, by the irritation of the throat it excites
violent coughing, which detaches the mucus and shreds of membrane so
that they are ejected often in considerable masses."
Tracheotomy should not be performed in weak or very young children,
or in those having lung disease.
It should not be performed unless the child can receive the most care-
ful nursing, with a constant attendance of the surgeon, and the best of
after treatment.
Dr. Talbot suggests that it is a favorable thing for free hemorrhage to
occur during this operation, he claiming that it relieves the turgescence
of venous blood.
THERAPEUTICS.
Aconite. The child after going to bed apparently well, wakens from
the first sleep with a harsh, croupy cough; this cough reawakens it when
again asleep. Great nervous and vascular excitement; thirst; hot
skin; restlessness; weeping or alternations of mirth and sadness. Icy-
cold hands, or hot hands with cold feet. Pulse hard, full, frequent or
slow and almost imperceptible. Some perspiration on covered parts.
Dark red and burning inflammation of whole buccal cavity, extending to
the bronchia, with inability to swallow. The child restrains cough on
account of the pain it causes. Coughing after drinking.
M
Cough following and ending each expiration, absent during inspiration;
cough excited by drinking; short, dry, hurried cough, with quick, loud
breathing during expiration, but not during inspiration. (Spongia opposite.)
Shortness of breath, especially after sleeping. Breathing anxious, labored,
sobbing, or quick and superficial, or loud, strong, and noisy. Suffocating
paroxysms with anxiety. Urine is bright red, hot, or retained.
Stitches in chest, side, and back. Constant desire to cough from a tick-
ling in the larynx. Aching pain in the chest temporarily relieved by
bending the trunk backwards. The child cries when attempting to
swallow, as if from soreness and pain in the throat. Constipation. Fear
of music. Grasps throat while coughing. Spasm of the glottis.
Aggravation.--During expiration; after first sleep at night; after ex-
posure to cold dry winds, or from remaining in a dry, cold room, from
lying on the left side; when being raised up.
Amelioration.-During inspiration; when at rest.
Aconite is useful in the spasmodic or false croup, when it will often
relieve promptly, and when the case looks more dangerous than it really
is. It is of little use in the pseudo-membranous form. It is especially
adapted to a condition of plethora, but is said to reduce the vital power
when it fails to relieve after producing perspiration. It is a very import-
ant remedy in the first stages of croup. Hepar sulph. follows Aconite
well.
Acetic Acid.-Hissing respiration, with rattling in the throat. Foul
10
breath, aphonia. Children swallow with difficulty, even a little water.
Fever, with redness of the left cheek, without thirst. Hurried and labo-
rious breathing.
In large doses, this remedy produces a fibrinous deposit in the larynx
similar to that seen in membranous croup. Does not follow Borax and
Causticum well.
Ailanthus Gland.-Throat tender and sore on swallowing or on admit-
ting air; hawking of mucus from throat; great accumulation of matter,
part of which is easily expectorated, while part is detached with difficulty
in small flakes. Tenderness and enlargement of the parotid and thyroid
glands, croupy choking, raising of mucus and yellow matter from the
throat, constant hawking and efforts to raise hardened lumps of whitish
matter.
Ammonium Causticum.—Deep weak voice, can scarcely utter a word.
Cough, with copious expectoration, especially after drinking. Difficult,
labored, rattling, or stertorous breathing. Suffocative spells, scraping
burning in throat, dark redness of velum pendulum palati, tonsils, pos-
terior wall of pharynx. The uvula is drawn up and covered with white
mucus. Stoppage of nose, face pale, spasm of chest.
In poisoning from this the epiglottis and entrance to rima glottidis is
found covered with a pseudo-membrane. Deposit of pseudo-membrane on
epiglottis, trachea, and bronchia.
Antimonium Tart.-Severe forms of catarrhal and first stages of mem-
branous croup. High pulse, drinks often, but little at a time. Head hot
and it sweats after each coughing-spell. Yawning, stretching, sleepiness,
stupor. Coughing induces perspiration.
Face pale, bluish, sunken, covered with cold sweat. Failing strength;
collapse. Nausea and straining to vomit, with perspiration on the forehead ;
perspiration more profuse on affected parts; often cold and clammy. Im-
pending suffocation, dulness, dizziness. Lips parched, dry, red, cracked,
excoriated. Dysphagia, with difficult breathing. Feeble voice, nightsweats,
blue rings around eyes, urine smells sour. Raw, sore, velvety feeling
throughout the respiratory passages. Irregularly round, white or grayish
passages in the throat; loose cough, with much phlegm, causing a sensa-
tion of suffocation; cough, which sounds below the larynx loose and
croupy.
Sound at each cough as though a cupful of mucus were lodged in the
bronchia, but which cannot be expectorated. Hollow cough, with rattling
of mucus in trachea and chest. The child sits erect, gasping for breath;
dyspnoea from congestion and oedema of the mucous membrane: Paraly-
sis of the lungs, gasping for air at the commencement of each paroxysm
of cough, larynx painful to the touch, torpid croup.
Aggravation.--In the evening, when warm, when lying down, from anger
(cough). Tart. emetic is especially adapted to the last stages of the catar-
rhal variety, or after relief has been obtained from other remedies from
the more violent stages.
The symptoms last frequently but a short time, recurring in paroxysms.
Post-mortem after poisoning reveals larynx and trachea covered with
large deep pustules.
Apis Mellifica.-Hoarseness and difficulty of breathing, roughness and
sensitiveness of the larynx. Talking is painful; sensation as if larynx
were tired after talking; drawing pains in the larynx; cough when start-
ing during sleep. Rough cough during the evening. Larynx feels weak.
11
Morning hoarseness, great feeling of suffocation, can bear nothing about
throat. Croupy, ringing cough, with soreness of upper chest and painful
concussion of the head, difficult breathing, suffocation after every drop of
liquid. Labored inspirations.
Cough worse during warmth, rest, and on rousing from first slumber;
predisposition to hives or nettlerash. Edema of glottis, tongue swollen,
tenacious mucus in throat; impending brain trouble.
Arsenicum Album.-Last stages of membranous croup. Great and
rapid exhaustion, weakness, fainting. Pulse scarcely perceptible, but
rapid. Eyes sunken and turned up, cold extremities, sunken or bloated
face, bluish, slightly swollen lips, stupor, collapse.
Great heat, with frequent drinkings; the child only wets its lips, but in
a moment again calls for water. Anguish, restlessness, constant tossing
about, cold perspiration. Afraid of death or of being alone, sleeplessness.
Dark vesicular eruption around red border of the lips, spasmodic constric-
tion of the larynx, with anxious, short, oppressed respiration. Cory za,
with stoppage of nostrils, impeding breathing, worse at night. Burning
or dryness in larynx with hoarseness. Faucial croup, burning pain ex-
tending into the stomach.
The patient gets worse in paroxysms; between them there is compara-
tive ease.
Mouth and throat dry and burning, dry, inflamed, swollen.
Voice rough, hoarse, trembling, or at one time strong and again very weak.
Cough, with sensation of suffocation or constriction; or it is clear, ringing,
and is excited by a burning or constant tickling in throat-pit. Cough
raw, dry, metallic. Roughness and hoarseness of throat in the A.M.
Cough, dry, short, as if from a vapor of sulphur.
Suffocation on lying down, although he lies down carefully; there is
a shrill whistling sound in his constricted windpipe, such as is produced.
by a fine harp-string. He is likely to choke, and protrudes his tongue.
Aggravation.-After midnight; from cold water; from lying down.
Amelioration.—From heat; lying with the head high or with the head
thrown back.
-
Arsenic is adapted to croup having a fungoid origin, arising after ex-
posure in damp or mouldy rooms. It is sometimes useful during resolu-
tion after the paroxysmal stage, when there is a failure of the vital
powers. It must be thought of in children subject to hives or nettlerash.
The Arsen. cough is always worse after drinking. Inflammation of the
tracheal membrane is seen in Arsenic poisoning.
Belladonna.-Hot head; face flushed, eyes red, skin burning hot, great
soreness of the larynx; when touched the child appears to suffocate.
Fauces bright red and inflamed. Dry, barking, spasmodic cough. Short,
anxious inspirations with moaning. Drowsiness with sleeplessness. Sud-
den starting, as if frightened, during sleep. Rough, hoarse voice, child
cries just before each attack of coughing. Difficult inspirations, as if
mucus were accumulated in windpipe. Burning in chest, spasm of
glottis.
Belladonna is adapted to plethoric red-faced children, whose actions
are characterized by rapidity of motion and who are very irritable and
peevish. It is most adapted to the spasmodic form.
Bromine.-Later stages of membranous croup. Fever, with hot face,
thirst, restlessness, anguish, temperature of body unequal, frequently
changing, great prostration; pulse quick, at times so rapid as to be un-
countable, face blue, turning purplish at each effort to cough. Sleep
full of vivid, startling dreams. Excessive drowsiness and languor. Stop-
page of nose and fluent coryza at the same time. Soreness, scurfiness of
12
nose, with corrosion of adjacent parts, on account of frothy mucus in
mouth and nostrils, nose dry, with sneezing. Increased saliva, white
tongue, convulsions, escape of flatus from the vagina. Child grasps its
neck as if in pain. Soreness of abdominal muscles.
Gastric catarrh. Spasm of larynx, with much rattling during respira-
tion and during the cough; great accumulation of mucus in the larynx,
causing danger of suffocation (the Tart. emet. rattling is lower down).
Tickling in trachea during an inspiration, with laryngeal soreness.
Netlike redness of the throat, with corroded patches. The false mem-
brane is brownish, granular, filmy, tightly adherent (Kali bich.). Sensa-
tion of a lump or hair in the throat. Fauces feel raw, sore, irritated;
voice hoarse, croupy, whistling, with hoarse wailing or crying, partial
or complete aphonia.
Spasmodic, suffocative tickling cough, dry wheezing without expecto-
ration. Cough hoarse, whistling, or dry and stridulous, or paroxysmal,
causing vomiting.
The child during the cough grasps the throat as if trying to tear some-
thing away. Gasping and snuffing for breath, with wheezing and
rattling in larynx, heard during respiration. Chest elevated and depressed
from labor in breathing; the muscles of the throat and neck are violently
exercised, producing depression at the throat pit; the abdominal muscles
are drawn up and the head is thrown back. Breathing is alternately
slow and suffocating and hurried and superficial. It is labored and at
times seems impossible. Child gasps for air as if from suffocation. The
inhaled air feels cold.
Aggravation.—In evening, first part of night; from deep respiration ;
from warmth; at night (cough).
Amelioration.-After midnight.
Bromine is suited to fleshy children, with blue eyes, clear skin, and fair
hair. It follows well after Spongia. It is chiefly useful in the last stages,
when prompt relief is needful, and may be then used as an inhalant, when
it will often soften the membrane (use 10 drops to Zij of boiling water,
allowing the child to inhale the steam). It is also useful internally.
Bromine is one of the most important remedies, and is not used enough.
Experiments on pigeons show in the post-mortem a severe inflammation
of the larynx and trachea, marked by slight reddish stripes, and showing
a dull-rel color, especially about the glottis. There is an exudation of
plastic lymph, almost blocking up the air-tubes.
Bromine is very volatile, and should be kept in a vial with a glass
stopper to which a small glass tube is attached, through which a drop can
be at any time added to a bottle of pure water. It must be prepared fresh
each time of using, as it soon becomes Bromic acid.
The differential diagnosis between Bromine and its analogue Iodine, can
be found under the latter remedy.
Bryonia.-Spasmodic croup; hoarseness, with tendency to perspire.
Dry, hacking cough, single spasmodic cough against the upper part of
trachea. Scratching, painful, hacking cough as from rawness of larynx,
after lying down in bed at night; desire to hawk, because of a sensation
of mucus in larynx. Cough on going from cold into warm air, from
a sensation of vapor in the windpipe. Frequent gasping for breath
before a fit of coughing; quick spasmodic respiration, as if child could
not recover its breath. Suffocation fit followed by cough (after midnight).
Bronchial croup with insufficient reaction of the organism after danger-
ous symptoms are subdued. Violent headache, worse from motion; all
symptoms better from rest.
1
13
Bryonia if the right remedy will induce speedy perspiration. It is use-
ful in children attacked after having measles; also, in the rheumatic
diathesis.
Caladium seguinum.—Spasmodic form. Epiglottis and adjacent parts
swollen, painful to pressure; the larynx and trachea seem constricted,
impeding deep respiration, which is incomplete; the inspiration being
catching, with sinking in of pit of stomach during it. Grasps throat with
hand constantly. Aphonia, no thirst.
Cough originating above larynx, weak, toneless, occurring at night,
preventing sleep, and continuing on the following morning.
Cough incessant, hoarse, worse on attempting to speak, and without
expectoration or with expectoration of small lumps of mucus.
The least noise awakens the child; aversion to taking medicine.
It is adapted to the phlegmatic temperament. After sleep in the day-
time the pains are gone.
Calcarea carbonica.-Spasmodic croup; during inhalation, the cheeks
and supra-sternal fossa are forcibly drawn inwards, indicating spasm of
the glottis. Each inspiration is hearse, rough, loud, and difficult,
causing the child to cry with pain; purplish face, worse after sleeping.
Adapted to fleshy, large-headed children, with flabby skin and light hair.
During dentition. Children whose heads sweat and smell sour. General
sour smell about the child. Flabby, emaciated children.
Calcarea phosphorica.-Suffocative attacks on lifting child up from the
cradle. After nursing, after crying, or after being raised from the cradle
breathing ceases. The head turns backward, the face is blue, there is
fighting with hands and feet. After the attack great relaxation.
Calcarea sulphurata.—Exudation of tough mucus in larynx and tra-
chea, obstructing respiration; voice hoarse, cough dry, loud, almost
barking, frequently repeated, yet not constant, and not producing any
great anguish. Violent cough, with danger of suffocation from the pro-
fuse accumulation of plastic exudation. Loose cough, without expectora-
tion or expectoration by vomiturition. The cough is toneless, loose, yet
there is no expectoration, and the respiration is free from any whistling
sound, but is rattling and sometimes short. This little-used remedy, may
be useful after the exudation stage, when, after the hard membrane has
been softened, there exists a great quantity of tough mucus in the throat,
causing much discomfort. It will sometimes change the croupous to a
catarrhal cough, and when given in season, will sometimes prevent exu-
dation.
Carbo animalis.-Evening hoarseness; roughness and hoarseness in
throat early in A.M., with dry cough. Hoarseness in daytime with aphonia
at night. Cough with constriction of throat and spasm in chest. Cough
arresting the breathing. Suffocative evening cough. Rattling and whizz-
ing in chest, in evening in bed; sudden oppression of chest when at-
tempting to inspire deeply. Suffocative constriction of chest early in
A.M.; fear of death; stitches in heart from talking; sensation when
moving the arms as if heart and chest would tear.
Carbo vegetabilis.-Is sometimes useful for hoarseness and loose cough,
continuing for a long time after an attack of croup.
Causticum.-Catarrhal variety. Sensation of rawness and tightness in
with puffiness of left side of throat, causing him to pull clothes loose
14
from it. Aphonia from spasms of laryngeal muscles; voice obstructed,
with sensation of a plug in larynx, which cannot be thrown off. Fre-
quent paroxysms of suffocation during inspiration, as if some one con-
stricted the trachea, causing a momentary arrest of breathing; this comes
on when sitting.
Sudden arrest of breathing in open air, palpitation, perspiration, rush
of blood to the head, face purplish, arrest of breath while talking, has to
gasp for air. Cough, with rawness of throat, with sensation of soreness
in interior of trachea, along a narrow space from below upwards.
Each turn of cough causes pain in that space, nearly stopping the
breathing.
Long-continued hoarseness and aphonia from paralysis of laryngeal
muscles.
Chamomilla-Catarrhal croup. Much hoarseness, wheezing, and rat-
tling of mucus in the trachea. Dry, short, croupy cough, worse at
night, often occurring during sleep. Child is cross, and is only quiet
when carried about or rocked. One cheek red, the other pale; hoarse-
ness from tough mucus in the larynx, which can only be brought away
by hawking strongly. Catarrhal hoarseness, with dryness of the eyelids.
Suffocative tightness of the upper chest, with desire to cough.
China off.—Laryngismus stridulus. Voice has a deeper and impure
sound when talking or singing. Mucus in larynx causing constant hawk-
ing, making the voice hollow and hoarse; stitches and feeling of
roughness in larynx; whistling and wheezing in trachea, when inspiring
air. Suffocative fit, as if larynx were filled with mucus, especially
toward evening, and when waking at night. Painful and difficult in-
spirations and hurried expirations. Suffocative paroxysmal cough; arrest
of breathing.
Chlorine.-Laryngismus stridulus; spasmus glottidis, both during ex-
piration and inspiration; shrill sounds; expiration difficult (also Acon-
ite); inspiration easy. (Sambucus and Spongia opposite.) Spasm of
glottis interfering but slightly with inspiration, giving it a crowing
sound, but preventing expiration. The respiratory acts consist of a series
of crowing inspirations, each followed by an ineffectual effort at expira-
tion, the whole inflating the chest to a most painful extent.
phyxia with or without convulsions, during which the spasm relaxes and
respiration is resumed.
As-
Desire to cough from tickling, with sensation of rawness behind thy-
roid cartilage. Difficult expulsion of air when attempting to cough.
Abortive cough, with the desire growing more and more intense.
The great characteristic is, that while the air can be drawn into the
lungs freely, it cannot be expelled.
A weak solution of Chlorine should be prepared in cool water, and a
teaspoonful should be given at each paroxysm.
Cina.-Spasmodic croup. Difficult loud respiration, short breath, as
from much mucus in chest. Loud whistling whoop in trachea while in-
spiring, not audible during expiration. (Vide Spong, and Acon.) Before
coughing the child starts suddenly up, looks wildly about, the whole
body is stiff, the child becomes unconscious; this is followed by cough.
Whimpering after cough, or a clucking noise is heard; anxiety, gasp-
ing for breath, pale face.
Cinnabar.-Has been recommended by Teste in pseudo-membranous
croup. Its efficacy is doubtful.
15
-
Cocculus indicus.-Spasmodic form. Wheezing, suffocative, snoring
breathing, worse during inspiration, with slow expiration, sometimes ar-
rested, with puffed face. Cough from smoky feeling in trachea, con-
stricting it and arresting breathing. Each paroxysm of cough consists of
two turns. Irritation in upper larynx inducing cough.
Conium.-Spasmodic form. Suffocative fit, as if throat were stopped
with mucus. Hoarseness, with dry cough. Heavy inspiration, with pain
in chest, short, panting breathing.
Cubeba.-Membranous croup. The false membranes are thick and of
a dark shade. Abundant flow of viscid, purulent, or blackish mucus from
the bronchia, which accumulates in the throat, threatening suffocation;
viscid mucus in the mouth.
Expectoration is always difficult and painful. Throat burning and
contracted, constant desire to hawk and cough. Constant need to swallow
saliva in order to relieve the dryness and suffering in the throat and
larynx. Sensation of fulness and strangulation in the neck; deglutition
is difficult and very painful, water and food often passing through the
nose and into the larynx, causing cough with expectoration of blood.
Sensation of a foreign body in the throat. Tubercles in throat and
larynx. Sensation as of a miliary eruption in the bronchia and lungs.
Sensation as of a thousand pins sticking into the lungs on respiring.
Muscles of throat seem paralyzed. Burning erythema in the mouth,
changing to gray patches.
Cough, with coryza and hoarseness. During and after the cough, cold
sweat upon the breast and back, with burning in the abdomen. Barking,
croupy cough, with sensation of a foreign body in larynx. Quick loud
cough, which terminates in the expulsion of masses of white mucus, and
occurs in the morning and evening. Incessant bronchial cough, worse
in the evening, from heat, in the open air, and from movement. Short
and constant cough, as if from swallowing the wrong way. Harsh cough,
seeming to tear and rupture the bronchia. Voice harsh and wheez-
ing; respiration noisy and panting, impeded, difficult, with crepitant
râles. Great fulness in chest, dyspnoea and sensation of suffocation.
Can lie only on the left side. Desire to take milk and warm drinks,
especially such as induce perspiration.
The patient will drink anything, even stagnant water, to relieve the
intense pain. Ill-temper; face red and pale by turns, shrunken or
bloated. Contractive, pressive headache, with drowsiness but without sleep.
Anxiety, cannot remain in bed. Skin moist, burning; pulse frequent
and hard; pricking in the legs; nausea; craving for acids.
Cubebs is a much-neglected remedy, and when the peculiar condition
above described exists it will produce a brilliant result.
Cuprum metallicum.-Laryngismus stridulus. Angina faucium, with
croupous exudation on the left tonsil. Asthma Millarii. The larynx is
drawn downward, the trachea is hard as a bone, and nearly even from
the chin. Each effort to swallow increases the spasm; whistling, crow-
ing, very difficult breathing, audible a long distance; rattling in chest
when awake; hoarseness on breathing dry cold air, continuous, so that
speech is prevented, with inclination to lie down. Complete aphonia; me-
tastatic cough, with a croupy sound; cough, with regular inspiration, but
sighing expiration. Cough, with almost suppressed respiration; spasm of
glottis preventing speech. Spasmodic vomiting occurs when the suffoca-
tive spasms cease.
•
16
Cough, with bleating as though it came from abdomen, relieved by a
swallow of cold water. (Veratr. oppos.) Hollow, hoarse, or metallic cough.
Face and limbs blue and puffy. Convulsions; cold nocturnal per-
spiration.
Child wakens with quick, difficult breathing; restlessness; eyes wide
open; abdominal respiration. Head thrown far back on pillow, mouth
wide open, cheeks dark red, purplish eyes, partly closed; hands and feet
cramped and rigid, but not cold.
Cuprum will often lessen the suffocative lack of breath found in this
form of the disease.
Drosera.-Tightness of chest when talking, even when uttering a single
word. Creeping sensation, exciting cough, with sensation as if a soft
body were lodged in the larynx, with fine stitches to right side of the
throat. Hoarseness, deep voice.
Drosera is useful when after croup there remains a chronic form of the
disease, which returns periodically, is spasmodic, and has bronchial rat-
tling. This sometimes if neglected changes into hydrocephalus.
Gelseminum.-It is useful in a paralysis, following croup, of the mus-
cles of the neck. There may be aphonia, long inspiration with a crowing
sound, while the expiration is sudden and forcible. Spasmodic croup.
Hepar sulp. calc.--Catarrhal variety occurring with or without fever.
Pain in the larynx, worse from pressure, speaking, coughing, or breath-
ing. Swelling below the larynx; sensation of down in larynx. Sensa-
tion in throat as if some sharp instrument were sticking in it (imaginary
fish-bone), or of internal swelling when swallowing. Hoarseness or apho-
nia. Attacks of dry, rough, hollow cough, with anguish, scraping in
larynx, rattling, choking, and suffocation, often ending in crying.
Abundant expectoration of tenacious mucus with relief to the rattling
breathing. Hoarseness and rattling of moist mucus, which the child can-
not raise, with but slight difficulty in breathing. The cough (looser
than Spongia) often produces desire to vomit. Subdued cough from
oppression of the chest; cough, whistling or moist, from tickling in
larynx, excited from uncovering even a single limb.
Respiration easy, or it is hoarse, anxious, with danger of suffocation.
when lying down; suffocative attacks compel child to sit erect, and to
bend head backward.
Sensitiveness to cold air. Stitching pain extending from car to ear when
swallowing or turning the head. Every little motion causes slight sweat;
profuse, clammy, or sour sweat continuously; sweat before midnight.
Frequent desire to pass urine, which is dark yellow and soon deposits a
white sediment. Head thrown back during profound sleep, with frequent
startings. Irritability or sadness, and weeping; desire for acids or strong-
tasting food or drink. Easily excitable; throbbing of carotids. Eyes
protruding, or lids are spasmodically closed. Starts during sleep as from
want of air, with moaning and great general anxiety. Hot flushes, with
sweat; burning heat, with red face and great thirst.
Frequent deep inspiration, as after running. Epistaxis. Cough causing
vomiting. Great drowsiness in the evening; deep dry cough, with ob-
structed breathing on inspiring, and pain in top of chest at every cough.
Swelling of right hand, or of fingers of both hands, with stiffness whilst
lying.
Aggravation. From 12 to 2 A.M.; from exposure to dry cold west winds;
t
17
nightly; from cold air; from uncovering even a single limb; during ex-
ercise; from lying down.
Amelioration.-When warmly covered; when at rest.
Differential Diagnosis between Hep. and Spongia.
Hep. 3. c.-Aggravation in the morning (after midnight).
s.
Spongia.-Aggravation in the evening (before midnight).
Spongia.-Cough piping, crowing, very dry-sounding, with rough
crowing cry and sensitiveness of the larynx to the touch; cough worse
when sitting erect; better lying down, and from eating or drinking.
Hepar. sulp.-The cough is produced or aggravated by lying, espe-
cially with the head low; better with the head high; worse from cold
food. The cough is deep, rough, barking, with hoarseness or aphonia,
with slight suffocative spasms. There is more rattling of mucus than in
Spongia
Aconite follows Hepar well.
Hydrocyanic acid.-May be useful for a spasmodic condition after Hepar.
Iodine. Last stages of membranous croup, tracheal or bronchial vari-
ety, with tendency to torpor. Pain, with feeling of contraction and heat
in the larynx. Roughness, with pressure and stitches in larynx and
pharynx as if swollen. Discharge of hardened mucus. Increased secre-
tion of tenacious mucus in trachea. Soreness of throat and chest, espe-
cially when in bed, with wheezing in throat and drawing pains in the
lungs. Fauces inflamed, with burning and tickling. External glandu-
lar swellings of throat and of thyroid gland; tightness and constriction
about larynx, with soreness and hoarse voice. Laryngeal spasms. The
child grasps chest and laryn.c. Difficult deglutition. Creeping and
tickling in the larynx, only to be removed by hawking and coughing,
with flow of water in the mouth in bed in A.M. Expectoration of tough
mucus, with pressure as of something he might swallow, in the morning.
Voice rough, deep, hoarse, with pain in larynx and chest, or aphonia.
The voice continually becomes deeper. Hoarseness, with flushed face.
Cough accompanied by expectoration of blood-streaked mucus. Dry,.
short, hacking, hoarse, or rattling cough; spasmodic morning cough,
from contraction and tickling in larynx and supra-sternal fossa. Violent
attacks of cough threatening suffocation, with whistling tone and great
anguish. The peculiarity of the Iodine cough is that it has lost the
peculiar metallic, loud timbre, so characteristic of croup, and has become
muffled and indistinct. Violent difficulty of breathing; great dyspnea;
much rattling of mucus, which is difficult to expectorate. Difficult
inspiration, with wheezing, sawing respiratory sound.
Face cold and pale. Restlessness, changing position, without anguish
(Arsenic); thirst; putrid smell from the mouth. Great prostration and
debility. Sleeplessness. Profuse nosebleed. Aphthæ in mouth. Ob-
stinate retention of urine, which when passed is dark, turbid, or milky.
Constipation, or copious discharge of watery, foamy, whitish mucus;
nightsweat.
Aggravation.-Nightsweat. Cough worse mornings, from motion,
heat; when lying on the back.
Amelioration.-By cold; after eating
Iodine is especially adapted to fat children with dark hair and eyes.
(Light hair, Hepar.) The symptoms steadily increase in severity.
(Chronic laryngitis.) It will be found most useful when the trachea
and bronchi are principally involved, the membranes being lower in the
18
throat than usual. The membranes may be moist, but the child has not
the strength to expel them. It follows Hepar well.
Iodine is used internally by placing a few drops of the 1 in liquid,
and has been recommended to be given in the first stages of the disease
to abort the attack. It has been also locally applied to the throat inter-
nally, but the most usual method of administration is by inhalation, as
follows: Put a few drops (from the tincture to the second dilution) of
Iodine in a shallow vessel containing boiling water, and holding the
child's head over this, cause him to inhale the vapor.
Renew this every
two to six hours. This will sometimes soften the false membrane and
cause its expectoration when all other means have failed.
Dr. Elb claims Iodine to be useful in all stages of croup.
Differential Diagnosis between Iodine and Bromine.
Iodine.-Moist cough with expectoration.
Bromine.-Wheezing cough without expectoration.
Iodine.-Worse in the morning.
Bromine.-Worse in the evening and during the night.
Iodine.-Hoarseness and dyspnoea from congestion and exudation.
Bromine.-Spasms and oedema of the glottis.
Iodine. More fever, thirst, and general irritability.
Bromine.—Local symptoms more violent.
Ipecacuanha.-Deep-red color of the tonsils and pharynx. Suffocative
cough. Child becomes stiff. Croupy cough occurring during the night.
Dry, tickling cough, or with rattling in the bronchi. A rattling is
heard in the bronchial tubes during respiration, which is short and pant-
ing (also Ant. tart.); urine bloody, or with brickdust sediment; night-
sweats; vomiting of large quantities of mucus. Diarrhoeic, fermented
stools; nausea.
Cases characterized by slow progress of the disease.
Useful in the catarrhal condition following croup.
The panting sound during respiration is an important symptom.
-
Kali bichromas.—Membranous croup; early formative stage. Insid-
ious onset, catarrhal form. Pain as from ulceration in larynx. Tick-
ling in upper larynx on lying down at night, causing considerable cough-
ing. Thickened feeling about bronchia; soreness in the chest; painful
deglutition. Tonsils and larynx red and swollen, covered with false
membrane, difficult to detach Fauces dark red, glossy, puffed, showing
ramifications of pale-red vessels, and having deep-eating ulcers with dark-
red centres and overhanging edges, which discharge tenacious yellow
Severe pains in left side of throat, extending to the head and
neck. Pharyngeal fissures exuding blood (left side). Parotid glands
Elastic, gray, or yellow false membrane, extending from fauces
into trachea and nares (see Bromine).
Pressure at root of nose, re-
lieved by discharge of tough, hard, stringy mucus. Tightness at tracheal
bifurcation. Irritation of the larynx in the morning, causing hawking
of mucus. Voice hoarse, rough in the evening; aphonia (Causticum op-
posite).
matter.
swollen.
-
Cough hoarse. Child strangles when coughing from an inability to
detach the tough mucus, which he has to swallow. Dry cough with
tough expectoration. Cough hoarse, dry, barking, metallic, or harsh.
Paroxysms of loud rattling cough, lasting several minutes and ending in
expectoration of tough mucus, which hangs from the mouth in long
“ ་*
19
4
1
tough strings. Cough at every inhalation. Short, wheezing, or hard
cough, worse early in the morning. Cough from insupportable tickling
in larynx or at tracheal bifurcation, or from an accumulation of mucus.
Cough preceded by wheezing or panting. Morning cough, with tough
expectoration, or on account of full feeling at the epigastrium.
Stridulous respiration, with an effort to vomit a viscid, tough, stringy
mucus, which can be drawn out in long strings to the feet; wheezing during
sleep. Laborious respiration with great prostration. Breathing is per-
formed only with the muscles of the abdomen, neck, and scapulæ, in the
later stages. Violent wheezing and panting immediately after waking,
followed by a violent cough, causing patient to sit bent forwards. Wheez-
ing and rattling in chest during sleep, audible at a distance.
Countenance anxious; cheeks puffed and livid; pulse frequent and
small. Extremities cold. Great restlessness and jactitation. Slight
eruption over entire body, varying in persistence. Left side mostly
affected. Thick coat of yellowish fur at root of tongue. Loss of appe-
tite. Constipation. Debility. Loss of smell. Elastic plugs of mucus
in left nostril.
Aggravation.-2 to 4 A.M.; in the cold; after eating; when taking
a deep inspiration.
Amelioration.-By heat.
Kali bichromas will produce exudation and hardening of a false mem-
brane in trachea.
In a case of poisoning by it, the air-passages were found lined with a
thick, ropy, muco-purulent fluid, the trachea contained a false mem-
brane, the epiglottis, rima glottidis, bronchia, and trachea were deeply
injected, the lungs were healthy. The exudation was yellow and loose
in texture. It is adapted to children with light hair, blue eyes, who are
fat and chubby. The Kali bich. croup comes insidiously; the child
seems only to have a severe cold, there is slight difficulty of breathing;
as the disease advances there is fever with a slight elevation of tempera-
ture and increased dyspnoea. Finally there is diminished temperature,
prostration, stupor, and death results from asphyxia. The attacks come
on in the morning. It will sometimes soften the false membranes and
cause their expectoration or vomiturition. It resembles Tart. emetic
and lodine, and is often applicable in the severe catarrhal forms after
Tart. emet. fails.
Kali bromatum.-Spasmodic forms. In the earlier stages when the
child appears well in the daytime. The child at night is agitated, has a
flushed face, suffused and bloodshot eyes; after several hours he sleeps,
breathing easily and naturally, but soon he wakens in a paroxysm. Hy-
peræsthesia of laryngeal nerves followed at a later stage by a natural
reaction. Loss of sensibility in the larynx. Exudations of a whitish,
firm texture, affecting trachea and bronchi. (The membrane of Kali
bich. is yellow.)
Harsh, painful voice, with hoarseness. Hacking cough, with dulness
and confusion of head. The child wakens suddenly from sound sleep
with a sensation of suffocation, and with a peculiar ringing, dry, brassy
cough and hurried breathing.
It follows Acon. and Spong., whose action it resembles, well.
Kaolin.—This is a remedy which has been recommended for mem-
branous croup seated in lower larynx and upper trachea. The respira-
tion is sawing and labored. Husky voice. Metallic, rasping breathing
and suffocative cough. The cough and suffocative spells are worse in the
20
evening. Suffocative paroxysms with labored sawing breathing. Great
feverishness. Dry skin.
It is said to dissolve false membrane.
It should be thought of as a last resort after all else has failed.
Lachesis.-Diphtheritic croup, advanced stages. Exudative patches
in fauces extending downward on pharynx and larynx Sensation as if
trachea had become narrower after the siesta; the mucus cannot be de-
tached as before.
The trouble commences on the left side and extends to the right.
Sensation as of something fluttering above the larynx. Contraction
and constriction of larynx, with sensation of tension and swelling.
Weak voice. Dry, short, suffocative, and croaking cough. Fatiguing
cough, whose utmost efforts can detach nothing, excited by tickling in
the larynx. Cough at times attended with vomiting. Impending pa-
ralysis of the lungs. Patient seems likely to choke while sleeping. Suf-
focative attacks when the throat is touched. Tendency to deep inspira-
tion. Attacks of suffocation, especially on lying down in the evening or
in bed at night, but principally when anything is placed before the nose
or mouth.
Dry heat, principally at night or in the morning, often accompanied by
agitation and tossing, headache, delirium, insatiable thirst, rapid pros-
tration, pulse frequent, feeble, irregular, great anguish, mental dejec-
tion, fear.
Children sleep into croup; when thoroughly aroused they breathe
pretty freely. Child wakes from a short nap as if dying. Extreme
rigidity of the body.
Aggravation. After sleep; from having the least thing touch the throat;
worse until midnight; on waking.
It is im-
Adapted to children subject to inflammatory rheumatism.
portant in the very fatal cases to which Lachesis is adapted that the
child should be kept awake, as if left to itself it will at once sink into a
stupor, and that it should be fed at short intervals with beef tea, milk
punch, and the like nourishing and stimulating food.
Lactic acid.-Dryness, scratching, and burning in the throat; tearing
in the larynx and trachea, with hoarseness, difficult expectoration of
gray, tasteless mucus, or it is so tough as almost to exclude the air. Hor-
rible dreams of abysses, and restless sleep.
During all these symptoms there is no croup-sound to be heard.
Lycopodium.-Last stages. Membranous or diphtheritic croup. Hoarse
voice. Loose cough in daytime with suffocative fits at night. Suffoca-
tive fits alternate with free intervals. Hoarseness remaining after croup.
(Phosphorus.)
It is also said to be useful for children where there is a marked dispo-
sition to croup.
Moschus.-Laryngismus stridulus. Swelling of the larynx. Sudden
attacks of crowing and protracted inspiration. Spasm of the lungs.
Feeling in upper larynx as if the breath would be excluded, as if he
had inspired a sulphurous vapor, with constriction. Pressure on chest,
worse on lying, with gasping for breath.
Children with a light complexion; often useful in the last stages after
other remedies have proved useless.
Naja tripudiens.-Spasmodic croup. Clogging up of the larynx and
21
trachea with thick mucus, which is hawked up with difficulty. Sensa-
tion of soreness in larynx and trachea (Caust.), or as if there was a hair
in it, causing constant tickling, coughing, and hoarseness, with finally
expectoration of tenacious mucus. Breathing is laborious; gasping for
breath for several hours.
Natrum muriaticum.-Scraping in larynx, with rough voice. Violent
hoarseness, worse early in A.M. Rough, hoarse, short, hacking cough.
Cough making the child breathless. Soreness in larynx and trachea when
coughing. Oppression of chest, with burning in the hands.
Nitric acid.-Violent coryza, with great hoarseness, and cough with
stitches in the throat at every impulse. Shooting pains in region of
larynx; sharp, scratching roughness in throat, like a file, not felt on
swallowing, but on breathing, with oppression of chest and coryza. Dry,
barking, evening cough; rough, dry cough before midnight, giving no
rest, shaking the whole body; stitches through chest; fever; shortness
of breath. Oppression on the chest.
The cough is much worse at night, and is troublesome during the day,
when reclining or slumbering.
Opium.-Spasmodic form. Hoarseness, as if trachea were filled with
mucus; the mouth is dry, tongue white. Hollow, dry cough, followed
by yawning, and a sudden loud cry. Suffocative catarrh. Cough when
swallowing. Coughs up frothy mucus. Difficult, tight breathing, worse
at night. Single deep inspirations or arrest of breathing. Anxiety,
and contraction and constriction of chest, as if it were stiff. Croup in
adults.
The hoarseness is a marked symptom.
Phosphorus.-Is adapted to a disposition to relapse after the disease has
yielded. Croupy bronchitis, with great weakness. Hoarseness obstinate,
remains after croup. (Lyc.) Child is hoarse, croupy, at night; better
toward morning.
Hoarseness and raw pain and soreness in the chest, as if it were exco-
riated. Continual irritation in the larynx and trachea, low down, with
oppression in chest. Pain, roughness, and burning in the larynx. Velvety
look about fauces. Sensation as if a piece of flesh or skin were hanging
loose in the larynx. Burning and dryness in the throat. Swollen tonsils.
Hourse, trembling, hissing, or croupous deep voice. Aphonia (inter-
rupted voice, Spongia). Dry, tickling, not very harsh-sounding cough.
Dry, hacking, or loose cough. Hollow, hacking, shrill, spasmodic cough.
Cough from tickling in the chest; worse at night. Shortness of breath ;
expectoration of mucus, with a hollow cough.
Respiration hurried (slow, Spongia). Constant expectoration in the
morning, and during the day. (The Spongia cough is dry; the expectora-
tion is not constant; it is loosened in A.M., and swallowed.) Great oppres-
sion of breathing; worse during inspiration.
Aggravation.-At night (cough); from lying on the left side; from
going from a warm into a cold room. (Bry. opposite.)
Amelioration.-Toward morning.
Phosphorus is adapted to tall, slender patients, where there is a weak-
ness of the chest. It is useful for sequelae of croup when improvement
seems to stop.
After Hep. fails, or after Acon. and Spongia.
Rumex crispus.-Dry, barking, croupy cough. Some fever. Useful
after Spongia and Hepar have failed.
22
Spongia tosta.—Membranous and spasmodic varieties. Difficult respi-
ration, as if a stopper or plug were in the throat, and as if the breath
could not pass through the constriction in the larynx. Cough excited
only by inspiration.
Piping, crowing, very dry-sounding cough, and rough, crowing cry,
with great sensitiveness of the larynx to touch. Barking like a hoarse
dog; worse during inhalations.
\
Great dryness in the larynx, with short and barking cough, and em-
barrassed breathing, as if the larynx and trachea were narrowed. Whis-
tling in the larynx; rough false membranes in the larynx. Glands of
the neck are swollen. Shock upwards in the trachea, like a suffocative
paroxysm, rousing the patient from sleep. Hoarseness; aphonia; voice
hollow, low, lisping, weak. (Hoarseness remaining after Spongia, Carbo
veg.) The voice suddenly fails while speaking. Aphonia after laryn-
gotomy. The throat remains dry after inhaling Bromine. Tickling and
heat in the larynx and trachea. The larynx is elevated and depressed
during respiration; the head is bent backward, the throat pressed for-
ward, to get more breath. Sometimes the larynx is swollen, almost pro-
truding above the chin. Suffocative sawing breathing, as if a saw were
driven through a pine board. Pale, distressed face. Sudden attack, vio-
lent coughing spells, with great anxiousness. Synochal fever, followed by
a remission, with much relief to breathing, Slight sawing sound during
inhalation. Cough hollow, barking, whistling, loose, painful. Children
with fair skins. Pit of stomach drawn in with the cough; difficult ex-
pectoration of small quantities of slime. Slow, loud, whistling respira-
tion, with attacks of suffocation, and impossibility to inhale without the
head thrown back. Stridulous respiratory sounds during inspiration
(Aconite opposite). Pain in the chest, with dyspnoea.
Sawing sound during remission of the attack. Dry cough day and
night, with burning in the chest, as of something hot inside. The cough
subsides after eating or drinking. Each cough corresponds to one thrust of
a saw driven through a pine board. Hollow cough remaining after croup.
Cough increased by excitement. Very painful cough. Whooping-cough,
with croup.
The child falls asleep well, and wakes up choking and
croupy.
-
Heaviness, languor, shiverings, flushes of heat, hard quick pulse.
Easily frightened. Weeping. Bronchitis following croup. Weak after
every exertion.
Fluent coryza, and sometimes sneezing, with saliva
drivelling from the mouth.
Aggravation.-Complaints in throat are worse from using sweets.
Larynx painful from touch, when moving neck or throat, when cough-
ing, talking, swallowing.
Amelioration.-From eating and drinking.
Spongia acts on the fibrous tissues. It is often indicated, not only in
the first stages of the disease, but also when the exudation has been re-
moved by other remedies, and there still remains a rough, hollow, dry,
scratching cough, almost incessant, with scraping in the larynx and
trachea, with or without shortness of breath.
Fever continuing after Aconite will often yield to Spongia.
The characteristic points of this remedy are the great sensitiveness
of the larynx, the feeling as of a plug in the throat, the sawing respira-
tion, the amelioration from eating or drinking, and the aggravation from
sweets.
It is useful after Bromine, Iodine, Phosphorus.
Spongia resembles Hepar, and their differential diagnosis is given
under the latter remedy.
23
f
'
Spigelia.-Suffocating cough, as if from a quantity of water flowing
into the windpipe. Sudden violent cough, occasioned by water having
got into the windpipe. Dry, violent, hollow cough, from an irritation
in the trachea, worse when bending forward, and arresting breathing.
Sepia.-Spasmodic croup. Cough in violent, protracted paroxysms,
infrequent, rather dry, and accompanied by retching.
Sempervirens tectorum.-Dr. Garin with this remedy cured three-
fourths of his cases of croup, being led to its use by observing that the
peasants used it for throat affections, characterized by a deposit of false
membranes. (U. S. Med. and Sur. Journal, vol. ii, p. 200.)
Sambucus nig.-Spasm of the glottis. Dryness of throat and mouth,
with thirstlessness. Inflammation of larynx and trachea, with accumu-
lation of much tough mucus. Laryngismus stridulus. Spasm of the
chest.
The breathing through the nose is impeded. Quick, wheezing, crow-
ing breathing, with suffocative attacks just after midnight, and from
lying with the head low; difficult inspiration.
Head and hands blue and swollen. Heat without thirst.
Burning, red, hot face; hot body with cold hands and feet during sleep.
On awaking the face breaks out into a profuse perspiration, which ex-
tends over the body, and continues in a greater or less degree during the
waking hours; on sleeping the dry heat returns. Great restlessness,
with throwing the arms about.
Frequent waking, as if in fright, with fear of suffocation, the mouth
and eyes being half open. Head bent backwards. Face and hands
bloated, and dark blue. Pulse small, quick, at times intermittent.
Dread of being uncovered.
The dry heat occurs during sleep, profuse sweat appearing first on face,
only after awaking. Worse from 12 till 4 A.M.
Impending suffocation and paralysis of the lungs.
Sulphur.--Very rough throat. Aphonia. Swollen larynx. Sensation
while coughing as of a painful blow in the larynx. Creeping in larynx.
Speaking excites cough. Blackness before the eyes when attempting to
cough. Stoppage of breath with suffocation during the day, and also
whilst asleep, so that the patient must be wakened to prevent suffocation.
These attacks of suffocation are painless during sleep.
It is recommended after Aconite, in mild cases of spasmodic croup.
A case of true croup is recorded in which the administration of pow-
dered Sulphur, by an allopath, was followed by coughing up of the false
membrane.
Sanguinaria Canadensis.-Chronic dryness of the throat. Sensation of
swelling in larynx, with expectoration of thick mucus.
Aphonia, with swelling in the throat.
Severe cough without expectoration, with pain in the head and cir-
cumscribed redness of the cheeks.
Tormenting cough, with exhaustion. Whistling or metallic cough, as if
coughing through a metallic tube. Dry cough, not ceasing until he sits
up in bed, when it is followed by discharge of wind, above and below.
Diphtheritic croup. Catarrhal croup.
It is much used by the Eclectics in true croup, by adding 20 grains of
Sanguinarin to Vinegar iv. Steep and add i Sugar, to form a syrup.
Dose, one teaspoonful.
It is said to prevent the extension of the disease, and also, where given
for some time, to eradicate a predisposition to it.
24
Sulphuric acid.-Mucous membrane of bronchia and trachea inflamed;
epiglottis covered with a thick layer of false membranes, deep-scarlet color,
intensely inflamed, but not corroded. Ulceration of larynx and trachea.
Sarsaparilla.-Spasmodic variety.
Laryngismus stridulus. Throat
rough, hoarse, and dry, in the A.M., on waking. Hoarseness in the throat
every other day. Tough slime in the throat in the morning, which can-
not be removed by hawking. Constant hawking of mucus in the A.M.,
the slime being reproduced in abundance. Spasmodic constriction in the
throat and chest, with difficult breathing. Loosens clothes from the
neck, in order to get breath; but this is without avail. Rawness and pain
in the larynx.
Veratrum album.-Spasmodic constriction of larynx, with contraction
of the pupil of the eye.
Arrest of breathing. Breathing imperceptible, or very labored. Suf-
focative constriction in throat. Deep, hollow evening cough, three or
four turns at a time, which seems to come from the abdomen.
Veratrum viride.-Membranous croup after Aconite.
Zincum sulf. in a two-and-a-half per cent. solution has been used by
Dr. Fukula, of Vienna, to pencil the larynx. Good results are claimed
therefrom. If the child objects to pencilling, the solution can be used
as an injection.
The following remedies, although but seldom if ever used in croup,
may be sometimes available.
sculus hip., Anantherum mur., Alumina (Ammon. brom.), Amyg-
dalæ, Asparagus, Bufo ranun., Baryta acet., Baryta carb., Benzoic
acid, Baptisia, Cannabis sat., Cantharis, Carbolic acid, Carbonum
oxygenatum, Carbonum sulp., Chelidonium, Carduus ben., Curare,
Chloralum, Colchicum, Coralium rubrum, Croton tig., Euphorbia, Fluo-
rine, Glonoin, Guaiacum, Guarea, Gadus morrhua, Graphites, Hell.,
Hyos., Ignat., Ledum, Lauroc., Lobelia, Merc. iod., Podop., Stramon.

