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B96 HR | BAY, S="SER "n -mil IF 1 1 ? 1 1 ✓ } 1 ܝܕܟܝܪ { 7 ! į + * DOCTOR BURNETT'S ESSAYS, 3-873 CONTAINING ECCE MEDICUS. NATRUM MURIATICUM, GOLD, CAUSES OF CATARACT, CURABILITY OF CATARACT, DISEASES OF THE VEINS, SUPERSALINITY OF THE BLOOD. NEW YORK, 145 GRAND ST. BOERICKE & TAFEL: PHILADELPHIA, 1011 ARCH ST. J : ܢܝܫܝܕܪܝ ܬ . ! $ K ܗܚ * : . PREFACE. THE eminent publishers of this volume having intimated their willingness to publish my various little monographs together in the form here presented to the profession, I am desirous of making one or two brief remarks by way of preface. First of all I wish to explain to my American colleagues that these little treatises did not follow each other as the outcome of a preconceived plan, but were published just as they grew. Hence they are in no wise to be regarded as complete essays with pretensions to literary polish or technical finish, but rather as odd frag- ments, mere chips fresh from the workshop. Writing them afforded me much pleasure and instruction, and if they prove, in some small measure, suggestive to others I shall be amply rewarded. Then, as to their present ap- pearance, brought together in one volume, it is but right to remark that the publishers have not only sought my authorization so to publish them, but they have shown themselves, in our arrangements, exceedingly generous. In the absence of any copyright treaty between Great Britain and America this large-heartedness is pleasing and graceful. 5 HOLLES STREET, CAVENDISH SQUARE, LONDON, W., August 26, 1882. J. COMPTON BURNETT. I ļ CONTENTS. 1. Ecce Medicus, or Hahnemann as a Man and as a Physician, and the Lesson of his Life, . 2. Natrum Muriaticum as a Test of the Doctrine of Drug Dynamization, . 3. Gold as a Remedy in Disease, 4. The Causes of Cataract, with Suggestions as to its Prevention, 5. Curability of Cataract with Medicines, . 6. The Medicinal Treatment of Diseases of the Veins, 7. 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DaaĢ --ca „Zone Palade na radi ADVANJA, • ba • * - ma de m PERKARAMPARARNARDAL, Arkama kevadkond P c) aga v kg, rght Phar kj mya MPV 2001 (E GRĪVARAN (SEEDE BEKANN LOKA UMANNE LARGE Gorskompisar 2 ** ECCE MEDICUS; ! OR, HAHNEMANN AS A MAN AND AS A PHYSICIAN, AND THE LESSONS OF HIS LIFE. BEING THE FIRST HAHNEMANNIAN LECTURE, 1880. Es liebt die Welt, das Strahlende zu schwaerzen. SCHILLER. # 2 THIS FIRST HAHNEMANNIAN LECTURE IS DEDICATED TO WILLIAM BAYES, Esq., M.D., IN ADMIRATION OF HIS PUBLIC SPIRIT AND FAR-SEEING WISDOM, AS SHOWN IN THE ESTABLISHMENT AND MAINTENANCE OF THE LONDON SCHOOL OF HOMOEOPATHY. : PREFACE. ON sending this Hahnemannian Lecture to press, it is right to remark that, in deference to the expressed wish of valued friends, certain expressions that were made use of in delivering it have been omitted. The substance, however, remains the same. To say a thing in simple homely Saxon is often apt to shock; such is better told with the tamed tongue of a Talleyrand, and with . . . . sourtout point de zèle. It has not been deemed wise to extend the subject by following up Hahnemann's history at Coethen and Paris: that would have involved a consideration of his tripartite pathology; and the Parisian episode has but little scientific interest so long as his latest writings are beyond our reach. The following pages, therefore, contain the first Hahnemannian Lecture essentially as it was delivered at the London Homoeopathic Hospital in Great Ormond Street last October. HOLLES STREET, CAVENDISH SQUARE, W., January, 1881. J. C. BURNETT. A HAHNEMANN AS A MAN AND AS A PHYSICIAN, AND THE LESSONS OF HIS LIFE. G ENTLEMEN: At a meeting of the authorities of the Lon- don School of Homœopathy, held in this building on July 12th, 1880, it was proposed by Major Vaughan Morgan, and sec- onded by the Earl of Denbigh, "That it is desirable that a Lecture be delivered explanatory of the History of Hahnemann's Discovery of Homœopathy, illustrating its Principles, and the Life and Works of its Founder; that such Lecture shall be delivered annually, in place of the Introductory School Lecture, by a lecturer to be ap- pointed each year by the Committee of the School, in accordance with Rule V." This was passed unanimously, and the speaker was asked to de- liver the first lecture under arrangements to be made by the sub- committee, consisting of Drs. Bayes, Hughes, and Yeldham. Thus, gentlemen, I stand before you to-day to carry out the in- tention of the London School of Homeopathy in this regard. May this first Hahnemannian Lecture be the starting-point of a genuine, free, and manly appreciation of him whom the Earl Cairns, not long since, very justly designated the greatest benefactor of his age. We, whose duty it is to hand on a true history of Samuel Hahne- mann to our children and to posterity, could not well adopt a better plan than that of a yearly Lecture on the subject of his Life and Labors; and it is with the desire of bearing my share of this sacred duty that I beg leave now to address you. Some account it a shameful thing to be a believer in homop- 14 BURNETT'S ESSAYS. I athy or in its founder, because, forsooth, the powers that be have decreed the former a delusion, and the latter an unworthy outcast. from the fold of the true Ecclesia medica catholica. As for me, I count it the proudest day of my life to be permitted to stand here and endeavor to vindicate the honor of the master, than whom a kinder or purer man, a greater savant, a profounder thinker, or a truer physician, the world has but seldom seen. It is not unknown to you that the very vilest slanders have been hurled against him. The highways and byways of all the languages of Europe-nay, of the world-are literally strewn with these slan- ders, in order thereby to damn the man and make his name a by- word in the mouths of the people. Medicine-mongers and leeches, worshipful companies of apotheca- ries, colleges of physicians and surgeons-royal and imperial—have all united to do him to death; the serial journals of the world, med- ical and surgical, have with one accord combined to bespatter his name with dirt, or they have entered into a conspiracy of silence, to mum him and his homœopathy to death. For eighty-one years Hahnemann has been thus treated, and yet there are some six or seven thousand physicians and surgeons in the world who swear by him as by a holy prophet, and millions of the human race have cause to daily bless his memory; and I venture to predict that in the ripeness of time the peoples of the world will unite to give him a high place, not merely in the Panthéon at Paris, or in our own Westminster Abbey, but in the great Walhalla of mankind. But that time is not yet; and no one here, not even the youngest, is likely to live to see it. Ours is the seed-time; let us see to it that we sow the sound seed of truth, and tend it carefully, and root up the weeds of hatred, ignorance, slander, and prejudice, in the sure and certain hope that such time will come, although we may not be there to witness it. To this end it is of vast importance, alike in the interest of medi- cal science and of our common humanity, that the real Hahnemann, and the labor of his life, should be held up in the clearest possible light. It is also needful that the labor of his life should be frequently examined afresh, for the benefit of successive rising generations, who | י HAHNEMANN. 15 • do not always know much of what was done even a few decades ago, and that we may have a standard whereby to measure the fashion- able foibles of the hour; for there is fashion in physic, and the pig- mies of the day are very apt to appear mighty giants, unless the deeds of the great dead be present with us. Hence, I take it, the far-seeing wisdom of a yearly Hahnemannian Lecture, so that we may learn and re-learn the lessons of his life. Much misconception of Hahnemann's labors and teachings exists even amongst some of his disciples, and it will be the privilege of the Hahnemannian lecturers, from time to time, to throw as much light as they can thereon; and may we all catch the true spirit of the mighty man and fervid physician, that it may not be said of our lesson-learning what the Jaeger said of the Wachtmeister in Schiller's Wallensteins Lager: "Sie bekam euch übel, die Lektion. Wie er räuspert und wie er spuckt, Das habt ihr ilim glücklich abgeguckt; Aber sein Schenie, ich meine, sein Geist Sich nicht auf der Wachparade weist." No, gentlemen, the genius of the great general does not show it- self on parade, when playing at soldiers is going on, but in battle. So the genius of Hahnemann's teachings cannot be found by the dandy doctor à la mode, or by the mere scientist, or bookworm, or dead-house pathologist, but rather in reading the book of Nature with an humble, receptive mind, and with the aid of Hahnemann's biopathology, and in treating the living sick according to his law. Did I say his law? I mean Nature's law, which he first saw IN A CLEAR LIGHT, and which he practically elaborated for us, thereby firmly fixing the treatment of the sick upon a scientific ground work. THE BOY HAHNEMANN. * Will you come with me now and let us scrutinize the boy Samuel Hahnemann? But, before doing so, just go over in your minds the early preparatory history of any of the heroes of our race, and you will almost invariably find that before the real lifework began there * Born April 10, 1755. 16 BURNETT'S ESSAYS. had been a trialful preparation, then a Sturm- und Drang-Periode, and then comes the working out of the individual redemption. Hahnemann was destined to meet with enormous difficulties, to encounter unheard-of opposition, and then to come out victor over all. So he was not born of rich parents, nor nursed in the lap of luxury; he was not "swaddled, rocked, and dandled"* into his life's work. Great reformers do not come that way. Scions of noble houses are often great leaders of men, but not because they are scions of noble houses, but because they still retain the pith and marrow of the original founders of their families. Hahnemann was, however, not the offspring of vulgar or illite- rate parents. His parents were indeed poor, but they were neverthe- less people of taste and refinement-notably his father, who was a painter on porcelain in Saxony; for poverty, happily, neither ex- cludes genius nor culture. S We should expect the son of an artist to become a man of refine- ment and taste. Such was Hahnemann. He was of small stature and of a delicate constitution; not a man of muscle, but of iron will and indomitable perseverance. Yet he must have been well-knit, for he lasted nearly ninety years. You know the old saw-" She who rocks the cradle rules the world;" and hence I wish I could draw you a word-picture of Hahnemann's mother, for mothers make our men. But the material necessary for such a delineation was not at my disposal; yet perhaps it matters little, as the real history of a mother is written by the lives of her children. Of Hahnemann's father we know sufficient to be sure that he was no ordinary man, inasmuch as he taught the young Samuel to think for himself for which purpose he is said to have shut him up alone, and given him a theme to think out. How many fathers show such a knowledge of what true education means in its etymological sense, viz., a leading, or drawing-out? Without these lessons in thinking, the young Hahnemann would never have studied medicine; for he did so in the teeth of parental opposition, and without them he would never have discovered scien- tific homœopathy. I was not swaddled, rocked, and dandled into a legislator.”—Burke. ! HAHNEMANN. 17 } The great anatomist Hyrtl was wont to relate how, as a little boy, he used to study the anatomy of his throat with the aid of a hand- glass; and he was fond of exclaiming, at the close of the story: "Was Essig werden soll, muss früh sauer werden !”* So with Hahnemann: as a lad he wrote an essay on the human hand. He had an excellent education-first at the Communal School till he was twelve years of age, and then at the Grammar School of his native place,† and was, moreover, the pet pupil of his master (the rector), from whom he received friendly instruction in his free time; and so well did he profit by this large-hearted instruction that he was an accomplished linguist at the age of twenty, when he left Meissen for Leipsic to study medicine. Hahnemann began already, at the Grammar School, to be a teacher of his fellows; and already, at the age of thirteen, he was so far ad- vanced in his knowledge of Hebrew as to be able to give lessons in that tongue.‡ He was not permitted to go away to the universities to study med- icine without having first been subjected to parental opposition, for we are told that his father compelled him to take a situation in some business; or, rather, his father's poverty made it an apparent neces- sity. But trade was so distasteful to the ambitious and gifted boy Hahnemann that he fell ill in consequence, and then he was permit- ted to follow the bent of his noble mind. We have here the key to his subsequent successes; for what greater opposition can there be offered to the onward career of any man than that of his own parents and poverty combined? When a lad has the stuff in him to con- quer father and mother and poverty combined, what possible concate- nation of adverse circumstances in after life is likely to thwart him? And so we find him, then, at twenty en route for Leipsic University, * "What is to be vinegar must soon get sour!" † Meissen has also the honor of being the birthplace of the two brothers Schlegel. The little town is in the kingdom of Saxony, at the confluence of the Elbe and the Meisse. 1. Biographie Universelle Ancienne et Moderne, par M. Michaud. Paris. Art. S. Hahnemann. 2. Treue Bilder aus dem Leben der verewigten Frau Hofrath Johanne Henriette Leopoldine Hahnemann, geb. Küchler. Berlin, 1865. 3. Hahnemann's grandson, Dr. Süss Hahnemann, of London, informs me that this statement is strictly correct. 18 BURNETT'S ESSAYS. and already at that age thoroughly acquainted with German, Arabic, Hebrew, Greek, Latin, French, Italian, and English. To know eight languages already at the age of twenty is, you will admit, not a bad preliminary education. THE STUDENT HAHNEMANN. It was his extensive knowledge of languages that enabled him to gain a livelihood while studying medicine and after taking his degree. It was this same linguistic knowledge that subsequently was the means of his great discovery, as we shall presently see. History tells us that Hahnemann had not the means to pay for his classes at the University of Leipsic, and that he enjoyed the privilege of free instruction. It is right to explain that this has been a com- mon thing in German universities from time immemorial, and it is not there thought by any means an undignified thing to receive gra- tuitous instruction, as it is the right of poor students, especially such as matriculate with honors, as Hahnemann evidently did. Many of the most renowned professors in Germany were thus educated; for instance, Skoda, Oppolzer, and Hyrtl. Such students are not re- garded as receivers of alms, but as being educated by the State, which pays and pensions its professors to educate its promising young citi- zens. Such men, also, most frequently fill the professorial chairs in after years. To this is largely due the astounding erudition of the German professorate, that is justly a source of pride for the German fatherland and the admiration of the world of science and letters.* Thus Hahnemann was already, as a student, a man of great ac- quirements. Not the least of his acquirements was that of the auto- didact in its grandest sense. Who in this world ever rose to eminence in learning other than autodidactically? No doubt it is immensely important to receive sound instruction at school and university, but those who mount the ladder of life begin to learn where teachers cease to instruct: so did Hahnemann. * Some ten or a dozen years ago Professor Billroth, of Vienna, proposed to ar- range the medical curriculum, in Austria, with the avowed object that only students of some means could possibly enter the profession. In the heated controversy that ensued it transpired that nearly all the noted, then teaching, professors of the Vienna School (Rokitansky, Hyrtl, Skoda, and Oppolzer) had been poor students. HAHNEMANN. 19 } In Leipsic he earned his living by translating scientific works from the English and French, for which he was paid by the publishers. It might, not unnaturally, be asked how it was possible for the young Hahnemann to study medicine and gain his daily bread at the same time. He managed it in this wise: he sat up all night at his translation work every third night, and this became such a habit that he continued to do so for more than forty years. This also explains. how he found time for his enormous literary labors in after years. And, oddly enough, he not only managed to live during the two years he heard lectures at the Leipsic University, but he also contrived to save a little money, and thus became enabled to extend his field of observation; so we find him at the end of this period passing from the University of Leipsic to that of Vienna, one of the most re- nowned Schools of Medicine of the world, where he enjoyed the friendship of Professor von Quarin, by whom he was treated as a son, and who took great pains to teach him the practice of medicine. What was there, then, in this poor young Saxon that endeared him thus to his teachers? Clearly he was an extraordinary youth. After a stay of an annus medicus, he accepted the post of librarian and family physician to the Governor of Transylvania, at Hermann- stadt, the new home of his Saxon fellow-countrymen. The learned Dr. Dudgeon, in his Biography of Hahnemann,* tells us that Hahnemann resided two years at Hermannstadt; but this can hardly be, for, as Dr. Dudgeon himself states, Hahnemann re- moved to graduate in Erlangen in 1779, and this was in August. It is to be remembered that Hahnemann practiced in various parts of Lower Hungary during this period. He was either not altogether or else not all the time attached to the Governor's service, or the Governor must have resided in various places. This is clear from Hahnemann's remark on page 114 of the second volume of his trans- lation of Cullen's Materia Medica, where he says, in regard to Cul- len's opinion that engorgements of internal organs do not constitute a contraindication for the bark in ague: "The author (Cullen) is wrong; he would appear to have been unacquainted with the stubborn intermittents of hot fenny countries. I (Hahnemann) observed such in Lower Hungary, more particularly in the fortified places of that * Lectures on Homœopathy. 20 BURNETT'S ESSAYS. country, which owe their impregnability to the extensive marshes around them. I saw such in Carlstadt, Raab, Comorn, Temesvar, and Hermannstadt," etc., etc. And from the subsequent detailed remarks it is clear that he must have had practical experience in these places of sufficient extent to observe the courses of the various kinds of ague of the very worst types, and also their concomitants and sequels. Those of us who have seen the human wrecks that even at this day come in large numbers from the low-lying marshy plains of Hun- gary to the Allgemeines Krankenhaus in Vienna, will have a very concrete conception of the enormous practical advantages which Hahnemann enjoyed in observing the worst forms of disease that can ever fall to the lot of any physician; for in malarial districts such as those in which Hahnemann spent these two years in active prac- tice, and of which he thus gives an account, we have in the wake of their pernicious intermittents the most severe forms of heart, lung, liver, spleen, kidney, and abdominal affections, with all varieties of dropsy, and to have gone to school in such a place means, at the very least, much practical experience. Be it noted that this was all before he graduated as doctor of med- icine at the ripe age of twenty-four years and not quite four months. Thus we have seen our youthful Hahnemann at the Communal and Grammar schools of his native place, Meissen, until he was twenty years of age, and then we find him studying medicine, first in Leipsic then in Vienna-my own dear old alma mater—and then in practice in a district full of disease, and finally graduating at the age of twenty-four. And, be it remembered, earning his living and paying his way during the whole of his medical curriculum. I dwell somewhat largely on the practical professional education of Hahnemann because some of his detractors try to persuade us and themselves that he was not a physician at all, but something else,— a librarian, a teacher, a translator, a book-worm, a chemist, anything, but not a physician. C You have seen that his farewell grammar school thesis was “On the Human Hand," and if you only read the footnotes to his very earliest translations, you will agree with me that he was al- ready at twenty-five a notable physician. Notable, I say, for some men see more in a year than others in a lifetime. Many a man has - HAHNEMANN. 21 ? grown gray in the wards of hospitals, and yet has never seen any- thing. We have made the acquaintance of the schoolboy Hahnemann, and of the student Hahnemann. Gentlemen, I beg you will now come with me and take a look at DOCTOR HAHNEMANN. I have seen a painting of the young Dr. Hahnemann painted by his father on a fan representing the young Esculapius giving physic to his first patient, a shoemaker. Little did his good father then dream what a son he had begotten; let us study him a little closely. He is one of the chefs d'œuvre of the Creator. By the way, why did Hahnemann go to Erlangen for his doctor's hat rather than to Leipsic? Because the graduation fees at Erlangen were much less there than at Leipsic. This information I have from his grandson, Dr. Süss Hahnemann, who resides in our midst. The subject of Hahnemann's inaugural thesis was “Conspectus af- fectuum spasmodicorum ætiologicus et therapeuticus.' "" We come at once to his wanderings, and to the Sturm und Drang period of his life. First he goes to a little place called Hettstädt, and then to the small capital Dessau, where he devoted himself particularly to the study of chemistry and mineralogy, and also as it would seem to the no less agreeable occupation of courting the fair German maiden, Miss Henrietta Küchler, the daughter of an apothecary at Dessau. He afterwards became medical officer of health at Gommern near Magdeburg, and there in 1782 he led the young lady to the altar. We owe much to this noble woman, who was a beautiful character, and stood by him as a true companion and a faithful loving wife in the many terrible trials that were in store for him; but for her love and encouragement he would often have found the burden of his life an unbearable one. In after years he would often take her endearingly by the hand and exclaim, "Darling, but for thy loving support I could not bear it." Mankind thus owes much to this noble Deutsche Frau, and in con- nection with our great medical reform she deserves our grateful re- membrance. 22 BURNETT'S ESSAYS. Learned colleagues, do not think that in this hall the mention of a woman is out of place, for the influence of Hahnemann's wife has been a blessed one in the life of her illustrious husband, and has thus helped to bring health and happiness into many hearts and homes all the world over. Honor then to her who loved and helped him when wellnigh all were against him. But Gommern soon became unbearable for Hahnemann, and he left it after a two years' stay, and betook himself to polite and pol- ished Dresden, the home of learning and culture. Here Hahnemann soon became a favorite with the leading men, and particularly with the eminent chief surgeon of the hospital, Dr. Wagner, who formed such a high opinion of his abilities that he chose him to take his place -the highest medical post in the country-during a long illness. Remember, gentlemen, this was the pre-homoeopathic Hahnemann who was thus chosen to temporarily fill the place of the highest med- ical functionary of his country. He was no longer the poor struggling student or the obscure parish doctor, but his professional position was one of which any physician at any period of life would be proud. I do not mean merely because he was thus, for a time, as a very young man called to such a responsible position, but he had also by this time made a name for himself in the world of medicine and of science, and his literary labors had carried his fame far beyond the confines of his own immediate country. In 1786 he published his work on Arsenical Poisoning, that is even now authoritative. If you want to know Hahnemann's frame of mind at this period, you will find it in the introduction to this book on Arsenical Poison- ing, which is dedicated "To the Majesty of the Good Kaizer Joseph,” and called by the author his firstling. You will see it is full of the bitterness of despair at the miserable condition in which he found practical medicine, and in it he appears to us as an expert medical jurist and practical toxicologist. He evidently had his back to prac- tical medicine at this period (1786), for he says: "A number of causes, I care not to count them up, have for centuries been dragging down the dignity of that divine science of practical medicine, and have con- verted it into a miserable grabbing after bread (Brodklauberei), a mere cloaking of symptoms, a degrading prescription trade, a very God-forgotten handiwork, so that the real physicians are hopelessly HAHNEMANN. 23 C } jumbled together with a heap of befrilled medicine-mongers. How seldom is it possible for a straightforward man by means of his great knowledge of the sciences and by his talents to raise himself above the crowd of medicasters, and to throw such a pure bright sheen upon the Healing Art at whose altar he ministers that it becomes impossible even for the common herd to mistake a glorious benign evening star for mere vapory skyfall! (Sternschnupfen). How seldom is such a phenomenon seen, and hence how difficult it is to obtain for a purified science of medicine a renewal of her musty letters of nobility." In 1787 he wrote a treatise on the advantages of using coal as a means of warming, there being at that time much prejudice against its use. In 1789 he wrote a work entitled Instruction for Surgeons in the Treatment of the Venereal Disease, and at this same period he wrote many important articles in Crell's Chemical Annals on chemical sub- jects, and amongst these: Chemical Investigations on the Nature of Gall and Gallstones, and another On Antiseptics. And he also pub- lished about this time in Baldinger's Magazin the mode of making the preparation of quicksilver that to this day is known in Germany as the Mercurius solubilis Hahnemanni. Then he occupied himself with the question of the "Insolubility of Certain Metals." Hereupon he wrote in Blumenbach's Bibliothek, "On the Means of Avoiding Salivation and other Ill Effects of Mercury," and in Crell's Annals, "On the Preparation of Glauber's Salt." His enormous literary activity, coupled with his practical work in the chemical laboratory and his extraordinary knowledge, both in medicine and chemistry, began at this time to fix the attention of men of science and practice upon him, and he was accordingly elected a Member of the Oekonomische Gesellschaft in Leipsic, and a Fellow of the Academy of Sciences of Mayence. HAHNEMANN IN THE SLOUGH OF DESPOND. Gentlemen, we are still in the presence of the pre-homoeopathic Hah- nemann; he is thirty-five years of age, and thus barely in the prime of his years and mental development; he has already practiced a dozen. years as a physician, and it is fifteen years since he left his father's roof 24 BURNETT'S ESSAYS. to go to study at Leipsic; he is happily married, the head of a large family, and enjoys a considerable reputation as a physician and as a man of science and letters. He returns to that Leipsic which had been the seat of the early student life and labor. And what next? He suddenly gives up the practice of physic in disgust. He has lost all faith in physic, and believes ordinary medi- cine worse than nothing-not only no good, but a positively hurtful art. From the frame of mind in which he wrote the introduction to his book on Arsenical Poisoning (in which he had already his back to the practice) to a total giving-up of such practice is a very great dis- tance for a poor man, with nothing else to fall back upon, And, then, he had practiced medicine with more than ordinary success. His detractors ask us to believe that he had no patients, and that it was practical medicine which gave him up, and not he it; but this is merely a falsehood. He absolutely refused to con- tinue to treat those who had long been his patients-declining to live by practicing a system of medicine that experience at the bed- side had taught him was far worse than useless. At this period of the world's history a revolutionary spirit was in men's minds, and a medical revolution was brewing in Samuel Hahnemann's brain. Was he conscious of it? I think not. Was God's hand leading him in this mighty matter? So it seems to me. You will agree with me that a violent storm of doubt and fear was raging in this man's mind. It raged with some effect, for it swept everything before it except his uprightness, his honesty of pur- pose, and his mighty manhood. We shall have a concrete conception of the terrific nature of this psychic whirlwind when we bear in mind that he had no fortune be- yond his practice, for his literary labors at this period were purely scientific, and mostly unremunerative. He had comparative mone- tary ease in his practice, could give an elegant home to his loved ones, and an adequate education to his children, who, with his exemplary wife, were the sweetness of his life; but nothing could withstand the force of this whirlwind, and he abandoned his practice entirely, and once more-but this time voluntarily—became a book- seller's hack, a translation-slave! To get a living as a translator was hard enough for a young stu- C HAHNEMANN. 25 dent with only himself to care for; but to keep a wife and a large family, all accustomed to plenty and comfort, was quite another mat- ter. At one stroke he reduced himself and his wife and children to penury and want; and this for conscience' sake! And yet he knew but too well the pinch of poverty and the weirdness of want. What a contrast, this, with some of the young men of our own day, whose doctrine is expediency and fashion, and who deem the chance of a hospital appointment or a professorship a fair exchange for their modicum of conscience, and who coolly say, "Homoeopathy is true, of course-I know that well enough; but if I say so, what chance have I of becoming Surgeon to the Infirmary, or Lecturer at the Medical School?" Well, we must remember that there is the wrong, and the Nemesis of wrong, too. These men (save the mark! I mean these social eunuchs), who thus deny or ignore the truth for mere expediency and supposed social advantages, will nevertheless attain to nothing. Why? Because I find it written in the Big Book that "whatsoever a man soweth that shall he also reap." But to return. Hahnemann removed, we saw, to his old Leipsic, that was not specially propitious to him at any time, and again took up his old book-making drudgery. Read his footnotes to his trans- lations from this period, and behold the bitterness in his soul. When some of us feel bitter and downcast at being debarred from some coveted social or professional preferment for conscience' sake, let us just look at this period of our master's life, and we shall feel that ours are as the piping times of peace to the horrors of war. Are you weary of the story of these dismal days of doubt and de- spond? Bear with me yet a little, and let us see how he bore his burden. After a certain time he found that he no longer earned sufficient to pay the expenses of town life in Leipsic, and so we find him re- moving to a village outside of the town, in the hope that his literary earnings might suffice to keep the wolf from the door. He there clad himself in the garb of the very poor, wore clogs of wood, helped his wife in the heavy work of the house, and kneaded his bread with his own hands; and the blatant ignoramuses who forge medical history, and who rule the rostrum in medical societies, ask the world to believe that Samuel Hahnemann was a lover of lucre, 3 26 BURNETT'S ESSAYS. and a man given to gain! But poor Hahnemann had not yet drunk the dregs of his misery. As things got worse and worse, and his daughters and his wife began to reproach him for sacrificing the amenities and comforts of life for seemingly chimerical dreams, his cup was full; yet his firmness of character and his rooted steadfast- ness in his consciousness of right kept him up, and he worked on, perhaps with a faint inkling of a great something to come. But his cup of misery, though full, had not yet run over; but even this was to be. Several of his children fell ill. Now he was in the Slough of Despond indeed. He, the accomplished physician, has given up physic as worthless, and see-his own children fall ill! In despair he cast about for the right remedies, and found them not; yet he seemed certain that they must exist. Writing to Hufeland, he ex- claimed: "Oh! I cannot believe that the almighty and fatherly good of Him whom we cannot even call by a name worthy of Himself, who so freely cares even for the tiniest of His animate beings that are invisible to our eyes, who freely lavishes life and plenty through- out His whole creation-I cannot believe that He should inevitably deliver over His dearest and highest creatures to the pangs of dis- ease." We thus see that he did not despair of a Healing Art, but, on the contrary, was firmly convinced that Nature was replete with ele- ments and forces for such an art, and that they were present in plenty all around. He also did not deny the possibility of a science of med- icine, but the then existing methods and systems were demonstrably and in his own experience false. On the contrary, he evidently did believe in a science of medicine that was yet to be found; but how to find it he did not see. Cate This brings us to the threshold of the discovery of Homœopathy. Here we have the soil tilled, ready for the seed; an invisible power sowed the seed, and the harvest is sure. We are about fo part with the pre-homoeopathic Hahnemann. But before we do so let us just run back over the ground we have traversed; let us picture to our- selves the boy studying in his father's house by the light of a little lamp made of clay with his own hands; let us follow him from the national school up to the grammar school; let us realize him at the age of thirteen giving lessons in the mystic language of the Hebrews; and let us go with him, the accomplished youth, to Leipsic, silent in eight tongues, and watch how he toiled for bread, and studied amid HAHNEMANN. 27 1 such difficulties a system of medicine that he was destined in the full ripeness of manhood to cast away as worthless. But enough; time presses, so we must hurry on to that point in his history whence arose a thought that grew so mightily that it has revolutionized medical society, and cast down the old idols from the high places to make room for a true Esculapian cultus. A French biographer tells us that chance led Hahnemann to the discovery of homoeopathy. Nay, I cannot believe it; chance never did such a mighty thing. Chance may roll up a bit of clay, or per- petrate a daub, but chance does not mould such an exquisite model or paint such a perfect picture. I see the hand of Providence in this thing; if chance did it, I, individually, have lived in vain. DAWN OF HOMEOPATHY. * The renowned Scotch professor Cullen once wrote a remarkable work on Materia Medica that has gained much in reputation by hav- ing been rendered into German by Hahnemann. Perhaps the world does not owe much to South America, but it owes Cinchona to it, and we are not usually specially grateful for the benefactions of the Jesuits, but for once we may think kindly of them for bringing us over the bark which has immortalized them in every marsh of the world. Cinchona has probably saved more lives than any other remedy in the Pharmacopoeia, and to it we owe the discovery of homœopathy. Hahnemann went to Transylvania, as you know, and studied ague in the Danubian marshes; he not only studied it in others, but he had it himself. When Hahnemann was living in the country near Leipsic clad in homespun and clogs, he got an order from a publisher to translate this Materia Medica† of Cullen, so our own tongue had a share in the discovery, and I think Cullen had more to do with paving the way for it than is generally thought. In all his translations Hahnemann had the habit of writing footnotes, * Proud science owes its knowledge of Cinchona really to the Indians, and these first ascertained its antiperiodic property by drinking the water of the swampy pools in which the Cinchona trees stood; so they really got a natural cold infusion. + William Cullen's ABHANDLUNG über die MATERIA MEDICA nach der nunmehr von dem Verfasser selbst ausgearbeiteten Originalausgabe ÜBERSEZT UND MIT ANMER- KUNGEN von Samuel Hahnemann, der Arzneikunde Doktor. In 2 vols. Leipzig, 1790. 28 BURNETT'S ESSAYS. often sitting heavily on his author's shortcomings; and it is in one of these footnotes to his translation of Cullen's Materia Medica that homoeopathy dawns upon us. Not the homoeopathy of Hippocrates, nor the homœopathy of the writers of the 16th and 17th centuries, but the scientific homoeopathy that is based upon the proving of drugs on the healthy, as shadowed forth by the genial Stoerck and incidentally taught by the immortal Haller. I believe it has been asserted that the Irish physician, Crumpe, was before Hahnemann in trying drugs on the healthy. This state- ment is not correct. I beg leave to show you Crumpe's most inter- esting and scientific Inquiry into the Nature and Properties of Opium, which you will see was published in this city in 1793. (Antonius Stoerck was, however, before Hahnemann, in this respect.) Hahnemann's translation of Cullen's Materia Medica bears on its title-page the date 1790, that is ninety years ago (and three years before Crumpe's work). It was published in two volumes, and these two ragged old books I take the liberty of showing you also, both on account of their great historic interest as the birthplace of homoeopathy, and because of their being decidedly rare books. Here arose a therapeutic thought that has not so much reformed the practice of medicine as revolutionized it. There is a slight indication of a crude kind of homoeopathy in this translation anterior to the Cinchona episode. If you look at p. 17 of vol. ii. you will find this footnote in regard to the use and utility of astringents: "Acids have likewise the power of bettering a weak stomach that has a tendency to produce a morbid acidity, as, for instance, sulphuric acid." The influence of the great Cullen upon the ripe mind of the dis- coverer of scientific homoeopathy has not been, I think, sufficiently dwelt upon. Cullen, at the beginning of his work, gives us an exhaustive his- tory of Materia Medica as found in pharmacological works, and comes to the conclusion that the writings on this subject are in great part "a collection of errors and falsehoods." We can readily imagine how consonant this was with the feelings of his translator at this period. At the end of his history of the Materia Medica, Cullen faintly apologizes for his almost wholesale condemnation of the writer on 1 HAHNEMANN. 29 1 that subject, and says that a number of the public may be dissatisfied with his judgment thereon. To this Hahnemann remarks: "The translator does not belong to this number. For having himself read, compared, and thought over most of the older writers and many of the newer ones quoted by Cullen, so that the non habet osorem nisi might not be applied to him, he is constrained in a general way to subscribe to Cullen's opinion with all his heart. Dioscorides and Schröder, with all their shallowness, indefiniteness, old women's stories, and untruths have all along been slavishly worshipped (with but few exceptions); and neither the old fathers themselves nor their weak disciples deserve to be spared." "We must," continues Hah- nemann, "tear ourselves by very force away from these worshipped authorities if we in this important part of practical medicine are ever to be able to cast off the yoke of ignorance and superstition. It is indeed high time that we did!" So you see the skeptic Cullen had found a congenial translator in our Hahnemann, and we can fancy with what eagerness the latter went on from the iconoclastic to the reconstructive Cullen. Hahnemann was looking with keen pleasure on the idols that Cullen had cast down and smashed. Now said he to his hero Cullen, give us something better; let us have a really scientific Materia Medica. Hahnemann was already hungering and thirsting after a scientific therapeutics, and translating Cullen rendered him starving and fam- ished: Hahnemann was longing for the bread of science; Cullen gave him the stone of hypothesis! Thus he still craved for something better. For it must not be lost sight of that Hahnemann had never for a moment lost faith in the efficacy of given drugs, but he yearned for a fixed unalterable law according to which drugs in general might be used. He was sure it existed somewhere close by, but where? How was it to be found? Yet Cullen came very near the proving of drugs on the healthy; he discussed all possible ways of finding out the remedial properties of drugs, and cast them all away one after another just as Hahne- mann does six years later in his "Essay on a New Principle." He enters into the question of the trial of drugs on animals, and rightly remarks that this mode can have but a very limited application; our 30 BURNETT'S ESSAYS. allopathic friends still cling to this method which their own Cullen for the most part condemned ninety years ago. Cullen even went so far as to mention the trial of drugs on the human body, but he merely mentions it in passing, and he seemingly meant the ordinary way of trying them on the sick. After he had upset everything he simply put up a counterpart of the old idol he had himself but just demolished. Yet I think Cullen's tabula rasa greatly helped Hahnemann in his discovery of scientific homoeopathy, inasmuch as it cleared the ground for the homoeopathic edifice. Hahnemann himself would most probably not be conscious of this; great minds read books and nature, and often build up new structures with very old material. Then it is the trite old story of Columbus and his egg. HOMOEOPATHY LOOMING THROUGH THE AGES. Gentlemen, will you allow me here to interpose a somewhat long parenthesis, by way of setting forth some forecastings of homœop- athy? I fear I shall have to trouble you with a few rather dry quotations, but the line of thought which I am following necessi- tates it. It is often said that homoeopathy existed before Hahnemann. So it did just as gravitation existed before Newton. Even a little more than this, for the formula similia similibus curantur may be found in authors from Hippocrates onwards, from some of whom Hahnemann himself quotes (Organon). Nay, more, I have myself works from the 16th and 17th centuries in which the question is clearly argued, viz., Whether are diseases best cured by similars or by contraries? There is a whole literature on the subject, princi- pally in the 16th and 17th centuries. I have read quite a number of these works with avidity, and have been more than once on the point of declaring that this was the pit whence Hahnemann dug his homeopathy. How true it is: Die Welt liebt, das Strahlende zu schwärzen! More than once I have gravely doubted Hahnemann's honesty in this particular, but wrongly, as I now know. The sub- ject is too vast to be largely entered upon here,* but I will give you *For a masterly contribution to this subject see Practice of Homœopathy, by R. E. Dudgeon, M.D. Lectures on the Theory and London, 1854. This incom- · HAHNEMANN. 31 the conclusion to which I have come. THE HOMEOPATHY OF HAHNEMANN HAS NOTHING WHATEVER TO DO WITH THE HOME- OPATHIES OF THE PARACELSISTS, HERMETISTS, AND IATROCHE- MISTS-i. e., nothing whatever beyond the mere notion of healing by similars; yet I shall submit that the suggestive value of these other homœopathies was great to him in thinking out his own scientific system. You will therefore see that those who quote triumphantly from these various authors to show that our homoeopathy was an old affair, and needed no Hahnemann to discover it, have merely skimmed the surface and run away with an entirely false impression. Honesty compels me to confess that I was myself, for a time, in doubt. Let me ask, if it was already there, why did not somebody use it and teach it? Scientific homoeopathy was not there, but only its foreshadowings. Just to give those younger colleagues, who may not be familiar with the details of this part of our subject, an idea of what the ho- mœopathies of these others consisted in, it will suffice to state that their homœopathies were of various kinds, and principally of these four: Firstly. The doctrine of signatures.* For instance, the juice of the Chelidonium majus is yellow; the bile is yellow; like cures like; ergo, Chelidonium majus is a remedy for bad bile-a remedium icteri- cum. If you take a walnut and remove the hard shell carefully, and take a thoughtful look at the surface of the kernel, and note its sulci and gyri and hemispheres, you will get a simile of the brain And still better than Dudgeon's is de Gohren's. parable savant here traces the homeopathic idea all through medical literature, be- ginning with Hippocrates. I cannot, however, subscribe to several of his conclu- sions. By the way, nothing gives one such an exalted conception of literary labor as trying to do it one's self! * A modern supporter of the practical value of the doctrine of signatures is M. Chassiel: Des Rapports de l'Homoeopathie avec la Doctrine des Signatures, Lettre à M. le Dr. F. Frédault. Paris, 1866. This is an honest work, seemingly aimed at M. Teste, who had entrevu the principle of ubi malum ibi remedium, without refer- ring to Porta or Crollius. Chassiel starts a fifth notion of healing by similitudes, viz. (p. 48), diœcious plants cure contagious diseases: La Similitude avec le Mode de Propagation. But all this is not homeopathy. The best historical essay on the subject with which I am acquainted is: Medi- corum Priscorum de Signatura imprimis Plantarum Doctrina; autor, F. L. A. H. de Gohren. Jena, 1840. This is an inaugural thesis, giving a faithful account of it, and, of course, ridiculing it. 32 BURNETT'S ESSAYS. surface; therefore walnuts* are good for the brain, and a reliable remedium encephalicum, and so on. Secondly. Parts of the macrocosm (the world) as compared to sup- posedly similar parts of the microcosm (man's body). For instance, the sun in their pharmacology was the metal gold, which was there- fore called sol. In the microcosm, or man's body, the heart is the sun, or sol microcosmi. Like cures like; therefore gold is a good cardiac. Silver is the moon-luna;t the luna microcosmi is the brain; therefore silver is a brain medicine, etc. Thirdly. Animal parts to cure similar human parts. For instance, a fox's lung in pulmonary affections. This is the crude prototype of Schüssler's clever notion with his Tissue Remedies; and the lamented Grauvogl a few years since recommended the Pulmo Vulpis for asthma. This idea is as old as the hills. Fourthly. Certain types of disease prevail in certain regions of the earth; in these same or similar regions their remedies are to be found . . . ubi malum, ibi remedium. Thus, in cold, damp places we find the Solanum Dulcamara; therefore Dulcamara is remedial of the diseases of such places. Cinchona has a malarious habitat; it cures malarial diseases. A modern example of this might be found in the undoubtedly anti-rheumatic virtues of the willow, which grows in wet places where rheumatism abounds, as some of us know but too well. Now, Hahnemann had evidently read these 16th century homoeop- athies. No other hypothesis is conceivable in one of his extensive reading; and they enlightened him, no doubt, very considerably by setting him thinking about a LAW of healing, and as to whether diseases are best cured by likes or by contraries. But they could not have taught him more; they could not have given him his homo- *The similitude of the walnut with the head is complete: 1. The outer covering of the shell corresponds to the scalp. 2. The shell to the skull. 3. The membranous covering of the nut to the meninges. 4. The kernel to the brain. What has this to do with our scientific homœopathy? † The curious in etymologies will note that this old designation of silver (luna) survives to this day in our lunar caustic—the nitrate of silver, We may laugh at this anthropo-teleological contemplation of natural things; but suppose we had the ordaining of Nature, where would we have put the Cinchona tree? ? The willow (Salix, whence our Salicin) was of old in good repute as a febri- fuge. HAHNEMANN. 33 Papatan Para opathy for the best of all reasons, viz., that the scientific homoeopathy of Hahnemann has nothing to do with either the doctrine of signa- tures, the relationships of the macrocosm to the microcosm, the cure of human organs by giving the corresponding organs of animals as remedies, or with the apparent fact expressed by the words ubi ma- lum, ibi remedium. Thus we see that Hahnemann's homoeopathy (our scientific ho- moeopathy) has really nothing in common with those homoeopathies which flourished in the 16th century and thereafter (as well as be- fore) but the formula similia similibus curantur. To prove this to you in extenso would carry us too far away from our present purpose; but a consideration of this subject is, I submit, here not out of place, as it helps to shed light upon the dawn and rise of our own Hahnemannian homoeopathy, the more so as I am not aware that this view of the subject has ever been propounded; these various homoeopathies having been usually confounded, and re- garded as identical with Hahnemann's. That certain of these authors come very near to it I freely admit ; and it will be right, even at the risk of wearying you, to show how near they came. Therefore I beg to bring to your notice one or two of the works bearing on these more or less crude prototypes of homœ- opathy that have led many sound scholars away with the idea that our homoeopathy existed before Hahnemann. For instance, Fernelius argues against the principle of healing by similars (Joannis Fernelii Ambiani, Therapeutices Universalis, 1574, p. 6, c. ii. De Remedii Inventione). He says, in effect, that every disease is driven out by its contrary, but that many evert this great law, and affirm that diseases are cured by their similars. He then discussed the mode of action, of exercise in fatigue, of the vomiting which cures vomiting, and of the purgation which cures dysentery, and maintains that they are, in truth, examples of healing by con- traries. Here Fernelius comes very near indeed to true homo- opathy, yet only in arguing against it, and without comprehending its real essence. We may affirm that, with his crude conception of dis- ease and of remedies, homoeopathy would indeed be an impossi- bility.* * Morbus omnis contrariis profligandus: contraria enim sunt morborum remedia. Remedium est quod morbum depellit: quicquid autem morbum depellit, id illi 34 BURNETT'S ESSAYS. I will not, however, stop to argue the points which he raises, as I merely wish to show that the idea was prevalent, and I quote from Fernelius as an out-and-out opponent of it. That he was a stanch adherent of the principle contraria contra- riis curantur may be seen from his introduction to the fourth book, p. 126: "Nullus igitur affectus subsistere potest in nobis, cui non pariter contrarium quiddam tanquam remedium illa protulerit." He nevertheless discusses the use of Pulmones vulpecularum in asthma, and explains their action on the ground of similitude and affinity for the offended parts; and Dr. Sharp, F.R.S., will be inter- ested to learn that Fernelius terms their mode of action antipathia. It Dr. Dudgeon quotes Rivière on the side of the law of similars, but Rivière argues hotly against it. Dr. Dudgeon also credits Paracelsus with being in possession of enough knowledge of drug pathogenetics to lead us to suppose that he (Paracelsus) had conceived and taught our Hahnemannian homeopathy; this is decidedly erroneous. is quite true that Paracelsus was a very close observer, and an orig- inal and deep thinker, but he nowhere teaches that his notion of sim- ilars was based on knowledge of the pathogenetic effects of drugs. And not only so, but he clearly inculcates the doctrine of signatures and the similitudes of the macrocosm with the microcosm. No doubt he understood and taught organopathy, i. e., local drug-affinity, though of course, somewhat crudely. Riolanus was also an opponent of the idea of healing by similars; the gist of what he says in his Ars Bene Medendi, Parisiis, 1601 ("De Remedio," s. iv. c. 1, p. 12), amounts practically to this, that all diseases are necessarily cured by contraries, and then he indulges vim infert: quod vim infert, contrarium est: omni ratione igitur remedium morbo contrarium esse necesse est, omnemque morbi depulsionem atque curationem con- trariis perfici Rata igitur constansque manet curandi lex per contraria. ARBITRANTUR PLERIQUE, MEDENDI SUMMAM LEGEM EVERTI, DUM MORBOS QUOS- DAM AUDIUNT REMEDIIS DEPELLI SIMILIBUS. At ejusmodi omnia morbo licet si- milia sint, ejus tamen causae primum ac per se adversantur, morbo autem exacci- denti: huncque tollunt non per se, sed sublata ejus causa. Sic rheumbarbarum quamvis calidum febrem solvit, dum ipsius materiam expurgat. Et lassitudinem exercitatio lenit, quod humorem per musculos effusum discutiat. Et vomitionem sedat vomitio, quae proritantem humorem excutiat. Et dysenteriam purgatio le- vat, noxia materia ejus efficiente causa detracta. Ad eundem prope modum frigidae larga perfusio convulsionem (ut est apud Hippocratem) (Aph. 25, lib. v.) solvere putatur. . . Sunt autem ejusmodi omnia curando affectui vere contraria, etc. • • C by HAHNEMANN. 35 1 in a little innocent fun at the expense, as he supposes, of Paracelsus, and of the Paracelsic signatural homœopathy.* Having given one or two opponents of the principle of similia, I will ask you to listen to me while I adduce a couple of advocates of it. The following article was copied verbatim by Mr. W. H. Heard, of St. Petersburg, as it appeared in the Daheim, No. 16, of 17th January, 1880, under the heading, "Zur Geschichte der Homo- opathie :" "So far back as the seventeenth century homeopathy was under- stood and preferred to allopathy by Paul Fleming, a celebrated poet, who was at the same time a physician. In his poem to his friend Dr. Hartmann the following passage occurs: : "A clever physician takes his remedies from substances which cause the harm: removes a craving for salt with salt, puts out fire with flames, a thing not understood by many. You contract the art by doing so little with much you ought to make much out of little. A grain should be more efficacious than a long draught capable of doing harm to a butcher. We have got rid of the old fancy. Who is there now who will commend the doctor simply for his deserving the thanks of the chemist who prefers the latter mode to the former; and must then the poor patient's weakness be redoubled by a heavy potion?' etc."† * Ergo morbi omnes contrario curantur. Sit hoc primum inveniendi remedii principium, quod in genere breviter declaratum sequentibus libris singulorum mor- borum et remediorum comparatione fiet notius. Velim interea lectorem observare quam sapienter Paracelsus suae medicinae contrarium jecerit fundamentum, Morbos omnes sunari similibus. Quod si contrariorum contraria sint consequentia, sanitas autem servetur similibus, quis non videt morbos abigendos esse contrariis? Nonne morbus cum sit hostis naturae se depellendum indicat! at simile non agit in simile, contrario igitur profligandus. † "Schon im XVII. Jahrhundert kannte Dr. Paul Fleming, der berühmte Dich- ter, der zugleich auch Arzt war, die Homeopathie und gab ihr vor der Allopathie den Vorzug. In seinem Gedichte an Dr. Hartmann, seinen Freund, findet sich fol- gende Stelle: 'Ein kluger Arzt der nimmt Da seine Hilfe her, von was der Schade kömmt Lös't Salzsucht auf durch Salz; löscht Feuer aus mit Flammen. Was mancher nicht begreift. Ihr zieht die Kunst zusammen, Macht wenig aus so viel. Ihr wirket viel durch wenig 36 BURNETT'S ESSAYS. And Mr. Heard in a letter to me observes: "This remarkable extract deserves a place by the side of an equally interesting acknowledgment made about the same time by Johan Faramund Rhumel, physician to the Duke of Anhalt, and evidently a disciple of Paracelsus, in his work entitled, Medicina Spagirica. The passage is brought forward in the Populäre Homœopathische Zei- tung, 1871, No. 10." So you perceive, gentlemen, that every one looks upon all these various notions of healing by similars as identical with the scientific inductive homœopathy bequeathed to us by Hahnemann. Now let us glance at the author thus introduced by Mr. Heard; he says: "For every spirit must be modified by that which is the most intimately related to its own nature (simile a simili curari), and herein we see the difference between the Hermetists and the Galenists." Then : "And thus it is with the diseases in the elemental fire, air, and water, and in like manner must these same be helped and ever must like help its like."* We have already seen that Rhumel was a Paracelsist, and we note that he puts the date of Hermes in the time of Moses, when the law of similars was (he says) first committed to writing. Rhumel's homœopathy (like that of his master Paracelsus) con- sists in the doctrine of signatures, and generally in the similarity Von Euch thut ein Gran mehr, als jener langer Trank, An dem ein Fleischer wol sich möchte heben krank Wir sind nun überhoben Der alten Fantasey. Wer will den Arzt noch loben Um dass er nur verdient des Apotheker's Dank Der doch dies setzt vor das. Soll man die armen Schwachen Durch einen schweren Trunk noch doppelt schwächer machen?' etc." * Medicina Spagijrica Tripartita, oder Spagijrische Artzneij Kunst in dreij theil getheilet. Authore, Joanne Pharamundo Rhumelio. Franckfurt, 1662. Editio Secunda (date of first, 1630). In the Compendium Hermeticum, c. ii. p. 3, we read: Dieweilen ein jeder Spiritus allein begehrt von demjenigen mutirt zu werden das seiner Natur am hefftigsten verwandt ist (Simile a simili curari) dardurch der Hermetisten Galenisten Unterschied kund und offenbar. Then (c. iv. p. 11). . . . Also, auch wird eine Krankheit im elemento ignis, aëris, vel aquæ microcosmi, so müssen ihr dieselbig auch zu hülff kom- men, und ALLEZEIT MUSS GLEICHES SEIN GLEICHES Helffen. درا HAHNEMANN. 37 · } Paul KAN * (and equality) of the major mundus to the minor mundus. This he makes perfectly clear; indeed of all the Paracelsists, he is, perhaps, the least mystic, and his writings constitute a good introduction to those of Paracelsus himself. Thus he says (c. vi., De Curatione Morborum, pp. 82–83): "With regard to the cure, it is either general or special, and takes place either in the common, or Galenic way, or else after the manner of the new Hermetic or Paracelsic medicine, in which we must in- clude natural Magia. As for the ordinary Galenic mode of treat- ment, I will pass it by in silence rather than make much ado about it, SO THAT I MAY NOT OPEN THE WOUND AFRESH. This con- sists in stubbornly maintaining: contraria contrariis curari debeant. "But on the other hand the old Hermetic method of treatment is far preferable, as daily experience teaches us, for by it the human body may often be cured (with the help of God) even of diseases commonly considered incurable, as we can sufficiently testify from our own humble experience. This consists in the formula similia similibus curentur.” He then goes on to enlarge upon the sympathia and antipathia, and the concordance of the macrocosm with the microcosm. There are a number of other authors, some of whom are quoted by Dudgeon, who write in the same strain, but these examples suffice for our present purpose. Rhumel's remark about not being willing to "open the wound afresh," shows that a bitter controversy had been carried on between the Galenists and Hermetists about the principles of similars and contraries. Dudgeon (op. j. cit.) shows that even popular preachers referred to the controversy in their sermons. Gentlemen, I much fear you are finding these arid quotations a * Die curation belangend, ist dieselbe generalis oder specialis, und geschicht ent- weder auff die gemeine oder Galenische Weise, oder aber nach Art der newen Her- metischen und Paracelsischen Medicin, neben welchen auch die naturliche Magia, was bisshero durch die gemeine Galenische Art zu curiren verrichtet, will ich lieber still- schweigend vorbeij gehen, als davon viel Klagens machen, DAMIT ICH DIE WUnde NICHT ERFRISCHE. Welche darinn beharrlich besteht: contraria contrariis curari debeant. Was im Gegentheil die alte Hermetische art zu euriren praestiret, lehret die täg- liche Erfahrung, und wird der Menschliche Leib so dadurch vielmals glücklich von auch unheilbar gehaltenen Kranckheiten (mit Göttlicher Hulffe liberiret), wie auch unsere wiewol geringe experientz genugsam bezeugen. Diese beruhet in dem : quod similia similibus curentur. 38 BURNETT'S ESSAYS. 7 little tedious, but I want to prove not only that these old authors had crude inklings of a law of cure by similars, but that the coming event did cast a shadow before it, and that this shadow led Hahne- mann to the substance. It is very important to dwell a little on this foreshadowing, be- cause it has been urged by no less a man than Sir Robert Christison as an argument against our scientific homœopathy, that no such shadow had been cast before the coming event; so Sir Robert's objection falls to the ground. You know this had already been amply proved by Hahnemann, and since by Dudgeon. You will, perhaps, ask the very pertinent question: Did Hahne- mann himself claim to have originated the notion of healing by sim- ilars? No, he did not. He rightly claimed to have seen the sub- stance of the various fitful and flickering foreshadowings, and to have transformed a semi-superstitious inkling into an inductive science. Let us see what he says on the subject in his Organon. The copy which I have at hand is the fourth Leipsic edition. (1829), and from this I quote. On page 51 he gives examples of involuntary homoeopathic cures wrought by the physicians of the old school. He mentions the palliative mode of treatment according to the law contraria contrariis, and then remarks: (6 By observation, reflection, and experience, I found that, on the contrary, the true, right, and best way of healing is to be found in the formula: similia similibus curentur. In order to cure gently, quickly, certainly, and enduringly, you must in every case of disease choose a remedy that is itself capable of producing a complaint like the one it is to cure (ὅμοιον πάθος). "This homoeopathic way of healing has thus far been taught by no one, nobody has carried it out [in practice]. [The italics are Hah- nemann's own.] But if the truth lie solely in this proceeding, as you will see with me, then it may be expected that, admitting that it had not been acknowledged for thousands of years, nevertheless traces of it may be found in all ages. And thus it is." He then goes on to argue that all real cures by remedies in every age have been according to the law of similars, although the physi- cians who prescribed the remedies were not aware of the fact. And in a footnote he says: "For truth is coeternal with the all-wise beneficent Godhead. Man may long leave it unnoticed until HAHNEMANN. 