Day
16
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ORIFICIAL PHILOSOPHY APPLIED
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RESPIRATORY ORIFICES.
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BY
H. BALLOU BRYSON, B.S.D., M.D., ·
PITTSBURG.
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Reprinted from the TRANSACTIONS of the Homœopathic Medical Society of the
State of Pennsylvania for 1895.
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ORIFICIAL PHILOSOPHY APPLIED TO THE RESPIRATORY ORIFICES.
BY
H. BALLOU BRYSON, B.S.D., M.D.,
PITTSBURG.
DACOSTA,* in 1888, presented at his clinic a boy who, sud-
denly seized with an attack of le grand mal, had fallen in the
street. When presented before the class, the boy exhibited the
typical asthmatic paroxysm, and this continued until, in a spell
of coughing, a piece of apple was expelled from some part of
the respiratory tract, whither it had found its way when the
act of deglutition had been perverted by the epileptic seizure.
Knight reports the case of a girl who, at the age of 6 years,
got a bean into the trachea. Tracheotomy was performed, but
the bean was not found. Three days later, in a fit of coughing,
the bean was expelled. After this a cough developed, and was
severe for months; then asthma developed, and the patient, at
the age of 28 years, had had it ever since.
Torsternson,‡ of Stockholm, in 1891, by so placing a cotton
tampon in a nose as to make pressure upon the superior part
of the septum, caused an attack of asthma in a patient not
subject to the disease.
Aronsohn,§ 1891, while removing a fibrous polypus from the
nose of a clergyman, caused him to have an attack of asthma,
though he had never before had this disease.
I now have a patient who, five years ago, had an enchondro-
sis removed from the septum, and the turbinates cauterized by
Dr. Bosworth. This patient has had hay fever annually ever
since, and never had it before.
* Boston Medical and Surgical Journal, December 29, 1888.
† New York Medical Journal, January 17, 1890.
Eira, Stockholm, November 18, 1891.
& Journal American Medical Association, March 1, 1891.
2-
Every one familiar with the examination and treatment of
the nose has had the very common and instructive experience
of seeing more or less violent sternutation and coughing ex-
cited by the contact of an instrument, the pressure of a cotton
pledget, or the irritation of a cleansing or medicinal applica-
tion. Moreover, it is a matter of the commonest observation
that odors, gases and powders coming in contact with the
Schneiderian membrane, will excite in some people violent
spells of sternutation, fits of coughing or paroxysms of hay
fever.
These facts and considerations are in the nature of provings,
and certainly furnish a priori homœopathic evidence that simi-
lar disease conditions may have a similar aetiology in pathologi-
cal conditions often existing in the respiratory orifices.
But as the Hahnemannian, like every other theory, finds its
demonstration only in the successful application of that theory,
I wish to strengthen the above presumptive evidence with
some practical results.
CASE I. Rev. E. B., æt. 65, a prominent and able Lutheran
minister, referred to me by courtesy of Dr. W. D. King. This
reverend patient has been an asthmatic sufferer nearly all his
life, and in his clerical work had been driven by his malady
from pillar to post all over the country in hope of finding a
climate where he could have comparative case. This he, in a
measure, found in the dust-laden atmosphere of the "Smoky
City;" yet here he was constantly subject to, and often had the
most violent attacks of asthma. Ordinarily he could not walk
up even the gentle acclivities of Pittsburg hills without causing
asthmatic dyspnoea, and often precipitating a paroxysm. Slight
exercise in his garden, in which he took an uncommon interest,
or simply stooping to pick up something from the ground, was
often provocative of the same trouble; while, again, some of
his worst attacks came on when he was at complete physical
rest. When I first saw him at his home, in company with Dr.
King, he was just recovering from a paroxysm of three weeks'
duration, during which time he had not been in the recumbent
position, but sitting or standing, and laboring, gasping for
every breath. I found the patient conscious of nasal trouble,
i
+
1
3-
confessing to the ordinary catarrhal symptoms and difficult
nasal respiration for many years. Rhinoscopic examination
showed much turgescence of the Schneiderian membrane, hy-
pertrophy of the lower turbinate bones, and, on the left side, a
large septal enchondrosis, well forward, stretching entirely
across the fossa, and having its apex buried in the lower tur-
binate bone, making permanent contact and constantly irritat-
ing the nerve terminals of this respiratory orifice.
Seeing this condition of the respiratory orifices, and having
learned his history of coexisting nasal and asthmatic trouble,
I told the patient that I thought the whole cause of his trouble
was in his nose, and that if this spur were removed his asthma
would disappear. Acting upon my advice, he came to my
office April 16, 1894, and had the spur removed. This was
done with the saw, the growth proving to be of almost ivory
hardness. The hemorrhage was profuse for a moment, but
stopped completely without the employment of artificial means.
For a few days the wound was dressed daily, and from that day
to this the patient has not had the slightest touch of asthma,
and says he tends his garden and climbs Pittsburg hills in his
pastoral work at will.
CASE II-Mr. J. L., t. 28, wholesale boot and shoe mer-
chant, by heredity predisposed to asthma. Six years ago began
to have his first attacks of asthma, coming on at irregular in-
tervals, usually when he contracted a cold, or when the air
was uncommonly humid. For the past four years his attacks,
after getting gradually severer in type and recurring more fre-
quently, have been so numerous as to confine him to the house
about one week out of every month, and so bad that during
an attack he could neither eat, sleep nor lie down. Examining
the respiratory orifices for a source of irritation, I found the
nasal passages free from malformations and marked pathologi-
cal changes. However, on examining the throat, I found the
right tonsil very much hypertrophied, and, on inquiry, learned
that the initial tonsillitis and consequent hypertrophy antedated
the onset of the asthma, and that persistent remedial (homœo-
pathic) treatment had failed to reduce the hypertrophy and pre-
vent repeated attacks of tonsillitis.
4-
I accordingly advised extirpation of the tonsil, not only for
the benefit of the throat, but because I believed it, as a source
of orificial irritation, to be the cause of his asthma. On June
19, 1894, fifteen months ago to-day, I removed the tonsil, em-
ploying the McKenzie tonsillotome. Two days later, before
the reparative process was complete, he had a mild attack of
asthmatic breathing, lasting for twenty-four hours, but since
that time he tells me he has had nothing approaching even a
semblance of asthma.
CASE III. Mr. S. M. R., æt. 23, a superintendent of the
street paving work being done by a member of the late and
lusty, but now defunct, "hog combine." For seven years past,
this patient, beginning with the output of foliage each year
and continuing always into August and sometimes into Septem-
ber, had suffered from hay fever; would have violent spells of
sternutation, nasal coryza, lachrymation and some cough;
could not go near a load of hay, a hay-loft or chaff without
having a paroxysm of sternutation, lasting as long as he stayed
and for one-half hour after leaving. His father had been a
life-long asthmatic. Examination showed the lower turbinate
bones to be so congested and hypertrophied as to almost com-
pletely nullify nasal respiration and to make much contact with
the septum on both sides, the left being the worse. I cauter-
ized the left lower turbinate body deeply with the electro-
cautery, and, later, the right with chromic acid. This was
done early in the season, when his annual attack was just de-
veloping, and is practically all the treatment he had; quite all,
save a little local cleansing and antiseptic treatment following
the cauterizations. He is now at the end of his hay-fever
season, and has had no trouble.
CASE IV.-Miss M. C. K., æt. 28, a seamstress and sales-
lady. Previous to the present summer she had had, annually,
for eight years, hay fever very badly, the attacks coming on in
the latter part of July and continuing until the middle of Sep-
tember. Her attacks, ushered in by sternutation, lachrymation
and nasal coryza, were accompanied by profuse perspiration
day and night; she was feverish all the time; her breathing
was always labored, and in some seasons, she says, the respira-
}
— 5 —
=
►
tory trouble amounted to asthma; in her own words, "could
scarcely get my breath; thought I would choke to death." A
brother, dead, who had rheumatism and heart disease, had
asthma; her father and mother had neither asthma nor hay
fever.
This patient I treated first about a year ago for an affection
of the eyes which proved to be very obstinate. In December
last I noticed that she was often blowing her nose, and that
her nostrils were red and excoriated. This led me to examine
the nasal chambers, thinking the ocular and nasal troubles
might have some etiological relation, as they often have. I
found the middle and lower-especially the lower-turbinate
bones on both sides so much swollen as to practically cause
stenosis. Under a local application of cocaine, this swelling
would largely disappear, showing that it was not permanent.
Local treatment to the nose was at once instituted; it con-
sisted in the application of the compound tincture of benzoin.
Good nasal respiration was soon established, and the ocular
trouble began to improve markedly. The while I was treating
her eyes and nose I knew nothing of above history of hay fever
and asthma; she had never mentioned it until recently, when
she told me that the most wonderful result of her treatment
had been that during this season, the first for nine years, she
had had no symptom of hay fever or asthma. I then learned
the above history. Incidental results are just as instructive,
sometimes more so, than those we seek.
These cases are reported as a part of that vast mass of rap-
idly-accumulating a posteriori or clinical evidence which goes to
show that such respiratory neuroses as sternutation, hyperæs-
thesia, cough, aphonia, laryngo-spasm, asthma and hay fever
may be, and often are, due entirely to pathological processes
or conditions in the respiratory orifices. It is accepted without
argumentation now-a-days, thanks to the originality and lead-
ership of our Dr. Pratt, that many chronic and reflex ail-
ments heretofore so disappointing in their responses to medici-
nal action are now amenable to surgical measures directed
against pathological conditions found to exist in the lower ori-
fices of the body. The first principle Dr. Pratt announces,
*
- 6 —
among those upon which orificial philosophy is based, is:
"Irritation of an organ begins at its mouth." This is broadly
stated, and if it be true at all-and I believe it is-it must, of
necessity apply to every organ having a mouth. This theory
of Dr. Pratt's is broad and universal, as it ought to be; but
when he comes to make application of the theory, there is the
same old and sad difference between theory and practice; for
he says: "There is one predisposing cause for all forms of
chronic diseases, and that is a nerve-waste occasioned by orifi-
cial irritation at the lower openings of the body." These two
statements cannot both be true; there can be no restricted and
exclusive application for a law or theory stated in unrestricted
or general terms. This application of the theory cannot be
true, or I never could have cured these cases of chronic disease,
as I did, by removing orificial irritation from the upper, or
respiratory, openings of the body. I cured the cases under
Dr. Pratt's theory, but not under Dr. Pratt's practice, accord-
ing to which I could not have cured them. Dr. Pratt's theory
of orificial irritation is an invaluable one, making us think of
and consider all of the orifices of the body; his application of
it is, I think, faulty and ill-considered.
Certainly the respiratory orifices stand in the same anatomi-
cal and in closer physiological relation to the lungs than do
any of the lower orifices to their respective organs. Exception
may be taken to the similarity in anatomical relationship by
saying that the respiratory are not sphincter-guarded orifices,
and hence that the orificial principles do not apply to them.
If this be the case, the orificial theory is wrongly stated; it
says: "Irritation of an organ begins at its mouth," and not
that "irritation of a sphincter-guarded organ begins at its
mouth.” But if this latter were the statement of the law, or
theory, I hold that the conditions, anatomically speaking,
would be practically the same; for the action of the soft
palate is physiologically analogous and tantamount to that of
the voluntary sphincters of the lower orifices-giving us just
as much will-control over the one orifice as we have over the
others; again, in the act of deglutition, by action of the epi-
glottis and also of the laryngeal muscles, we find the mouth
}
—7—
of the lungs involuntarily guarded, and, further, in normal
respiration, the narrowing and widening of the rima glottidis
is an involuntary action, similar to that of the involuntary
sphincters of the lower orifices. So it appears that while the
respiratory orifices are not, literally speaking, guarded by espe-
cially designed voluntary and involuntary sphincters, they are,
nevertheless, guarded by analogous anatomical structures that
perform functions which are the physiological equivalent of
those performed by the lower sphincters.
Finding, then, in the respiratory orifices anatomical condi-
tions and physiological functions similar to those found in the
lower orifices, let us compare the physiological and pathological
sources of irritation and consequent nerve-waste, and see if we
may not expect similar results, rather than have these orifices
entirely ruled out of all participation in the causation of chronic
diseases, as does Dr. Pratt.
Pratt, speaking of the functions of the lower orifices, says:
"They are the universal gateways for the entire body." Since
gateway implies both entrance and exit, this statement is true
neither in fact nor figure, as the lower orifices are outlets only.
We may, however, very properly speak of the respiratory ori-
fices as gateways, since they are functionally orifices of entrance,
as well as of exit. This is true, it will be observed, of no other
orifice of the body; and so they and the lungs are rendered
doubly subject to physiological irritation-irritation from poi-
sonous and mechanical inhalations as well as from poisonous
exhalations. Another potent fact, true also only of the respi-
ratory orifices, is that they are double while all others are
single; and so we again find in the respiratory, as compared
with the lower orifices, the opportunity for physiological and
pathological irritation just doubled. Further, on the score of
functional activity, it is safe to say that the respiratory orifices
are ten thousand times as subject to irritation as are the lower
orifices. Yet, it is upon this point of functional activity, when
speaking of the lower orifices as channels through which the
débris of the body is removed, that Dr. Pratt says: "For this
reason, the lower openings of the body can never rest." When
we consider that this statement is made merely with refer-
- 8 -
ence to the regular removal of the débris of the body-that
for this purpose the anal sphincters are active for a few mo-
ments once in twenty-four hours, and the vesical sphincters
active for half a minute at a time, four or five times in twenty-
four hours-this "never rest" statement is a most remarkable
and unwarranted one. He seems to forget that the débris of
respiration and, in a measure, of circulation, must be removed
from the lungs through the nasal orifices eighteen times every
minute, or twenty-five thousand nine hundred and twenty times
in twenty-four hours.
The author of Orificial Surgery makes another startling state-
ment when, in his zeal to look downward only, he says:
"Those organs having outlets at the upper part of the body,
while they have important functions in the animal economy,
are not so essential to the maintenance of the general health of
the system as are those which open below." I should feel that
I was attempting to impose upon credulity if I should attempt
to prove that the function of respiration, which must supply the
life-giving oxygen, and must remove the death-dealing carbonie
acid gas, each about 25,920 times in twenty-four hours, is a less
important systematic function than the passive reception and
retention, and active discharge of much less poisonous débris-
fæces and urine-from one to five times in twenty-four hours.
Still another remarkable declaration is made in the endeavor
to show that the upper orifices, which are included in the the-
ory of orificial irritation, are excluded from the application of
that theory. The author says, referring to the upper openings
of the body: "The nose can be protected from contact with
the air (closed), and the mouth may remain closed, and all this
for an indefinite period. But not so of the sphincter-guarded lower
orifices." This, also, is so obviously untrue-so much less true
of the upper than of the lower orifices, that its simple state
ment is its own refutation.
Passing now from these anatomical and physiological con-
siderations, we have to consider briefly the sources of patho-
logical irritation found in the respiratory orifices, as compared
with those found in the lower orifices. While the lower ori-
fices are subject to pathological processes from within only,
I
M
S
9-
}
3
the respiratory orifices are subject to the same from within,
and to others originating from the poisonous and mechanical
inhalations already referred to, and from a peculiar exposure
to traumatic influences to which the nose is subject. We may,
in general, say that the pathological conditions found in the
respiratory are the counterparts of those found in the lower
orifices; that the congested and hypertrophied turbinate bodies,
with their obstructed venous return, are but a type of the hæm-
orrhoids and varicoses found elsewhere; that an ulcerative or
an atrophic rhinitis is similar to conditions often found in the
pile-bearing inch; that septal deflections, enchondroses, exos-
toses and nasal polypi have their irritating equivalents in the
papillæ and pockets of the rectum or hypertrophied prostate
and vesical calculi of the urinary organs. And surely spasm
of the soft palate, glottic spasm and laryngo-spasm show that
the musculature of these structures, analogous to the lower
sphincters, are subject to the same tightness, rigidity or spasm
as are they. And surely, too, the fact that I cured the cases
above reported by removing irritation from the respiratory ori-
fices, and the fact that thousands of other similar and different
cases have been similarly cured, proves that irritation in the
respiratory orifices may and does cause spasm of the millions
of sphincters found in the bronchioles, and guarding the air
vesicles, just as it happens in the lower sphincters.
So, considering the a priori experimental evidence, or prov-
ings, above reviewed, the clinical cases I have reported, as a
part of that vast mass of similar a posteriori evidence reported
by others, the analogy in anatomical relationship, the vastly-
increased opportunities for creating physiological and patho-
logical irritation, and the striking similarity in the pathological
conditions found in the respiratory, as compared with the lower
orifices, allows us very reasonably, I think, to conclude, and to
insist, that the principle that "irritation of an organ begins at
its mouth," does apply, in every essential particular, to the
respiratory orifices just as it does to the lower openings of the
body.
In contending that respiratory neuroses are often caused by
some form of irritation in the upper air passages, I am doing
- 10-
nothing new; this relationship was suspected and observed
even in the earliest ages of medicine. In reporting these cases,
in curing them as I did, I have done nothing new; hundreds
of others have done the same thing, and the principles of ori-
ficial surgery have been known, and applied to the relief of
respiratory neuroses, for the past quarter of a century-evor
since Voltolini, of the Italian school, in 1871, cured cases of
asthma by removing irritation from the respiratory orifices. I
only wish to show that the principles and practice of the so-
called orificial philosophy, which has done so much to broaden
our knowledge of the etiology of disease, are just as applica-
ble to the respiratory as to the lower orifices.
cause.
The practice of orificial surgery, whether it be in the lower
or upper orifices of the body, is simply a case of recognizing
and removing the causes of disease-a problem under nature's
universal law of cause and effect. And the law of similars is
involved in it because it is based upon the law of cause and
effect. We apply a certain cause, and more or less supplant a
physiological process by a pathological one, and the group or
groups of symptoms by which the resulting pathological pro-
cess is shown we recognize as the effects corresponding to this
Thus is our entire materia medica constructed-a se-
ries of effects corresponding to certain causes. At the bedside
we take the totality of symptoms-effects-manifested by the
disease, and finding in our materia medica a similar ensemble
of symptoms-the effects of a known cause-we apply this
known cause of known effects to the removal of the correspond-
ing effects of disease. Thus was our therapeutic law devel-
oped-on the correspondence between cause and effect, and
thus is it applied-on the converse relationship existing be--
tween effect and cause.
Every ease of disease presents to the homeopathic physician
a problem under the rule of three-three terms of the propor-
tion being given, to find the fourth. Two of these known
terms are constant, and supplied by the materia medica; the
first, a cause, consists of the various morbific agents whose
physiological action has been definitely determined or proven ;
the second, an effect, corresponding to this cause, consists of
-11-
the symptomatologies or pathogeneses produced by these func-
tion- or structure-disturbing agents. Having these two terms
constantly before us, the patient comes, and presenting his
objective and subjective symptoms-another effect-furnishes
the third known term in our proportion. We are now ready
to solve the problem, which bears this general statement: If
certain known causes (morbific agents) produce certain known
effects (symptoms), which one of these causes (agents) will pro-
duce the effect (similar symptoms) presented by the patient?
And, by way of solution, we apply our medical rule of three,
which says: That morbific agent (cause) which, acting upon
the healthy organism, produces a certain set of symptoms
(effect) is the agent (cause) which will remove a similar group
of symptoms (effect) existing in a case of disease-said disease-
symptoms being the effect of a different, though in effect simi-
lar, cause.
From this view of the problem presented to us by a case of
disease, it will be noticed that the unknown term in our pro-
portion—the remedy sought for the case in hand-is always a
cause—a cause which, operating in the healthy organism, has
been proven to be sufficient to account for an effect, or group
of symptoms similar to that presented by the patient. We
thus see that in applying our therapeutic law we are constantly
searching for and prescribing a cause--a cause which bears an
established relationship to the effects we see in the patient-a
cause which, coming, as it does, as a special case under the
natural law of cause and effect, must bear a correlative and
invariable relation to the effects seen in the patient-a cause
which, according to the law of similars, will remove, cancel or
neutralize the morbid effects seen in the patient.
Working under this rule of three we may be able to solve
our problem, cure our patients, or we may not. If not, why
not? Not through any errancy of the law, but simply because
some of the necessary three known terms in our proportion are
wanting in a given case-because we have not yet discovered,
or proven, a cause, which, operating on the healthy organism,
will produce an effect, or symptom-picture, sufficiently similar
to that of the case before us.
1
12-
Operating, as we thus are, under the law of cause and effect,
we, as adherents of the law of similars, are in theory undivor-
cibly wedded to, and in practice ought to be, above all things
else, devotedly and inquiringly bound to the necessary relation-
ship existing between cause and effect-between the etiology
and symptomatology, which is but the objective and subjective
expression of the pathology of disease. It is often said of us,
in opprobrium, that we are mere symptomatologists, symptom-
mongers; but in this view of our law, in the final analysis, con-
sidering that in every case of disease we are searching for a
cause which could produce the effects we see, we are essentially
and pre-eminently ætiologists. Hence are we foresworn to a
search for, and to the removal of the causes of disease-causes
physical and mechanical as well as dynamic.
1
❤
1
VACCINATION NO SAFEGUARD AGAINST
Dam
}
SMALLPOX.
B. CLARKE, M. D., INDIANAPOLIS, IND.
Read before the American Association, of Physicians and Surgeons, at
its annual meeting at Indianapolis, January 14th, 1895.
A little more than 100 years ago Edward Jenner was a country
doctor in Gloucestershire county, England. He had in 1789 ac-
quired a fellowship in the Royal Society through a queer ornitho-
logical contribution on the cuckoo (now known to have been in-
accurate in its vital points), as well as by the aid of some 'friends
at court." He was also a member of his local medical society.
The ignorant and superstitious country folk of this dairy region
were familiar with the trifling and infrequent affection of the cow's
teats called cowpox, and with the severe and frequent disease of
the human race called smallpox, and, because of the purely ac-
cidental orthographical jingle between the words cowpox and
smallpox, had come to believe that in some mysterious way the
diseases had some connection with each other. As inoculation
(vaccinating direct with smallpox matter) was then in vogue, this
idea of connection insensibly took the shape of a belief that per-
sons who, in milking cows, had accidentally become inoculated
with cowpox matter were thereby rendered incapable of taking
smallpox. There was no scientific or practical foundation for such
17
}
}
{
a belief, but Jenner took up the idea, or rather the idea took pos-
session of him, and he kept bringing it up in the meetings of his
local medical society. He did this so often that he became a bore
because of it, and came near being expelled therefor. The other
members often showed him, in a practical way, the fallacy of the
idea, his most prominent opponent being Fewster, of Thornbury,
who cited case after case where cowpoxed milkers had contracted
smallpox. But Jenner was anxious to get up something new for
the Royal Society, and settled on the cowpox-smallpox story, in
spite of the fact that its falsity had often been proved to him by
his immediate colleagues. So on May 14, 1796, he made his first
vaccination, putting the matter in the arm of James Phipps, &
years old, in two places. This material was not cowpox virus,
however, but was matter taken from a vesicle or sore on the
hand of a young woman named Sarah Nelmes. As she milked
cows, Jenner inferred that the vesicle or sore was caused by cow-
pox, but it might have been almost anything else. In July he
made a superficial, unfair and bogus inoculation of the vaccinated
boy (which it would require too much time to now fully expose),
and because smallpox did not therefrom result made the bombas-
tic, wholly unproved and previously disproved assertion that
"whoever is once vaccinated with cowpox is forever protected
from smallpox." He put his story together, citing no other per-
sonal experiment, and sent the paper to the Royal Society for its
meeting the next year, 1797, in it, as indicated above, twice de-
liberately lying to the world, as his historians, Baron and Creighton,
so plainly show. But his paper was rejected by the Royal Society,·
a fate which ought to have befallen all his subsequent ones on the
same subject. Piqued and sorely stung by this rejection of his
pet, Jenner resolved to wheel the society into line, and devoted all
his energies toward that object and the development of the vacci-
nation plan by which it should be achieved. It is not my prov-
ince to here recount the long list of prevarications, suppressions,
evasions, mystifications, and ingenious inventions and quibbles.
through which Jenner's ambition was finally gratified. That is
all a matter of history, as is the huge job of political chicane in
Parliament by which he was voted $150,000 as bonuses, and by
which England and the world was saddled with a legacy of dis-
ease and death and internal strife, to say nothing of the financial
expense of chasing this ignes fatuii. The estimate of Jenner and
his work, personally delivered by a contemporary, Ingenhousz, a
celebrated physician, "You are either a knave or a fool," has
been pronounced just. Whatever else may be said, Jenner was no
fool.
The wonder is not so much that Jenner could have deluded
the medical profession of 100 years ago as that so large a propor-
tion of the profession of to-day persists in hugging this delusion to
its breast. It can only be accounted for on the ground that the
profession is ashamed to acknowledge that it has been gullible.
enough to be so easily imposed upon.
There is much interesting history in connection with this sub-
K
T
ject which, it is my impression, is quite unfamiliar to the profes-
sion at large, but which is so voluminous that it cannot even be
alluded to here. Only one point will be illustrated, viz.: The vac-
cination of to-day is not the Jennerian vaccination of old. As I
have shown, Jenner's first vaccinations were not done with cow-
pox virus at all, but with matter taken from a vesicle or sore on a
woman's hand, and that 24 years after farmer Jesty's original
three vaccinations with cowpox virus. After a while he began to
use cowpox virus direct, and afterward changed to various other
agents, changing several times. Soon after using cowpox direct
Jenner had to face numerous inquiries as to why it was that vacci-
nated persons were having smallpox. Just as Peter denied his
Lord, Jenner now denied that cowpox had virtue. He then an-
nounced that all cowpox virus was "spurious" (a favorite term
with him) and absolutely worthless unless it was cowpox virus
that had been caused by or grafted with horse grease (which is
eczema pustulosum), conveyed on the unwashed hands of hostlers
from the horses' heels to the cows they milked. He did this as
follows: Speaking of the pustular sores that appear spontaneously
on the nipples of the cows (now so eagerly sought after), compared
with the horse grease inoculated sores, he says: "This disease is
not to be considered as similar in any respect to that of which I
am treating, as it is incapable of producing any specific effect on
the human constitution." And he reiterates this point several
times in his writings. So we see that the vaccination of to-day is
not the Jennerian vaccination, lauded as he and his are, but one
which even Jenner publicly condemned as worthless.
Almost at the beginning of the vaccination epoch Jenner him-
self, writing to a friend, said: "I wish my professional brethren
to be slow to publish fatal results after vaccination," and they
have been so to this day. And they have many times juggled
with the facts and figures relating thereto in a way that would
make a political gang of tally-sheet manipulators turn green with
envy. It is easy to truthfully say this, but impossible to elucidate
it in the short time now at my disposal. The question of impor-
tance now to be considered is: Does vaccination prevent small-
pox? Parents allow their children to be vaccinated by the physi-
cian because they have been told and have come to believe that
such a procedure is a preventive of smallpox. But even those who
believe in vaccination and have studied the subject freely admit
that that claim cannot be substantiated, and all they claim is that,
if the disease is contracted, vaccination will make it milder,
and thus lives are saved. But the rank and file of the vaccinators
blindly believe in the superstitious charm, and without even glanc-
ing at the literature of the subject complacently continue raking
in vaccination fees, seemingly oblivious of the responsibility in-
curred or the injury done to their trusting but deluded con-
stituents.
I will not weary you with large drafts from official statistics
showing that vaccination does not prevent smallpox, but a few are
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proper. The latest is the official report, made this month, of the
epidemic in Chicago in 1894. The board reports a total of 3,062
cases, and admits that 55 per cent had been vaccinated. Add to
this the cases where the marks have been obliterated by the disease
or by age, and other loopholes I could point out, the per cent
would be increased to at least 70. In the New York Medical
Journal of March 17 last you will find a report of 5,000 cases of
smallpox occurring in Philadelphia of late years, made by the
physician in charge of the hospitals. He admits that 3,550 of
these were vaccinated, some of the Germans "having as many as
twenty typical vaccine marks on their bodies," many having six.
Bradford, Eng., had 974 cases of smallpox in 1893, and of those
702 had been vaccinated. Indeed, all the officials who have to
do with many cases of smallpox freely admit that vaccination
does not prevent smallpox, but, in order to save the system from
total reproach and utter failure, are trying to show that it tends to
prevent death.
But an expert can generally show that their efforts
in this direction are merely adroit feats of juggling with facts and
figures. Before leaving this country, I may say that at Riverside
Hospital, New York, 2,427 cases were received in 1875, and of
these 1,866 were vaccinated, 405 not, and 156 not stated. Balti-
more had 4,630 cases in 1884, of whom 2,853 had been vaccinated.
We always have to go abroad for large figures on this subject,
as this is not a pest-ridden country. To make plain the ricketty
character of vaccination we must look at the reports from
Prussia and England.
Now, England enacted a compulsory vaccination law in 1853,
and since then has had three great epidemics, in the first 14,244
dying, in the next 20,059, and in the third 44,840. The total
deaths from smallpox in England from 1854 to 1883 were 121,147.
And the number of cases were 5 or 6 times that. Prussia may be
considered the best vaccinated country in the world, its compulsory
law having been enacted in 1835. It requires vaccination in infancy,
again on entering school, again on marrying, again on changing
from one college to another, and again on entering the army or
public employment. Yet in the epidemic of 1871 there were
68,869 deaths, increased to more than 124,000 by those of the next
year. In this epidemic Bavaria had 30,742 cases, 29,429 of whom
had been vaccinated, or 95.7 per cent. The city of Berlin had
17,020 cases in this epidemic, 14,287 in vaccinated persons.
In conclusion, it is a wonder that this ridiculous delusion can
continue to hold a lodgment in the brain of any one who pretends
to have a scientific education. The practice has been weighed in
the balance, and long ago found wanting. Let us hear no more
of it, and if we are obliged to hear of it, let us do all in our power
to make it but a memory of the foul blot on the fair escutcheon of
the noble art and science of medicine.-Reprinted from the Medical
Free Press, Indianapolis, February, 1895.
18

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INTRODUCTORY
TO THE COURSE ON
Special Pathology Diagnosis
BY
AND
ASA S. COUCH, M.D.,
PROFESSOR OF SPECIAL PATHOLOGY AND DIAGNOSIS IN THE HAHNEMANN MEDICAL
COLLEGE AND HOSPITAL OF CHICAGO.
P
PUBLISHED BY REQUEST OF THE CLASS,
CHICAGO:
CAGO:
PRESS OF THE AMERICAN HOMŒOPATHIST,
1877.
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CHICAGO, Oct. 29, 1877.
1
3
PROF. A. S. COUCH,
Dear Sir: The students of Hahnemann Medical College and
Hospital, being much pleased with your eloquent and highly
instructive Introductory Address, have appointed us a committee
to request a copy for publication.
A compliance with their wishes will be highly appreciated by
the class as a body and by us individually.
Yours very respectfully.
W. A. BARKER, Illinois.
D. E. LANE, Wisconsin.
E. E. HOLMAN, Minnesota.
E. G. FREYERMUTH, Indiana.
G. L. RICE, Michigan.
CHAS. HILLWIG, Iowa.
C. L. TISDALE, California.
H. C. JESSEN, M.D., Nebraska.
E. E. GWYNNE, Ohio.
J. W. WHIDDEN, New Hampshire.
JOHN MURPHY, Pennsylvania.
N. L. MACBRIDE, New York.
W. H. SIBLEY, M.D., Maine.
E. S. BAILEY, New Jersey.
L. C. Wells, West Virginia.
F. M. HAWKINS, Tennessee.
ISAAC PRINCE, IVest Indies.
A. WILSON DODS, England.
J. J. STOEHR, Germany.
972 WABASH AVENUE, Oct. 30, 1877.
GENTLEMEN :
I am in receipt of your favor of the 29th inst. requesting a
copy of my Introductory Address for publication, and although I
deem it wholly unworthy the high compliment thus paid it, I beg,
herewith, to place the same at your disposal.
With my best wishes for your individual and collect ve welfare
I am, gentlemen,
Your friend, truly,
ASA S. COUCH.
To W. A. BARKER, H. C. JESSEN, E. S. BAILEY, A. WILSON DODS,
and others.
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...
1
INTRODUCTORY
TO THE
COURSE
SPECIAL PATHOLOGY
PATHOLOGY AND DIAGNOSIS
"
ON
LADIES AND GENTLEMEN: I have
left a much loved home and a very
agreeable retirement and come here
for a purpose.
I have left a large circle of affec-
tionate friends-and their many kind
remembrances, during the past few
days, are set in my life as the
spangled foliage after congealing rain
sets against a rising sun-but I have
come here with a hope.
ASA S. COUCH, M.D., FREDONIA, N. Y.
[Professor of Special Pathology and Diagnosis in the Hahnemann Medical College and Hospital of Chicago.]
The purpose is-God helping me
-to do my whole duty during the
ensuing season, in teaching you
Special Pathology and Diagnosis";
and the hope, that I may here contract
life-lasting friendships which shall, in
BY
a measure at least, compensate for
those I have left behind.
I therefore greet you with a full
heart at the inauguration of our rela-
tions.
Twenty-four years ago, I occupied
a relation to a medical faculty similar
to that which you now sustain. I am
consequently prepared to appreciate
and understand the cast of your
thoughts, I know of your hopes and
fears, your anticipations and misgiv-
ings, and withal, of the beautiful halo
with which inexperience is tinging the
forecast of your lives.
I also know with what anxious in-
terest you are scaning the thoughts
2
INTRODUCTORY TO THE COURSE ON
and acts of each professor, and especi-
ally of those new to the faculty. As
one of the latter, I submit to the or-
deal with misgiving, while I concede.
the propriety of the act.
It is very
important, especially at the outset of
your career, that you drink from pure
fountains, and receive reflections from
wise guides, and I do most sincerely
invoke the Divine blessing upon all
connected with the institution that
such may be the result.
And now, without further preamble,
will you permit me to trespass upon
your patience for a few moments
while I call your attention, first, to
what I consider the fullest scope of
pathology in the abstract; second,
second,
to a slight reference to what is termed
general pathology, a subject which
will not be embraced in my teaching;
and lastly, to special pathology and
diagnosis, which constitutes the full
title of my chair. At the very outset
let me remind you that from time im-
memorial, introductory lectures have
been permitted to be as discoursive as
the author pleased, and as impractical,
as they generally are, and to assure
you that mine will prove no exception
to the rule.
First, then, of pathology in the ab-
stract. It is not easy to make you
understand its definition, without first
explaining its associate terms.
Let us say, therefore, that physi-
ology is the science of organization, and
anatomy that of structure. If this is
true, we are prepared immediately to
understand the interpretation I give
to our word, which is, that pathology
is the science of dis-organization, or of
decay.
Perhaps it would be better to term
physiology the science of reproduc-
tion and continuance, pathology that
of destruction and change. They are
consequently only relative terms. The
one has been called the science of
life, the other, therefore, may be
termed the science of death. But I
do not like this expression, for scien-
tifically speaking, there is no death,
only change.
Even when it works out its greatest
ultimate results, that which in all ages
has been called death, and which from
necessity, so far as humanity is cor-
cerned, has been invested with super-
stitious terror, pathology is only the
shadow of God's dissolving views.
At this juncture two questions
naturally arise: first, What wisdom is
there in constantly changing existing
creations? and second, If they must of
necessity change, why manufacture
doctors? In answer to the first, I
reply: To reach that refinement of
matter which God has ordained, with-
out increasing its quantity. New crea-
tion of atoms would sooner or later
fill up and impede the universe, how-
ever large, for all agree, scientists,
theologians, philosophers, that there
is no such thing as destruction or an-
nihilation. But to turn over that
which is, in the multiple changes of
life and death, and constantly evolve
higher forms, that shows us the wis-
dom of a comprehensive plan, the
wonder-working of a Deity. Is there
any evidence that it is so? Let us see.
F
[
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SPECIAL PATHOLOGY AND DIAGNOSIS.
3
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Commence if you please in the Silu-
rian age, or that of the invertebrates;
next came the Devonian period with
its fishes; then the Carboniferous with
its amphibious animals; then the
age of animals, and lastly, that of man.
"The series beginning with the lowest
form of life and ending with the
highest."
Now these changes were not sharp
and decisive, they were graded. For
example the Devonian period has
been called the "age of fishes," be-
cause of their superabundance, but
they began to make their appearance
in the Silurian. So also the age of
mammals was foreshadowed long be-
fore, in the reptilian age. As Profes-
sor Dana remarks, "The beginning of
an age will be in the midst of a pre-
ceding age, and the marks of the
future coming out to view are to be
regarded as prophetic of that future.
If this is true let us go a little fur-
ther, and as historians are said to
become prophets, on the ground that
history repeats itself, perhaps we
may be able to forecast the destiny
of man and the kingdom of Nature.
It is said that every square yard of
the earth's surface has given birth and
burial to half a hundred human be-
ings. So far as man is concerned,
the refining successions of all this life
and death commenced with the sav-
age, Adam, who was created in the
image and likeness of God," and in
years, how many shall I say? they
evolved the wonderful second Adam
of Gethsemane, who was God. Has
there been any halt, any failure of
CA
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On
continuity, any backward tendency in
all this chain of advancement from
the lowest form of animal life in the
Silurian age, to the greatest develop-
ment of man to-day? Not one.
the contrary it has been undeviating,
straight onward, and to-day the chain
remains unbroken. Let us under-
run the cable a little way and con-
template the successive steps: I said
that these changes, so far as man was
concerned, began with the savage,
Adam, an unclothed, untutored va-
grant; living in the wilds and subsist-
ing upon spontaniety; without the
rudest symbol of an art, or the faint-
est echo of a science. From this
state of wholesome savagery man-
kind became nomadic; then pastoral;
then half civilized; next civilized,
and finally, enlightened-a prince
putting the entire earth under con-
tribution to his luxuries, girdling it
with his voice and even analyzing the
atmosphere of the stars! Now, as
the chain of progressions is com-
plete, give your imagination its
widest range, and tell me where
the development will stop. Only
fifty years ago, the prophecy of what
is to-day, would have been adjudged
a lunacy. If, then, you cannot grasp
the problem for all time, lift up your
eyes and tell me of man's condition
only one hundred years from now? But
I am not here to preach the doctrine
of evolution. I have only taken so
much of your time that I might show
you the full scope of pathology in the
abstract, for it was the half of all this,
the undertow of each successive wave,
1
4
TO THE COURSE ON
INTRODUCTORY
to give you, if possible, the thought
that in the growth and exfoliation of
every rock, the organization and de-
cay of every leaf and flower, the life
and death of every inferior animal
and man—two operations have been
going on from the beginning, will con-
tinue to work on to the end, building
up the kingdom of God and His like-
ness, and that they are-growth and
decay.
It has been my wish, as briefly as
was possible, as fully as might be
necessary, through the millions of
years that have transpired, to evoke
from the dark nothingness of the past,
without the addition or substraction
of one atom, the light and glory of
the present and future, and then al-
low the enchanting wand of your im-
aginations to raise the transformation.
scene which must come-the three
Graces through whom it had all been
accomplished—a group of spiritual
statuary for all your afterl ives, Physi-
ology, Anatomy, Pathology.
One thought, just here, touching
Least of all things,
Great and small things
our infinitesimal doses-not because
they are in any sense an integral part
of our system; not because an allu-
sion to them here is at all consistent
with my theme, but simply because it
comes, and the freedom of an introduc-
tory accords me the opportunity to
give it utterance. I ask you then, if
you can, to grasp the difference be-
tween the first Adam and the present
man-the Allegory of Eden and the
accomplished facts of to-day. Then
come.
I ask you to endeavor to appreciate
the difference between the present and
the future of a thousand years to
Our infinitesimal doses were
sneered at because the drug in them
was not tangible to the senses, but a
better chemistry and a finer micro-
scope brought it to view; still higher
with the attenuation, and spectrum
analysis demonstrated it; higher still,
and the response from the divine
mechanism of the human body under
the law, "similia similibus curantur."
shows its continued presence. Tell
me, you who can, or you who care, the
size of the material atoms in our high-
est potencies, which have had their
presence thus proven hundreds of
times in the experience of thousands
of intelligent observers. My point is
that, comparing what is with what is
to be, in the development of mind,
its æsthetic conditions; its psychical
relations; what will cause and what
will cure; the subtelest analysis of
Hahnemann and the highest potences
of Jenichen are as crude as the mean-
est purge of Hypocrates.
Turning now to the second ques-
tion, propounded a little back, Why
manufacture doctors if pathological
conditions are inevitable?-if they
are the half of a duality without which
God could have no economy. Be-
cause after instinct, which never errs,
comes reason, which is made subject
to such pathological conditions.
Hence God's agents to temporarily
prevent, modify, and control patho-
logical states, that the higher results
of His alchemy may be reached.
SPECIAL
5
PATHOLOGY AND DIAGNOSIS.
LA
The soul that sinneth it shall die."
Bodies only change-souls may be
lost. How? Through pathological
physical, engendering mental and
moral, depravity, whereby come lust
and brutality. That which should
soar, sinks; that which should rise,
falls; turns backward, becomes the
necessary scum of a gigantic material
ebulition. Hence the necessity for
doctors to check and prevent back-
ward tendencies after the develop-
ment of reason-to hold in the crucible.
It is to estop the sins of the fathers
that they may not be visited upon the
children; to direct the development
of better heads, purer hearts, more
spiritual lives-that is all. So there.
will still be doctors, God has appoint-
ed them, and you will never be com-
belled to say of yourself, as the jealous
Moor said of himself,
Othello's occupation 's gone!
Spade
But Second: General human pa-
thology. This is a department with
which I, technically, have nothing to
do, but very closely related to mine
and of the greatest importance. No
one who professes and calls himself a
physician, can afford to be without an
exhaustive knowledge of it.
The great trouble in regard to all
pathology, as taught in the schools
and text books, is the running to-
gether of that which is called general
and that which truly is special pathol-
ogy. If this were always done in the
same way, or in the same degree,
there would be no trouble, no con-
fusion; but what one teacher or writer
has classed as general, another equally
eminent and learned, has called
special pathology. Doubtless the
reason for this has been that they act-
ually do run together; spread them-
selves, as it were, into each other, by
such insensible gradations that if any
division, definite and arbitrary, is at-
tempted, it sooner or later fails-one
beginning where another leaves off
dividing differently, that's all.
Take for example the subject of
tubercle. That is certainly attended
upon by general pathological condi-
tions before its actual deposition. It
does not spring right out of healthy
constitutions-robust and vigorous-
otherwise, its appearance would be
considered an accident or an anomaly.
On the contrary, there is usually a
vague, indefinite foreshadowing of re-
sults, easily recognized by the pathol-
ogist, before the actual deposit of the
tubercles themselves. Now this state,
this precedent condition, in all its
length and breadth, in all its shades
and details, might very properly be
classed and described under the head
of general pathology. But I claim
that when deposition in any organ or
viscus of the body has actually taken
place, that then the nosological malady
so occasioned, should be classified and
described under the head of special
pathology. The actual classification,
however, is quite different, for all
varying degrees of division have been
employed, and some have even gone
so far as to include the entire history
of tubercle, all its conditions and re-
sults, under the head of general
pathology.
}
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INTRODUCTORY TO THE COURSE ON
Take another example, the dropsies.
These I believe are universally classi-
fied under general pathology, and at
first glance it does not appear incon-
sistent that they are so; but all drop-
sies, excepting possibly hydræmia,
(excess of water in the blood,) and a
few local but comparatively unimpor-
tent effusions, result either from the
inflammation of serous membranes,
disease of the heart, kidneys, or liver.
Then why should not these be classed
and described under the special
pathological conditions on which they
depend?
The better way, perhaps, would be
to abolish the distinction altogether;
arranging, classifying and describing
all diseases under the one general
head of pathology.
An evil in our profession is to mul-
tiply books without increasing the
stock of knowledge, and to attain
personal altitude by rising upon a
kind of second fermentation of other
people's thoughts. But as I am pow-
erless to change the existing order of
things, I will call your attention to a
few of the points embraced in general
pathology, with a view of showing you
how much there will still be left to
learn, if we should go over the entire
field of special pathology during the
ensuing session.
In the first place, the general causes
of disease are treated of under the
head of general pathology, and if
there is anything at all right in the
nosological division which I have
alluded to, it is just here, for such
causes are extremely general. Let
us enumerate a few: The air, the
water, the light; habitations, cloth-
ing, bedding; food, drink, occupa-
tion; age, sex, inheritance; parasites,
fungi, habits. How strange! Many
of these are among the commonest
conditions of our lives, nay more,
most of them are essential to our con-
tinued existence, and yet it requires
no subtle analysis to show that they
all are or may be direct causes of dis-
ease, suffering and death. For ex-
ample, the air put in motion through
an open window impinges upon some
limited portion of the surface and
checking the perspiration, inflamma-
tion follows, an abscess comes and if
located in some noble viscus too often
the patient goes. Or again, who has
ever shaken hands with the unseen
but disease-producing miasma of your
beautiful prairies? And yet who that
is susceptible has not, after sufficient
exposure, been shaken by it, head,
hands, feet and all, to his heart's
content? It would be easy to multi-
ply examples, from each and every
one of the causes mentioned, but
these will perhaps suffice. It is
enough that all these and many more
are general causes of disease and that
the sepulcheral forms which they
create are like the mocking genii
evoked to frighten and perplex poor
Rip Van Winkle after his debauch.
But what are some of the most gen-
eral of the diseases thus directly or
indirectly caused? I will take but one
department in illustration—the blood.
Here we find anomalies in the size
and shape of the corpuscles; changes
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SPECIAL PATHOLOGY AND DIAGNOSIS.
7
in the amount of hæmoglobulin; in
the amount of albumen, too much or
too little; in the amount of water,
too much or too little; excess of fat;
changes in the fibrin; plethora; leu-
ocythæmia, or increase of the white,
with simultaneous diminution of the
red, corpuscles; Hodgkin's disease or
false leucocythæmia, without multipli-
cation of the white corpuscles; mel-
anæmia, or blood containing pigment
granules of altered hæmetin; icterus,
or bile pigment in the blood; suffoca-
tion, or that fearful condition wherein
the function of respiration partially
fails, or its results. are afterward
aborted by the actual expulsion of
oxygen from the blood; uræmia, or
direct blood-poisoning, by failure of
sewage on account of the kidneys;
diabetes, or sugar in the blood; pyæ-
mia, or purulent fermentation of the
blood; fever, or increased heat; mar-
asmus, undoubtedly a result of dis-
eased conditions of the blood not yet
well understood; hæmorrhagic diathe-
sis; infection, etc., etc.
Now in this brief summary of titles,
I have only enumerated the affections
in one department, leaving the sub-
ject of general pathology scarcely
touched at all. You will, therefore,
perceive how much there is to be
learned before approaching the sub-
ject of special pathology, in order to
entitle one to rank as a pathologist.
Fortunately, a full and complete
knowledge of it all will be imparted
to you in this college from the chairs
of theory and practice, gynecology,
surgery, and clinical medicine.
(
M
Passing now for a brief reference to
the real field of my labor-special
pathology and diagnosis.
As its name implies, special pathol-
ogy includes the definition, history,
and minute discription of every
special disease. By diagnosis is un-
derstood such a complete individual-
izing of diseases, such a thorough
separation of each from every other,
by a contrast of differences as will
enable the observer at all times, and
in all places, to call it by name and
include it under a single title. Now
it is just this compound work that has
been assigned me in this institution,
and it is just this work, covering the
entire field of diseases, except such as
are included in the specialties, that I
intend to attempt and hope, during
the winter, by your kind encourage-
ment and forbearance to accomplish.
You are well aware that, if you
please, contrasting two galleries of
portraits, the one may be filled with
beautiful paintings, the blendings ex-
quisite and the colors deftly laid on;
the other, with jutting, bold outlines,
but having less harmony of color, and
yet the latter is vastly the more val-
uable for its intent, for it is filled with
likenesses-there is no mistaking them
-it requires no catalogue to ascertain
whom the pictures are intended to
represent. In a similar way, I shall
endeavor to serve you. I have no
ambition even if I could have any
hope to do so, to excel as a mere word
painter, no desire to fill up your valu-
able time with unessential details and
superfluities. On the contrary, I shall
00
INTRODUCTORY TO THE COURSE ON
constantly strive to sketch disease by
its bold and rugged outlines, leaving
you to fill up the pictures in the ma-
turer culture of your after lives. It
will not do to say that because a pa-
tient has almost a complete picture in
his rational symptoms of a certain
malady that, therefore, he has that
disease per se, for they might indicate
a rapidly approaching phthisis and
yet the subject be entirely innocent of
such a malady at all. For example,
a young man came into my office three
weeks ago, with all the rational symp-
toms of arapidly-developingcon sump-
tion; haggard, emaciated appearance;
impaired appetite, great debility,
rapid respiration, harrassing cough,
chills, fever, night sweats, etc., etc.
Now I had treated this gentleman
fifteen years before for unmistakable
lesion of the left lung, and by the
blessing of God he had recovered. It
was very natural that I should at once
suspect and ask for an examination of
his lungs. To my surprise I found
nothing except a slight impairment of
the left lung remaining over from the
old attack. How then should I ac-
count for this list of very troublesome
symptoms? I did not hesitate to re-
assure him with reference to his lungs
and yet I did it in the face and eyes
of the rational probabilities. What
then? I did not any more hesitate to
inform him that there was some ma-
teries morbi, some general patholog-
ical condition of the blood which would
soon disclose itself, and sure enough
on the day prior to my departure for
this city, he returned with a large car-
buncle upon the superior dorsal
region. Now it would have been very
easy to have fallen into the error,
taking the history of this case and the
almost unmistakable signs present,
of pronouncing it a fresh attack of
lung disease.
Take one more example. Three
years ago I was summoned to see a
patient, at quiet a distance from my
office, who was said to have cancer of
the stomach, the father who called
me remarking at the time: "Doctor, I
do not suppose that you can do any-
thing for her, she has been sick a long
time, has had excellent attendance,
and the physicians all agree that she
has cancer of the stomach." I need
not assure you that this case gave me
pause when I reached the bedside,
for she certainly presented all the
characteristic symptoms of malignant
disease of the cardiac orifice of the
stomach; difficulty in deglutition,
local pain, burning, twingings, vomit-
urition, etc., etc.; but after a trial of
the case, on the totality of the evi-
dence extending through two hours, I
did not hesitate to pronounce that
she had no cancer at all, and that she
would attend to her work as usual
during the ensuing summer. This
proved to be the case, indeed she re-
mains thoroughly well to this day.
Mark the further sequel: on the next
summer she came to my office accom-
panied by an aunt, remarking very
pleasantly, Doctor, you cured me so
quickly I would like to have you do
the same by my aunt. An examina-
tion of her case revealed unmistak-
།
+
I
SPECIAL PATHOLOGY AND DIAGNOSIS.
2
able epithelial cancer of the external
generative organs; an absolutely un-
favorable prognosis was made, and
before the middle of the winter she
had passed away. I ask you what
would have been the result to the first
patient had the cases been chronolog
ically reversed? Can there be any
reasonable doubt that any physician
would have fallen into error and de-
cided the first case to be one of true.
carcinoma? And can there be half
as much reasonable doubt that in such
an event, she would sooner or later
have reposed under the inscription:
“of carcinoma, on the day of —
Oh! my friends, it is a melancholy
reflection, that in far too many in-
stances the cemeteries are the con-
servators of our reputations.
But again it will not always do be-
cause a patient may have a special
disease, unmistakable-absolute-to
settle down contentedly and treat that
disease as such. A patient may come
to you with an alarming bronchitis,
no doubt about the diagnosis what-
ever, and it prove symptomatic of,
and one of the later complications in
an incurable case of Bright's disease.
In such an instance you perceive that
a comprehensive, differential diagno-
sis would be the only salvation from a
prognosis that would endanger a rep-
utation. But I must not weary your
patience. Let me say that my in-
struction in diagnostics will include
not only a full reference to all the
latest chemical analyses and micro-
scopical examinations, but that it shall
fully familiarize you with all the best
""
and most desirable mechanical appli-
ances, such as the stethoscope, the
laryngoscope, the athæsiometre, and
so forth.
In laying out my work I shall, with-
out intending any offence to any of
you, temporarily consider man as a
machine. I shall assume that every
machine, however simple or compli-
cated, has some kind of a balance to
preserve its equilibrium and keep it
running. For example, a watch has
a single balance; but a man has four.
They are respiration, assimilation, com-
bustion and intermission. In other
words, to breathe well; to eat and di-
gest well; to exercise well, and to sleep
well, is all that is necessary for any
body to do to keep well; that this,
sum it all up, is all there is of what is
called health. Three of these you
preceive are incoming avenues, one
an outgoing; three are sources of sup-
ply, one of waste. In brief, the ali-
mentary canal supplies carbon and
nitrogen, the lungs oxygen, the pillow
perhaps something more than mere
rest, and then the action of the
muscles and the molecular move-
ments of the convolutions of the brain
consumes-burns up-that is all there
is of it.
is of it. Now if any one of these
balances fail, nothing is surer than
that sooner or later all will symp-
athize and participate. To keep them
nicely adjusted and in working order
will mark an extraordinary phy-
sician, for he will have to contend
with foes from without and foes from
within; but it is abolutely certain that
in proportion as he does keep them in
4
ΤΟ
THE COURSE ON
INTRODUCTORY TO
working order, so will the attacks of
the former be rendered futile and
abortive. But without further elabo-
ration of the idea I adopt it for the
purpose of classifying and arranging
my work, and I mention it thus fully
that you may be enabled to under-
stand my intent. It is to group the
various diseases as they affect the one
or the other of these various functions,
and then I think we will have a clear
idea of what we are working to, and
what we are working for.
And now, in conclusion, will you
permit me to call your attention to
some of the opportunities for disting-
uishing yourselves that present them-
selves in connection with this depart-
ment. Although there is already
much known, there is still much, very
much more, to be learned, and that
which is vastly more important than
all which has preceded it. For ex-
ample, as we shall come during the
course to the consideration of carcin-
oma in its various forms, the question
will naturally arise, What is this dis-
ease; what its nature, its origin, its
essence? I may be able, perhaps, to
instruct you as to its nature, but as to
its origin, or essence, I shall be com-
pelled to confess an utter and an
absolute ignorance; I shall be able to
describe to you its varieties, its stroma,
its fluids, its cells, its lymphatics; I
can tell you of its course, its exten-
sion, its influence and its structure,
but alas! I can tell you nothing what-
ever of its cause. Pathological writers
pretend to unfold cause, but how lame
and impotent!
For example the distinguished pro-
fessor of general pathology and path-
ological anatomy in the University of
Leipsic, in speaking of this subject,
says, "The causes of primary cancer
are, in general, the same as of other
new growths"; "on the causes of
secondary cancer, that which has been
said in general, especially holds true ":
(6
also here stand opposed the so-called
implantation and infection theories.”
And this is every word, only referring
back by page to what has been said
in general, as aforesaid. Almost as
wise as the great Greeley's famous
financial aphorism, "The way to r
sume is to resume." Here the profes-
sion stands, after two thousand years'
work utterly unable to tell whence or
why this fearful malady comes. Lit-
tle better is its treatment of it. Now I
belong to the class of those who be-
lieve the time is coming when the use
of the scalpel in cancer will be voted
and adjudged an inexcusable mal-
practice. But why does not the pro-
fession provide and sustain institutions.
for the proper care and especial treat-
ment of cancer? Confessing an
impotency as to knowledge is no
reason why it should practice inhu-
manity as to results. It is well known
that physicians in full practice can-
not take patients into their houses for
treatment, by the sloughing process of
malignant growths, and it is equally
well known that quack institutions
consequently do abound where such
things are occasionally accomplished,
but where much more that is brutal
ignorance-bald-headed assumption
Mater
Ħ
SPECIAL PATHOLOGY AND DIAGNOSIS.
II
i
or criminal knavery-flourishes in a
congenial atmosphere. This ought
not so to be. A profession that stands
near to the vital interests and welfare
of mankind should conserve that wel-
fare and endeavor to advance those
interests. A patient coming to me
with a small nævus materni on the
side of the nose was afterward cured
of a fearfully malignant cancer at an
expense of $1500. Another came with
such a terrible scirrhus degeneration
of the left mamma and axilary region
that I dared do nothing but advise it
to be let alone. As near as I could
judge the tumor of the breast was as
large as an orange, and that in the
axilia as large as two, with the hard,
fibrous bands reaching out in many
directions. I was not alone in advising
that nothing be done; on the contrary
many physicians of both schools co-
incided in the opinion. But this
woman, with the heroism of her sex,
determined to live, at whatever sacri-
fice of pain or peril, and going to
one of the quack institutions alluded
to, she had it successfully removed,
and now after three years she is yet
alive. Of course the old adage holds
good, "He who knows nothing, fears.
nothing." But I remark, in this con-
nection, the inconsistency of a pro-
fession which curses a quack for doing
something—yes, prolonging a human
life-while it justifies itself by digni-
fiedly doing nothing; which, while
conceding the terrible nature of the
disease, and admitting its absolute in-
ability to successfully combat its rav-
ages, provides no hospitals for its
-
subjects where they may, at least, re-
ceive enlightened and scientific treat-
ment and be saved from the "tender
mercies of the wicked, which are
cruel "; creates no corresponding bu-
reaux in the different countries where-
by comparisons might be instituted,
histories investigated, and facts ac-
cumulated, that in time would, per-
haps, enable it to proclaim the glad
tidings to thousands upon thousands
of suffering souls: the monstrons mal-
ady has been disarmed!
sue.
One more allusion and I am done.
What is tubercle? An eminent pa-
thologist answers the question as fol-
lows: "Tubercle is an infiltrated or
nodular growth, almost always multi-
ple, round or irregularly formed, for
the most part miliary, non-vascular,
new formation of varying size which
consists especially of neuclei, small
and large, indifferent cells and giant
cells-all embedded in reticular tis-
. Its orgin is in connective
tissue of different kinds, especially
that of the so-called lymph-sheaths of
small arteries, lymphatics, perhaps
also of small veins.
In all these
parts tubercle probably proceeds from
a growth of the common so-called
fixed connective-tissue corpuscles and
the endothelium identical therewith.
Whether tubercle can arise from the
endothelial layer of serous membranes,
blood and lymph vessels, is still
doubtful. The more intimate micro-
scopic relations of the origin of tuber-
cle are not yet accurately known."
So much for the description and
origin of a disease that sweeps away
1
&
12
INTRODUCTORY TO THE COURSE ON
one-half of the human family; so
much for the intrinsic nature of a mal-
ady whose ghostly visage has visited.
every family; so much for an abstract
knowledge of that which actually
crowds the valley of the shadow of
death! Oh! Merciful Father, is there
no remedy? I do not believe it; but
oh! the labor involved, the self-abne-
gation, the sacrifice! No one man
will probably ever achieve the dis-
tinction of detecting the approach of
this thief in the night, but what glory
to him who contributes to the result.
That you will hereafter work earn-
estly in this field, is my sincere hope
and will be my earnest prayer. Un-
worthy though the motive may be, I
commend you to it on behalf of
Hahnemann medical college, that its
Alumni may not be found in the rear
rank, of the great army of advanced
thinkers in medicine. I commend
you to it on behalf of homœopathy,
for what advances it, will bless the
world. I commend you to it because,
"There is no great excellence without.
great labor," and finally, I commend
you to it, that you may win laurel
wreaths in this world, and, through
the development of your intellectual-
ity by hard, unceasing work, and the
cultivation of a higher spirituality by
doing it for humanity, you may wear
a crown immortal in that which is to
come.
ĭ
:
}
་
1
Sample Copy, Free!
The "American Homoeopathist,
121 Dearborn Street, Chicago.
1
}