39 :.3 the time comes when, according to the decree of Providence, its bright sheen shall irresistibly penetrate the fog, and appear as the aurora of the morn and the dawn of day to shine brightly, for the weal of mankind for evermore." Further on (p. 102) he quotes real inklings of scientific homoeopa- thy; but they were mere inklings, and remained such, and no one taught them or put them into practice. Hahnemann remarks in a foot- note (p. 102) that he gives these examples of inklings of home- opathy not as proofs of a really founded homoeopathy, but so that he may not be reproached with having purposely ignored them in order to secure for himself the priority of the idea. Thus you clearly perceive that he does not lay any claim to hav- ing originated the idea of healing by similars. To my mind all these historic inklings very much enhance Hah- nemann's great merit as an original thinker, and as the founder of scientific homoeopathy. I do not, however, think that Hahnemann was himself acquainted with all these inklings at the time of his great discovery, most probably he hunted many of them up after- wards. I also question very much whether he had himself a clear conception of how the idea first came to him. He must have gradu- ally thought it out, and applied the result of his experiment with Cinchona to the idea, or conversely. Hahnemann's position with regard to the notion of healing by similars is also very prettily and clearly indicated by himself in his historical communication to Guizot. Writing to this great man in 1835, on the question of homoeopathy, Hahnemann quotes the fol- lowing lines from Béranger: Combien de temps une pensée, Vierge obscure, attend son époux ! Les sots la traitent d'insensée ; Le sage lui dit: cachez-vous. Mais la rencontrant loin du monde Un fou qui croit au lendemain, L'épouse; elle devient féconde Pour le bonheur du genre humain. Till Hahnemann, homeopathy was an obscure, wandering, and despised maiden thought, awaiting marriage with a male mind; this thought became united with Hahnemann's mind, and fecundity fol- lowed for the weal of mankind. 40 BURNETT'S ESSAYS. You will readily admit that familiarity with these sixteenth century writers in their homœopathies, and on the question of whether dis- eases are best cured by contraries or similars, would prepare Hahne- mann's mind for his own scientific induction. Nay, perhaps you will even admit with me, that had he been unacquainted herewith, his historic proving of Cinchona might not have eventuated as it did in the establishment of scientific homoeopathy. For we admit that Hahnemann did not originate the conception of a law of cure by contraries or by similars; neither did he origi- nate the idea of the trial of drugs on the healthy human organism. Baron von Stoerck tried medicines on himself: Haller, and possi- bly others also. Crumpe's trial of opium on himself and others, in health, is, as you have seen, subsequent to Hahnemann's. Haller's position may be seen in the preface to his Pharmacopæia, where he clearly enunciates the principle of trying drugs on the healthy in these words: "Primùm in corpore sano medela tentanda est, sine peregrina ulla miscella, exigua illius dosis ingerenda et ad omnes, quae inde con- tiguas affectiones, qui pulsus, qui calor, quae respiratio, quaenam ex- cretiones attendum. "Indè adductum phaenomenorum in sano obviorum transeas ad experimenta in corpore aegroto."+ Let us now just glance at a veritable forerunner of Hahnemann : I mean the Danish regimental surgeon Stahl, whom Hahnemann re- fers to in his Organon (p. 104). The passage runs thus: "The rule that is generally accepted in the medical art, to cure by means of oppositely acting remedies (con- traria contrariis) is quite false, and the very reverse of the truth; on * Before venturing to publish his work on Opium, Crumpe submitted the MS. to Dr. Gregory of Edinburgh. Dr. Gregory "read it with attention," and considered that " as a book of medical science it possessed considerable merit." But Gregory was led to no law by it any more than Crumpe himself. So we see that the mere fact of carefully conducted experiments with drugs on the healthy did not of itself lead to the discovery of homoeopathy, any more than did the various inklings of real homeopathy, or the various notions of healing by similitudes already al- luded to. †This is the birthplace of the modern physiological phrase of allopathy, to which the rank of a science cannot be denied, i. e., the science of palliative medi- cine; homoeopathy being the science of curative medicine. HAHNEMANN. 41 3 the contrary, he (Stahl) is convinced that diseases yield to and are cured by a remedy that can produce a like affection (similia similibus) -burns, by being brought near a fire, frostbitten limbs by the appli- cation of snow and very cold water, inflammation and bruises by dis- tilled spirits; and thus he was in the habit of treating a tendency to acidity of the stomach by a very small dose of sulphuric acid with the most happy results, in cases in which absorbent powders had been used in vain." But Stoerck also seems to have come very near to it. Anton Stoerck (Libellus quo demonstratur: Stramonium, Hyoscia- mum, Aconitum non solum tuto posse exhiberi usu interno homini- bus, verum et ea esse remedia in multis morbis maxime salutifera. Vindobonae, MDCCLXIJ.) tried drugs on himself on June 23d, 1760,* by rubbing some fresh stramony on his hands to see whether the dic- tum of the botanists,-Si tantum olfeceris stramonium, ebrietatem facit,—was correct, but no ebriety followed. This emboldened him. Then he and his famulus cut up a quantity and rubbed it up in a mortar, and expressed a succus. Then he slept in the same room with it and got a dull headache. Then he made an extract and put << * But Stoerck had already previously tried remedies on the healthy. See his Libellus de Cicuta, Vindobonae, 1760 (c. i. p. 8). He first gave cicuta to a dog, and : His audacior redditus, in me ipso experimentum feci. Mane ac vesperi sumsi granum unum hujus extracti, et vasculum unum infusi theae hausi desuper. Diae- tam tune paulo strictiorem observavi, ut ilico (sic) adverterem, si quid insoliti in meo corpore fieret." It did him no harm. Then he increased the dose, but still obtained only a negative result. What was his conclusion? "Jam ergo optimo jure et salva conscientia hoc in aliis mihi licuit tentare.” That was the extract. "Quae autem radici cicutae vis inesset? quoque scire volui." The significance of this question is seen in Stoerck's answer to it. He says: "Radix recens dum in taleolas discinditur, fundit lac, quod gustu amarum et acre est. Hujus lactis unam alteramve guttulam linguae apice delibavi. Mox lingua facta est rigida, intumuit, valde doluit, et ego nec verbum loqui poteram. Sinistro hoc eventu terrefactus multum timui." This was much relieved by lemon juice, so that the pain and tension were so far better that he could just lisp a few words (balbutire). In two hours he was all right. He then took the dried root, reduced it to powder, and found it “minus nociva.” He therefore prepared a dry extract. . "tunc fit extractum minus efficax, atta- men utile." Did this lead Stoerck to use cicuta (conium maculatum) for a painful tumid tongue with loss of speech? By no means, but for indurated glands! 4 42 BURNETT'S ESSAYS. . a grain and a half on his tongue, and pressed it against the palate, and so on. But his object was not to discover an explanation of its modus in morbis operandi, but to find out whether such a poison could be safely exhibited as a remedy. That is a very different thing to Hahnemann's first trial with cinchona thirty years later. Stoerck's next step after determining that the extract of stramony might be safely exhibited to human beings (I beg to show you the work, you will find this narrated on pp. 7, 8, and 9)—his next step was this: (6 Agebatur" (says he) "tunc de morbo, in quo conveniret, et de aegris, quibus prodesset." To this end he consulted both the older and more recent writers, but found nothing to favor its use as a rem- edy. He exclaims: "Etenim omnes scribebant : "Stramonium turbare mentem, adferre insaniam, delere ideas et memoriam, producere convulsiones." All this, says he, is bad, and forbids the internal use of stramony. Here comes a memorable sentence,-memorable, that is, from our present scientific standpoint: "Interim tamen ex his formavi sequentem quaestionem : G "Si Stramonium turbando mentem insaniam sanis, an non licet ex- periri num insanientibus et mente captis turbando, mutandoque ideas, et sensorium commune adferret mentem sanam, et convulsis tolleret contrario motu convulsiones ?” These are the nearest approaches to our scientific homoeopathy with which I am acquainted, and how near too! Yet they resulted in noth- ing beyond enunciating the ODD notion of healing by similars, and establishing the fact that moderate doses of stramony may be safely given in disease, and that it causes and cures insanity and convulsions. Stoerck here came so near to discovering scientific homeopathy, that, with our present light, we may marvel that he did not do so. * Thus you see he made no attempt at induction. + Not a law. (( Oddly enough, Stoerck's bitter foe, de Haen (Ratio medendi, tom. iv. p. 228), almost stumbled against our scientific homoeopathy, for he says: Dulco-amarae stipites majori dosi convulsiones et deliria excitant, moderata vero spasmos, convul- sionesque solvunt." Well may Hahnemann remark, “How near de Haen was to recognizing nature's law of healing!" (Organon.) Yet he did not. The mighty genius of a Hahnemann is not often found in nature's children. HAHNEMANN. 43 I submit that these near approaches of Stoerck and many others to the discovery of our great law, with the trial of drugs on the healthy, and the very question formulated by Stoerck himself in such clear language, prove how much was necessary for its discovery. Stoerck (and most of the others) wanted three things: 1. The true spirit of philosophy. 2. The requisite leisure and the habit of thinking deeply. 3. A knowledge of the history of theories of drug action. Stoerck came to the very verge of the discovery of scientific home- opathy, and nevertheless did not see it; this is proved by reference to his later works. Thus if you refer to his Libellus, quo demonstratur : Herbam, veteribus dictam Flammulam Jovis, etc., Viennae, 1769, you will find that he had rather retrograded, as he there only tried it very superficially on lower animals, and not on man at all, by way of prov- ing it. These facts give us, better than anything I know, an adequate con- ception of Hahnemann's true greatness. Had Hahnemann stumbled against homoeopathy, as so many did, or formulated Stoerck's ques- tion in 1790, he would have infallibly discovered scientific home- opathy. Had Stoerck been a better read man, with a little more of the spirit of philosophy, and been also an impecunious physician who had given up practice for conscience' sake, he, too, must infallibly have discovered the therapeutic law that leads us, and we should have to-day met at a Stoerckian Address. But Stoerck was a baron of the empire, and court physician, and too much success does not conduce to mental progress and development. It is fortunate for mankind that Hahnemann's noble conscientious- ness had reduced him to beggary. Had he too been a baron of the Holy Roman Empire, and court physician, we should not have been here to-day, for the doctrine of healing by similars had been freely discussed for centuries, and yet homeopathy was there only as a por- tentous shadow. Progress in science is not made by big bounds with great gaps be- tween, but rather bit by bit, one succeeding another unconnectedly, and then comes a third connecting the two. So was it, I submit, with the scientific homoeopathy of Hahnemann. Drug physiology had just dawned, and may be said to have existed as an odd notion. The question of a law of similars was there looming through the ages, and awaited, in the language of Béranger, as an obscure maiden 44 BURNETT'S ESSAYS. thought for a husband; this she found in the male mind of Hahne- mann. For what was the use of these two without the connecting link? None, and the absolute proof of this lies in the fact that although they were there, still there was no scientific homoeopathy. This ends my long parenthetic chapter; let us now return to Cullen. HOMEOPATHY AS A SCIENTIFIC INDUCTION. We can readily imagine how Hahnemann would receive any new hypothesis anent the modus operandi of cinchona. He knew well enough that this remedy did cure certain forms of ague, just as he knew that arsenic would cure other forms of the same disease, but according to what law, how? Cullen said the bark cured ague because it was a bitter and an as- tringent combined, and at the same time somewhat aromatic, a tonic and a roborant. It strengthens the stomach and thus cures ague as a roborant stomachic. Thus, for Cullen, cinchona is a bitter, astringent, aromatic, roborant, stomachic tonic! Surely it was not needful to clear away all his predecessors from the pharmacological field in order to set up such a worthless hypoth- esis; no wonder Hahnemann in his turn dealt with Cullen as Cullen had dealt with his predecessors. Here is Hahnemann's historical footnote: "By uniting the strongest bitters with the strongest astrin- gents you may get a compound that in a small dose shall possess much more of both qualities than the bark, and yet you will in all eternity never obtain a fever specific from such a compound. Our author should have settled this point. It will not be such an easy matter to discover the still lacking principle according to which its action may be explained. Nevertheless, let us reflect on the following: Substances such as very strong coffee, pepper, arnica, ignatia, and ar- senic, that are capable of exciting a kind of fever,* will extinguish the types of ague. For the sake of experiment I took for several days four quentchen of good cinchona twice a day; my feet, the tips of my fingers, etc., first became cold, and I felt tired and sleepy, then my heart began to beat, my pulse became hard and quick; I got an in- P * You observe Hahnemann already knew something of the pathogenetic effects of drugs. HAHNEMANN. 45 sufferable feeling of uneasiness, a trembling (but without chill), a weariness in all my limbs; then a beating in my head, redness of the cheeks, thirst, in short, all the old symptoms with which I was fa- miliar in ague appeared one after another, yet without any actual chill or rigor. In brief, also those particularly characteristic symp- toms such as I was wont to observe in agues, obtuseness of the senses, the kind of stiffness in all the limbs, but especially that dull disagree- able feeling which seems to have its seat in the periosteum of all the bones of the body—they all put in an appearance. This paroxysm lasted each time two or three hours, and came again afresh whenever I repeated the dose, but not otherwise. I left off, and became well." (pp. 108, 9, Vol. II.) On the next page Cullen seeks to defend his hypothesis against all comers, and hereto Hahnemann adds this remarkable footnote. By the way, Hahnemann's footnotes are very like the traditional post- scripts to ladies' letters-they are the most important parts of the whole. Well, the note is this: "We readily see how sorry our au- thor is, not to be able to fell his opponents to the ground, with all their objections to his mode of explanation. His zeal seems particu- larly directed against those who always have the vague word spe- cific* in their mouths when they discourse of the bark, without knowing what they really mean by it; but had he for a moment re- flected that one can prepare from an extract of quassia and oak- apples a far more powerful astringent bitter than cinchona is, but which nevertheless cannot cure a quartan fever that is half-a-year old,—had he scented in the bark a power of exciting an artificial an- tagonistic fever (etc.),—most certainly he would not have so zealously stuck to his own hypothesis." You will note, gentlemen, that here, at the birth of scientific ho- mœopathy, ninety years ago, Hahnemann's conception of homoeo- pathic drug action in disease is that of antagonism to it. He speaks of the cinchonic fever as artificial and antagonistic; i. e., antagonistic * There is too great a tendency amongst us now to degenerate into mere homo- opathic Specifiker; witness Dr. Yeldham's Presidential Address at the Leeds Con- gress, 1880. No doubt it is good-nay, very good-to be a homœopathic Specifiker; but it is better-very much better-to be an individualizing homoeopath. I do not claim to be any better than my neighbors. Almost daily I find myself slipping back into the royal road of treating the disease in lieu of the patient. Individual- izing is so laborious, and still too far in advance of the hodiernal medical mind. 46 BURNETT'S ESSAYS. to the ague, which it cures by reason of its similarity. This has been lately presented to us as something new with vain verbosity; but the babe is no more, having succumbed to antipathy. The fact is, the number of men who persist in burning farthing ruslilights of their own is verily not small-another reason, this, for an annual Hahnemannian Lecture, so that the old lamp may not be allowed to choke up with the soot of neglect; for we cannot afford to give up the grand electric light of homoeopathy for the faint flickerings of these tiny tapers. Two or three pages further on we already find Hahnemann indi- vidualizing, for he speaks of the cinchonic fever as of a particular kind (von besondrer Art, p. 117). We now proceed to take leave of the pre-homoeopathic Hahne- mann, to learn how he thought out his homeopathy from this cin- chonic artificial fever which he had produced in himself. Before doing so, let me express a hope that no one here is yawningly saying to himself: "Hier auf diesen Bänken Vergehen mir Hören, Sehen, und Denken." In 1795 the renowned Hufeland began his Journal der practischen Arzneikunde und Wundarzneikunst in Jena. Hahnemann and Hufe- land were of the leading medical men of the day, and personal friends; the latter was then professor of physic in Jena. In the first volume (1795) Hahnemann is quoted on the treatment of an impor- tant affection. In the second volume (1796) the historic cure of Klockenbring is mentioned. In this same volume we find Hahnemann's celebrated Versuch über ein neues Prinzip zur Auffindung der Heilkräfte der Arzneisub- stanzen, nebst einigen Blicken auf die bisherigen, which must be re- garded as the starting-point of the greatest revolution in medicine that the world has ever witnessed. In this masterly essay he under- mined the whole then existing fabric of practical medicine, and laid the corner-stone of scientific therapeutics, by enunciating the law of healing by similars, based on the effects of drugs on the healthy hu- man body. I feel it is utterly impossible for me to do justice to this wonderful essay, or to the majestic modesty of its style. You all know it well; and, although it was published eighty-four years ago, our very presence here to-day is its echo. HAHNEMANN. 47 HAHNEMANN THE HOMEOPATH. We have at last come into the presence of Hahnemann the Ho- moeopath. Of course a little country village like Stötteritz was not the place in which the founder of a new system of practical medi- cine was likely to be content to remain; not because a physician's skill should be measured by the number of inhabitants of the place he lives in, but because a village does not offer the requisite material for testing a new doctrine of practical physic. 1 The iconoclastic Hahnemann goes pari passu with his upbuilding of a new teaching; and herein lies his vast superiority over all other medical reformers. He does not merely knock everything down, and then leave everybody staring hopelessly about in anarchic chaos, as did Cullen, but he skilfully uses the débris of the demolished edi- fices for the erection of his own. Having been set thinking by his trial of cinchona that grew out of his translating Cullen's Materia Medica, he returned to his old love, the practice of medicine. Very fortunately he obtained a post as medical superintendent of an asy- lum for the insane at Georgenthal, in the Thuringian forest, which was offered him by the Duke regnant of Saxe-Gotha. Here he wrought the cure of the wonderfully-gifted Hanoverian Minister Klockenbring, who had been driven mad by a withering satire of Kotzebue. An account of the case was published (you will find it in the Lesser Writings), and it very naturally created a considerable stir in Germany, where Klockenbring was at the time a kind of Lord Beaconsfield. Perhaps the most remarkable part of this case lies in the fact that Hahnemann gave bodily freedom to his maniacs, and in general treated them with kindly, benevolent mildness. Thus we see that Hahnemann must be regarded as the pioneer of a rational treatment of the mentally afflicted. He has left on record that he never allowed any insane person to be punished by blows or any other pain-giving bodily inflictions, inasmuch as there cannot possibly be any punishment, properly so called, where there is no real responsibility; for when the law shuts up an individual in an asylum, such person thereby receives the stamp of irresponsibility. Hereupon we find Hahnemann again on the wander, after a stay of only a few months at the asylum. He is first at Walschleben, then at Pyrmont, then at Brunswick, then at Wolfenbüttel, and finally at Königslutter, where he remained till 1799. 48 BURNETT'S ESSAYS. You remember that his famous experiment with cinchona was in 1790; and during the nine years that elapsed between this and his being driven out from Königslutter he had tried his new notion, and found it the basis of a scientific therapeutics. It is no wonder that Hahnemann was restless and given to roaming during these nine years, for he must then have begun to realize the immense range of his new idea-he must have foreseen that it would bring about a total bouleversement of time-honored physic. At Königslutter he gradually ripened into a scientific practitioner, for he gave one medicine at a time, and that according to the law of similars; and he, moreover, made use of only comparatively small doses. Of course these were material and appreciable; but, remem- ber, this was eighty-odd years ago, when a physician who dared to give one medicine at a time was looked at askance both by his col- leagues and by the apothecaries-especially by the apothecaries. It is still a very suspicious thing to give but one medicine at a time. At that period an orthodox prescription was half a foot long, and contained a score of invaluable ingredients, and a mysteriously oc- cult art lay supposedly in the mode of combining them in such pro- portions and degrees that they should be, at any rate, a mighty mys- tery to the less canny colleagues. We are told that in these latter days nous avons changé tout cela, and that the allopaths and homo- opaths are now all alike in their mode of practice. Well, let us compare the prescriptions of our most eminent allo- pathic practitioners. We have them daily in our hands, and we see them in our literature. Judging from these, I must affirm that the general run of allopathic practice of to-day is, taken for all in all, no better than it was a century ago, and that because their principle is I have taken the trouble to compare the papers on practical wrong. medicine that appear nowadays in the Lancet with those that ap- peared eighty years ago in Hufeland's Journal, and, with the single exception of bleeding, I prefer those cases in Hufeland's Journal as less hurtful and less complicated, and some of them as at least em- pirically commendable. But I am wandering away from my text; yet, having wandered so far, permit me to say, before returning to it, that when I speak of the "general run of allopathic practice" I mean allopathy, and not homoeopathy on the sly, or crypto-homeopathy, that some of the - i ; tam kar : i HAHNEMANN. 49 writers in the Practitioner impose upon the credulity of their igno- rant readers as discoveries of their own; for along the corridor of Time I hear the voice of the sage of Coethen echoing the words, "Hos ego versiculos feci: tulit alter honores." Homœopathy is homoeopathy, whether openly and honestly taught within these walls or elsewhere, or slily smuggled into the students' skulls at certain colleges and schools. Professor Bathyllus* has car- ried on this smuggling business for a good many years, and his pu- pils are beginning to fill the other chairs of medicine throughout the country; but I have yet to learn that plagiarism is so far condoned as to be converted into honesty by social success. Gentlemen, do not misunderstand me; I am not pleading for priv- ileged schism and narrow sectarianism, as do the allopaths by crying themselves out from the very housetops as the Levites of the Ark of the Medical Covenant. No; I am merely maintaining that home- opathy is the mental property of Samuel Hahnemann, and of such of his disciples as have contributed to its development and propagation, and honestly give honor to whom honor is due. Science is the com- mon property of mankind; the honor of her discoveries is private property. The mean-souled Bathyllusses of our medical colleges may impose upon beardless boys raw from the schools, but they cannot, in the very nature of things, own what belongs to another man, although that other man be dead. Hahnemann is dead, it is true, and cannot ap- pear in the flesh to claim his own; but he has followers still, who dare stand up and maintain that with all respect for professional unity, with all regard for professional brotherhood, there cannot be any real unity in the profession so long as common honesty is banished from its portals, and the premium of professional rewards is put upon plagi- arism. In my opinion the man who knowingly appropriates another man's discoveries, and debits them as his own, is to all intents and purposes dishonest; and the more so as he is beyond the reach of or- dinary laws. Gentlemen, you are perhaps shocked at my making use of such a strong expression. Be shocked rather at the THING, not at the WORD. I would I could call it by some other name that, being more euphe- * Quamobrem donatus honoratúsque á Cæsare fuit. 50 BURNETT'S ESSAYS. mistic to your ears, were still as true to fact; but I cannot. Through- out the profession-may God forgive them—the great name of Hah- nemann is shamelessly maligned, while at the same time his life's labor is being appropriated by the pilfering professors of our schools. And the worst thing about it is that the present generation of students are thus deliberately demoralized by being taught to sacrifice moral principle for mere expediency; taught at the very threshold of life to gain a cheap pseudo-success, to crown themselves with tawdry tin- sel in lien of earning a really golden crown that comes only to honest truthful labor. Tell me, you with hoary heads, and you who have only the silvery streaks of time to mark the years which have gone, what has helped you most in the march of life thus far? Was it public applause, or the still small voice within that kept you up in the most trying hours of your life's battle? Have you unexpectedly triumphed over disease and death at your isolated posts with the aid of the doctrine of expe- diency? I trow not. Alas! that the brightness of the honor of our students should be tarnished by the example and precepts of their own teachers before the trials and temptations of real life begin. C'est le premier pas qui coûte, and hence the future of such is not bright. Of the original Bathyllus we read that after a while. . . . ... Romae fabula fuit, Maro verò exaltatior. So it will be in this matter; if not, it will be the fault of our future Hahnemannian lecturers. MILITANT HOMEOPATHY. I come back now and ask you to fix your attention for a moment on the beginning of militant homoeopathy, and the hatred that is as alive to-day as it was eighty-one years ago, when bigoted ignorance and a degrading trades-unionism drove the enlightened and learned Hahnemann out of Königslutter. You know certain wiseacres say that the founder of homoeopathy had himself to blame for this hatred by violently attacking his medical peers. Gentlemen, this is not cor- rect. Permit me to point out that Hahnemann's violent language is found at a later date than 1799. Just turn to his " Essay on a New Principle," and point out one single unbecoming word, or one flash of passion: it is modest and dignified, and respectful to his fellows. --- * - - - ---འ་བསྟན་ཟྭ་། ། . HAHNEMANN. 51 7 1 J I find nothing anterior to his departure from Königslutter that be- tokens even the slightest anger or hatred of a blamable nature against his fellow-practitioners. I maintain that up to the departure from Königslutter Hahnemann was filled with love and respect for his worthy fellow-physicians. We are also told that it was the small dose notion that set the med- ical world against him. This is impossible, for the best of all reasons, viz., that when the opposition to him began, Hahnemann had not yet enunciated his doctrine of drug dynamization, and he himself was still using certainly small, but nevertheless moderate, material doses. Then we are told that it was his notions about pathology, his doc- trine of psora more particularly. But, gentlemen, Hahnemann was driven out of Königslutter twen- ty-eight years before he called Stapf and Gross to Coethen to announce to them his theory of chronic diseases. We, therefore, come to the inevitable conclusion that it was neither his vituperative language, nor his doctrine of drug dynamization, nor his psora doctrine, because none of those existed when the bitter persecution set in. You probably remember the sweet little story of the lamb and of another quadruped that, I believe, was not a lamb; in that celebrated tale the water flowed up-stream. So it must be with militant homoeopathy in Hahnemann's person: for his personal persecution began in 1798, and in a most violent mau- ner. If therefore his violent language, or his small doses, or his psora doctrine set the medical world against him, they must have done so by anticipation, and the effect preceded its causes by a good many • G years. Then it has been flaunted in his face that he went to the lay public with his discovery, and thus set the profession against him. This is equally untrue: Hahnemann published his "Essay on a New Prin- ciple" in the leading medical journal-I hold it in my hand. There it is. (Hufeland's.) Moreover he kept within the most strict code of medical ethics. Thus we see that the separation of Hahnemann from the profession did not come from him but from his beloved professional brethren, who thrust him out, as they thrust you out, by forbidding freedom to openly and honestly practice according to the law of similars. 52 BURNETT'S ESSAYS. The vulnerable point with Hahnemann was this: at Königslutter he gave his own medicines to his patients, though gratuitously. The physicians at Königslutter became jealous of his rising fame, and they incited the apothecaries against him, and these latter brought an action at law against Hahnemann for dispensing his own medicines, and thus encroaching upon their rights. It was decided against him : he was forbidden to give his own medicines, and this of course ren- dered his further stay impossible. That was what these unprofessional brethren wanted. The letter of the law was no doubt against Hahnemann, but the spirit of the law was in his favor, as were also justice and common sense. The injus- tice of the decree against him was all the more glaring because he was a recognized authority on the apothecaries' art, and had thoroughly qualified himself as an overseer of chemists, and had actually been in such a position before. Then already, in 1787, Hahnemann had pub- lished a kind of adaptation of a pharmacological work from the French of Van den Sande (Brussels, 1784), entitled La falsification des med- icamens dévoillée. But this work is completely put into the shade by his "learned and laborious Pharmaceutical Lexicon." It is important to know that in Germany the pharmaceutical chemists are under the control and supervision of the medical officers. of health, the Stadtphysici, who are necessarily medical men. The Stadtphysikus of a given district must visit the chemists' shops of his neighborhood at stated intervals to see that the proper drugs are in stock and good. Now Hahnemann had years before held such a post, and his books were actually the authorities for the chemists and their respective overseers. I dwell on this because it explains to us how flagrant the injustice done to him was: he the great authority in pharmaceutical chemistry was prohibited from even giving his med- icines away for nothing! Nay, more, he was such an authority on all matters pertaining to the apothecaries' art that some of his de- tractors on that very account maintained, and maintain it still, for I have heard it with my own ears, that he was not a physician at all in reality, but an apothecary!! The fact is, Hahnemann was a master in materia medica, whether such medical material be on the chemists' shelves, in their original habitats, in the laboratory, in the healthy body, or in the sick. NE ~ HAHNEMANN. 53 Driven out of Königslutter in 1799 by the persecution of the pro- fession, he wended his way to Hamburg. Of course in those days there were no railways or any of the furniture-removing vans that rendered our flittings comparatively small affairs. In 1799 it was no small undertaking to remove with all the household gods from Königslutter to Hamburg. At that time those who moved to some little distance used to buy a van or wagon for the purpose; this Hahnemann did, and put his wife, children, and movable property in it, and went out of Königslutter, as the Vicar of Wakefield left his parish, accompanied on the road for some distance by those who had received his benefactions. No doubt Hahnemann left Königslutter with a heavy heart, for he had there begun to taste of the sweets of comfort once again, he had there put his divine discovery to the test; he had there discovered the prophylactic virtue of belladonna in scarlet fever, he had there proved to his wife that his days of clogs and homespun, at the vil- lage by Leipsic, were but a, perhaps necessary, preparatory trial to a mighty future, like a run before a long leap, on the principle of “Reculer avant de sauter." There happened a terrible epidemic of scarlet fever at Königslutter during the last year of his stay there, and his discovery of the brilliant curative and preventive virtues of belladonna in that dire disease-discovered by means of the law of similars-enabled him to save the lives of very many of the inhabi- tants. Hence you will not marvel that so considerable a number of them came out with him, and accompanied him some way on the road to Hamburg before bidding him "God speed." What was the frame of mind of the gentle and genial Hahnemann as he thus wended his way towards Hamburg, with all that was near and dear to him of this world's blessings-driven away from those who loved him and thought thankfully of him for saving their lives -driven away from a certain material prosperity to strange uncer- tainties. This journey was destined to become memorable, for an ac- cident happened to the wagon: it was upset going down a hill, the driver was thrown off his seat, Hahnemann and his whole family and all his goods were thrown together into one confused mass; he himself was injured, the leg of one of his daughters was fractured, his infant son mortally injured (he died shortly afterwards), and his goods were much damaged by falling into a stream at the bottom of 54 BURNETT'S ESSAYS. the hill. With the help of the country folks, they were got to the next village, where he was compelled to remain for six weeks on ac- count of his daughter's fractured limb-thus he would, of course, fritter away any little savings from Königslutter. However, he eventually did reach Hamburg. I think a good deal of Hahnemann, myself, yet I do not think he was other than a man, but he was every inch a man; so I can in thought put myself into his place, and methinks he may have solemnly cursed his professional prosecutors as he lay at yon village with de- stroyed property, a bruised body, his daughter with a broken leg, and his baby son sick unto death. Undoubtedly a change came over him after this, and he began gradually to assume a very haughty and bitter tone, and this event- uated in very strong language indeed. But not by any means too strong, in my humble judgment. Let me put it to any one of you, gentlemen, what sort of language would you use if you were thus driven out of house and home over and over again, and reduced to poverty, simply because you knew more, and worked harder, and cured better and more pleasantly than your neighbors? Especially if your favorite baby-boy was killed in consequence, your daughter's leg broken, and you yourself bruised and hurt? I do not claim divine qualities for Hahnemann, and hence I not only do not blame him for his bold independence and daring, but think it right and reasonable. Even the divine Nazarene was once filled with anger. The departure from Königslutter is the starting- point of Hahnemann's freedom, and considering that he was then forty-four years of age, and in mental grasp and medical knowledge vastly superior to even Hufeland, "the Nestor of German Medi- cine," I think the time had come for the breaking loose from the trammels whereby professional jealousy sought to reduce him to the low level of a mere medicine monger. We once again find Hahnemann on the wander; Hamburg failed him, and he went to the neighboring town of Altona, and not faring there any better, he removed to Möllen in Lauenburg. But here a violent longing for his fatherland came over him, and he retraced his steps back to his beloved Saxony, and planted himself at Eulen- burg. Here he was again prosecuted by his professional brethren through the medical officer of health of the place, and driven thence. HAHNEMANN. 55 We find him in Dessau in 1803 writing a book against the use of coffee, that was, and is, the favorite beverage of the Germans, espe- cially of the women and poor, as much as tea is with us. Those who are familiar with the insides of German hospitals know that cases of chronic poisoning with coffee are by no means rare even now; to Hahnemann's antagonism to coffee we owe the popularity of cocoa amongst the homoeopaths, the earlier homoeopaths recommending it in lieu of the forbidden coffee. Then Hahnemann published a translation of an English work called the Treasury of Medicines, evidently much against the grain, and shortly afterwards wrote a German adaptation of J. J. Rous- seau's De l'Education, and he translated Haller's Materia Medica in 1806. From the time of his flight from Königslutter in 1799 till now he was maturing his discovery and fixing it. His Esculapius in the Balance is a work wherein allopathy is weighed and found wanting in such a masterly way that it would no doubt create many most implacable enemies. But this Esculap auf der Wagschaale was not published till 1805, and Hahnemann's persecutions began six years previously. In this same year we have the first sketch of a Materia Medica Pura in Latin, under the title Fragmenta de viribus medicamentorum positivis, etc., and in the fol- lowing year his Medicine of Experience. Dr. Dudgeon justly char- acterizes this as "the most original, logical, and brilliant essay that has ever appeared on the art of Medicine." Hereupon a whole flood of calumniators and detractors fell foul of the common enemy, Hah- nemann, and no wonder, considering human nature is what it is; and there is a good deal of this human nature in our beloved profession now as well as then. Hahnemann received for his remarkable dis- coveries nothing but opposition, hatred, contempt, and calumny from his medical brethren. At length he could stand this no longer, and he appealed from the prejudice and injustice of his professional brethren to the public, and henceforth published his essays and papers in a magazine of general literature and science entitled Allgemeiner Anzeiger der Deutschen. In this journal he published a series of bril- liant essays that won for homeopathy the support of the general in- telligent public, and, as Dudgeon* puts it-"The doctrines which - Ga *The preceding paragraph is also nearly word for word from Dudgeon, as are likewise several others further on. 56 BURNETT'S ESSAYS. were scornfully rejected by the scribes and Pharisees of the old school found favor with the public, and the number of his admirers and non-medical disciples increased from day to day." In 1810 he pub- lished the first edition of his great Organon, and then returned to Leipsic, where he soon became surrounded by a numerous crowd of patients, admirers, and followers. It is a great wonder that the abuse and calumnies hurled against Hahnemann and homoeopathy at this time, and during the follow- ing two decades, did not drive him mad. But it did nothing of the kind, though it must have rankled in his sensitive soul. Happily Hahnemann treated them all with silent contempt, and worked away at proving medicines and collecting pathogenetic symptoms; and in 1811 he began with the first volume of his glorious Materia Medica Pura, that constitutes the grandest monument ever erected to or by any physician since the world began. He no doubt said to himself, Ye poor fools! ye know not what ye do! In all Hahnemann's checkered career, nothing strikes me as showing more profound wis- dom than his letting his adversaries alone in their vile abuse. He might have hurled back their slanders, and defended himself and his discovery with the eloquence of a Demosthenes; but, as Celsus re- marks, Morbi non eloquentia sed remediis curantur;* and so he plodded on at his Materia Medica, on which much of his great glory must ever rest. At the period at which we have now arrived, viz., 1811, Hahne- mann's great idea was to establish a Leipsic School of Homoeopathy, for the purpose of indoctrinating the rising generation of physicians with homoeopathy, both theoretically and practically, by founding a college with hospital attached; so you of the London School of Ho- mœopathy are strictly Hahnemannian in your efforts in this direc- tion sixty-nine years after he tried to do the same in Leipsic. He had, however, to content himself with giving a course of lec- tures on the principles and practice of homoeopathy to those medical men and medical students who wished to be instructed in the subject. To this end he had to obtain permission from the Medical Faculty to become a Privat-Docent. This was readily granted, most proba- bly in the hope that in defending his thesis he would show himself to be the ignorant, shallow character which his detractors had an- * Diseases not cured by eloquence, but by remedies. HAHNEMANN. 57 nounced him to be. So the day for defending his thesis arrived, and the subject thereof was De Helleborismo Veterum, which, as Dud- geon truly says, no one can read without confessing that Hahnemann treats the subject in a masterly way, and displays an amount of ac- quaintance with the writings of the Greek, Latin, Arabian, and other physicians, from Hippocrates down to his own time, that is possessed by few, and a power of philological criticism that has been rarely equalled. At this period Hahnemann was fifty-seven years old, and became at last teacher in that university in which he had been taught thirty-seven years previously. Here he lectured to medical men and students, and attached a number of these to himself, and here he built up that grand pharmacological edifice in which we reside. Hence we may truly say, as we luxuriate in our splendid Materia Medica, Hahnemannus nobis hæc otia fecit. He remained at Leipsic till 1821, and was enjoying a very large practice and making untold converts to his new system, and had then attained to the age of sixty-six. But his professional brethren in Leipsic could not bear his success. They could find nothing against him; he led an exemplary life, almost entirely in the bosom of his own numerous and happy family; he was almost worshipped by his patients, and he was already at the head of a considerable number of talented physicians who had declared for homoeopathy. They tell us that Hahnemann voluntarily created a schism, and thus set the profession against him. I deny this. He did everything in his power, even at this late period, to infuse his reform into the profes- sion itself; the profession spurned him and his better way. Is he not, at the very time of which we are treating, public lecturer on homœopathy in the University of Leipsic? Did he not qualify him- self for the post in the ordinary legal way? Did not the dean of the Faculty warmly congratulate him on his marvellous display of learn- ing when publicly defending his thesis, De Helleborismo Veterum? Wh The medical profession expected he would come to grief in defend- ing his thesis, and they were there to witness his downfall. He did not fall, however, but rather so staggered his opponents with his great learning that none of them any longer dared hope to hurt him on that side. Then they tried it on at his lectures in the Leipsic my 5 58 BURNETT'S ESSAYS. University, but they found in him their master. They could not impeach him for anything, or even cook up a scandal against him, so they resolved to play the old game that had succeeded so well at Königslutter, twenty-two years previously: they incited the guild of apothecaries against him for giving away his own medicines. This was the great crime of the noble old seer. An injunction was obtained against him, and he was forbidden to give his own medicines under pains and penalties. He was urgently advised to defy the law and give his medicines secretly; but his noble mind revolted against such a proceeding, and his great respect for the law deterred him, moreover, from even attempting to infringe it. It was impossible for him to prescribe his medicines from his bitterest enemies the apothecaries, because some of the remedies he made use of were not kept by them; others they did not know how to prepare; and, moreover, he could not trust his bitterest foes. Hence he had to quit Leipsic and his much-loved Saxon fatherland. At this time Hahnemann was the most celebrated physician of his country, and drew many from far and near to consult him. In con- sideration of this, and in consideration of his advancing years-he was over sixty-six-one might have thought that the kind and gentle old man would have been spared by a liberal profession of which he had been so distinguished a member for forty-two years. But no; he had to leave the place that had become dear to him, and find a new home once again. We thus note that Leipsic expelled Hahnemann in 1821 because he dispensed his own remedies! There is no doubt but Hahnemann was very much distressed at this treatment. You remember he had been a student at Leipsic, and this city was, therefore, the site of his youthful castles in the air; it was there, too, that he had got into the terrible slough of despond from which the cinchona experiment saved him; and it was there he had at last triumphantly taught, where he had laboriously learned so many long years before; and it was there, too, that he had his first disciples, whom he loved so much. But his expulsion from Leipsic was necessary for the further development of his system. · The reigning prince of Anhalt-Coethen was an ardent admirer of Hahnemann; and he offered him state rank and protection at his * I refer to his biopathology, that is true in nature and ridiculed in books. · HAHNEMANN. 59 J little capital, Coethen, which Hahnemann accepted, and thereby im- mortalized both the prince and his capital. At Coethen Hahnemann may be said to have entered into a haven of rest. There I take leave of him. When I go over his wondrous life, I am profoundly impressed with his greatness as a mere man. He taught Hebrew at the age of thirteen; he knew eight languages when he went to the University at twenty; he became a doctor of medicine at twenty-four; he lived to be nearly ninety, and labored all the time; certainly he was a hard worker for eighty years. Throughout the course of this long life I do not find one single shameful act recorded against him by real history. Of how many men can we say as much? He was in- deed a great, and almost a perfect man. As a physician he stands exalted far above any the world has ever seen since the time of Hippocrates. As a physician he was, indeed, incomparable; his was, and is, the truest definition of the real phy- sician, viz., one whose sole business is that of healing the sick, citò, tutò et jucunde. And looking back, now, on the vast vista of his medical life, how can we refrain from exclaiming: Ecce Medicus, "Behold the physician!" Lastly, let us look at the lessons of his life. From his boyhood, from his youth, from his manhood, and from his old age, we learn industry, perseverance, love of learning, devotion to science for the direct benefit of mankind, singleness of mind, sterling irreproachable honor and probity, not having regard unto man merely, but having a firm faith in God—in a word, he dared to be wise. He sowed immortality, and deathless is his fame. And finally, gentlemen, if you ask me where his monument is to be found, my answer is: Look around you! B NATRUM MURIATICUM AS TEST OF THE DOCTRINE OF DRUG DYNAMIZATION. Licht mehr Licht!-GOETHE, To the Rising Generation of Homœopathic Physicians of America―our great hope for the immediate future of Homœ- opathy-these pages are fraternally dedicated by 2, FINSBURY CIRCUS, LONDON, E. C. THE AUTHOR. ર ; F NATRUM MURIATICUM AS TEST OF THE DOCTRINE OF DRUG DYNAMIZATION. THE theory of the dynamization of drugs was, perhaps, an arca- num of the jatrochemists, in the middle ages, and was promul- gated by Hahnemann as a doctrine while this century was still young, and it may be regarded as the natural outcome of his law of cure. He says: — "The homoeopathic healing art develops for its purposes the dy- namic virtues of medical substances, and to a degree previously un- heard of, by means of a peculiar and hitherto untried process (i. e., by triturating and shaking). By this process it is that they become penetrating, operative, and remedial-even those that, in a natural or crude state, did not exercise the least medicinal power upon the hu- man system."-Organon, § 269. Then again, § 275: "The appropriateness of a remedy for a given case of disease depends not alone on its being homoeopathically just the right one, but it also depends as much on the right strength or sufficient smallness of the lose. If you give too large a dose of a remedy, even though it be fully homoeopathic to the morbid state present, and be it never so harmless in itself, it will be sure to do harm simply by its quantity, and by the unnecessary overstrong im- pression which it will make by acting exactly on the parts of the or- ganism rendered tender and weak by the natural disease; and this it will do by the very reason of its like homoeopathic action."—(§ 273 of 4th German edition.) According to Hahnemann, then, the strength (size) of the dose is 64 BURNETT'S ESSAYS. very important, and the more homoeopathic our remedy in a given case, the greater the danger of doing harm. Many followers of Hahnemann accept his law only, and cast aside the theory of increasing the remedial power of a drug by trituration or succussion as irrational or unscientific, and these are by no means the least accomplished or least scientific of them, and also by no means the least popular. Perhaps, we may go as far as to say that, the more a man is prone to scientific research, the less easily can he conceive it possible to exalt the remedial energy of a drug by diminishing its quantity, even though the diminished quantity be spread out over an indifferent medium; and the more popular he is, the less likely is he to tread the tortuous path. Thus Dr. Kidd tells us (Laws of Thera- peutics, pp. 34, 35, London, 1878): "Twenty-seven years ago, I saw the essential truth of Hahnemann's law was totally independent of his speculations about dynamization. Adopting with great delight the law of similia similibus curantur as the chief, though not the only, foundation for therapeutics, I learnt for myself that Hahnemann's sober teaching, the use of the pure undiluted tinctures, was a far better guide to heal the sick than Hahnemann 'drunk' with mysticism, calling for the exclusive use of infinitesimal doses. The latter I cast aside in toto as untrustworthy and unjust to the sick, whose diseases too often remained stationary under treatment by globules, but were most effectually and quickly cured by tangible doses of the same med- icines which failed to cure when given in infinitesimal doses.” Dr. Kidd's position entitles his opinion to great respect, but until he publishes satisfactory accounts of those sick "whose diseases too often remained stationary under treatment by globules" [was the right medicine in those globules?] we take it only as his own subjec- tive opinion, fully concurring in his own quotation from Plato that "nothing can be more repugnant to an ordinary mind than the thor- ough sifting of deepseated, long-familiarized notions." Dr. Kidd also states (op. cit., pp. 33, 34), “Truth is greater than Hahnemann, and of late years his speculations about 'Psora' and 'infinitesimal doses' have been tacitly given up by all the most skilful and intelligent of his followers." The italics are mine. This sentence contains three propositions. 1st, that truth is greater than Hahnemann; admitted as a truism. 2dly, that of late years Psora and Dynamization have been tacitly given up; admitted NATRUM MURIATICUM. 65 pagka * But even suppose it as to some, but not as to the vast majority. were true of all, would the presence of nothing but atheists in the world do away with the Supreme Being? And 3dly, that these tacit up-givers of "Psora" and "infinitesi- mal doses" constitute "all the most skilful and intelligent of his followers." Of course we all know that those poor psoric dilutionists have neither skill nor intelligence; and besides,-Codlin's the friend, not Short. The absolute proof that the apsoric crude-druggists monopolize "all the skill and intelligence" lies in their tacit mode of doing the doughty deed. They have invented a new system of philosophy- the tacit method, and "cast aside" exclaiming, "get thee behind me, for I am more skilful and intelligent than thou art." But casting the doctrine aside without adequate experimental in- quiry does not become science because it is done by a scientist; we are all very apt to leave the rules of scientific investigation at the door when we involuntarily feel we will not have a thing be true. The writer has long been cast about on a sea of doubt and per- plexity with regard to this doctrine of drug dynamization: he has frequently listened to the arguments brought forward for and against it, and frequently himself joined in ridiculing it, constantly feeling himself unable to believe it possible that the remedial potentiality of a given drug could be increased by any process or subdivision what- ever, in fact, by any process whatsoever. The question is constantly presenting itself to one's mind thus: can the billionth of a grain be potentially more than a grain? and the ready answer willingly fol- lows-impossible. It may be conceded that the doctrine of drug dynamization is a priori, absurd: so is homeopathy. How can a drug that causes diarrhea cure diarrhoea? Surely it must make it worse. What, castor oil for an alvine flux? Clearly it cannot cure it. Yet experiment shows that what causes diarrhoea does indeed cure diarrhea; like does cure like whether we believe it or not; and hence, what is a priori absurd, may be a posteriori true. We * Since writing this I have been honored with a copy of An Address delivered be- fore the Annual Assembly of the British Homoeopathic Society, June 20th, 1878, by R. Douglas Hale, M.D., etc., Vice-President of the Society, and on page 6 read, inter alia, "We emphatically deny that we have ceased to employ the in- finitesimal dose." 66 BURNETT'S ESSAYS. are all very apt to lose ing to do with truth. sight of the fact that our beliefs have noth- Truth is truth whether it be believed or not. The born blind may not believe in the existence of the sunlight be- cause he does not see it. Sound is absurd to the deaf. The existence of the word paradox shows that things apparently absurd and untrue may yet be true in fact. However, there is this to be well considered. In the drug treat- ment of disease we have to deal with conditions and not with enti- ties, and it is not paradoxical to suppose that two like and equal forces may neutralize one another. Two equal showers of rain will make the ground wetter than one, but a pair of scales weighed down with a one-grain weight is restored to equilibrium by the addition of another one-grain weight on the other side; it is similar in its ac- tion, and like in its power, only it works. at the other end of the beam. Here the state of equipoise is brought about by similar means that are also equal: rest results from two motions. Those ignorant of homoeopathy laugh at it; the writer went through this laughing stage of ignorance, but did not find it very blissful, and so was constrained to put the doctrine of similars to the test of scien- tific experiment, and found it a true one of great practical value. Almost all homoeopaths have come that way. Hence, disbelieving a thing does not disprove it. Those ignorant of the doctrine of drug dynamization in truly scientific practice, laugh at it; so did the writer, and that in very good company; but finding that Hahnemann spoke truly in regard to drug action, he thought that circumstance some slight presumptive evidence in favor of his other doctrine that remedial power is developed and increased in a drug by trituration and succussion. Therefore he put the theory to the test of careful clinical experi- ment, with the result that he has passed considerably beyond the laughing stage. The results obtained from clinical experiments ought to satisfy the most critical mind, if not blinded by prejudice, for they constitute the only scientific method of settling the question at all either one way or the other. But it is much easier to satisfy one's mind about the truth, or other- wise, of homoeopathy than about the truth or falseness of the theory of potentizing drugs. Expediency and policy can have no weight with us; if the Hahne- NATRUM MURIATICUM. 67 mannian doctrine of drug dynamization be, as it is averred on com- petent authority, a great stumbling-block to the profession, and a hindrance to the spread of the major doctrine of similars, we can only regret it, but must proceed, and also insist upon it before the whole world, in the path of truth seeking coûte qui coûte. What can be more beautiful than truth for its own sake? In casting about for the best method of carrying out these clinical experiments various plans suggested themselves, but no satisfactory one. In the first place, we cannot accept most acute diseases as appro- priate for experimentation, because of the many objections that may reasonably be offered to the results of any treatment of them. It is said that almost all acute affections tend to recovery of themselves. If an experiment result in apparently shortening the course of any such affection, it is objected that the vis medicatrix naturæ did it; or, the disease being one that runs a definite course if treated expectantly, the diagnosis is called in question. Apropos of the expectant or do-nothing method. If one of our learned fraternity declare his non-belief in medicine and give only a placebo without prayer, we think him very scientific, a great patholo- gist, and a fine kenner of the natural course of disease; he watches nature's ways purely and simply, desiring to be neither her minister nor her master, but only her observer, and the law protects him and the faculty honor him. But let one of the unlettered Shaker com- munity do the same thing with prayer, and the law and the faculty unite to punish him. So if there be not one law for the poor and another for the rich, there is one for the doctor and another for the Shaker and all the worse for the Shaker. << But to return, the writer believes that he sometimes succeeds in breaking up measles with the aid of Gelseminum and Sulphur, but it might be a very difficult matter to satisfy another that he really does. Hence, acute affections of fixed nosology are mostly eliminated as offering too many difficulties, in private practice especially. Of chronic affections a great number are also not appropriate; thus a chronic ulcer of the leg may suddenly take on a healing action in- dependently of the treatment; a chronic bronchitis or other conges- tion may be suddenly made better by change of temperature or the · 68 BURNETT'S ESSAYS. veering round of the wind. Still there remain some chronic com- plaints that are eminently fitted for experimentation, more particularly certain symptoms or groups of symptoms. Of course no alterations are to be made either in diet or hygiene, or place of abode. Having determined on the kind of case best adapted for proving or disproving the doctrine of drug dynamization, another serious difficulty presents itself, viz.,-whether the drug that supposedly proved itself curative of a given ailment, for instance, in the billionth dilution, did so simply because it contained some of the right medicine. Thus if a headache disappear in three days, under the use of Gelsem- inum 6, and granted that it disappeared propter hoc, how are we to know that there was any dynamic effect there, since probably it may have yielded to five drops of the fresh juice of the plant perhaps even more promptly? Therefore it should be shown that the crude sub- stance in various quantities and in a soluble condition failed to effect the cure. Here, again, another difficulty crops up. You must give the rem- edy in substance first, for the dilution might cure, and whether it did or not the experiment would fail; if the dilution cured there would be no opportunity of trying the crude substance, and if it failed to cure the experiment would of course fail altogether in the present sense. Therefore you give the drug in substance first of all. Then comes this other question: how long does the substance given continue to in- fluence the economy or the disease in it? Suppose we were to assume a fortnight as the duration of its action, say of Bryoniae, might not the objection be raised that Bryonia, continues to influence the organ- ism for three weeks, and therefore the cure supposedly effected by Bryonia 6 in the third week might in reality have been due to the Bryonia,? Again, this would have to be determined for every single drug, since the duration of their action is held to be different. So the thing bristles with almost insuperable difficulties. Still the matter calls for elucidation and, if possible, settlement. For it has been affirmed by many able practitioners, by Hahne- mann himself, and it is being daily and hourly re-affirmed by men of sound science, that drugs do act differently and better when dynam- NATRUM MURIATICUM. 69 ized. In fact, many affirm, as did Hahnemann, that the doctrine is of transcendental importance, as many serious diseases can only be cured with dynamized drugs, being entirely incurable with the same drug in substantial doses, and so often altogether incurable unless with a highly potentized remedy. Yet we cannot accept any man's dictum, and faith can have no place in science. In verba magistri jurare does not advance science one whit, but neither does mere skeptical negation. Any experiments on the subject, to be satisfactory, must be of such a nature that they may be repeated by others, proper circumstances and material being given. It seems to the writer that there is one drug above all others in the materia medica which may greatly help in the elucidation of this im- portant subject, viz., Natrum Muriaticum. He has not the pretension to settle the question one way or the other, except for himself, but he thinks his ideas on the subject, together with a few clinical experiments, may prove suggestive to his professional brethren, and possibly ad- vance the cause of truth a little. He will advance it historically, that is as the thing arose and grew in his own mind stimulated by observation. OBSERVATION I.-Mrs. B., æt. 24, came under my treatment in 1876, in the early months of pregnancy, with very severe neuralgia of the face. The case proved itself very obstinate, and many drugs were fruitlessly tried, but eventually it yielded to China given in the form of pilules saturated with the matrix tincture, which drug was chosen because of perspiration breaking out when the pain became very bad. The neuralgia constantly reappeared, and finally China ceased to have any effect. Then Populus tremuloides was given sim- ply because of its being a congener of China and did good, in fact quite cured for the time. This pregnancy passed and my patient consulted me again, being enceinte early in 1877, for the same kind of neuralgia, and this time its obstinacy nearly reduced her and her physician to despair. The case was treated in the old Hahnemannian fashion according to the totality of the symptoms, which were very few and apathog- nomonic, the neuralgia being always bad, and always worse, and ap- parently not ameliorated by anything. After many weeks of fruitless endeavor to cure this neuralgia 710 BURNETT'S ESSAYS. with medicines chosen from the repertory I turned to Guernsey's Obstetrics (2d edition), and found I had already tried all those given in his list at pp. 372, 373, 374, except two; these two I then fairly tried, and again failed. So my patient had received Aconite, Bella- donna, Bryonia, Calc. c., Cocculus, Cimicifuga, Coffea, Gels., Glon., Ignat. Mag. c., Nux v., Puls., Sepia, Spig, Sulph., Verat. a., China, Populus, and some others; besides which she had applied, often in almost frantic despair, nearly every known anodyne, so that the soft, parts of the face seemed almost macerated. Here I suggested change of air (what should we poor practical physicians do without this ultimum refugium?); but circumstances prevented her from leaving Birkenhead for more than a day or two, so her husband took her for little outings to New Brighton, and Southport, and Chester, when it was observed that the neuralgia was worse at the seaside and better inland. A happy thought struck me that this might be due to the salt in the air at the seaside; and being, moreover, absolutely at the end of my tether, I acted on it and gave Nat. Mur. 30, one pilule very fre- quently. The neuralgia at once began to get better, and in a day or two was quite well. It subsequently returned at intervals, much less severely, but promptly yielded to the same remedy in the same dose. The 30th dilution was chosen simply because some pilules of this strength were in patient's chest. The patient was quite satisfied that the Nat. Mur. 30 effected the cure, and so was I, and so will many others be; but in a general way the case will not carry conviction to unprepared minds, and still less so to prejudiced ones. Hitherto, I had had no great respect for Natrum Muriaticum, as a remedy in fact none whatever, having but rarely, if ever, prescribed it. Indeed, how can a sensible man believe that the common condi- ment salt, which we ingest almost at every meal, can possibly be of any curative value, especially as some are known to eat salt in con- siderable quantities every day, and that without any apparent dele- terious effect? Dr. Hughes in his Pharmacodynamics, 2d ed., p. 411, says: "I really know nothing myself of the virtues of salt." We find him now, however, a riper homoeopathic scholar, for in the 3d edition of the same admirable work, p. 561, he gives an interesting case of de- NATRUM MURIATICUM. 71 7 fective nutrition, showing itself especially in emaciation, with dry and ill-colored skin, accompanied with depression of spirits and sus- pected abdominal disease. Here a few occasional doses of Nat. Mur. 30 changed the whole condition and initiated a complete recovery. This testimony is very valuable and especially gratifying to me, and, moreover, carries conviction to my mind. It is evident that Dr. Hughes unwillingly yielded to a belief in the doctrine of drug dynamization, and would fain have continued to "know nothing of the virtues of salt." To believe in salt as a remedy is almost synonymous with believ- ing in the doctrine of drug dynamization; and a belief in this doc- trine is extremely repulsive to one's common sense. Perhaps the proper spirit would be gratitude to a beneficent Creator. Worse at the seaside has since proved itself a valuable indication for Natrum Muriaticum with me. OBS. II.—A young gentleman of about 21 years of age came un- der treatment for Synovitis of right knee, with considerable effusion. Patient had a dirty-looking skin, was constipated, and had many Nat. Mur. pains in the lower extremities. R. Natrum Muriaticum 6. Fiat pul. gr. vj. DOSE.-One in water every three hours. Rest in the recumbent position. I did not see the patient again, but he was observed by my col- league, Dr. Reginald Jones, who kindly gave me the following re- port: "The medicine purged the patient so severely that it had eventually to be left off; it also produced a great discharge of the urates, the urine becoming very thick therewith.” No other medicine was given, and patient was quite well in a fort- night. Dr. Jones was much interested in the action of the remedy, and declined to accede to the patient's request to be allowed to discon- tinue the medicine because of the purging. Patient's friends at length became alarmed at the catharsis, and his brother called upon me to beg that the medicine might be discontinued. This case being acute might have got well of itself in the man- ner described, and Natrum Muriaticum possibly had nothing to do with it. 72 BURNETT'S ESSAYS. We know that synovial effusions will often spontaneously rapidly disappear. (Sir Thomas Watson.) The diarrhoea ceased when the medicine was discontinued, but this may also have been mere coincidence: critical diarrhoeas tend to cease of themselves. This case is not given in the expectation that many will credit Natrum Muriaticum with having anything to do with the course of the case, but to introduce— OBS. III.- Mrs. M., æt. 50, or thereabout, had a most severe at- tack of rheumatic fever, the joints being much swollen, red, and dis- tressingly painful. The usual homoeopathic treatment was adopted, but with no great success. It was her fifth attack of rheumatic fever. Between the 3d and 4th week Dr. Jones and I saw her together, and found this condition: ill-colored skin; obstinate constipation; foul tongue; urine very pale and limpid; great depression of spirits; joints red, swelled, and painful; great restlessness; low and despond- ing of the future; sour perspirations; insomnia; bed-sores, and great weakness. We agreed in the opinion that the emunctories had almost left off work and required to be brought back to their duty. A sharp ca- thartic combined with a diuretic seemed to be indicated by the gen- eral condition, but contraindicated by the profound adynamia, and hence the blessing of a refractissima dosis. My consultant's observa- tion in Case II. caused him to suggest the same remedy; so we put patient on Nat. Mur. 6 trit., as much as would lie on a shilling, every two hours, in water. No other medicine was given, and no auxiliaries used. Next day her urine became a little cloudy; the second day the bowels were moved and the urine had a red deposit; then diarrhœa with loaded urine set in; the swelling, redness and pain in the joints went away; the skin became cleaner-looking; the tongue cleaned gradually, the perspirations ceased, her spirits became brighter, and in ten days from beginning the medicine she was in full convales- cence, though still very weak. Patient suffers from chronic asthma with slight emphysema, and is always obliged to sleep in a semi-recumbent position; but for six weeks after this critical evacuation she was able to lie down in bed like anyone else without any dyspnoea. NATRUM MURIATICUM. 73 $ 1 Many months have elapsed and she is now about in her house and drives out, still asthmatic and has chronie rheumatic pains here and there. Her tongue was cleaner for two months than I had known it for the previous three years. This patient lives ten miles away and was not seen often, but the husband brought daily reports, and when doing so pleaded hard, day after day, that the Natrum Muriaticum might be discontinued because of its purging so severely, he fearing lest it might weaken her too much. On that account it was then given interruptedly, but with no other medicine, and the alvine and renal functions fluctuated accord- ingly. Hahnemann says (Chronische Krankheiten, 2d edition, vol. iv. p. 348): "Pure salt (just the same as any other homoeopathic somatic force dynamized) is one of the most powerful anti-psoric remedies." And higher up he speaks of it as an heroic and violent remedy that, when dynamized, must be cautiously administered to patients. Then he exclaims: "Welche unglaubliche und doch thatsaech- liche Umwandlung!—eine anscheinend neue Schoepfung!" Still it goes against all common sense and all one's notions of things, and no man may be blamed for declining to accept such a preposter- ous proposition, merely on trust; it is scarcely possible to accumulate sufficient facts to get any one to listen to it, much less to believe it. Dr. C. M. retorts: "There are more things in heaven and earth, Horatio, than are dreamt of in thy philosophy." OBS. IV.-At this stage of things I felt curious to know what the sixth centesimal trituration of Natrum Muriaticum might do to my humble self pathogenetically, I being in my usual health. So I took 3iv. in about ten days in little pinches dry on the tongue at odd in- tervals. It produced-no, that's too bold a statement. I got gradu- ally during that time a deep crack in the middle of my lower lip, which swelled and became burning and very painful; the Natrum Muriaticum may have had nothing to do with it, but I gave it up and both crack and swelling went away. I never had the like before, nor since. The same symptom is noted by Hahnemann, and Dr. Allen in his Encyclopædia—but removed by the latter from the regional divi- sion of the "lips," and placed under "skin," which is not only con- fusing, but also a mistake. 17- 6 74 BURNETT'S ESSAYS. OBS. V.—Mr. H., æt. 45, came under treatment for great pain in the stomach, which sent him to bed and kept him there in great agony. The last year or so he has been subject to these attacks of epigas- tric pain, and I was sent for to relieve this as on previous occasions, and the wife specially requested me to give something not only for this attack but to use whenever the attacks came on. He had, be- sides the pain, vesicles on the lips drying up into scabs. I gave Nat. Mur. 6 trit. gr. vj. every two hours in water; next day (observed by Dr. Jones) it was followed with a great discharge of the urates and a regular attack of gout. Has since remained free from these at- tacks of pain, and this is now many months since. It is impossible to tell whether the Natrum Muriaticum had any- thing to do with the metastasis of the gout from the stomach to the big toe; moreover it is not now medico-scientifically fashionable to believe in metastasis. OBS. VI.—A girl of 15 suffering from Hemicrania dextra and cloudy, thick, red, sedimentous urine. I gave her Nat. Mur. 6 trit. and received shortly thereafter a written report, "Urine quite free from sediment or cloud in a way it has not been for long." The megrim was not affected. The young lady and her mother attributed the changed condition of the urine to the powders; the urine had been in the abnormal condition for a long time and my ordination consisted only in pre- scribing the powders. Weeks afterwards the urine continued clear. This case is not adapted to carry conviction to the mind, as we know that many atmospheric changes and accidental circumstances of all kinds alter the state of the water at once. OBS. VII.-A baby on the bottle some three months old. I find it has not slept well for some time and is now very restless and fret- ful, and vomits water. Gave Nat. Mur. 6 trit. It at once began to sleep two or three hours at a time and the watery vomiting ceased. Two days afterwards measles broke out. The mother conceived a very high opinion of the soothing sopo- rific effect of the powders. OBS. VIII.-Mr. P. æt. 26, has had very thick urine for months, and for two months very great pain in small of back, worse on bend- ing and very much worse when digging in the garden. Gave Nat. : . NATRUM MURIATICUM. 75 Mur. 6 trit. The back pain and turbid urine disappeared in four days and did not again appear. This case carries a little weight with it, and looks something like a medicinal cure. OBS. IX.-A lady, æt. 54, with Stillicidium lachrymarum and bad chronic yellow excoriating Leucorrhoea, Nat. Mur. 6 trit. In one week the Leucorrhoea had quite disappeared but the Stilli- cidium was worse. Chronic Leucorrhoea are not apt to disappear spontaneously in one week, though its possibility cannot be denied. OBS. X.-Unmarried lady, æt. 24, Polyuria; constipation with much flatus; amenorrhea these two months. First symptoms worse at the seaside. She is rather thin with an ill-colored skin. Nat. Mur. 6 trit. In a few days the menses appeared, and the renal and alvine func- tions became normal. She had passed her second menstrual period. A causal nexus between the taking of the Natrum Muriaticum and disappearance of the symptoms is not easily established here. OBS. XI.-A clergyman's wife, about 50 years of age, consulted me on Feb. 29th, 1878, complaining of severe dyspepsia with other symptoms of Natrum Muriaticum. My visit was a hurried one, so I did not enter very fully into the case. Nat. Mur. 6 trit. vj. grains in water twice a day was the prescription; it cured in three days these symptoms: "Hiccup occurring morning, noon, and night, for at least 10 years, which was brought on by Quinine; it was not a hic- cup that made much noise but 'shook the body to the ground;' it used to last about ten minutes and was 'very distressing.' >>> How do you know that the hiccup was really produced by quinine? I inquired. She answered: "At three separate times in my life I have taken quinine for tic of the right side of my face, and I got hic- cup each time; the first and second time it gradually went off, but the third time it did not. When the late Dr. Hynde prescribed it, I said, do not give me quinine, as it always gives me hiccup, but he would give it me; I took it and it gave me hiccup, which lasted until I took your powders; it is more than ten years ago since I took the quinine." The cure of the hiccup has proved permanent. 76 BURNETT'S ESSAYS. This patient is a most truthful Christian woman and her statement is beyond question. She has been a homoeopath for many years and my patient off and on for more than three years, during which time I have had to treat her for chronic sore throat, vertigo, palpitation, and at one time for great depression of spirits. She had also previously mentioned her hiccup incidentally but I had forgotten all about it, and on this occasion she did not even men- tion it, so as far as the hiccup goes the cure was a pure fluke! But it set me a-thinking about the Hahnemannian doctrine of drug dynamization for the thousandth time and has seriously shaken my disbelief in it. Hiccup is a known effect of Chininum sulfuricum: Allen's Ency- clopædia, vol. iij. p. 226, symptoms 370 and 379. We note from this case that- 1. The effects of quinine, given for Tic in medicinal doses to a lady, last for more than ten years, that— may 2. Natrum Muriaticum in the sixth trituration antidotes this effect of quinine while— 3. The same substance in its ordinary form, viz. common salt, does not antidote it even when taken daily in various quantities and in various forms for ten years. Inasmuch, then, as the crude substance. fails to do what the triturated substance promptly effects, it follows, therefore, that- 4. Trituration does so alter a substance that it thereby acquires a totally new power, and consequently that- - 5. The Hahnemannian doctrine of drug dynamization is no myth but a fact in nature capable of scientific experimental proof, and, in- asmuch as the crude substance was taken daily for many years in al- most every conceivable dose, in all kinds of solutions of the most varied strength it results- 6, and lastly. That the Hahnemannian method of preparing drugs for remedial purposes is not a mere dilution, or attenuation, but a positively power-evolving or power-producing process, viz., a true poten- tization or dynamization. da This case is probably as good a one as we may ever expect to get, and it might here fitly close the subject as far as its simple demonstra- 1 NATRUM MURIATICUM. 77 tion is concerned, but I have others in my case-book both corroborat- ing it and presenting new features. Before leaving this Case XI. let us reflect for a moment on the certainly immense number of modifying and perturbating influences this lady had been subject to during those ten years, as well as living at the seaside and including the daily use of salt, and yet her hiccup persisted until dynamized salt was given. Before coming to these conclusions I exhausted all my ingenuity in trying to explain it away, and that backed by no small amount of scepsis, but I cannot avoid them do what I will. Moreover I require more scepsis not to believe it than to believe it. I am thus in a dilemma: either I must believe in the doctrine of drug dynamization or disbelieve the most incontrovertible evidence of facts, which is the province of the demented. Or canst thou, critical reader, being more ingenious and more skep- tical than I, help me out of the dilemma? Fain would I believe thou canst, for this doctrine of drug dynamization seems to take away firm material ground from under one's feet and leaves one standing in the air. But I must emphatically decline Dr. Kidd's tacit method as going quite beyond my skill and intelligence. The next observation of which I have notes, is OBS. XII.-A lad, æt. 12, living at Parkgate. He suffers for some time from constipation, loss of appetite, dirty-looking complexion, emaciation, frontal headache going round to the back, sleepiness to- wards evening and first thing in the morning, urine thick with nasty smell. Excepting the "nasty" smell, which the boy could not define, I find all these symptoms in the pathogenesis of Natrum Muriaticum in Allen's Encyclopædia of Pure Materia Medica and numbered respec- tively 529, 353, 251, 885, 64, 970, 561. Therefore Nat. Mur. 6, and that six grains in water forenoon and afternoon. After taking 24 powders he returned cured of all the symptoms except the odor of the urine and the emaciation, and "feel- ing very much better." The prescription was repeated and patient did not return. His father subsequently informed me that the cure was complete. OBS. XIII.-Young lady about 28 years of age: emaciation, chlorosis, for eighteen months slight bearing down in the hypogastrium, 78 BURNETT'S ESSAYS. gradually getting worse, and the last week increasing to very severe cramp beginning in the back and coming round to the pubic arch, and, when walking, felt severely in the knees; had frequently to sit down to get relief from the hypogastric pain; urine muddy for a long time, obstinate chronic constipation, the mouth is dry but there is no thirst, taste disagreeable, bitter. Nearly all these symptoms are in the pathogenesis of Natrum Mu- riaticum. Hence Nat. Mur. 6, twenty-four six-grain powders taken in a fortnight resulted in the permanent disappearance of all the symp- toms excepting the emaciation and the chlorotic condition, for which she was put on phosphorus. As to the emaciation she gained six pounds. in ten weeks, but this gain in weight was partly made while under Ferrum 6, for hæmop- tysis, chronic cough and large moist râles in the left lung, and these symptoms having disappeared under Ferrum 6, she went into the country for three weeks and returned with the above symptoms. In this case the Natrum Muriaticum certainly cured the constipa- tion and with it the intra-pubic pain. OBS. XIV.-Gentleman, æt. 34 or thereabouts, has suffered from a general feeling of chilliness (attributed by himself to a poor circula- tion), for more than two years, sleepiness and drowsiness after dinner for two months, compelling him to go and lie down; black spots before the eyes; disagreeable taste in the mouth, sour; watery eyes; urine clear; bowels moved twice a day; looks very pale. Ordered him Nat. Mur. 6 trit. six grains in water twice a day. Having taken 24 of such powders he paused a few days and re- turned stating that the chilliness had quite disappeared and also the postprandial drowsiness, the black spots had quite disappeared but were returning again a little, the sour taste was gone, the watery state of the eyes as bad as ever, the urine had become cloudy. In this case the medicine was evidently quite homoeopathic to the condition of the patient, and it is manifest that the Nat. Mur. 6 pro- foundly affected his organism, as the chilliness of more than two years' duration quite disappeared, as also the after-dinner drowsiness. Of course these sensations may not be indicative of profound or- ganic lesions, but they are not indicative of a normal condition either, but the evidence of drug action does not hang on this. The symp- tom that brought him to me was the postprandial drowsiness, as it NATRUM MURIATICUM. 79 materially interfered with his business in the afternoon (he dines early). He formerly lived in Tranmere and then always felt this drowsiness; he afterwards came to live in Birkenhead itself and during his resi- dence here did not feel it, but on removing again to Tranmere the old drowsiness reappeared and he thought he would have to leave the neighborhood to get rid of the troublesome symptom. The billionth dilution of Sodium Chloride has saved him this trouble. Was it faith that cured him of his drowsiness and 'chilliness? If so, what rendered his water cloudy? Besides, this was our conver- sation : 66 Was that a kind of salt you gave me, doctor?" Why? "Because I showed the prescription to my old schoolmaster, and he said you were giving me salt.' "} Yes, it was salt in what we homoeopaths call the 6th centesimal trituration; i. e., the billionth dilution. "Do you think it can have had anything to do with my chilliness and drowsiness going away? Could it have affected the circulation and liver (his theories) like that?" A broad grin was on his face when he put the last question; then he checked himself and apologized for it. No one will, I opine, maintain that an open mouth with a broad grin are specially expres- sive of faith that worketh a cure of chilliness of two years' duration. When formerly living in Tranmere, and suffering from this post- prandial lethargy, he was treated allopathically and homœopathically for it without avail; the latter treatment included that wonderful vegetable mercury Podophyllum peltatum, given because "it was liver." Do we not all know that Podo. is good for the liver? That being so, the livers of very many people must be preternaturally good, for a veritable podophyllomania has been raging for years un- der the commercial ticket of "homoeopathic." Microscopical sections of the livers of some of these Podophyllum- eaters might be instructive as showing the pathological outcome of direct liver irritation. The gin-drinker's liver we know; the Podo- phyllum-eater's liver awaits an historiographer. There is one thing to be said in favor of the Podophyllum-givers: they are impartial, and give it to all alike. But this is digressive. 80 BURNETT'S ESSAYS. Here let me note that I have noticed that some of the Natrum Muriaticum affections are worse in cold and better in warm weather. OBS. XV.-Lad of 12 came under observation on March 30, 1878, suffering from a group of symptoms that collectively are con- veniently called Phlyctenular ophthalmia. The left eye was spas- modically closed from the photophobia. A month before he had caught a cold in this eye, and it had remained closed, inflamed, and painful ever since, and was not getting any better. On everting the lids an ulcer in the cornea is observed, resulting evidently from a burst phlyctenula of about the size of a split pea. The dimness of vision from this ulcer determined the parents to seek advice, they fearing the "eye" was being affected. To leave an ophthalmia for a month without seeking advice is a phenomenon that will greatly surprise many, but not medical men. The prominent symptom in the case was the great lachrymation, and this is very characteristic of Natrum Muriaticum; so six grains of Nat. Mur. 6 trituration was given in water three times a day. April 6. Opens his eye wide and sees quite clearly. The photo- phobia, pain, inflammation and lachrymation gone; the ulcer nearly so. Continue the medicine. Excepting some very faint leucomatic streaks, the cure was com- plete in a few more days. Patient had formerly been long under my treatment for caries of the petrous portion of left temporal bone, and had got quite well of it. Sodium chloride has an ancient reputation as an anti-scrofulosum, as we all know. OBS. XVI.-Boy of 9, with ganglion on leg of the size of a small hen's egg. Has been under my treatment for many months with no good result except very slight amelioration from Sticta pulmonaria. Silicea did no good. On Dr. Schüssler's recommendation (Abge- kürzte Therapie, Vierte Auflage, p. 46, Oldenburg, 1878), I gave Nat. Mur. 6, six grains in water night and morning. Three months later I received by letter the following report: "The swelling on the little boy's leg, I am glad to say, is much bet- ter-a good deal smaller, now about the size of a small nut, and rather more in its original position-not so much under the knee- joint as it was." NATRUM MURIATICUM. 81 1 www Continue the medicine. OBS. XVII.-Lady æt. 63. Regular gout in left big toe and foot. Patient is fond of beer. R. Nat. Mur. 6 trit. Six grains every two hours. In four days all symptoms had disappeared. Here I did order her to leave off her beer, but was . . . not obeyed. Patient since this keeps a stock of these powders on hand, and calls them her "gout powders." They have since promptly relieved two or three similar attacks, as I learn from her daughter. Since treating this case I have used Nat. Mur. 6 trit. frequently repeated, in several other cases of gout, with very great satisfaction indeed. Query: Does the remedy cause an increased elimination of the urate of sodium? I think it probable. OBS. XVIII.—April 21, 1878. John H., æt. 29, seaman, had fever and ague two or three times a day, with watery vomiting, in Calcutta, in September, 1877. Was in the Calcutta Hospital three weeks for it, and took emetics, quinine, and tonics. Left at the end of the three weeks cured; but before he was out of port the ague re- turned, or he got another, and he had a five-months voyage home to the port of Liverpool. During the first three months of this home- ward voyage he had 2, 3, 4, 5 attacks a week, and took a great deal of a powder from the captain, which, from his description, was prob- ably Cinchona bark. Then the fever left him, and the following condition supervened, viz.: "Pain in right side under the ribs; can- not lie on right side; both calves very painful to touch-they are hard and stiff; left leg semiflexed; he cannot stretch it." In this condition he was two months at sea, and two weeks ashore; and in this condition he comes to me, hobbling with the aid of a stick, and in great pain from the moving. Urine muddy and red; bowels regular; skin tawny; conjunctivæ yellow. Drinks about three pints of beer daily. I recommend him not to alter his mode of life till he is cured, and then to drink less beer. The former part of the recommendation he followed, as I learned from his brother; of the latter part I have no information. Obs. XI. bears directly on this one, we having evidently to do 82 BURNETT'S ESSAYS. with an ague suppressed with Cinchona. Therefore ordered Nat. Mur. 6 trit.; six grains in water every four hours. April 27. Pain in side and leg went away entirely in three days, and the water cleared at once; but the pain returned on the fourth day in the left calf only, which to-day is red, painful, swelled, and pits. He walks without a stick. Continue medicine. May 4. Almost well; feels only a very little pain in left calf when walking. Looks and feels quite well, and walked into room with perfect ease without any stick. He thinks he had a cold shake a few nights ago. He continues to perspire every night; ever since he got the ague the sheets have to be changed every night. Continue medicine. May 11. Quite well. No medicine. July 20. Continues well. The last two reports were obtained by me from his relations, he, being well, not thinking it worth while (notwithstanding his promise to report himself) to come again after the third visit on May 4th. Considering that patient had been a fortnight here on shore before coming to me, it is not probable that his rapid cure after taking the Nat. Mur. was due to the climate. Still this is the weak point in the case, if it have any. Patient and doctor both think the medicine wrought the cure; others may think differently. It is to be noted that the salt provisions and sea air during a voy- age did not cure it. OBS. XIX.-Mrs. B. æt. 53. For four or five weeks cold shakes many times a day and night, beginning in the shoulders like cold creeps, and going down the back and then all over; cold creeps in legs in bed at night; head cold and sweaty; nauseous taste in mouth; great sleeplessness these four or five weeks, viz., wakes at 2 A.M., and is unable to get off to sleep again. She is very tearful; merely describing her symptoms brings tears into her eyes. R. Nat. Mur. 6 trit. Six grains in water every four hours. On my calling a few days later to see how she was progressing, I got the following report: "The cold creeps and shakes left off after NATRUM MURIATICUM. 83 I the first powder." (She speaks of the powders subsequently as "those powders that made me warm.") Feels altogether warmer now, not like the same, and sleeps well. She never had ague. Two months after this I had occasion to see her daughter, when patient (the mother) said, "Those powders did me so much good that I have been better than I had been for years." Subsequent to the cure I thought I should like to know whether patient was in the habit of partaking of salt with her food; and on in- quiring was much astonished to hear the following statement from her: "About a year ago I was recommended by a friend to take a good deal of salt, as she thought it would be good for me, and since then I have taken about 1½ teaspoonfuls a day, often spread on bread.” Query Was this a case of chronic salt poisoning antidoted by its own dynamide? This is a most interesting observation indeed. Here we have a lady who in addition to partaking of salt in the ordinary way with her food, and in her food, had actually partaken of one-and-a-half teaspoonfuls of salt daily for a twelvemonth, and was even still doing so during the cure, and yet the very first powder of triturated salt wrought such a marked change. The difference in the look of the patient was also remarkable: at my first visit she came to me in her drawing-room with a shawl over her shoulders, and looking evidently cold; at my second visit only a few days later she wore no shawl, and was quite free from any chilly feeling. This lady suffered for years from Angina pectoris (true breast- pang), and had been given up by members of both schools to the brandy bottle; but under my treatment (extending over two years) she made a complete recovery, having been now quite well of it these 18 months. OBS. XX.-Mrs. W. æt. 60. Came under my treatment for cold- ness of the legs from the knees to the feet, for three months; she can- not keep them warm in any manner; at night she wraps them up in flannel, and encases them also by day, but still they are cold; the coldness is subjective not objective; she suffers also very much from sleeplessness and great nervous irritability. R. Nat. Mur. 6 trit. At the next visit a few weeks afterwards she reported that she had been promptly cured of her old insomnia, and also of the coldness 84 BURNETT'S ESSAYS. of the legs, but the legs were not as she would like, the coldness. having given place to a burning feeling, especially in the veins of the part, which now swell. She no longer wraps up or encases her legs, but on the contrary they are almost too warm. To continue the medicine. The cure was permanent. The medicine so improved her nervous state that she still speaks of it as the "powders that soothed her nerves." OBS. XXI.-Constipation, of long standing, in a pale anæmic young lady of 23; only one motion in two or three days. R. Nat. Mur. 6 trit. Twenty-four six-grain powders, one in water forenoon and afternoon. This one set of powders quite cured it; there is now daily stools. Also the menses came on a week late (very unusual), and the usual painfulness was absent; they were also not so excessive as usual. OBS. XXII.—A gentleman æt. 60, with oedema of the præputium for some weeks; severe intertrigo between thighs and scrotum, with a good deal of acrid discharge, and considerable excoriation; this condition has existed for many months, notwithstanding daily ablu- tions often several times repeated. Patient is arthritic and very melancholy and despondent. His skin is very dusky and unhealthy-looking. B. Nat. Mur. 6 trit. Six grains four times a day. In a week the oedema and intertrigo were nearly well, and he was in very much better spirits, and at the end of the second week he was well. He continues well, and the skin of his face is lighter in color, but the color of that of the trunk remains as before. The change in his mood was quite remarkable. - OBS. XXIII.-Gentleman of 35. Pain in left side of the lower jaw extending to the lower end tooth of left upper jaw, and up to the left eye, always after food, throbbing wrenching pain, making the tears come into his eyes; the pain he describes as terrible, and it lasts about an hour. He has been in this condition for three months, which coincides with his leaving Liverpool and coming to reside in Tranmere. Urine high-colored and thick. NATRUM MURIATICUM. 85 7 The pain evidently proceeds from a decayed tooth. He sleeps well after the after-supper pain has gone. B. Nat. Mur. 6 trit. Six grains in water three times a day. In a week he reported: Pain much better, it comes on and lasts only five or six minutes, and no tears come into his eyes. To continue the medicine. The next report was that just as he thought he was cured he caught a slight cold, and the pain came on in all its original vio- lence, when a dentist relieved him of both tooth and pain. Goes under treatment for hæmorrhoids. The fact that the pain returned in all its original violence is only what we should expect under the circumstances, and it militates against the case as one of permanent cure, but does not invalidate the evidence of the potent drug action. OBS. XXIV.—A gouty gentleman of 70. Until three years ago he was in the habit of perspiring freely, but latterly he perspires less, and for three years he has always felt chilly and cold. Urine bloody and thick; he urinates with great difficulty, and uses the catheter at night these two years. He takes Nat. Mur. 6 trit. for three weeks, and reports that after the first day or two he ceased using the catheter altogether, having sufficient power over the bladder; the urine is free from blood and slime, but still thick, but not so red or brickdusty; he is more cos- tive than usual, and feels considerably warmer. He begs to go on with the medicine, to which I agree. He did not consult me again, but when he came to pay his little bill he informed me that he had gradually got quite well of his chilli- ness, that his urine had become normal, and that he no longer needed to pass the catheter at all. The urine may possibly have come right of itself, and passing the catheter those two years may have been a mere habit, and unneces- sary; but how are we to account for the disappearance of the cold, chilly sensation that had lasted three years? OBS. XXV.-Gentleman of 50, usually enjoying good health, and of splendid physique. Symptoms: For the last six weeks coldness of the abdomen, from the navel downwards, including the genitals; swelling of the abdomen after late dinner, with flatulence; passes a 86 BURNETT'S ESSAYS. very large quantity of water with a strong odor; it does not contain any sugar; he is cold about the legs, and is restless at night, with cold creeps from navel down the legs; as he sits on the sofa before me I notice that he holds both his hands tight over the pubes; and to the inquiry why he does so, he replies that he is so cold about those parts that he holds his hands there to warm them. The sensa- tion is as if his shirt were wet and cold; when he urinates it seems as if he would never leave off for the dribbling. Fearful thirst of mouth, not of the stomach; bowels regular; tongue coated; breath foul. Very despondent of himself. Takes vapor baths regularly. Here the chilliness, profuse urina- tion and thirst seem the prominent symptoms; and, as we all know, they are those of Natrum Muriaticum. R. Nat. Mur. 6 trit. gr. vj. Fiat pulv. Tales xxiv. One in water four times a day. Eight days later: The coldness a great deal better; does not pass quite so much water, and its smell is less bad; the coldness of legs better a great deal, as also that of the pubic parts; the thirst is also much better; so also the tongue; breath sweet; feels better all over; warmer. Is anxious to continue the medicine, which is done. He did not come again, so I wrote to him to inquire how he was doing, and received a reply to the effect that the second lot of pow- ders had finished the cure, except a little thirst, for which he intended coming to see me again; but he never did. From a mutual acquaintance I learn he continues well. In this case the amelioration commenced immediately after the powders were taken, and as far as I can see the cure can be attrib- uted to them only. This, critical reader, is the way I have wandered in my search after truth as it is in nature. From it I am forced against my will to admit the existence of a something in drugs that becomes opera- tive by trituration. What it is, I do not know; what you call it, I do not care. Mach's nach, aber mach's besser. · GOLD AS A REMEDY IN DISEASE, NOTABLY IN SOME FORMS OF ORGANIC HEART DISEASE, ANGINA PECTORIS, MELANCHOLY, TEDIUM VITE, SCROFULA, SYPHILIS, SKIN DISEASE, "Aurum AND AS AN ANTIDOTE TO THE ILL EFFECTS OF MERCURY. Medicina Catholica in senibus et juvenibus." -GLAUBER, 1651. PREFACE. IN reference to the subject of this little volume Hahnemann says, "Das Gold hat grosse, unersetzliche Arzneikraefte" ("Gold has great remedial virtues, the place of which no other drug can supply"); and having myself used it in practice for several years, I have come to regard it in the same light: I cannot do without it. To my mind there are varieties of disease that Gold, and Gold only, will cure, and others that Gold, and Gold only, will alleviate to the full extent of the possible; and not a few of these varieties of disease of the gravest nature. As a heart-remedy alone it claims the most earnest attention of every medical man. are In homœopathic practice it is neglected, and in allopathic practice it is practically unknown. I claim for the following pages only that they constitute a rough Introduction to the Study of Gold as a Remedy in Disease. J. C. B. 2, FINSBURY CIRCUS, LONDON, E.C., February, 1879. I GOLD AS A REMEDY IN DISEASE. FE EW things affect mankind in more ways or more than the sub- ject of this essay. But few of the drugs in our pharmacopoeia possess such remarkable remedial properties; none are in general less known or less appreciated by both physician and patient than this metal in its physiological and therapeutical effects upon the human body. C This arises largely because the metal being insoluble in its ordi- nary form-it is taken for granted that it cannot possess any remedial virtues. But I shall hope to show in the course of these pages that Gold may be so subdivided that it becomes operative upon the living tis- sue of the body, and thus acquires medicinal properties of the highest order, and that, not merely in some functional disturbances of the or- gans and their parts, but also in states of deepseated pathological changes that constitute complaints usually termed organic. The various phases of thought in medicine have produced views of drugs and drug-action that differ widely from one another. To some a drug simply cures because it is endowed with remedial vir- tues .. quia est in eo vertus dormitiva, as Molière has it. Some consider that there are substances that are of a benign and kindly na- ture, and are present in creation only to be remedies for our diseases, which really amounts to the same thing; while other substances are in themselves hurtful to our bodies, simply, and altogether bad. In one word, there are good and evil substances, considered in relation to our bodies, the good ones to heal, the bad ones to hurt. 7 0990 BURNETT'S ESSAYS. But Nature is not thus childishly constituted; the same substance is either good, bad, or indifferent, according to how it is used, and according to the state of aggregation of its parts. Two equivalents of hydrogen and one of oxygen, as water, will quench our thirst, act as a solvent to our food, with a few other con- stituents float about in our bodies as blood. Hail, ice, sleet and snow are also only hydrogen and oxygen in the same proportion; they are practically only water, just the same as the steam that whirls us along in the train. We are not astonished at these things; the most marvellous things cease to excite wonder after we have grown accus- tomed to them. Tell the noble savage that snow, hail, ice, water and steam are chemically the same, though physically and dynamically so different, and he will not fail to laugh at your ignorance! He knows better. Tell the mediocre medical mind that common table-salt* may be so subdivided by means of friction that it thereby becomes a most pow- erful and even dangerous drug, and he will not fail to laugh at you. He knows better. Tell the same that Gold may be so subdi- vided by simple friction that it becomes an active remedy, second to none in its great power, and the same result follows,-he laughs at you. He knows better. 'Tis true he never tried, but he knows. But who should be angry at the poor savage for that he knoweth nought of? Civilization will teach the untutored mind of the sav- age what difference of temperature and pressure may effect in the physical state of water—if he survive long enough. The advance of general and medical knowledge will teach the untutored medical mind (car il y a beaucoup de docteurs qui ne sont point doctes), what trituration will do in the way of transforming a non-medicinal substance into a potent remedy, but it will, probably, not be the medical mind of the crude chirurgeons of the present day. They know better. The subject we wish to introduce is, "Gold: as a Remedy in Dis- ease, notably in (some forms of) Organic Heart-Disease, Angina Pec- toris, Melancholy, Tedium Vitæ, Scrofula, Syphilis, Skin Disease, and as an Antidote to the Ill Effects of Mercury." * See "Natrum Muriaticum as Test of the Doctrine of Drug Dynamization” (Lon- don: E. Gould & Son, 1878), on this subject. † Dangerous when administered to the sick. GOLD AS A REMEDY IN DISEASE. 91 I We will try to keep to our text. It is now admitted on all sides that a true and thorough knowl- edge of a medicine can be obtained in only one way, viz., by first test- ing it on the healthy. Why? Because if you give a sick person, X, a dose of medicine of any kind, and there follow, say, six phenomena, how many and which of these were due to the drug, and how many and which were due to the disease? You cannot tell, and therefore you give it to a healthy person to find out. Suppose we give thirty grains of powdered ipecacuanha root to a healthy person, we find it produces vomiting. That is a symptom of Ipecacuanha; all the symptoms produced by a drug on a healthy person constitute the pathogenesis, or proving, of that drug. When we know all the physiological effects of a given drug, that is, its pathogenesis, we have a firm scientific basis to work upon. This pathogenetic material constitutes the means of curing disease by using it on the now well-known, but ill-comprehended, principle of similars. But before coming to this point, it is, to say the least, very inter- esting to cast a glance back into the history of a drug to see what was thought of it by our fathers that have gone before us, and by our forefathers in the old times before them. By this means we learn the empirical uses of a drug, and can compare notes with those that have long since gone over to the majority, and thus we can satisfy ourselves whether they were right or wrong, and whether we know more than they knew on the subject, or whether indeed they knew many a useful thing that we have allowed to lapse into disuse or even oblivion. Therefore I shall treat my subject somewhat historically, and expect to show that all the medical wisdom we ween to possess on this subject did not originate with us of this generation. If we have the history of the subject in a few outlines-just a sil- houette—then the effects on the healthy, or pathogenesis, also only in outline, and then a few experiments on animals, we shall be able to fully appreciate that to which all this is only preliminary and in- troductory, viz., Gold as a remedy in disease. J To begin, then, with the first: The history of Gold begins very early in the records of our race; 92 BURNETT'S ESSAYS. it is the first metal discovered by man, and also the first metal men- tioned in the Bible. The eleventh verse of the second chapter of Genesis reads: "The name of the first is Pison; that is it which compasseth the whole land of Havilah, where there is Gold." Thus it is noticed even before Eve was created. This is, of course, some thousands of years ago. I need therefore not state that a complete history of Gold lies beyond the scope of this little work. The great Linné (Mat. Med.) writes its history in four words: Vis politica, usus œconomicus. I propose going a little further than this. Magpies, crows, and other thieving birds are attracted by its color and its sheen, and hence a state of man in which Gold is unknown is hardly conceivable. The first metallic instruments were made of Gold (Hoefer, His- toire de la Chimie). In the 25th chapter of Exodus there is an account of dishes, spoons, bowls, etc., made of this metal, as every one knows. The first trituration of Gold was made by Moses out of the re- mains of the golden calf of the Israelites, and he made the children of Israel drink it in water (Exodus, chap. xxxii. v. 20). Hence it is also the first Aurum potabile on record. What the precise object of Moses was in thus dealing with the re- mains of the golden calf may be a fit matter for discussion; certainly a more efficient way of proving the nullity of a god could not be well devised. What the opinions of Biblical scholars on the subject may be I do not know. In medical works I have read the opinion that the golden calf was really made of wood, and only encased with Gold, and that causing the children of Israel to drink it was with the view of purifying them of their great sin of worshipping an idol. Gold is constantly connected with the idea of purity and purifica- tion, as witness the expression, "Pure as gold." At the risk of being irksome and of appearing pedantic, I shall give the sources of my information in many instances, and sometimes. even give the original text when I think it best. The first notice of Gold as a medicine known to me is that in Wiegleb's History of Alchemy (Historisch-Kritische Untersuchung der Alchemie, Weimar, 1777), p. 185, where he treats of the antiquity ¡ , : I GOLD AS A REMEDY IN DISEASE. 93 E of chemistry amongst the Chinese, and according to which Gold was used by them medicinally 2500 B.C. I sometimes wonder how much blague is contained in these pretensions of the Chinese to such great antiquity. All along the march of time, physicists have been seeking a Per- petuum mobile, mathematicians have been squaring the circle, and husbandmen trying to manure without dung; what wonder, then, that alchemists should have sought the philosopher's stone, and phy- sicians a never-failing panacea! Gold has more than once figured as the universal cure-all, as a veritable elixir vite; and it will indeed cure many diseases, as has been long known, and as I hope to show, but it has never been known to cure chrysodypsia; at any rate I know of no such case on record. It is wonderfully strange to read of the doings of the curious craft of alchemists, and nowhere more strange than in the works of that erratic genius and honest man Hohenheim, commonly called Para- celsus. - But, withal, the transmutation of common metals into gold and silver, and the discovery of the true lapis philosophorum, run like a thread through them all. That such a gestation should have eventu- ated in the birth of chemistry is only another proof that good comes of all honest work. The alchemists called Gold the king of metals, rex metallorum, and the sun, Sol. We may fairly invert it, and say it is the metal of kings. The Greek aupo is parent of the Latin aurum, and of the French or; the more usual Greek word is χρυσός. Dioscorides and Avicenna employed Gold as a remedy in the metal- lic state. Paracelsus used it with sublimate as a universal panacea, and called this Calcinatio et solutio“ solis.” For years I have tried to fix the date at which Gold was first used as an antisyphilitic, but I must confess that I have been unable to do so. It is pretty sure that Hahnemann thus used it, as it is so evidently homoeopathic to some cases of this disease, but it did not originate with this great man. Dr. Richard Hughes, in his remarkable work, Pharmacodynamics, seems to ascribe it to Chrétien (meaning evidently Chrestien), but Chrestien certainly did not originate it. What Chrestien did would seem to be this: he first started a would-be new method of cure, 94 BURNETT'S ESSAYS. “Méthode par Absorption," very early in this century, and then this became, Méthode jatraleptice" (de l'an xii.), and then (1811), “ De la méthode jatraleptique, etc., et sur un nouveau remède dans le traite- ment des maladies vénériennes et lymphatiques." He met with violent opposition from the profession, which had long abandoned the use of Gold in medicine (the ancient Pulvis Auri, Tinctura Auri, Aurum potabile, Aurum potabile verum, Tinctura Solis, Tinctura aurea, etc.), it having been so highly prized and praised by the alchemists, and long been the stock-in-trade of secret-mongers and quacks of all kinds, that it passed from being the remède à la mode into utter ob- livion. This is the rock upon which lawless therapy has always stranded at first a given drug is a "new remedy," then it is a won- derful medicine, and then a universal panacea, then it is not such a very good medicine after all, and finally it is accounted no good at all, is abandoned like an old mine, and venturous spirits set out in quest of another "new remedy," and so on in a veritable vicious circle. 66 SME Hahnemann gathered up the fragments, welded them together with the light of his law, and gave fivity to the whole. The proof of this lies in the fact that Gold has never ceased being used by the homœopaths, in cases judged appropriate, from his day to this, and that is some fifty years since. Be it therefore observed that I do not claim to resuscitate the dead when I call attention to this great poly- chrest. It is now essentially a homoeopathic remedy, just as Aconite or Belladonna, not that the homoeopaths originated its use (any more than that of Aconite, for instance), but they use it on a fixed principle, which reduces fits of fashion in the drug treatment of disease to a minimum. M. Chrestien, as we have said, met with violent opposi- tion, and this put him on his mettle; and he set earnestly to work to explore this veritable therapeutic mine of Gold with the result that quite a school of men arose that one might fitly term "Auralists," more especially amongst syphilidographers, and the movement culmi- nated in the important work of M. Legrand, "De l'Or, de son emploi dans le traitement de la syphilis récente et invétérée et dans celui des dartres syphilitiques; Du Mercure, de son inefficacité, et des dangers de l'administrer dans le traitement des mêmes maladies, etc. Paris, 1828." Thus these auralists constituted one camp, and the old mercurialists the other; as if the one excluded the other! As if the fact of Gold " GOLD AS A REMEDY IN DISEASE. 95 being a good remedy in some forms of syphilis precluded Mercury from being equally good in some other forms of the same malady, or even in the same! Dr. X. tells you pompously he does not believe in this or that remedy, but in the other; as if the purging of jalap pre- vented Colocynth from doing a similar thing! But the auralist and anti-mercurialist, Legrand, did important pharmacological work, of which we shall make full use in these pages. M. Legrand's position is not the one I propose to defend in what fol- lows; I purpose merely making use of his facts. Neither do I propose to join in the insane cry of the so-called anti-mercurialists; on the contrary, if I were reduced to one remedy in the treatment of the protean manifestations of this disease, I should certainly choose Mer- cury, for if there is any one thing certain in practical medicine, it is that Mercury is, facile princeps, the antisyphilitic remedy. But the dose? Ay, there's the rub! To do the good without risking the harm is the true test. Moreover, I do not propose to vaunt the use of Gold in this special disease, but rather to point out that it deserves a very much higher place in the armamentarium of the physician than is accorded to it in general. For centuries Gold has been used with excellent effect in scrofula, heart-disease, skin diseases, dropsy, tedium vitæ, melancho- lia, and the Morbus Gallicus, or syphilis. In the treatment of some heart diseases, some bone diseases, and of sarcocele, to know the medicinal value of Gold or to ignore it, is just the important difference between curing and failing. But, of course, the metal must be first triturated, so that it may become remedial. In combination with Mercury, Gold has long been used as an anti- syphilitic, certainly as early as 1621, by J. Colle, and in 1623, as Aurum vitæ, by Planis Campi, in the pest, in syphilis, leprosy, dropsy, etc., as we read in the Dictionnaire Universel de Matière Médicale, of Mérat and De Lens. And lying before me is old Glauber's "De Auri Tinctura, sive Auro Potabili Vero, etc.," Amsterdam, 1651, in which he distinctly recommends his tincture of Gold in the Morbus Gallicus. The same author also recommends it in leprosy, the pest, epilepsy, fevers, for promoting the menses, and in diseases of the uterus, and sterility. Further, he commends it very highly in dropsy, and concludes by 96 BURNETT'S ESSAYS. apostrophizing it as a Medicina catholica in senibus et juvenibus. And such it is. Moreover, Mérat states that Pitcairn proposed, in 1714, powdered or leaf-gold as an anti-syphilitic in lieu of Mercury. This is about a century before M. Chrestien, of Montpellier. Again Timpe cites "Plencik: Opera Medico-physica, Vindob., 1762," and "Gmelin: Apparatus Medicaminum, Goething, 1795," on the same subject. Finally, Mitchell, of New York, is quoted by Mérat before Chres- tien. It is, however, only on the ground of priority that we must refuse honor to Chrestien's publications, as they undoubtedly mark a distinct era in the history of Gold as an anti-syphilitic, anti-vene- real, and anti-scrofulosum. After the publication of Chrestien's works, the question, Is Gold a reliable anti-syphilitic? occupied the medical mind of Europe for twenty years; to say that Gold has hardly been recognized, in this connection, outside of France, is incorrect. A mass of trustworthy evidence is collected by M. Legrand on the subject of the medicinal value of auric preparations. He gives a list of about eighty medical men of the time-auralists-who had tried Gold in syphilis and venereal diseases generally, and in scrofula and sarcocele, with a total number of 387 cases of these various diseases successfully treated by it, and comprising cases of recent origin, and treated with Gold only, as well as very inveterate ones that had resisted the action of Mercury, though other remedies were at times used with it. There is a later publication of M. Chrestien, Paris, 1821, entitled, "Recherches et observations sur les effets des preparations d'Or, du Docteur Chrestien, dans le traitement de plusieurs maladies; et notamment dans celui des maladies syphilitiques. Par J. G. Niel, Docteur en Médecine de Montpellier, etc." Niel was a Spanish practitioner of some position. Lying before me is also, "De auri muriatica in morbis syphiliticis usu," which is an inaugural dissertation of L. B. Timpe, of Berlin (1834), and which I here only note, but shall hereafter have occasion to again refer to more fully. The "Dissertatio medica inauguralis de auro ejusque praeparatorum in medicina usu, auctore J. D. Schepers, Groninge, 1838," shows conclusively that at the period of its date Gold was a thoroughly es- tablished remedy in Dutch hospitals, and was as such lectured upon by the teachers and highly commended in the same class of maladies. - DOMEN, EVENING GOLD AS A REMEDY IN DISEASE. 97 =4 In De Methodis atque medicamenibus anti-syphiliticis thesis of F. G. Sarfass, Berlin, 1816, p. 13, we read, "Nec auri usus deest in syphilidis therapia, Scotus Pitcairne (Girtanner, 3 Bd. p. 351, Diss. de ingressu morbi, qui venerea lues appellatur vulgo, in Pitcairnii dissertationibus, Amstelod., 1714), auro subtilissime alcoholisato in lue adhibito, melius et tutius quam hydrargyro hunce morbum sanari docet." But no mention is made of M. Chrestien. Clearly, then, the honor of first using Gold as an anti-syphilitic remedy cannot be claimed for M. Chrestien, although he vulgarized its use and orig- inated the Aurum muriaticum natronatum. Perhaps I dwell more on this point than it deserves, but I am anxious to show that the assump- tion by certain writers of the honor of introducing this drug into the therapeutics of given ailments is wrongful. Nevertheless, I am unable to say positively who first used Gold in the treatment of syphilis ; cer- tain it is that Glauber recommends it in 1651, and in his Tractatus de Medicina Universali sive Auro Potabili Vero (a small tract in German and Latin mixed), Amsterdam, 1657, p. 69, he again asserts that it will cure the Morbus Gallicus. Hence, to claim the introduction of Aurum into the therapeutics of syphilis for the homeopathic school, as do some, or for M. Chrestien, as do some modern writers, and as did many of M. Chrestien's imme- diate followers, is incorrect. I have a strong feeling against this system of robbing the dead of what is fairly due to their names. The use of Gold in scrofula, in heart affections, in dyspnoea, and in mania, is at least equally ancient with those other of its uses just indicated. Strictly speaking, in homeopathy no remedy is used as against any specific disease, but in any and every disease to the symptoms of which a given remedy is pathogenetically similar. Still practical medicine, without a nosological nomenclature, is an Unding, and equally so practical pharmacology. All we have to bear in mind is that, e. g., pneumonia is not an entity, but a generic term for a group of symptoms and a state of the organic tissues. I often wonder that such terms as Morbus Auri, Morbus Aconiti, Mor- bus Chelidonii, etc., are not more frequently met with in medical lit- erature. They would be convenient, to say the least; they are used by Rademacherians, as followers of Paracelsus. To say much more anent the medical history of Aurum might be I 98 BURNETT'S ESSAYS. tedious and unprofitable; but the historical part can hardly be avoided if we wish to be fair to the memories of the departed. It is the great glory of Hahnemann to have introduced the sys- tematic study of the effects of drugs in the healthy subject into medi- cine, thereby laying the very foundation of any system of Scientific Medicine. This is now admitted on all sides, except that every little chanticleer gets the credit of it rather than Hahnemann. The world is not yet capable of appreciating the herculean labors of this great teacher. The day will come when the Hahnemannian Oration will be the rendezvous of all that is great and good in the medical world. At present his lot is scorn, ridicule, slander, and contempt; and, worse than all, his life-labor is daily filched from him by the pig- mies of the hour. But Nemesis lives, happily, through all time, and may tarry, but will surely overtake them. Awaiting this, it is for the small and persecuted body of the disciples of Hahnemann to follow in his wake, fearing neither ridicule, slander, nor hatred. Our next step will be a consideration of the Pathogenesis of Gold, or an account of what Gold does when taken into the living body of the healthy. Here we are entirely upon homoeopathic ground, for an account of the effects of metallic Gold upon the healthy human subject does not, I believe, exist in medical literature before the time of Hahnemann, who first gives a proving* of Aurum in the fourth volume of his Reine Arzeneimittellehre (1825), and this is again. given, with additions, in his Chronische Krankheiten (1835). Dr. Richard Hughes throws discredit upon these additional symptoms in these words: "The worth of these, according to the facts we have ascertained, is more than problematical" (Pharmacodynamics). What Dr. Hughes's facts are I do not know; the work of verifying Hahne- mann seems to be undertaken by Dr. Hughes with a very light heart. Now we require some one to verify Dr. Hughes; for that the latter may sometimes err also, is seen on the very same page, and indeed in the very same paragraph, where he states that the symptoms of me- tallic Gold "were obtained from one- and two-hundred-grain doses * "Proving" is the English rendering of the German word Pruefung, meaning a trial, and is exclusively used in homœopathic literature, and is equivalent to trial of a drug on a healthy organism-i. e., what it does. GOLD AS A REMEDY IN DISEASE. 