V potem zagatna
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<<
'A LIMITED FACULTY AND BETTER TEACHING."
HAHNEMANN
MEDICAL
L
COLLEGE and HOSPITAL
OF CHICAGO.
The Spring course of Lectures in this Institution will commence
March 5th and continue until May 5th, 1878. This course is
especially designed for beginners. The clinics, however, are con-
tinued the same as through the Winter Term.
The present course now in progress is the most successful one in
the history of the College. So great is the number of students in
attendance that the Faculty have in contemplation the enlargement
of the Lecture Rooms before another Fall. For catalogues and other
information, address,
I. S. HOYNE, M.D., Registrar,
817 Wabash Avenue.
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1


Compliants от
of
1
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John
Dim
SPHYGMOGRAPH.
The Author
THE
WHAT IT TELLS US AND ITS VALUE AS AN AID
TO THE DIAGNOSIS OF DISEASE.
BY
DOWLING, M. D.,
PROFESSOR OF PHYSICAL DIAGNOSIȘ
DISEASES OF THE HEART AND LUNGS,
– na plne pod pod kryer kampe
AND
jaktig mana turn me o
NEW YORK HOMEOPATHIC MEDICAL COLLEGE.
19

READ BEFORE THE HOMEOPATHIC MEDICAL SOCIETY OF THE
STATE OF NEW YORK.
REPRINT FROM THE TRANSACTIONS.
HAVANA, N. Y.
PRESS OF L. E. KEYSER & CO.
1881.
*
TELEFONA
SEMINAR pt 200
01
gehrt Apaganda (PTS)


܀܀ ܗܘ
lazhin terakhi
Chaumet win
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THE
1

SPHYGMOGRAPH.
WHAT IT TELLS US AND ITS VALUE AS AN AID
TO THE DIAGNOSIS OF DISEASE.
BY
J. W. DOWLING, M. D.,
PROFESSOR OF PHYSICAL DIAGNOSIS
AND
DISEASES OF THE HEART AND LUNGS,
NEW YORK HOMEOPATHIC MEDICAL COLLEGE.
READ BEFORE THE HOMOEOPATHIC MEDICAL SOCIETY OF THE
STATE OF NEW YORK.
REPRINT FROM THE TRANSACTIONS
HAVANA, N. Y.
PRESS OF L. E. KEYSER & CO.
1881.
}
{
}
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}
THE SPHYGMOGRAPH.
What it tells us, and its value as an aid to the Diagnosis of Disease.
It is announced in the programme that I will give an exemplification
of the action of the Sphygmograph and discuss its value as an aid to the
diagnosis of disease.
What do we mean by a sphygmograph? An instrument which will
develop and record the minute peculiarities of the circulatory current.
Of course we refer to the arterial side of the greater circulation.
I am far from being an enthusiast on the subject of the pulse (I refer
to its minute peculiarities), although it is frequently a most valuable
guide to the physician in forming his opinion as to the general condition
of his patient, for its character certainly does indicate the condition of the
great central organ, the heart, whether feeble or strong, and its action
as regards rhythm.
It also indicates the quantity of blood sent with each systole of the
left ventricle.
It also, which is very important, indicates the tone and tension of the
elastic tissue composing the arterial walls, all of which are valuable guides
as to the condition of the system at large.
Is this instrument a scientific toy, or can the arterial tracings be made
of such service as to be a valuable aid to us in the diagnosis and treat-
ment of disease?
In answering these questions, everything that can have any influence
upon the circulation, must be thoroughly understood and carefully con-
sidered.
First the arterial pulsation with the heart and arterial walls, and every-
thing influencing them, in a state of perfect health must be studied not
only with the ordinary means, but by the aid of the tracings produced by
this delicate instrument.
Not only must the tracings be taken at the wrist, but over the heart
itself and over every prominent accessible artery in the various portions
of the body. And as from positive observation, the tracings of the same
individual vary at different periods of the day, at different periods of life,
and under the many conditions of the system, (physiological) which are
calculated to influence the circulation and the action of the heart, in order
}
4
THE SPHYGMOGRAPH:
?
to understand departures from the healthy standard, it will be necessary
to familiarize ourselves with the tracings of health at these various periods
and under these varying circumstances.
In an article such as this is intended to be, time will not permit us to
go thoroughly into the consideration of the sphygmographic tracings of
the heart itself and of the many accessible arteries of the body. Conse-
quently we will confine ourselves to the radial artery, the pulse at the
wrist, this having been for centuries the vessel whose pulsations have
guided (or appeared to guide) the members of the medical profession in
the diagnosis and prognosis of many diseases.
Long ago, when a student, I undertook, without the aid of the sphyg
mograph, to study the different pulses laid down in the book, some sixty-
five different varieties, each in the estimation of some one indicating a
different condition of the system.
Aside from these forms, so familiar to all practitioners, such as the fast,
slow, feeble, irregular, intermittent, compressible, etc., we find described
by the old authors, the respiratory pulse, the sharp tailed or myurus pulse,
the urinal, supposed to indicate an approaching evacuation of urine, the
vermicular, supposed to indicate the movements of a worm in the intes-
tinal canal, the hepatic pulse, etc., etc.
As a student, I carefully studied these from the books, and watched for
an opportunity when I could with my own fingers, feel the delicate varia-
tions which would so plainly and in such unmistakable terms, tell of the
wonderful changes going on in the system.
Nearly a quarter of a century has elapsed, and although I have con-
stantly educated my sense of touch, I have thoroughly mastered and
understand but about a baker's dozen of the sixty-five varieties.
Gladly did I hail the introduction of the sphygmograph into medicine,
carefully have I studied it, much time have I devoted to taking tracings
in health, at all ages, and in every disease where the circulatory organs
seemed influenced either primarily or secondarily to any considerable
extent, and the conclusion to which I have arrived is, that in organic
diseases of the heart and of the blood vessels, the tracings which the
sphygmograph affords us are confirmatory aids to diagnosis; that in dis
eases of the nervous system with their constantly varying influences upon
the circulatory organs, these tracings can be of no special service in form-
ing a positive diagnosis, although they will readily indicate certain de-
rangements of the nervous system.
Four instruments have been introduced. First, that of Vierordt, which
was calculated simply to mark "the extremes of dilatation, and the num-
ber of pulsations of the artery in a given time." It did not accurately
indicate the character of the pulse.
THE SPHYGMOGRAPH.
5

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TRACE OF THE RADIAL PULSE TAKEN
VIERORDT.
WITH THE SPHYGMOGRAPH OF
FROM FLINT'S PHYSIOLOGY.
Then came the sphygmograph of Marey, which, although much more
perfect than the instrument of Vierordt, registering, as it does, not only
the extremes of dilatation of the artery, and the number of pulsations in
a given time, but also the oscillations of the arterial walls, was objected to
by some investigators on the ground, principally, that owing to the fact
that in using the instrument it was necessary to bind it somewhat firmly
to the wrist, thereby interfering with the return current of blood, rendered
the arterial walls more tense from the overfilling of the vessels.
Α
Then came the Marey's instrument improved by Edgar Holden, who
has added to our medical literature a work containing some two hundred
and fifty tracings taken under varying circumstances with the physiolog-
ical or patholigocal conditions under which each was taken.
The principal advantage of Holden's over Marey's lies in the fact that
the bandages are dispensed with, the instrument being held immediately
over the artery, between the thumb and finger of the operator.
The adjustment of the pulse spring, it is claimed, is less difficult, and
the interference with the current and the natural emptying of the artery,
which results from the bandages, is done away with.
The most recent and probably the most simple and accurate sphygmo-
graph is that of Dr. E. A. Pond, of Rutland, Vermont, acknowledged by
Dr. Holden himself to be superior to his own. This instrument has been
so extensively advertised that it is probably familiar to all. It is with
this that most of my own tracings have been taken.
I have asserted that in certain organic diseases of the heart and arteries
the sphygmograph is a confirmatory aid to diagnosis. Merely confirma-
tory, for in my opinion, with the ear practiced and educated by long ex-
perience, the educated touch, and the known train of symptoms-we might
almost say constant symptoms-accompanying certain organic diseases of
the heart and blood vessels, we can, with the mechanical aids long in use,
be almost positive in our diagnosis.
What does the sphygmographic tracing over an artery indicate?
It indicates the character of the puise. "The minute peculiarities of
the current of blood" through that particular artery, and what is really
valuable, it records these peculiarities for future reference.
6
THE SPHYGMOGRAPH.
Now the question naturally arises, what influences this blood current?
We are all familiar with the fact that upon the systole of the healthy
heart the left ventricle, provided there is no arterial obstruction, sends its
entire contents through the aortic orifice into the aorta. This action is
so sudden, so violent as it were, that an impression is made not only upon.
the column of blood in the aorta itself, but upon the blood in the entire
arterial system, down to the vessels of the smallest magnitude. A sudden
impulse, a shock is imparted, and felt throughout the entire arterial sys-
tem. So violent is this shock wave as it is called, or in sphygmographic
parlance, this first event, that when one knee is placed over the other,
the beating of the popliteal artery will produce a marked movement of
the foot; and according to Flint, the idea of such an instrument as the
sphygmograph was first suggested by this simple observation.
This shock wave sends the spring of the instrument upwards in almost
a perfectly vertical direction, reaching the highest point which will be
obtained during the pulsation. Then with the subsidence of this wave
the spring falls, but not to the point of starting (except in extreme dicro-
tism) prior to the systole of the ventricle, but about one-third of the dis-
tance, when suddenly it is arrested in its downward progress, and then there
is a second rebound of the walls of the vessel. This second rebound is the
actual blood current, and is more or less marked, according to the quantity
of blood propelled through the vessel. Probably the condition of the
walls of the vessel influences the size of this event.
This blood wave or second event as it is called, is followed by a partial
collapse of the vessel. The downward line produced by this partial
collapse is called the third event of a tracing. This downward line is
suddenly arrested in its progress by another wave producing a marked
distension of the artery, and a consequent upward movement of the spring
indicated on the tracing by a slight elevation.
This wave is generally supposed to be produced by the sudden closing
of the semilunar valves at the aortic orifice. It is like the first im-
pulse of a shock wave. The return current in the aorta, upon the diastole
of the ventricle, coming with force against the valves, a sudden recoil
takes place, which makes an impression upon the column of blood, and
thence upon the clastic walls of the artery throughout the entire system
of vessels.
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Under certain circumstances this impulse is very marked, so much so
that it can be distinctly felt by the finger. In such cases we have the
double or dicrotic pulse which is frequently felt in typhoid and other
adynamic fevers-in certain valvular disease of the heart, and conditions
of general anæmia.
Following this impulse which is called the fourth event, comes the
.
[
1
•
THE SPHYGMOGRAPH.
7
3
almost entire collapse of the artery, with, in rare instances oscillations of
the vessel, indicated upon the tracing by slight waves, varying in number
and size. This ends the impulse which is succeeded again by the shock
wave, indicating the systole of the ventricle.
The tracing described is the tracing of perfect health. The exceptional
cases of dicrotism and oscillation are indicative of some pathological con-
dition.
Below will be found tracings taken at four different periods of life.
The first, second and third plate were taken from boys at about the age
of puberty. Plate two from a lad of fifteen, well developed, in perfect
health, to all appearances, although the rather marked decrotism would
perhaps indicate to the contrary.
PLATE 2.

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Plate three is the radial tracing of a lad fifteen months younger, not
having as yet quite reached the age of puberty; in perfect health, well
developed, and inclined to be stout.
PLATE 3.

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There is but little difference in these two tracings, but the experienced
eye will detect dicrotism well marked in the first, with a comparatively
feeble blood wave. While in the second, the second event or blood wave
is more prominent than in the first, and the dierotic wave or fourth event,
less prominent.
PLATE 4.
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Plate four is taken from same child as plate three, six months later,
when entering upon puberty, and after some three months of confinement
in school. It will be noticed that the up stroke is more perpendicular
than in the former tracing, and that from some cause, unknown, the fourth
event or dierotic wave is more prominent. This tracing was taken some
two hours after a hearty meal, and possibly the digestive process may
have had something to do with the prominence of the dierotic wave. The
boy seemed to be in perfect health.

8
THE SPHYGMOGRAPH.
PLATE 5.

Plate five is taken from a man at the age of twenty-four, with a pulse
beating at the rate of seventy-two to the minute, and in a perfect state of
physical and mental health.
Plate six is from a lady of thirty-eight, in perfect health, of rather
sedentary habits. It differs from the preceding tracings in the absence of
a marked blood and dicretic wave.
PLATE 6.
PLATE 7.
Plate seven is from a young man, a student of medicine, in most per-
fect health.
PLATE 8.
Plate eight is from a mau of twenty-eight years, in comparative health,
although not so vigorous as those from whom plates five and seven were
taken.
PLATE 9.
The above plate nine was taken from a man of fifty years in perfect
health. It will be noticed that the amplitude is greater than in the five
preceding tracings, that the blood wave is well marked, and that the diero-
tic wave is not at all prominent. The second impulse, owing to a more-
ment of the wrist, is much higher than those which follow; if this irregu-
larity was not owing to this accident, of course it would indicate serious
disturbances in the circulation.
PLATE 10.
Plate ten is taken from the wrist of a man of the same age as plate
nine, but much less vigorous, and inclined to derangement of the nervous
system. In other respects healthy.
1


I



THE SPHYGMOGRAPH.
PLATE 11.
NAAAAAAAAAAAAMMMMMM
Plate eleven is from a strong healthy man of sixty-five, in perfect health,
and accustomed to hard work. The irregularity is owing to difference in
the amount of pressure.

PLATE 12.

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Jud
Plate twelve is from an old lady of seventy-three years, suffering from
no cardiac disease, but unable to exercise owing to chalky concretions in
the joints, the result of gouty diathesis.
Here we have tracings taken at five or six different periods of life,
from persons in perfect or comparatively good health. It is interesting
to note the great differences in the amplitude of the shock wave, which
seems to be highest at puberty, diminishing to forty, and then rising
again, till at seventy it is quite as great as at the age of fifteen, marked
departures from the above tracings would indicate departure from the
health standard.
What is it that influences this blood current, and what conditions will
change it from the normal pulsation described above to the endless variety
which any investigator may obtain by examining a number of persons at
different periods of life, at different periods of the day, and in different
physiological and pathological states of the system?
The first question is readily answered by any student of physiology.
The second requires thought, study and constant practice with the in-
strument.
Nothing has been said with regard to the frequency of the heart's
action, or of the pulse which is its index.
Although the instrument under consideration accurately records it, other
means are more ready and quite as accurate.
We know that under purely physiological conditions the frequency of
the pulse varies with the age of the individual, with the sex, with exercise
and rest, with the position of the body, and with the temperature of the
surrounding atmosphere. We also know that any impediment to respira-
tion renders the action of the heart slow and labored.
The force and rhythm are what we are most interested in.
Physiologists tell us that there is an inherent irritabitity possessed by
the heart which causes it to contract, and that its free and regular action
10
THE SPHYGMOGRAPH.
is dependent upon the nourishment supplied to the organ itself by the
coronary arteries, also upon the circulation of the blood through its cavi-
ties. That the action of the heart is influenced by the quantity and
quality, and particularly by the density of the blood passing through it. And
we are told that even after the irritability of the heart has become extinct,
and it has ceased to contract, blood brought into contact with its lining
membrane will restore its action.
We also know that the action of the heart is influenced by the nervous
system, particularly the sympathetic, as evidenced by the effect of over-
loading the stomach, of fright, anger, grief, and emotions of various kinds.
A blow upon the epigastrium which is supposed to injure the solar
plexus, will, in some cases, instantly arrest the action of the heart, and
cases are on record when death was the immediate result of such an
injury.
We are all familiar with the influence of the pneumogastric nerves, as
far as known, upon the action of the heart: "Section of these nerves in
the neck, increasing the rapidity of its action, and rendering the pulsa-
tions more feeble; and galvanization arresting the heart's action.”
Although the heart, in a large measure, influences the character of the
pulse at the wrist; much is dependent upon the arteries themselves. We
must remember that the arteries are largely composed of elastic tissue;
that, under some circumstances, without regard to the quantity of blood
contained, they are more tense than at others. That they are always
rendered more tense, by an increased quantity of blood. We must re-
member that the smaller arteries are supplied with muscular fibres, so that
at times they are more contracted than at others. Consequently the blood
has a more ready exit at one time than at another, leaving the larger arteries
fuller, or more empty as the case may be. We must remember that these
muscular fibres are under the control of the vaso-motor nerves, and that
these nerves are influenced by a great variety of causes.
Taking the normal tracing as an example, we have seen that the first
event is an index :
First-To the force with which the blood is sent into the aorta.
In simple hypertrophy of the left ventricle, which arises in many in-
stances from plethora, from nervous excitement with consequent over-
action of the heart, from the frequent lifting of heavy weights, from vio-
lent and long continued bodily exercise, etc.,-all tending not to enlarge
the cavity, but to increase the thickness of its muscular walls-the arteries
would naturally be well filled with blood, and the tension of their elastic
walls consequently much greater than if the vessels were less distended;
the result would be that this shock wave would be well marked, prominent
and almost perpendicular.
1
THE SPHYGMOGRAPH.
11
Again, suppose the same condition of the arteries existed from another
cause—obstruction to the escape of blood into the venous circulation
through the arteries of smallest size, owing to contraction of their muscu-
lar fibres-or through the capillaries, owing to increased and unnatural
density of the blood—with an absence of hypertrophy, and a feeble action
of the heart. This first event or shock wave would be necessarily less
prominent.
In another case suppose the vessels to be but partially filled with blood,
and compressible, their walls consequently relaxed. This shock wave,
unless the pressure upon the artery were great, would be very prominent,
but less perpendicular, and the sphygmographic tracing would be corre-
spondingly large, but owing to the partially filled condition of the vessel,
the collapse, the downward movement of the pulse spring, would be sud-
den and great.
So we see this shock wave can be influenced by the condition of the
heart, by the state of the muscular fibres of the small arteries, whether
relaxed or in a state of contraction-owing to the influence of the vaso-
motor nerves, by the density or anæmic condition of the blood, and by
the quantity of fluid contained in the vessel. The first event of the trac-
ing, influenced as it is by so many different causes, is, therefore, by itself of
no great value as a guide to the diagnosis of special diseases either of the
heart or of the nervous system.
Of far greater significance is the systolic or true blood wave, or the second
event in a tracing; for as before stated this event or wave is an indica-
tion of the quantity of blood thrown into the artery under examination,
provided there is no obstruction to its escape into the venous circulation.
Although I should hesitate about deciding as to the existence of a valvular
disease of the heart, by the character of this wave alone, if I were in
doubt as to the presence of a murmur, owing to thickness of tissue over
the præcordial region, or from other causes which might interfere with my
accurately studying the heart sounds in a particular case, the sudden
collapse of the first wave, with almost a total absence of this second event
or blood wave, would prompt me to examine the case most carefully,
for I should suspect, particularly if the patient suffered from shortness of
breath, the existence of mitral disease. If the wave were prominent, it
would, in my mind, exclude this condition, and be an evidence of free cir-
culation of a good quantity of blood through the vessel. I should look
upon the character of this wave as valuable confirmatory evidence of the
existence or non-existence of certain forms of valvular disease.
But even here I might be in error, for in insufficiency of the aortic
valves—with compensating hypertrophy of the left ventricle-the wave
would be quite as prominent as in perfect health. But the moment the
12
THE SPHYGMOGRAPHĮ.
times
compensation began to fail, that moment the blood wave would become
small, while the shock wave might be quite prominent.
I can imagine a case of rapid pulsation of the heart with feeble action,
dependent upon purely nervous conditions, when the left ventricle failed
to empty its entire contents into the aorta, in which this systolic or blood
wave or second event of a tracing would be entirely wanting or so blended
into the shock wave or first event as to be imperceptible.
The third event of a tracing, the downward line from the prominence
produced by the systolic wave to the prominence produced by the wave of
recoil, indicates the freedom, or difficulty with which the artery is emptied
of its contents. If there is an obstruction in the capillaries, owing to con-
traction of their walls, or owing to a dense state of the blood, which
prevents its free passage through these minute vessels, this line of collapse
will be more horizontal than if the capillaries be relaxed, or the blood
passing through them be anæmic, under which circumstances the line will
be nearly perpendicular. As before remarked, the wave of recoil is prom-
inent or wanting, according to the relaxed or tense state of the vessel,
owing to causes already mentioned. As we have already stated, this
dicrotic wave or fourth event, as it is called, is exceedingly prominent in
some cases of typhoid and other adynamic fevers,
During the period elapsing between this dicrotic wave, and the next
systolic impulse, the line generally descends, the ventricle being at rest
and gradually filling with blood. This diastole of the ventricle actually
commences at the close of the third event, before the dicrotic wave makes
its appearance.
In the use of the sphygmograph much depends upon the amount of
pressure brought to bear.
Dr. Holden contends that by the aid of the spring attachment to his
improved instrument, the amount of pressure can be graduated to a cer-
tainty. This may be true, but in the use of the sphygmograph no rule
can be laid down which will apply to every case.
In some the tissues covering the artery are so thick that it is with the
greatest difficulty, no matter how much pressure is used, that a tracing of
any kind can be taken. In other cases the vessel is so compressible, and
the tissues covering it so thin, and the action of the heart so fecble, that
with the least possible pressure, it is equally difficult to secure an accurate
tracing. I have on many occasions, at the same sitting, taken tracings
from the radial artery of a patient, entirely unlike in appearance, although
the expert would recognize a similarity between them.
Taking this fact into consideration, and the fact that so many and such
varied influences change the character of the pulse, and that almost iden-
tical tracings can be developed in entirely dissimilar pathological condi-
THE SPHYGMOGRAPÍÌ.
13
tions, we are led to the conclusion that sphygmography can never reach
such a state of exactness as to be deserving of the title of a science.
The only tracing which approximates to a constant one, is the tracing
of perfect health. Even then the ages of the respective subjects must
correspond. In serious nervous conditions, we can readily see by the
tracings that something is wrong with the circulation. But what produces
this departure from the healthy standard, in a very large majority of the
cases (from the tracing alone) it is utterly impossible to say.
I am inclined to believe that, although as was before remarked, it is a
confirmatory aid to diagnosis, all that can be learned by the aid of this
instrument that is of value, can be as well learned by the skillful physi-
cian by other means.
I would not have it thought that I underestimate its value as an aid
to diagnosis. On many occasions it has been of great service to me, not
in deciding my diagnosis, but in prompting me to make a second or possi-
bly a third examination, endeavoring, perhaps, to discover a murmur
where I had failed to find one.
On more than one occasion, I have succeeded, and thus a case has been
made clear to me which previously had been very obscure. The follow-
ing case will illustrate:
Mr. H. O. C., was sent to me for a physical examination, and a diag-
nosis.
He was a large stout man of 55 years, height five feet eleven inches,
weight about 220 pounds. Had always been subject to bronchial catarrh
from the slightest cold. Six years ago had an attack of inflammatory
rheumatism which lasted for five weeks. Since that time had complained
of sinking sensation in the epigastrium, shortness of breath upon going
up stairs, or upon taking any violent exercise. Has had a short cough,
with mucous expectoration, principally in the morning, appetite good,
bowels regular, sleeps well, but is worried about this shortness of breath,
which, at times, is the cause of great inconvenience.
Physical examination showed a beautifully rounded chest and abdomen,
covered with a thick layer of adipose issue, abdomen very prominent.
But little movement of the ribs upon inspiration. Respiration apparently
being performed principally with the diaphragm.
A chest expansion of but one and one-half inches, a vital capacity of
but 130 cubic inches, when it should have been at least 240.
By palpation or mensuration I was unable to locate the apex of the
heart, owing to the thickness of the chest walls, and to the feeble action.
of the heart. Upon percussion, I found normal resonance in the supra
and infra-clavicular regions, and in the upper portions of the chest pos-
teriorly, but dullness anteriorly and posteriorly in the lower lobes.
14
THE SPHYGMOGRAPH.
The cardiac dullness extended to the nipple line on the left side. Hepatic
dullness normal. Abdomen tympanitic, evidently largely distended with
gas. Upon auscultation, I got vesicular breathing in all portions of the
chest where it is found in health, but of a remarkably feeble character,
and almost entirely suppressed in the lower lobes.
I fully expected to find a cardiac murmur, but utterly failed. What I
could distinguish of the heart sounds seemed pure. The apical impulse.
seemed to be in the fifth inter-costal space a little to the left of the nipple
line.
The second sound of the heart at the pulmonary orifice was much more
intense than at the aortic. Pulse feeble and compressible but regular. An
examination of the urine showed traces of albumen, and upon microsco-
pical examination granular and hyaline casts were found.
My diagnosis was uncertain. The missing link, a regurgitating mitral
murmur was wanting.
In the absence of rales I was at a loss to account for the evident lung
engorgement. On the following day I took a sphygmographic tracing of
the pulse, at the radial artery. The dicrotic tracing which I here present
was so remarkable that I was satisfied, in my own mind, of the existence
of valvular disease.
PLATE 13.

hhhhhhhhhh hhhhhhhhhhh
I requested him to remove his underclothing, and made a second ex-
amination. At this time-owing to his having walked from his hotel to my
house-the heart was beating more violently, and I discovered a blowing
murmur, heard most distinctly at the apex, and with the first sound of
the heart. My case was complete, and I had no difficulty in accounting
for all his symptoms, and the pathological changes which I had discovered.
Here the sphygmograph was of service, not in guiding me as to my
diagnosis, but in prompting me to make a thorough examination, which
resulted in my finding the murmur which made the diagnosis perfectly
clear.
I would not have it thought that I underestimate the value of the
sphygmograph in physiological investigations. The instrument under
such circumstances has been of undoubted value; and I am satisfied too
that in the proving of drugs upon the perfectly healthy, if accurate trac-
ings were taken, and a dictionary of these tracings compiled, the sphyg-
mograph could be made of material service in selecting the proper remedy
when there was an absence of organic disease of the heart or arteries.
1
}
20
NATURE OF MALARIA
AND ITS
Peculiarities of Origin as to
Place.
A paper read during the Thirty-sixth Annual Session
of the American Institute of Homœopathy, Held
at Niagara Falls, N. Y., June, 1883.
BY JW. DOWLING, M.D.,
John
PROFESSOR OF PHYSICAL DIAGNOSIS AND DISEASES OF THE
HEART AND LUNGS, NEW YORK HOMEOPATHIC
MEDICAL COLLEGE,

REPRINT FROM THE TRANSACTIONS.
PITTSBURGH:
FROM THE PRESS OF STEVENSON & FOSTER, No. 151 WOOD STREET.
1883.
1
1.
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1
NATURE OF MALARIA AND ITS PECULIARITIES OF
ORIGIN AS TO PLACE.
By J. W. DoWLING, M.D., New York City.
No disease-producing element is more generally distributed
over certain large portions of the face of the globe than that
which gives rise to the various forms of malarial illness. I use
the term illness rather than fever, for in my own experience
the most distressing-the most harrassing--derangements of
the system resulting from the absorption of this poison and,
too, those most difficult to combat, are not characterized by a
febrile rise of temperature.
I take the ground that the poison known as malaria is
the same in all parts of the globe; and that this poison taken
into a system susceptible to its action produces a peculiar
form of illness of greater or less intensity varying with the
amount of poison absorbed, and the susceptibility of the indi-
vidual to the action of this particular poison. In some a sim-
ple benign intermittent fever is the result; in others, or in the
same individual at another time, a masked intermittent with
its various and perplexing symptoms; in others, or in the same
individual at another time, a pernicious intermittent with its
protracted chill, and as a result a distended and partially or
completely paralyzed heart; or a remittent fever: or a continu-
ous fever: all frequently followed by the so-called malarial
cachexia-a condition of chronic malarial poisoning-giving
rise to periodic illness of every kind and character cropping
out whenever the system from any cause, sickness of other
kinds, a cold, an over-indulgence in the pleasures of the table,
excessive sexual indulgence, over mental exertion, grief,
2
AMERICAN INSTITUTE OF HOMEOPATHY.
fatiguing physical labor, or the excessive use of tobacco, is
brought below a certain level of health.
From time immemorial, the brains of investigators have.
been taxed to ascertain the origin and nature of this poison;
and as years, decades, centuries have rolled by, bringing greater
and greater familiarity with the resulting disease, and as they
have noted the appearance of malarial illness in localities sup-
posed from the nature of the soil and surroundings to be entirely
free from a possibility of its existence, and have noted its dis-
appearance from other localities where it had held supreme
sway for years, they have become more and more perplexed
until the question has actually been asked: "Is there in reality
such a substance as malaria?" with strong and to some con-
clusive arguments tending to prove, that malarial illness, so-
called, was not the resultant of an absorbed poison, but was
either the effect of heat on the "temperature centres" of the
body (Dr. Reber), or the result of ennervation from privation of
electricity caused by evaporations of water (Dr. Penn, Trans.
of Med. Soc. of Tenn., 1879); or the effect of the debilitating
effects of long-continued heat or of sudden absorption of heat
following sudden changes of temperature; heat without sudden
alternations being powerless (Oldham in his work entitled
"What is Malaria ?").
In chapter 21 of his work, Dr. Oldham gives the following
synopsis of the views therein expressed, viz:
1. Exposure at night in a malarious locality necessarily in-
volves exposure to chill.
2. All effects produced by so-called malarious influence can
be caused by rapid abstraction of animal heat without inter-
vention of any specific poison.
3. Exposure to chill is admittedly the cause of the diseases
that are constantly associated with malarial fever as well as of
the recurrent attacks or so-called relapses of the fevers them-
selves.
4. The effect of continued exposure to a high temperature
is at once to diminish the heat generating powers of the sys-
tem, and to increase the susceptibility to malarious fever as
well as to aggravate the intensity of the disease.
I
I
!
NATURE OF MALARIA.
3
Under all these circumstances, says Oldham, it is impossible
to arrive at any other conclusion than that malaria is chill.
. It has been and is an easy task to conclusively refute the
arguments offered in support of these theories. Space will not
permit of our reviewing them here. Suffice it to say, that
these theories have not been favorably received by most investi-
gators, for superficial observations were sufficient to show con-
clusively that the so-called periodic or malarial illness in
various portions of the world could not be accounted for by the
theory of chill, or by the effect of heat on the temperature
centres of the body, or by ennervation from privation of elec-
tricity caused by evaporation of water.
In fact, it is generally conceded that malarial fever owes its
origin to a poison which taken into a system susceptible to
its action, produces a peculiar form of illness, varying with
the amount of this poison absorbed and the susceptibility of
the individual exposed to the action of this particular poison.
Some authorities, standing high in the medical world, have
been willing to acknowledge their ignorance as to the nature
of this poison. Bartlett, in his work on the "Fevers of the
United States," says: "The nature and composition of this
poison are wholly unknown to us. Like most other analogous
agents, like the contagious principles of small-pox and ty-
phus, and like epidemic poisons of scarlatina and cholera, they
are too subtle to be recognized by any of our senses; they
are too fugitive to be caught by any of our contrivances.
Neither the strongest lenses of the microscope, nor the nicest
analysis of chemistry have succeeded in discovering the faint-
est traces even of the composition and character of these
invisible, mysterious, and stupendous agencies. As always hap-
pens in such cases and under similar circumstances, in the ab-
sence of positive knowledge, we have been abundantly supplied
with conjecture and speculation; what observation has failed
to discover, hypothesis has endeavored and professed to sup-
ply." He says: "It is quite unnecessary even to enumerate
the different substances to which malaria has been referred.
Amongst them are all the chemical products and compounds
4
AMERICAN INSTITUTE OF HOMEOPATHY.
possible in wet and marshy localities: moisture alone, the
products of animal and vegetable decomposition, and invisible,
living organisms."
In regard to the alleged agency of animal and vegetable
decomposition in the production of malaria, he says: We have
no positive knowledge on the subject; it is possible enough
that this decomposition may produce the poison, but there are
reasons for doubting it. One of these reasons is to be found in
the common and notorious fact that this same decomposition
is constantly going on without giving rise to periodic fever.
Watson says:
"Where there is much heat and much mois-
ture, there we usually find also much and rank vegetation,
and much vegetable dissolution and decay. The belief was
as natural, therefore, as it had been general, that the putrefac-
tion of vegetable matters was somehow or other requisite to
the formation of the poison that exists so commonly in swampy
situations. This belief has descended almost unquestioned,
from the time of Lancisi; and it obtains almost universal ac-
ceptance, I fancy, among physicians of the present day. Yet
very strong facts have been adduced to show that the decom-
position of vegetable substances is only an accidental though a
frequent accompaniment of the miasm, and not by any means
an essential condition of the evolution." "In the first place,
the decomposition of vegetable matter goes on abundantly
without the production of malaria. The rotting cabbage
leaves of Covent Garden and those which taint the air
of the streets from the neglected dust-holes of London,
during the hot weather of summer, give rise to no ague. The
same may be said of the putrefying and offensive sea-weed,
which is deposited in large quantities upon some very health-
ful parts of our sea coast. But the converse facts are the
most remarkable and conclusive. Marshes are not necessary
to produce malaria. It has been shown that vegetation is not
necessary, that the peculiar poison may abound where there
is no decaying vegetable matter and no vegetable matter to
decay."
After mentioning some striking facts detailed by Dr. Fer-
•
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NATURE OF MALARIA.
5
1
guson, in his paper on the " Nature and History of the Marsh
Poison," tending to prove the above statements, Dr. Watson
says: "These facts and facts like these, seem to prove that the
malaria and the product of vegetable decomposition are two
distinct things. They are often in company with each other,
but they have no necessary connection."
Of the hypothesis of the animalcular or crypto-gamic na-
ture of this poison, he says: "It may be safely said of it that it may
be made to correspond to the ascertained phenomena in connection with
the aetiology of malarial diseases better than most other hypotheses, and
that it is less embarrassed by objections which cannot be met, and by dif
ficulties which cannot be overcome."
Laveran, in his work entitled "Impaludiome," asserts that
malaria is caused by parasitic pigmentary elements or melan-
iferous leucocytes.
Niemeyer attributes malaria to low vegetable organisms,
whose development is chiefly due to the putrefaction of veget-
able substances.
Leibig associates malaria with the deoxidizing caused by
putrefactive decay.
Barker, in his work entitled "Malaria and Miasmata,"
teaches that an organic poison comes into contact with decom-
posing matters in the soil and acts as a ferment producing
compounds which, when breathed, become poisonous develop-
ing the condition known as malarial illness.
I, accepting Leibermeister's definition of the word infection
in considering the nature of malaria, take the ground that the
poison known as malaria is infection. Leibermeister de fines
infection as a poison which differs from ordinary poisons in
the fact that it can reproduce itself under favoring conditions
to an endless degree.
I take the ground with him that infection consists of living
beings--germs, or low organisms. That the infection or germs
of malarial illness can produce only the various forms of
malarial illness. So with the infection or germs of typhus,
typhoid, scarlet fever, measles, small-pox, syphilis, cholera,
yellow fever, etc.; they can produce only their own specific
diseases.
6
AMERICAN INSTITUTE OF HOMEOPATHY.
All pathological conditions arising from the presence in the
system of infection are classed by Leibermeister under the one
general heading of infectious diseases. These are sub-divided
into acute and chronic infectious diseases; and further, into
miasmatic and contagious diseases. The miasmatic include
all diseases owing their origin to miasm—which is defined as
"a specific excitant of disease which propagates itself outside of
and disconnected from a previously diseased organism." "Miasm
originates from without, taken up into the body it can call
a specific disease into action; but it cannot spread the disease
any further by conveying it from a diseased to a sound person."
The contagious include all diseases owing their origin to
contagion, which is defined as "a specific excitant of disease
which originates in the organism suffering from the specific
disease."
These are further divided into purely contagious, purely
miasmatic and miasmatic-contagious diseases.
"In the purely contagious the poison can be conveyed from
one individual to another by contact, and mediately from the
vaccinator's lancet, from other instruments, from clothing,
through third persons, and, in many of the purely contagious
diseases, by the air; the poison having no special stage of
development to pass through on the way from the infecting
organism to the one to be affected, but at the time of infection
it is essentially in the same condition as when given up by the
organism yielding it." "Included under this heading are
measles, scarlet fever, variola, vaccinia, typhus, diphtheria,
glanders, malignant postule, rabies, virulent ulcers, blennor-
rhoeas, syphilis, pyæmia, and puerperal fever."
"In the purely miasmatic, which includes the malarial diseases,
the morbid poison develops itself externally-within the body
it appears to vegetate for an indefinite time. Thus far it has
not been known that the germs, reproduced within the human
system can be conveyed to other men, and can infect them, or
that they can again escape from the body and reproduce them-
selves further."
In the miasmatic-contagious diseases, "The poison cannot be
}
NATURE OF MALARIA.
7
}
:
conveyed from diseased to healthy individuals by mere con-
tact. First of all it is drawn from without; is then gener-
ated in the diseased individual, but is not in a condition to
infect others when it first leaves the body, but must undergo
a subsequent development before it is in a condition to pro-
duce its peculiar disease in other individuals. This subse-
quent development occurs when the discharges from patients
suffering from this class of diseases are permitted to remain
standing for a length of time, but particularly when they come
in contact with great quantities of organic substances that
readily decompose, as in water closets, dung heaps, sewers, and
also in the soil of inhabited localities that are damp and rich
in organic debris. In this stage of development, there seems
to be a considerable increase of the poison, and after this re-
production it is again in a condition to multiply further in
the human body and produce the disease."
Under this heading are included "cholera, typhoid fever, dys-
entery, and probably also yellow fever and the plague."
Recent investigators include croupous pneumonia among the
infectious diseases, but no conclusion has been drawn as to
which of the above classes it belongs.
We conclude then :
1st. That there is a disease-producing poison known as ma-
laria.
2d. That it invariably proceeds from without the system.
3d. That it is capable of reproducing itself under favorable
circumstances to an unlimited degree.
4th. That this poison is composed of living beings—known
as bacteria.
A bacterium Dr. Belfield defines as a mass of matter which
possesses a definite size and shape; may or may not exhibit
motion; has a certain chemical composition, and is capable of
growth and reproduction; is in short a living organism.
At the present time, scarcely a doubt seems to exist as to
the truth of the first three of these conclusions. Consequently,
it will be unnecessary to advance arguments in their favor.
The same can hardly be said of the fourth and last. The
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AMERICAN INSTITUTE OF HOMEOPATHY.
germ theory of disease is comparatively in its infancy, al-
though, even in the seventeenth century the theory that cer-
tain diseases arose from the presence in the system of low
organisms of living beings-was strongly advocated by many
prominent authorities. It will not be out of place for us to
say a few words in reference to this subject, defining the term
germ, theory of disease, and bringing forward a few of the
most conclusive arguments to prove that malaria is composed
of germs or, as they are now called, of bacteria.
The subject is conclusively argued by Leibermeister in the
first volume of Zeimssen's Encyclopedia, but more recently and
quite as conclusively by Dr. Belfield in the Cartwright Lec-
tures of 1883, published in full in the Medical Record. He says:
"The germ theory supposes, that all infectious diseases are caused
by the vital activity of parasitic organisms," and supports the theory
by reference to the stage of incubation, the unlimited repro-
ductive power of the virus, and the cyclical course and self-
limitation with which these diseases are generally character-
ized. He says: "The stage of incubation can be explained
by the assumption of no unorganized virus. All mere chem-
ical compounds with which we are acquainted, even the fer-
ments Ptyalin and Pepsin, begin to manifest the characteristic
effects as soon as absorption has occurred." All infectious dis-
eases, including malarial illness, are characterised by a stage
of incubation; and the period which elapses between the
absorption of the poison and the development of the disease,
according to this theory, is the period during which the organ-
isms which have been taken into the system, are multiplying
till their number is sufficient to produce their characteristic
disease. The period varying with different disease-producing
germs, with different infectious diseases, some requiring but a
short time, others days, and others even weeks.
The unlimited reproductive power of the virus of these
diseases, can be accounted for in no way except by the theory
of organized poisons. "No unorganized poison, acid, salt,
alkaloid, ferment is at present known, which is capable of
manifesting the phenomena shown by the virus of syphilis,
NATURE OF MALARIA.
9
F
variola, scarlatina, etc." "With a minimal quantity of vac-
cine virus, we can vaccinate a child and obtain vaccine virus
from him. From this child ten and even more in turn, and
so on, so that what at first was a scarcely appreciable quantity
of the virus, is sufficient to produce the disease in 1, 10, 100,
1,000, 10,000 children, and so on ad infinitum. There is no
limit to the extension of the disease until there are no indi-
viduals left to whom the poison can be successfully conveyed.
So with all of the infectious diseases, the poison can be multi-
plied to an endless extent." (Leibermeister).
How account for the cyclical course and self-limitation of
infectious diseases? This question, according to Belfield, has
not been decisively answered. "Several facts suggest that
the products of their own vital activity arrest further devel-
opment." The soil finally becomes unfit for their further
development, and with the death of the bacteria existing in
the system commences the recovery of the patient, provided
the presence of the disease-producing element does not prove
fatal in its results.
If the truth of this theory is acknowledged as regards the
origin of the purely contagious and miasmatic-contagious
diseases, the application of it to the malarial diseases may be
questioned from the fact that their cause is not so well marked
as is that of the other infectious diseases. Notwithstanding
this fact, the peculiarities by which malarial diseases are char-
acterized, the peculiar habits of the poison producing the dis-
ease can be better accounted for on this theory than by any
other. I will say more, they can be satisfactorily accounted
for by this theory, as is evident to any one who carefully
peruses the literature of the subject as it relates to other infec-
tious diseases.
We now proceed to consider the peculiarities of malaria as
to locality? Bartlett says: "With certain limited exceptions,
it may be said to encircle the earth in a broad belt, parallel
with the equator; its northern and southern boundaries quite
irregular in their disposition-now approaching to the line of
the tropics, and now receding from it. The portions of this
1
10
AMERICAN INSTITUTE OF HOMEOPATHY.
immense territory, which are entirely exempt from periodical
fever, increase with the distance from the equator; while
within the tropics and along the range of several degrees beyond
them, these portions are confined mostly to certain geological
formations, and to elevated situations.
The particular regions most extensively and constantly the
seat of malarial disease in its more malignant forms are low
lying and wet lands situated in hot climates and covered with
a rank and spontaneous vegetation-the flat wooded sea
coasts, the interior swamps and marshes, and the rich alluvium
of the deltas, and courses of the great rivers."
The poison known as malaria seems to emanate from the
earth. It floats in the atmosphere, hovering near the surface
of the earth, and undoubted evidence exists of its being car-
ried by the wind from malarial spots to localities which would
otherwise be entirely exempt from it-to a certain extent
purifying the atmosphere of the regions where it is generated
It is more apt to be found in localities where the upper
crust of the earth is moist and subjected to the action of the
heat of the sun. In warm climates wherever there is a sub-
soil of clay, or a rocky bed covered with a thin layer of soil,
malarial diseases are almost surely to be found.
As a rule, wherever is found a fog which hovers but a few feet
from the earth's surface, making its appearance with the setting of the
sun, and gradually disappearing with its rising, malaria is sure to
be generated.
•
It is found also in localities entirely free from moisture, in
some sandy regions, sandy to the depth of many feet where
there is no vegetation, but this is the exception.
It is affected by the temperature of the atmosphere-frost
rendering it entirely inactive. Trustworthy authorities assert
that after once being submitted to an atmosphere of or below
the freezing point, it is not again operative in producing dis-
ease till it has been exposed to a temperature above sixty
degrees Fahrenheit.
It is more active at night than during the day. Evidence
has accumulated to prove that certain localities exceedingly
}
NATURE OF MALARIA.
11
!
dangerous at night are perfectly healthful during the day.
Watson records an instance. "In 1776, the Phoenix, ship
of war, was returning from the coast of Guinea. The officers
and ship's company were perfectly healthy till they touched at
the island of St. Thomas. Here nearly all of them went on
shore; sixteen of the number remained for several nights on
the island. Every one of them contracted the disorder, and
thirteen of the sixteen died. The rest of the crew, consisting
of 280 men, went in parties of twenty or thirty on shore in the
day and rambled about the island, hunting, shooting, and so
on but they returned to the ship at night, and not one of
those who so returned suffered the slightest indisposition.
Exactly similar events occurred the following year with the
same ship at the same place, when she lost eight men out of
ten who had imprudently remained all night on shore, while
the rest of the ship's company, who, after spending the greatest
part of the day on shore always returned to their vessel before
night, continued in perfect health." These are but two of
many examples of the same kind.
The fact that those remaining on ship board did not contract
the disease proves one of two things, viz., that the wind was
not blowing from the land, or that water has the power of ab-
sorbing the malarial poison.
It has been conclusively proven that miasmatic atmosphere.
passing even over a small body of water becomes inoperative.
The poison, hovering, as it does, near the surface, is undoubt-
edly absorbed by the water. Proof positive exists that water
which has absorbed large quantities of malarial poison can
impart intermittent fever to those drinking of the water so im-
pregnated.
In proof of the above assertion Watson cites the following:
Dr. and Mrs. Evans, of Bedford, were both attacked with ague
while staying at Versailles, in the year 1845. The water used
there for domestic purposes is brought from the Seine at
Marli. A large tank in which it was collected for distribution
to a particular quarter, happened at that time to be damaged ;
and the mayor of the place provided a new supply of water
12
AMERICAN INSTITUTE OF HOMEOPATHY.
consisting of the surface drainage of the surrounding country,
which is marshy. This water the inhabitants of Versailles
would not drink; but Dr. and Mrs. Evans, living at an hotel,
drank of it unwittingly. It was made use of by the regiment
of cavalry also. The result was that they who drank the
water suffered from intermittent fever of so severe a type that
seven or eight of the soldiers died, in one day. Upon careful
investigation it was ascertained that those only of the troops
were attacked who had drank the marsh water; all the rest, as
well as the townspeople, having escaped, though all of them
breathed the same atmosphere. He records other instances of
the same kind. It has long been known that the poison of
other of the infectious diseases could be conveyed to an indi-
vidual in water.
The poison, according to Watson, is attracted by and adheres
to the foliage of trees; it is not absorbed by them, for the dis-
ease is almost surely produced in those who sleep or even
remain for any length of time under these trees. This fact is
taken advantage of by the natives of certain malarial sections,
who plant trees between their residences and the marshy dis-
tricts that a barrier may be interposed which will protect them
from the poison.
The culture of the soil lessens the generation of malaria.
Certain plants and trees apparently destroy the poison, for
when they are cultivated in malarial sections the disease soon
disappears. The Eucalyptus is an example of this.
Malaria, from its almost constant existence in marshy regions,
has been known as marsh miasm, yet there are swampy regions
in hot climates that are entirely free from malarial diseases.
It is less apt to be generated where the marshes are covered
with a depth of water; and malarial diseases are more likely
to abound when the marshes are covered with a thin sheet of
water exposed to the heating influence of the sun. In such
localities decomposition of organic matter is rapid, and we
have one of the elements favorable for the generation of
malaria.
Marshes that have dried up offer the most favorable con-
ditions for the development of the poison.
1
NATURE OF MALARIA.
13
Marshes formed partly of salt, partly of fresh water are ex-
ceedingly noxious from the destruction of fresh water plants
by the action of the salt water-thus producing a larger
amount of decomposing vegetable matter.
Marshes resting upon a substratum of sand or peat are more
wholesome than those resting upon limestone, clay or mud.
In localities once malarious the upper crust of the earth
seems to become oxidized in time if left undisturbed. The
building of railroads and turning over the soil for improve-
ments of various kinds seems to develop the poison anew, as
if it had existed below but was unable to escape.*
Instances are on record where earthquakes and volcanic
eruptions have been followed by the appearance of malaria,
where it was previously unknown. The poison having been
undoubtedly shut up, as it were, beneath the surface of the
earth.
As was before stated, malaria will sometimes, in a compara-
tively sudden manner, leave a section and appear in another,
without any known changes having occurred in the condition
of the soil.
Malaria is most active during the summer and fall.
A re-
markably wet and warm summer will develop the poison to
an alarming degree, as will a remarkably dry and hot summer.
This is accounted for, in the first instance, by the wetting of
the soil, loaded with organic matter, and the subsequent action
of the sun's rays upon it, producing decomposition, which
renders the soil favorable for the generation of the poison ;
in the second instance, by the fall in the height of the water
beneath the surface of the earth, owing to evaporation, leaving
a stratum moist but uncovered by water, ready to be acted
upon by the heat of the sun.
According to most authorities, the requisites for the develop-
ment of the malaria are organic matter-heat and moisture;
* During the past year, owing to the turning over of the soil necessary in the
building of the West Shore Railroad, malarial fever has been generated in many
of the towns on the west shore of the Hudson river, in localities, too, where it
had never been known to exist, or which had been free from it for years.
14
AMERICAN INSTITUTE OF HOMEOPATHY.
but it has been proven that it may exist where there is no
organic matter-where there is no moisture; although heat
seems to be in every instance a necessary requisite.
For the above facts I am mainly indebted to Zeimssen's En-
cyclopedia, and Watson's Practice of Medicine-see articles
on intermittent fever.
Finally, the germs of malaria may exist for an unlimited pe-
riod and be generated in the human system, remaining dormant,
as it were, so long as the system is above a certain level of health,
but if it become reduced from any cause, and brought below
that certain level, the poison becomes active, to generate
itself and to produce its specific disease.
I have positive evidence of this in my own person, in that
of members of my family, and in almost innumerable instances
among patients whom I have treated for this disease. In many
instances patients have apparently been cured of the disease,
resulting from exposure to malarial atmosphere, and have
remained perfectly well for months-even years in some cases
-and then without fresh exposure, and too, at a season of the
year when malaria is supposed to be inactive; from an ordi-
nary cold, a debauch, or any excess which has brought the
system below the proper level, an attack of intermittent fever
has been developed, which yielded to measures calculated to
elevate the general tone of the system.
It has been proven that the spores of certain bacteria will
resist influences which would destroy the bacteria themselves.
"Their vital activity is sometimes unimpaired by prolonged
boiling, or by immersion for months in absolute alcohol, either
of which procedures destroy mature forms. The spores seem
under ordinary conditions, the impersonations of immortality,
time seems powerless to weaken them." (Belfield.)
It certainly seems as if it were so with the spores of the
bacteria producing malarial illness-they apparently remain
for years in the human system, and so long as the soil is not
ripe for their development into the mature form, they are
harmless, but so soon as the soil is brought to a condition fitted
for their growth, from any cause, they mature and multiply,
producing their peculiar disease.
NATURE OF MALARIA.
15
'
I
We see this demonstrated without the body. In malarial
sections certain seasons, certain years, are comparatively free
from the malaria and its diseases, while other seasons, other
years, are remarkable for its virulence. This is easily account-
ed for by the condition of the soil, varying, as it does, with the
amount of moisture and heat. Belfield says, as is well known
by all pathologists who have investigated this subject, “Every
moist substance of organic origin, and all water containing
even a trace of organic matter is favorable soil for one or more
varieties of bacteria. The upper layers of the earth containing
these essential ingredients, and remaining comparatively warm,
constitute a continual breeding place for these organisms.
The minuteness and lightness of bacteria explain their presence
in the atmosphere. They are swept by currents of air from dry
or moist surfaces; they float in clouds of dust; they are carried
by insects. The persistence of their vitality, the rapidity of
their propagation result in practical ubiquity." These facts
have been proven with regard to certain forms of bacteria,
and taking into consideration the known facts relating to
malaria, is it not probable, more than probable, almost certain,
that this poison is composed of bacteria?
As an evidence of the peculiar manner in which malaria
may be generated in certain healthful localities, I would men-
tion the following remarkable case, which was related to me by
my friend Prof. St. Clair Smith: A box of growing plants, in
earth which was covered with mold, was placed in the warm
sitting room of one of his young lady patients, who had never
had malarial illness of any kind, and who had never, to her
knowledge, been exposed to the action of malarial poison. Soon
she developed an intermittent fever in mid-winter. The disease
resisted medicinal measures so long as the box of earth was
permitted to remain in the room. Finally the box was
removed and she entirely recovered. Later, it was brought
back, and she was again taken down with the disease. The
box was again-this time permanently-removed, and the dis-
ease responded readily to remedies, there being no further
return of it.
mag
16
AMERICAN INSTITUTE OF HOMEOPATHY.
A patient of mine built a magnificent house on the sea
shore, far from any malarial region; no such disease had ever
been known there. The soil was sandy; even a blade of grass
would not grow. He wanted a lawn, and consequently went
to the expense of having several hundred car loads of earth
brought from a distance, and, too, from a section which I have
since learned is malarious. He had a beautiful lawn, which
was the envy of his neighbors, but in the fall he, with every
member of his family, was taken down with malarial fever.
L
21
THE EFFECTS
OF THE