99 E 22 7 of the first trituration" (see Pharmacodynamics, 3d edition, p. 153, § 2), which is incorrect. If Dr. Hughes will kindly reach his Chronische Krankheiten from his library shelf, and turn up the 217th page of the "Antipsorische Arzeneien" and glance at it again, he will, I think, agree with me that he has made an important mistake, inasmuch as the one and two hundred grains there mentioned were the quantities used in the en- tire provings of the individual provers, and not the "doses;" also that it was not precisely our "first trituration" that was used, as the proportion was 1: 100, and not 1: 99. This latter point is, of course, unimportant; but not so the former. It should also be stated that this one per cent. trituration was taken dissolved in water. Again, Dr. Hughes asserts that Gold does not affect the gums, which it cer- tainly does. I should not thus take upon myself to correct Dr. Hughes, for I owe my conviction of the truth of homoeopathy largely to a perusal of his beautifully-written and most erudite works,* and I shall never be able to pay this great debt; but as he corrects his master, Hahne- mann, I may perhaps be fairly forgiven for correcting mine. For my part, I find Hahnemann so reliable and so exact that if my ob- servations and his do not tally I look again, and am convinced of my error. Dr. Taylor, F.R.S., of Guy's (On Poisons in Relation to Medical Jurisprudence and Medicine, 3d edition, London, 1875, p. 493), says that nothing is known of the effects of Gold in the human subject. Would this eminent man and learned author be very much sur- prised to learn that, just fifty years before the date of his book, one Samuel Hahnemann and ten other medical men carefully tried the effects of large doses of Gold upon their own bodies (not on rabbits and guinea-pigs, and dogs and cats, be it well understood, but on themselves)? How is it possible that such misstatements pass cur- rent? Because the spirit of Dr. Taylor's medical party forbids the avowal of any acquaintance with the writings of Hahnemann. The motto of this party is, "Nul n'aura de l'esprit que nous et nos amis." But some have naughty notions of free thought in matters medi- * And to my friend, Dr. Hawkes, of Liverpool. 100 BURNETT'S ESSAYS. cal, and, to use an inelegant expression, chew their own cuds; and these do read Hahnemann. Some, having read the Chronische Krankheiten aforesaid, find it a most masterly production, full of sound learning, deep philosophical thought, true insight into Na- ture's ways in the maze of morbid phenomena that are the in-grip and the outcome of that hydra-headed monster psora, that in the times that be is just visible in the van of medical thought as the Her- petic Diathesis. We would respectfully commend a perusal of the Chronische Krankheiten to all medical men, of whatever shade of opinion. Allopath, homoeopath, hydropath, eclectic-all should read it; and no man's medical education is so good but he may learn much by so doing. For the purposes of this little book a simple sketch of the patho- genesis of Aurum in broad traits will be best. A bare list of all its symptoms is the province of an encyclopædia. In all it comprises 440 pathogenetic facts usually called symptoms-i. e., symptoms of the drug-disease. We say drug-disease in the sense of Paracelsus, who regarded drug- effect as an infection-being herein a forerunner of Hahnemann. Triturated Leaf Gold, Aurum foliatum, was the substance used. Some of the experimenters-all healthy men-took as much as a hundred grains of a one per cent. trituration, and others as much as two hundred grains, dissolved in water. Whether they took the quantity in one single dose or in various doses is not distinctly stated, except as "in der Prüfung;" and evidently this, with the context, means in divided parts. Beginning with the sensorium, we note how some became depressed in spirits, plaintive, tearful, melancholy, desirous of death, suicidal, rest- less, anxious, and some timid, irritable, disagreeable, getting into quite a rage at the least contradiction, and wanting to quarrel and going into violent passions. In some the opposite state of great hilarity is noted; and in others the two states alternate. One sits moping in a corner, desirous of being left alone, while another is all vivacity, and has a lively word for everybody. In some the memory is rendered very acute, while in others it be- comes almost annihilated. Not only does Gold thus affect the brain, but it is a great disturber of the cranial circulation; there are rushes of blood to the head and GOLD AS A REMEDY IN DISEASE. 101 * brain, headache, giddiness and hammering, and rustling noises in the head. And not only are the contents of the skull thus so materially dis- turbed in their states and functions, but the bony shell itself is pro- foundly affected in its life and being, as witness the pains in the bones of the head, with tenderness on pressure, and the bony lumps to be felt under the hairy scalp. The eyes, too, are powerfully and painfully affected, and in one ob- server the pupils were at first contracted and then dilated, while the vision of another is interfered with; "he sees indistinctly," and there is total loss of vision for a moment; and finally Dr. Hermann is so affected that he sees only with the lower half of his eyes, as if they were covered superiorly with something black (see the eye cases later on), and then again he cannot see anything distinctly, as everything seems double, and thus objects get jumbled together. There is a pustular eruption on the face, neck, and chest, the paro- tid and submaxillary glands swell and are painful; the bones of the face and nose are tender and painful, while the wings of the nose are sore and inflamed, and there is a sore within them that scabs over. The teeth pain and are loose, the gums are sore, and so is the throat; there is an offensive smell from the mouth (one of the earliest uses of Gold was to correct foul breath), with a good deal of saliva in the mouth (the muriate produces inodorous (?) salivation). The digestive tract is irritated and disturbed throughout; un- easiness in the stomach, amounting at times to a sense of weight, pain, or swelling; stitches in the sides; nausea; retching; griping; colie; flatulence; flatulent colic; weight in the abdomen, with icy cold hands and feet; pressing in the right inguinal ring as if a hernia would pro- trude, an inguinal hernia protrudes with great pain; distension of the bowels with rumbling within; constipation, flatus, diarrhea; stitches, burning and swelling of anal end of rectum; in fact, the whole of the intestinal tube is irritated and fretted till it writhes and wriggles, protruding at the inguinal ring, and voiding its contents. Nor are the kidneys exempt; there is constant desire to micturate, the urine is like buttermilk, and more fluid is passed than is drunk (its use in dropsy is very ancient). The genital sphere is powerfully moved (in these experiments all adult males); a long dormant appetite is roused in one, and generally 102 BURNETT'S ESSAYS. great orgasm of the parts, with all the known phenomena that result therefrom. Their various anatomical parts are fretted; stitches in the urethra and glans, with escape of prostatic secretion; the scro- tum itches, the right testis pains as if bruised in one observer, and in another observer the same organ becomes a tumid mass with pressive pain when touched or rubbed against from 6 to 11 P.M. Going back now to the respiratory sphere, we note all the symptoms of a running cold in the head, and then congestion and catarrh of the entire bronchial lining with the dry and humid stages and cough with dyspnea and constriction of the thorax, or just the opposite-viz., un- usual freedom of breathing. The symptoms of cardiac asthma are thus and in the following well depicted: extreme tightness of the chest with difficult breathing at varying times, great weight on the chest, especially a heavy weight in the sternum. This latter symptom points to angina pectoris, in which I have used it with marked success. In view of its ancient reputation as a cordial,* the cardiac symp- toms have a great interest. We read further: In walking the heart seems to shake about as if it were loose; at times a single thump of the heart; palpitation of the heart; violent palpitation of the heart; a kind of restless anxiety, arising in the region of the heart, and driving him from one place to another, so that he cannot stay anywhere. There are various tearing stitch-like pains about the body, and the spine pained one prover so much one morning that he could not move hand or foot. There are tearing pains in nearly all the joints, and the muscular system is considerably affected, so also the bones. There are wheals in the skin of the lower extremities like nettle-rash that itch, are made worse by rubbing, and are worse out of doors. There is a weary, tired pain in the head and in all the joints in the morning in bed that motion ameliorates. The arms and legs are numb and asleep in the morning on awaking. I have cured this symptom, occurring in a middle-aged man, with Gold.) There is great liability to catch cold and great sensitiveness of the * "For gold in physic is a cordial, Therefore he loved gold in special." ---Chaucer. GOLD AS A REMEDY IN DISEASE. 103 ** 7 whole body to all kinds of pain, so that the very thought of pain is al- most the pain itself. There is a good deal of wakefulness by day and restlessness by night with bad dreams; "he often awakes in the night in a fright;" "he moans in his sleep." Chilliness and rigors are very prominent symptoms: "cold hands and feet," "cold down the back," "cold in the whole body," ""shivers with cold,” “shudders with cold in bed," "cannot get warm all night,” “in the evening feverish chilliness over the whole body with a bad cold in the head, but not followed by fever or thirst.” Symptom 440 in Hahnemann is "morning perspiration all over." This gives a rough outline of the effect of Gold on the healthy human economy as elaborated by Hahnemann and ten other medical men working with him and under his direction. For a full list of symptoms see Allen's Encyclopædia. This pathogenesis of Gold is unique, and the outcome of honest conviction, hard work, scientific experiment, accurate powers of observation, unusual love of science. and of humanity, and betokens almost heroic self-abnegation. eye As far as my reading carries me, a better or more reliable provers' committee never existed for working out the pathogenesis of any drug whatsoever. Complete it is not, neither is it, or could it then be, per- fect. We miss the use of the ophthalmoscope to interpret the symptoms; of the stethoscope for the investigation of the hearts and lungs of the provers, both before, during, and after the provings; the renal secretions were not examined, and the temperature was not taken. Future Regii Professors of Experimental Drug Pathology will fill in the Hahnemann Cadre, and thus bring it abreast of modern requirements. But even as it is, how immeasurably superior is it to the cat-dog-and-rabbit crudities of the dominant sect in medicine, whose one aim would seem to be to paralyze and kill countless lower animals to see how much a given drug can do and how soon it can do it. These points have a certain value as giving us a knowledge of the last links in the chains, but what we require for clinical pur- poses is an accurate knowledge of all that drugs can do on the hither side of that stage of absolutely lethal organic change from which no recovery is conceivable. These able and honest men are working hard for the science of the deadhouse, but not for that at the bed- 104 BURNETT'S ESSAYS. side. On them the light of the Hahnemannic Law has not yet dawned, and they are still where Haller was. A somewhat fuller symptomatology of Aurum Metallicum than that of Hahnemann (and which includes Hahnemann's) may be read in Allen's Encyclopædia of Pure Materia Medica, art. Aurum; but nothing was ever done before, and nothing has been done since, on this part of the subject at all comparable to this lasting contribution of Hahnemann and of his ten able coadjutors which I have just endeavored to portray. The clinical applications of these pathogenetic facts are to be sought in the homoeopathic literature of the past fifty years, and in the nu- merous examples of involuntary homoeopathy in general medical literature. The Pathogenetic Records of the various preparations of Gold, on the other hand, do not commence with Hahnemann, and are only just touched upon by him-viz., he only gives eighteen symptoms of Au- rum muriaticum, and three of Aurum fulminans. His own idea would seem to be that the pure metal is to be preferred on account of its noble simplicity and superior merits. At first he used the muriate because of its solubility, being influenced by the current literature of the time on the subject, and by those authors who affirm that metal- lic Gold is totally useless as a medicine because of its insolubility; but then finding that a whole series of Arabian physicians had suc- cessively used finely-powdered Gold, beginning as far back as the eighth century, and since when Geber (de Alchimia traditio, 1698) praised powdered Gold as a " Materia laetificans et in juventute corpus conservans," and probably being acquainted with M. Chrestien's works, he set about powdering some for himself, and then proved it on the healthy as we have seen. Hereafter he tells us he only made use of the pure powdered metal, therein following the example of the Arabian physicians. Legrand arrives at the same conclusion- viz., that the powdered metal is the best form of administration. But the salts of Gold are Gold and something else; still their chief effects justify us in considering them, for practical purposes, as Gold. Moreover, they seem to give us a deeper insight into the action of the metal on the economy, though possibly only because they have been experimented with to the neglect or exclusion of the triturated metal. GOLD AS A REMEDY IN DISEASE. · 105 Chrestien's earlier work was with pulverized Gold, but unfortu- nately I do not possess his earlier publications; and Chrestien's later work-viz., Niel's Recherches, etc., 1821-I certainly possess; but, being unbound, I fear the greater part of it has served the useful purpose of fire-lighting, as I lately found only a small portion of it cast aside in a corner. But M. Legrand's work will supply its place, as it embodies it in its more important details. It bears date 1828. Hahnemann's first account of the effects of Gold bears date 1825. I cannot quite agree with those who affirm that Hahnemann probably knew nothing of the publications of M. Chrestien on the subject of Gold; and I hardly think it quite sure that he was unacquainted with Legrand's work, though he does not notice it in his Chron. Krankheiten in 1835. For we must remember that Hahnemann may have been well ac- quainted with Chrestien's work, or at least with the fact of its exist- ence; indeed, it is very possible that Hahnemann occupied himself with the study of Gold partly in consequence of such knowledge; for we read a very good review of the subject in Hufeland's Journal of 1817, i. 117, where Triller's joke about the tincture of Gold of the old alchemists-viz., that it was not Aurum potabile, but Aurum putabile—is quoted.* Then Chrestien's work is mentioned, and the fact that he used the muriate. Then it is mentioned that in Sweden Berzelius prepared a salt of Gold, and of it Schulzenheim, Gahn, Pontin, and Gadelius, made successful use in a case of syphilis; also that Odhelius had published seven cases of inveterate syphilis suc- cessfully treated with inunctions of the same remedy-stress being laid on the fact that cases in which mercury had been used in vain yielded most readily to the action of Gold. Then a successful case of cancer treated by Westring with Gold is mentioned; but other remedies were here used with it, especially Calendula. We may fairly assume that Hahnemann read Hufeland's Journal of 1817 at the time, and as his own experiments are not published till 1825, we can hardly claim any originality for him; and, indeed, he sets up no such claim at all himself. His great glory is that he proved the drug on the healthy, and thus gave it fixity and a scien- tific basis. * So, also, Erastus affirms: "Aurum non aurum.” 00 106 BURNETT'S ESSAYS. + About this time (1812-1820) Gold was used in London and New York with considerable success in syphilis and in dropsy. To return to Legrand's account of the Medicinal Properties of Gold, and of its mode of action on the economy, he says in substance that Gold is an excitant, seeming to act principally upon the arterial, venous, and lymphatic system. This excitation is always mild at first, when the dose is small. A weakened stomach is strengthened, the appetite is at times incredibly increased, and the digestive functions become regulated. The patients feel an indescribable sense of well- being; they feel themselves lighter (as they express it); so that we may say that Gold possesses hilariant properties. The intellectual faculties are more active. It has been known to produce frequent erotic sa- lacity, going on to painful priapism. M. Legrand, however, states that he has not used it as an aphrodisiac; but it has been used as such with success. By its action on the circulatory system it becomes a powerful em- menagogue. M. Souchier treated more than thirty cases of amenor- rhoea with the Perchloride of Gold, and these same cases had resisted the use of tonics of many other emmenagogues. (Gold was of old used in sterility and female irregularities.) If Gold is rubbed into the gums when the stomach is à jeun there ensue pains in the stomach. The preparations of Gold also cause con- stipation, but not obstinate; pushed a little further, diarrhoea ensues. The excitement of the arterial system produced by Gold is worthy of special attention, for herein lies its similarity to the conamen naturæ at the onset of eruptive and other diseases. M. Niel says: "This augmentation of tonicity has for object and result the expul- sion of whatever the venous blood may have poured into the circu- lating fluid and into the lymph." Gold leads sooner or later to evacuations of secretions that are pre- ceded by a slight febrile state; the temperature is raised, the pulse is more frequent, and then follows profuse and long-lasting perspirations, or a great flow of urine, or inodorous salivation, or diarrhoea. The perspirations have been known so severe that the mattress was wet through. These perspirations have at times an alkaline odor; at times they are very fetid. The great perspirations are followed by a gentle moisture of the skin, that at times lasts nearly a month. The urine is unusually thick, cloudy, and very fetid. GOLD AS A REMEDY IN DISEASE. 107 1 MM. Neil and Legrand think that this action of Gold causes the elimination of the morbid principle, this elimination being the result of the exciting properties of the metal that produce a reaction from the centre to the periphery of the body, or to some point of its extent. We know that Hahnemann places Aurum among the antipsories. As Barthez says, "Les mouvements critiques se concentrent tous vers l'organe qui en est le terme." Thus, continues M. Legrand, "the existing ulcers and chancres secrete an abundance of laudable pus, buboes become vast hearths of suppuration, suppressed urethral dis- charges are re-established and existing ones increased; other morbid secretions are at once re-established, eruptions of pimples, crops of pus- tules all over the body; so that the preparations of Gold bring back those symptoms whose suppression had caused such serious mischief. Beyond doubt it is good in syphilis, as in so many other maladies, to favor the development of external symptoms. " This is a truly Hahnemannic idea. Many thoughtful men have enunciated the same sentiment through all the history of medicine. It is just this idea that lies at the root of Hahnemann's tripartite pa- thology, especially of psora. - The critical diaphoresis and diuresis produced by Aurum led Dr. Delafield, in New York, in the second decade of this century, to ad- minister it in dropsy, which he did with success; but this had been done long before, as we have seen. The same critical diuresis was observed at the Paris Hôpital des Vénériens. Dr. Souchier observed the same thing; so also Gozzi (Sopra l'uso, etc.). But I am much inclined to think that the Sodium had also something to do with the diuresis and diaphoresis.* According to Gozzi the perspirations are decidedly worse at night; moreover, an excessive dose of Gold renders it a debilitant and de- pressant. Thus Gozzi has observed suppression of urine and of per- spiration, exacerbation of the disease; the patients complain of ma- laise, and of unusual heat. Gozzi also asserts that dry warm weather favors the action of Gold, and, on the contrary, its use is apt to cause inconvenience in cold weather, especially cold and wet, which, in a homeopathic sense, is equivalent to saying that the symptoms calling for Gold are ameliorated by warm dry weather, and made worse by - *Hence the Aurum muriaticum natronatum occurs to my mind when excessive per- spirations are a prominent part of the auric disease picture. 108 BURNETT'S ESSAYS. 1 cold and damp. In this it is like syphilis itself, and also like the plague (bubo plague). Reading this, therefore, in connection with its other symptoms, we see why Grauvogl classed Aurum in his Carbonitrogenoid Group. Irritable, sanguine, and bilious persons are more obnoxious to the effects of Gold than the phlegmatic. Exercise, even fatigue, aids the action of Gold (Chrestien). Hahnemann affirms the duration of the action of Aurum, when given in not very small doses, to be at least twenty-one days. On this point M. Legrand expresses himself thus: "The preparations of Gold act sometimes for a very long time after they have ceased to be given; besides, the phenomena then produced are analogous to those usually observed during its employment." M. Chrestien cites the case of a scrofulous child to whom Gold had been administered, and who got quite well of many grave manifestations of the scrofulous diathesis; but an enormous goître persisted. All treatment was given up, and in the course of a year the goître insensibly disap- peared. M. Niel cites the case of a sailor treated with the muriate for an exostosis of the right cheekbone, but it resisted the action of this salt of Gold at the time, and then gradually disappeared in two months. Schepers (op. jam cit.) thus summarizes the effects of the salts of Gold: 1. They excite the vascular and muscular systems and may induce fever (Niel and Chrestien; Hermann, Arzneimittellehre). 2. They augment absorption (Zum Zobel). 3. They increase the urine (Plencicz, Niel et Chrestien, Zum Zo- bel, Vering, Bluff, Bartels, Bourquenod, Delafield, "On the Use and Efficacy of the Muriate of Gold, 1817"). 4. They augment perspiration (Niel et Chrestien, Zum Zobel). 5. They excite the secretion of saliva (Niel et Chrestien, Zum Zobel, Wendt, Bourquenod). 6. Ingested into the stomach they stimulate its forces and produce a sensation of heat in the stomachic region, accompanied with increased appetite; if a larger dose be given, they pro- duce pains in the stomach and intestines; they cause nausea and vomiting and even produce erosion of the membranes of the stomach. GOLD AS A REMEDY IN DISEASE. 109 7. They move the bowels (Wendt, Vering, Bourquenod, Fr. Hoffmann, Plenck). 8. They bring on the menses (Niel, Carron du Villards). 9. They incite the organs of generation (Wendt). 10. Some are of opinion that Gold belongs to that class of metals, such as silver and copper, which exert a powerful influence on the nervous system. Of this opinion is Vogt (Pharmaco- dynamik). Thus we see only Hahnemann's proving epitomized, and everybody quoted except Hahnemann, and this is in 1838 in the University of Groningen in Holland. C'est bien tout comme chez nous! But Schepers adds one important piece of information thus: "The Cl. Sebastian has informed me that after the use of the hydrochlorate of Gold he has not only seen the salivary secretion increased, but also the mouth and gums affected, as is often seen after the use of calomel, viditque dentes mobiles atque halitum oris similem ejus, qui post hydrar- gyri usum frequens est. Here it may be stated that one of the oldest uses of Gold in medicine was for the cure of foul breath! And one of the auralists, in his anxiety to prove that Gold does not hurt the teeth, says that, on the contrary, it made loose teeth firm again! If this be reliable, the inodorous salivation will no longer constitute a differentia between the effects of Gold and those of mercury. I have myself observed very slight salivation and great tenderness of the gums and a pustular eruption result from the Tinctura Auri Mur. 3x, in drop doses four times a day for post-gonorrhœal indura- tion of left testis (from abuse of injections of Cup. Sul.), given with only partial success. Kali Chlor. 4 trit. cured the mouth in two days, the eruption in eight, and .resolved the induration and cured some obstinate subprepucial ulcers in a very few more days. Perhaps too much Aurum had been given, and simply ceasing to give it allowed the cure to effect itself. I think too much stress should not be laid on the inodorous mild- ness of the auric salivation, as the statement emanates from the aural- ists, who are always very anxious to show how virulent the effects of mercury are, and how mild and benign, on the contrary, are those of Gold. We must remember that mercury has been much used and Gold comparatively only a little. A French writer of fifty years ago says: "In England they use mercury as much as we use choco- 110 BURNETT'S ESSAYS. late in France." Von Schroff thus sums up the Physiological Ac- tion of Gold (Lehrbuch der Pharmacologie): "The soluble prepara- tions of Gold combine with the albumen of the body, and hence when given in bulk and concentrated, they, on reaching the stomach, corrode and produce Gastro-enteritis. The albuminate of Gold is soluble in the juices of the stomach and abdominal tube, it thence enters the blood and is excreted principally by the kidneys. The preparations of Gold have great similarity in their effects with the preparations of mercury, inasinuch as they both loosen the cohesion of the organic tissue; they both stimulate the absorbent, secretory, and excretory functions of the skin, kidneys, and salivary glands, and when employed for a longer period they initiate a peculiar metamorphosis of plastic life. They differ from the mercurial remedies in this, that they stim- ulate more the activity of the heart, and of the blood vessels, but do not fluidify organic tissue so powerfully as does Hg." PROVING OF AURUM FOLIATUM. To get a really concrete conception of what a given drug can do, there is nothing equal to trying it on your own body. As I, in this, practice what I preach, I made the following short proving on my- self. Jan. 27th, 1879. In my usual health and spirits. 12.15 P.M. Take four grains of Aurum foliatum, first decimal trituration, dry on the tongue. This sample was most carefully triturated for a long time. My object in making use of the IX trituration was to see if our lowest trituration had any power. 3 P.M. While returning from St. Martin's-le-Grand I felt intolerable itching in the right groin in its in- ner third, and here was realized the old proverb, Ubi dolor, ibi digitus, the street and the public notwithstanding. 4 P.M. Having returned, an inspection shows a wheal, now become tender from the violent. rubbing that has been carried on every few minutes for the past hour. 5 P.M. The wheal is gone, but the part remains tender. 28th. Sensations in joints and muscles like one has after unwonted exercise. Feel very strong, with plenty of go in me. Going up- stairs I involuntarily take two steps at a time, and run in and out of patient's houses instead of walking. Clearly this is the primary action of the Gold; its first action as an excitant and as an exhilarant. When will the reaction come, and how great will be the recoil? GOLD AS A REMEDY IN DISEASE. 111 29th. Evening. Proctostasis these twenty-four hours, which is most unusual with me and clearly drug-effect. Renal secretion much less in quantity; feel well. 30th. Normal. 11.30 A.M. Take four grains of Aurum foliatum, IX trituration, dry on the tongue. Evening. Very wakeful; well up to work; great mental activity; testes a little swelled and hard. 31st. Last night erotic dreams; early in the morning in bed weary pain in right tarsal bones, shooting up towards the knee. Pains in the bones of skull, soon passing off. Astringent metallic taste in mouth; tongue slightly coated with brownish fur. Feb. 4th. In the groove between nose and cheek a cutaneous lump of the size of a split pea; it irritates, gets picked, scabs over and per- sists. Feel not up to the mark; very depressed and low-spirited; nothing seems worth while. After proving Cundurango several years since, a small wart on my chest increased in size, and it has continued to grow ever since and is now about the size of a split horse-bean, with irregular hill-and-dale surface; it is beginning to lap over and to catch things. Since commencing the Aurum it seems a little flat- ter. The last two nights I have dreamed a great deal of death. 2 P.M. Take four grains of Aurum foliatum, IX trituration, dry on the tongue. Evening. Am unusually wakeful; am told that I look pale. 5th. Dreamy towards morning; am repeatedly told that I look pale and worn; have a dazed feeling in the head. 6th. Feel ill; look pale; have pain at lower part of spine; have had bad nights, dreaming of the dead and of corpses. Take four grains of Aur. fol. IX trituration as before. Evening. Feel fagged, but yet not able to sleep. Feel quite out of sorts. For many days great morbid activity of uropoetic system; sleep does not refresh ; dreams of the dead and of dead bodies. Uncomfortable feeling in forehead, pain at the bottom of spine. 7th. Look and feel ill, and although weary, no inclination for either rest or sleep. Having thus taken one grain and six-tenths of metallic Gold I am thoroughly satisfied that it can make me ill. My allopathic brethren maintain that the metal Gold is inert! Sure proof they have never tried it, properly triturated, on their own bodies. Fiat experimentum in corporibus vilibus homeopathicorum, say they, perhaps. I desist from taking any more of the Aurum, as I 112 BURNETT'S ESSAYS. feel so out of sorts, and my memory is so sharp that I fear the sec- ondary effect in this direction might be serious. March 25th. Still have some pain at the bottom of the spine; the last week or two my memory has been very bad indeed, and I am low-spirited. The before-mentioned wart is flatter and certainly much smaller. April 16th. Memory a little less clouded; still a little pain at the bottom of back occasionally; the wart is nearly gone. 30th. Memory getting good again; the wart seems again slightly on the increase. • CHAPTER OF ACCIDENTS FROM OVERDOSES OF GOLD. Under this head I propose to narrate a few cases that appear in literature, and offering most valuable pathogenetic facts, and rightly belonging to the pathogenesis of Gold; but as the involuntary prov- ers (for these cases may fairly be considered as provings) were more or less diseased, it is not easy to discriminate the wheat from the chaff. By giving the cases in extenso the reader may judge for himself, and a proper discussion may elicit the truth. Impure pathogenetic observations must in part supply the place of pure ones, as the chap- ter of accidents often takes us to a point of organic change that no healthy voluntary prover would be justified in seeking. I will num- ber them. - First Involuntary Proving. M. Chrestien was consulted by a man of 22 years of age, of strong constitution, who had been suffering for several weeks from a syphilitic (we should now use the generic term venereal) disease, characterized by two chancres on the prepuce, a bubo in the left groin, and gonorrhoea (blennorrhagie). The muriate of Gold was administered, beginning with the fif- teenth of a grain; before the end of the fourth grain all the symp- toms had disappeared, but the patient, unknown to his doctor, took it into his head to administer to himself two more grains, in divided doses, the one into eleven and the other into ten parts. Hardly had he finished the last dose of this when there appeared a very consider- h GOLD AS A REMEDY IN DISEASE. 113 ORANGE PALESTIERIA. able hæmorrhoidal swelling,* and a large number of excrescences near the anus accompanied by an abundant serous discharge (ex ano). M. Chrestien considered this merely extreme excitement of the lymphatic system, and could not recognize any syphilitic (venereal) character in these excrescences. Presently the mouth was filled with aphthee, the tongue became ulcerated in various places, and the hair, the eye- brows, and the beard fell out. Baths, refreshing drinks, bland diet, and above all the lapse of a little time, repaired all this momentary disorder, and patient became, and remained, quite well" (in Legrand). Second Involuntary Proving. A patient who had some chancres and buboes was delivered of them by the administration of four grains of the auriferous salt. Two further grains that he took needlessly, produced excrescences ex- tending from the glans up to above the os sacrum. A few glasses of syrup of orgeat, lotions of fresh water, and rest caused these acci- dents to disappear (ib.). Those symptoms that are in italics are most unwillingly regarded by M. Chrestien as effects of Gold, and referred to the disease by M. Legrand, express, I think, the veritable effects of Gold IN THE DIS- EASED. We call to mind that Pliny already reports that Gold cured warts eighteen centuries ago.‡ Third Involuntary Proving. A goldsmith a little over forty years of age, after having been cured of a chancre on the interual surface of the prepuce, and of a bubo in the fold of the groin, by means of the muriate of Gold and of soda, then took himself other three grains in two strong doses, notwithstanding the advice of the physician who treated him (M. Bertrand). During the use of the last grain he had intolerable itch- ing all over the body; this was soon followed by an eruption of tuber- * Legrand here adds this footnote: "Other observations have offered us exam- ples of hæmorrhoidal tumors that owed their appearance to the exciting effects of the perchloride" (of Gold). †The protrusion of a hernia (Hahn.) and that of the rectum are of a piece.— J. C. B. See also the writer's proving of Gold. 114 BURNETT'S ESSAYS. cules (little lumps), several of which being soon covered with dartrous scabs; these accidents were very soon complicated with a continual humming in the head and beating of the carotid and temporal arteries visible to the eye; the violence of this beating became extremely annoy- ing, and so violent was it that nothing could calm it; the disquiet caused by it, and that put the sufferer into constant excitement, almost rose to delirium. The little lumps much increased in size and they became as hard as horn; a beginning gutta serena was soon added to this ensemble de maux." It is to be remarked that the patient. was guilty of indiscretions of diet, notably making frequent use of coffee and alcoholic liquors, during this prolongation of his treatment (Niel in Legrand). It would seem then that the effects of Gold are made worse by coffee and alcohol. Fourth Involuntary Proving. Baron Girardot gave the auriferous salt for months together in the daily dose of a third of a grain without its producing any other ill effect except Cephalalgia (ib.). Fifth Involuntary Proving. M. Chrestien gave the muriate of Gold during forty days to a pa- tient; then followed a considerable swelling of the glands of groin, although the other symptoms had disappeared; the swelling subsided a few days after the remedy was discontinued (ib.). Sixth (M. Cullerier, Collaborateur du Dictionnaire des Sciences Médicales). This author thus summarizes the ill effects of Gold: 1. Internal heat. 2. Headache. 3. Dryness of the mouth and throat. 4. Oppression. 5. Gastric and intestinal irritation. 6. Constipation or diarrhoea. 7. Acceleration of the circulation. 8. Fever. Seventh Involuntary Proving. Lady: Gonorrhoeal discharge and slight swelling of both groins. Patient was taking the second grain when, one morning, after • GOLD AS A REMEDY IN DISEASE. 115 " having rubbed in the remedy (into the gums) she felt a trembling of the lower jaw and was threatened with trismus. M. Legrand attributes this nerve accident to the too irritant qual- ity of the muriate. She had previously had mercurial treatment, which was followed by hæmorrhoids and fistula. Eighth Involuntary Proving. (Absolutely analogous to the foregoing, says Legrand.) Lady quite at the end of her treatment with Gold, in very small doses, her tongue became stiff and prevented the articulation of certain words; it went off of itself. Ninth Involuntary Proving. M. Chrestien cites the case of a young man to whom the muriate of Gold was given, and it set up a state of nervous irritation; this gentle- man, very irritable, had just made use of sulphurous waters in bath and as a drink to rid himself of a rheumatic affection. Then mak- ing a venereal acquisition he took 2 grains of the perchloride of Gold, which developed a serious nervous affection with disgust of life, insomnia, and augmentation of the melancholy to which he was sub- ject (ib.). 1 + • Tenth (Summary of Accidents by Baron Percy in his Report to the Academy of Sciences). "We must confess that the muriate of Gold does not always act so happily. In a few cases it had no appreciable effect; in some others it produced salivation, perspirations, and other evacuations. In several it roused a general nervous sensibility; it turned indolent glandular and osseous tumors into a state of exacerbation and inflammation very difficult to calm. In two patients the muriate (although given in moderate doses and by friction) produced gastritis or phlegmasia of the stomach of a very alarming nature. In two others we saw it pro- duce violent attacks of fever and of very severe colic. Once it covered the body with a kind of herpes, after the disappearance of which all the antecedent symptoms showed themselves with the same intensity. A voluminous periostitis, thus far free from pain, was seized with se- vere lancinating pains at the tenth dose, which soon brought on car- cinomatous degeneration, of which the patient died” (ib.). 116 BURNETT'S ESSAYS. It may be remarked that this report was conceived and written in a very unfriendly spirit to the auralists, albeit Baron Percy admits Gold to be a powerful remedy. Eleventh (Gozzi's accidents are these). "Sometimes it causes slight inflammation of the tongue, of the gums, and of the throat (arrière-bouche). Also inflammation of the cheeks in two cases" (we shall subsequently see that it cures inflammation of the cheeks). Twelfth, but Voluntary, Proving of M. le Baron Girardot, who, be- fore administering Gold to his patients, made some trials on himself. He took six grains rubbed into the tongue (beginning with the eighth and finishing with the fifth of a grain pro dosi); it produced very con- siderable diuresis. I have thus given the pure experiment on the healthy first, then the impure experiment on the unhealthy. The latter corroborates the former, and shows other valuable effects of a noxious kind. If we now add the experiments on animals we shall be able to fol- low the effects of Gold still further, even to their fatal issue. Such a picture of drug-disease requires chronic cases of poisoning in moder- ate doses to show not only the length of the picture, but its breadth. Who will supply them? We want various kinds of animals kept under the use of Gold for several months, to see the effects of chronic poisoning on them. PATHOGENETIC EFFECTS OF AURUM ON ANIMALS. Orfila (Toxicologie Générale, 2d ed., T. I., Paris, 1818) says. Several experiments, tried upon dogs, have proved to me that this salt (Aur. Mur.) acts with much less strength than corrosive subli- mate, when introduced into the stomach. This does not, however, hold good when injected into the veins; its action is then most mur- derous. • Experiment First.—At eleven in the morning we injected into the jugular vein of a robust dog of large size three-quarters of a grain of the perchloride of Gold, dissolved in a drachm of distilled water; fif- teen minutes afterwards his respiration became difficult, and wheezing GOLD AS A REMEDY IN DISEASE. 117 with suffocation and vomiting of a white matter, floating in foam. These symptoms went on increasing at such a rate that at thirty-five minutes after one o'clock the animal was suffering great uneasiness, uttering plaintive cries, and breathing with the greatest difficulty. Con- siderable noise was heard at every expiration; he still preserved the power of walking, but remained lying and changing his position fre- quently. At half-past four increase of all the symptoms, and an hour later he died. Post-mortem appearances: lungs of a livid color, except a few rose- colored spots; texture dense, like liver, filled with blood, and non-crepi- tant; put into water they remained just below the surface; only the rose-colored spots would float, and these were slightly crepitant. Mucous membrance of stomach and intestines sound. Second Experiment.—Half a grain of the perchloride of Gold, dis- solved in two drachms and thirty-six minims of distilled water, was injected into the jugular vein of a small dog; the animal felt no in- convenience; two days afterwards he seemed well, and had a good appetite. Being of opinion that the poison had not acted, because it was diluted with too great a quantity of the vehicle, we injected into the jugular vein on the other side a grain of the same salt, dissolved in thirty-six minims of distilled water. Immediately after the ani- mal became giddy, he seemed suffocated, his inspirations were deep, tongue pendant, livid, he whined, became senseless, and died in four min- utes after the injection. Autopsy. Opened on the spot: left ventricle of the heart contain- ing black blood, and was still contracting feebly; the contractions were much more strongly marked in the right auricle and ventricle. Lungs shrivelled in folds, slightly crepitant, discolored, and hardly floated in water. Third Experiment.-Two grains of the perchloride of Gold, dis- solved in thirty-six minims of water, were injected into the jugular vein of a strong dog, though of small stature. At once his breathing became difficult, the tongue and mucous membrane lining the mouth became livid; he became giddy, uttered sharp plaintive cries, and died three minutes after the injection. A minute before he died the crural artery was opened, and the blood which issued was of a deep red color, and that part which flowed a few seconds before death was nearly black. 118 BURNETT'S ESSAYS. ! Autopsy. On the spot: heart of a violet color, containing blackish blood in all its cavities; auricles and ventricles still contracted at the end of three minutes. Volume of lungs considerably diminished, their color inclining to orange, their texture contracted, wrinkled, crepitating but little, and containing a small quantity of blood. These experiments prove incontestably that the muriate of Gold, when injected into the veins, produces death by acting upon the lungs. Fourth Experiment.-The œsophagus of a little dog was detached, and a hole pierced in it, through which three grains of the perchlo- ride of Gold in a solid form, enveloped in a small cone of paper, was introduced into the stomach, the animal experiencing no pain. The two following days he was depressed and sorrowful, but walked about very well. He died in the night of the third day. Post-mortem appearances: mucous membrane of stomach slightly rose-colored, corroded in three places without extending to perfora- tion; muscular and serous membranes intact. The edges of these corrosions were not black, but exhibited the same rose-color as the rest of the membrane. Texture of the lungs not hardened; it ex- hibited a few livid patches. C Fifth Experiment.-A small dog was made to swallow ten grains of the perchloride of Gold, dissolved in an ounce of distilled water; he vomited three times in the space of the first six minutes after the injection of the poison; the matter vomited was nearly all liquid, and in no great abundance. At the end of twenty minutes he threw up a great deal of frothy saliva. Two days afterwards his appetite was good. He ran about, and tried to make his escape. On the fourth day he began to refuse food; he grew lean, and was very much de- pressed. He died in the night of the seventh day. (The temperature of the air was at 3° or 4° below zero, and he remained almost con- stantly out of doors.) Autopsy. Mucous membrane of the stomach, which was of a clear red color, was ulcerated, and as if in a state of suppuration in more than twenty spots. The lungs appeared to be only slightly affected. 0 It follows from these experiments that the perchloride of Gold, in- troduced into the stomach, acts as a corrosive, and that the animals sink under the inflammation produced by it in the coats of the diges- tive tube. ** GOLD AS A REMEDY IN DISEASE. 119 : ► → For toxicological purposes these experiments suffice, inasmuch as they show that death may be caused by the perchloride of Gold in the one instance, when injected direct into the veins, by apnoea; in the other, when injected in the stomach, from exhaustion arising from a suppurative process consequent on corrosive lesions of the living tissue, or else from inanition consequent on want of proper food; for it is not shown by Orfila that similar corrosions and suppuration cause death when located elsewhere. For clinical purposes these experiments teach us too little; we re- quire less acute cases not carried quite so far. For the pathology of the dead-house is not the pathology that we meet with at the bedside, any more than the pretty sights we see en route to Paris are those that delight us when we get there. But Orfila's experiments on dogs are instructive, and they were quite justifiable, being instituted not wantonly, but for the benefit of mankind. PRACTICAL USES OF GOLD IN THE TREATMENT OF DISEASE. Having endeavored to trace the origin of the use of Gold in med- icine, and then sought to give a rough outline of the effects of Gold on the healthy subject, human and animal, and on the unhealthy human subject, we now proceed to consider its clinical uses. And first. Is Gold a medicine at all? Are not its pretended uses in medicine a mixture of medieval and modern credulity and won- der-workings? What evidence have we in the archives of practical medicine to show that Gold has ever really cured disease? This. There is not wanting evidence of the use of Gold as a remedy, even amongst the ancients; thus Pliny the Elder describes the use of Gold in medicine in these words (Hist. Nat., lib. xxxiij., cap. xxv.): "Aurum plurimis modis pollet in remediis. Vulneratisque et infan- tibus applicatur, ut minus noceant, quæ inferantur, veneficia. Est et ipsi superlato vis malefica, gallinarum quoque et pecorum foeturis. Remedium est abluere illatum et spargere eos, quibus mederi velis. Torretur et cum salis grumo, pondere triplici misso, et rursum cum duabus salis portionibus, et una lapidis, quem schiston vocant: ita virus tradit rebus una crematis in fictili vase, ipsum purum et incor- ruptum. Reliquus cinis servatus in fictili et ex aqua illitus, lichenas C 120 BURNETT'S ESSAYS. in facie sanat. Lomento eum convenit ablui. Fistulas etiam sapat et quæ vocantur haemorrhoides. Quodsi trito spuma abjiciatur, putria hulcera et tetri odoris emendat. Ex melle vero decoctum cum melan- thio et illitum umbilico, leviter solvit alvum. Verrucas curari eo M. Varro est author." Pliny died in the year 79; this account must therefore have been written eighteen hundred years ago. It is computed that his Natu- ral History was published about two years before his romantic death. Bostock and Riley thus translate the foregoing quotation from Pliny: "Gold is efficacious as a remedy in many ways, being ap- plied to wounded persons and infants, to render any malpractices of sorcery comparatively innocuous that may be directed against them. Gold, however, itself is mischievous in its effects if carried over the head in the case of chickens and lambs more particularly. The proper remedy in such cases is to wash the Gold, and to sprinkle the water upon the objects which it is wished to preserve. Gold, too, is melted with twice its weight of salt, and three times its weight of misy; after which it is again melted with two parts of salt, and one of the stone called 'schistos.' Employed in this manner, it with- draws the natural acridity from the substances torrefied with it in the crucible, while at the same time it remains pure and incorrupt; the residue forming an ash, which is preserved in an earthen vessel, and is applied with water for the cure of lichens on the face: the best method of waslring it off is with bean-meal. These ashes have the property also of curing fistulas, and the discharges known as hæmor- rhoides:' with the addition, too, of powdered pumice, they are a cure of putrid ulcers and sores, which emit an offensive smell. Gold, boiled in honey with melanthium and applied as a liniment to the navel, acts as a gentle purgative upon the bowels. M. Varro assures us that gold is a cure for warts." In a footnote the translators add, "Similar to the notion still prevalent, that the application of pure Gold will remove styes on the eyelids." The italics are mine. It is certainly interesting to note that already at this early period Gold was a recognized remedy in disease: lichens in the face, fistulas, hæmorrhoids, putrid ulcers, and foul sores and warts. Are not psora, syphilis, and sycosis here expressed? Gold produces cutaneous eruptions and hæmorrhoids; the erup- 2 " GOLD AS A REMEDY IN DISEASE. 121 ! tions would probably become sores and ulcers if the proving were pushed far enough. It is evident also that the use of Gold as a remedy in disease did not originate with the Arabian physicians; long before them it was a tradition, and they merely handed it on. Pliny's account of it is that of a compiler, not that of an original observer, and hence Gold was a remedy before his time. Hahnemann mentions nearly thirty authors (1698-1730) who praise 'Gold as a valuable remedy in various diseases, such as Melancholia, Weak Heart, Foul Breath, Falling out of the Hair, Weak Eyes, Breast Pang, Palpitation of the Heart, Difficulty of Breathing.* Hahnemann himself used it with success in Caries of the Bones of the Nose and Palate, as an antidote to the Ill Effects of Mercury, in Hypochondriasis, Melancholy, Tedium Vitæ, Suicidal Tendencies, Congestion of Blood to the Head, Weak Sight, Toothache from a Rush of Blood to the Head with Heat therein, Inguinal Hernia, Chronic Induration of the Testicles, Prolapse and Induration of the Uterus, Angina Pectoris, Nocturnal Bone Pains, and Arthritic de- posits. Chrestien, Niel, Legrand, and some seventy other physicians and surgeons in France in the second and third decades of this century, used it with great success in all forms of venereal diseases and in scrofulosis (see Legrand). All forms of the former were treated by them: Chancres, Balanitis, Urethritis, Adenitis, Hunterian Chancres, many Syphilides, Sarcoceles, Orchitis, Epididymitis, Ozana, Caries, Ostitis. The mass of evidence in favor of Gold as an anti-venereal is really overwhelming, and that in favor of its use in scrofula is not much less so. But their treatment was sometimes mixed, and not infrequently Gold was administered in cases in which other medicines were clearly indicated rather than this, their pet remedy. Withal these enthusiastic auralists have brought Gold into disre- pute as a therapeutic agent by their absurd prejudices against Mer- cury and exaggerated pretensions with regard to the anti-venereal virtues of Aurum. At first there was violent opposition, then a ripple of professional opinion arose, and soon swelled into a wave that was going to sweep away every other anti-venereal remedy; but * We have seen that Gold causes melancholy, weakens the heart, renders the breath foul, causes the hair to fall out, weakens the eyes, causes oppression of the chest, makes the heart palpitate, and renders the breathing difficult! 9 122 BURNETT'S ESSAYS. Nature does not work in that way, and hence the ebb set in, and the auralists drifted out to sea and were lost in the mid-ocean of ob- livion. One of the most able of pharmacologists and most genial of prac- titioners, Von Schroff, the celebrated Vienna professor (Lehrbuch der Pharmacologie, Wien, 1868), gives the following case in these words. (p. 289): "I remember a case of syphilis in which the strongest mercurial preparations, such as sublimate, had failed to arrest the on- ward march of destruction of the nasal bones or the deep, spreading, syphilitic ulcers of the skin, but the miserable patient was restored with the help of Gold" (Aur.-Mur.-Nat.). Speaking of its use in dropsy, especially from induration of ab- dominal organs, he says: "I remember such a case, that I saw in Kromholz's Clinic in Prague, in which Gold acted as a diuretic and a cure resulted." The period referred to by Schroff would be some fifty years ago. The grand old octogenarian is a bitter, but honest, hater of the “nihilism of Hahnemann," but we see he is nevertheless guilty of Homeopathia involuntaria; and he is also a most successful practi- tioner. Dr. R. Hughes says of Gold: "It is an admirable medicine for those constitutions broken down by the combined influence of syphilis and mercury which sometimes come before us for treatment. I once gave a poor fellow thus afflicted the first trituration of Gold. He came back to me in a week's time, looking quite another man, and exclaimed, 'Surely you have given me the elixir of life!'” Dr. Chapman has narrated a similar case in the seventh volume of the British Journal of Homoeopathy (p. 396). I myself have published in the same journal a case of syphilitic exostoses of the bones of the skull speedily cured with this great remedy. Thus the traditional efficacy of Gold in syphilis and in chronic hydrargyrosis is handed on from one generation to another in both schools. The point brought out in Dr. Hughes's, Dr. Chapman's, and Von Schroff's cases is precisely that insisted upon by Baron Percy in his official report of the Committee of Inquiry that sat, on the subject of GOLD AS A REMEDY IN DISEASE. 123 } the treatment of venereal diseases with auriferous preparations, in France fifty years ago. We may, therefore, consider this point as proven. In scrofulosis, Laluette, Chrestien, Niel, Legrand, and quite a host of others, praise it. We find enumerated scrofulous ophthalmia, tinea capitis, scrofulous cervical glands, arthrocace scrofulosa. I be- lieve Dr. Dudgeon, no mean authority, commends it in scrofulous ophthalmia. Chrestien, in his Quelques faits intéressants rélatifs à l'emploi thera- peutique des préparations aurifères, Montpellier, 1835-8 (in Schepers), lays special stress upon it as an antiscrofulosum. In scrofulous and syphilitic affections of the bones of the nose and face, even of the very worst kinds, and in ozæna, it is much lauded, and when we consider this fact we may well pause, for a more dire calamity can hardly befall a human creature than to be thus afflicted. At present I have one such case, in a middle-aged scrofulous gentle- man, that is steadily improving under the use of Aurum foliatum.* In Von Schroff's case, already cited, there was extensive destruc- tion of the nasal bones, and this remedy cured. Hahnemann used it in the same affection. We e may safely affirm that its efficacy in some cases of this really terrible disease is no longer open to any reasonable doubt. Let those who are skeptical on the subject try it. The implantation of the syphilitic virus upon a scrofulous constitu- tion is one of the most intractable of all morbid manifestations, and but few medicines will touch it at all. Gold does. This condition I would term Psoro-syphilis, or Scrofulo-syphilis, if I may be allowed to coin an expression to serve the purpose of this paper-viz., to elu- cidate the curative range of this remedy in this unhappy marriage of two vile constitutional taints. Then, the term being allowed, we may speak of PSORO-SYPHILIS, OR SCROFULO-SYPHILIS. Gold seems specially suitable to such forms of syphilis in the stru- mous; we have seen that Hahnemann reckons Gold to the antipsoric remedies. The glands, bones, skin, nose, are alike stricken with scrof- ula, syphilis, and Gold. * Kali bichromicum had been previously administered in vain. 124 BURNETT'S ESSAYS. Speaking of the good effects of Gold in the treatment of syphilitic affections, Schepers reports a clinical lecture of Sebastian, who said, "Auri præparatis non opus est in iis recentis luis casibus, in quibus ægri ab omni alio morbo liberi sunt, sed quando morbus ille in hom- inibus scrofulosis obtinet, in quibus syphilis facile ad nares transit, ad cutem atque ossɑ, tum aurum præferendum est hydrargyro, etc.” Most practical men will subscribe to this. About eighteen months. since I treated a baby with "snuffles," and anal and intercrural ex- coriations; the infant's nose was dinged in, and she had the well- known ancient appearance. I had previously treated both parents for syphilis (affected skin, indurated glands, and alopecia, the mother's eyebrows even were shed). A six weeks' course of Aurum restored the infant to health; when I last saw it it was ruddy and fat. We may, therefore, do well to think early of Aurum when we meet with syphilis in the scrofulous. In the case just narrated there were numerous circumanal condylomata. That scrofula itself is sometimes the offspring of syphilis is un- doubted. Equally sure is it that the scrofulous are very prone to cancer in later life. Aurum in Cancer.-Chrestien used Gold in scirrhus of the uterus, but, unhappily, with Cicuta. Westring, Hufeland, Gozzi, Wendt, Helm, Werneck, all affirm the efficacy of Gold in this dire malady. Westring, in carcinoma mammæ et uteri; Hufeland, in cancer of the womb; Gozzi, the same; Helm, in that of the tongue; Werneck, the same. Scepsis says: Mistaken diagnosis, but why? Gold has strong affinities for the organs affected, so it has, at least, specificity of seat. Aurum in Dropsy.-We have already noted that it was used in olden times in this affection with success, and in New York sixty years ago, and also centuries ago in Germany; the case of Schroff has also been quoted. De Haen and Plencicz gave it in post-scarlatinal hydrops; Wendt, in the same; Groetzner also in several cases: inter cos unum, qui locum habuit in viro quadragenario strenuo potatore. Fielitz also used it successfully in two cases of dropsy. I do beg no one will so far misunderstand me as to suppose that I intend to defend the thesis that Aurum is to be given whenever there is dropsy, because this is how medicines get discredited; myself I GOLD AS A REMEDY IN DISEASE. 125 should give it in any disease whose symptoms showed similarity to those of Aurum, and also purely and simply as an antisyphilitic if only a very few symptoms warranted it. An individual with dropsy, and who was broken down with syphilis, or Mercury, or both, would at once strike me as a suitable subject for Gold. The following is a case of dropsy of the lower extremities, which came under my observation some two years ago. I was fetched, I think it was one Sunday, to see a lady in Cheshire; it was feared she was beyond recovery. I found my patient, a lady of about fifty, in bed; her lower extremities were swollen, painful, they pitted on pres- sure, and were worse at night, better in the morning. This oedema had been coming on for a week or two, but it had usually quite dis- appeared by the morning, and thus caused but very little anxiety, but now it had greatly increased even in bed, and very naturally was caus- ing great alarm. Dropsy is almost always a grave symptom, though not always. In this case I think it was. There was a history of many illnesses, and altogether this drug-picture presented itself; 1. There was dropsy, and patient had 2. Great depression of spirits, amounting to 3. Profound melancholia. 4. Then there was great difficulty of breathing, and 5. Weak pulse and feeble heart. 6. She was psoric, and had a good deal of 7. Discharge from the nose, that at times contained some blood. I gave her the Muriate of Gold in the third decimal dilution, but I do not remember the exact number of drops or the repetition of the dose, but the dose was not less than one drop (it may have been two or three), and as often as every two or three hours, and given in water. The case got rapidly well, all the dema having permanently dis- appeared in less than a week. Eighteen months after this she informed me she had never since had any return of the dropsy, though her health was anything but good. This was only a recent case, and, though grave, was yet not severe as to the dropsy, but the despondency was almost a substantive malady. In this case Gold acted as a veritable pick-me-up, and I submit that the remedy was homoeopathically indicated, and the cure a homœ- opathic one; about the dose I will not quibble; with me the best dose is the one that cures. 126 BURNETT'S ESSAYS. It may be objected that as the use of Gold in dropsy is almost as old as the hills, it cannot be claimed for Homoeopathy. To this I would reply, Gold will only really cure it if homoeopathically indi- cated; that having a proving of the drug from the hands of that wondrous worker Hahnemann, we have means by which we can dif ferentiate, and thus we are enabled to prescribe scientifically. Thus here the symptoms of the case were those of Gold, and patient had dropsy. So a cure of this kind is not merely a lucky hit, or a happy guess, but the outcome of true therapeutic science. The fact that it is in accordance with its empirical use and with authority is of value also, as it completes its history. It is scientific, because Gold covered the symptoms, including the dropsy. Beyond this case my experience of it in dropsy is nil, and nil because it is the only case of dropsy I have met with of the aurie kind. But has Gold ever produced your principal symptom, dropsy? some one asks. No, not that I am aware of, but it has suppressed both urine and perspiration. I should use it hopefully in ascites from syphilitic liver. There is a remarkable cure of Bright's Disease with Anasarca narrated in the British Journal of Homeopathy, vol. xvi., p. 500, effected with Aur. Mur. 6. Aurum in Fistulas.-Pliny already speaks of it (qy. in ano?). Case of Fistula in ano.-Young man, twenty-one years of age, bilioso-sanguine temperament. For five months fistula in ano, ex- crescences on scrotum (eight months after primary symptoms). Cured with five grains of the perchloride of Gold; all the symptoms had disappeared with the third grain (Clinique of M. Lallemand, in Le- grand, p. 188). Another. Young man of bilious temperament, twenty-six years old, of strong constitution; had chancres, fistula in ano for five months. Cured with five grains of the perchloride of Gold. (Digestive func- tions excited. Hilarity.) (Ib.) In lachrymal and dental fistulas Aurum is a very likely medicine indeed, for a constitutional taint usually underlies them. In that kind of anal fistula, for which Kali Carb. has such a deserved repu- tation, Aurum does not suggest itself to my mind, but Kali Carb. 30 is a grand wrinkle. Aurum in Hæmorrhoids was, it appears, already a tradition in the P GOLD AS A REMEDY IN DISEASE. 127 i time of Pliny.* The brunt of the action of Gold after absorption falls first and foremost on the vascular system. Physiologically it produces piles and greatly irritates the rectum. One thing strikes me―viz., that there must be something rotten in practical medicine when the first surgeons of the day gravely teach, and honestly believe, that piles can only be radically cured by opera- tion; when the first physicians of the day are at one with the surgeons on this point. As a matter of fact piles can no more be radically cured by sur- gical operation than can a hole in the roof of a house be cured by catching the infalling rain in a bucket. I have never met with a case of uncomplicated hæmorrhoids (I would not deny that more experienced men may have) but could be cured by one, or all, of the following measures-viz., diet, rest, pos- ture, and medicines internally and topically. Topical applications are absolutely needful in very extreme cases in which the bowel is protruded very much, and the atony of the part is so extreme that the very hypostasis becomes a source of danger, and a part of the tumor being thus practically outside the organism. But very few appreciate the value of posture. I find many homoeopaths even never attempt the medicinal cure of piles. How wrong and unfair is this to the patient, and, more- over, how cruel! Unhappily, too many medical men "finish their education” when they get their sheepskins; others again use prac- tical medicine as a milch cow and spend all their spare time on a hobby. Aurum in Skin Diseases.-Of its use in syphilides there is abun- dant proof; the lichens in the face mentioned by Pliny show how early Aurum was used in affections of the skin. I shall pass over the cure of the numerous syphilides pure and go on to other cutaneous affections. Case of Squamous Skin Disease (M. Golfin in Chrestien's Mémoire). —A gentleman, thirty-two years of age, of healthy parentage, and of lymphatic temperament. He has a humid squamous eruption on the left arm and hand. A year previously he had had successively gon- orrhoea, the itch, and syphilis, which latter was badly treated. Then * Hæmorrhoids in olden times sometimes signified the Morbus ficarius. 128 BURNETT'S ESSAYS. ophthalmia, eruptions on the skin of an ill-defined character, and finally dartre (tetter). Depurative treatment for three months, but in vain. Short course of treatment with sulphur ointment and another with one of the acetate of lead. Then a repercussion from sulphurous baths: hereafter violent cough, causing great distress with copious ex- pectoration and with pains in the chest. A large blister on the arm, tepid baths and sudorifics, reproduce the exanthem, and the pulmonary irritation yields somewhat to soothing and anodyne treatment. Then treatment with the perchloride of Gold rubbed into the tongue and pills of the oxide of Gold prepared with potash, and many other remedies supposed to be auxiliary to the treatment with Aurum. Patient quite recovered, his recovery being preceded by long-last- ing perspirations. Is since married and has healthy offspring. Case of Severe Skin Disease; Noli me tangere, by M. Souchier. Alexandrine D-—, eldest daughter of an inhabitant of Drôme, en- joyed good health until she was eleven years of age (she is now, De- cember, 1826, nineteen). At this period her father and mother, who state that they have always had good health, were surprised to see her two cheeks become the seat of a peculiar eruption that the physicians, whom they consulted for her, called dartre vive rongeante, and which soon made destructive progress at the end of the nose and around its base, notwithstanding the most appropriate and energetic treatment that could be devised for her at Lyons, to which place they had taken her and placed her under the care of the best physicians. Neverthe- less the menses set in between thirteen and fourteen; but this brought no amelioration in her condition, as had been expected. At the age of fifteen all the soft parts of the nose had been eaten away, both cheeks were excavated by the ulcerous inflammation, to the extent of two inches in diameter; she was very thin, glands of neck much enlarged, so also the submaxillary glands, and those in all the bends of the joints. To this horrible state was soon added all the early symptoms of a tuberculous affection of the chest. Alexandrine continued in this wretched condition till the month of May, 1824, without getting either better or worse. At this period the ulcers of the nose and of the cheeks became covered with pretty large excrescences; those situated on the cartilages of the nose, being transverse, closed up the orifices of the nasal fossæ, and the nasal fosse were horribly enlarged by the GOLD AS A REMEDY IN DISEASE. 129 PENGIG STANAS KE SASA Martin Ba Sa paikan indomen was the one that be dette babe PATNA 2500! TANOVANJA TACTIýkopia a • pangarapanda " TATA, a way t men, met destruction of the wings of the nose. Such rapid progress was all the more inconceivable, as nothing was neglected to thwart and coun- teract it. Portal's syrup, all kinds of tonics, the most vaunted dep- uratives, had, as it were, been showered upon her; the most bland diet, and at the same time analeptic, with a view to the state of mar- asm into which she had sunk, was also adopted. Presently she ceased menstruating and then her parents lost all hope. In November, 1824, a fungous tubercle came in the region of the right eyelid; its progress was very rapid; all the other symptoms of this horrible disease were getting daily worse, when, on the 21st November, 1824, M. Souchier was consulted, who at once declared the affection to be venereal. The coppery look of the wounds and surrounding parts was the point on which he based his diagnosis, and directed him in the choice of his remedial treatment. << Four grains of the perchloride of Gold and of Sodium, divided into thirty, twenty-nine, twenty-eight, and twenty-six fractions, were ad- ministered to her successively by being rubbed into the tongue night and morning. After the administration of the fourth grain a change for the better was observed in the state of Alexandrine: her cheeks and all the ulcerated parts of the face, which were dabbed with an ointment of Gold (five grains of powdered Gold to the ounce of lard, and altogether fifteen grains were thus used), were two-thirds healed. The excrescences, that at first had become paler, grew less, and entirely disappeared at the beginning of the sixth grain, divided into twenty fractions; the fifth had been divided into twenty-four. The fungous growth of the middle part of the right eyelid had also disappeared at this period. At the end of the seventh grain, divided into sixteen fractions, the cicatrization of the ulcers was complete and her menses reappeared. The stubborn cough, to which the young patient had been subject from her fourteenth year, and which had sensibly di- minished from the fourth grain, ceased entirely at the end of the ninth and last grain of the muriate. She got quite strong, and her physi- ognomy had, very nearly, resumed its former appearance. The end of the nose, although it had been eaten away down to the cartilages, was covered with a very even scar. The cheeks had again taken on almost their natural rotundity, but they have the peculiar appearance of cicatrized parts, and this face, formerly so horrible, is now not even absolutely ugly. It is now December, 1828, three years since this 130 BURNETT'S ESSAYS. cure was completed, and it still holds good. The girl, whom I see pretty often, no longer gets the severe colds she was formerly subject to* in the winter months: she had also frequently spit blood. M. Souchier had at times to cauterize the ulcerated parts when they became granular. When he began the treatment he inserted a seton into the neck. A more interesting or more terrible case of skin disease can hardly be imagined, and greater evidence of the efficacy of Gold in the scrof- ulous it is needless to seek. Therefore I shall tarry no longer under this head. I may, however, just mention that M. Legrand's work contains other such, as well as cases of pustular eruptions, elephantiasis, psora, syphilis, sycosis, and hybrids of the three, and all conducted to a successful issue by the use of this great polychrest. No wonder Hahnemann should exclaim: Gold possesses great healing properties, the place of which no other remedy can supply. "Das Gold hat grosse, unersetzlich Arznei Kräfte.” GOLD IN DISEASES OF THE HEART AND GREAT BLOOD VESSELS. From the physiological action of aurum it is clear that it must be an important weapon in these diseases, since what hurts may heal. Angina Pectoris.-The use of various preparations of Gold as a heart† remedy dates far back, as we have abundantly shown. That this traditional use was no mere fancy the pathogenesis of the drug renders clear, and it is confirmed by subsequent observation. Hahne- mann used it in this serious malady. Dr. Kafka, some years since, published in the Allgemeine Hom. Zeitung, a most interesting case of the successful use of Gold in Angina Pectoris. With me it is, next to Arnica (a grand cardiac!), the most frequently prescribed, and it has rendered me most important services. It is here truly uner- setzlich, as Hahnemann has it. I have seen cases of severe heart mischief, in which Dr. Drysdale, of Liverpool, had prescribed Aurum with marked benefit. I am not sure I did not first learn its use from conversations with this eminent savant. * Gold produces a liability to take cold. Hearing of the projected publication of this book, a cruel critic writes and says he is reminded of the Chaucerian- "For Gold in physic is a cordial old, Therefore the doctor specially loved Gold.” C 19 GOLD AS A REMEDY IN DISEASE. 131 : But angina pectoris can but rarely be cured with one remedy; there is often a constitutional taint lying behind and beyond the cardiac symptoms. A case in point just occurs to me. A young married lady used to be seized in the street with indescribable anguish, great oppression of the chest, and fear of death, and violent palpitation. I do not affirm that this was a case of pure breast-pang with degenera- tive change. I tried various remedies, hit off from memory, but did no great good. Then I went to work à la Hahnemann (of course, I ought to have done so at first; you need not tell me that), and ascer- tained the previous history of my patient. She had had, as a young girl, an eruption in the bend of her left arm, with rhagades (Manganese). A truly eminent dermatologist was consulted, because the young lady was going to make her social débút, and of course, required to appear with bare arms. But there was that horrid eruption in the bend of the left arm, and so the début had to be postponed. An ointment was applied; the eruption was-well, sent to the rightabout. She made a brilliant début, soon got married, and began to have a family (once a dead foetus). She was never well-and her children? Scrof ulous. I gave her Sulphur 30, and before the twenty-four one-drop powders were used there the identical old eruption was again in the fold of the arm. "Just as it was when I went to Dr. -;" and patient was at once free from all other symptoms. Patient was so satisfied that there was a causal nexus between the exanthem in the arm and her distressing trouble, that she refused absolutely any fur- ther treatment for fear it might be cured (!) again. "I do not mind the arm; I can wear long sleeves now." But this has carried me away from the use of Gold as a heart med- icine. Gold in Rheumatic Endocarditis. In the third part of the second volume of Frank's Magazin für Physiologische und Klinische Arzneimittellehre und Toxicologie, Leipsic, 1849, p. 642, we read: "Endocarditis rheumatica. "A stout young man who had already had several severe rheumatic attacks, was down with violent rheumatic fever accompanied by pain- ful swelling of the joints. On the second day the rheumatism left the joints and attacked the heart, causing violent irregular palpitation, 132 BURNETT'S ESSAYS. with great oppression of the heart. Five venesections, with the usual antiphlogistic arrangements, got rid of the immediate danger to life; but the subsequent treatment did not relieve patient of his cardiac anguish, and hydrocyanic acid would not afford even transitory relief of this anguish (Beaengstigungen).” Then this prescription: Aur. Mur. gr. j. Solv. in Aq. Meliss. 3j. Add Syrup. Chamom. 3ij. D. S. Every two hours a teaspoonful. Already the first night (after a few doses) was calm-the first good night since the commencement of the illness. The next day there were only slight indications of oppression and irregular heart-beat. Patient went on several days continually improving, when there ap- peared a painful swelling of the right hand. The patient felt such benefit from it that he became quite sad when his physician, Dr. Spir- itus, discontinued it in order to give other remedies to complete the cure. The symptoms I have italicized show that Gold was homœ- opathically indicated, though it may be questioned whether Dr. Spir- itus knew it. I call to mind a very similar case of metastasis from the feet to the heart, in a lad who had rheumatic fever, brought on by the nurse. putting his feet into hot water. Said nurse exultingly informed me at the morning visit that she had cured the feet! The next night there was frightful oppression of the heart, somewhat relieved by Aconite, but it persisted off and on for days, and the poor lad's heart is damaged to this day. I confess in all humility that I think Gold was the medicine because homoeopathic to the state, but unhappily I did not know it then. Would that we homoeopaths kept closer to our study of the Materia Medica Pura, and spent less of our valuable time and talents in inter- necine squabbles about the precious dose and the eternal name of the school. I think enough has been said to show that Gold has an important place in the treatment of heart affections of the gravest kinds. But considering the great importance of it in this connection, I will just add very short notes of two other heart cases treated with Gold. They may both be read in Frank's Magazin, vol. i., pp. 25, 26. The first of these is that of a lady who, after severe bleeding from the womb, consequent on the expulsion of a molar mass, had violent palpitation, anxiety, and congestion of blood to the head. Usual remedies did no GOLD AS A REMEDY IN DISEASE. 133 good. Then Aur. praecipitat (per fer. sul.) in doses of one-sixth of a grain brought relief after a very few doses, accompanied by this re- markable phenomenon: "From evening til midnight violent itching, beginning in the soles of the feet and then extending to the whole of the body." The use of the Gold was continued, and the same phenomenon recurred for several days, diminishing in intensity. After the use of two grains of Gold the heart symptoms were quite cured. We have already noted that Gold is an antipsoric with Hahnemann, and in connection with this case the question suggests itself to my mind whether this fore-midnightly itching was a pure pathogenetic symptom or a psoric crisis? Itching is a very prominent symptom of Aurum we know. Now this one more case and then I have done with the cardiac virtues of Aurum. Four weeks after a normal confinement a lady greatly exerted herself and brought on exhausting bleeding; then a few days afterwards there were rushes of blood, violent palpitation of the heart, great anxiety, and faintings. Digitalis and acids brought no change; then half a grain of Gold was given twice daily with rapid good result. Dr. Becker, who is the author of these cases, mentions a third and similar case in which Gold was given with the same satisfactory re- sult. My obstetric friends, how many such cases do you remember in your practices in which you did not remember this cardiac action of Gold? I remember one. Cactus relieved it; Gold would have cured it by virtue of the firm grip it gets of the living tissue of the vascular system, and physiologically producing symptoms similar to these. For Gold is no mere function disturber, but a producer of organic change, and hence its brilliant effects in organic mischief. The vas- cular turgescence of Belladonna and that of Aurum are very different affairs. While this was at the printer's the following interesting and instruc- tive case occurred in my practice, viz. : Rheumatic Endocarditis in the course of rheumatic fever. I was fetched one day in February (17th), 1879, by a gentleman in the City to see his wife, a lady of about fifty-five or sixty, who was lying very dangerously ill at the end of the third week of rheumatic fever. This gentleman, who is an old homeopath of thirty years' standing, and 134 BURNETT'S ESSAYS. whose knowledge of drugs and disease is really remarkable for a lay- man, had treated patient himself, and with no inconsiderable success considering the severity of the case, but suddenly patient's condition became very alarming on account of the rheumatism having appar- ently seized upon the heart. I found this condition: Patient was propped up in bed and breathing very hurriedly; the lips bluish ; tongue dry and coated; anxious expression of face; puffy under eyes; moist râles all over chest, with cough; pulse rapid, compressible, and intermittent; action of heart floundering; loud endocardial bruits; slight dropsy of feet; no appetite at all, could just suck a grape or sip tea; profuse perspiration; limbs swelled and painful, the joints almost as firmly locked as if anchylosed, cannot move hand or foot for pain and from this swelled inflamed state of the joints; flesh of hands puffy; bones of hands swelled, almost immovable and tender. I ordered Aurum foliatum, 2d trituration, very frequently. Alone and no auxiliaries. Why did I order Aurum? Because it affects the heart and respi- ration very much like they were affected in this patient, and because it moreover produces profuse perspiration, profound weakness, ano- rexia, and great anxiety. Then the bones were greatly affected. Feb. 18th. A little easier. Rep. 19th. Better in all respects. Rep. 20th. Considerable improvement in the action of the heart; breath- ing comfortable; is out of danger. Rep. 22d. Continued improvement. Rep. 24th. Quite comfortable. Continue the Aurum and take Nat. Sul. 6 trit. in alternation with it. My reason for alternating was that I thought it imprudent to leave off the Gold, and yet Nat.-Sul. was now indicated. March 2d. Is up sitting by fire. Appetite good. 6th. Heart, joints, bones, and hands free from rheumatism; is sitting by fire quite comfortably; appetite good; tongue moist, but slightly furred; feet swell a little towards evening. This is going to press, and hence I cannot give the sequel ;* but this case so well illustrates the action of Gold on the organic tissue of the heart that I here insert it. *Delay at the printer's enables me to say that patient's recovery is complete; she is now quite well. 150 € GOLD AS A REMEDY IN DISEASE. 135 When I saw patient first I gave a bad prognosis, and had it not been for the Gold I fear it would have been realized. Auxiliaries did not do it, for I used none; faith in the doctor did not cure her, for patient had never seen me before. GOLD AS A REMEDY IN OLD AGE. There is some truth in Geber's praise of Gold as a materia laetifi- cans et in juventute corpus conservans. Of course it is not literally true, but it has something in it. Gold will not make an old organism young, but it will do an old organism good, and, pro tanto, it rejuvenates. Last week I saw a lady of some seventy odd summers. She had great oppression at the heart, cardiac difficulty of breathing, weak pulse, and great depression of spirits. Her skin showed large patches of a brown hue, and again patches like albugo. She was unable to rise. I gave her the third centesimal trituration of Aurum foliatum in four- grain doses every three hours. Yesterday I found she had left her bed for a few hours; her spirits were bright, appetite better, her breathing easy, and the oppression at the heart much relieved. "I am quite cheered, mamma is so much better," said the daughter. Six weeks later: She is down stairs, still weak, but very much im- proved. The elective affinity shown by Gold for the blood vessels might make one think of it in incipient atheroma of the arteries in middle and advanced life. I am much impressed with the visible beating of the carotids and of the temporal arteries in its provings. In many heart affections, especially in the aged, one sees this. Before leaving the question of Gold in the conditions of the aged, I will note that I lately prescribed it in a low trituration for an old gentleman of eighty-five who had severe attacks of oppression at the heart at night with palpitation and with great debility. I sent him twenty-four powders, but before they were finished I received the report that "my father is so much better that he is now only taking one powder a day." It may seem fanciful to some to talk about remedies for old age, but it is not so in reality, for old age may fairly be treated as a dis- ease, inasmuch as it has peculiar symptoms, the like of which are in the pathogeneses of our drugs. 136 BURNETT'S ESSAYS. GOLD IN THE SPHERE OF THE MIND. The efficacy of Gold in Melancholia is, as we have seen, of very ancient date. Apropos of this Hahnemann says: "I have cured several cases of Melancholy, similar to those of Gold, promptly and permanently, and they were those of such who went about with the serious intention of committing suicide." He informs us that he needed for the whole treatment about or of a grain. 3 100 Here I call the attention of the exclusively high dilutionists to this statement of Hahnemann's. He promptly and permanently cured cases of disease with a one-per-cent. trituration of Gold. These cases are thus on record, and I claim to be a Hahnemannian when I do the same thing. Can any cure be anything better than prompt and per- manent? I have satisfied myself that Hahnemann's doctrine of drug dynamization is true and capable of scientific experimental demon- stration. I honor the high dilutionist as a true physician, and can but pity the arrogance of a crude materialist who denies ability and scientific attainments to high dilutionists because they are high dilu- tionists. 9 100 G On the other hand, I cannot but feel that the high dilutionists are very much to blame in their self-assumed isolation. It savors too much of pharisaism. Militant homoeopathy wants all her adherents, and has a right to their allegiance. Do not let us elude ourselves. Giving crude drugs does not necessarilly exclude homoeopathicity of drug to disease, and the mere fact of giving high dilutions never was homoeopathy and never will be. Hahnemann was an omnidilutionist, and gave low dilutions, al- though it is quite true that he subsequently gave much higher dilu- tions the preference. Thus far I have confined myself to the lower dilutions of Gold. When I meet with cases to which Gold seems to me to be homœo- pathic, and which the low dilutions fail to cure (and such I have hitherto not met with), I shall mount a rung or two of the nosologi- cal ladder. Drs. Chapman, Bayes, and Sharp, all able men, have also treated suicidal melancholy with Aurum with like curative results, as we read in Hughes.* * Dr. A. C. Pope tells me he has likewise used it with great success in such cases of insanity. GOLD AS A REMEDY IN DISEASE. 137 . -9 } He says, As everywhere else Dr. Hughes has a theory here too. “Whether this affection is one primarily seated in the brain is doubt- ful from the other facts about the action of Aurum. I am myself inclined to think it a hypochondriasis having its seat either in the liver or in the testes." 66 Now the other facts" show that Aurum affects the brain much more than it does the liver, and quite as much as it does the testes. Hypochondriasis lodged of old in the liver free of rent; it has been many times ejected, and formally located for some time in the testes; latterly it has been a homeless waif. It is satisfactory to learn that its ancient vested rights of domicile are respected. That comes of our living under the reign of law. Query.-Does hypochondriasis ever sit in the ovaries? or in the Ligamenta lata. GOLD IN THE TREATMENT OF PINING BOYS. Not unfrequently one is consulted about the non-thriving, pining condition of boys; they are low-spirited, lifeless; their memories are bad; they are not up to the mark, and are lacking altogether in boyish go; the tongue is commonly coated at the back, and the appetite for plain food is bad. They are the despised ones at cricket and football, and at school they are not wanting in taste for books, but still they take no position in their forms. "I do not know what it is, but he does not seem to get on." These boys are not necessarily vicious or given to naughty habits, but they are maudlin and unmanly fellows. Examine the testes, and you will find them mere pendent shreds; just on the verge of atrophy. A short course of Aurum foliatum, 3d trituration, four or five grains three times a day, seems to act like magic on them; they brighten up, eat, work, play, and sleep like boys should; and their comrades begin to take some account of them in the playground and cricket-field. They become altogether more manly, and spend less time over their books, and yet take better places in their classes. Now look again at the before-mentioned glands, and you will find them larger, firm, and well suspended. 10 138 BURNETT'S ESSAYS. GOLD IN ITS EFFECTS ON THE UTERUS AND OVARIES, AND AS A REMEDY FOR STERILITY. To treat of this part of the subject is a very delicate undertaking; hence all I have to say is that it once enjoyed considerable reputation in the treatment of sterility, and that I have noticed cases of this condition in which the use of Aurum and of its salts was followed by conception. It is appropriate for such cases in which due ardor is wanting, or where specific or other taint has lowered the organic vitality of the parts; it is specially called for when want of children has resulted in great depression of spirits. GOLD AS ANTIDOTE TO THE ILL EFFECTS OF MERCURY. The immense power and all-sidedness of mercury when introduced into the living body are more or less known to all civilized mankind. To those who know how to use it in sufficiently small doses it is no less powerful and all-sided as a remedy. To the disciple of Hahne- mann the greater the poison the greater the remedy. A complete symptomatology of Mercurius would fill a big volume with small print. All authorities agree that Gold is chemically cousin-german to mercury; a comparison of their pathogeneses reveals the fact that they are no less so physiologically. If the effects of Gold are sim- ilar to those of mercury the effect of one should be to antidote that of the other. That being the theory on the subject, here are some facts. Hahnemann used it successfully in chronic hydrargyria. A severe case of chronic poisoning with mercury is narrated in the thesis of Timpe (jam cit.) completely cured with the perchloride of Gold in the Charité of Berlin. There is also narrated a case of mercurial tremor cured with Gold by M. Massel, of Toulouse (in Legrand). Swediaur speaks of a physician of reputation who was in the habit of using Aurum fulminans in the treatment of mercurial sali- vation, giving three or four grains every evening. In Legrand, Chrestien, Niel, are a number of cases of venereal af- fections combined with chronic mercurial poisoning successfully treated with Gold. GOLD AS A REMEDY IN DISEASE. 139 To give such cases in detail is needless, as very much of what is contained in the body of this little work belongs equally here. Our attention is constantly arrested by the remarkable fact that the worst cases of disease cured with Gold had previously been treated with mercurial preparations. The point has been constantly referred to in these pages, and the number of observers who assert this puts the question entirely be- yond any reasonable doubt. Of course it is not meant that a case of acute poisoning with corrosive sublimate is to be treated with massive doses of auric chloride; I make this remark because some of the dapper allopathic knights try to blague the unwary by falsely imput- ing this egregious folly to the homœopaths. What I mean is that if a given individual shows chronic symp- toms of mercurialism pure and simple, or mercurial symptoms with symptoms of any given disease, the chronic mercurialism may be successfully combated with refracted doses of Gold. The utter childishness of asserting that homeopathy consists in treating acute cases of poisoning with homoeopathic remedies is only equalled by that other pretty assertion that homeopathy means to grow giants on infinitesimal portions of a bread crumb. An Australian worthy has lately rediscovered this old mare's nest. And he even accuses a well-known homeopathic author with inconsistency for teaching the same treatment of cases of poisoning as is recognized by the au- thorities in toxicology. Such nonsense is believed by the simple and is hence noticed in passing. Nevertheless, even in acute cases of poisoning, after the ingested poison has been eliminated, or chemically antidoted, or rendered chem- ically inert, the remaining symptoms can truly be successfully amelio- rated by homœopathically chosen remedies. GOLD IN DISEASES OF THE EYE. To those accustomed to prescribe for disease as if it were of an essential substantive nature, or to those who fancy that a given drug possesses a specific benigu nature that will meet and neutralize the specific malignant nature of a disease that it is said to cure, the em- ployment of one drug in so many morbid conditions and of various organs, as indicated in these pages, will appear not a little absurd. 140 BURNETT'S ESSAYS. Thus I have endeavored to show that Gold will cure Scrofula, Psora, Syphilis, Sycosis, Cutaneous affections, Suicidal Melancholia, Mercurialism, Dropsy, Angina Pectoris, Inflammation of the Heart, Vascular Turgescence, Cancer, and Specific Indurations. And shall I add now to this long chapter a laudation of Gold as an Eye Med- icine? Is it not enough that it should be accredited as anti-scrofu- lous, anti-psoric, anti-venereal, anti-syphilitic, anti-sycotic? Is it not enough of therapeutic titular dignity for even Gold, that in addi- tion to its thus being a kind of antiomnia it should be a Skin Medi- cine, a Heart Medicine, a Kidney Medicine, and a discutient of ma- lignant and specific tumors? Will it really do all this, and do good to bad eyes as well? Yes. And let me explain how that comes to pass. It is in this wise. Gold will only cure some of the conditions of the various parts of the body I have enumerated; it will only cure a few kinds of the diseases I have mentioned. Which condi- tions? What kinds? Herein lies the kernel of the nut: THOSE TO WHICH GOLD IS HOMEOPATHIC. Now you will observe that I have most of my clinical material, and a good deal of my pathoge- netic material, from general medical literature, from allopathic sources, and yet we see that wherever Gold turns up a therapeutic trump, there the symptoms of the cases cured by it are to be found amongst those symptoms that Gold has produced on the healthy. Do not take my word for it; I may be mistaken. Look for yourself. Compare, for instance, the symptoms of the heart cases I have given (from allo- pathic sources) with those of the drug, and see how very alike they are; that is g Like cures like, no more and no less, whether people have vous enough to see it or not. Now this Hahnemannian doctrine of similars has been fermenting the medical world for the past eighty years, and although it has not yet leavened the whole lump, it has leavened some small portion, for which bumanity has cause to be grateful, and is so, too, as far as its light goes. Unhappily, this homoeopathy is nothing like so good as-health! But it comes next to that delightful boon, which most. of us throw away when we have it, and then work hard to get it back again. GOLD AS A REMEDY IN DISEASE. 141 In a former part of this little work I cited the symptom produced in Dr. Hermann by gold. It was this: the upper half of the field of vision seems covered by a black body—that is, hemiopia or half-sight -the lower half being visible. That was fifty years ago and more. Now read this: 66 Case of Eye Disease-perhaps Glaucoma-reported by Dr. E. M. Pease, and which may be found in Allen and Norton's capital work, Ophthalmic Therapeutics," whose authors are surgeons to the New York Ophthalmic Hospital. "Mr. I., æt. 24, lawyer, while reading, was suddenly affected with partial loss of sight. Seeking medical advice, he was told that he was suffering from congestion of the retina, and was put under the use of Mercury. After a few weeks of treatment (being twice sali- vated) he lost his sight completely, January 14, 1873. Received Aconite 12, first three times, then twice per day. January 30. Could distinguish light from darkness; improved slowly to March 26, complaining of fulness over the eyes and floating specks in vision. He received Apis 2c and Merc. Viv. 30m. March 31. His state was as follows: Feeling of severe pressure from within outward, and from above downward, in both eyeballs, accompanied by dull, heavy aching deep in both globes. On pressure, the eyeballs were more tense and firm than usual. He saw yellow, crescent-shaped bodies floating obliquely upward in the field of vision; sees a little better on looking intently and steadily at an object, though he sees no trace of the upper half of an object. In the upper dark section of the field of vision, occasional showers of bright, starlike bodies; the lower half looks lighter, and he can distinguish color, light or dark. By gas- light a number of bright, floating specks and dots are seen. Eyes better by moonlight, and after muscular exercise. Pupils irregularly dilated; cornea dull, with loss of usual lustre; anterior chamber con- tracted; color of the optic nerve-entrances of a greenish hue, except round the periphery, which was yellowish white, with a slight trace of pigmentary deposit on lower outer edge of optic disk in left eye; the retinal vessels bent abruptly on their exit from the disk, and closely hugging the door of the excavation, bent sharply upon the periphery of the papilla; central portion of retinal vessels strongly pulsating; large letters cannot be distinguished, he seeing only some- thing black upon a white ground. Aurum was given in the 200th. 142 BURNETT'S ESSAYS. After three weeks, patient was much improved, could get about the streets alone, being able to follow the cracks in a board sidewalk; the dark half-vision had disappeared, seeing as well the upper as the lower half of an object. Five weeks from commencing with Aurum, everything looked blue, and objects generally much lighter. May 5. He received Aurum M., but was shortly after lost sight of by removing to the West." Hemiopia.-A man, æt. 52, accustomed to drink whiskey every day, has complained for three months of a gradual decrease of vision. At first it appeared to him as if a fog or smoke lay before his eyes; to this, at a later period, black spots were added, and for the last few weeks he can only see the upper half of objects; their lower half seems to be covered by a black veil. Appetite poor; sleep restless and full of anxious dreams; is sad and would ery all the time. Oph- thalmoscopic examination gives no clue. Thinking that it was due to the whiskey it was strictly forbidden. Aurum cured in four weeks, notwithstanding the patient did not abstain from his accustomed dram.-Baumann in A. H. Z. Hemiopia, in which nothing to the right side can be seen, has been helped, though not cured. But the form of hemiopia to which Au- rum is especially adapted is when they can see nothing above the medium line, as the following cases illustrate. Some years ago, a gentleman who had taken large quantities of Iodide of Potash complained that the vision of the left eye had been failing for a year and a half. He could not see the upper half of a room or any large object, though the lower half was clear. No pains in the eye; objects seem smaller and more distant; has some black spots before vision; is always worse as day progresses, and better in the morning; twitching in the upper lid. On inquiry, it was found that he had had syphilis ten years ago, but had not been recently troubled with any secondary symptoms, except that a large bursa- like swelling on the wrist had persisted a long time. Vision was Upon ophthalmoscopic examination there was found chorio- retinitis (chronic), with an accumulation of fluid beneath the retina, which settled to the lower portion of the eye and caused a large de- tachment of the retina. Vitreous hazy from infiltration. Right eye normal; refraction normal. Knowledge of the pathological condi- tion here gave no clue to the remedy, and we were obliged, this time 5 200 72 GOLD AS A REMEDY IN DISEASE. 143 at least, to rely upon the symptomatology (as one should be always ready to do). The remarkable symptoms of not seeing anything in the upper half of the field of vision is, of course, the most prominent. In addition to the Aurum symptom, we may find under Digitalis, 66 "" as if the upper half of the field of vision were covered by a dark cloud in the evenings on walking. Digitalis, moreover, covers the pathological point, having been found curative in fluid exudations of various kinds. It is also worse in the evening, while Aurum is usually worse in the morning. Still, taking the history of the case into account, and the previous dosing with Iodide of Potash, Aurum 200th was given, under which he steadily improved. The haziness of the vitreous almost entirely disappeared, the inflammation of the retina subsided, and in one year the vision rose to and remained at 15, beyond which it will not go, for the retina was partly disorgan- ized, and cannot be repaired with retinal tissue. Since then, several cases of the same disease have been treated with Aurum with almost unvarying success, though in some cases no improvement followed, and the remedy only served to arrest further progress of the malady. Many of these cases will be found to follow overdosing by Potash or Mercury, and perfect vision can never be expected from the nature of the tissue changes. One singular case of a man forty years old was sent for advice. A large, black, sub-choroidal tumor was found behind the lens in the fundus, growing from the inner side. He suffered no pain, but the symptoms of vision were those of Aurum (the whole disease had only lasted about six weeks); vision, 5. After taking Aurum 200th a week, vision rose to; and in eight weeks more to, since which time he has not been seen. It was probably an exudation tu- mor, and may have been absorbed. 200 Thus we see that Gold is also no mean medicine in diseases of the Eye. We also note that the high dilutions act as well as any other. So Hahnemann said fifty years ago. This finishes my task. I have purposely omitted any account of the chemistry of Gold, as that may be referred to in Roscoe, or any work on chemistry the reader may have at hand. I have also said but little of pharmacy, as that lies without the scope of the work en- tirely. In my practice I have used the Aurum Muriaticum Natron- 144 BURNETT'S ESSAYS. F atum a little, the muriate a good deal, but I prefer the pure triturated metal. My favorite dilutions are usually not high, but I am never- theless by no means sure that the effects of the higher dilutions may not be more truly remedial by being more enduring, especially in chronic cases. I trust the reader may not be less pleased than myself with the effects of Gold as a Remedy in Disease. 1 + J THE CAUSES OF CATARACT, WITH SUGGESTIONS AS TO ITS PREVENTION. PRESENTED TO THE AMERICAN HOMOEOPATHIC OPHTHALMOLOGICAL AND OTOLOGICAL SOCIETY. ና :: ! € THE CAUSES OF CATARACT. GF ENTLEMEN OF THE AMERICAN HOMEOPATHIC OPHTHAL- MOLOGICAL AND OTOLOGICAL SOCIETY: Your Secretary hav- ing kindly offered me the privilege of reading a paper before your Society at this present meeting at Indianapolis, I promised to avail myself thereof, and chose as my subject the Pathology of Cataract. But as time passed I felt that what I wanted to give expression to would be more appropriately found under the present heading of my paper, viz.: "The Causes of Cataract, with Suggestions as to its Prevention." It is well to cure by operation, it is better to cure with medicine, but prevention is better than any cure. But before we can prevent any given disease, we must necessarily first know its nature and its causes. Let us clear the ground before us, and first agree as to what we are to understand by cataract. In this paper I take the practical clinical standpoint and say: Cataract is an opacity of the crystalline lens or of its capsule. You will all agree to this, but you will say that the expression is too vague and loose, because there are lenticular opacities which are not cataract. Nevertheless I think it is sufficiently definite for prac- tical purposes. I do not admit that all intra-lenticular changes re- sulting in opacity must show themselves unyielding to treatment in order to be called cataract: such a limitation is not true to nature, and is not in consonance with the history of the word in general medical, surgical, and ophthalmological literature. However, I come before you to-day (vicariously, it is true) to give some ideas of my own, and as one seeking instruction from you. I want to ask you, gentlemen, whether the day has not dawned for an earnest effort to get at the true nature of cataract, and ascertain whether we must fold our hands impotently in its presence till it is 148 BURNETT'S ESSAYS. + like a ripe kernel in its shell ready to be enucleated, or whether we should fix our diagnosis as early as possible, to the end that our pa- tients may have the benefit of our scientific therapeutics, and reason- ably look for retardation, amelioration, or even complete cure of that which threatens to shut out the light of day from them. I rejoice to come before this Society to-day, even though vicari- ously, to lay before you a few thoughts and reflections that I hope may be accepted in a brotherly spirit, and yet subjected to the most searching criticism. If the little house I am about to build be founded in the quagmire of fancy, instead of being reared on the solid basis of fact, I pray you overturn it, every stone, before you leave to-day, and spare it not. THE TRUE NATURE OF CATARACT. It is necessary to a right understanding of the subject that we have a clear conception of the essential nature of cataract, not merely as a pathological entity in a given cadre, but from a microcosmic stand- point from the point of view of the entire economy. Cataract is a general disease, i. e., the opaque state of the lens is most frequently only a local expression of a general state. To me an opaque lens existing by itself in an otherwise healthy body is inconceivable, except from trauma, or from mal-development, or from obstructed nutrition; but given a normally developed lens, not mechanically or chemically injured, it cannot of itself become opaque unless from some other part of the organism. It is barely possible to have a sclerosis of the lens and a supple elastic condition of the other parts of the economy. In a word the sclerotic change in the lens is of a piece with the state of the other tissues of the same individual at the same time. If this be granted, then cataract is a constitutional state, and our remedial measures must be directed to the constitution, and they should be taken at the earliest stages and continued for a long time, for chronic disease can only be cured by chronic treatment. I was very much gratified to read in the last edition of Professor Angell's work, A Treatise on Diseases of the Eye, 6th edition, 1882, that ophthalmologists are beginning to take a broader view of the pathology of cataract. This eminent colleague says (p. 270): "Re- THE CAUSES OF CATARACT. 149 • cently, investigations, chiefly by Michel, in regard to the influence of the general circulation upon the nutrition of the eye, go very far to prove that cataract is generally caused by sclerosis of the carotid ar- teries. Thus in the course of ten months fifty-three cases of cataract observed showed a sclerosis of the carotid in every case. In some, where one eye only was affected, there was sclerosis of the carotid in the same side only, or it was more highly developed in that side, while in double cataract the opacity of the lens was most advanced on the side corresponding to that in which the sclerosis of the carotid was greatest. In addition to the sclerosis there was also in some of the cases an enlargement of the thyroid gland. The ages of the pa- tient varied from eight to eighty-one years." Here I must object not to this statement in itself, but to the way in which Professor Angell puts it. It is hardly correct to say that because sclerosis of the carotid ac- companies cataract that, therefore, the lenticular opacity is secondary to the sclerosed carotid. I submit that cataract is itself a sclerosis of the lens, and that the hardened condition of lens and carotid is merely common to both, though the carotid may possibly degenerate first. I quite agree with Dr. Angell that it is not probable that every case of cataract will show a sclerosis of the carotid, and that there may be senile marasmus, or a feebleness of the circulation after exhaustive disease, or congenital insufficiency of the arterial circula- tion, or abnormal growths pressing on the carotids-all and any of them as causes of cataract. Salt, Sugar, and Hard Water. S Some of the most frequent causes of cataract are, in my opinion, gout, rheumatism, rheumatic gout, and syphilis, and here what bene- fits the gout or rheumatism will tend to better the cataract. But the limits of my paper will not admit of my dealing with all the causes of cataract, and I therefore propose to confine myself more particularly to three that have not hitherto been brought before the profession, and to which I attach very great importance. I refer to I have watched cataract cases with great care for some years, and I am prepared to maintain that the most frequent causes of cataract • 150 BURNETT'S ESSAYS. are the use of much salt, or of much sugar, or of hard water; very frequently we find all three causes operating at the same time in the same individual. Gentlemen, before proceeding allow me to say that I do not pro- pose to exclude any of the other causes of cataract—no, I merely confine myself to these three as emanating from my own experience, and because I wish to call the very special attention of your learned Society to them. Then first as to SALT-EATING AS A CAUSE OF CATARACT. I lately published a little treatise entitled, Supersalinity of the Blood an Acceleration of Senility and a Cause of Cataract, and in it I claim to have proved that an excess of salt acts as a positive cause of cataract. The proof that salt will cause cataract in the lower animals has long been given, and it has been my object, in the little work just cited, to show that not a few of the cases of cataract that we meet with are more or less due to the fact that the patients had been in the habit of partaking of too much salt with their food or in their food, or perhaps even as a saline mineral water. It will not be needful that I go over much of the ground again here, as I shall not have time, but I may just give the conclusions to which I have arrived, and a few points that lead up to them. According to the experiments of Künde, we find that certain of the lower animals to which salt has been administered, at once get cataract. Künde's experiments were confirmed by other observers. Subsequently Künde says (Ueber Wasser entziehung und Bildung vor-uebergehender Kartarakte, 1857), if you take a frog weighing 30 grammes, and give it a 0.2-0.4 dose of salt, either under the skin or in the rectum, you will, in a short time, observe a bulging out of the cornea, with an increase of the aqueous humor, and sooner or later, an opacity of the lens, which will begin, sometimes anteriorly and at other times posteriorly. This opacity increases in propor- tion as the animal gets weaker, and attains to such a degree at last, that the lens takes on a light ash-gray appearance. And again: two grammes of rock-salt was introduced into the stomach of a young cat, and it killed her in three hours, but the lens had turned opaque before death. THE CAUSES OF CATARACT. 151 ' Künde repeated the experiment many times, but always with the same result, the lens became opaque. Here, then, we find that common salt, administered to the lower animals, causes a development of cataract in them. In his experiments, Kunde was aided and controlled by Kölliker, Virchow, H. Müller, and Von Graefe. His experiments have been repeated by Köhnhorn, in Germany, by Weir Mitchell, in America, and by B. W. Richardson, in England, and amply confirmed. I hope you will pardon my going over ground so well known to you all, but I want to bring out, very prominently, this important fact, that the common salt of our tables is a ready producer of cataract. In my little treatise "Supersalinity of the Blood," etc., a copy of which lies before you, I take up this idea, and endeavor to show that not a few of the cases of cataract that come before us, have their origin in the excessive use of salt. When too much salt is ingested, the blood becomes supersaline; when the blood is supersaline, its specific gravity is raised, and the lens is deprived of its natural condition as a transparent body,—in fact, it becomes opaque. If this condition of the blood continue for any lengthened period, the lens must necessarily degenerate, and the cataractous state becomes permanent. I have shown that very many cataractous patients are fond of salt, and I submit that the salt must, in not a few instances, be held re- sponsible for the dried up, sclerosed state of the lens and other tissues of the body. The physiological effect of salt upon our bodies is to dry up, to deprive of water, to harden, and hence salt makes us thirsty. This is, I hold, with Kunde, the essentiality of its action, Weir Mitchell and Richardson to the contrary notwithstanding. Let us now pass on to the next cause of cataract, viz., to THE USE OF SUGAR AS A CAUSE OF CATARACT. The experiments of Weir Mitchell, as set forth in a paper in the American Journal of the Medical Sciences, for January, 1860, show that not only salt, but also sugar can cause cataract. I have not read this paper myself, but only know it from Richardson's references 152 BURNETT'S ESSAYS. to it. Hence I must refer to the experiments of Richardson that were undertaken to the same end, and gave a like result, i. e., sugar causes an opacity of the crystalline lens. When a patient comes to you, and you find the lenses opaque, the skin dry, the quantity of urine excreted large, the thirst great, and the specific gravity of the urine much increased-say 1040 or 1045— then you test the urine, and find it is full of sugar, and you say your patient has diabetic cataract. Ophthalmologists were well acquainted with this clinically, long before science showed that saccharine cataract could be synthetically produced. I believe the honor of this discovery belongs to your country,—to America. But science knows no territorial frontiers, and no nation, and her fruits belong to mankind. Although it has been so long known that the diabetic are apt to get cataract, and although it is more than twenty years since Mitchell showed that cataract can be induced in the lower animals by putting sugar into their bodies, yet I have not heard or read of any one carrying out the thought to its natural conclusion, and inquiring whether the dietetic use of much sugar could be charged with the power of inducing cataract in those partaking of it. Latterly I have directed some attention to this point, and from what I have observed, and guided by analogy, I affirm that a certain number of cases of cataract which we meet with in daily life, are indeed due to the pro- longed use of much sugar. The diabetic cataract is not due to a primary disease of the lens; it is not due to the hepatic or neutral lesion underlying the disease, known to us as diabetes; it is due to the presence of sugar in the blood of the diabetic patient. When sugar is put into the circulation of animals, it produces cataract in just the same way as does the saccharine blood of the diabetic. In like manner, when a person habitually partakes of sugar in considerable quantities, cataract may ensue as a direct physical effect thereof. Gentlemen, if you doubt this proposition, just question your cataract patients closely, and I believe you will soon come over to my view. Of course it is not maintained that every large sugar consumer must necessarily develop a cataract; no, but let a person with some THE CAUSES OF CATARACT. 153 morbid proclivity, partake of a great deal of sugar as a general thing, and let a plus of this ingested sugar course about in his blood for a lengthened period, then it must be obvious that such a person must suffer from sugar poisoning; the sugar in his blood must develop its physiological effects, one of which is the formation of cataract. For my part I see no escape from this conclusion. Do you? HARD DRINKING-WATER AS A CAUSE OF CATARACT. Not only do salt and sugar cause the lens to lose its transparency, and to become opaque, but many other substances produce the same result. Thus Richardson enumerates the chloride of ammonium, the chloride of potassium, the lactate of soda, the carbonate of soda, the carbonate of potash, the sulphate of potash, the chloride of calcium, and the chloride of barium, as being likewise capable of causing lenticular opacities. Thus it is evident that the power of common salt and of sugar to produce cataract is not by any means to be regarded as their pecu- liarly specific effects. In the words of Dr. Richardson, "It must be remembered, as the primitive fact, not only that the increase of the specific gravity of the fluids of the eye by sugar will destroy the re- fracting power of the lens, but that whatever soluble substance will increase the specific gravity of the fluids will induce the same con- dition." This gives us the key to a right comprehension of the causa- tion of cataract, at least in many instances, and certainly in a majority of them. The ergot cataract has probably a very different explana- tion, and so of others. The specific gravity of hard drinking-water is higher than that of soft drinking-water. Hard drinking-water contains in solution va- rious mineral substances, depending upon the nature of the ground through which it flows, lime in some form being the most common; and half-a-dozen different substances may be found in solution in most of our drinking-waters. When we inquire of persons suffering from cataract what kind of water is in use in their houses, we usually find that it is hard; such is, at least, my experience. If a person is in the habit of drinking hard water, he is constantly imbibing that which is capable of raising the specific gravity of his fluids; and, according to Richardson's experiments, it must follow that hard drinking-water must be capable of producing cataract. Of 11 154 BURNETT'S ESSAYS. course this must have a general bearing, but we are here concerned only with the lens. How often do we find that a cataract patient partakes freely of salt and salted provisions, of sugar and sweetened foods, and caps it all by drinking hard water! Salt and sugar are both great producers of thirst, so that if a given individual takes salt and sugar freely he must drink freely to allay his thirst; and if his drinking-water is hard, he is certainly taking the very shortest road to early physical degeneration and to the pro- duction of cataract, provided there be the least determining influence. directing the fluid of increased specific gravity to his eye. And what shall we say if he be suffering from the modern mania of drinking mineral water! THE PREVENTION OF CATARACT. My paper has doubtless already wearied you, and hence it is for- tunate that what I have further to say may be epitomized in a few words. In view of these facts, I am in the habit of suggesting to per- sons suffering from cataract that they would do well to reduce their consumption of salt and salted provisions, as well as that of sugar, to a minimum, because both in excess can produce cataract. Also that hard water is to be equally avoided; and if soft water cannot be got, the expressed juices of succulent fruits in a fresh state more than take its place. In conclusion, my thanks to Dr. Park Lewis for his great kind- ness in reading my paper, and to you, gentlemen, for hearing it. CURABILITY OF CATARACT WITH MEDICINES. "The patient must wait till the Cataract is ripe. He must wait till he has gone slowly, without doing anything, through all the moral suffering of get- ting blind, in order to try and get his sight again! How deficient is a treat- ment which can only begin at the time when it should have been ended!"- MALGAIGNE. PREFACE. THE subject of the medicinal treatment of cataract has occupied my mind at odd intervals for several years, and having, in general practice, succeeded in curing, or ameliorating a few cases of this malady, I have, after much hesitation, determined upon the publi- cation of this volume. My original intention was to write nothing on the subject until I could prove the curability of cataract by an extensive experience and a consequent array of facts likely to convince the ophthalmic surgeons themselves; but mindful of the fact that the pretension of being complete too often results in sterility, I have decided to delay it no longer. In magnis voluisse sat est 4, HARLEY PLACE, HARLEY STREET, LONDON, W., Nov., 1879. J. C. BURNETT. CURABILITY OF CATARACT WITH MEDICINES. CHAPTER I. TE HE limits of the curable and of the incurable are not represented by any fixed lines. What is incurable to-day may be curable. to-morrow; and what we all of this generation deem incurable may be considered very amenable to treatment in the next generation. When walking the hospitals years ago, I was taught, in respect of cataract, that there was nothing for it but an operation. A few months since I spent a little time at an excellent metropolitan hos- pital for the eye, and found that that is still the one thing taught, viz.: if you have a cataract, there is no hope for you beyond that of getting blind, and then trying to get your sight again by having the cataractous lens removed. On the twenty-eighth of May, 1875, I was sent for to see a lady suffering from acute ophthalmia. She informed me that her friend, Dr. Mahony, of Liverpool, had recommended her to try homœopathy when she should again require medical aid, and had also mentioned my name to her. She seemed rather ashamed of calling in the aid of a disciple of Hahnemann, and was very careful to lay all the blame upon Dr. Mahony; for, said she, I know nothing about it. My patient was in a darkened room, and hence I could not well see what manner of woman she was; but I soon learned that she was the widow of an Indian officer, had spent many years in India, where she had had ophthalmia a great many times, and that she was in the habit of getting this ophthalmia once or twice a year, or even oftener, ever since. It generally lasted several weeks, and then got better; no kind of treatment seemed to be of any great avail. Did I think 158 BURNETT'S ESSAYS. homœopathy would do her any good? I replied that we would try it. I made an attempt at examining the eye by lifting up one of the laths of the venetian blind to let in the light, and then everting the lid; but the photophobia and consequent blepharospasm were so great that I barely succeeded in recognizing that the right eye was a red, swelled mass, while the left one was only comparatively slightly affected-in fact, a case of panophthalmitis. A more minute exam- ination was impossible, as the pain was so great that the patient screamed whenever any light was let into the eye. I took a mental note of the chief symptoms, notably of the fact that the inflammation was chiefly confined to the right eye, and went home and worked out the homoeopathic equation. I was especially anxious to make a hit, and so I spent about half-an-hour at the differential drug-diagnosis. The drug I decided upon was phosphorus. Thus: R. Tc. Phos. I. my xij. Sac. lac. q. s. S. One in a little water every hour. Div. in p. æq. xij. That would be about the one-hundredth part of a grain of phos- phorus at a dose, or rather less. I called the next day, about eighteen hours thereafter, and my patient opened the door herself, slightly screening her eyes with her hand, and quite able to bear a moderate amount of light. The in- flammation was nearly gone; the next day it was quite gone. Patient's amazement was great indeed. In all the twenty years of these ophthalmic attacks she had suffered much, and had a number of doctors, including London oculists, to treat her; but to no purpose. And yet she had been treated actively, and there had been no lack of physic and leeches, and also no lack of medical skill; but there was lacking in their therapeutics the one thing needful: . . . THE LAW OF SIMILARS. How was it that I, with no very special knowledge of the eye or of its diseases, and with only usual practical experience, could thus beat skilled specialists and men of thrice my experience? Was it, perhaps, greater skill, deeper insight into disease, more careful investigation of the case? By no means. It was just the law of similars, patiently carried out in practice. My dear allopathic confrères, WHY are you so very simple that you • CURABILITY OF CATARACT WITH MEDICINES. 159 leave us homœopaths with this enormous advantage over the best of you? Any little homoeopathic David can overcome the greatest allo- pathic giant if he will only keep to his Materia Medica and the direc- tions of Hahnemann. And the good thing lies so near, and is so constantly thrown at you. If we homoeopaths were only to make a secret of our art, you would petition the Government to purchase it of us! But-revenons à nos moutons. My patient was naturally very grateful, and said, "If that is homoeopathy, I wonder if it could cure my cataract?" On examining the eyes now with some care one could readily perceive that there were opacities behind the pupils, that of the right being the much more extensive. She then informed me that she had had a cataract for some years, and was waiting for it to get ripe, so as to undergo an operation. She had been to two London oculists about it, and they agreed both as to diagnosis and prognosis and eventual operative treatment. She had waited a year and gone again to one of these eye-surgeons and been told that all was satisfactorily progressing, although but slowly; it was thought it might take another two years before an operation could be performed. Her vision was also getting gradually worse, and she could not see the parting in her hair at the looking-glass, or the names over the shops, or on the omnibuses in the street; could see better in the dusk than in broad daylight. In answer to her question as to the curability of cataract with med- icines, I said I had no personal experience whatever on the subject beyond one case,* and I thought that from the nature of the com- plaint one could hardly expect medicines to cure it, or even affect it at all. Still some few homeopaths had published such cases, and others had asserted that they sometimes did really succeed in curing cataract with homoeopathic treatment. I added that, inconceivable as it was to me, yet I had no right to question the veracity of these gentlemen simply because they claimed to do what seemed impos- sible. In fine, I agreed, at patient's special request, to try to cure her cat- aract with medicines given on homœopathic lines! I must confess that I smiled a little at my own temerity. But I *This was the case of a lady of 78 years of age, with senile cataract, in which Calcarea 30, and Silicea 30, had been given with apparent benefit. 