ABUSE OF ALCOHOL
ON THE
Circulatory and Respiratory Organs,
READ BEFORE THE MEETING OF THE
AMERICAN INSTITUTE OF HOMEOPATHY,
SESSION OF 1884,
*
BY
JW. DOWLING, M.D.,
hm
PROFESSOR OF PHYSICAL DIAGNOSIS AND DISEASES OF THE HEART AND
LUNGS, NEW YORK HOMEOPATHIC MEDICAL COLLEGE; LATE PRESIDENT
OF THE AMERICAN INSTITUTE OF HOMEOPATHY, AND DEAN OF
THE NEW YORK HOMEOPATHIC MEDICAL COLLEGE.
REPRINT FROM THE TRANSACTIONS.
PITTSBURGH:
PRESS OF STEVENSON & FOSTER, No. 529 WOOD STREET.
1884.
16
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ERRATA.
On page 9, 20th line, for "diastole," read "systole."
On page 12, 15th line, for "insiduous," read "insidious."
The Fitects of the Avuse vi fi
Effects of
latory and Respiratory Organs.
I
ཟ{༦
By J. W. DOWLING, M.D., New York City, N. Y.
བཪ ཕ ཨ”
With but few exceptions the exhilarating, the damaging in-
gredient of all of the so-called stimulating drinks is alcohol.
It matters not whether they be in the form of spirituous liquors,
cordials, still wines of high and low grades, the most delicate
champagnes, ales or beers.
It is true that in some instances, either to add to the gains
of the dealer, or to improve the flavor, or to impart peculiar
stimulating or intoxicating properties, substances are added
which are in themselves poisonous, in rare instances even more
poisonous than alcohol itself. Thus, fusil oil is found added
to some brandies, and gin, the favorite drink of the toper, the
lining membrane of whose pharynx, oesophagus and stomach
have become tanned, so to speak, is made fiery and at the same.
time smooth, by the addition of oil of vitriol, oil of juniper,
alum, carbonate of soda, turpentine, etc., all helping to impart
to the popular beverages their peculiar flavors and properties.
But of all poisonous substances added to alcohol in the prepa-
ration of palatable drinks, the essence of absinthium or worm-
wood is the most injurious. In addition to its destructive
effects upon the stomach, it has been known to produce in man,
as it does in the lower animals, a species of epilepsy, the con-
dition becoming lasting where the use of the poison is contin-
ued. As is well known, wormwood, aside from alcohol, is the
active ingredient of the popular cordial known as absinthe.
But it is of the effects of the abuse of alcohol that we propose
to treat, and enough can be truthfully said on the subject to
satisfy every thinking man that the constantly working, and
in health, never tiring heart, is invariably weakened in its
action, and often, very often, permanently ruined by the con-
2
THE EFFECTS OF THE ABUSE OF ALCOHOL
stant use of stimulating beverages; and so, too, with those
equally important and vital organs, the lungs and air passages.
As in our heading we use the term "abuse of alcohol," it is
but proper that we should have some understanding as to
what constitutes abuse in this connection.
It is undoubtedly true that some constitutions are far more
susceptible to the action of alcohol than others. It is also true
that in some, the effects are more marked on the nervous
system, in others on the digestive organs, in others on the kid-
neys, and in others on the circulatory and respiratory organs.
How often have we as physicians been called to treat diseases
resulting from the habitual use of alcoholic beverages in
patients who considered themselves temperate men or women,
and who boasted that they were never under the influence of
liquor in their lives, while at that very time they were dying
of Bright's disease, cirrhosis of the liver, chronic gastritis,
brain or spinal disease, fatty degeneration of the heart, chronic
bronchitis, with emphysema of the lungs, or even of pulmo-
nary consumption, resulting alone from the long continued
use of some of the many fascinating drinks containing alcohol.
It will be difficult for us to give an intelligible idea of what
constitutes abuse, or rather what may be considered the mod-
erate use of alcohol. My own opinion accords with that of the
great investigator, hygienist and physician, Benjamin W. Rich-
ardson, M.D., F.R.S., whom I shall have occasion to quote in
this article as authority for statements made. He says:
"This chemical substance, alcohol, an artificial product de-
signed by man, for his purposes, and in many things that lie
outside his organism a useful substance, is neither food, nor a
drink, suitable for his natural demands. Its application as an
agent that shall enter the living organism is properly limited
by the learning and skill possessed by the physician, a learn-
ing that itself admits of being recast and revised in many im-
portant details and perhaps in principles."
"If this agent do really for the moment cheer the weary,
and impart a flush of transient pleasure to the unwearied who
crave for mirth, its influence (doubtful even in these modest
and moderate degrees) is an infinitesimal advantage by the
side of an infinity of evil for which there is no compensation
-
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
3
and no human cure." Still we occasionally have evidence
presented to us that the daily moderate use of alcoholic prepa-
rations may be continued for many years with no apparent
injury in some individuals, and very frequently equally strong
evidence that the same moderate use will produce in others
serious, and in many cases fatal, chronic diseases. It is true
that permanent injurious results rarely follow the occasional
use or even abuse of stimulants, for if the patient be of healthy
constitution the system has opportunity to entirely recover
from the toxicological effects before the indiscretion is repeated.
This will explain why so many periodic drinkers live to a good
old age and die from natural causes.
As an answer to the question: What constitutes abuse in
the use of alcohol? I most unhesitatingly assert that habitual
use is abuse, even if the quantity be small. It is no argument
against the truth of this statement that men have lived to be
eighty or ninety years of age in tolerable health, who have
used alcohol in moderation the greater portion of their lives.
Perhaps if they had abstained entirely they would have lived
to be ninety or one hundred, and enjoyed still better health.
Certain it is that alcohol is a poison. That but a small
portion of what is taken into the system is eliminated as
alcohol. That, to a certain point, what remains is decom-
posed. That in this process of decomposition or oxidation it
does not supply nutriment to the body, neither does it sup-
ply muscular strength or animal warmth, for this oxidation
is "at the expense of the oxygen which ought to be applied
to the natural heating of the body." That the product of its
decomposition is a poisonous substance which, circulating as
it does, through every portion of the body, injures the deli-
cate texture of the various organs, and interferes with their
functions to a greater or less extent, according to the amount
present or the susceptibility of the organs to its action. That
even the accumulation of fat which sometimes follows the con-
tinued use of certain alcoholic beverages, if it results at all
from the alcohol contained in them, is produced by "indirect
and injurious interference with the natural processes."
But to the subject of our paper, "The Effects of the Abuse of
Alcohol on the Circulatory and Respiratory Organs." At the
井
​4
THE EFFECTS OF THE ABUSE OF ALCOHOL
"
present day all are familiar with the physiological action of
Nitrite of amyl. We know that it has a paralyzing effect on
the vaso-motor nerves, and that the muscular fibres of the ar-
terioles throughout the entire body lose their power of contrac-
tion, the vessels become dilated, not on the surface alone but
everywhere. The heart, which has been kept in check by the
tension of their walls, is relieved of a portion of its labor, and
as a locomotive increases its speed rapidly on the breaking of
the coupling which attaches it to the train behind, so the
heart's action is increased in frequency. This fact, in connec-
tion with the action of Nitrite of amyl, has been taken advan-
tage of by physicians throughout the civilized world to relieve
the arterial spasm which causes the overloading and distend-
ing of the heart in that dreadful condition known as angina
pectoris. The drug, like alcohol, has its uses, but it is, never-
theless, a poison. To a less extent alcohol acts in precisely the
same way, paralysing the vaso-motor nerves, dilating the
arterioles, increasing the frequency of the heart's action.
Richardson, in referring to this, says: "If you attend a large
dinner party, you will observe after the first few courses when
the wine is beginning to circulate, a progressive change in
some of those about you who have taken wine. The face
begins to get flushed, the eye brightens, and the murmur of
conversation becomes loud. What is the reason of that flush-
ing of the countenance? It is the same as the flush from
blushing, or from the reaction of cold, or from the Nitrite of
amyl. It is the dilatation of vessels following upon the reduc-
tion of nervous control, which reduction has been induced by
the alcohol. In a word, the first stage, the stage of vascular
excitement from alcohol has been established."
As was before stated, if the indiscretion stop here, provided
the subject be a healthy one, the paralyzing effect of the alcohol
soon passes away. The walls of the vessels regain their tone,
the vessels resume their former calibre, the old obstacle is
offered to the too free emptying of the heart, and the undue
frequency of action disappears; but if the indiscretion be soon
repeated again and again, by and by, a condition of permanent
vaso-motor paralysis is established. The vessels become per-
manently dilated, the heart's action permanently increased in
frequency.
+
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
5
If this was the only effect of alcohol, it is easy to prove
that from this, and this alone, serious injury, permanent injury,
injury calculated to shorten life, would result to the circula-
tory and respiratory organs. But its action does not stop here.
The poison generated by the combustion of alcohol in the
system produces cellular changes everywhere; by its contact
with the blood-discs, changes are produced in them; by its mix-
ing with the serum of the blood, changes, injurious changes,
are produced here, the character of the blood is changed, the
heart, the arterial walls, the elastic lung tissue, the muscular
fibre of the bronchial tubes, the mucous membrane lining.
them and the upper air passages, the muscles concerned in
respiration, all receive impure, poisoned blood and are damaged
accordingly. The immediate action of alcohol on the nervous
system, the digestive organs and kidueys, will be considered
by my associates in the bureau.
What is the result, so far as the circulatory and respiratory
organs are concerned, of this dilatation of the blood-vessels,
of this increased frequency of the heart's action, of this poisoned,
this pathologically changed blood?
As a certain number of years are allotted for the life of man,
so a certain number of heart strokes, of respiratory movements,
are allotted. If the life of a healthy man should extend three
score and ten, or four score years, with the heart beating after
maturity at the rate of seventy a minute, and with eighteen.
respiratory movements in the same length of time; with a
heart beating at eighty and with twenty-one respirations to the
minute, his life from the time of commencement of the excess
would be shortened by about one-seventh. This, in itself,
would seem to many a serious and unfortunate result, but this
is not all. The life, in by far the greater majority of cases
owing to the discomfort produced, is rendered miserable, and
in some instances death, to the individual, and frequently to
his relatives and friends, is a welcome visitor. From overwork
alone the heart would be prematurely worn out.
The diseases resulting immediately or secondarily from the
abuse of alcohol, so far as these organs are concerned, may be
enumerated as follows:
Dilatation of the heart. Hypertrophy of the heart.
6
THE EFFECTS OF THE ABUSE OF ALCOHOL
Endocarditis.
Pericarditis. Valvular disease of the heart.
Fatty deposit on the heart and infiltration of the walls of
the heart with fat. Fatty degeneration of the heart.
Aneurism of the walls of the heart, and rupture of the heart.
Fibroid disease of the walls of the arteries.
Fatty and calcareous degeneration of the walls of the arteries.
Aneurisms of the arteries.
Nasal, pharyngeal, laryngeal and bronchial catarrh.
Pulmonary emphysema. Asthma. Pneumonia.
Pulmonary phthisis. Pleuritis.
We will now attempt briefly to state how these conditions
can be produced by the continued use of alcohol, and the
results arising from them.
DILATATION OF THE HEART.
The fact being established that the first effect of alcohol is
to quicken the heart's action, it can readily be understood how
the walls of the heart may become hypertrophied by this con-
tinual over-action, for the muscular fibres of the heart, like
those of other muscles, are thickened by over-exertion, provided
the nutrition of the organ is good, and, too, it has been estab-
lished, that new muscular fibres are formed in the walls of a
heart that has an excessive amount of work to do, and under
such circumstances we do not look on this hypertrophy as a
disease, but as nature's method of compensating for the amount
of extra labor to be performed. But in habitual drinkers of
alcohol the nutrition of the heart is not good, and particu-
larly if there be inherent weakness from other causes; instead
of the walls becoming hypertrophied from increased growth of
old muscular fibres and the development of new, the muscu-
lar fibres atrophy, and the heart walls during systole are no
longer able to empty the chambers of the organ, which being
partially filled during the diastole, instead of being empty as
they should be, the incoming blood from the veins to the
auricles, and from the auricles to the ventricles, stretches the
relaxed muscular fibres, [and the heart walls become dilated
enlarging the capacity of the chambers. If on the first evi-
dences of heart failure from dilatation of its walls the excesses
4
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
7
be suspended, provided the subject be free from complicating
diseases, the muscular fibres will regain their former strength
and return to their normal condition, but if the excess is con-
tinued the well-known consequences of dilatation follow.
Pulmonary engorgement, over-distension of the systemic veins,
percolation of serum through their walls, general dropsy and
finally death.
ENDOCARDITIS.
C
HYPERTROPHY OF THE HEART.
We have just alluded to the manner in which the heart
walls may become hypertrophied from too rapid action as a
result of the paralysis of the walls of the arterioles, accompany-
ing the early stages of alcoholism, but, as we shall learn later,
there is another stage in which, notwithstanding the paralyzed
condition of the vaso-motor nerves, the lumen of these vessels
is actually diminished, then comes resistance to the emptying
of the heart, and if the nutrition of the organ be fairly good,
compensating hypertrophy gradually takes place, and the
heart in its strengthened condition does good work for a long
period of time, till death comes from the rupture of an atherom-
atous cerebral artery, from the rupture of an aneurismal sac,
from uræmic poisoning, as a result of kidney changes, or from
heart degeneration with pulmonary edema, the pathological
conditions mentioned, as will be seen further on, being but a
portion of a general disease process resulting from the abuse
under consideration.
It is well known that acute inflammation of the endocardium
is a frequent complication of articular rheumatism, and it is
well established that this complication is owing to the presence
of lactic acid in the blood in this disease. Endocarditis is also
a complication of other diseases, characterized by the presence
of acids of a different nature in the blood. It is often found
as a complication of so-called Bright's disease, but there is a
doubt in my mind as to the endocarditis being the result of
the changed condition of the kidneys; rather is it the result of
the poisoned state of the blood which has itself really given
rise to the kidney degeneration. Lithæmic subjects suffer from
fibroid and granular degeneration of the kidneys arising un-
8
THE EFFECTS OF THE ABUSE OF ALCOHOL
doubtedly from the changes which first commence in the walls
of the arterioles of those organs owing to the excess of waste
material (uric acid) in the blood. The endocardium is sensi-
tive to the action of acid poisons, and how common is it for
the blood of persons addicted to the use of alcohol to be loaded
with lithic acid and other poisons, resulting from the oxida-
tion of the alcohol taken into the system. Is it surprising
then that acute endocarditis should result directly from the
abuse of alcoholic beverages? That it does there is no doubt,
for post-mortem examinations in cases of death from acute
acohol poisoning have proved it. The consequences of endo-
cardial inflammation, whether it arise from this or other causes,
are too well known to require mention. In the majority of
cases changes take place in the edges of the valves which.
progress and cripple the heart for life.
PERICARDITIS.
Acute inflammation of the pericardium is almost as common
a complication of rheumatism as endocarditis, but it is not so
easy to surmise the cause as in endocarditis. So is it a com-
plication of lithæmia, and as lithæmia is one of the most direct
and common results of the excessive and prolonged use of
alcohol, we can assert without fear of contradiction that peri-
carditis results directly from the presence in the blood of waste
material and poisonous substances which would not be there
were it not for the excess referred to. In this disease, as well
as in endocarditis, there is probably generally an exciting
cause for its development, but a cause which would be inoper-
ative were it not for the predisposition resulting from the
alcoholic dyscrasia. Although pericarditis is not generally
fatal in its results, adhesions of the two layers almost invaria-
bly follow the absorbtion of the exudation, and the heart is
hampered in its action through life.
VALVULAR DISEASE OF THE HEART.
We have alluded to valvular deformity as a result of the
endocarditis complicating alcoholism. As it is secondary to
endocardial inflammation, so is it late in life a result of the
arterial changes arising from alcoholism which will be de-
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
9.
scribed further on. Atheromatous degeneration of the aorta
near its root readily extends to and involves the segments of
the semilunar valve at the aortic orifice, as a result, deformities
from fibroid growth and calcareous degeneration result. Fre-
quently too, from the narrowing of the lumen of the arterioles
owing to the thickening of their walls to be described later, the
recoil against the aortic valves during diastole and the strain
of the mitral during the systole of the ventricle are so great
that a chronic inflammation results with fibroid thickening,
the newly developed tissue subsequently contracting produc-
ing deformities resulting in insufficiency or constriction or
both. In some instances the valves yield to the pressure.
which they are called on to sustain, and are lacerated. In-
flammation follows and by its consequences adds to the valv-
ular derangement.
-
The result of valvular deformity in every instance, whether
it constricts the orifice or permits regurgitation, is to obstruct
the blood-current at the orifice involved. As a consequence
there is imperfect emptying of the chamber back of this orifice
during the diastole of its walls and dilatation follows; if the
nutrition be fairly good, compensating hypertrophy gradually
takes place, and, to a certain extent, the injury is overcome,
but the patient is crippled for life.
FATTY DEPOSIT ON THE HEART AND INFILTRATION OF THE WALLS.
OF THE HEART WITH FAT.
Although it has been asserted in this article that alcohol in
itself does not form fat in the body, it is notorious that many
habitual drinkers-aud, too, including some who partake of
but little food, owing to the catarrhal conditions of the stom-
ach resulting from their habits-accumulate fat rapidly; par-
ticularly is this true in reference to ale and beer drinkers.
-
Richardson, in discussing this fatty tendency on the part of
habitual drinkers, says: "The fattening may not be due to the-
alcohol itself, but to the sugar or the starchy material that is
taken with it. As a matter of general experience on which I
have tried to arrive at the truth, I am led to the conclusion.
that pure spirit drinkers among men, I mean those who do
not mix sugar with the spirit, and who dislike spirit which is
10
THE EFFECTS OF THE ABUSE OF ALCOHOL
artificially sweetened, are not fattened by the spirit they take.
This tallies also with the observations on the action of abso-
lute alcohol on inferior animals, for they certainly, under that
influence if they are allowed liberty to move freely, do not
fatten. Alcohol when it is largely taken, unless the will of
the imbiber be very powerful, is wont to induce desire for un-
due sleep or, at least, desire for physical repose; under such
conditions there is an interference with the ordinary nutrition
processes. The wasted products of nutrition are imperfectly
eliminated, the respiration becomes slower and less effective,
and there is set up a series of changes leading, independently
of the alcohol as a direct producer of fat, to the development
and deposit of fatty tissue in the body."
In the obese, fat is not alone deposited on the surface of the
body. It is with man, as with animals fattened for market—
the appearance of prize beef is familiar to all-fat nearly every-
where, between the muscles, in and between the muscular
fibres, on the heart, beneath the pericardium, along the edges
of the lungs.
Certain it is that habitual drinkers, particularly those who
confine themselves mainly to malt liquors, grow fat and die
many years before the allotted time of man. Such are found
post-mortem to have fatty hearts.
This condition of a few ounces of fat deposited on the organ
to a certain extent hampers its action; it has a greater daily
amount of work to do, and fails earlier than would otherwise.
be the case. It is not supposed that the muscular fibres them-
selves are weakened by the mere presence of fat around them,
so long as there is no actual fatty degeneration of tissue.
43
FATTY DEGENERATION OF THE HEART.
Although fatty degeneration of the muscular fibres of the
heart frequently co-exists with fatty deposit, it is quite as often
found where there is no undue deposit of fat on the heart,
and it is even said to be rare as an accompaniment of fatty
infiltration.
The causes of fatty degeneration are faulty nutrition of the
organ from a deteriorated or poisoned condition of the blood,
or from improper blood supply resulting from obstruction to
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
11
the current through the coronary artéries. The former is
found where the blood is loaded with waste material resulting
from improper oxidation of effete tissue, and in anæmia re-
sulting from a diminished supply of red blood-corpuscles with
excess of white, and in the same condition resulting from
pathologically changed blood-discs; the latter where there is
insufficiency of the aortic valves with the consequent regur-
gitation during the diastole of the ventricles, and where the
coronary arteries are tortuous and atheromatous.
Each of these pathological states results directly from the
continued use of alcoholic beverages; consequently, as the
effect follows the cause, we are safe in asserting that fatty de-
generation of the heart is not an uncommon result of pro-
longed excess in this direction.
Although it is a mooted question as to whether it is possible
for new muscular fibres to take the place of the old ones which
have become converted into fatty debris (necrosed), all agree
that a heart which has become degenerated to any extent is
in by far the greater majoriy of cases permanently disabled,
and that owing to its enfeebled condition venous engorgement
of the various organs of the body may result, and to such an
extent as to disturb their function sufficiently to be incom-
patible with life itself; or that acute oedema of the lungs, as a
direct result of weakened heart's action, may destroy the life.
of the patient; or that the heart may suddenly fail during its
diastole, owing to shock, or sudden change from the recum-
bent to the upright position, the result of course being instant
death. Several cases of death from fatty degeneration of the
heart, from each of the above causes, have come under the
writer's immediate observation.
ANEURISM OF THE HEART AND RUPTURE OF THE HEART WALLS.
In rare instances fatty degeneration of the heart exists to
but a limited extent. In small areas there is obstruction of
the minute branches of the coronary artery. The part involved
not being properly nourished degenerates, and of course becomes
weakened, and as during the systole of the heart the pressure
is equal in all parts of the ventricle the weakened portion
yields and bulges, as does a weakened portion of the aorta
during systole of the ventricle, it is readily seen that quite a
12
THE EFFECTS OF THE ABUSE OF ALCOHOL
large aneurism may result which eventually ruptures, or the
degenerated portion may rupture on the first extra violent
systole of the ventricle from any cause. Of course death under
such circumstances is the inevitable result. Although these
conditions may not be considered the immediate results of
alcoholism, they are the immediate results of the degenerative
process which can be and frequently is caused by the abuse of
alcoholic drinks.
We now come to the consideration of the most interesting
pathological changes which may result from the long continued
use of alcoholic beverages, viz.: Fibroid disease of the walls
of the arteries, from which some of the conditions already
described are the immediate result. It would carry us too far
were we to attempt to go fully into the consideration of this
insiduous disease which, in by far the greater number of cases
where it exists, results directly from the abuse, the effects of
which we are considering. Hypertrophy of the left ventricle
of the heart which is a constant accompaniment of the form of
Bright's disease known as contracted kidney, was till recently
supposed to arise from the obstruction the blood met with in
its passage through the kidneys, owing to their cirrhotic state,
and the narrowing of the lumen of their arterioles and capil-
laries. It was conceded by all that this condition was a frequent
result of the prolonged use of alcoholic drinks. Recent inves-
tigations have proved that in the disease mentioned, this con-
dition of the arterioles is not confined to the kidneys, and that
the walls of these vessels throughout the entire body are
involved in a general vascular lesion, viz.: hypertrophy of their
longitudinal and circular muscular fibres with hyperplasia of
fibrous tissue cells, the latter involving the capillaries as well,
the connective tissue resulting, subsequently contracting, in
accordance with the general law governing newly developed
connective tissue and narrowing the calibre of the vessels, the
hypertrophy of the heart being nature's method of compensat-
ing the obstruction to the blood current thus produced. Why
is this contraction of the kidneys, this change in the walls of
the smaller arteries and the capillaries, this hypertrophy of
the left ventricle of the heart so frequently found in those who
have been habitual drinkers of alcoholic beverages?
I
f
I
:
ON THE CIRCULATORY AND RESPIRATORY ORGANS. 13
}
We have made the assertion that alcohol is itself a poison.
Entering the blood it produces pathological changes here, the
blood-discs are changed in shape, they are made to adhere to
each other, in some instances clogging the capillaries, their
function as oxygen bearers is impaired. It produces by its
toxic effects cellular changes in every portion of the body,
particularly is this seen in the stomach, the duodenum, the
liver and the endothelial lining of the arteries, the arterioles,
the capillaries and the veins. Thus by its presence alone seri-
ous injuries result, but in addition it interferes with the proper
elimination of waste material," and directly leads to the forma-
tion of excess of uric acid in the blood, more than can be
eliminated or destroyed in the system," by disturbing the
action of the digestive organs, and by interfering with the
functions of the liver and kidneys, and by developing indo-
lent and lazy habits so far as physical exertion is concerned,
all combining to induce excess of waste material in the blood,
and to prevent its proper elimination. A condition of chronic
lithiasis results, precisely similar to that found in gouty sub-
jects who have acquired the disease by inheritance, or by the
excessive eating of nitrogenous food. Gout is frequently at-
tributed to these latter causes, but it will generally be found
on inquiry that in addition, the habitual use of alcoholic bev-
erages has been common with such subjects.
This excess of uric and other acids in the blood acts as a
local irritant to the endothelial lining of the blood-vessels,
finally bringing about the condition mentioned. Degenerative
processes are liable to take place in this newly formed tissue,
first fatty, later possibly calcareous degeneration. What is the
result? As was before stated, the heart suffers through want
of proper food supply, and the conditions already enumerated
follow, for its tortuous and atheromatous blood-vessels cannot
carry and supply the normal amount of blood to its muscular
walls. The walls of the blood-vessels throughout the system
generally are weakened owing to degenerative changes-conse-
quently with an hypertrophied heart back of them pumping
at times with great force, they sometimes yield and aneurismns
result, or during excitement or violent physical effort a vessel
may rupture, particularly is this common in the spleen, in the
14
$1
THE EFFECTS OF THE ABUSE OF ALCOHOL
1
lungs and in the brain, for in these localities the walls of the
vessels are not well sustained by support from the surround-
ing tissues. If in the spleen or lungs hæmorrhagic infarction
results; if in the brain apoplexy, in fact the latter condition
is the most common cause of death in lithæmic subjects who
die in the prime of manhood; later, unless they die of some
disease contracted accidentally, and which, owing to their
lack of resisting power, they have not the strength to withstand,
they succumb to fatty degeneration of the heart, granular
kidneys, abscess of the kidneys, resulting from calculi, stone in
the bladder, cirrhosis of the liver, chronic catarrh of the
stomach, intestines or bladder, or all combined, prostatitis,
chronic bronchitis, pneumonia or pulmonary phthisis, result-
ing directly from the abuse of alcohol.
EFFECT ON THE RESPIRATORY ORGANS.
-
We have already extended our paper so far that we shall
necessarily be brief in what we have to say of the effects of
the abuse of alcohol on the respiratory organs. We beg to
call your attention again to our definition of abuse, viz., habit-
ual use.
Niemeyer says, and truthfully, "Whenever there is hyper-
æmia of mucous membrane, active or passive, the condition
known as catarrh is also more or less distinctly observable,"
and every physician in active practice will confirm the state-
ment of this great pathologist, that "habitual topers almost
always have catarrh of the pharynx in which the laryn-
geal mucous membrane takes a part."
The paralyzing effect of alcohol on the vaso-motor nerves
and the resulting dilatation of the arterioles and capilla-
ries which is general, of course extends to the mucous mem-
brane lining the air passages. We, therefore, have the hy-
peræmia, which is always accompanied to a greater or less
extent by the condition known as catarrh; but there seems to
be an inherent predisposition in some from the same exciting
cause, to catarrh of the pharynx and nasal passages; in others.
to catarrh of the larynx and trachea, and in others to bron-
chial catarrh. In some all of these mucous surfaces are
4
:
*
!
[
ON THE CIRCULATORY AND RESPIRATORY ORGANS.
15
}
#
equally susceptible. Certain it is that nearly all habitual
users of alcoholic beverages suffer to a greater or less extent
from catarrh of one or all of these mucous membranes. Long
continued hyperæmia of a part produces cellular hyperplasia,
consequently in time the mucous membrane is thickened-
hypertrophic catarrh—and still later owing to the contraction
of the newly formed fibrous tissue, we may have the condi-
tion known as atrophic catarrh, in which the membrane is so
pathologically changed that its function is permanently de-
stroyed.
In the larger air passages, aside from disturbance of func-
tion, no serious consequences result, unless there be a predis-
position to tubercular troubles or a syphilitic complication.
Not so in the smaller air passages; their lumen is diminished,
not only by the hyper-secretion, but by the increase of tissue.
Inspiration being an active process, in which many powerful
muscles are concerned, air can readily find its way through
these constricted air passages to the air vesicles; but as it is
expelled from these by the elasticity of the lung fibres alone,
it is readily seen that they will become over-filled and dis-
tended; and later, owing to the pressure of the air on the two
sides of the walls of the vesicles, their blood supply is inter-
fered with, and they atrophy and finally break down, and sev-
eral vesicles are merged into one large air sack, and a condi-
tion of permanent pulmonary emphysema is established.
The results of this condition are too well known to require
but mere mention; permanently diminished vital capacity;
dyspnoea on the slightest exertion; obstruction to the free
emptying of the right heart with consequent dilitation, and
if the nutrition be good, subsequent hypertrophy; but until
this hypertrophy is established, venous engorgement of every
organ of the body, the brain, liver, stomach and intestinal
canal, kidneys, etc., with pronounced disturbance of their
functions. As a direct result, too, even without hereditary
predisposition, owing to nervous irritation resulting from the
bronchitis and emphysema, we have in some, severe attacks of
asthma.
We are all familiar with the etiology of lobular, broncho or
catarrhal pneumonia, we know that in every instance an at-
16
THE EFFECTS OF THE ABUSE OF ALCOHOL.
tack is preceded by a bronchial catarrh, and that this bron-
chial catarrh is the direct cause of the difficulty, aided in some
instances by a predisposing cause, none greater, aside
from a phthisical tendency, than alcoholism, this form of pneu-
monia differing materially from croupous or lobar pneumonia,
the etiology of which is not settled, and which never attacks
a single or a few lobules, but always an entire lobe, and which
is not preceded by a bronchial catarrh, but which is primarily
a lung inflammation.
The latter disease rarely leaves any sequelæ behind; in
nearly every instance it terminates in entire restoration to
health, or death, while lobular pneumonia frequently develops
pulmonary ulceration-necrosis of lung tissue-which is noth-
ing more or less than pulmonary phthisis. If the factors are
present, the result may be tubercular phthisis.
Pleurisy the last condition under our heading, which we have
enumerated as a result of the abuse of alcohol, is always an
accompaniment of chronic interstitial pneumonia (fibroid
phthisis of some authors), which results directly from bron-
chitis, involving the deeper structures of the bronchial tubes
(peri-bronchitis). It is also a constant accompaniment of
pulmonary phthisis, where that portion of the lung covered
by the pleura is involved; but in addition we may have pleu-
ritis primarily as a direct result of the abuse of alcohol.
This latter assertion has been proven by post-mortem examina-
tions in patients who have died from acute alcoholism.
In the writing of this paper, which has been after careful
study of my subject, I have not exaggerated the effects of this
poison. Every statement I have made can be substantiated.
And although I have always been fond of the pleasures of the
table, with all that the term implies, and have suffered from
sundry attacks of gout, which I cannot trace to hereditary
predisposition, and which gave me opportunities for much
needed rest from the arduous duties of my profession, my
investigations have almost converted me to total abstinence.
The half has not been told by me.

22
LITHEMIA
BY
J. W. DOWLING, M.D.,
NEW YORK,
PROFESSOR OF PHYSICAL DIAGNOSIS, DISEASES OF THE HEART AND
LUNGS, AND CLINICAL MEDICINE; NEW YORK HOMEOPATHIC
MEDICAL COLLEGE.
1
NEW YORK :
JOHN C. RANKIN, JR., PRINTER,
34 CORTLANDT STREET.
1886.
),
US
****
•
$
1
7
FUNCTIONAL DISTURBANCES
ORGANIC
AND
DISEASES
ARISING FROM

LITHÆMIA.
Written by special request for the Pennsylvania State Homœopathic Medical Society,
Session of 1886.
BY
J. W. DOWLING, M.D.,
NEW YORK,
AND HONORARY M.D. FROM THE REGENTS OF THE UNIVERSITY, STATE OF NEW
YORK, PROFESSOR OF PHYSICAL DIAGNOSIS, DISEASES OF THE HEART AND
LUNGS AND CLINICAL MEDICINE, NEW YORK HOMEOPATHIC MEDICAL
COLLEGE, EX-PRESIDENT OF THE AMERICAN INSTITUTE OF HOMŒ-
OPATHY, LATE DEAN OF THE NEW YORK HOMEOPATHIC MEDI-
CAL COLLEGE, HONORARY MEMBER OF THE PENNSYLVANIA
STATE HOM. MED. SOC., HONORARY MEMBER OF THE
RHODE ISLAND STATE HOM. MED. SOC., ETC., ETC.
A REPRINT FROM THE
TRANSACTIONS
AND
NORTH AMERICAN JOURNAL OF HOMOEOPATHY.
vid
1
1
1
THE FUNCTIONAL DISTURBANCES
AND
ORGANIC DISEASES
ARISING FROM