160 BURNETT'S ESSAYS. consoled myself thus: What harm could it do to treat her while she was waiting to get blind? At the worst I should not prevent it! So it was agreed she should report herself every month or so, and I would each time prescribe for her a course of treatment. All this was there and then agreed to. She took from May 29th to June 19th, 1875, Calcarea Carbonica 30, and Chelidonium 1. One pilule in alternation 3 times a day. Thus she had two doses of the Calcarea one day and one the next, and conversely of the Chelidonium. There were indications for both remedies, though I cannot defend the alternation; I hope I alternate less frequently now. Then followed Asafoetida 6, and Digitalis Purp. 3. Then Phosphorus 1, and subsequently Sulphur 30, and then Cal- carea and Chelidonium. Thus I continued ringing the changes on Phosphorus, Sulphur, Chelidonium, Calcarea Carbonica, Asafoetida, and Digitalis, till the beginning of 1876. On February 17th, 1876, I prescribed Gelseminum 30 in pilules, one three times a day; this was continued for a month. Then I gave the following course of drug treatment: Silicea 30 for fourteen days; Belladonna 3 for fourteen days; Sulphur 30 three times a day for a week, and then Phosphorus 1 for a fortnight. A month or so after this date, March 20th, 1876, I one morning. heard some very loud talking in the hall, and my patient came rushing in and crying in quite an excited manner that she could see almost as well as ever. She explained that latterly she seemed able to dis- cern objects and persons in the street much better than formerly, but she thought it must be fancy, but that morning she suddenly dis- covered that she could see the parting in her hair, and she at once. started to inform me of the fact, and, en route, she further tested her vision by reading the names over the shops, which she previously could not see at all. I ordered the same course of treatment again, and in another two months the lenticular (or capsular) opacities completely disappeared, and her vision became and remained excellent. She never had any recurrence of the ophthalmia, and she remained about a year and a half in my neighborhood in good health; she then went abroad again, and in her letters to her friends since, she CURABILITY OF CATARACT WITH MEDICINES. 161 Mkamer, MƏN ADLARIMINAAL Sże warten trail Whisen... JE TREBATEGA Vogt, 201 makes no mention of her eyes or sight, and hence I fairly conclude that she continues well. The patient's age is now about 50 or 51. I have detailed this case somewhat circumstantially, so that my conversion to a belief in the medicinal curability of cataract may ap- pear to others as it does to me. This case made a consideraable stir in a small circle, and a certain number of cases of cataract have since come under my care in con- sequence, and the curative results I have obtained in their treatment are extremely encouraging. Be it noted that the diagnosis of cata- ract was made by two London oculists. This case had led me to look up the literature of cataract a little, to see what others have said and done on the same subject; and in treating various cases of cataract, I have been often moved to a consideration of the true nature and origin of this affection, and on. these points some few thoughts will not be out of place by-and-bye. In consequence of this cure of cataract with medicines, I began, as just stated, to look about in our literature to see what others had done. Here is what I found: CHAPTER II. IN the British Journal of Homeopathy, for 1847, vol. v. p. 224 et seqq., there is a very able article on this subject by the late Dr. Henry V. Malan. This writer considers the primary cause of cataract to be a psoric taint in the constitution, and asserts that all constitutional cataracts are from a psoric cause. This, of course, does not apply to traumatic cataract, and not nec- essarily to those of inflammatory origin. Dr. Malan continues . . . "Many circumstances accompanying the formation of the cataract render the surgical treatment, if left to itself, either impossible or most difficult; for that reason the attempt has frequently been made to find a medical one. According to Vidal de Cassis (Pathologie Externe, Paris, 1840), none have been found ex- cept in some rare cases, and then only for the inflammatory and re- 162 BURNETT'S ESSAYS. cent cataracts. The French surgeon Velpeau corroborates this state- ment, and tells us that some cures have been made by revulsives to the skin, setons, moxas, etc., and that it is only by revulsion that the cures of some cataracts in their infancy have been made; but that these cures, after all, are only the exceptions; old cataracts of the capsule, or of the lens, must always be operated on.' "Here I (Malan) differ. The general opinion entertained on this point is not mine. I shall try to point out, in a few remarks, my reason for differing, and shall endeavor to be concise. "We have seen that for cataract, as for many other similar states of the human body, no better treatment has been, to this day, found, than surgical operation; we shall see, also, that in many cases these means prove useless; in others they are injurious, and often they might, with much advantage, be exchanged for homoeopathic treat- ment. "I have said that surgical operation often proves useless. It is the case when the cataract is a constitutional disease; if the general health be not improved, and the disease arrested and cured by previ- ous internal and rational treatment, the removal of the diseased organ will not cure the process of the malady any more than plucking rotten fruit from off a tree, because it is the only one as yet decayed, will remove the internal cause of disease in the tree. Too often, however, are surgical operations made on quite a similar mode of pro- ceeding, and are, to say the least, useless. This applied to the case of cataract will explain why internal treatment will often be most beneficial. "I said also that surgical operations were sometimes injurious to the general state. How often, for the same reason mentioned above, is the removal of an organ, visibly more affected than the others, really injurious to the whole body, as the internal disease, finding its outlet cut off, will often burst out in weaker but more essential organs, and by this inroad into the constitution bring on rapid and inevitable death. "In other cases, I have said that surgical operation might, with advantage, be exchanged for homœopathic treatment. It is often so in the complete and ripe cataract, though, generally speaking, surgical operation is not injurious to it, and often cures the affection when the internal process which caused the cataract has ceased, and then this CURABILITY OF CATARACT WITH MEDICINES. 163 = morbid product stands as an inorganic mass, and in the way of the functions of the organ. Even in this most favorable case, however- the only one in which surgical operation ought to be permitted-it can often be, with much advantage, exchanged for homoeopathic treatment. "No medicine or internal treatment has, as yet, been of any avail in confirmed and ripe cataracts; this was left for better days in med- ical science, and homoeopathy has given us means of cure which were totally unknown before. I do not mean to say, be it well un- derstood, that homoeopathy will entirely supersede surgery, and that we are not to trust this latter means, or ever employ it-no; but I wish to draw attention to these three remarks only: that, 1st, in many cases, homoeopathy will cure, completely cure, real cataracts, even old and ripe ones; 2dly, in many more it will prevent the progress of the cataract in the other eye, when as yet only one is affected; 3dly, that if it does not always succeed in curing, it will always prepare the whole constitution for the surgical operation, prevent inflammatory accidents after it, and secure its success. "This part of medical treatment has been, to this day, too much neglected because, to our eyes, this more or less ex-organic body seemed not fit for medical treatment, and because our ears have been accustomed to hear that surgical operation only is of any use, we have left aside the internal treatment, which will often be crowned with far more success than is generally expected. Not the least pro- cess in the human body, morbid or natural, can take place without the whole constitution taking some part in it. We cannot expect that an organ of the body, be it ever so small, can become affected quite independently of the organism, but rather that it becomes affected in consequence of a morbid process existing, though not seen, in the or- ganism itself. I am as far from admitting such confined notions, as I would be right to admit that the very same organ has no com- mon tie with the rest of the body, and is not one constituent part of it, by its nerves, its vessels, and all its texture. (C 'If, therefore, one part of the body is diseased, we must not di- rect our treatment to it solely, and use what is called local treatment alone. We must act on the whole constitution in the same way as we would direct our attention to the whole tree when it bears decayed fruit. In this case, and for this very simple reason, it is not only 164 BURNETT'S ESSAYS. advisable, but necessary, to have internal treatment, and this way of attending to disease will prevent many a failure, and the harm which might ensue from local treatment. In a case of cataract, therefore, the whole constitution must be acted upon, as in all similar diseases. Our Materia Medica has many a remedy against such a state." The remedies reckoned the most important by Dr. Malan are sulph., silic., caust., caun., phosph., calc., and conium. The cause is psora; the remedies principally antipsories. Accidental symptoms to be removed by apsorics. He concludes.. "It is not possible to say that, in this or that species of cataract, this or that remedy will cure. The tout en- semble of the symptoms must always decide us in the choice of the remedy; and, in all cases, no second remedy is to be given before the first has exhausted its action.” Ist mir alles wie aus der Seele gesprochen. Dr. Malan's cases: CASE I.—In the spring of 1841, a lady of about sixty years of age applied for homœopathic treatment, and came to my notice under the following circumstances: She had for two or three years past gradually lost the sight, first of one eye, and then of the other— both affected with cataract, now complete-and had for some months previous entirely lost her sight. Monsieur Maunoir, whose name is authority in such matters, had advised the operation to be made as the season was favorable: he considered the case to be one of com- plete and ripe cataract of the lens. However, the lady being strongly advised by her friends to apply to homoeopathy, and as she could not better employ the intermediate time until the operation could take place, she called in an old homœopathic practitioner, whom I joined later. He prescribed Silic., then Cann. sat. and then Sulph., and the cataract improved so rapidly that the patient, after a few months' treat- ment, travelled to a distant country, Russia, from thence she wrote to me that, her sight having still continued to improve, she was now enjoying it as completely as she could ever expect at her age. CASE II.-In November, 1844, a man of strong constitution and lymphatic temperament, fifty-one years of age, applied to me under the following circumstances: He had had cataract of the right eye, ripe for some years, and one of the left, which had been ripe only a few months. Mons. Maunoir had operated on the right eye three CURABILITY OF CATARACT WITH MEDICINES. 165 times, but without any success; the third operation took place four weeks before applying to me. Ever since, the patient had suffered from a violent inflammation of the whole eye; the sclerotica was much injected, the cornea opaque; there was great photophobia, a constant discharge of tears, and complete loss of sight. Besides, the eyeball had partially emptied itself, the patient had lost his appetite; there was great thirst and much fever. I prescribed Aconite (3) pulv. ij., and next day Bell. (25), a tea- spoonful three times a day until amelioration. On the 15th of November there was a great change, but the cor- nea remained opaque, the eyeball partly shrunk, and the patient was made aware of the complete loss of that eye. Merc. sol. (1³½). On November 22, all the inflammatory symptoms of the right eye had disappeared; the left one presented a thick whitish opacity of the lens; the pupil was dilated, but mobile. The patient had cer- tainly lost the sight of the right eye, and with the left he could only distinguish day from night, but was unable to guide himself. He was led about by his servant. Sulph. (3) was given dry on tongue. On December 7, there was much amelioration, even of both eyes; the opacity of the right one had sensibly diminished in appearance; he could distinguish the fingers of the hand interposed between him and the light; and with the left eye he could distinguish the differ- ence between some coins. Nothing was given. On December 25, amelioration continued in the left eye, the right remaining in the same state. He went about to his affairs, drove his own gig, and attended to all his business. A pustular eruption, ae- companied with much itching, covered the whole body. He was given Cann. (), and the sight continued to improve until he left off treat- ment, as he thought himself far enough recovered to need no further medical care. I met with the patient seven months afterwards; he was still enjoying his sight and health. It is much to be regretted that Dr. Malan does not give a minute account of both eyes at this period; still, the evidence of curative drug action cannot be contested. Note well the sentence in italics. CASE III. December 21, 1844. A man of forty-two years of age, living in the country, of bilious temperament, thin, and who had suf- fered much from headaches, applied to me. He complained, for the previous six years, of a whitish hard cataract of lens of the left eye, Jeg ble de 166 BURNETT'S ESSAYS. and had for some years past completely lost the sight of that eye. He had the itch twenty years ago, and kept it three months. Sulph. (3) removed chronic headaches and an inflamed state of the eyes. January 23, Silic. () was given. Not much change occurred till Sulph. (3) was repeated. On the 24th of February a violent itching came on, particularly when undressing at night; and all over his body an eruption of small pustules ensued. From that time the eye began to amend. He could distinguish the fingers of the hand, and gradually see objects more clearly; but having left the country I was unable to follow this interesting case. Dr. Malan thus concludes: "I know of other cases where the homœopathic treatment proved most beneficial, but I object to men- tion those I have not myself witnessed. patient, who, for "At this moment I have under my treatment a some years back, has had a cataract of the left eye. He has lost the sight of that eye for more than two years, and, when he came under homoeopathic treatment, the cataract of the right eye was fast pro- gressing. Since that time, now fifteen months ago, the right eye has been very nearly stationary, though the bad state of the general health has been much in the way of its treatment. It is to be re- gretted that he did not apply to homoeopathy at an earlier period, but he was prevented from doing so by the advice of a homoeopathic practitioner. I mention this,-not to say that, contrary to this ad- vice, homeopathy will always cure the cataract, and that it will su- persede surgery,—but only in order to draw the attention of my col- leagues to this part of practice too neglected. I feel assured that regular homœopathic treatment will, if not always cure the cataract, yet do so in many cases; in many more it will stop the progress of the disease in the constitution, and the development of the cataract in the other eye; and in all cases where the operation must be re- sorted to, it will prepare the organism for the surgical operation, and prevent any danger attending it. S "The treatment of the cataract must, therefore, be first medical, and, en désespoir de cause only, surgical." This being Dr. Malan's experience, it must be admitted that he has at least demonstrated the possibility of the medicinal cure of cataract. **** 17 CURABILITY OF CATARACT WITH MEDICINES. 167 That all cases are not amenable to medical treatment is not to be any ailment wondered at; indeed, it cannot be said of all the cases of that they are curable with medicines, since some cases of common cold end fatally, even with the most skilful treatment, and yet we do not usually consider a cold to be a deadly malady. The fact is, the eye is considered the exclusive province of the surgeon; and so long as this idea remains there cannot be any great advance in the medicinal treatment of eye affections, and therefore not of cataract. Everything is impossible until it is tried. At one time it was im- possible to heal an inflammation without bloodletting. One very great drawback to the medicinal treatment of so-called surgical complaints is its difficulty as compared with mere knife- work, and then any one can appreciate a clever operator, but very few can appreciate the best work of the real physician, of which the effects can only be seen after many days. The medical or surgical Hodge demands bulk, and obvious imme- diate effects; the sterile skeptic weens fertility impossible, since it is not in him; the weakling dreads any deviation from the trodden path, lest he be thought a medical dissenter, and you know dissent is not comme il faut. The original dissenter must be a man of grain and grit. To be in the van is to be in an exposed position, and in the van of medical dissent involves misapprehension, and imputations of wrong and un- fair motives. The man who advocates the medicinal treatment of anything authoritatively considered to lie solely within the province of the surgeon, must expect to be either ignored or tabooed at first; medical men constitute a trades-union, and they ill brook any in- dependent thought or action. I now give another case: Mrs. McM., an intelligent lady of about sixty years, lost the sight of her right eye, and began to lose the sight of the left. She consulted several of the best physicians of both schools of Philadelphia, who all pronounced it a cataract, and agreed that nothing but an operation would restore her sight. An old wo- man told her to apply the oil from a rabbit to the eye, which she did twice a day, and in six months it completely restored her sight, and removed all traces of cataract, so that she can read without glasses, which she had not done for many years. She complained of con- 168 BURNETT'S ESSAYS. stant dryness in the eyes, which the oil removed, and this was the only peculiar symptom.-(W. Lovell Dodge, M.D., Philadelphia ; Hahnemannian Monthly, July, 1878, p. 648.) What the oil from a rabbit may be I do not know. This is a cu- rious case, and perhaps of no great weight. Let some one with cat- aract try it. Here is a further case: An infant that was born with cataract. Sulph. effected considera- ble improvement; a cure was finally completed by means of Euphra- sia and Lyc., which is recommended by Rummel.-(Jahr, Forty Years' Practice, Hempel's Translation, New York, 1869.) Jahr says further: "In this disorganization (cataract) of whatever kind I have so far accomplished most with Sulph., allowing the dose to act a long time. If the action of sulphur seems exhausted, I then commonly resort to Calc. and next to Lye. with tolerable success. If these remedies do not help, I have given, with more or less success, Magnes., Cannab., and Silic., and in the case of old people Conium 30, of which I cause a solution of six globules to be at the same time applied externally." There is not much individualizing here. Tout comme chez nous ! Dr. Angell, the eminent ophthalmologist of Boston, U. S., in his Treatise on the Diseases of the Eye for the Use of General Practi- tioners, Boston, 1870, thus expresses himself on the medicinal treat- ment of cataract: "It does not seem improbable to me that in the course of time, we may find some reliable remedy, the administration of which before the lens-fibre has become degenerated, may restore its transparency. Cataract is known to be a result of ergotism. It has also been produced in frogs by administering sugar in large quan- tities or by injecting it under the skin. Chloride of sodium and al- cohol* have produced similar results. In our school, cures, or bene- ficial results, are reported to have followed the use of cannab., con., phosph., silex, sulph., and a few other of our remedies." — Then why not try medicinal treatment during the ripening, and in cases in which operation is impossible or undesirable? But the cause of scientific therapeutics cannot be advanced on the line of 66 some reliable remedy; we must rather individualize and treat رو * An old Vienna oculist used to recommend his cataract patients to drink brandy so as to hasten the maturation of the cataract. CURABILITY OF CATARACT WITH MEDICINES. 169 the patient, not the cataract. A specific for cataract, in the very nature of things, cannot be found, because there are no two cases of cataract exactly alike. Thus, I have noticed in my own experience one case due to re- peated attacks of inflammation; another arose from arsenical poison- ing; another from a liver affection; another was congenital, and another hereditary. Then there are those due to trauma, to retro- cedent gout and suppressed menses, and, again, the many arising from a repercussion of an affection of the skin, as also those in the diabetic. Not being a specialist, my experience is necessarily limited, yet I have seen enough to know that there is cataract and cataract ; and I do not mean merely nosological forms. Moreover, various substances are known to cause cataract—such as ergot, nitric acid, common salt, alcohol, santonine, and sugar; and certainly of as many different kinds. CASE VII.—Cataract of right eye; man, æt. 61. August, 1859, Cannab. 30; September 1, Mag. met. 30; October 30, Cannab., high potency; Nov. 9, Mag. met., high potency. The eye, dry before, is now moist, and the sight commences to improve. March 18, 1860, Sulphur, high potency; May 22, Sulphur, high potency; July 22, Caustic, 30; September 22, Sulphur, high potency. Sight clearer, but no dissolving of cataract. November 21, Silic., high potency. Seven days after, great improvement of sight. January 5, 1861, Silic., high potency; entire disappearance of cataract.—(Drs. Kirsch, Senr., Allgemeine Hom. Zeitung, lxxxiv., 214. From Raue.) There is no mistake about this case; the persistent treatment per- severed in from August, 1859, to January, 1861, is a worthy example to be followed. And one is very apt to be senile at 61, especially if there is a cataract. CASE VIII-Cataract in a lady, æt. 60, was cured by the admin- istration of Sulph., Pulsat., Silie., Cale. carb., Pulsat., Baryt. carb., Amm. carb., and Mag. met., given at long intervals and high attenua- tions.—Dr. Kirsch, Senr., Allgemeine Homœopathische Zeitung, lxxxv. 44.) Here, too, we trace the hand of a great master in the therapeutic art. CASE IX. Cataract. Mrs. E., æt. 48; complains of heaviness of the eyelids, mist and gray fog before the eyes, and a feeling as of 12 170 BURNETT'S ESSAYS. sand in the eyes. She was nursing a baby. In the right eye begin- ning of cataract. Burning in forehead; flashes in right eye; pain, as if beaten, in small of back. Sulph. 200, December, 1871. Nebu- lous sight; ERUPTION ON EARS; the eye becomes clearer. Feb. 1. Sulph. 400; and March 1, 1872, Caustic 60; perfect cure.-(Ibid.). In fact, rapid medicinal cure of incipient cataract. CASE X.-Woman, æt. 63; cataract in both eyes, worse in the right. October 18, 1869, Sulph. 60; January 4, 1870, Amm. carb. 30, and higher potencies till May. May, Calc. carb., high potency; July 7, Lycop., high potency; latter part of August, Mag. carb., high potency; October 24, Baryta carb., 30; December 21, Baryta carb. 200. In the last two months A NUMBER OF RHAGADES AP- PEARED IN THE PALMS OF BOTH HANDS; the eyes got entirely clear in that time.-(Ibid.) This is good, honest therapeutic work of the right stamp. CASE XI. Cataracta dura incipiens. A lady, æt. 67, was sud- denly attacked, after taking cold, with pressing pain around the eyes, which was worse in the open air; before the eyes she constantly saw dark figures, like spider-web or lace, of the size of a hand. She had been subject to sick headaches all her life. Sepia 3, one dose night and morning, for fourteen days. In four weeks the large dark figures were reduced to mere specks, and her general health greatly improved. -(H. Goullon, Junr., Internationale Hom. Presse, 1875, p. 691. In Raue.) Maddy Dr. Goullon, Junr., is a man of considerable reputation. CASE XII.-Young man, æt. 20, had had the itch one year and a half ago, of which he got rid by internal and external use of medi- cines. Later, he had an attack of intermittent fever, which he cured with pepper and whiskey. A short time since he discovered that he could not see with his left eye. The eye had a dead look; pupil was enlarged and immovable; in the middle of the lens there was an opacity, as if it had been punctured by a needle; the lids and con- junctiva were somewhat reddened. On holding the hand quite near to the eye, he could dimly discern the fingers. August 2, Sulphur 6; August 9, SEVERAL PIMPLES ON THE FACE AND ARMS. Sight better. Sulph. 6, which was repeated on the 19th, 26th, and 29th of August, and on the 3d and 23d of September. THERE APPEARED A NUMBER OF FURUNCLES ON THE ARMS; the eye looks natural CURABILITY OF CATARACT WITH MEDICINES. 171 }) ་ again, and he sees as well as ever before.-(Fr. Emmerich, Arch., XIV., iii., p. 105. In Raue.) In Hale's New Remedies, 1875, vol. ii, p. 569, we read under the heading, Pulsatilla Nuttalliana: "Dr. W. H. Miller, of St. Paul, Minnesota, struck with the many points of similitude between this plant and the European Anemone Pulsatilla, conceived the idea that in chemical composition and therapeutical effects they were also closely allied, if not identical. He instituted numerous experiments with a view of verifying the latter surmise, and according to his statements, they proved to be entirely successful. He claims to have established the value of this remedy in many chronic diseases of the eye, particularly cataract, amaurosis, and opacity of the cornea. Very decided advantage was also experienced from its employment in cutaneous eruptions, and in secondary syphilis." This latter remark, regarding its good effect in skin diseases, is significant, considering that the lens and its capsule and the skin are embryologically of identical origin. It may be remarked that our pulsatilla was already considered by Stoerck to be a remedy for cataract. At this moment I have a lady patient suffering from cataract, who is taking pulsatilla nuttalliana. It must not be given in too low a dilution, or it causes considerable distress at the neck of the bladder with frequent micturition. In Hale (op. cit.), p. 671, under the head of Santonin, we read : "It was also used in nine cases of cataract, of which four were cured, the rest not benefited.” We will next quote from Ophthalmic Therapeutics, by Timothy F. Allen, M.D., Surgeon to the New York Ophthalmic Hospital, and George S. Norton, M.D., Surgeon to the New York Ophthalmic Hospital, Ophthalmic and Aural Surgeon to the Homeopathic Hos- pital on Ward's Island, New York, 1876. On p. 252, we read . . . . “A large number of cases are to be found in our literature, in which the internal administration of a few doses of the properly selected remedy has worked a wonderful cure of cataract, but the great majority of these must be taken cum grano salis, and put aside with the remark 'mistaken identity.' "We are, however, certain that by a careful selection of drugs accord- ing to the homœopathic law, and by continuing the use for a long period, 172 BURNETT'S ESSAYS. we may succeed, in a large proportion of cases, in checking the progress of the disease, and are often enabled to clear up a portion of the diffuse haziness, thus improving vision to a certain extent. But after degen- eration of the lens fibres has taken place, no remedy will be found of avail in restoring its lost transparency and improving the sight. We must then, providing the vision is seriously impaired, and it is senile or hard cataract, wait until it has become mature, when the lens should be extracted. "The medical treatment will consist in the selection of remedies according to the constitutional symptoms observed in the patient, for the objective indications are entirely or nearly absent, and we cannot yet decide from the appearance of an opaque lens what remedy is required. "The drugs found below have been verified by us, as having arrested the progress of the cataract. Baryta carb., Calc., Caust., Lyc., Mag. carb., Phos., Sepia, Sil., and Sulph." Now, even though we accept these statements of Drs. Allen and Norton at the same price at which they accept the like statements of others on the same subject, viz., cum grano salis, still they are of con- siderable weight, even allowing that they, too, are sometimes mis- taken in their diagnosis. The italics are mine. In the North American Journal of Homœopathy, vol. xiv., 1866, p. 592, is this article: Cataract.-Dr. Quadri, of Italy, has for several years been treat- ing cataract with ammonia. He gives the following case: A woman, aged 22, perceived a diminution in her power of vision. Her mother, two of her brothers, and her sister had all been afflicted with cataract. Her eyes presented a cortical opacity, which appeared greater at the circumference than towards the centre. Dr. Quadri prescribed the daily application of liquid ammonia in a watch-glass to the temples, and a few centigrammes of hydrochlorate of ammonia administered internally. After following this treatment for two months, her eyes had so far improved as to enable her to resume her needlework. The ophthalmoscope revealed at the same time a diminution in the extent and density of the opacity. The patient persevered in this treatment for five years, during which the affection continued to diminish; she left it off for a month, but was obliged to resume it CURABILITY OF CATARACT WITH MEDICINES. 173 at the end of that time, the infirmity having again gained ground ; her return to the old treatment was attended with success. From this case we may at any rate learn patience and perseverance in treatment. What the modus operandi of the ammonia is may not be readily determined (let us call it revulsive), but as there are num- bers of cataract patients waiting for the completion of the maturation process, it could not harm them to give Dr. Quadri's ammonia treat- ment a fair trial. new. The treatment of cataract with ammonia, is, however, by no means Ammoniated counter-irritants have been successfully used in the treatment of cataract; a very convenient form is Goudret's Pom- made Ammoniacale, certainly less objectionable than Dr. Quadri's method. The next case is culled from the American Homœopathic Review, vol. ii., 1860, p. 413. It is translated by the late (alas that we should say late) Carroll Dunham from l'Homeopathe Belge, and is by Dr. J. Mouremans, of Brussels. M. J., aged seventy-seven, had been blind four years. She is small, emaciated, and of sallow complexion. She had had three children. The account she gave of the exciting cause of her disease was very unsatisfactory. She could only say that several years ago, in conse- quence of a cold, she was attacked with inflammation of the conjunc- tiva, and that from that time her vision became more and more feeble. She saw snow-flakes and spider-webs continually in the atmosphere; surrounding objects appeared to her to be enveloped in a thick mist, which prevented her from distinguishing with accuracy the external margin of an object; the light of a candle was encircled by a halo; she could distinguish everything more clearly in the evening than in the morning; artificial light she could not well tolerate. The patient came to our institution (Brussels Policlinique) April 29th, 1856. At this time, she could hardly distinguish light from darkness; the pupils were dilated, and the mobility of the iris was partially impaired; the crystalline lens was obscured, of a whitish color and uniformly shaded. The patient complained of no pain; her disposition was much affected, however, and she had, for four years, found it impossible to apply herself to her accustomed occupa- tion. All bodily functions were normal. We began our medical treatment 29th April, with Euphrasia 30; 174 BURNETT'S ESSAYS. three globules were dissolved in six ounces of water, and a teaspoon- ful taken every night and morning. May 16th. The patient reported an improvement. She could al- ready better distinguish day from night. The same remedy was continued, but in a higher potency, and the three globules were or- dered to be taken all at once. August 4. The patient began to distinguish objects, but they ap- peared distorted. Cannabis 30 was prescribed, three globules to be dissolved in five ounces of water, and a teaspoonful of the solution to be taken every morning and evening. This remedy was allowed to act undisturbed until December 1. The condition of things was unchanged. The high potencies were then resorted to. Sulph. 200, three globules, was given. On the 2d of March, the crystalline lens appeared to be less clouded. The patient could distinguish persons, although they appeared to her as if in a mist. After this time she was able to come to the clinique unattended. Causticum 200 was given. April 30th. She still saw black spots floating before the eyes, but vision kept gradually and steadily improving. Silicea 30 was or- dered, to be taken as the previous remedies. At the end of the month of May, the patient, quite overjoyed at her condition, informed us that she could readily distinguish all objects; could clearly recognize the letters in a book; that she could devote herself again to her usual occupation, but that she saw a halo around. the light of a candle. Phos. 30 was the last remedy which the patient received. Two months later she came to render thanks for the bene- fits she had received, assuring us that her vision had improved to such a degree that she could thread a needle, could sew, and could read with ease. Before publishing this history, we have made inquiries respecting the good woman, who has now reached her eightieth year, and learn that the happy result, thus attained by her through Homœopathy, has continued to the present time. As this case bears the approval of Carroll Dunham, few in our school will gainsay it. The next case is Dr. Berridge's* (in Raue, 1871, pp. 60-1). Since this was printed, we gather from a conversation with our learned colleague that he does not affirm that this was a case of cataract. CURABILITY OF CATARACT WITH MEDICINES. 175 * Cataract of Right Eye. For ten months has often seen a very bright light, beginning at right outer canthus, increasing in size, then standing before right eye as large as a penny for a minute, then de- creasing in size and vanishing. It is seen when the eyes are open or closed, but closing it tightly makes it decrease and disappear: it comes chiefly when stretching himself; it causes lachrymation when looking into it, and makes him feel stupid. Hahnemann gives under Cheli- donium: "A dazzling spot seemed to him to be before the eyes, and when he looked into it, the eye watered." One dose of Chel. 200 (Leipzig) was given. Fourteen days after he reports that the light is smaller, dimmer, does not cause lachrymation, or make him feel so stupid. This symptom is thus confirmed. After this Dr. Berridge did not see him. Apropos of the use of Chelidonium Majus in cataract, we may here note that Dr. Buchmann, in his monograph on this remarkable rem- edy, gives two cases of cataract cured by it. I myself can add a case of amelioration of a right-sided cataract brought about largely by Chelidonium. The patient is a lady of about forty years of age, who used to suffer much from chronic congestion of the portal system, and this was my indication for it. (See Buch- mann's monograph.) In connection with this use of the Greater Celandine in cataract, it may not be uninteresting to consider the etymology of the word, and the old notions once current respecting its efficacy in blindness. It is derived from the Greek yeλtown, a swallow, because the swallows. were said to restore sight to their blind young therewith. This strange story may be found in very numerous authors, from Aristotle and Pliny down to our own herbals. As old Macer has it: Caecatis pullis hae lumina mater hirundo, (Plinius ut scripsit) quamvis sint eruta, reddit. Dr. Baehr (in his Science of Therapeutics, vol. i., p. 257, Hempel's Translation, New York, 1869) says: "Cataracts are generally con- sidered incurable by internal remedies. The proposition has been refuted in homoeopathy by a number of successful cures, and we can boldly assert that we have succeeded in controlling this disorder by the use of internal agents. Unfortunately, however, when the proper 176 BURNETT'S ESSAYS. remedy is to be selected, we are compelled to admit that we have not yet succeeded in determining what remedies are adapted to the dif- ferent forms of cataract. The main remedies are: Phosphorus, Pul- satilla, Sulphur, Calc. Carb., Lycopodium; the less certain and less tried remedies are; Silicea, Cannabis, Euphrasia. Of course, we do not mean to say that we can remove every cataract by homoeopathic rem- edies. As a general rule, we can only say that the prognosis is so much more favorable the younger the patient, and the shorter and the less developed the disorder. In the case of old people, where cataract may be regarded as a gradual dying out of the lens, it would be absurd to suppose that internal treatment is of any use. The prognosis of capsular cataract is more favorable than that of any other form." In the Homœopathic Theory and Practice of Medicine, by Marcy and Hunt, New York, 1865, p. 133, we read: "Treatment of Cataract.-Before resorting to the operation of couching or extraction, as is so often done by the old-school surgeons (and the new?) we should always give our medicines a fair trial. It is quite true that we have but few remedies which simulate this affec- tion in their pathogenesis, yet the successful results which have been observed from the use of medicines in a few cases, render it incum- bent on us to avail ourselves of them on all proper occasions. "After a thorough trial with medicines like Silicea, Graphites, Kali hydriod., Merc. hyd., Calc. carb.-acet., if there is no prospect of amendment, the patient should be turned over to the surgeon for the necessary operation. "In a few cases of incipient cataract, much benefit has followed the local employment of sulphuric ether vapor to the eye, and should our internal remedies prove fruitless, there can be no objection to the trial of this substance. "As internal remedies we suggest: Silicea, Graphites, Iodine, Merc. hyd., Conium, Pulsatilla, Mag. carb., Sulphur, Cannabis, Phosphorus, Digitalis, Spigelia, Euphrasia. Conium and Cannabis may be employed where the cataract has arisen from a wound or other injury to the eye. "Magnesia carbonica, Pulsatilla, Digitalis and Phos. have proved curative in capsulo-lenticular cataract, either with or without abnor- mal adhesions, also in opacity of the lens or capsule alone. These CURABILITY OF CATARACT WITH MEDICINES. 177 remedies are useful when the disease has been accompanied with ophthalmia." We will now quote from Dr. Richard Hughes's Manual of Thera- peutics (Part II., p. 27, et seq., London, 1878). This eminent writer thus expresses himself: "Cataract.—You may be surprised at my including this disease in a treatise on Medicine, as it is ordinarily supposed to be amenable to surgical measures only. But it is difficult to see why it should be beyond the reach of medi- cines. Grant that in aged persons a hard lenticular cataract is merely, like ossified arteries, an evidence of senile decay. But this is one variety only of the disease. Capsular cataract is nearly always the result of inflammation, and corresponds pathologically with opacity of the cornea. Both capsular and lenticular cataracts have been known to form within a few days, or even in a single night. They have followed retrocedent gout, suppression of the menses, of cuta- neous eruptions, and of habitual perspiration of the feet (I do not speak of diabetic cataracts, as there is reason to suppose that these are of purely physical origin). Morbid conditions so characterized ought to be amenable to specific remedies; and homoeopathic literature al- ready witnesses that such remedies are in existence.” A paper by Dr. Malan, in the fifth volume of the British Journal of Homoeopathy (already cited by us in extenso), and the section in Peters's Treatise, contain all the cases of homoeopathic cure or im- provement of cataract with which I am acquainted. Some of these are of dubious value; but even when they are eliminated, the power of Sulphur, Silicea, Cannabis, Pulsatilla, and Calcarea must remain unquestioned. Silicea has been most frequently successful; it should be especially thought of when suppressed perspiration of the feet seems to have been the exciting cause. Sulphur ranks next; its value. is obviously best marked when the trouble dates from repercussion of a cutaneous eruption. Cannabis, and perhaps Euphrasia, would be suitable when the cataract was capsular, the result of inflammatory action. Should we catch such a cataract in the act of formation, i. e., in the inflammatory stage-it seems probable, from one of Peters's cases, that Belladonna might be relied upon to disperse it. Pulsatilla was a reputed remedy for cataract in the hands of Stoerck. It acted very satisfactorily in one of Peters's cases, where a chronic catarrhal oph- 178 BURNETT'S ESSAYS. thalmia calling for it was present; and would be specially indicated where suppression of the menses was the exciting cause. Calcarea would naturally be thought of in strumous subjects. I add a note, furnished me by my friend, Dr. Madden, who had un- usual experience in the treatment of this disease. . . "In the early stage, where vision is but clouded, and streaks only of opacity are seen by the ophthalmoscope, a check to further deposit may very often be expected. If there is nothing more than smokiness of the lens, it may clear away entirely. The medicines I have found of most ser- vice are Merc., Calc., and Phos., all in the higher dilutions." Dr. Hughes mentious a case of traumatic cataract in which blind- ness had continued for eighteen years, and which was then cured by Dr. Bayes with Conium. It must be admitted that this is a goodly array of fact and opin- ion concerning and affirming the curability of cataract with the aid of medicines administered internally according to the law of similars, or guided by one or more of its corollaries. It may be repeatedly noted that some morbid cutaneous activity is manifested just before a striking amelioration in the cataract takes place. In a case of my own, which I shall presently narrate, the same thing occurred; it may, therefore, be conceded that some pre- vious epithelial disease had lain at the root of the cataract formation. At a meeting of the Cercle Médical Homœopathique des Flandres, held on the 31st October, 1878, a paper was read by Dr. Bernard, of Mons, on the Homœopathic Treatment of Cataract. It may be found in the Revue Homeopathique Belge, November, 1878. It seems that Dr. De Keersmaecker, a rising homoeopathic oph- thalmic surgeon of Brussels, had doubted, if not actually denied, the possibility of the cure of cataract by internal treatment, at least so far as concerns les cataractes séniles, dures, nucléaires ou corticales: Drs. Criquelion, Martiny, and Van den Neucker expressed an opposite opinion, and the two latter stated that they had themselves succeeded in curing cataract with medicines. Dr. Chargé had informed Dr. Bernard that he had himself only suc- ceeded in curing one single case of cataract that coexisted with gen- eral psoriasis; both cataract and psoriasis yielded after the admin- istration of Sulphur and Calcarea. * Here, again, we note the pathological homogeneity of skin and lens: in fact cataract is a skin-affection. CURABILITY OF CATARACT WITH MEDICINES. 179 Dr. Bernard's searches in literature for medicinal cures of cataract gave the following results: In the Clinique Homoeopathique of Beauvais-Saint-Gratien may be found seven cases of cataract cured or ameliorated with medicines,- five in the first volume, and two in the second. The first is the observation of Caspari, which we cite later on. The second observation is by Dr. Hoffendahl, and in which the cure was obtained by means of Spigelia, Belladonna, and Stramony. The third is Dr. Haubold's, and runs thus: A cataract, rather ad- vanced, was cured in six weeks, and that radically, by Sulphur 30, and a fortnight afterwards by Causticum, in an old lady of sixty-one years of age. The fourth case is Dr. Schroen's, and comes later. The fifth is Dr. Emmerich's, also reported further on. In the sixth observation, Dr. Kopp also notes a marked ameliora- tion in a maiden lady, sixty years of age, due to Pulsatilla, Bella- donna, Conium, and Mercurius Solubilis. This patient had previously been seized with left-sided facial hemi- plegia. The author of the seventh observation is Dr. Stender, and it runs thus: A cataract, already formed, in a scrofulous lad twelve years of age, was cured in two months and a half by a few doses of Sul- phur, Pulsatilla having been twice exhibited between whiles. Dr. Bernard then gives an epitome of fifteen cases from Rückert's Klinische Erfahrungen. I will only give the fifteenth at this place, as the others occur in other parts of this book. The fifteenth is this: Crusta lactea disappears and cataract super- venes, which latter is cured with Spirit. Sulph. (Autore, Schoenfeld). Dr. Bernard also notes that in several of the cases habitual per- spirations reappear, or a cutaneous eruption either appears or reap- pears. Need we any further proof that cataract is a cutaneous affection? Dr. Prié has published numerous observations of ameliorations of cataract from homoeopathic treatment. First, we find in the fifth volume of the Bulletin de la Société Médicale Homœopathique de France, a short account of sixteen observations; a second memoir, published in the sixth volume of the same journal, contains an ac- 180 BURNETT'S ESSAYS. count of other six cases, in all twenty-two, with results that Dr. Ber- nard thus epitomizes: 13-Ameliorations more or less marked; 5-remained stationary; 3-not ameliorated; 1-result not known. Total 22. In these twenty-two cases of Dr. Prié it would seem that Magnesia Carbonica 6 was largely accredited with the beneficial results. Then there comes the case of Dr. Streintz, published in the Allge- meine Hom. Ztg. Patient was a retired major, seventy-five years old, in whom an amelioration almost equivalent to a cure resulted from Phosphorus 30, after Sulphur and Causticum 30 had been given without effect. I cannot agree that all the honor be accorded to Phosphorus in this case, as my experience shows that the last medicine given is by no means necessarily the one that produces the benefit; we must remem- ber that the changes in the cataracts of the aged are, in the nature of things, slow, and may exist long before one can detect them. We may read in the Art Medical (t. xliii., p. 226) the following case: Cataract of the left eye in a maiden lady, thirty-four years of age. Oleum phosphoratum by instillations into the eye, and frictions on the brow and temples. At the end of four months there were great amelioration of the sight and notable diminution of the cataract. Dr. Bernard does not tell us the original author of this case. "Le traitement de la cataracte, disait M. Ozanam, le 15 Juin, 1868, à la Société Médicale Homœopathique de France, offre encore de grandes lacunes. J'ai espéré en triompher un instant en m'inspirant du principe homoeopathique, car ayant lu l'histoire des épidémies d'er gotisme, j'y trouvais un assez bon nombre de cas de cataractes pro- duites par l'usage de l'ergot de seigle. Mais, ni l'emploi de Secale à doses variables, ni l'emploi de l'huile essentielle d'ergot de seigle ne m'ont donné de résultat efficace, et la question est encore à résoudre." Then, in 1869, M. Ozanam treated eight cases of cataract in aged persons for the space of one month, with Phosphorus in various doses, but without success. CURABILITY OF CATARACT WITH MEDICINES. 181 BE Here I would remark that this is very unscientific homoeopathic treatment to give eight cases right off the same medicine. No wonder he had no success. Moreover, one has no right to expect any success in one month. To do this is to ignore the essential nature of cataract; and to take eight cases of cataract, and give them all one drug, is equally to ignore, or to fail to comprehend, what homoeopathy really means. This is where Hahnemann's other teachings come in; here we require the higher homoeopathy of the pathologist Hahnemann. .. In 1872, M. Ozanam says: "Ainsi le seigle ergoté produit la cataracte double; il la produit plus facilement chez les femmes et dans. l'âge adulte. Il détermine surtout des cataractes molles ou semi- fluides; donc le seigle ergoté sera d'une indication très-générale dans le traitement de la cataracte, et sera, en outre, tout particulièrement indiqué chez les femmes adultes atteintes d'une cataracte molle et double, c'est-à-dire, dans les cas les plus graves et les plus complets de cette pénible affection.” That is a good deal better; only there must be other differentiæ as well; especially must the history of each case be carefully weighed, or there will be only indifferent success. Jousset recommends Cannabis indica, Secale cornutum, Iodium, Kali hydriod., Conium, Silicea, Magnes. carb.; and says, Colchicum would be called for in capsular cataract of rapid development. Dr. Hubert-Begenne, in his Traitement Homeopathique des Mala- dies des Yeux, declares himself unequivocally for the curability of cata- ract with purely internal treatment, that is, in a certain number of cases. Dr. Bernard continues: "That which Boerhaave, one may suppose, thought to himself when he wrote Cataractas mercurius solvit; that which others have thought to obtain by the prolonged use of Bella- donna or of Pulsatilla, or by energetic revulsion in the neighbor- hood of the eye, we may say can be better obtained with medica- ments homoeopathically appropriated to the state of the subject, and amongst which we cite Conium, Phosphorus, Pulsatilla, Causticum, Cannabis, Calearea, and Silicea, administered for a long time in infi- nitesimal doses, and consequently always without danger." Mille faits négatifs ne sauraient infirmer un fait positif. Dr. Anastasio Garcia-Lopez, medical director of the mineral water establishment of Ségura, published a memoir on the effects of the Ségura waters upon cataract. His statistical table was thus: Of 182 BURNETT'S ESSAYS: 118 patients suffering from cataract, 14 were cured; 65 relieved; 15 received no benefit; and of 24, the result remained unknown. These were treated between the years 1859 and 1863. A discussion on the Homœopathic Treatment of Cataract took place at a sitting of the Cercle Médical Homœopathique des Flandres, on January 30th, 1879. Dr. Martiny had treated three cases of hard cataract successfully with medicines; he had not only succeeded in arresting the progress of the affection, but had got the patient well enough to do without atropine. One of his cases he treated with Silicea alternated with Phosphorus; the second case with Calcarea, and the third improved under Cannabis. Dr. De Keghel had obtained a very manifest amelioration in three cases of soft cataract: one with Sulphur 30; another in an obese lady, with Sulphur followed by Calcarea; the third case, in a lady at the change of life, with Pulsatilla 30. Dr. Schroen published the following case in All. H. Ztg. This case, and several of the following, I take abridged from Peters: A tailor aged sixty, affected with capsulo-lenticular cataract of both eyes, could barely distinguish light from darkness. Magnes. carb. 30 was given once a week in alternation with the essence of Cannabis sativa. Two months from that time he could read large-sized print. He received several other remedies, but no further improvement was effected. Mrs. B., aged 31, was left after typhus fever with weakness of the eyes and eyesight. Everything appeared as if she were looking through a mist; she could only see outlines of objects, and did not dare to walk out alone. The left eye was most affected; behind the pupil there was an opacity of the lens, the bulb of the eye not affected, the pupil responded to the influence of the light; menses was sup- pressed. Pulsatilla, Sepia, and Cannabis, were used without ben- efit. Lycopodium (4) was then given, and six days afterwards the menses reappeared; in two weeks more there was decided improve- ment of the sight, so that she could discern smaller objects, and in three weeks her sight was entirely restored.-(Dr. Diez in Hyg., 18, 457.) Dr. Becker treated a carpenter who had been affected for some time with tetters about the face, which disappeared after a while. Q CURABILITY OF CATARACT WITH MEDICINES. 183 without his taking any medicine, but his sight became impaired ; everything appeared in a place different from its real position, so that he was unable to use his tools properly. The pupils presented a misty, smoky appearance, as in the form- ing stage of cataract. He received Sp. Sulph., ten drops three times a day; the old eruption reappeared, and he now saw everything in the right position, but otherwise his sight was not improved. Then on March 22d, Aq. Silic. was administered in doses of seven drops daily, and this was followed by a great improvement in his sight. He perspired easily, and had much perspiration about the feet. Deposit in urine like lime. July. A rheumatic inflammation of the foot set in.-(Ib.) The same gentleman treated a lady whose feet generally perspired freely, and then became very dry, and thereafter she noticed that her sight became affected in such a manner that everything she looked at appeared to be enveloped in a cloud; she could only read large print. Aq. Silic. was administered in doses of ten drops twice a day. The accustomed perspiration of the feet returned again in about a month. Her eyesight became much better. Two months later, at the time of menstruation, her eyes became worse again, and she then took twenty drops Aq. Silic. three times a day, after which she im- proved very much, could read better, and continued taking the same remedy. I have before referred to Dr. Caspari's case; it is this: it is this: "Mrs. D., aged 36, had had small-pox while a child, and her eyes have been affected ever since. "Her symptoms were: tears from the right eye, of a corroding, salty nature, which caused constant irritation of the lower lid and cheek; trichiasis of the few remaining eyelashes of the upper lid; conjunctiva pale red; varicose vessels running to the cornea; some- times a sensation as if sand were in the eye; agglutination of the lids during the night: for six months past she had simple light-gray, lenticular cataract; she could still distinguish very large objects at a distance of four yards. "After she had taken Pulsatilla 9, there was a subsidence of the inflammation and photophobia; her sight was improved; the lens be- came clearer at its circumference, and the pupil was distinguishable; 184 BURNETT'S ESSAYS. after a further use of Pulsatilla there was observable only a small, grayish speck in the lens; the circumference was fully transparent, and the sight only remained slightly obscured. "The essence of Cannabis, and, lastly, Opium 6, rendered the lens perfectly transparent." Dr. Caspari examined the eye on several subsequent occasions, but there was no return of any of the former symptoms. Dr. Argenti published the following case (Arch., 19, 1, 77): "A young man, aged 20, otherwise healthy, except that he was subject to inflammation of the eyes and weak sight. 66 During one of these attacks, which had lasted for some time, he was found in the following condition: Conjunctiva of both eyes much inflamed and very much swollen, resembling a piece of raw meat; great intolerance of light; lids agglutinated in the morning; pressure on the eyes, especially on opening them; sight almost extinct. “Belladonna 30, in often-repeated doses, subdued in two weeks the inflammatory state of the eyes, but produced no change in the eye- sight. After a more critical examination, a cataract in each eye was noticed. "Belladonna was continued, without benefit. Finally Silicea 30, once in six or eight days, perfectly re-established the eyesight in three months." Perhaps I have already given a sufficient number of cases of the medicinal cure of cataract to show that the thing is at least possible. Some of my readers, who may have read thus far, may be already convinced of this; but others may be skeptical, and these I must pun- ish with yet a few more cases. At all events, I shall give plenty of work to such as may attempt to explain them all away. "Mrs. E. became afflicted with arthritic ophthalmia and leucoma- tous opacity of the cornea, and after the gradual clearing off of the opacity the lens was noticed to be of the color of a beginning cata- racta glaucomatosa. "After receiving Phosphorus 30, the lens returned gradually to its former healthy state." (Arch., 8, 3, 156, by Dr. Schüler.) "A gentleman, aged 38, in consequence of a cold in the face, be- came affected with an inflammation of the left eye, with the follow- ing symptoms: Towards the cornea an arterial network was noticed, over which were coursing some larger vessels towards the circumfer- ! [C 4 CURABILITY OF CATARACT WITH MEDICINES. 185 ence of the cornea; drawing pain between the shoulder-blades and right upper arm. Bryonia and Puls. were given without benefit; four days later, however, the inflammation had somewhat diminished, but was followed by nebula of the left eye, in consequence of which the patient could distinguish large letters only; behind the pupil could be noticed an opacity of the capsule of the crystalline lens; the pupil was round, and the iris was also unchanged; there was no pho- tophobia, and no secretion from the eye. The accompanying symp- toms were, pressure and distension over the region of the stomach, extending as far as the right breast and lower lumbar regions. Great uneasiness, pressure in the forehead, feeling of heaviness and drawing in the thigh, and sleeplessness. "Nux was given, without benefit; then Bellad. 3 was used night. and morning for two days, with such surprising results that every vestige of disease disappeared." (All. Homoeopathische Ztg., 37, 340. Lembke.) "M., aged 20, tinsmith by trade, was affected a year-and-a-half ago with the worst kind of itch, and subsequently with fever and ague. Sometimes he had tearing pains in the left eye, and some itching of the skin, to which he paid very little attention; suddenly he noticed, however, that he had become completely blind in the left eye. “Symptoms.—A staring look of the left eye; pupil dilated and im- movable; in the centre of the lens there was a slight opacity; his sight was almost extinguished. "Treatment.—August 2, Sulph. 6; from August 9th to September 23d, six doses of the same. "Six days after the first dose, many pustules appeared on the face and arms; in the meanwhile his eyesight improved so much that he was enabled to distinguish large letters. From September 13th to September 23d, furuncles on the arm made their appearance; after that the skin became clear again, and the affected eye was as useful as it had ever been before." (Arch., 14, 5, 105. Emmerich.) "A girl, aged 12, had been affected since her earliest recollection with flocculent cataract (probably congenital) of both eyes. She had had an operation performed about four months ago, without the least benefit; four doses Magnes. carb. 200 were also given, without any benefit. Five months later she received Euphras. 200, in water; a tablespoonful once a day was followed by some improvement of the 13 186 BURNETT'S ESSAYS. left eye. The Euphrasia was continued for four months with steady improvement; as soon as the patient ceased to improve Sulph. 200 was given, followed by Magnes. carbon. 200, one dose every week for five months, at the end of which time the circumference of the cataracts in both eyes was only just observable. Euphras. 200, Silic. 200, and Acid. nitr. perfected the cure. The use of spectacles for cataract assisted, however, very much to increase the sight of the child. "How much the former operation had done towards the cure, referent is not able to say." (Allg. H. Ztg., 35, 205. Rummel.) "A farmer, aged 50, of small stature and with light-brown hair, had suffered for the last few weeks with impaired sight; the patient had formerly been troubled with scrofula. 66 Symptoms.-Patient sees with the right eye only those things which are above him, and with the left eye only those which are at his side; but in all other directions everything appears as dark as night to him. "Partial opacities of the crystalline lenses were clearly observable; the one in the right eye occupied the larger, and that in the left the smaller half of the pupil. "Treatment.-Cannab. 2, three drops daily in water for three weeks, was given without benefit Calc. 3, six doses, at first one dose a day for two days, afterwards one dose every week; before the last dose had been taken, patient had entirely recovered his sight." (Viertelj. Schr., 2, 426. Villers.) "A priest, affected with cataract, took extract of Conium inter- nally with benefit; finally, he became tired of taking medicine, and made a cataplasm of the bruised leaves, which he placed upon his eyes at night. This enabled him to read his breviary without diffi- culty, and to walk about without a cane or guide."