LITHEMIA.
Lithæmia is a comparatively new name for a very ancient
and common disease, and patients will accept a diagnosis of
lithæmia and be perfectly satisfied, when, if they were told
they were suffering from irregular gout, they would doubt the
diagnosis, and their confidence in the physician would be
shaken, simply, because in their minds, gout is always associ-
ated with a swollen large toe-joint and pain. No such condi-
tion ever having existed in their cases and believing themselves
to be temperate in their habits, of course in their own minds
they have not and never have had gout.
The term lithæmia was first introduced into medicine by
Murchison, and is intended to indicate conditions resulting
from the presence in the blood of waste material in the form
of lithic acid. It is claimed, however, by some authorities,
that lithic or uric acid never occurs under its own form in the
fluids of the body, but exists in the form of soluble salts of
sodium and potassium; but whether in its own form or in that
of these salts, its accumulation in the blood results from dis-
turbances in the chemical function of the liver, and probably
also from functional or organic disease of the kidneys; for it
is believed that the renal epithelium in health is active in
eliminating uric acid from the blood.
4
Lithaemia.
Although arising from the same cause, a distinction should
be made between gout and lithæmia, and Murchison in his
celebrated Croonian lectures, delivered in 1874, made this dis-
tinction-defining gout as a condition in which the urate of
soda crystallized out into the cartilages of the joints and into
other portions of the body, giving rise to a train of symptoms
familiar to us all, and known and described by all of the
ancient medical writers as gout. Although every gouty sub-
ject at some period of his illness suffers from lithæmia, every
lithæmic subject does not by any means suffer from gout.
The condition which is the subject of this paper has been
known as irregular or non-articular gout, although unfortu-
nately for patients in by far too many cases, owing to its
subtle development and peculiar train of symptoms, the gouty
element has not been recognized.
In considering the functional disturbances and organic dis-
eases arising from the accumulation of lithic acid in the blood,
the questions naturally arise: What is lithic acid? and why this
accumulation in the blood?
In the healthy subject, that great glandular furnace and
chemical laboratory, the liver, is capable of transforming any
excess of nitrogenized matter which may result from metabol-
ism of tissue or exist in the food consumed, into the highly
soluble excrementitious substance known as urea. This
excrement is eliminated from the blood with which it has
become combined, mainly by the kidneys, and to a much less
extent, by the skin. In certain derangements of the liver,
kidneys, and nervous system, but principally of the liver, the
nitrogenous waste is not converted into urea but into uric acid,
a comparatively insoluble excrementitious and toxic sub-
stance. In a perfectly healthy state of the kidneys, this pois-
onous substance is eliminated with the urine, but in its pas-
sage through the urinary tubules, irritation is set up, and if
the quantity be large and the irritation long continued, the
function of the renal epithelium is impaired and it is not prop-
erly eliminated from the system, and consequently, accumu-
lates in the blood.
In perfect health, youth and early manhood, the liver can
be taxed considerably without serious disturbance of its
chemical functions, but in the naturally delicate, and in those
་
{
I
Lithæmia.
5
ill from any cause and particularly during the declining years
of life, this organ will rebel at the most trifling abuse, while
the strongest liver will sometimes revolt against taxation im-
posed upon it by the ingestion of certain kinds of food.
This can readily be illustrated by the combustion of the
principal product of your own State. You Pennsylvanians
know all about coal and furnaces. There are coals which burn
in almost any furnace, leaving as refuse simply fine ashes
which will readily pass through the meshes of the finest grate.
There are others of a cheaper and poorer quality which, after
giving off all that is useful in the way of heat, leave behind a
material known as clinkers, which accumulate in and dis-
turb the workings of the most powerful furnace. So there
are foods which are readily digested, never taxing the most
sensitive stomachs and livers, and leaving behind but little
waste, which must be gotten rid of in the form of excremen-
titious matter. Then there are foods, some of them rich in
nitrogen, which try the strongest digestive organs and leave
behind excrementitious waste which in its elimination, will
severely tax the various organs concerned in its excretion;
food perhaps, which draws so heavily upon the working
powers of the assimilative organs as to seriously impair their
functions, in time entirely destroying them. The more rational
kinds of food which supply all the requirements of the sys-
tem, may be compared to the coal of better quality, the urea
and other readily excreted refuse matter remaining, to the fine
ashes, which, with ordinary care, never accumulate and never
disturb the working of the furnace, until, from the natural
effects of age, it is no longer competent to do even ordinary
work. But it is a fact, familiar to us all, that too large a
quantity, even of good coal at any one time, will clog the fur-
nace and interfere with proper combustion, so will too great a
quantity of good and rational food, at any one time, disturb
the functions of the liver, stomach and intestinal canal.
The poorer quality of coal may be likened to food too rich
in nitrogen and to irrational articles of diet which disturb the
stomach and derange the liver; the refuse matter of the coal,
in the form of clinkers, to uric acid which accumulates in
the system, by its presence disturbing the functions of all the
organs of the body, developing organic diseases in many of
6
Lithæmia.
them and permanently injuring, perhaps ruining, the kidneys
in their efforts to eliminate it from the system. We have all
experimented with such coal in our houses. We have all,
time and again, taken such food into our stomachs. It is no
exaggeration to say that nearly if not all of the cases of that
form of Bright's disease, known as chronic interstitial neph-
ritis, are caused by the presence in excess, in the blood, of this
excrementitious substance, known as uric or lithic acid, and
that by far the greater number of cases of chronic catarrh of
the bladder, in middle and advanced life, and nearly all of the
cases of renal and urinary calculi, result from the same cause.
The comparison which has just been made between coal
and food, and the two waste materials, ashes and lithic acid,
if not supplemented would rather imply that coal and food
were the only factors on which depended the proper working
of the furnace, and the nutrition of the body. Ever since "fos-
sil fuel" (as coal was originally called) was first discovered
and its nature understood, the genius of man has been taxed
to invent and improve upon methods of easy combustion of
this material. Tall and expensive chimneys have been
erected and great pains taken to construct furnaces which
would give out the largest quantity of heat, with the smallest
consumption of coal, until now it seems as if perfection had
been reached. As there are powerful and weak furnaces, so
there are naturally strong and weak livers, stomachs and kid-
neys; weak, not from individual indulgences, but from
hereditary influences, and undoubtedly owing to indiscretions
of parents or their ancestors, for I believe that the divine law,
"The iniquities of parents shall be visited upon the child unto
the third and fourth generations," will apply here as in
iniquities of other and graver nature. In these subjects, even
in early childhood, we have frequently well marked lithæmic
conditions, from inability of the liver to perform its ordi-
nary functions, the lithic acid crystals frequently being found
in the urine, in the form of lateritious deposit or the so-called
brick-dust sediment.
C
A remarkable example of this kind came under my
notice a few months ago. A bright little girl of eight
years of age had suffered, since she was an infant at the
breast, with occasional attacks of loss of appetite, derange-
F
{
Lithæmia.
7
ment of the stomach, constipation, sleeplessness, palpita-
tion of the heart, and unnatural excitability and irritability.
These attacks were always accompanied by diminished flow of
urine, which became cloudy almost before cooling, and finally
deposited a quantity of lithic acid in the form of brick-dust.
As she improved, the urine became free, the deposit disap-
peared, and all of her unnatural symptoms, aside from the
constipation, would subside. During the illness, there would
be no elevation of temperature; the excess of uric acid was
not, therefore, owing to increased metabolism of tissue, result-
ing from fever. The child's father had been a gouty subject
through life by inheritance and personal indiscretions. The
mother was a lithæmic subject, and had been, long before the
birth of this child, the condition in her case resulting from
an indolent, fashionable life, and participation, for a series of
years, with her husband in the pleasures of the table. Neither
father, mother nor child showed, on physical examination,
any evidences of organic disease of any of the viscera. If my
directions with regard to exercise, habits of life, total absti-
nence and diet are carried out, I believe they will all
finally recover; if not, in the "sweet by and by," if they live
to see it, there will scarcely be a sound organ in any of them.
In this case the iniquities of the parents were visited upon the
child, for it had had the best of care, only one mistake having
been made that I could discover, and this was an excessive
quantity of meat with its diet ever since it left the breast.
Heredity as a factor in the etiology of gout has been conceded
since the days of Hippocrates, but unfortunately, with the
inheritence of this tendency to an uric acid producing liver,
comes by heredity and example, a tendency to indiscretions
which would produce the disease in a man perfectly healthy
and born of parents who, with their ancestors, had earned
their bread by the sweat of their brows, and who had always
been too poor to indulge in so extravagant a luxury as the
gout. It has long been known that lead poisoning is accom-
panied by excessive generation of lithic acid and its imperfect
elimination.
There is no denying the fact that a large portion of the ills
to which man, and woman, too, are heir, results from the pres-
ence in the blood of an excess of waste material in the form of
8
Lithæmia.
}
|
lithic acid, and that this excess results, in by far the greater
number of cases, from actual indiscretion, violation of nature's
laws. Many of the so-called cases of neurasthenia-the new
name for the fashionable and flattering disease, nervous pros-
tration or exhaustion--are cases of lithæmia which can be
cured,—this I know to be a fact,-by proper diet, the avoid-
ance of stimulants and drugs, and a proper amount of physi-
cal exercise, and, with some, more brain work, for I believe
that brain work is as necessary to some men as is physical
exercise to others. It is painful to see in our large towns and
cities the number of men and women whose main object in life
seems to be to kill time. Instead of their chronic ailments
arising from nervous exhaustion or prostration, it is more than
probable that they arise from stomach and liver exhaustion.
I have had lazy, indolent and ignorant men and women come
to me with a diagnosis of neurasthenia from mental strain,
who for years, have neither worked brain, legs or arms, the
only muscles which they have ever tired by exercise having
been the masseter; and yet these patients have accepted from
physicians, without cavil, a diagnosis of nervous prostration,
and have been pleased and flattered with the thought. So,
too, with the highly popular disease malaria and malarial
cachexia. Many of these malarial subjects are suffering from
lithæmia, and are cured by the method just mentioned. It is
true that malarial cachexia often complicates lithæmia as it
does other diseases, and the periodic aggravations naturally
lead to a diagnosis of malaria, but if we regulate the habits
and diet of our malarial patients, stop their quinine and restore
the function of the liver, or give nature a chance to do it, the
system will be brought to a proper level of health, and the
malarial poison will be inactive. It is to be remembered that
it is not by any means certain that the periodicity of many of
these so-called malarial conditions is owing to the presence of
the malarial germ in the system. Malarial diseases are not the
only ones characterized by periodic exacerbations. How often
are cases of phthisis mistaken for malarial illness and diag-
nosed as such by attending physicians because the patient has
passed the summer in a malarial section and suffers from a
daily chill, rise of temperature and sweat? We have all seen
cases of phthisis where no careful physical examination had
Y
F
1
Lithæmia.
9
I
been made, the true nature of the malady not having been
suspected till the disease was beyond the control of remedial
measures.
Only a few months ago a lady presented herself at my
office, who for some weeks had had a daily chill appearing
about two P. M., this was followed by subjective heat, lasting
for a few hours and succeeded, about six P. M., by a profuse
sweat. She hesitatingly acknowledged having a hacking
cough and some expectoration, but laughed at the idea of pul-
monary trouble. No such disease had ever been known in her
family. She had been told and was convinced that her trouble
was intermittent fever, and it is not surprising that such a
train of symptoms, without a careful consideration of the
case had deceived the physicians who had treated her. The
quantity of quinine she had taken was enormous, no benefit
had been derived from its use, and at the time of her visit she
was taking large doses of Fowler's solution of arsenic. Physi-
cal examination proved conclusively that the patient was suf-
fering from tubercular phthisis. She has since died.
Another familiar example of periodic symptoms in other
than malarial diseases, is the daily chill, fever and sweat
accompanying extensive suppuration going on in any part of
the body.
It is an established fact that in like manner some of the
functional disturbances known to arise from an excess of lithic
acid in the blood, and that too in patients who have never
been exposed to miasmatic emanations, are most prominent at
certain regular periods of the day.
In what has already been written, I have referred in a gen-
eral way to the etiology of this disease, and have ascribed it,
in the cases not arising from hereditary influences and lead
poisoning, to indiscretions in living. In what do these indis-
cretions consist? In a former article prepared two years ago
for the American Institute of Homoeopathy, entitled "The
Effects of the Abuse of Alcohol on the Circulatory and Respi-
ratory Organs," I considered very carefully the effects of the
indiscrete use of this poison and attributed many of the cases
of organic disease of the heart, arteries and respiratory organs
to a lithæmic condition resulting from its use. Two more
years of extensive experience with these diseases have con-
10
Litheemia.
1
firmed me more and more in my belief that the continued use
of this poison in any of its forms through its primary effect on
the liver, produces organic diseases of all the viscera, which
embitter and shorten life. Aside from its direct toxic effects
on other organs it disturbs the functions of the liver to such
an extent that this organ is unable to convert nitrogenous
waste in the system into urea, and lithæmia is the result.
Next in the order of importance as a factor in the produc-
tion of this disease is the too free use of nitrogenous food, the
liver under such circumstances being unable to convert the ex-
cess into urea. It is true that large quantities of meat have
been taken with impunity by many invalids, and even good
results have followed, but in these cases, all articles of diet
having a tendency to tax or irritate the stomach have been ex-
cluded, and several pints of hot water have been taken daily
with the diet of meat, and have probably prevented the forma-
tion of uric acid or acted as a solvent for it, so that it has not
accumulated in the system.
Then come indiscretions in diet which have a tendency to
disturb the stomach, developing chronic catarrh of that organ
and dyspepsia, by which substances are generated in the
stomach, which, by their absorption and passage through the
vessels of the liver, poison that organ and disturb its function,
so that instead of waste material being converted into urea,
uric acid results, which enters the general circulation and is not
properly eliminated by the kidneys. It should be noted that
authorities now agree that there is an uric acid secreting func-
tion of the kidneys; if the kidneys are injured by the presence
of an excess of this material circulating in the blood-vessels
of their parenchyma or by other causes, changes take place in
the renal epithelium which result in temporary or permanent
loss of the uric acid excreting function. Excessive production
with diminished power on the part of these excretory
organs to eliminate uric acid necessarily results in a perma-
nent accumulation of the poison in the blood.
The next, and a most potent factor, in the etiology of lith-
æmia is an indolent, lazy life-even with a diet of mush and
milk. For the liver to work properly, exercise of the body-
and perhaps of the mind-is imperative; if its function is dis-
turbed, lithæmia necessarily results.
r
1
:
Į
Lithæmia.
11
T
One of the worst cases I ever examined was in a man, a
model man, of most exemplary habits. He never drank, never
smoked, never ate any meat, at least he had been a vegetarian
for years when I saw him, and he supposed there was nothing
left, so far as this world was concerned, to make him perfect
in his habits. He always rode in the horse cars to his business,
sat at his desk writing and counting money till noon, ate a
plain lunch of farinaceous food and fruit in his office, returned
to his desk immediately, worked all of the afternoon, rode to
his home in the cars, ate a hearty dinner of vegetable food,
and spent the evening in his room, except on church nights,
when he always attended divine service. He lived next door to
the church. He amassed a fortune, grew fat, short-winded,
dropsical, and finally died, a bachelor, of fatty degeneration
of the heart. When I saw him, almost his first remark was:
“I can't understand, doctor, why I am in this condition, for I
have led a most exemplary life." The tortuous temporal
arteries and other external evidences showed that he had been
a lithæmic subject for years, the condition having been
brought about by direct violation of nature's laws, by which
the function of the liver and kidneys had been permanently
ruined, the fatty degeneration of the heart resulting from mal-
nutrition of that organ arising from atheroma of the walls of the
coronary arteries and their branches.
-
Functional Disturbances Resulting from Lithæmia.-
With a toxic element circulating in the fluids of the body it is
hardly to be expected that any of the organs should escape its
influences; and a close study of this disease and a large ex-
perience, both in my consultation and general practice, in the
investigation and treatment of lithæmia and the organic dis-
eases resulting from it, satisfy me that such is the case. The
entire nervous system is affected by the presence of this poison
(lithic acid) in the blood. As was before remarked, many of
the so-called cases of neurasthenia are cases of lithæmia, and
can be cured by eradicating this poison from the blood; and
the etiology of many cases of insanity can be cleared up by.
carefully considering the antecedents of the patients as re-
gards the indiscretions of life and hereditary influences, not
with special reference to insanity, but lithæmia, gout, and renal
and urinary calculi.
12
Lithæmia.
The digestive organs always suffer, although the lithæmic
patient may not be aware of the fact, for in the absence of
prominent gastric symptoms, particularly if the bowels are
moved daily, he will hardly suspect derangement of the liver
function, and that of other organs concerned in digestion and
assimilation. Prominent, also, among the functional disturb-
ances arising from lithæmia are derangements of the circula-
tory and respiratory organs, resulting later in incurable
organic disease. The urinary and genital organs in both
sexes, in chronic cases of the disease, are rarely exempt from its
influences. Renal, bladder, and urethral catarrh I have fre-
quently found in men and women, and loss of virile power,
with prostatic enlargement, is a most frequent accompaniment
in the male, and in the female, functional disturbances and or-
ganic diseases of the generative organs occur, while hæmorr-
hoids are common in both sexes.
In Fagge's "Practice of Medicine," under the head of
Hepatic Dyspepsia, may be found Murchison's tabulated
arrangement of the prominent symptoms of this dis-
ease. Bitter or coppery taste in the mouth, especi-
ally in the morning, intestinal hæmorrhage, neuralgic pains,
feelings of oppression and heaviness, creeping sensations,
aching pains in the limbs, lassitude coming on after meals,
sometimes accompanied by irresistible drowsiness, severe
cramps in the legs and in different parts of the body, head-
ache, characterized by a dull, heavy pain, seated in the fore-
head, or more rarely in the occiput, giddiness or swimming in
the head, particularly when the patient stoops or lays his
head upon the pillow, often passing off in the erect posture ;
tendency to grind the teeth during the waking hours, passing
off while the patient is asleep. Convulsive attacks, simulating
epilepsy, are sometimes due to the same cause; noises in the
ears of various kinds, muscæ volitantes, sleeplessness, un-
quiet dreams, depression of spirits, irritability of temper,
palpitations and fluttering of the heart, exaggerated pulsations
in the large arteries. irregularity and intermissions of pulse,
chronic catarrh of the fauces, chronic bronchitis and spas-
modic asthma, pains in the lumbar regions, distention and
tightness in the epigastrium after meals, dull aching in the
right hypochondrium, and sometimes shooting pains in the
Lithæmia.
13
same region; sense of weight and fullness below the ribs,
often increased by lying on the left side; the hepatic region
may even be sensitive to pressure, pain in the right shoulder,
sometimes in the left. Often the conjunctivæ have a slight
yellow tint, and the skin may even display traces of the same
color. The urine is sometimes scanty and high-colored, as it
cools depositing large quanties of lithates of bright red color.
Again, the urine may be clear, large in quantity, and of low
specific gravity. The bowels may be constipated or the
patients may be troubled with frequent semi-fluid discharges.
A common and almost one of the most frequent symptoms of
chronic lithæmia is a disposition to urinate during the night.
It is found, on questioning, that nearly all patients suffering
from this disease are obliged to rise during the night once,
twice, or even more frequently, to urinate, not because the
accumulation is large, but owing, probably, to hyperæsthesia
of the sensory nerves of the bladder, and to the irritating
quality of the urine and its effects either upon the walls of the
bladder or the nerves of the kidneys.
Before considering the organic diseases known to arise
from long continued excess of waste material in the form of
lithic acid in the blood, I will select a few cases from my
record book illustrating the functional disturbances of lith-
æmia, cases which, on physical examination, showed no evi-
dences of organic disease in any portion of the body.
CASE I. Mrs. H., a strong, healthy-looking woman, but with a
superfluity of adipose tissue, fifty-three years of age, living in the coun-
try. Of late years her circumstances have been such that it has not
been necessary for her to do her own household work.
Has a good ap-
petite, eats largely of meat three times a day, and for the past three or
four years has taken a bottle of lager at dinner and another before retir-
ing to bed at night. Formerly active in her habits, but now
takes but little exercise; drives occasionally, but spends most of
her time within doors sewing and reading. Family history good.
Till three years ago always perfectly healthy, with the exception of
an attack of inflammatory rheumatism twenty-five years ago,
from which she entirely recovered. Has had but one child, who is now
seventeen years of age; never had any miscarriages; still menstruates,
of late every three weeks; for two days the flow is quite profuse; at
these times she suffers from great weakness-she thinks from the loss
of blood. Present condition, which has been her general state for
14
Lithemia.
the past three years: Complains of "nervousness," remarkably irrita-
ble for her; annoyed by trifles, constantly depressed in spirits, suffers
from indigestion, with distention of the stomach, belching of wind, and
intestinal flatulency; constipation, is obliged to resort to cathartic
remedies to have a movement from the bowels; sleep disturbed by dis-
agreeable dreams; awakes suddenly from her sleep frightened; rises
in bed, then her heart will beat violently; this subsides after a while,
but it will be a long time before she gets to sleep again, and then her
sleep will be restless and disturbed; always rises two or three times in
the night to urinate, and the urine is high-colored and deposits large
quantities of sediment, sometimes whitish in color, but generally looks
like brick-dust; has occasional attacks of neuralgia, commencing in the
præcordial region, accompanied by violent action of the heart, the
pains passing up over the shoulder and down the left arm, paroxysms
lasting from two to ten minutes; more apt to come on during the
menstrual periods.
By these symptoms her life was rendered miserable. The fact of
the patient having had inflammatory rheumatism, and of her suffering
from paroxysms resembling angina pectoris, prompted me to make a
thorough physical examination of the heart, which was found to be
perfectly normal, as was every organ which could be reached by physi-
cal exploration. The specific gravity of the urine was high (1026),
loaded with lithates, but free from albumen and sugar.
I was inclined to attribute her condition partially to climacteric in-
fluences, but decided to direct my treatment towards a regulation of
the hepatic function, feeling that a woman of so strong a constitution
should pass through the climacteric epoch without serious disturbances.
I ordered total abstinence from alcoholic beverages of any kind, a diet
mainly of farinaceous food, fish and fat bacon, meat in very small
quantities, and never more than once a day, and excluded beef entirely
from her diet, preferring lamb, the breast of chicken and turkey. I
ordered exercise, a brisk walk (rain or shine), moderate at first, but in-
creasing gradually till she could walk five miles a day, and large
draughts of hot water four times a day.
It is now twelve months since she came under my care. Her
menses still continue, but the quantity of blood lost is much dimin-
ished. She has had none of the paroxysms of "neuralgia." She sleeps
well without dreaming; her bowels are regular, her urine free from
deposit. Her appetite and digestion are good. She has no more flatu-
lency. She does not suffer from depression of spirits or nervousness.
In fact, she is a well woman. The only remedies she has taken are nur
vomica and berberis. She has followed my directions carefully, and still
Lithaemia.
15
continues the mode of life I laid out for her at my first examination.
This was a typical case of lithæmia, resulting from luxurious, lazy liv-
ing, with indiscretions in eating and drinking, cured by regulating her
habits of life and assisting nature by homoeopathic remedies, indicated
by her condition and symptoms.
My remedies received the credit, but the cure was effected
by the change in her mode of life. The vis medicatrix naturæ
was strong enough, with a little assistance, to effect a perfect
cure if it could only have an opportunity, unhampered, to
make the effort. It is not always that patients will adhere so
religiously to a doctor's prescriptions. You have all heard the
story told of Abernethy, who had been trying in vain to relieve
a distinguished but gouty nobleman of ailments arising from
the indiscretions of life. "I should advise you, sir, to steal a
horse," the doctor said. "What do you mean, doctor? I did
not come here to be trifled with." "I am not disposed to trifle
with anyone, sir. Steal a horse." "Why, doctor, what do
you mean?"
"I mean, sir, if you steal a horse you will be
put where you will have proper food, a proper amount of ex-
ercise-where you will be obliged to retire at the proper time.
for going to bed, and be compelled to rise early in the morning
and go to work. In brief, you will be placed where you will
be made to lead a decent, rational life; and this is all that is
needed to make a well man of you, sir. Steal a horse.
""
CASE II-A lady of great refinement, surrounded by every luxury
which wealth could afford, the wife of a good husband and the mother
of a large family of children, all grown. The history of her case was as
follows:
Never had employed a homeopathic physician; in fact, one of her
sons was an old school doctor. Family history good. Had had no ser-
ious illness, and had been well till within the past five years, during
which time she had been a confirmed dyspeptic; was nervous, depressed
in spirits, sleepless, generally constipated, but occasionally troubled
with diarrhoea; suffered from a dull pain in her head during the first
half of every day; weak and unable to exercise on account of severe
pain in the lumbar region; a bearing down sensation in the lower por-
tion of her abdomen; inability to take much food on account of dis-
tress in the stomach, which comes on after eating, and described as a
feeling of distention and weight, and accompanied by belching of
wind; occasional cramps in the abdomen, generally confined to the left
side beneath the ribs; dull pain and fullness in the right hypochon-
16
Lithæmia.
drium; tongue swollen and covered with a slimy fur; rises at least
twice every night to pass water, and the urine is always dark-colored,
and deposits a thick, reddish sediment.
Physical examination showed no evidences of organic disease, but
the finger-joints were enlarged from deposits of urate of soda. For
some weeks prior to my being sent for she had been confined to her
room, the most of the time to her bed, with diarrhoea and its debilitat-
ing effects, each passage being preceded and accompanied by pain in
the bowels. She had been under the care of an old school physician,
who had prescribed astringent remedies and opium for the looseness
of the bowels, and brandy and hypnotics of various kinds for the sleep-
lessness, which had been very distressing of late. I learned that for
many years it had been her custom to drink wine with her dinner, and
in addition to this she had taken a little whisky or brandy before
meals for the dyspepsia.
The character of the urine, the enlarged finger-joints, and the gen-
eral symptoms led me to a diagnosis of lithæmia. In the management
of her case I stopped all of the paliative drugs, cut off the brandy and
wine and placed her on a diet of milk and farinaceous food, cutting off
all meat. Of course for a few days she missed the palliative drugs and
the stimulants she had been accustomed to; then, with an occasional
dose of the remedy indicated by her symptoms as they showed them-
selves from day to day, she commenced to improve. In six weeks from
the time she came under my care she was comparatively a well woman.
Nearly all of her distressing symptoms had disappeared, the urine had
cleared, and she was having one natural movement from the bowels
each day. The patient remains well. In the absence of other causes,
I attributed her lithamic condition to disturbances mainly resulting
from her daily allowance of alcohol, the palliative drugs she had taken,
and to excess of nitrogenous food, for she had been a hearty meat-eater
through life, and I attribute her recovery to the entire change made in
the mode of life.
These are but two of many such cases which have been
treated or examined by me during the past few years. And I
am not exaggerating when I say that in the absence of organic
disease, if the patient is willing to follow directions as to exer-
cise, diet and mode of life, with but little aid from medicine all
can be entirely cured.
Of course where organic disease results from lithæmia the
case is different. Such patients cannot be cured, but many of
the cases are, to a certain extent, amenable to treatment with
Lithaemia.
17
I
the result of arresting the progress of the disease and improv-
ing the general condition so that life instead of being a burden
is at least endurable.
Among the organic diseases known to result from lith-
æmia or, what in this connection is the same thing, from high
living--indiscrete living-including the long continued use of
alcoholic beverages, even in small quantities, intemperance in
eating, sedentary habits, long continued mental strain and
worry, may be mentioned first and most common, chronic in-
terstitial nephritis, chronic catarrh and hypertrophy of the
walls of the bladder, chronic prostatitis, chronic pyelitis-
from the accumulation of lithic acid crystals and the forma-
tion of renal calculi in the pelvis of the kidneys—stone in the
bladder, atheroma of the arterial walls in various parts of the
body with its terrible consequences, including hypertrophy of
the muscular walls of the heart, although this latter condition
can hardly be called a disease, for in every instance it is com-
pensatory, in that it compensates for the narrowing of the cali-
bre of the arterioles resulting from fibroid changes and
obstructions owing to atheromatous changes in the walls of
the larger vessels, aneurisms, large, small and capillary, the
latter particularly in the substance of the brain which, by their
yielding, result in cerebral hemorrhage, the apoplectic attack
being sometimes the cause of sudden death, valvular disease
of the heart and peri and endocarditis, fatty degeneration of
the heart walls-a most common cause of death in lithæmic
subjects--chronic pharyngeal, laryngeal and bronchial catarrh
resulting from the latter, pulmonary vesicular emphysema,
broncho-pneumonia and chronic interstitial pneumonia or the
so-called fibroid phthisis, and finally various chronic diseases
of the stomach and intestinal canal, hæmorrhoids and fistula.
in ano.
And I am convinced from observation of cases which
have been under my own care that many serious organic dis-
eases of the nervous system result from lithæmia.
Two cases
of progressive locomotor ataxia which I have treated have, in
my opinion, resulted alone from this cause.
If time would permit I could give you examples of all of the
organic diseases mentioned resulting, I am positive, from lithæ-
mia, all having been under my own personal observation and of
which I have kept an accurate record, but my paper is already
18
Lithæmia.
too long, and I will cite but three, two of organic disease of
the heart and one of the kidney.
CASE I-In September, 1881, I saw, in cousultation with Dr. Pratt,
of New York City, a gentleman, thirty-nine years of age. He appeared to
be in good health, but complained of symptoms which led me to a careful
examination of his heart. The walls of the left ventricle were hyper-
trophied and there was a double murmur at the aortic orifice, systolic
and diastolic, showing constriction of the orifice with insufficiency of
the valve. The urine was albuminous and he subsequently died of
fatty degeneration of the heart, the death process being slow and tedi-
ous-the immediate cause being pulmonary edema.
The history of this man's case was as follows: Family history :
father died of apoplexy at the age of fifty-nine; mother living and well;
no history of disease in the family likely to be hereditary.
Personal history: Started out in life with a strong constitution ;
never suffered from any serious illness aside from those of childhood,
from which he recovered nicely; always strong and equal to any
amount of mental or physical work. From time to time for some years
past has had symptoms which he supposed arose from malaria, and for
which he took large doses of quinine. From boyhood has had a good
appetite and has always eaten largely of meat. For many years has
been in the habit of drinking wine with his dinner, and brandy or
whisky at all times during the day or evening when the opportunity
offered. "Never was drunk in his life." Never had rheumatism or
gout. An active politician and a leader, a few months prior to his visit
to me, he passed through a very exciting campaign, and on the occa-
sion of a political parade had the entire work of the arrangements
on his shoulders, and he was on horseback from seven A. M. till two
the next morning. For an hour before dismounting had a pain across
the sacrum; this increased in severity and was painful all the next day.
This was followed by violent action of the heart, dyspnoea on exertion
and oedema of the feet. His progress was steadily downward, and he
died in the following fall of fatty degeneration of the heart as above
stated.
He had complained of many of the symptoms of lithæmia; for years
had risen two or three times in the night to urinate, and the urine was
generally high colored and frequently deposited a reddish sediment.
This man had undoubtedly been a lithæmic subject for years, and
in the absence of other common causes of valvular disease of the heart
it is fair to presume that his organic disease resulted from fibroid
changes at the root of the aorta extending to the valve and this was
brought about by lithæmia. His habits of life were one constant viola-
Lithæmia.
19
tion of nature's laws; the exciting cause of the final breaking down
being long continued over-exertion, mental and physical.
CASE II.—The case I am now about to relate has not as yet had so
serious an ending. And from a proper diagnosis having been made,
and the fact that the patient has been convinced that the cause of his
troubles was indiscretions of various kinds, the conviction has led him
to an entirely different mode of life, I am hopeful from his present im-
proved state, that he may be spared in fair health for many years to
come, although he can never be perfectly well, and is liable at any time
from an error in diet to have a return of his symptoms, and an aggra-
vation of his disease which may result fatally.
The history of the case is as follows: Family history: father gouty,
suffered from sciatica during the latter years of his life, and finally died
of softening of the brain. Mother always well and lived to a good old
age.
Until two years ago the patient had been in the enjoyment of good
health as he supposed. Suffered from insomnia at times, and occasional
nervous symptoms and dyspepsia, but these were generally relieved by
palliative drugs and alcoholic stimulants. For over twenty years had
been a heavy drinker of wine and the stronger alcoholic beverages.
"Never was intoxicated."
Three years prior to my examination, while at the theatre, was
seized with a severe pain in the back; relieved by an hypodermic in-
jection of morphia. Recovered from paroxysm and seemed in his usual
health, aside from occasional slight pains at the seat of the original
trouble. One year from the date of the first attack, was again taken
with the same character of pain, confined to the region of the right
kidney; this was accompanied by nausea and vomiting. From that
time on for two years was never well; constant pain extending entirely
through the abdomen to a point about two inches below the margin of
the ribs. Sometimes these pains would be very severe, sharp and cut-
ting, then they would become modified, but never entirely leave him ;
the liver, also, was sensitive and painful on pressure. He was always
nauseated, his appetite was poor, and only the simplest kinds of food
were retained, his skin became sallow, he lost flesh, and his nights were
deprived of continued sleep. He was unable to attend to business, and
longed for death.
Brandy and whisky were continued, for they were
the only things which afforded any relief. Old school physicians pre-
scribed palliatives but with no permanent benefit. After a careful
examination of his case I gave a diagnosis of pyelitis with great enlarge-
ment of the right kidney; this enlargement I could make out by palpa-
tion, and an examination of the urine showed pus-corpuscles and blood-
20
Lithæmia.
discs in abundance, with large quantities of lithic acid crystals. The
urine, also, contained albumen in greater quantities than could be ac-
counted for by the pus and blood-globules, no casts were found. Bry-
onia³ was given and electricity administered [faradic current], one elec-
trode being applied over the affected kidney and the other anteriorly
at the seat of the pain. Much to my surprise he passed a compara-
tively comfortable night, sleeping fairly well and having but little pain.
The following morning he passed, with his urine, large quantities of
lithic acid in the form of a coarse brick-dust sediment. This had evi-
dently been impacted in the pelvis of the kidney, I placed him on a non-
nitrogenous diet, and deprived him of everything in the form of alco-
holic drinks, and of course, stopped all palliative drugs. His improve-
ment has been steady. A year has now elapsed; during this time he
has had two attacks of renal colic but at the present time thinks he is
in fair health. Under date of August 11th he wrote me: "For a well
man I am well; for me splendid." His urine, however, still contains
pus and albumen, showing that he is by no means a well man. From
this condition of chronic pyelitis he will probably never recover, but
with his present careful mode of life he may live for many years in com-
parative comfort.
CASE III.-Since commencing this article the sister of this gentleman
has placed herself under my care. She has a history of excess in the
use of wines, and of nitrogenous food, sleepless nights and dyspepsia
for years.
No serious illness till the present one, which she describes
as follows:
On July 3d was taken with a severe pain in the back of the neck,
which extended to the head. Shortly after this, in the night, was
seized with a dreadful pain in the præcordial region, coming on in
paroxysms. She could not breathe for the pain; at times it would ex-
tend to the back and dart through the entire spine. This lasted for
some six weeks, with intervals of freedom from pain. This has now en-
tirely left her, but she is troubled with great shortness of breath, on
the slighest exertion; had to stop several times in coming from the
horse cars at the corner to my office, a distance of not over one hundred
feet. She has a feeling of dreadful oppression in the præcordial region,
with violent, irregular and rapid action of the heart; complains also of
numbness in the hands and feet.
The patient is well nourished, hair of an iron-gray color, although
she is only forty-six years of age, menstruates regularly. The urine is
scant, contains no albumen, but is very thick and loaded with lithates.
Physical examination showed her to be suffering from stenosis of the
aortic orifice of the heart, with all of the evidences of fatty degeneration
Lithæmia.
21
།
of the heart walls. There was a fatty arcus senilis on the upper border
of the cornea, and the pulse at the wrist was scarcely perceptible, rapid
and very irregular. She will, in my opinion, never rally.
Both of these patients had been suffering from lithæmia for
years, largely brought about by their own indiscrete living,
but partially owing to hereditary predisposition, the father, it
will be remembered, having been a gouty subject through
life. Possibly the first case was aggravated by hereditary
taint, for the father had died of apoplexy, and this usually in-
dicates a previous life of excess in eating, drinking, etc.
In the treatment of lithæmia and the organic diseases re-
sulting from an excess of lithic acid in the blood, we some-
times have to arrive at a diagnosis by exclusion. There is a
cause for every morbid condition, and there are habits of life,
atmospheric influences and occupations, which give rise to
certain diseases and aggravate them if they already exist.
The first step towards treatment is to make a positive diag-
nosis, then to see if we can learn the causes of the disease, and
to learn whether the life of the patient is such as to permit us
to labor untrammelled with our remedies and measures for his
relief. Then we should correct the mode of life, if we find need
of it, and insist upon the patient aiding us by his own efforts
to effect a cure, if a cure be possible, or to arrest the progress
of the disease, if it is of an incurable nature, and thus make
his life as comfortable as can be under existing adverse cir
cumstances.
If a patient consults us suffering from the symptoms given
above, or from any of the organic diseases mentioned, we
should make careful inquiries to learn if other known causes
exist. If we find they do not, on further inquiry we will
learn of indiscretions which have given rise to or are aggra-
vating the condition, and a careful examination will lead us
to a diagnosis of hepatic disturbance, by which waste material
in the blood, instead of being converted into urea, which is
readily eliminated, is by imperfect oxidation converted into
lithic or uric acid, and retained in the fluids of the body. The
treatment is then simple enough: Correct indiscrete habits
of life, lay out a proper course for the patient to pursue, and
help nature by the administration of the carefully selected
homoeopathic remedy. If in doubt as to the special mode of
22
Lithæmia.
life and diet in an individual case, advise, on general princi-
ples, a life and diet which we know to be harmless, as did the
pioneers of homœopathy. Professor Small used to say to us
in the lecture room: "Gentlemen, if you are in doubt as to
the remedy in an individual case give sulphur high. It is a
general corrective and can do no harm, and it is more than
likely it is just the remedy the patient needs."
In closing this subject of treatment, and with it this paper,
I propose asking a pointed question: Are the average homeo-
paths of to-day as successful in the treatment of disease as
were the pioneers of half a century ago? By contrast with
the results accomplished by the old school of now and then,
certainly not. If this is conceded, the question naturally
arises, Why? Many factors will enter into the answer to this
question. The first and most cogent reason is undoubtedly
the revolution which has taken place in the treatment of dis-
ease by members of the old school. All familiar with the
history of medicine for the past half century know in what
those changes consist. Far into the period mentioned the
generally conceded irrational, violent, murderous system pre-
vailed. Then came the expectant, and now the physiological,
largely mixed with the homeopathic system, is adopted by all
of the old school who are abreast of the times.
Then, again, I believe the change, so far as contrast is con-
cerned, is partially owing to the fact that the members of our
own school are not, as a rule, as careful in the selections of
their similimums; instead of studying the materia medica,
they read the old school journals. Then our improved know-
edge of pathology is perhaps another factor, and this in itself
will, to a certain extent, excuse the laxity which exists among
some of our practitioners with regard to the selection of their
remedies in accordance with the homoeopathic law of cure.
There are those present who will perhaps disagree with me in
the belief that this can, under any circumstances, be an ex-
cuse, but with some it is hard to reconcile certain supposed
pathological laws with the law propounded by the father of our
school--the law by which, as homœopaths, we profess to be
guided. The temptation to resort to physiological pharma-
ceutics with such is very strong.
Another, and by no means the least important, factor in
Lithæmia.
23
the cause of the lessening of the contrast in the results of
treatment, so far as the two schools are concerned, is the fact
-for it is a fact that the average homoeopath of to-day is
not as careful in the dietetic rules laid down for his patient as
was the pioneer. Then, printed rules, general rules, were
given to every patient; certain articles of food and drink
were strictly prohibited, in the minds of the patient and, too,
in that of the physician in many instances, because these
articles would antidote the medicines given. On this ground
patients were willing to abstain from tea, coffee, condiments
of all kinds, tobacco, alcoholic beverages and palliative drugs.
It is a pity that this idea does not prevail at the present time,
for, although the articles mentioned may not antidote the
drugs, they certainly do interfere with the health of the
patient, and too frequently are the cause of the very diseases
we are endeavoring to cure.
As homœopaths, we claim that God has given us a law for
the selection of drugs by which all curable diseases may be
cured, but has He not also given us laws with regard to diet
and habits of life, which, if violated, sooner or later lead to
disease? Is it rational for us to prescribe, in accordance with
one Divine law, medicines to cure a train of symptoms result-
ing from the violation of another Divine law, while that law
is still being violated? Certainly not. In studying the patho-
genesis of drugs, let us study hygiene, and then from posi-
tive knowledge lay down our rules and endeavor to see that
they are followed. Make our patients follow the good old
rule—eat and drink each day what is necessary to satisfy the
requirements of the system, those requirements being merely
to replace in the body what is lost by muscular contraction,
mental work, etc. And in enforcing these rules upon our
patients do not let us forget that we will be better men, better
husbands, better fathers, better Christians, better doctors, if
we follow them ourselves.


23
IS THE AMERICAN HEART
WEARING OUT?
BY
shm
J. W. DOWLING, M.D.,
NEW YORK,
PROFESSOR OF PHYSICAL DIAGNOSIS,
DISEASES OF THE HEART AND LUNGS
AND CLINICAL MEDICINE; NEW YORK HOMEOPATHIC
MEDICAL COLLEGE.
(Read before the New York State Homœopathic Medical Society, Sept. 11th, 1888.)
NEW YORK:
1888.
KANSA
:
;
וי
15
!
IS THE AMERICAN HEART
WEARING OUT?
(Read before the New York State Homeopathic Medical Society, Sept.
10th, 1888.)
BY
J. W. DOWLING, M. D.,
NEW YORK,
AND HONORARY M.D. FROM THE REGENTS OF THE UNIVERSITY, STATE OF NEW
YORK, PROFESSOR OF PHYSICAL DIAGNOSIS, DISEASES OF THE HEART AND
LUNGS AND CLINICAL MEDICINE, NEW YORK HOMEOPATHIC MEDICAL
COLLEGE, PHYSICIAN TO THE NEW YORK HOMEOPATHIC HOSPITAL,
CONSULTING PHYSICIAN TO THE HAHNEMANN HOSPITAL, NEW
YORK, EX-PRESIDENT OF THE AMERICAN INSTITUTE OF
HOMEOPATHY, LATE DEAN OF THE NEW YORK HOME-
OPATHIC MEDICAL COLLEGE, HONORARY MEMBER
OF THE PENNSYLVANIA STATE HOM. MED. SOC.,
HONORARY MEMBER OF THE RHODE ISLAND
STATE HOM. MED. SOC., ETC., ETC.
1888.
azmenoutdoor daam, Tan LAKE, ANAK ......
2'、,# - “v,
paga
→
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!
&
IS THE AMERICAN HEART
WEARING OUT?
THE
HE community, in many instances the nation, has been
so frequently shocked of late by announcements of
sudden deaths of men high in public and social position, from
diseases of the heart, that it seems not surprising that the
question should be asked: "Is the American heart wearing
out?" Why are these men thus smitten in the prime of man-
hood, in the prime of usefulness, in many instances without
even the opportunity of giving a parting word to loved ones
and friends? Certain it is, that disease of the heart is more
common amongst us than formerly, or that the physician of
the past failed to recognize this malady when it did exist. In
the majority of cases of sudden death the diagnosis of disease
of the heart is accepted without comment, without surprise,
notwithstanding the announcements made, that up to the
time of his death the deceased was apparently in the best of
health. It is rare that an investigation is made as to the cause
of this disease of the heart, or the question asked, why this
cardiac disease remained undiscovered till death had placed
it beyond the power of man to arrest its progress. No well-
informed physician will claim that the sound heart becomes
diseased suddenly, or that even the most obscure disease of
that organ has not associated with it certain physical signs
which will enable the expert diagnostician to recognize its
existence. Scarcely a day passes but the morning papers con-
tain obituary notices of which the following extracts are
samples :
"On Thursday he went to his office feeling quite well, but
on getting up yesterday was so weak that he returned to bed,
and died in a few minutes. The cause of death was heart
disease."
-
4
"He retired to bed at night apparently in his usual state of
health, and was found dead in the morning. The verdict of
the coroner's jury was, 'Death from disease of the heart.'”
"On Tuesday last he contracted a cold, but attended to his
duties as usual till the last of the week, when pneumonia
developed. He grew rapidly worse, and died on Monday, the
immediate cause of death being failure of the heart."
"He sailed from this country in February last in the best
of health. He stood the journey well, and was apparently as
well as usual till last night, when he was stricken with heart
disease and died."
"He left New York but a few days ago for a pleasure trip.
As he was about retiring for the night after a fatiguing
journey, he fell suddenly to the floor from a stroke of apoplexy.
He lingered till last evening, when he breathed his last. It is
supposed that for some time past he had been suffering from
disease of the heart."
66
Died, this morning, from a complication of maladies, in-
cluding trouble with the heart and Bright's disease of the
kidneys. Although he had been confined to the house for
several weeks, his death came unexpectedly to his family."
The object of this paper is to fathom, if possible, the causes
of this terrible mortality from diseases of the heart to call
attention to the indiscretions of life which give rise to certain
forms of this malady; to show how patients suffering from
organic disease of the heart may, by their own unaided efforts,
prolong their days in comfort, in many cases even beyond the
allotted life of man; to account for heart-failure as the imme-
diate cause of death in many accidental and infectious dis-
eases which, without this factor, would be recovered from;
and to explain intelligibly some of the most common forms
of diseases of the heart, and to correct certain misconceptions
with regard to them; for, in the minds of the laity, the idea is
firmly fixed that there is but one form of disease of the heart,
and that invariably fatal. Physicians, too, until they have
watched patients known to be suffering from serious valvular
disease of the heart, and seen them live, perhaps for years,
enjoying the ordinary good health of the average healthy
individual, and until they have studied and become convinced
of the compensating power of nature, untrammeled, in over-
?
5
coming obstacles to the free circulation of the blood, continue
to look with feelings of great anxiety on those of their patients
and friends over whose hearts they have discovered a valvular
murmur.
In order that those attracted by the title of this article, who
believe themselves to be suffering from disease of the heart,
may peruse these pages without palpitation of that vital organ,
I will commence the consideration of my subject with the
positive assertions, founded on an experience covering nearly
a third of a century, of which many years have been
largely devoted to the special study and teaching of diseases
of the heart and lungs, that cardiac disease is not invariably
fatal; that many apparently grave forms are entirely recovered
from; that enlargement of the heart is not in itself a disease,
but on the contrary is salutary, inasmuch as it is nature's
method of overcoming obstacles to the blood-current, either in
the heart or elsewhere, this very enlargement, accompanied as
it is by increased power owing to the development of additional
muscular fibre, sometimes compensating entirely for the ob-
stacle; that with serious valvular disease developed in child-
hood, patients have been known to live to be aged men and
women, the fathers and mothers of large families of children,
in some instances, to the writer's personal knowledge, sup-
porting these families by manual labor requiring at times great
physical exertion and mental strain; that with a large majority
of those supposed to be suffering from heart disease, that organ
is in reality perfectly sound, and, if affected at all, is suffering
secondarily to functional disturbances of organs remote from
the heart, disturbances which are curable by proper and not
too severe hygienic measures; and lastly, that whenever the
attention of the patient is called to his or her heart by symp-
toms which lead to the conclusion in his or her mind that he
or she is suffering from organic disease of that organ, the
chances are ninety-nine out of a hundred that the heart is per-
fectly sound. This last assertion will apply with equal force
and truth to the lungs, brain and kidneys.
Diseases of the heart may be divided into two general
classes: those originating from an inflammatory process
within the heart, and those originating from without. The
former result from an inflammation of the lining membrane of
de
6
the heart, endocarditis; the latter from (1) an extension of a
chronic form of inflammation of the walls of the main artery
of the body to the segments of the aortic valve which prevents
the return of the blood from this vessel into the cavity of the
left ventricle; (2) from an extension of this inflammatory pro-
cess to the walls of the blood vessels which nourish the organ,
the coronary arteries; (3) from the immediate contact of a
toxic element in the blood with the walls of the vessels which
nourish the heart, resulting in changes in those vessels which
interfere with the nutrition of the organ;* (4) from a dimin-
ished amount of the normal ingredients of the blood in the
general circulation, which weakens the heart walls from
faulty nutrition, and permits them to dilate, often to such an
extent as to render the valves at the various orifices incom-
petent to close them; and (5) from great physical strain which,
by compressing the small arteries of the body, obstructs the
blood-current, thus overdistending the cavities of the heart
and resulting in dilatation of its walls.
Added to these, may be mentioned certain nervous affections
of the heart which are secondary to disturbances elsewhere, and
which subside with the removal of the cause.
The first class of diseases of the heart, those originating from
within, are common to all periods of life, but occur more fre-
quently prior to manhood or womanhood, and involve almost
exclusively the left side of the heart, and more frequently
the mitral valve, or that which lies between the auricle and
ventricle of the left side, and which, during contraction of the
latter, closes and prevents the return of blood into the auricle
above. They result from an inflammation of the lining mem-
brane of the organ, the endocardium. This inflammation, en-
docarditis, is a complication of various acute diseases, which
are characterized by the presence of certain acid poisons in the
blood. Chief among these diseases is inflammatory rheumatism,
or rheumatic fever of some authors. About thirty per cent. of
* When this arterial change exists in the walls of the heart, it is never con-
fined to this organ alone; it is a general process, and in some of the vital
organs, particularly the kidneys and liver, produces serious changes by develop-
ing an adventitious tissue-growth which ultimately seriously impairs the func-
tions of the organs, Bright's disease of the kidneys and certain chronic liver
diseases being the result. These are an accompaniment of, and go hand in
hand with, heart disease resulting from this arterial change.
f=
7
all cases of inflammatory rheumatism are complicated by in-
flammation of the lining membrane of the heart. The inflam-
mation is more intense along the edges of the valves, from the
fact that the sudden closure of these valves brings the margins
of their segments into forcible contact with each other; this
occurring so frequently, from one hundred to one hundred and
fifty times to the minute in febrile conditions, it is readily seen
that on the edges of these segments the inflammation would be
most intense, owing to this additional cause of irritation. The
valve tips become infiltrated and swollen, and soon develop a
growth of fibrous tissue-adventitious tissue. As the inflam
mation subsides, this newly-developed tissue contracts, chang-
ing the shape and size of the segments, with the result, either
of rendering the valve imperfect or of narrowing the orifice, or
both. Thus is established a permanent deformity of the valve or
orifice, “valvular disease of the heart," the result being per-
manent obstruction at that point. If the nutrition be good.
the walls of the heart, back of the deformed orifice or valve,
thicken by the growth and development of new muscular fibres;
the heart is strengthened, and the obstruction is, to a certain
extent, overcome. This condition of the muscular walls of
course causes enlargement of the heart, which, as was before
stated, although the result of disease causing obstruction
to the blood current, is not in itself a disease process, but
Nature's method of overcoming obstacles to the circulation of
the blood. A patient suffering from valvular disease is crip-
pled; but, if the nutrition of the heart be good, by avoiding
indiscretions and adopting an occupation that does not require
great physical strain, by living on a level, as it were, life may
be prolonged in comfort for many years. All are liable to the
diseases producing this form of heart lesion, whether their
lives are good or bad, discreet or indiscreet, but not equally
liable by any means. A good and discreet life adds to the re-
sisting power against disease-producing influences, and to the
powers of endurance, while a bad and indiscreet life reduces
the vitality and resisting power. Those following the latter
course are much more liable to suffer by exposure to infection,
to sudden change of temperature, and to other disease-produc-
ing influences.
The second form of cardiac diseases, or those originating
from without the heart, are, save in exceptional cases, the
8
direct result of hereditary influences, or of indiscretions in life,
and, by proper knowledge and precautions, can in the majority
of cases be avoided; or, if already established, checked in
their progress. The portion of this article relating to the in-
discretions which give rise to disease processes, which result
in premature wearing out of the heart, should be carefully
considered, for it is from its perusal that possible good may
come, disease be warded off, and life be prolonged. Of late
years, physicians have paid more attention than formerly to
the preventable causes of disease of the heart and of other
organs of the body, and the time will come when a careful
study of the etiology of the form of disease under considera-
tion will enable the physician so to direct such of his patients
as are willing to be guided for good, that these diseases will be
arrested in their progress, and often, in those predisposed to
them, be prevented, and later this very predisposition may be
done away with.
There is a cause for every morbid condition, and the man
who discovers these causes, if he have the magnetism to draw
around him ardent followers who, for the love of man, will
disseminate his knowledge, will be a greater than Hippoc-
rates, a greater than Galen; for although all concede that
the calling which enables one to relieve suffering, and to cure
curable diseases, is a noble one, they will concede that one
which will enable man to prevent suffering and prevent incur-
able disease is far more noble.
-
A terrible bugbear to every one who is fat and short-winded,
and who suffers from occasional attacks of pain in the region
of the heart, or from palpitation, is fatty degeneration of the
heart. It is needless to say, that a person may be fat and still
enjoy perfect health, and that the above-mentioned symptoms
associated with obesity are no evidences of this malady, which
certainly does destroy many valuable lives. A distinction
must be drawn between fatty degeneration of the heart and
fatty heart. In the former there is a degenerative change in the
muscular fibres of the heart, a greater or less number of them
being converted into fat. In the latter, there is a deposit of
fat on the walls of the heart and between its muscular fibres.
The two conditions may co-exist. The causes of fatty degen-
eration are faulty nutrition of the organ from a deteriorated or
9
poisoned condition of the blood, or from improper blood sup-
ply resulting from obstruction to the current in the blood ves-
sels that nourish the heart. The first cause will account for
degeneration found where death has resulted from acute or
chronic infectious febrile diseases, such as typhoid fever or
pulmonary consumption; or from the various diseases in which
there is a positive and permanent deleterious change in the
constituents of the blood, as in progressive pernicious anæmia,
Bright's disease of the kidneys, and certain progressive dis-
eases of the spleen and lymphatic glands. The second cause
will account for degeneration when the blood vessels supplying
the heart, as a part of a general disease process of the arteries
throughout the body, have become tortuous and changed by
an inflammatory or degenerative process known as atheroma,
and where degeneration results from deformity of the valve at
the mouth of the aorta, which prevents its proper closure.
It is generally conceded that recovery is possible from the
fatty degeneration accompanying the acute fevers, new mus-
cular fibres being formed which take the place of the old ones
which have become converted into fatty débris. But a heart
which has become degenerated from the second cause men-
tioned, arterial change resulting in permanent obstruction to
the blood current, is permanently crippled, and owing to its
enfeebled condition, either venous engorgement of the various
organs of the body results-often to such an extent as to dis-
turb their functions sufficiently to be incompatible with life
itself-or acute dropsy of the lungs, or general dropsy ensues,
as a direct result of weakened heart action, and may destroy
the life of the patient; or, the diseased heart may suddenly
fail and stop beating, owing to shock, a fit of passion, over-
exertion, a sudden change from the recumbent to the upright
position, a chilling of the surface of the body, or the contrac-
tion of the superficial blood vessels during the cold stage of
ague; and death frequently takes place when the heart walls
are weakened, during an attack of angina pectoris. Several
cases of sudden death from fatty degeneration of the heart
from each of the above immediate causes have come under my
personal observation. This latter disease, angina pectoris, so
little understood by the laity, is not strictly speaking a disease
of the heart, although generally so considered. A person with
;
10
a perfectly sound heart may suffer from repeated attacks of
angina pectoris. It is in reality a transient disease of the
nervous system, an irritation of the nerve-centres from which
originate the nerves which supply the walls of the small arter-
ies containing muscular fibres. This irritation causes these
vessels throughout the body to contract. The heart is over-
taxed, overburdened; it struggles to empty itself; its cavities
become overdistended. If its walls are strong, it can withstand
many of these attacks. If it be weakened by disease, degen-
eration, or dilatation, it sometimes fails in its struggles, and
stops with its cavities filled with blood. The reason that
angina pectoris is so frequently an accompaniment of a degen-
erated heart and of disease of the aortic valve, is that the same
condition of the blood, i. e., an excess of uric acid, which it is
conceded produces the one, produces the others.
This con-
dition of waste material in the blood is the result of functional
disturbance of that great chemical laboratory, the liver. And
this disturbance is, in the great majority of instances, the
direct result of indiscretions of various kinds.
Fatty deposit on the heart and between its muscular fibres,
so common as a part of general obesity, hampers the action
of the heart by giving it extra work to do, in lifting with every
impulse a superincumbent weight. But if the muscular fibres
themselves are healthy, they can bear this additional labor,
and will even multiply, that they may the better bear it.
Ordinary life is in no way endangered by this condition, and
frequently, under proper hygienic measures, and diet, the
superfluous fat will disappear from the heart as it will from
other parts of the body.
There is a stage in this process of change in the walls of the
vessels which ultimately results in fatty degeneration of the
heart, or disease of its valves, which should be recognized and
understood, during which stage sudden deaths from apoplexy,
the result of rupture of a blood vessel in the brain, are not
unusual, and another stage in which death from "heart
failure" is common in the various acute diseases which are
ordinarily recovered from. Preceding the permanent change
in the walls of the vessels throughout the body, which is
characterized by thickening of their walls, lengthening of the
vessels themselves and a diminution of their calibre, is a con-
11
dition of irritation which produces contraction of the smaller
vessels and renders the larger ones more tense than is normal.
The heart, to overcome the results of these pathological
changes, which, of course, produce obstruction to the blood
current, beats with greater force, and ultimately enlarges to
compensate for the obstruction. The tension of these larger
vessels is owing to their distension; they are stretched to their
utmost capacity. At such a time anything which increases
the force and action of the heart still further, endangers the
walls of these vessels in parts where they are especially weak-
ened and are least supported by the surrounding tissues, as in
the mucous membranes lining the air-passages or in the sub-
stance of the brain. Thus a hemorrhage from the lungs or a
profuse nose-bleed is not uncommon, as the result of an extra
effort, a violent paroxysm of coughing or vomiting, or a fit of
passion, in persons supposing themselves to be in perfect health.
These accidents, like an attack of gout in the great-toe joint,
or an attack of acute indigestion, are merely reminders that
something is wrong. Unless these signals of approaching
danger are heeded, accidents of a more serious nature are sure
to follow; or the slow process of arterial change described
above is finally developed. The most serious accident which
can arise from this sudden overaction of the heart is the
rupture of a blood vessel in the brain, the result being an apo-
plectic stroke with its accompanying paralysis of one side of
the body, or death from pressure of the escaped blood on the
brain-cells in the neighborhood of the rupture. It will be seen,
therefore, that apoplexy and one of the forms of paralysis, so
dreaded by the laity, are the direct results of heart trouble;
for the heart under such circumstances is troubled in its efforts
to overcome obstacles in the circulatory current. These ob-
stacles are generally the result of indiscretions, such as the
habitual use of wine or excess in the eating of food highly
charged with nitrogen, as beef, mutton, venison; or of indis-
cretions of other kinds which lead to the same result.
The other stage referred to, is where the arterial changes
have actually become established, but are progressive. With
others, the arteries supplying the heart-walls are involved. As
was before stated, these changes interfere with the nutrition of
the heart, and the heart is permanently weakened. During
12
certain illnesses, particularly pneumonia, and pleurisy with
exudation, the heart has extra work to do in overcoming
obstacles the result of inflammatory processes and pressure,
and being itself further weakened by the high fever and the
diseased state of the blood from which it derives its nourish-
ment, it gives out, and the patient dies of heart failure, and
not of the acute, the accidental disease. Another danger in
these cases of weakened heart is that when still further weak-
ened by disease, loss of blood or prolonged fatigue, clots are
apt to form in the cavities of the organ and to be carried with
the blood-current through the arteries until they finally be-
come lodged at a point too small for them to pass. The supply
of blood is cut off from the tissues nourished by the occluded
vessels. If it be a vessel in the brain, a condition similar to
the results of pressure from hemorrhage follows, with poorer
chances of recovery, the result frequently being sudden death.
Disease of the aortic valve-or the valve which lies at the
root of the aorta and by its closure prevents the return of
blood from that vessel into the left ventricle from which it has
its origin-which is common as the result of extension of the
atheromatous disease process from the aortic walls, always
acts as an obstruction to the blood-current and requires a care-
ful, guarded life.
-
Space will not allow further consideration of the various
forms of heart disease, and, as those forms resulting from
these arterial changes are the most common in middle and ad-
vanced life, and are the ones which can be avoided by a dis-
creet life, I will briefly consider the mistakes and indiscretions
which ultimately give rise to them, and the errors which so
often result in sudden death.
These forms of heart disease are more common among the
well-to-do brain workers than among the middle classes and
those who earn their livelihood by manual labor. It is exceed-
ingly rare among the middle classes, for the reason that, in
order to keep up a respectable show of appearances, they are
obliged to forego certain habits of life and luxuries which tend
to a lithæmic condition of the blood, the result of disturbed
liver function. They are also, as is well known, a temperate
class. With the laboring classes, the drinking of ardent
spirits is common; but the daily physical work which they
WORD
13
f
are obliged to perform is conducive to great activity on the
part of the liver, and alcohol is readily consumed in their
bodies, otherwise these diseases would be more common among
them.
It is generally supposed that excessive brain work is the
main factor in the wearing out of the heart, and that nervous
prostration or neurasthenia is at the bottom of the conditions
of life which lead to these sudden deaths from heart disease
among our great men. It is exceedingly rare that nervous
prostration is mentioned in the newspapers as the cause of
death. The following is the nearest approach to this diagnosis
which has appeared of late.
"His unremitting labors since the beginning of the session
added to the great responsibility of his position have served to
exhaust his vitality and render him particularly susceptible
to attacks of this nature.
•
But even this only takes in a short period of the victim's
life. Would the healthy heart have entirely given out, even
with this strain, were there not a factor dating back and cover-
ing a long period of years, which contributed largely to this
fatal termination of a valuable life, and that factor lithæmia ?
True, excessive taxation of the brain often has to do with
the causes of these diseases, but a healthy brain in a healthy
body will stand an amount of work which is often truly sur-
prising; and the body rarely becomes affected by any of the
organic diseases from excessive brain work alone. Numerous
examples will come to the mind of every reader where even
into good old age, men who have led strictly temperate lives
have preserved their mental faculties in all their activity to
the very last, and have finally died with a quiet, painless,
peaceful form of death. But still, mental overwork long con-
tinued will bring about the conditions of the digestive organs
which result in arterial changes, which, as has been stated,
cause the heart to fail long before it should.
The following, taken from a medical journal, is a case in
point: "One of London's most successful physicians, a few
months before his death, in conversation with a friend, said,
'You see me, a little over forty years of age, in full practice;
my rooms are full and I am making several thousand pounds
per annum; all this I have done by sheer perseverance, un-
14
ceasing hard work and no holidays. I have fatal disease of
the heart, the result of anxiety and hard work. I know I can-
not live many months, and my parting advice to you is this:
Never mind at what loss, take your six weeks' holiday. It may
delay your success, but it will insure its development; other-
wise you will find yourself at my age a prosperous practitioner,
but a dying man.'" To what profession or business will this
not apply? Only recently a life-long temperance man of
seventy, came under my care for troubles resulting from
chronic disturbance of the function of the liver, requiring an
operation. He put the question in all seriousness, "If I have
this operation performed on Saturday night, can I not go to
my business on the following Monday morning?" adding,
"For thirty years I have never been absent from my business
a single day." The operation necessitated his remaining at
home for two weeks. His worry was evident. He seemed to
believe that his business would come to a standstill if he could
not give it his personal attention. At the end of the two weeks
he appeared quite surprised that his son, a man of thirty-five,
who had grown up with the business, had managed it about
as well as if he himself had been at the helm. Fortunately,
one of these two weeks was that of the "blizzard."
The son
has ris n in the estimation of the father. It would certainly
have been better for the father, for the son, and, perhaps, for
the business as well, if these two weeks of holiday had oc-
curred semi-annually for the past twenty years. It would be
good policy for all of our business men, instead of tiring them-
selves out, to give the young men a chance, and rest for a
period from their labors. It is only necessary for a prominent
business man to retire or die, and a young one will shortly
spring up who will handle the reins with equal skill and
success.
This steady, untiring labor is one of the causes of the wear-
ing out of the heart, but this pulsating organ will last a long
time if, added to this, there are or have been no grievous in-
discretions in life.
It is claimed by some pathologists that derangement of the
nervous system is the direct cause of organic disease of the
heart. But this is far from being proven, and is doubted by the
best authorities. Certain it is that when these affections exist
15
in such subjects, it is found that the heart is not alone in-
volved, and it is more than presumable that its diseased con-
dition is secondary to, or a complication of, disease of other
organs, aside from the nervous system.
Throughout this paper, the phrase, "functional disease of
the liver," has been repeatedly used; and to this condition,
long continued, has been attributed the changes in the walls.
of the vessels which ultimately lead to organic disease of the
heart and heart failure. It will be well to briefly explain what
is meant by this condition. This great glandular furnace and
chemical laboratory, the liver, is really chief of the organs
concerned in the digestion and assimilation of food. In per-
fect health, in youth and early manhood, it can be taxed con-
siderably without serious disturbance of its chemical functions;
but if, for a length of time even in the healthiest, it is over-
taxed, it rebels and refuses to do its work. One of its princi-
pal functions is the transformation of excess of nitrogenous
waste into the highly soluble excrementitious substance
known as urea.
This excrement is eliminated from the blood
with which it becomes combined, mainly by means of the kid-
neys. In certain derangements of the liver the nitrogenous
waste is not converted into urea, but into uric acid, a compara-
tively insoluble and toxic substance which is with great diffi-
culty eliminated. Its accumulation in the blood gives rise to
the condition known as the "gouty diathesis," or lithæmia,
and from this condition, it is generally conceded, result the
arterial and capillary changes which are ultimately instrumen-
tal in producing certain forms of organic disease of the heart,
kidneys, liver and nervous system. The writer unhesitatingly
asserts that the forms of heart disease which kill so suddenly,
and which do not result from an endocarditis or the presence
of a specific poison in the blood, in nearly every instance arise
directly from the pathological condition known as lithæmia.
Conceding, then, that liver disturbance is the primary cause
of the premature wearing out of the heart, it is proper to ask:
What gives rise in an otherwise healthy man or woman to this
disturbed function? The answer in brief is: Indiscretions in
living on the part of the patient or his ancestors. In what
does this indiscretion consist? What mode of life will prevent
these diseases? When they do exist, how shall a life be regu-
S
A
16
lated so as to avoid sudden death, or the rapid failure of that
most vital of all the organs, the heart?
It would carry me too far were I to attempt to give to these
questions answers that should be perfectly satisfactory to the
inquiring scientific mind. The answers given, however, are
founded upon careful study and observation, and supported
by the opinions of the best pathologists in this line, on our
own and the other side of the water.
Chief among the indiscretions referred to, is the habitual
though moderate use of drinks containing alcohol. With but
few exceptions, the exhilarating, the damaging ingredient of
all of the so-called stimulating drinks is alcohol. It matters
not whether they be in the form of spirituous liquors, cordials,
still wines of high or low grades, the most delicate cham-
pagnes, ales or beers. Independent of the effect of alcohol in
disturbing the function of the liver, its presence in the blood
and actual contact with the delicate structures of which the
body is composed, does injury which aids in the production of
the changes which finally result in the wearing out of the
heart.
Second in importance of these indiscretions is the excessive
use of meat as an article of diet, and the excessive use of other
kinds of food.
Third.-Sedentary habits, with a lack of a proper amount of
physical exercise in the open air, and lack of healthful mental
exercise.
Fourth.-Mental strain, too close attention to business, ac-
companied as it generally is by a lack of a proper amount of
diversion and amusement; irregularity in eating, which gen-
erally results in dyspepsia and loss of appetite; and too little
sleep, which finally results in insomnia or inability to sleep.
Fifth. The habitual and indiscriminate use of drugs and
patent medicines.
In a very large majority of the cases of weakened or dis-
eased heart there have been two or more of the above-men-
tioned factors concerned in their development.
Added to these are certain unmentionable indiscretions
which by their direct action on nerve centres disturb the func-
tions of all of the organs of the body, and finally result in
premature wearing out of the heart as a part of a general pro-
17
cess.
Many of our cases of supposed organic disease of the
heart in young persons, really cases of irritable heart, purely
nervous affections, are attributable to these indiscretions,
which may finally result in organic disease of this organ.
The answer to the question, What mode of life will prevent
these diseases? is simple enough. A discreet life, temperance
in all things, and particularly the avoidance of the above-men-
tioned indiscretions, especially the habitual use, even in
moderation, of stimulating drinks and the ingestion of too
much meat.
Finally, when these changes are known to exist, how shall
a life be regulated to avoid sudden death or the rapid failure
of the heart?
In the Medical Record of April 14th is found such a com-
plete and satisfactory answer to this question, and it is so in
accordance with my own views and experience in practice, that
it will be quoted in full:
"Dr. George Harley ends his lectures on the effects of mod-
erate drinking upon the human constitution with the following
conclusions: 1. That alcohol, when indulged in, even well
within the limits of intemperance, has a most prejudicial effect
on heart disease. 2. That mental excitement is a cause of rup-
ture of atheromatous blood vessels. 3. That sudden spurts of
muscular exertion act most deleteriously on all forms of
organic cardiac affections. 4. That mere extra distension of a
stomach by wind may suffice to fatally arrest a diseased heart's
action. The knowledge of these facts has for some years led
me to make it an invariable rule to impress upon all patients
laboring under diseases of the circulatory system who desire
to minimize the effects of their complaints and ward off as long
as is possible the inevitably fatal termination, to pay strict
attention to what I call the following three golden rules—(1)
Take exercise without fatigue, (2) nutrition without stimula-
tion, and (3) amusement without excitement.'"
In closing this article, which has already out-stepped the
bounds of its intended limits, the author proposes to leave the
sphere of his own profession and make a suggestion in politi-
cal economy to the law-makers of our land, which, if favorably
acted upon, would be the means in many instances of prevent-
ing the wearing out of the American heart, lungs, liver and
-
18
kidneys, and of saving to the nation many valuable lives, lives
that cannot well be spared. For the innovation he asks par-
don of the lawyers and statesmen.
The suggestion is this: That a corps of expert medical ex-
aminers be appointed by each State, whose duties shall consist
in the making of a thorough and scientific physical examina-
tion of every adult citizen at least once a year, and that the
result of that examination be given in writing to each
person examined; the expense of such examinations to be
borne by the State; the examiners to be salaried officers, who
shall not be permitted to engage in private practice; and that
such examination shall be compulsory.
By this method, and this only, could men active in business
or profession be kept informed as to the actual state of their
health. Few, till reminded by symptoms of which they are
conscious, trouble themselves as to their physical conditions.
The time for medical skill to be of service is often before the
evidences of disease have been made manifest to the patient;
and indiscretions are often indulged in which would be avoided
did he know that by such indulgences health, life, was en-
dangered. Our life insurance companies and our national
banks are obliged by law to submit sworn statements annually,
regarding their financial condition. Paid examiners, experts,
are provided by the Government, whose duties consist in care-
fully scrutinizing the books of these institutions to see if their
financial statements are correct. Is money of more value than
life? Had the late Chief Justice known that his heart was
weakened, probably from the very conditions mentioned above,
would he have insisted on attending court and participating in
an important and exciting decision, while in a feeble state of
health, the result of a cold? Would a late former Commander-
in-Chief of our armies have risked his life by an unnecessary
and sudden muscular spurt, had he known that his heart was
unequal to such an effort, and that death would result from it?
The very recent sudden death of Matthew Arnold was the im-
mediate result of a violent and unnecessary muscular exertion.
If it be argued that the law would be difficult to enforce, the
answer may be given that valuable citizens are law abiding,
and that few whose lives were worth the saving to the state or
nation, would violate the law by neglecting its provisions.
No. 6 EAST 43d STREET,
NEW YORK.
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