-(Frank's Mag- azin.) "A healthy girl, regular, aged 23, had had dimness of sight for two years, and complete cataract for more than one. "Treatment. She took 8 to 10 grains of Conium, increased to 25 grains, three times a day; her appetite remained good, and she seemed active and well, and the edge of the cataract seemed clearing up; she could see the window, and in October could see her hands CURABILITY OF CATARACT WITH MEDICINES. 187 and fingers, but all objects seemed red, and her menses became sup- pressed.”—(Ibid.) These, friendly reader, are some of the cases of the cure of cataract. that I have found in homoeopathic literature; I do not know what you may think now of the curability of at least some cases of cataract with properly chosen remedies; but I, for my part, must confess that the evidence in its favor is very considerable. I do not wish to persuade any one that cataract is curable with medicines if it is not, but I have tried to bring together sufficient evidence to interest thoughtful physicians and laymen in the subject; as for the ophthal- mic surgeons, I expect nothing but sapient smiles from them, and I shall not be disappointed in this expectation. All honor to their digits and their prejudices. They say they never find anything but an operation of any avail, and this is perfectly true too. Why? Forsooth, they never try anything else! For the same reason I never find anything but medicines, chosen homoeopathically, do any good, i. e., I never try anything else. And from the good results that I have heretofore obtained, I am confident that if all our homœopathic practitioners were to treat cataract on exactly the same plan as they treat any other constitutional chronic ailments, instead of sending them straightway to the surgeon's knife, we should be able to do great things in a few decades. It might be as well, perhaps, to say that I lay no claim to any special knowledge of the diseases of the eye in general, or of those of the lens, or of its capsule, in particular; at the same time I am not one of those physicians who consider ophthalmology as lying with- out their province and within that of the ophthalmic surgeon only. On the contrary, I consider that the duty of the true physician con- sists in constantly seeking to limit the domain of the surgeon by extend- ing that of the physician. The treatment of cataract concerns, first, the physician, and, failing him, the surgeon. The field of sur- gery—the ophthalmologic portion particularly-is wondrously well- worked; it has been most carefully surveyed, most minutely mapped out, and everything accurately named. Well may the surgeon-ocu- lists be proud of their position and progress. But where are our physician-oculists? Nowhere. In general practice I have met with very encouraging results in my treatment of cataract with medicines administered internally; 188 BURNETT'S ESSAYS. but, with only ordinary means of observation, the number of cases that have come under my care is necessarily limited. Hence my own experience has occupied and will only occupy a very small space, and will principally serve to introduce the observations of others. It is to be hoped, also, that this little work will encourage many other homœopathic practitioners to try the effects of well-chosen rem- edies in those cases of cataract that may come under their notice. At any rate, let us give medicines a full and fair trial, and in the end humanity and science must be the gainers. A cataract cannot be operated on until it is ripe; then why not try the medicinal treat- ment during the ripening process? We are neither doing our duty to the science of medicine, nor to that branch of it called homoeopathy, nor to our patients, nor to our- selves, unless we at all events try to cure our cataractous patients with medicines. But before entering upon such an arduous undertaking, it is well to have a clear conception of what a cataract really is, and how it comes about, so that the trial may be an intelligent one, and founded on a scientific basis. The attempt to cure cataract medicinally is not new; all through the history of medicine there have been cases of cataract reported as cured with medicines; but previous to the discovery of the ophthal- moscope it was not unfrequently confounded with, or included in, amaurosis, more especially some forms of it. And a facetious ocu- list was wont to say that amaurosis was that condition in which both doctor and patient could see nothing. That was in the pre-ophthal- moscopic days, bien entendu. But ever since Helmholz invented the ophthalmoscope, in 1851, the ophthalmologists have been busier than bees in the instrumental investigation of the eye; and now, as a well-known oculist lately informed the writer, they count over three thousand diseases of the eye. Such is the simplicity of science. I am dealing here with only one of these diseases, and that will leave two thousand nine hundred and ninety-nine for the ophthalmic sur- geons; hence they ought not to complain of this little poaching raid. There are eye-surgeons in plenty, and not a few of them are men of the highest attainments; we want some good eye physicians, NOT specialists but medical practitioners, who can focus their energies upon a small part of the human economy without ever for a moment G CURABILITY OF CATARACT WITH MEDICINES. 189 forgetting that the part is qualitatively the whole, and conversely. We should then make rapid strides in narrowing the limits of the supposedly incurable. To have one's ailments cured surgically is good, but to have them cured medicinally is better. As cataract is a disease of the lens or its coat, it will be well to inquire into the true nature of the parts involved, both from an em- bryological standpoint, and also from that of histology and chemical constituents. What is the lens, and where is it? CHAPTER III. THE LENS AND ITS CAPSULE. TH HE crystalline lens, or crystalline body, is a doubly convex trans- parent solid body, with a rounded circumference; it is inclosed in a capsule, is situated behind the pupil, and in front of the vitreous body. In Bowman's words, the capsule of the lens, a transparent glass- like membrane closely surrounding the contained body, is hard and brittle, especially in front, but very elastic and permeable to fluid. The anterior surface is in contact with the iris towards the pupil, and recedes from it slightly at the circumference; the posterior rests closely on the vitreous body. Around the circumference is a space, called the Canal of Petit. The fore part of the capsule is several times thicker than the back, as far out as of an inch from the cir- cumference, where the suspensory ligament joins it; but beyond that spot it becomes thinner, and it is thinnest behind. In its nature the capsule of the lens resembles the glassy membrane at the back of the cornea, for it is structureless, and remains transparent under the ac- tion of acids, alcohol, and boiling water, and when ruptured, the edges roll up with the outer surface innermost. J6 66 By structureless" is meant that our strongest magnifying powers are unable to show any further differentiation. It is very tough and exceedingly elastic. The histology of the lens is admirably given in Stricker's Manual 190 BURNETT'S ESSAYS. of Human and Comparative Histology, vol. iii., which is translated by Dr. Power for the New Sydenham Society (London, 1873). It is the work of Professor Babuchin, who was ably assisted by Sernoff. But it is much too elaborate for the present purpose. Max Tetzer's Compendium der Augenheilkunde, Gruenfeld's third edition, Vienna, 1878,-by the way the best Manual of Ophthalmol- ogy extant,—is a mine from which we shall dig a little. Poor Tet- zer was the most genial clinical instructor of his day (alas! so short), and made almost every student feel that he would go in for the eye. He puts the anatomy and histology of the lens thus tersely: The lens, with its posterior surface, fits into the plate-like groove of the vitreous. The connection of the posterior part of the capsule in this groove is, however, very loose, so that the capsule can be readily taken out. Of the greatest importance is the layer of the intracap- sular cells, that are very pretty epithelial cells, like mosaic. This epithelium of the capsule, lying on its inner surface, is to be regarded as the matrix of the fibres of the lens. Particularly those cells to- wards the periphery give rise to the formation of the fibres of the lens. The lens substance has a peculiar shape; its anterior surface is flatter, the posterior surface more convex. The proportion in the convexity is as ten to six. In the lens we distinguish the nucleus and the cortical substance. The cortical substance is rather softer, some- what succulent; the nucleus, on the other hand, is a compact mass. The cortical substance can be divided into leaves (lamina), but the nucleus cannot be divided into leaves. Towards the equator the cortical substance is most considerable. This depends upon the de- velopment of the lens, because the peripheral layers are the youngest, while those layers that surround the nucleus are the oldest. The color of the lens in young individuals is as clear as water; the older the person the more it becomes metamorphosed, turning yellow, yel- low-brown, even rusty-brown. STRUCTURE OF THE LENS SUBSTANCE. The fibres of the lens are its most important constituent; they are six-sided prisms, so that on section of a lenticular fibre we get a hex- agon. One fibre fits accurately to the other. The ends of the fibres are jagged like a saw, whereby the connection is more intimate. The CURABILITY OF CATARACT WITH MEDICINES. 191 fibres consist of a membrane, a contained fluid, in which globulin or crystallin was discovered, and of a nucleus, which, however, exists only in the young; in the older it has already disappeared. The complicated arrangement of the fibres themselves will not bere come under consideration. The consistence of the fibres of the lens varies in accordance with the layer in which they are found. The superficial fibres are very soft and delicate, and the nearer the centre the more hard and re- sistant. NUTRITION OF THE LENS. The lens has no blood vessels. With regard to the nutrition of the lens, we consider the capsule as the matrix of the lens. On the inner surface of the capsule there is a layer of epithelial cells, so that here the further nutrition is carried on through cells. The capsule is, as it were, the basement membrane for the epithelial cells; these grow and differentiate into lens fibres. Hence the lens proper is the product or fruit of the capsule, and it is this idea that we have found to encourage us in our therapeutical endeavors, more especially when considered in relation with its origin. The nutrition may reach the lens by transudation through the capsule. CHEMISTRY OF THE LENS. The principal chemical constituents are of an albuminous nature; consisting, in fact, chiefly of globulin, with a certain quantity of al- buminate of potash and ordinary ser-albumen. Other materials that have been ascertained to enter into the composition of the lens fibres are-a little fat, with traces of cholesterin, about one-half per cent. of ashes, and sixty per cent. of water. The qualitative characters, no doubt, vary with the layer from which the fibres are taken; for, apart from the fact that the central fibres are more resistant, the nu- cleus of the lens becomes much harder than the superficial layers under the same reagents; so that, in fishes, for example, the nucleus remains transparent, hard, and difficult to cut. The cloudiness of the fibres of the lens, and the formation of vacuole in their interior, are occasioned by the action of reagents which withdraw water from them. (Babuchin.) 192 BURNETT'S ESSAYS. 1 Probably this explains the modus operandi of salt, sugar, alcohol, and, secondarily, of ergot in the artificial production of cataract. EMBRYOLOGY OF THE LENS AND ITS CAPSULE. The development of the crystalline and its coat must, of course, be considered in connection with that of the eye as a whole. Now the eyes begin to be developed at a very early period, in the form of two hollow processes projecting one from each side of the first pri- mary cerebral vesicle. Each process becomes converted into a flask- shaped vesicle, called the primary optic vesicle, which communicates by a hollow pedicle with the base of the posterior division of the first primary cerebral vesicle. According to the observations of Re- mak on the chick, the pedicles, originally separate, come together, and their cavities temporarily communicate,-a condition which may explain the formation of the optic commissure. The primary optic vesicle comes into contact at its extremity with the CUTICLE, which some- what later becomes invaginated at this point, and forms a small pouch pressing inwards on the optic vesicle; the aperture of this pouch be- comes constricted and closed, and the pouch is soon converted into a shut sac, within which the contents, subsequently becoming solid, form the lens and its capsule. After the lens has been thus separated from the CUTICLE the deeper tissue contributes to the formation of the sec- ondary optic vesicle. This is as much of the embryonic develop- ment of the eye as we need for the present purpose; from it we see that the lens and its capsule are differentiated skin. This should be well remembered. The investigations of Babuchin and of Sernoff lead them to differ but slightly from this in their conclusions. They say that, as regards the origin of the lens, and the mode of development of its fibres, it is obvious from the direct transition of the anterior epithelial layer of the lens into the posterior fibrous layer, that each fibre of the lens is simply a colossal and greatly elongated epithelial cell, and the history of development shows further that the persistent portions of the body of the lens arise from the EPIDERMOID external layer of the embryo. The question of the development of the capsule is still open, according to Sernoff, who has long been occupied with its investiga- CURABILITY OF CATARACT WITH MEDICINES. 193 Ramla tani, plakkenden. Het kana, KazakADROS DATOS A PARKSEEN SALIZIRAJTESISENEGALOPARJAN RIN POKRETA tion; in the meantime he would appear to deny both its epidermoid origin, and also that it is the product of the excretion of the epithelial cells and of the fibres of the lens. Babuchin inclines to classify it with the metamorphosed connective tissue formation. But some light may be thrown on the question of the origin of the capsule of the lens--a very important question, by the way, for gain- ing a little firm ground for our therapeutic endeavors—by comparing it with the membrane of Descemet. The capsule of the lens and the membrane of Descemet have many properties in common; thus portions of either, when treated with reagents (as, for instance, permanganate of potash, or a ten per cent. solution of common salt) will roll inwards like paper that has been long rolled up, and they are both glass-like or hyaline. Hence the opinion of Babuchin, that the capsule of the lens is transparent con- nective tissue, would seem very probable. According to Rollett, the histogenesis of the cornea requires to be again worked over, especially with the aid of the silver and gold methods of preparation. But, leaving for the present the origin of the capsule undecided, we are in no doubt of the EPIDERMOID nature of the lens, and also in no doubt of the endothelial nature of the interscapular cells. From which we may deduce the general statement that the drugs that affect the epidermis and epithelial structures specifically will also be our remedies in some of the abnormalities of nutrition of the lens, and there- fore in some forms of cataract. From the albuminous nature of the lens we may deduce the general statement that substances which in the living body enter into combina- tion with the albumen to form albuminates, will likewise be remedies in certain forms of cataract. THE AQUEOUS HUMOR. The chambers of the eye are bounded posteriorly by the anterior capsule of the lens, and anteriorly by the posterior membrane of the cornea, the so-called membrane of Descemet. The iris dips like a circular curtain into the space so designated. They are occupied by the aqueous humor, which differs but little from water in its physical characters, but it contains a small quantity of some solid matter, chiefly chloride of sodium, dissolved in it.-(Quain.) 191 BURNETT'S ESSAYS. It is very probable that the aqueous humor plays a very impor- tant part in the nutrition of the lens. ETIOLOGY AND PATHOLOGY OF CATARACT. For this part of our subject a very important work is Des Causes Anatomiques de la Cataracte Spontanée, par Henri Chiray, Paris, 1875. In general thesis it is maintained that cataract is due to a thicken- ing of the blood from the abstraction of a portion of its water. The principal experiments on this point are those of Künde and of Kühnhern made on frogs, cats, and dogs, with common salt, the nitrate of soda, and concentrated solutions of sugar, introduced into the digestive tube and under the skin. Under this influence the ani- mals rapidly lose a great quantity of water, they attain to an extreme degree of desiccation, and in a period of time, varying from a few hours to as many days, an opacity of both lenses is seen to develop. Some authors will not recognize these as true cataracts, because they disappear as soon as the abstracted fluid is restored to the economy. But, as Chiray observes, this objection will not hold; for what con- stitutes, clinically, a cataract, is an opacity of the crystalline, and the just-mentioned substances do produce opacities of the crystalline. So we must say they are analogous, though not identical. But then the same holds good of all cases of disease, and therefore of cataract. Chiray also comes to the conclusion that we must consider it as a fact that loss of fluid is a cause of cataract. As examples of this, he reckons the cataracts of the diabetic, and those common to certain trades. Thus glass-blowers, for instance, who work a good part of the day before very hot fires; the vignerons, who work very hard in the full blaze of the sun on their shelterless hills; also a certain number of senile cataracts are to be attributed to this same cause; for we know the vascular changes at this age must necessarily impede the interchange of the fluids between the tissues and the blood vessels ; this is particularly the case with the aged, and those who are withered and emaciated by misery and privation. Then there is the cataract of ergotism, but how brought about we will not here tarry to discuss, but will briefly revert to the subject presently. CURABILITY OF CATARACT WITH MEDICINES. 195 It would lead us too far to enter into the much-vexed question of how inflammatory cataract becomes established; it is well discussed in Chiray. According to Ritter and Moers, irritation of the crystal- line produces at first sub-capsular and capsular lesions that might well be connected with capsular cataract, and these lesions subsequently extend to the crystalline. Clinically, we frequently note that cata- ractous patients tell us of former inflammations of the eyes. (See our first clinical case.) - GERONTOTOXON LENTIS is pretty frequent in the aged; it con- sists of an equatorial opacity of the lens, with very weak centripetal rays, and having but a very slight tendency to increase. The opaci- ties are due to deposits of fat between the fibres. This is analogous to the arcus senilis of the cornea; and although an opacity of the lens, is nevertheless no cataract in a strict sense. Choroiditis, and sclero-choroiditis are very frequent causes of cataract. Chiray (Thèse, 1858) very prettily terms the choroid the placenta of the eye. The most important part in the nutrition of the eye is undoubtedly played by the aqueous humor, and this fluid is secreted by the choroid, the nourishing membrane of the eye. Hence choroidal lesions must play an important part in the etiology of cataract by primarily altering the nature of the aqueous humor. Those cataracts that are produced by desiccation are, according to Kölliker, due to the production of vacuoles filled with fluid, and sit- uate between the crystalline fibres. And Chiray remarks, à propos of this (op. jam cit., p. 7), De plus, on sait que, dans la cataracte dure, au début, les fibres crystalliniennes s'isolent, se ratatinent, se décrochent, pour ainsi dire, les unes des au- tres, et laissent aux points où correspondent leurs extrémités des es- paces libres que remplit une substance grumeuse. On ne saurait nier, sinon l'identité, au moins la grande analogie entre ces espaces interfibrillaires et les vacuoles qui se forment dans les expériences indiquées. He then goes on to note, however, the extreme rapidity of the formation of the one and the extreme slow- ness of the formation of the other. But this difference, I submit, may be more apparent than real. 196 BURNETT'S ESSAYS. Thus he admits that certain forms of cataract are, up to a certain point, susceptible of resolution. There are, he says, those slight trou- bles of the subcapsular epithelial layer that follow irido-choroiditis or traumatism of the crystalline, and also those that occur in the dia- betic. With regard to the cataract of ergotism the fact is admitted. But how does it come about? Some maintain that it is from deperdition of water from the organism. It has struck me as remarkable that no one seems to have succeeded in curing cataract with ergot; Mons. Ozanam, for instance. Now, it occurs to me that another, and very plausible, explanation of how the ergotic cataract is brought about may clear this point up. We know that ergot produces spasm of muscular fibres; in ergotism we shall, therefore, get spasmodic contraction of the ciliary muscle and of the choroidal vessels, and consequent obstruction in the apportation of the blood to the part involved. Hence, Secale would be only homoeopathic to this peculiar variety of cataract, viz., when spasm causes it, and when the spasni still exists. Production of Cataract from Imbibition of the Aqueous Humor.— The following very instructive case of M. Forarini may be found in Chiray (p. 18): A young laborer was hit with a very small fragment of steel filing, which penetrated into the substance of the capsule of the lens, and this is what was observed: For the space of a month this fragment remained quietly lodged in it, without causing the least visual trouble. At the end of this period a small perforation in the capsular cicatrix was observed, and M. Forarini was able to follow, step by step, the development of a cataract from aqueous imbibition. For more than a month the alteration only propagated itself in the peripheral cortical layers. Little by little it extended to the deeper layers, and it was only then that the region surrounding the metallic splinter was seen to be disturbed in its state. The gist of M. Chiray's work is to prove that cataract is due, very frequently, to atrophy of the choroid and to choroiditis. No one can gainsay his facts, but his reading of them is another matter; to me he seems to have fallen into the usual error of letting a younger brother descend from an elder brother. Just as some persist in say- CURABILITY OF CATARACT WITH MEDICINES. 197 ing that English is derived from German, whereas the two languages are separate branches of a common stem. So it is, I submit, with choroiditis, atrophy of the choroid, and cataract; neither is from the other, but all have their origin in the general constitutional state. The most positive knowledge in regard to the etiology of cataract is that resulting from Kunde's experiment with salt; we know cer- tainly that the lens may become cataractous from a too great loss of fluid. Speaking anatomically, the lenticular opacities, i.e., cataracts, are different according to whether the nucleus or the cortex is involved. There is a difference between the nucleus and the cortical substance. C First, with regard to the kernel, or nucleus, we see that it becomes hard, dry, and brittle; in color, yellow, rusty, or yellow-brown, but still retaining a certain degree of transparency. If a cataractous nu- cleus is analyzed it is found that it is composed of concentric layers in which the several fibres cannot be separated from one another. If the nucleus is broken asunder, the fracture-surface is found to be ir- regular. Sometimes the lens fibres have become as if broken, and then an amorphous granular mass is imbedded in it, and this splits it up. The nucleus of the lens becomes broader and thinner the older the individual. In the débris of a cataractous lens there are found particles of fibres, molecules of fat, and cholesterin. The entire process, therefore, consists in a disintegration of the lenticular sub- stance with chemical changes, the lens at the same time containing less water; in fact, it is atrophy of the lens, starting originally from phakitis. There is at first a proliferation of the capsular epithelial cells, and these new elements drive the lens fibres asunder. Then these neoplastic cells degenerate, and thus render the lens opaque. (Tetzer.) I must pass over the various kinds of cataract, except just giving a list of them from Tetzer; their names are to some extent descriptive of them. They are: Cataracta accreta, aridosiliquata, capsularis, com- plicata, corticalis, cystica, fluida, glaucomatosa, gypsea, hypermatura, immatura, incipiens, intumescens, lactea, lenticularis, matura, mem- branacea, Morgagni, nigra, nucleolaris, perinuclearis, polaris, pyra- midalis, secundaria, simplex, spuria, traumatica, and zonularis. It must be obvious that many of these varieties can only be recog- 198 BURNETT'S ESSAYS. nized after the cataract has been extracted, so they will help us but very little in a therapeutic sense. I will revert to the Hahnemannic pathology subsequently. I have thus stated how I came to believe in the possibility of cur- ing cataract with medicines; then I have brought together a certain number of homoeopathic cures of cataract, together with the opinions of some eminent homoeopathic practitioners on the subject; after this I have given a very short account of the biology of the lens, and added thereto a rough sketch of its characteristics when diseased. Now I propose to take the reader for a little ramble into the gen- eral medical literature of the eye, and see what certain eye-surgeons say on the subject of the medicinal curability of cataract. After that I purpose giving my own further limited experience on the same sub- ject, and then I will conclude with a few observations and remarks on psora as bearing upon it. My object is to get and to give an all-round view of the subject, so that we may know the ground upon which we stand. CHAPTER IV. Ga Į FACTS AND OPINIONS CONCERNING THE CURABILITY OF CATARACT FROM GENERAL MEDICAL LITERATURE. MAY begin by saying that the great mass of oculists utterly ridi- cule the idea of curing cataract with medicines; they nearly all forget that no number of negative facts can do away with one single positive fact. Moreover they appear to ignore the very important point that they are incompetent to judge of the subject. Why? Be- cause they (as a rule) never try to cure cataract with medicines. If they were to do this in a careful, PERSEVERING, scientific way, for a sufficient length of time, with a sufficient variety and number of cases, then they could give an opinion on the subject that would be worth having. But this they have not done. I give them all honor for their surgical knowledge and operative skill, but I cannot see what they can possibly know about the curability of cataract with CURABILITY OF CATARACT WITH MEDICINES. 199 7 * medicines since they do not try to cure it medicinally. That they should just give—solatii causa—a tonic, or a bitter, or a little mer- cury (or much of it for the matter of that!) or iodine, cannot reason- ably be called a fair trial. The fact is, a dexterous operator cannot, in the nature of things, be ever a fair judge, inasmuch as his fingers itch too much for the knife, so that he has not the requisite patience in order to give medi- cines a full and fair trial. But to my task. 1. Carlsbad. It is an admitted fact that certain cataract patients who have gone to Carlsbad and used the waters have returned cured of their cataract. This is well known in the Vienna school, and not denied. Yet I never heard of a single Vienna oculist sending a pa- tient with cataract to Carlsbad with a view to its cure; I believe it never strikes them, so accustomed are they to hear that cataract can only be cured with the knife. 2. Tetzer says (p. 268), "It is very remarkable, but cataract does sometimes get well without operation." 3. Curtis (A Treatise on the Physiology and Diseases of the Eye, containing a new mode of curing Cataract without an operation; Lon- don, 1833), who was aurist to George IV., was very decidedly in favor of the medicinal treatment of cataract. Amongst the causes of cataract he reckons exposure to great heat, as cataract seems common to forgemen, glassblowers, and black- smiths; strong liquors; sour wines; rice diet; and sudden applica- tion of cold to the extremities. Speaking of cystic cataract, which is usually consequent on con- cussion, he says: "Cases of this kind, more frequently than any others, get well without an operation." Then, speaking of traumatism (p. 115), he says: "A spontaneous cure of cataract takes place in those cases where an injury which has caused the cataract has also so ruptured the lens and its capsule that its solution and absorption take place by the agency of the aqueous humor. In other more rare cases, where the lens has become de- tached from its connections in consequence of disorganization of the vitreous humor, and fallen from the axis of vision, a spontaneous cure has also happened. M. Boyer mentions an interesting case of a gentleman who, after twenty-five years' blindness, his eye having 200 BURNETT'S ESSAYS. $ been considered unfit for an operation, suddenly had his sight re- stored when walking along the street; the detachment of the lens above described having taken place at its upper half, by which it waved to and fro in the eye." He continues (p. 116): .. "The late Mr. Ware communicated an account of the dissipation of cataract to the Medical Society of London in 1789 and 1790; and in his Chirurgical Observations he states that, since the preceding communications were read to the Society, he had had occasion to attend a considerable number of cases in which an opacity of the crystalline humor was produced by violence done to the eye; and in most of these the opacity was dissipated, and the sight restored, during the external application of ether." His treatment consists in the use of alteratives, aperients, and then, "after the chronic inflammation is subdued, the 'cataract' is to be touched every morning with a solution of potassa cum calce, begin- ning with a weak solution, and increasing it gradually." He proba- bly means to touch the "eye," to stimulate it. He also made use of antiphlogistics and counter-irritants. He then says: "Some practitioners recommend that when a cataract is newly formed, we should wait until it is fit to be operated upon. On the contrary, I think we should use every means in our power to dissipate it as speedily as possible after it has made its ap- pearance." Some of this author's cases were evidently not cataract. 4. Jonathan Wathen (A Dissertation on the Theory and Cure of the Cataract; London, 1785), has no faith in the cure of cataract other than by operation, but quotes (p. 30) some few cases of spon- taneous cure. He also adds that he has reason to believe that some cases of incipient cataract have been arrested by the external applica- tion of electricity and ether, and at the same time taking the ether internally. 5. C. G. Guthrie, formerly Assistant Surgeon to the Royal West- minster Ophthalmic Hospital, in his work (On Cataract, etc.; Lon- don, 1845), says (p. 53): "It is a fact, however, that cures (of cataract) have been completed by the operations of nature," etc. Then again: The possibility of the recovery of the trans- parency of the lens after it has become partially opaque must be ad- mitted." 66 Also, speaking of his father (p. 51), he says: "Mr. Guthrie CURABILITY OF CATARACT WITH MEDICINES. 201 admits, however (our author is arguing against the curability of cat- aract by any then known medicinal means), that he has seen, in the course of his long experience in diseases of the eye, some very few cases in which incipient cataracts or commencing opacities disappeared in one eye after operating on the other, and in two cases after suppu- ration of the eyeball of the other eye from accidental causes." Finally (p. 52), “In some few instances the extraction of the cataract from one eye seemed to have caused the removal of the commencing opacity in the other; but in all these instances the opacity was never central, but was commencing from the circumference." It seems to me that the very unwilling admissions on the part of Mr. Guthrie, Sr. and Jr., are extremely important as demonstrating the possibility of a resolution of cataract by nature herself. And if unaided nature can sometimes do it, why not nature aided with ap- propriate remedies? The thought occurs to me, also, that the suppurative process may have afforded nature a means of ejecting some materies morbi, and this done, the remaining eye recovered in consequence. This idea is borne out in many of the cases treated homoeopathically. 6. I will next quote from A Treatise on the Diseases of the Eye, and their Remedies, etc., by George Chandler, Surgeon: London, 1780. On p. 164 is mentioned the case reported by Fabricius Hildanus, "of a cataract arising in one night's time from an incessant weeping for some days before." This does not seem impossible when we consider the etiology of some pathogenetic cataracts. On p. 165 he says: Dr. Buchan affirms that he has himself re- solved a recent cataract, by giving the patient frequent purges with calomel (we note the dictum of Boerhaave, cataractas mercurius sol- vit), keeping a poultice of fresh hemlock constantly upon the eye, and a perpetual blister upon the neck. Platner strongly recommends the juice of live millepedes. Sauvages extols the white henbane as a specific in this case. These are his words: "Usus extracti hyoscyami albi quotidianus, a triente grano incipiendo, et sensim augendo, quamdiu, nulla est œsophagi nariumve siccitas, est egregium et ferme unicum remedium quod cata- ractam resolvat, ut pluribus observationibus compertum habeo. Pres- 14 202 BURNETT'S ESSAYS. · : byter ea affectus in oculo dextro, post octo dies quibus hoc medica- mine usus est, quo intervallo, ad tria grana pervenit, jam minutos librorum characteres legere valet, qui prius non nisi maximos per- spiciebat; chrystallinus, prius albus, jam subcaeruleus evasit et sub- pellucidus, suffusio myodes qua laborabat evanuit, fames autem et somnus, prius languentes, vigent maxime. Ab hoc medicamine alumi vidimus a D. Coulas etiam curatum, cujus chrystallinus omnino di- aphanus evasit." We shall come to Hemlock again. 7. I go now to Leçons sur la cataracte professées à l'hôpital Saint Louis, par Em. Foucher. Paris, 1868, and read: Gentlemen: What are we to think of the medicinal treatment of cataract? In olden times they used to believe in the possibility of curing cataract by purely medicinal means. Goudret, in a memoir that he published in support of the treatment of cataract with revulsives, cites a certain number of cures. These cases of cure refer, no doubt (How do you know, M. Foucher?), to false or accidental cataracts in their incipiency. These opacities being almost always from an inflammatory cause, may be dissipated, as Mi- rault, of Angers, has demonstrated, by extinguishing with antiphlo- gistics and revulsives the inflammation that engenders them. Having made this admission to the partisans of the medicinal cu- rability of cataract, we may say that the tentatives still made by them every day to again render the crystalline transparent (How do you know, M. Foucher?), are fruitless. Within the last few years M. Sperino, of Turin, tried puncturing the vitreous body, but soon abandoned it. Can we stop an incipient cataract in its onward march? M. Cusco, in his researches on the nutrition of the crystalline, de- monstrated the intimate connection existing between the vitality of the lens and that of the choroid by showing that, "when the latter be- came morbidly affected the crystalline was modified in its nutrition and turned opaque. To arrest the progress and even the formation of cata- ract by curing the choroiditis was the practical deduction drawn from the ingenious discovery of M. Cusco. But, unhappily, we possess no efficacious therapeutic means against choroiditis." Then, according to M. Foucher, cataract is due to inflammation of CURABILITY OF CATARACT WITH MEDICINES. 203 → (6 So the choroid, and if we had any sure means of curing choroiditis we should at once arrest the onward march of every such cataract. we not only cannot cure cataract, but we also cannot cure an inflamed choroid, and so we are altogether helpless! Or shall we, perhaps, perform an operation for the extraction of the choroid?" Granted, that a regular panophthalmitis, in a dyscratic individual, is a terrible thing to deal with, still I cannot admit that we do not know how to quell an ordinary choroiditis. It is an odd choroiditis that will not yield to rigid diet, scientific homoeopathy, and hydropathy. The hy- dropaths tell many an instructive tale of "incurable" cases of oph- thalmitis that had gone on their weary months, aye years, with Nitras Argenti and Hydrargyrum cum―stupiditate. 9. My readers will remember that Conium maculatum occurs very frequently in the prescriptions of the narrators of the homoeopathic cures of cataract which I have given in a former part of this little work. If they possess Störk's monographs on Cicuta (ANTONII STÖRK, Medici Viennensis et in Nosocomio civico Pazmariano Physici ordinarii, LIBELLUS, quo demonstratur: CICUTAM non solum usu interno tutissime exhiberi, sed et esse simul remedium valde utile in multis morbis, qui hucusque curatu impossibiles dicebantur, Vindo- bouæ, 1760), they will see it was so used in pre-homoeopathic days, and that notwithstanding its "impossibility." Störk knew no im- possible in therapeutics on the ipse dixit of the superlatively sapient, who ween their own endeavors to be the full extent of the possible. Störk cured bona fide cases of cancer and cataract with Conium; of that there can be no reasonable doubt. If you doubt, my skeptic reader, peruse his books; they are about in old bookstalls. I will only give his cataract cases. The italics are mine. Casus Decimus Octavus. In viro quinquagenario, ex cataracta in ambobus oculis caeco, et in meo nosocomio ex acuta convalescente, pilulae hae (that is, of Conium) tantum effecerunt, ut intra duos menses non modo solus ambulare, sed et objecta, et colores potuerit distinguere. (P. 92, Cap. ii.) Casus Decimus Nonus. Virgini, 22 ann., ex incipiente in utroque oculo cataracta, visus adeo debilis factus est, ut jam citra summam adtensionem vix amplius ola incidere potuerit. 204 BURNETT'S ESSAYS. Ex usu autem harum pilularum intra binos et dimidium menses cataractae penitus dispulsae sunt, et visus adeo bonus rediit, ut jan fila per subtilissimarum acuum foramina ducat, et neat accuratissime. Dominus Leber hanc Virginem ad Illustrissimum VAN SWIETEN adduxit, ut Ipse historiam audiret, et videret effectum. I am specially glad Störk sent the girl to van Swieten, as we thus have the case verified by the highest mèdical authority then existing in Europe. In the Corollaria to the First Monograph, Cap. iii., Corollar. 14 et 15, p. 105, are these epitomes. 14) Visum, cataracta nondum in- veterata, demtum, quandoque restituit. 15) Incipientes cataractas aut solvit, aut earum progressum saltem impedit. 10. In the following year, 1761, Antonius Störk published his LIBELLUS SECUNDUS, quo confirmatur: CICUTAM, etc. We note from the title that from being only the Hospital Ordi- narius, he is now Imperial Court Physician in Vienna. On p. 154 we read: Casus Vigesimus Septimus: Operarius, qui ab anni fere spatio cataractam in oculo sinistro habuit solo usu ci- cutae et decocto bardanae spatio trium et dimidii mensium curatus est. Omni decimo quarto die datum fuit purgans. Per sex septimanas quotidie drachmam unam et dimidiam extracti cicutae assumpsit. Ultimo autem mensa drachmas duas. Usu cicutae hicce homo non tantum visum recuperavit integerrimum; verum et longe robustior factus est, et liberabatur simul a suis dolo- ribus rheumaticis quibus per totum corpus jam ab octo annis ad om- nem temporis mutationem excruciabatur. Possibly this additional information, relating to the collateral cure of this patient's rheumatic pains in the whole body, that he had had eight years at every change of weather, may sometimes be useful in the homœopathic differential drug diagnosis for the treatment of cataract. We cannot afford to do without the aids ex usu in morbis, especially on this comparatively new ground. In the Supplementum to the foregoing we read further: Corollarium Sextum. (P. 39.) Cicuta subinde fundit cataractas, aut eorum progressum impedit. Et hac ratione visum conservat, aut auget, aut perditum restituit. Störk's remarkable success with conium in cancer, scrofula, and į CURABILITY OF CATARACT WITH MEDICINES. 205 some of the worst forms of cutaneous affections is not a little note- worthy. 11. In Krebel's Volksmedicin und Volksmittel verschiedener Völ- kerstämme Russlands, Leipzig, 1858, p. 159, it is noted that, in certain parts of Russia, burnt sugar,* vitriol, and pounded glass are reputed remedies for cataract. The Grusians strew the powder of the kernels of a certain kind of cherry (die Cornelius-Kirsche) into the eyes for the purpose of curing cataract. Also in Russia they make use of the gall of the sturgeon and the gall and the blood of the partridge. Also an injection of a solution of soap. They likewise make use of the Succus Chelidonii majoris dropped into the eye. We have seen that Buchmann cites two cures of cata- ract with Chelidonium; Dr. Berridge's case has also been quoted, and likewise my own case. 12. Plenk in his Lehre von den Augenkrankheiten, Vienna, 1788, p. 197, says: Drugs are not often capable of curing cataract, but people have lauded the internal use of the extract of Aconite, of the black Pulsatilla, of the white Hyoscyamus, with Mercurius dulcis. The juice of Millepedes, and Theden's tincture of antimony. Thus I (Plenk) gave a man, who had a cataract of the left eye for three months, eight drops of this tincture night and morning, with such a good result, that already on the fourth day he could again dis- tinguish large objects. Cataracts due to a certain acridity seem more amenable to treat- ment, so I recommend you to try mercury in venereal cataract, the bark with Conium in the scrofulous, and in the arthritic the extract of Aconite with antimony. 13. I now pass on to the excellent work entitled, On the Cure of Cataract, etc., by Hugh Neill, Surgeon to the Liverpool Eye and Ear Infirmary, London, 1848, where may be read (p. 22) these words: "Cases, no doubt, .have occurred, but they are assuredly rare, in which Cataract has been cured by the use of drugs. Recourse may be had to such means at the beginning, where the object is,-to remove constitutional irritation, to restore the secretions, and to im- prove the tone of the digestive organs. Local applications, too, are of concurrent use." * We have seen that sugar causes Cataract. 206 BURNETT'S ESSAYS. 14. Victor Stoeber also observes, that in such cases antimonials, and affecting the system with mercury, is the practice of some;" and in addition to Aconite, Arnica, Belladonna, and above all, Pulsatilla, the last being administered in doses varying from five to twenty-five grains of the extract." (In Neill.) Then Neill adds condemnatory remarks, and concludes very char- acteristically in these words: "And as to Pulsatilla, whether exper- imented with in infinitesimal or less scrupulous doses, I equally recommend being left to an undisturbed place in the Quixotic Phar- macopoeia of Homœopathy." Now, above, the same writer says: "Cases, no doubt, have occur- red, but they are assuredly rare, in which cataract has been cured by the use of drugs." Hence it transcends my comprehension why the drug treatment of cataract should be condemned on the same page. Oh! prejudice, thy optic opacity is indeed a thousandfold worse than the hardest cataract, and oh! how senile withal. To purge such a visual ray would require more euphrasy and rue than could be found on the whole globe. 15. I might thus continue to multiply instances from ophthalmo- logical literature, but it would serve no useful end; so let me con- clude with the Treatise upon a New, Expeditious, and Safe Method of Treating Cerebro-Sensorial Affections, particularly Amaurosis and Cataract, by which the Cataract is removed Without Operation. By Louis François Goudret, London and Paris, 1840. Goudret gives some twenty cases of amelioration or cure of cata- ract without operation. They are for the most part undoubted cases of true cataract, and clearly demonstrate that cataract can be cured by derivatives, revulsives, and counter-irritants, and therefore with- out operation. His treatment is rough, painful, and slightly disfiguring, but it cures without operation, and better. It consists essentially in cup- ping, and the application of his ammoniacal pomade and some gen- eral treatment with diet. In cases in which homoeopathy had failed either wholly or in part, we might have recourse to it; and in those cases in which homoeop- athy had at first been beneficial, and then the cataract seemed at a standstill, I should not shrink from a trial of dry cupping and the gentle use of his pomade. Then would recur to the more radical and CURABILITY OF CATARACT WITH MEDICINES. 207 scientific homoeopathic treatment. And to give an occasional stir-up to a very hard cataract, Goudret's treatment might be useful. Having thus wandered a little in, and culled from, the literature of cataract, and considered also the nature and seat of the opacity and the histogenesis of the lens and of its capsule, it now only re- mains for me to give a little more of my own experience, which is neither special nor large, and then some general notions on its treat- ment, as they are present to my mind. CHAPTER V. TH HE following case is, I think, although not very successful, in- teresting: A lady, æt. 64, widow of a staff officer, has resided many years in India. She has cataract of both eyes these four years, worse of the right. Previously to the discovery of the cataract she had slept for four years in a room lined with arsenical wall paper. In this room she lay with diseased kidneys for nine months. She dreads an operation, and has already received mercury, iodide of potash, sulphate of zinc, and borax either topically or internally. The opacity of the right lens has a stellate appearance. There is constant and great photophobia, and much secretion and morning agglutination. The treatment was begun with Nux Vomica 3, and Sulphur 30. This was in June, 1876. July 22. Eyes more comfortable. To take Bell. 2, and Lith. Carb. 3 trituration. Sept. 12. General health decidedly improved. To bathe the eye- lids with a weak infusion of Calendula, and take Zine. Mur. 3. Sept. 30. Calc. Carb. 3 trit. Nov. 21. Sight and everything decidedly better. Arnica 6, and Gelseminum 6. Dec. 12. Santon. 3. Feb. 12th, 1877. Improvement in sight; can see better to read and write. Zinc. Cyan. 3. March. Euphrasia off. 9. 208 BURNETT'S ESSAYS. April 25. The painfulness after dinner and on first waking is gone. Sight better. On examining with the ophthalmoscope one can see only very slight opacity of left lens; that of the right is whitish and opaque in its upper and outer portion. Rep. and Phos., 30. June 5. More pricking in the eye and more secretion. Arnica Montana 9. July 5. Sight better, but pain worse. Glonoin and Euphrasia. Aug. 9. The edge of the opacity seems a little less defined. Acid. Oxal. 2x. Sept. 24. Eyes very painful. Calc. Mur., 30. Jan. 12th, 1878. Ferrum Phos. 6 trit. Feb. 7. Kali Chlor. 6 trit. March 7. Nat. Mur. 6 trit. April 10. Eyelids look much better, not being so inflamed, and the secretion is far less. Rep. May 15. Worse. Kali Chlor. 6. June 20. No better. Santonin, 3 trit. Sept. 25. Slight indications of gout in big toe. Nat. Mur. 30. Dec. 28. No better. Puls. Nutt. 1. Feb. 5, 1879. No better. Aurum fol. 1 trit. March 11. Eyelids dreadfully bad; they smart very much, as if they contained pepper. Zine. Sul. 3 trit. April 25. Eyelids as sore as ever. Lith. carb. 3. May 29. Cale. Mur. 30. July 12. Eyelids better. Elaps. Cor. 6. This is the sum of three years' treatment, and is certainly not very encouraging. Still, I think the cataract is arrested, but the eyelids continue very troublesome. I intend next trying a high dilution of Arsenicum to see if it will antidote the old arsenical poisoning which persistently resists medica- tion, and the locus minoris resistentiæ once established by the arsen- icism seems fed by the gout. Could the chronic arsenical ophthalmia tarsi be got rid of, and some good reaction to the periphery be ob- tained, a good result may yet be looked for. Patient's general health is very good. I give this case to show the immensely difficult task before me, S · F CURABILITY OF CATARACT WITH MEDICINES. 209 and to try to get at the real truth, since I am neither desirous of de- ceiving my own mind nor the minds of others. My next case was an aged lady treated at the Wirral Homoeopathic Dispensary; I gave her many medicines during a considerable period, and did her no good at all. } OBS. IV.-Mrs. æt. 66, came first under observation at the beginning of March, 1877. For eight years previously her sight had been failing, and twelve months before coming from Scotland to consult me, she was examined by Dr. Argyll Robertson, of Edin- burgh, who diagnosed double cataract, that of the left eye advanced, and less so that of the right. She has an elder brother with cataract that began at about the same age as did hers. She has photophobia; great dimness of vision; objects do not seem distinct; cannot see anything at a distance; things at times ap- pear double; her dimness of vision is unquestionably increasing. I examine the eyes with the ophthalmoscope and note that the opacities are stellate in both eyes, that of the left much larger. Pu- pils react well to light; very slight arcus senilis; is breathless on going upstairs; suffers from flatulence; flushes readily; gets severe spasms at odd times over the stomach; has had erysipelas of the head and face six times, the first time more than forty years ago, and the last time three or four years ago; has hæmorrhoids; often gets indi- gestion. R. Te. Aurum Muriaticum 3x. One drop at bedtime. April 14. Better in general health, but the eyes are no better ex- cept that work does not strain them so much. R. Glonoin 2 and Iodium 2. May 16. Still better in general health; fancies she sees better. To continue the medicines. June 14. "I am thankful to say I do feel a shade of improvement in these bright sunny days. I used to feel the sunshine very blind- ing; but within the last fortnight I have felt my vision clear for distant objects." To continue the medicines. September 1. "I feel thankful to say I do feel a shade better, can discern objects more clearly." To continue the medicines. 210 BURNETT'S ESSAYS. October 24. "I am not sensible of further improvement, but am better in general health." R. Hydrastis Canadensis 1*. November."6 about my eyes-I am thankful to say I feel a little improvement, objects are clearer." To continue the medicine. January 16, 1878. Much the same. • ; B. Ferrum Phosphoricum 6 trituration. Six grains night and morning. March 9. Has been reduced by a bad attack of bronchitis. R. Acidum Nitricum 1. Three drops in water three times a day. April 26. "I feel my eyes stronger; the improvement in my sight is apparent." To continue the medicine. May 22. Much the same. July 3. No worse. B. Santonin 3 trit., grana vj. September 20. "Have taken two lots of the powders (= 72); no change. But after I had taken some seven of the powders AN ERUPTION CAME OUT ON MY ARMS AND SHOULDERS." Natrum Muriaticum 6 trit. R. Tc. Pulsatilla Nuttaliana 1. Two drops in water forenoon and afternoon. December 13. "I have continued the 'drops,' which I procured at Mr. Pottage's in Edinburgh, and am glad to say they have done me good; I do feel less of dimness and see things clearer than for some time previous. . . . . I do feel hopeful that the cataract is being checked, as I am feeling my sight better than it was six months ago.-P. S. My general health is very good: I have scarcely had a headache since I came under your treatment." To continue the medicine. February 17, 1879. Is continuing to improve, but reminds me that she is very deaf these many years. R. Tc. Elaps. Cor. 6. April 22. “I am glad to say the drops have really done me good ; my eyes seem clearer and I am quite sensible of improvement. Shall be in Edinburgh next week, and can get what you prescribe while there from Mr. Pottage. We have had a very severe winter, but I CURABILITY OF CATARACT WITH MEDICINES. 211 have kept well, and the longer experience makes me more convinced that the homoeopathic medicines agree very well with my constitu- tion." To continue the medicines. June 27. "I have again exhausted my little bottle I got filled when in Edinburgh, and feel thankful to be able to say my eyes are wonderfully improved; I am more sensible of this by the last medi- cine than I have felt by former drops or powders, and my constitu- tion seems in good order considering my years." To continue the medicine. September 5. "It is two months since I wrote to you; my eyes are wonderfully improved, sometimes I can read a little without the aid of my spectacles; I feel my constitution to be in a very healthy state; I am free of all headaches, and stomach and bowels in good order." As this lady has been taking medicines now for about two years and a half, and is so well in her general health, and the sight evi- dently not only vastly improved but still improving, I advise absten- tion from all medication for a time. C I have given the extracts from this lady's letters, and thus my readers can judge for themselves. I have not seen her since the commencement of the treatment. I call attention to the appearance of the eruption, to the lady's age-now nearly 69-to the fact that her brother has also cataract, and to the vast improvement in her general health. Cataract is a constitutional complaint, and we must treat the person, not the cataract. Thus in this case my first prescription was given for the heart symptoms, and it is very evident that the Aurum really benefited the heart, and that was the first step up the therapeutical ladder. As far as I know, an advanced cataract, of eight years' growth, does not thus behave between the ages of 66 and 69 when let alone. November, 1879. The report runs: "My breathing is no better, my eyes continue well, my sight is wonderfully strong.” but OBS. V. Gentleman of high position, 59 years of age, has cata- ract of right eye, left eye doubtful; his mother had double cataract; 47 years ago an apple hit his left eye and permanently injured it; thus more work has been thrown on right eye. 212 BURNETT'S ESSAYS. When looking at the moon or a candle, he sees a disk of red. May, 1877. R. Arnica Montana, 1. June 20. Has an impression that the left eye (which was injured) is a little improved. To continue with the Arnica. This gentleman did not consult me again; he seemed vexed because I would not give him any positive prognosis, and announced his in- tention of going to his eye surgeon again; and, as I know the latter spends his spare time in laughing at homeopathy, there is no diffi- culty in guessing the result of the interview. I never give a positive prognosis as to the curability of any given case of cataract, as I have no sufficient data to go by; I simply say, Try, and if we fail you can still have recourse to an operation. OBS. VI.-Maiden lady, æt. 49, came under treatment on January 13, 1878, for cataract. Had taken a great deal of Platina, 3x in 5 grain doses, night and morning, for many months! The first day of taking it, it gave her a congestive headache. This I mention, as it may have had something to do with the lenticular opacities. Her symptoms were these: Both upper lids swollen, the left worse; the right eye was the first affected, and is, perhaps, the more misty of the two, but in the left eye there is an appearance of white trans- parent threads, and when inflamed, a crescent-shaped band, like a flame, seems to cross it below the lids, but does not remain; the eyes are often inflamed, especially the left one; there are heat, soreness, and sometimes itching; the eyes are better at the seaside. R. Ferrum. phos, 6 trit. In 6 grain doses, three times a day. Feb. 10. "Have felt stronger; the bowels more regular the first week, but less so the week following. The halo I used to see around a candle-flame has almost disappeared, but seems to have given place. to a somewhat greater mistiness; there is also less dread of light, less aching, and less inflammation, so that on the whole the eyes are decidedly stronger." R. Trit. 6 Nat. Mur. July 5. "My eyes are much stronger and better in every way." Pergat. CURABILITY OF CATARACT WITH MEDICINES. 213 66 August 5. Altogether I am in much better health; the eyes are much stronger; can see distant objects better." She perspires a good deal in the head. B. Calc. Carb. 6 trit. She subsequently informed me by letter, that her vision was very materially improved; she could see distant objects better; from her sitting-room window she could clearly distinguish objects far down an opposite street. She is not desirous of further treatment. OBS. VI.-Case of cataract in an elderly, gouty gentleman, in whom the Iodide of Potash A trit. has decidedly improved the sight. He is still taking it. OBS. VII.-Case of cataract of both eyes in middle-aged gentle- It began three years ago. man. General Symptoms.-Great liability to catch cold; considerable lachrymation; profound sleepiness after dinner; dry pain in eyes. These symptoms determined me to give him Natrum muriaticum, 6 trit., 6 grains in water twice a day. All those symptoms promptly disappeared, and he continues to take the medicine these many months on his own responsibility; hence it may be presumed that he is getting better. OBS. VIII.-Young lady, about 25 years of age, double cataract these three years, perhaps congenital; the right eye has been pricked by Dr. General Symptoms.-Perspires in the hands a good deal; menses scanty, slightly painful; renal sphere normal; alvine function tardy ; hands and feet go to sleep, dead, yellow, numb. R. Pulsatilla Nuttal. 1. Three drops in water, three times a day. This was in September, 1878. Oct. 18. Bowels now quite regular; perspires less in hands. Pergat. Nov. 28. Hands do not often perspire now; sight in statu quo. R. Puls. 3. Dec. 30. Headaches better; menses more free than formerly. R. Pil. Sul. 30. 214 BURNETT'S ESSAYS. Jan. 30th, 1879. No difference, except that her headache is worse. R. Cina Anth. 1. February 26th, 1879. "Stronger and stouter than before treat- ment; mamma and my sisters think I can see with the affected eye better than I could, but I feel doubtful of it myself." To continue the medicine. R. Cina Anth. 1. April 15. "Can see to read better, but cannot see any better at a distance; the operated eye is not so serviceable as it was." To continue the remedy. June 20. "Do not know whether it is the clear sun or the medi- cine, but I see better; I am afraid it is the sun; my general health is now perfect." R. Trit. 6 Calc. Fluor. August 1. No further change. R. Pil. Silicea Terra 30. grindy Continues under treatment. This case looks promising, but time must show. OBS. IX.-Lady, married, 38 years of age. HISTORY. Has lived a number of years in South America, and there suffered from inflamed eyes. Returned to England in May, 1876, after an absence of twelve years. On returning consulted Mr. Shadford Walker, of Liverpool, for the inflamed eyes; he examined the eyes with the ophthalmoscope and found cataract of right eye. He cured the inflammation and said the cataract must be left alone. Saw Mr. Critchet at the beginning of August, who said it would probably progress very slowly. Has been under Dr. Drysdale, of Liverpool, with benefit for her general health. PRESENT STATE. Left pupil larger than the right; has always been weak in the right side of the body; there is opacity of the right lens, though not very extensive. She cannot see well; has always been myopic; wears glasses; cannot see so well with the right eye as with the left; has always a mist before the right eye. Has considerable pain in the right side for the past twelvemonth; before that, suffered for a year from dysentery; pain in the right hip; CURABILITY OF CATARACT WITH MEDICINES. 215 pain also in and around the right ovary. Menses rather too frequent; is very slightly hæmorrhoidal; ankles swell towards night, the right one more than the left. nium. R. Tc. Chelidonium Majus 3. November 18, 1876. No change. To go on with the Chelido- November 23. The pain in the right side is very much better; it is worse when she breathes; suffers very much from heartburn. R. Tc. Phosphorus 1. December 8. Much better in general health; the pains in the right hypochondrium, right hip, and right ovary, very much better; she feels stronger. R. Trit. 3 Natrum Sulphuricum. January 9, 1877. Still has pain in the right side, but it is less severe; the right eye very uncomfortable; dreadful heartburn; is very cold; worse in wet weather. R. Trit. B. Iridin. February. Is now quite well in general health, but the mist before the right eye is no better. R. Trit. 4 Acidum Oxalicum. April 27. Feels tolerably well; eye no better. At times gets acute attacks of pain in the right side. Is recommended at such times to take the tincture of Chelidonium 1. B. Tc. Euphrasia 6. June 20. The eye is worse, it feels uneasy, and is getting more dim; the pain in the side very bad; mouth dry and parched; tongue cov- ered with a thick orange-colored fur. R. Trit. B. Iridin and Phosph. 1. July 24. Eye better; many symptoms of the hydrogenoid constitu- tion. R. Trit. 5 Natrum Sulphuricum. October 24. The urine is very turbid; there is very much pain in the uterine sphere. R. Tc. Solidago Virga Aurea 1* and Te. Viburnum Opulus 1. 216 BURNETT'S ESSAYS. May 28, 1878. The eyes water a good deal. Natrum muriati- cum 30. June 15. Pil. Sanguinaria Canadensis 6, one before each meal. About this period, but whether before taking the Sanguinaria or after, I unfortunately cannot ascertain, AN ERUPTION CAME OUT ALL OVER THE BODY, IN PATCHES, ITCHING VERY MUCH, Worse on the inside of the thighs, legs, and arms and chest. It was an erythema- tous eruption and lasted only a few days. August 14. Natrum Sulphuricum 4 and Pil. Calcarea Carbonica 30. March 4. 1879. The pain in the right side is now observed only at rare intervals; eyes decidedly better; the lower lid of the right eye twitches a good deal. To take Dulcamara 3. Four drops in water at bedtime for two months. After writing this prescription, and while engaged in some general conversation, I noticed that my patient's eyes watered a little, and that she used her handkerchief to wipe them. There was no epiphora, but the eyes seemed to get brimful, and that apparently caused her to desire to clear them; perhaps the fluid interfered with vision. This lady had read, or heard about, my little monograph on Na- trum Muriaticum, and was telling me of a friend to whom salt is a positive poison; I then said, "Are you fond of salt?" and learned to my astonishment that she was extremely partial to it, being in the habit of putting salt into her drinking-water after sweet pudding! She also informed me that her tears were very salty. I then remarked that salt had been known to cause cataract in some of the lower animals, and recommended only a moderate use of this condiment. I did not see this lady again till the 21 of September, 1879, and then only casually, when she informed me that the haziness be- fore the right eye disappeared six months or more ago. Now she sees quite clearly with it, the only difference between the two eyes being that on closing the left eye and looking with the right one, and then reversing the process, she notices that she can see more distinctly with. the left one, but she remarked that that had always been the case. The eyes do not water, and there seems no reason to continue the treatment, as patient complains of nothing and looks exceedingly well. There was no time to make an ophthalmoscopic examination of the eyes CURABILITY OF CATARACT WITH MEDICINES. 217 as she was hastening to catch a train, but she has promised to call at her convenience to enable me to do so. If she calls before this goes to press, I will add the result. But as the haziness was no doubt caused by the cataract, and as the haziness is gone, it is pretty sure that the cataract has likewise disappeared. With the naked eye, one can detect nothing abnormal. It will be noted that the treatment began in October, 1876, and I may add that it was continued under the most unfavorable circum- stances; nursing sick relations and severe pecuniary losses from an earthquake in South America, circumstances tending to lower the vitality, and therefore not conducive to therapeutic success. With this I close my record of cases for the present. Now I will merely add a few remarks on Psora. CHAPTER VI. PSORA AS BEARING ON CATARACT, FROM A THERAPEUTIC STANDPOINT. TH HE expression Psora means different things to different minds. In the Hahnemannic historico-pathological case-taking it plays a most important part. Here its true appreciation is of the utmost significance and incalculable range. Psora may not, perhaps, express an absolute truth, but it is of ex- treme practical worth. It must not be regarded as synonymous with the acarus disease, although it may be, possibly, included in it. As far as I understand the subject, it has not any more to do with scabies than with eczema, psoriasis, rhagades, phthisis, or cancer; but psora is the soil in which these weeds thrive, the psoric individual is their appropriate host. Those who ridicule the Hahnemannian doctrine of psora, believing it to be synonymous with the acarus malady, are right and wrong: right in refusing to subscribe to the teaching of such identity merely, but wrong in supposing that Hahnemann ever taught so. At least I cannot see that he does so in the original. 15 218 BURNETT'S ESSAYS. The mucous membrane in its entirety and the common integument must be looked upon as homologous: what is on one to-day may ap- pear on the other to-morrow, and conversely. Metastases from the one to the other are most frequent. Both are dermoido-epithelial structures; and, for me, psora means a constitutional crasis that man- ifests itself as a disorganization of some portion or portions of these homologous structures, whereby we may have ITCHING when it is on the outside. We have seen that the lens is differentiated skin, a dermoido-epi- thelial structure; and hence cataract may well be conceived as being a metastatic, or primitive, psoric expression. This I conceive to be the Hahnemannic Pathology and Etiology of Cataract. On this line cataract Is curable with medicines. Further, I submit that this is pretty clearly demonstrated in quite a number of the cases of cure that I have cited and narrated. It is vague, I admit; neither would I maintain that it is an absolute truth; it certainly requires reading of books and of nature, and some reflection withal. But the willing mind, with fertile receptivity and docility, may in this wise get behind, and beyond, and under many otherwise inscrutable forms of disease, and he will be thus often enabled to cure what, from any other standpoint, seems hopelessly incurable. It would lead me too far (and this is not the place), were I to at- tempt to follow this up and to elaborate it. À une autre fois. I have, myself, obtained more insight into the doctrine of psora in working at this "Curability of Cataract with Medicines" than I ever before could; the light-crepuscular only as yet-is, nevertheless, better than the darkness of despair. "Censeurs savants, je vous estime tous; Je connais mes défauts mieux que vous." THE MEDICINAL TREATMENT OF DISEASES OF THE VEINS, MORE ESPECIALLY OF VENOSITY, VARICOCELE, HÆMORRHOIDS, AND VARICOSE VEINS. "Nisi utile est, quod agimus, vana gloria nostra." HUFELAND. 糖 ​PREFACE. THIS little book is not a complete treatise on the pathology and therapeutics of diseases of the venous system, but comprehends merely my own experience (Part I.) in the MEDICINAL TREATMENT OF DILATED VEINS in various regions of the body. Nevertheless, it is hoped that some few practical hints herein con- tained will be of interest and clinical value to others who may wan- der the same way, and to make it more useful to such, the Second Part contains indications for about fifty remedies likely to be useful in varicose conditions. The more I learn of practical medicine, the more I am impressed with the wise words of Fernelius .... Nulla Nulla usquam est remediorum penuria, sed nostra eorum plerumque turpis ignoratio. Verily, rem- edies are a great deal more than mere "aids to faith in the weary time." 5, HOLLES STREET, CAVENDISH SQUARE, LONDON, W., October, 1880. · J. C. BURNETT. ⭑ 4. 3 THE MEDICINAL TREATMENT OF DISEASES OF THE VEINS. PART I. WE HEN a man comes forward with a proposition not generally received by his fellows in his own walk of life, it behooves him to proceed inductively and independently. If he does this he is pro- ceeding scientifically, and trained minds, not being overladen with prejudice, soon know where they are in dealing with his proposition. Experience proves that a proposition may be demonstrably true, and that it may yet meet with only a very limited acceptance; especially is this the case with new truths, and truths that involve unpleasant consequences. And when a person has once committed himself, once taken sides, he is very apt to go on thenceforth forever-for his ever—from the standpoint of a parti pris. Most medical men are pretty well agreed that Diseases of the Veins are not amenable to drug treatment in any important degree. I refer more especially to general varicosis, hæmorrhoids, varicocele, and varicose veins. These affections are therefore relegated to the domain of the surgeon; and, no doubt, the surgery of the veins- particularly of hæmorrhoids-is now nearly perfect, being nearly bloodless and painless. That is very beautiful, and a matter of sin- cere congratulation for us all. It being pretty well perfect, the question may not unreasonably be raised. . . . Is surgery, then, the ONLY crutch to rely upon; has medicine nothing to say to the behoof of healing affections of the veins? 222 BURNETT'S ESSAYS. May not venous subjects fairly say to the physicians: What have you all been doing the past two thousand years; have you not, with all your learning, vivisections and mortisections, poisonings and drug-provings, and your never-ending ransacking of all creation for new remedies; have you not herewithal been able to hit upon some gentle innocuous means of bringing back a few dilated veins to their normal calibre? And would they be so very far wrong, if, individually, they were to continue in some such a strain as this What use is it to me, with my baggy veins, that you dub them with big names and learn- edly talk about hæmorrhoids, with hypertrophy of surrounding con- nective tissue, varicocele, varicose veins, varicosis, and all that, if I am merely an object of study for you, and my miseries only so many classes and sub-classes in your nosological natural history; and, hav- ing duly and scientifically classified my peccant parts, you bow me out with a placebo and show me thereafter the way to the amphi- theatre? But, then, this is not a thinking age for the many; only a few, in the present hurry and flurry, and race after riches, can find time to go after " a more excellent way." Oddly enough, the art of healing, pure and simple, is not in great repute nowadays; indeed, it is almost a reproach to fling one's self body and soul into the business of healing, and herein try to do bet- ter than one's father did. Nay, it is even dangerous for a man of good repute to strike out a new path in therapeutics, and try to cure what the solid phalanx of an ancient trades-union has ever held to be incurable; if he do, he will infallibly be looked at askance, and no one will thank him, while many will seek to deride and vilify him. The reason of this lies largely in the history of medicine and mankind; bad ware has been so often brought forward as good that no one may be much blamed for looking with some suspicion on all new notions. Now, I am coming forward with the thesis that atonic dilated veins may, in many instances, be made to shrink to their original size by the proper use of medicines, administered internally and aided by certain auxiliaries,-in other words, varicosis, hæmorrhoids, va- ricocele, and varices are amenable to drug-treatment, and therefore surgery, in this department of diseases of the veins, is to be super- PC MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 223 ! ว seded by medicines. Surgeons will no doubt object to being thus ousted, and will probably not fail to vent their wrath upon me. Good, my ireful brethren, you have done that before in another sub- ject,* and yet truth is gaining thereby, and a certain step in advance has been made. Of course you will perceive that neither there, nor here, am I orig- inating anything; I have merely been sitting at the feet of Hahne- mann, and have come out to do battle for his great truth. In the sincere hope that some truth-loving and truth-seeking brother may read this, and be desirous of seeking the path I have wandered, I will give it step by step, just as I have come. It is an honorable path, wherein walk many good men and true, who are striving to make the physician's business one of healing the sick, citò, tutò, et jucunde; the path is not easy to travel, neither is it always daylight therein, but it has just one safe and sure hand-railing run- ning along it from end to end, and that is . . . . the LAW OF SIMI- LARS. There are other guides, but they do not go all the way; they are only here and there, so we will, in the following pages, just hold on to LIKE CURES LIKE. We are the more constrained to do so, as we know no other safe guide in therapeutics. The surgical treatment of diseases of the veins may be reduced to three fundamental parts: Local astringents; pressure, by way of support; and the so-called radical operations of the knife, or its equivalent. • • • GENERAL VARICOSIS eludes the surgeon entirely, for surgery must necessarily be only local. But when we have to deal with such local manifestations of varicosis or venosity, the scholastic physician forthwith hands over the case to the surgeon for operation, or for surgical appliances. Thus with HEMORRHOIDS: The physician gives his aperients, with perhaps a local astringent, and gradually the state of things gets worse, and then the patient learns that there is nothing for it but a surgical operation. What a terrible prospect, even in these days of perfect anæsthetic and antiseptic surgery. Apart from the ultimate effects of shock-a thing no one seems to take cognizance of cutting off the piles cannot, as a rule, reasonably be called curing. And this shock to the whole economy, arising from an operation for piles, tells its tale for many a year afterwards, * ( Curability of Cataract with Medicines." 224 BURNETT'S ESSAYS. indeed, the sufferer often never recovers from it entirely. If we fol- low Hahnemann's method of historical case-taking we see strange things, as to the really primitive causes of disease. In my own prac- tical experience I trace cases of diabetes and cataract to the surgical traumatism in operating for piles. But more of this anon. Again, with VARICOCELE: This is held to be entirely within the surgeon's domain. I well remember the first case I ever saw was in one of the clinics in the Vienna General Hospital. It was an exqui- site case, and the subject an individual of about 25, suffering really from general varicosis, but this condition was most pronounced in the spermatic veins from evident causes. Our genial and much-be- loved teacher said to us . . . "There is nothing for it, gentlemen, but the radical cure." I inquired what the "radical cure" was, and learned, of course, that it meant a surgical operation. That is still the orthodox teaching, but it is as false as it is cruel, and as shallow as it is false. A merely surgical cure is no real cure at all, and in its very nature cannot be radical; better than nothing, no doubt, and often nearly as good as a cure, but still not a healing, in its true sense. - Finally, with VARICOSE VEINS: The scholastic physician has · here nothing whatever to say, beyond recommending his own favorite elastic stocking maker. The surgeon comes in to treat any hæmor- rhage that may eventually occur from a ruptured vein, or to treat the varicose ulcers or bad legs. All mere patchwork and cobbling, if nothing more be done. But if we are to relegate the simple surgical treatment of vein dis- eases to the lumber-room, what is to take its place? The answer Scientific medicinal treatment, and in therapeutics that means specific constitutional (homœopathic) treatment; for science in thera- peutics and homoeopathy are synonymous terms. The first time I became aware of the fact that the veins could be specifically affected with medicines at all, was in reading a book by Dr. Richard Hughes, entitled A Manual of Pharmacodynamics, that was a new revelation to me in so many ways. It has been called Homœopathic Milk for Allopathic Babes;" it would be a good thing for the world if the allopaths would but partake freely of this precious milk. However, there is one condition absolutely necessary to its digestibility, viz., the allopathic babe must have a clean tongue, (6 MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 225 : ? 7 and a stomach that calls loudly for healthy therapeutic food, or it will disagree with them. For, if his tongue be coated with crass prejudice, and his stomach gorged with medical conventionalism and scholasticism, he will be unable to take it up or assimilate it. And if he cannot bear the milk, how is he to partake of the more solid food of the Organon. Well, the special article I refer to is that on Acidum fluoricum, which to me, then, was an altogether new and un- heard-of remedy. The part that so impressed me runs thus: "Under its use whitlows have been blighted; fistula-lachrymal and dental- have healed; varicose veins have shrunk to half their size; fresh hair has grown on a bald head, and moist palms have regained their healthy dryness." This was good seed sowed, and it has borne much good therapeutic fruit in my subsequent professional life. An exquisite case of Alo- pecia areata recovered so completely, under the prolonged use of Acidum fluoricum, that a long-worn wig could be put off. This was observed by me while house-surgeon at the Hardman Street Homo- opathic Dispensary in Liverpool; and it was there, too, that I first had an opportunity of testing this remarkably bold assertion of Dr. Hughes, namely, that varicose veins would shrink to half their size under the influence of fluoric acid. THE LAMP-LIGHTER'S CASE OF EXCESSIVE VARICOSITY OF THE LEFT INTERNAL SAPHENOUS VEIN. A middle-aged man, by occupation a lamp-lighter, came under ob- servation at the Dispensary for an enormously dilated vein of the left thigh. At its highest and largest end, just where it dips down to the femoral vein through the saphenous opening of the fascia lata, it was as large as a child's wrist; and near the knee about the size of a man's little finger, so that there was no inconsiderable danger of its rupturing and causing dangerous hæmorrhage. It was not the local expression of general varicosis, but arose from a mechanical obstruc- tion in this wise: Patient had sowed his wild oats lang syne, and as part of the harvest had reaped a big bubo in the left groin. This had sloughed, and been burned with a strong acid, and there resulted as scar, a cicatricial surface of the size of a man's palm, and this scar- tissue in contracting had very much narrowed the entrance of the long saphenous vein, through the opening of the fascia lata into the deeper-lying crural vein. Then, in those days, lamp-lighters used 226 BURNETT'S ESSAYS. to do their work with the aid of light ladders, and were in the habit of sliding down them scores of times a day, and thus the vein, that had become dilated from the lateral pressure of the venous blood, coursing up the saphena, having such a contracted entrance, became still more disturbed in its function; hence the enormous dilatation. Patient received Acidum fluoricum 6 in pilules, and was directed to take one four times a day, and come and report himself every fortnight till further orders. This he did for several months, with the result that the enormously dilated vein shrank to about one-third of its original size, and this notwithstanding patient's continuance at his usual occupation. No auxiliaries and no local applications or appliances were used, and the diet was not altered. When I saw him last the varicosis had ceased to be of any inconvenience; it was no longer dangerous in anything like the same degree, as the vein felt firm and strong. Considering the irremediable mechanical hindrance at its inlet, the result seemed to me so striking, that I have ever since gone in very strongly for the medicinal treatment of varicosis under all circumstances, and the satisfaction one has in such medicinal treat- ment is truly great. * * * * It is not medically orthodox to believe in the amenability of Dis- eases of the Veins to drug treatment, and my own medical education having been ultra-orthodox, I thought it would be only fit that I should show what led me away from the generally received notions in this regard. This I have done in the foregoing, and the question may now be fairly put to any candid medical mind. . If a greatly dilated, long saphenous vein, whose inlet was considerably narrowed, could be so materially modified in its physiological life by internal drug treatment alone the mechanical hindrance at the inlet still re- maining—is it not at least probable that many other forms of vari- cosis would likewise yield to properly chosen remedies? That such is the case, I shall now proceed to show. Before doing so, however, it might not be amiss to state that this notion has not originated with me or with Dr. Hughes; this genial writer was my immediate de- vancier, and until I read his article on Acidum fluoricum, I had never even heard that anyone ever attempted the medicinal cure of varices. Since then, I have, of course, become fully aware that the thing dates back to Hahnemann and others, and that capable homœopaths * MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 227 SIGINTIP VAATA KOLAM NEW, Damentari Si Y, have herein followed in his wake for a good half century; careless homœopaths, however, often decline the bother and trouble conse- quent upon the acceptance of the dogma that vein diseases may be cured with medicines, more especially since the surgery has become almost painless by reason of the anaesthetics, and bloodless, by means of the neat, elegant, and effective surgical proceedings at the opera- tions; more particularly is this the case with piles. Yet, even here, how much is a kindly, gentle, medicinal cure to be preferred! Far be it from me to detract from any honor due to my surgical brethren nay, I am free to admit that, had my hand possessed the chirurgical cunning that lies in theirs, I should no doubt have also suffered from the surgeon's itch, and I may never have had the patience to try medicines as I have done, in the very worst forms of piles and other varicoses, and thus finally triumphed, to my own intense satisfaction. Necessitas non habet legem, and moreover she is the lawful mother of invention, as we have it in our own vernacular. While giving, therefore, all due honor to surgery, I must call very special attention to what may be termed . . . CHRONIC CHIRURGICAL TRAUMATISM. As far as I am aware, I have never read anything about this very important subject in any books; what I think I know thereon has been read in nature's ever-open book, that comes to us page by page, word by word, and letter by letter, in the form of living human beings that are technically termed patients. I am not referring to ordinary traumatism, nor yet to surgical shock, but to the chronic traumatism that is caused by the surgical operation per se-here for piles more particularly-and which gives an impression to the organ- ism that becomes chronic, and whose effects are seen years and years thereafter. And I do not think the traumatism is one whit the less for the anaesthetics; so that whether a patient feels any pain at the operation or not is, in the present sense, quite a matter of indifference. I could offer a good many proofs of this proposition, did space allow; but let us at least think over the matter a little. To begin with, traumatism is admitted when it arises from contretemps in ob- stetric practice; and no one of experience will be disposed to deny it when ascribed to blows, falls, railway accidents, and the like. This is so well recognized in homoeopathic practice that many successful 228 BURNETT'S ESSAYS. cures have been wrought by falling back on the traumatic etiology of, may be, twenty or more years ago. What made me first think about it was the very frequent observa- tion, in taking the cases of cataract* patients, that operations for piles were so often a part of their life history. It could not be accident or mere coincidence, I thought; if mere coincidence, it is, to my mind, very strange. Thus I am at present treating a patient for diabetes mellitus, and the whole of her almost hopeless case-she is a veritable sugar-maker en gros-points unmistakably to the traumatic origin of her com- plaint, the trauma being an operation for piles. Ophthalmologists are in no doubt about cataract being often due to blows and injuries; indeed, traumatic cataract is a recognized va- riety of that distressing affection. When we consider the exquisite sensitiveness of the rectum, and its extreme tenderness and resentful- ness of foreign interference; when we remember the hyperesthesia of the parts in a bad case of piles-let sufferers from piles say whether the rectum is a sensitive part!-there is, to say the least, nothing against the hypothesis that an operation for piles may, and does, make an abiding impression upon the organism that may years thereafter culminate in serious organic mischief. Still, I have not arrived at this conclusion from a priori reasoning, but induce it from observa- tion in actual cases. We need not enter into the matter any further here, as we are now concerned with the medicinal treatment of diseases of the veins, and to follow out the subject of chronic chirurgical traumatism would be digressive; I merely mention it parenthetically as it were, and com- mend it to the consideration of those whose refuge is the knife. GENERAL CONSTITUTIONAL VENOSITY. There are certain subjects whose venous systems are exceedingly prone to ail; if they have anything wrong with their hearts, it is pretty sure to be the venous side of it; if they get dyspepsia, it arises from congestion of the portal system of veins; if they suffer from headaches, it is from venous stasis; if they get constipated, piles de- * Operation for cataract has been known to be soon followed by complete loss of speech and memory. MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 229 $ velop at once; if they stand much, or wear a tight garter, they get varices of the legs; if the uro-genetic system gets irritated or injured, and fails to get tone-giving natural relief, they have varicocele, or menstrual troubles from dilated veins of the ovaries and broad liga- ments, as the case may be. They are constitutionally venous, and suffer from passive congestions at all turns. Such a one was the fol- lowing: CASE OF GENERAL VARICOSIS, VARICOCELE, AND VARICOSE VEINS. A gentleman about thirty years of age came under my observation on October 17th, suffering from chronic prostatitis, varicocele, and varicose ulcers of the legs. At a glance one could see that he was a venous subject, as he was swarthy, pensive, and melancholy, and had long, slender limbs. Almost every region of his venous circulation showed signs of dilatation, having an enormous left-sided varicocele, and very pronounced baggy varices of the legs. His internal saphe- nous veins were like big ropes. Around his left ankle were varicose ulcers, and the whole neighborhood around was very dark, almost black in places. He stated that this left ankle had been in this state nearly all his life. General health fairly good, except some lack of virility; but bandaging his legs was, of course, burdensome, and the varicocele was very inconvenient, more especially in view of ap- proaching marriage. R. Ferrum Phosphoricum, 6 trituration, ziv. To take four grains in water three times a day. Nov. 12. The spermatic veins are not any smaller, as far as he can perceive; the veins in his lower extremities are smaller, and the dark places under the left ankle are turning to a proper flesh color. Repeat the same remedy. Dec. 8. The varicocele is much smaller. "At one time its exist- ence was very inconvenient; now I hardly notice it," said he. The varicose ulcers have healed up, and the skin around is assuming a healthy hue. Repeat. Jan. 8. Has had gatherings in the place where the black patch was. All the varicose veins and varicocele much better. B. Kali Chlor. 6 trit. ziv. Four grains in water three times a day. 230 BURNETT'S ESSAYS. April 14. The veins are all getting smaller; the foot has completely healed. (Had had it nearly all his life!) The varicocele very much better, and also the varices of the lower extremities, the venae saphe- nae longae having notably diminished in size. These few months of treatment have wrought a great change in the patient and in the man, and I accordingly give him permission to get married. He is, of course, not yet completely cured of his general varicosis, the time has been too short for that, but the improvement is so great that all obvious unsightliness has disappeared; and this is no small boon to a man contemplating marriage. This case has given me great satisfaction, as a worse one has never come under my observation in a man of that age. I made use of no local application whatever; neither was any change made either in his diet, mode of life (standing nearly all day), or place of abode, but he continued the bandage to his foot, to which he had been accus- tomed for more than twenty years. He tells me his father suffered similarly. Practical men will agree with me that it is not very usual to have trouble from varicose veins at ten years of age, as "this gentleman had, and that, as it went on without getting any better for twenty years, the present remarkable amelioration is, and can be, due to nothing else but the medicines; and this being so―and considered in conjunction with the lamplighter's case- -my present thesis, that venous dilatation can be cured or ame- liorated by medicines, is established. The basis on which it is estab- lished is narrow perhaps, and therefore we will proceed to widen it, by citing other evidence in its favor. Before doing so, however, let me be allowed to give what surgery has to say on varicocele. I will quote from a young promising surgeon, of the very latest date. In the Lancet of July 17th, 1880, we read: PART OF A CLINICAL LECTURE ON THE RADICAL CURE OF VARICOCELE BY THE GALVANIC ECRASEUR, DELIVERED AT THE WESTMINSTER HOSPITAL ON JULY 3D, 1880, BY A. PEARCE GOULD, M.S., F.R.C.S., ASSISTANT-SURGEON TO THE HOSPITAL, AND LECTURER ON ANATOMY TO THE MEDICAL SCHOOL. GENTLEMEN,-Although there are very many cases of varicocele in which no treatment, or only palliative measures, are required, you will meet with others in which it will be your duty to undertake the permanent or radical cure of the varix. These cases are as follows: 1. Where the testicle is atrophying. 2. Where the var- icocele is double, especially if an examination of the semen shows an absence of spermatozoa, or the patient being married, is sterile. 3. Where the opposite testicle MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 231 is lost or useless from tumor, orchitis, epididymitis, or injury. 4. Where the varix is large and increasing, in spite of palliative treatment. 5. Where the varix causes much pain, or interferes with proper exercise and necessary work. 6. Where it is the occasion of marked mental depression. 7. Where the varicocele prevents accep- tance for either of the Government services. There are many plans for securing the radical cure of varicocele, including cas- tration, excision of the veins, the actual cautery, forcipressure, and ligature. The ligature is the method most commonly adopted, and has been variously modified by Ricord, Vidal, Erichsen, Wood, and H. Lee. (These methods of treatment were then described.) Of the efficacy of these treatments there can be no doubt, but unfortunately they have two drawbacks,-the pain attending them, and a certain amount of danger. For a long time surgeons avoided as far as possible any interference with veins, and although veins are now ligatured almost as freely as arteries, there is no doubt that diffuse thrombosis, embolism, and septic poisoning are more liable to follow injuries of veins than of arteries. This being so, it is plainly the surgeon's duty to avoid in every possible way any irritation or disturbance of an injured vein, and it is because this principle is not sufficiently carried out that the usual modes of treating varicocele have been attended with serious and even disastrous results. The daily twist of Vidal's pin, and constant traction of Wood's spring, are not only painful, but opposed to the great principle that demands perfect rest to all inflamed and injured tissues, and veins in particular, while, in Lee's operation, the presence of two hare-lip pins trans- fixing the scrotum is apt to set up œdema and inflammation, and their removal is not without risk of embolism. That these are no imaginary fears is evident from the published results of these and analogous treatments. Gant says that the results of the operations are "rariable” and include diffuse inflammation, and sloughing of the scrotum, suppuration of the testicle, phlebitis, pyæmia, and death; Erichsen records two deaths from the twisted suture; Gross had one death after ligature; Sir E. Home had one nearly fatal case; Escallier mentions two fatal cases of phlebitis, and Curling speaks of three cases of serious results, two of which were fatal. Some years ago the censor of one of the chief London hospitals died from pycemia after Lee's operation. This list by no means includes all the accidents of these treatments—it makes no mention of the pain suffered, or of the inflammatory ædema and suppuration of the scrotum. It was with the hope of avoiding these complications that I was led, now more than two years ago, to try the plan of subcutaneous division of the veins by means of a platinum wire heated to a red heat by electricity. The procedure is, as you have seen, very simple. First, feel for the vas deferens, and grasp the veins in front of it and nip in the scrotum with the left thumb and forefinger; transfix the scrotum at this spot between the duct and the veins with a narrow bistoury, and pass a needle armed with a platinum wire in the track of the knife; then return the needle through the same apertures, but this time in front of the veins between them and the skin. Of course, if the vas happen to be in front of the veins, as was the case in that of W. C, shown to-day, you modify the procedure a little. In this way you have the veins in a loop of the wire. It is better to make a puncture with a knife rather than merely to transfix with the needle, for the veins are looped up cleaner, there is not the same liability to include a portion of the skin in the noose as in the latter plan. Then attach the ends of the wire to the écraseur, and connect with the battery, using sufficient cells to cause a faint hissing noise; one cell of 232 BURNETT'S ESSAYS. Grove's battery, or at most two, is sufficient. This step must be done deliberately; I have taken as long as five or six minutes over it. To protect the skin from burn- ing, let some cold water trickle over it while the wire is burning its way through the veins. The after-treatment consists in perfect rest in bed for a few days, with the scrotum supported on a broad strip of strapping fixed across the front of the thighs. I have three times operated without anesthesia, but the pain may be severe, and I prefer to have the patient under the influence of ether. After recovery from the anaesthesia there is an entire absence of pain, and this perfect freedom from spontaneous pain continues uninterrupted throughout the convalescence. A few hours after the operation the knobby feel of the varix is replaced by a soft even swelling, which lessens and hardens, and at the end of forty-eight hours is usually to be felt as a hard lump, about the size of a big marble. This is tender on pressure, By the end of a week it has lost its tenderness, and has shrunk to three-quarters its original size. The veins below can still be felt full, but not compressible, the blood in them has by that time coagulated, and they become smaller and firmer, until ul- timately a small pea-like induration in front of the vas is all that is left, and even this may disappear, and no trace of the varix or operation be left, as in W. S—— I have employed this method eight times, each time the varix has been cured, the symptoms complained of relieved, and no mischief to the testicle has followed. These eight cases have shown me that there are three things to be carefully avoided. The first is hurry in the section of the veins; twice a few drops of blood have fol- lowed the escape of the wire, but only so little as to require nothing more than lint or cotton-wool to be placed over the wound; in neither instance was there any hæmatocele. The second is to operate well above the tunica vaginalis; in one of my cases acute hydrocele was lighted up; it quickly subsided under belladonna fomentations. The third is burning of the skin, leading to a small slough; although there is nothing of serious moment in this slough, it is, of course, best to avoid it, and if the skin is incised and kept cold and the loop of wire not brought too small it can generally be saved. I can recommend you to practice this operation, first, because of its entire pain- lessness after the few moments of its actual performance, and, secondly, because it fulfils the physiological indications better than any other I know of. My cases at present are too few to prove by statistics that it is less dangerous to life than those op- erations I have mentioned, but they are sufficient to show that the operation is sim- ple, effectual, and introduces no new danger, while it is obviously free from the sources of irritation common to other methods. The section of the veins is completed at once; there is no foreign body liable to set up inflammation left in contact with the healing veins, which are allowed to re- main at a perfect rest, while their seared ends are becoming permanently closed. As you are aware, the closure of an open vessel by the hot wire or iron is usually considered a particularly safe plan. There is also no interference with the skin of the scrotum, as in Lee's operation; no compression of the scrotal vessels, no oedema. The only other method that I should recommend to you is the use of the catgut ligature applied to the veins subcutaneously. I have had no experience in it, but it has been done with success. I think the heated wire is preferable, because the catgut ligature is rather uncertain in its action; it may soften very rapidly and then fail to occlude the vessels, or it may not soften at all, and cut its way through the + MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 233 veins like an ordinary hempen or silken thread, or remain and subsequently light up inflammation. These accidents are only occasional, but we should none the less be on our guard against them, and give the preference to a plan of treatment which is free from them. In none of my eight cases has any slough separated from the veins; the eschar formed has been absorbed by the living tissues. I show you to- day four cases at varying periods after the operation illustrating their progress. 1. W. J- aged seventeen, a large left varicocele, which he had noticed for "several years," left testicle smaller than right, complained of dragging pains in scrotum and up to left loin. Operation June 21st, 1879; left hospital June 28th. A firm induration the size of a marble felt; not tender; veins below plugged. 2. F. L.—————, aged twenty-four, single, injured left testicle five years ago; first noticed varicocele three years ago, after an attack of clap, since then the pain and swelling had steadily increased in spite of wearing a suspender. No constipation; external piles for two years. Operation May 28th; left hospital June 8th. The induration is very hard, the size of a horse-bean; veins below are firm and shrinking. 3. W. C aged thirty, single, very large varicocele, noticed suddenly in June, 1879, while bathing. Pain in scrotum and groin had increased of late; testicle smaller than right. Operation May 1st; left hospital May 7th; delayed on account of a slough of skin. Induration now small; veins below cannot be felt; testicle has regained its former size, and is a little larger than right. 4. W. S, twenty-one, a small varicocele noticed some years; scrotum not lax; considerable pain; frequent seminal emissions and mental depression. Operation Sept. 29th; left hospital Oct. 9th. No trace of dilated veins or of the seat of the operation to be felt. All symptoms relieved. I should state that the italics, in the foregoing quotation, are mine. Mr. Gould does not even maintain that his operation by the galvanic écraseur is less dangerous to life than the other modes of operative treatment. Was any one of these four cases sufficiently severe and hopeless to warrant an operation? Mentioning that one testicle is larger than the other proves nothing, as that is the normal state of all. Note also Case 3; here the operation was performed on May 1, and patient was discharged on May 7, and shown on July 3, so that he was under observation during two months; and such is the effi- cacy of an operation by the galvanic écraseur that we are informed that the testicle which was smaller than the right one, not only re- gained its supposed original size-all in the space of about two months-but actually it "is a little larger than right." What men- tal myopia. Now, let us just reflect on this last word of orthodoxy in the treat- ment of varicocele. Mr. Gould says "no mischief to the testicle has followed." How does he know? Just look at the dates of his cases. 16 234 BURNETT'S ESSAYS. In the one of longest date, just one year has elapsed since the opera- tion. In this period we have not time to see whether there will re- sult a withering or a pseudo-hypertrophy. In the third case, says Mr. Gould, the "testicle has regained its former size, and is a little larger than right." That is to say, hyperplasia of connective tissue has begun, and that testicle is probably doomed to get very large and useless, for these enlarged testicles are mere masses of tissue, and no real testicles any longer. Let us further note the ages of these pa- tients: 17, 24, 30, and 21, and all single. Of course this able surgeon believes he did the right thing by these poor young men ; no man can go behind his light, but we believe that he did them not only no real permanent service, but we main- tain that to operate thus on young single men for an affection of this kind is unjustifiable. At least medicines should have been carefully and persistently tried first. Be it remembered that patients at times die of operations for vari- cocele; and Mr. Gould himself admits that he cannot yet prove from statistics that his special operation by the galvanic écraseur is less dangerous to life than other operations that he himself condemns. We admit that Mr. Gould is a first-class surgeon, but, THE BETTER THE SURGEON, THE WORSE THE PHYSICIAN. This surgical treatment of varicocele may be very grand from a surgical standpoint, but it is a better commentary on the state of medicine at our public hospitals and in the profession at large. So I proceed with my task. CASE OF HÆMORRHOIDS CURED WITH NUX AND SULPHUR. Some six or seven years since a lady, about 40 years of age, came under my observation. She was suffering from external piles, but otherwise was in perfect health and of magnificent physique. She had taken advice on the subject of her complaint, and an operation had been determined upon, for which purpose she intended to go to her native city Dublin; but a lady friend of hers, having been ad- mitted to her confidence, told her that the homoeopaths were in the habit of treating this affection successfully with medicines. She did not expect to be cured, but thought there could be no harm in trying the homoeopathic method of treatment. MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 235 An eight weeks' course of Nux Vomica 30, and Sulphur 30, re- sulted in a complete cure. Nothing remained of the tumor whatever. The diet was not altered, and no local application of any kind was used. The case was recent, and not severe, but yet severe enough for her to have been advised an operation. Thousands of cases of piles may be cured with Nux and Sulphur alone; almost any dilutions will act, but the thirtieth is more endur- ing in its effects apparently than lower ones. Sulphur is a grand polychrest from the crude substance upwards, but Sulphur 30 is a mighty prescription. We get used to its wondrous effects, and cease to marvel thereat, just as we cease to wonder at the electric telegraph or steam locomotion. I have repeatedly seen Sulphur 30 PRODUCE piles, and I once saw Sulphur C. cause a rather severe attack of piles. "I used to suffer from piles, but I have cured myself with Nux and Sulphur," is an oft-told tale. The use of Sulphur in piles is not confined to homoeopathic prac- tice by any means, but the use of crude Sulphur rarely finishes a case, because its action seems to become what, in my mind, stands as cir- cular: it does the good, and then goes over to the opposite action and reverses the good. Sulphur is the great portal-system medicine with Rademacher in his organopathic division of abdominal complaints. His article on the subject of portal stasis is most excellent. The diagnosis of dilatations of the portal vein or of its tributaries is no easy matter, as the symptoms may be so varied. Many of those old chronic cases of "liver" are in reality portal congestion; the sufferers therefrom have generally tried many physicians and many medicines, and get a little relief, but soon are as bad as ever. It is clearly the liver, and yet the very best treatment has failed. They have often had the right remedies, but did not take them long enough; in vein affections we have to deal with a state that will only yield to well followed up coup sur coup treatment. Rademacher's remarks on the diagnosis of affections of the portal- vein system (Erfahrungsheillehre, p. 290, et seq.) are very instructive. He says: "The symptoms and conditions that I have seen arise from abdominal plethora are indeed manifold. In first line stands hypo- chondriasis, then follow giddiness, visual disturbances, chronic inflam- 236 BURNETT'S ESSAYS. mation of the tonsils and of the uvula, cough, asthma, hæmoptysis, urinary troubles of various kinds; the so-called cold rheumatism, or those chronic pains that many feel in the shoulder-joints; that pain in the heels (gallstones and hepatic obstruction cause these same pains in the heels), that does not prevent walking, but makes it painful to do so, and renders the gait stiff. Then, less frequently, colic; cramp in the stomach, especially during digestion; sciatica; impotence or salacity, or both. All these I have myself seen. The question is: How can we differentiate between a primitive affection of the liver, pancreas, spleen, bowels, and mesentery, and plethora of the portal system? This differentiation is not only difficult, but in many cases simply impossible.' "" And then he presently gives a very valuable clinical hint, viz., the use of organ-remedies to aid the diagnosis. He says (p. 292) 'At times we cannot get to the bottom of these obscure cases except with the aid of trial remedies (Probemittel). For instance, in some cases abdominal plethora disturbs the functions of the liver; then we have pain and fulness in the right hypochondrium, the secretion of bile more or less disturbed, a yellow dirty color of the face, yel- low urine, difficulty of breathing, and the like. Now, if we act with reliable remedies on the organ that appears primarily affected, on the liver, we either do no good at all, or the symptoms disappear sooner or later gradually, but the amelioration is, nevertheless, not felt by the patient. For before you can turn yourself round the spleen be- gins to cry out, or there is pressure on the umbilical region, or some other discomfort crops up, seemingly involving another organ; then, if we have the luck to get rid of this new affection, the liver begins the old tune again. When we get this wonderful hither and thither condition, you may safely bet we have to do with abdominal plethora; provided always that no worse disease lies hidden behind all this, such as scirrhus." This organ-testing I have found of great importance in practice, but it cannot be utilized unless one is well acquainted with the organ- remedies, that is to say, with the local electivity of drugs, respectively the homœopathic specificity of seat, which is equivalent to the or- ganopathy of Rademacher. The periodic orgasmus humorum to which those subject to hæmor- rhoids are so liable is, according to Rademacher, usually amenable € MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 237 to Sulphur; sometimes it is a mixed complaint, and calls for Sulphur and Soda nitras. The ancient physicians maintained that Sulphur is a lung-balsam. This Rademacher ridicules, but maintains that bad coughs, and even phthisis, may be cured with Sulphur, when they arise secondarily from an affection of the portal system. THE VENOUS ZIGZAG LINE. By the way, there is a pathognomonic appearance of the chest, in some cases of disturbances in the portal system, and to which I de- sire to call attention, viz.: We find marked on the cutaneous surface of the chest, about corresponding to the costal insertions of the diaphragm, a zigzag line of small veins. I have never read about this, as far as I remember, but I often see it when examining patients with chest and abdominal complaints; and in my case-takings I call it the venous zigzag. No doubt others observe it as often as myself. When the patients get better, this venous zigzag becomes less and less visible. Before going to what I have further to say on the amenability of piles to medical treatment, I will just give very short notes of a case of varicocele. CASE OF VA RICOCELE. When practicing in Chester, I treated a patient at the Chester and North Wales Homoeopathic Dispensary for varicocele. The subject was an Irish workman of herculean stature, and who had syphilis. After getting rid of most of the manifestations of this vile malady, I set to work at the varicocele. In this case Fluoric acid was indicated, not only on account of the dilated spermatic veins, but because of the moist palms and loss of hair. Indeed Acidum fluoricum is no mean anti-syphilitic remedy in the later manifestations, such as loss of hair, whitlows, and bone-disease; so this was given for a number of weeks with very marked benefit, the varicocele having considerably dimin- ished. At this stage the man ceased attending, having gone on a drinking bout, as I subsequently ascertained. CASE OF CHRONIC PILES WITH PROLAPSE OF THE RECTUM. Some three or four years since a gouty gentleman of about 50 con- sulted me for this distressing malady. For many years he had suf- 238 BURNETT'S ESSAYS. fered from hæmorrhoids, with prolapse at each stool. He had been treated with various domestic remedies, and by several medical men, both allopathic and homoeopathic, and had obtained temporary relief at various times. Besides this he had a medicine-chest of his own and a Domestic Vade Mecum, according to whose directions he was in the habit of taking Nux, Sulphur, and other such well-known remedies. He was of spare habit, very abstemious in all respects, and a careful liver. His bowels were inclined to be costive, but still they acted most days. All his organs seemed healthy, and there was no evidence of any disturbance in the portal system; but he used, at times, to pass fine sand like brickdust. His going to stool was very painful, and the act lasted a considerable period, owing to the state of the rectum; the motion was very hard, and usually more or less streaked with blood, and it always brought down the bowel. After carefully washing the part, he replaced it with more or less difficulty and severe pain. On account of this unhappy state he rarely left his home or family, as it took him nearly three-quarters of an hour to get the matter over, and the bowel washed and replaced. He thought it came originally from lying in the trenches in the Crimea. In this case there was considerable hypertrophy of the rectal mu- cous membrane, and also of the subjacent connective tissue, which, indeed, is pretty well always present in cases of old standing. The indications to be fulfilled were: - 1. To get this tumid mass dispersed. 2. To get the hæmorrhoidal varices to contract; and, 3. To procure easy defecation. Now, it may be affirmed that many physicians fail to treat such cases successfully with medicines; they look upon them as hopeless. Granted, say they, that simple recent cases yield readily to homœo- pathic treatment, but these old-standing cases do not, and they must be either borne or the tumor cut away. At first sight this seems evident; but a little thought on the sub- ject will show that it is not necessarily so. Let us remember that we have to deal with venous stasis for the most part hypostatic, and a resultant hyperplasia of circumjacent tissue; this goes on till a tumor is there, and this tumid mass lies practically without the organism to a large extent, and hence it is not reasonable to expect to affect it very radically from within, alone. At E MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 239 least that is my view of the matter, and I have, therefore, in all very severe cases of piles, made use of remedies externally-usually Hama melis, sometimes Mikania guaco. 66 Well," some reader will say, "I too have made use of Hama- melis externally for years, and yet bad cases for the most part will not yield to it; I have nevertheless to have recourse to the radical operation." To that I have several things to say. First of all as to the mode of applying it. A little reflection will show that we want the thing applied for a considerable period, and my very successful plan is simply this: Add to as much water as needful a few drops of Hama- melis Virginica -I find the ordinary homeopathic mother tincture acts better than Pond's Extract as a rule; but when the tumor is very painful, and active inflammation has been set up, pure Pond's Ex- tract of Hamamelis may be applied as they use it in America for hurts and sprains. Then take a piece of lint of convenient size, and dip it into the Hamamelis solution, and let it become thoroughly sat- urated therewith; then, on getting into bed, the patient is directed to place it on the tumor, or just within the anal orifice, AND LEAVE IT THERE ALL NIGHT. This leaving it there all night is of the greatest importance, and has helped me to cure cases that had baffled some of our very best men, including low dilutionists and the very highest dilutionists. I have noticed that the rock on which the low-dilution men specially are apt to strike is the recoil action of their too hig doses, while the Hahnemannians, in their laudable consistency, refuse to sanction the local treatment. The right diet for the hæmorrhoidal is a big chapter, and would lead me away from what I am specially pleading for in bad cases, viz., external treatment, combined with the internal. Neither will succeed alone, because external treatment will only aid so long as the mass cannot be thoroughly dealt with from the circulation, and local treatment is only child's play beyond a certain point, and utterly valueless to do more than influence the local mass; it entirely fails to cure any case of itself, and is to be discontinued as soon as this can be reached well from within; but so long as the mass is, as it were, a something outside of the body, so long must it be dealt with from the outside a rightly-chosen remedy being simultaneously administered internally. The saturated piece of lint, or other suitable material, 240 BURNETT'S ESSAYS. that has lain all night at the anal orifice, should be burned, and never used a second time. It is important to insist on this, as otherwise the part may get poisoned, as it is difficult to thoroughly cleanse a small piece of linen. Then, again, all aperients must be absolutely forbidden; this is of prime importance, and if a patient (the case being a bad one) will not absolutely give in on this point, I invariably decline the case. There is nothing for it but this. Of course the diet must be modi- fied accordingly. The physician who allows aperients cannot CURE bad piles, though he treat them with all the skill of Hippocrates, Galen, Sydenham, and Hahnemann combined. Why? Because the peristaltic action set up by the aperient acts from above downwards, and therefore increases the hæmorrhoidal mischief mechanically, to begin with, and then by increasing the active congestion, and finally making the hypostasis worse than ever. Furthermore, it is of almost equal importance to forbid the patient to go to stool until he positively cannot hold out any longer; that is, of course, in very severe cases. Why? Because hæmorrhoidal suf- ferers have often a knack of pressing at stool as if they were partu- rient; the abdominal press acts upon the whole contents of the belly, and thus the pressure from above brought to bear upon the piles will do more harm in a few moments than the best directed effort of any physician can mend by the time another stool takes place. It is simply not possible to cure very severe cases unless aperients be totally abandoned, unless all use of the abdominal press be, for the time given up. "But, Doctor, I have taken aperients every day for 30 years, and I must have them; and I must also have a motion every day or I am so dreadfully uncomfortable, and have such a fulness in my head, and besides, I dread the suffering of a stool if I put it off, it is too awful." Then, patient, go to Mr. Smith and get him to do the necessary operation, for unless you obey in these points, it is simply not possi- ble to cure such a bad case as yours with medicines; with absolute obedience it is possible, and very probable. Be it well understood that the question is now of very severe cases, where the rectum is prolapsed and perhaps almost strangulated. In simple cases it is often not needful to bother the patient with E MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 241 any change of diet whatever, but in bad ones it becomes a necessary condition of success. I have interwoven these remarks with the narration of this case to motive my prescription, which was Hamamelis Virginica locally, in the manner above described, and Aloes Soc. 6, one pilule four times a day. This was in August, 1876. Of course it will be objected that as I used Hamamelis externally, and Aloes internally, I do not know how much of the curative action is due to each respectively. This I grant, and the scientific value of the prescription is thereby lessened, no doubt. The gentleman was away from home at the time at the seaside for his holidays, and this prescription was forwarded to him by post. I had previously seen him through several pretty bad attacks of gout, and he had mentioned his hæmorrhoids to me several times, but he never really consulted me about them, because, in truth, he did not believe there was any medicinal cure for them, and he did not intend undergoing any oper- ation for them so long as he could manage to replace them, together with the bowel, after each motion. Now, however, being at the sea- side, they suddenly became worse, either from the sea air or his long walks, or some other cause, and being in lodgings, he missed the va- rious little contrivances present in his bath-room at home. Moreover, they were so much worse, that walking had become most, painful, and barely possible. Hence he applied to me. He did not write to me again, and remained away about six weeks. Neither did he call upon me on his return, but two or three weeks thereafter I met him accidentally, and then received his warm thanks for having relieved him of his great trouble. He informed me that he was quite well; all the piles had disappeared, and the bowels no longer came down at stool at all; the bowels, too, acted, naturally. For fully twenty years this gentleman had almost daily suffered the horrors of a painful stool and prolapsed bowel, followed by the tor- ture of getting it back again. Many months later I attended one of his children for fever, and learned that he continued quite well. In the face of this experience is any one at all astonished that I am a strong advocate for the medicinal treatment of piles, and other manifestations of the venous diathesis? In this case I made no al- teration whatever in diet, and there was no need to forbid aperients, as he had abandoned them for many years in favor of Nux, Sulphur, 242 BURNETT'S ESSAYS. Belladonna, and Opium, which he knew well how to use. Indeed, alvine constipation was not an important element in this case, it was more a proctostasis. * * * * * Perhaps any other further experience on the subject of the amena- bility of diseases of the veins to medicinal treatment may be needless, but there are two very bad cases recorded in my case-book that de- serve detailed narration, because they were about as bad as such cases. can well be, and they bring out another little auxiliary of mine,- I mean posture. Minor cases I omit entirely. ON THE IMPORTANCE OF POSTURE IN THE MEDICINAL TREATMENT OF SEVERE CASES OF PILES. When a patient has suffered for a number of years either from continued chronic hæmorrhoids, or when he has had attacks of piles for a more or less lengthened period, with the well-known general orgasmus humorum, there comes some fine day such a violent attack, or the defecatory effort has been unduly prolonged, from some cause. or other, that the piles and the prolapsed bowels cannot be replaced at all, and then something must be done. There is no help for it; the patient lies writhing in pain, half doubled up, and often moans and weeps like a child. Now, what have we to deal with in such cases? Naturally, cases differ exceedingly, and each one must be individualized and treated on its own merits. It is no use confining one's ideas to the rectum, although all the misery is at present concentrated there, and yet time presses, and the patient appeals for prompt relief. Some cases of piles depend upon a disturbance in the brain, others upon a spinal affection, especially about the cauda equina. Some are due to a liver complaint, and some to portal congestion; others, again, are connected with a disturbance around the neck of the bladder, the prostate, the spermatic veins, the uterus, the ovaries; or they may arise from chronic constipation, or be due to a really local cause in the rectum itself, mere proctostasis, or be merely a topic expression of general varicosis. Then, again, the lungs and the rectum are often in wondrous sympathy with one another. So each case has to be looked at all round, as to the other constituent organs and parts of MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 243 the same economy. Then there are various nosological forms that complicate piles: pregnancy, phthisis, gout, general plethora, cephalic congestion with threatened apoplexy (how often does apoplexy follow a wrong treatment of piles !), heart affections, and syphilis. Syphilitic hæmorrhoids are at times the most painful of any, and the pain is often an inch or two above the sphincter. But, with all the varieties, there is always one prominent and dis- tressing condition, viz., HYPOSTASIS, in other words, much of the distress is due to the hypostatic congestion, and this it is that an oper- ation gets rid of, and nothing else; only, with the operation, not only is the bath emptied, but the baby has been forgotten, and poured out with it. I have adopted the very simple plan of raising the buttocks above the horizontal, by means of various little mechanical contrivances im- provised at the time, according to the circumstances of the patient ; two or three pillows serve the purpose. Every one is familiar with the contrivances for raising the heads of sick people; well, I just reverse the process and raise the lower part of the trunk, and this is a great help in very severe cases, such as the following. In January, 1880, a gentleman about 40 years of age, residing in London, came under my observation. He had suffered for many years from constipation and piles, with prolapse, and he had had a sorry time of it at every movement of the bowels, as the large hæmor- rhoidal masses came down, together with the rectum, so that the whole resembled a big dahlia in configuration and in color; more- over, the constriction of the sphincter seemed so great, on my first visit, there seemed no inconsiderable danger of gangrene. His elder brother had suffered similarly, and been operated on very successfully ten or a dozen years ago, but had latterly got as bad as before the operation. My patient's sister, however, a kind-hearted capable maiden lady, who, instead of wasting her precious life nursing poodles goes into the courts and alleys of this huge city, carrying words of comfort, and healing many with the aid of a Homoeopathic Vade Mecum and a pocket-case of pilules. From her own experience (!) she was confident that homoeopathy could cure her brother, and this was the more desirable as he was very nervous and timid, and almost fainted at the very thought of an operation. Moreover, he is by no 244 BURNETT'S ESSAYS. • means a strong man, as indeed no one is at the end of fifteen hæmorrhoidal miseries and bleeding. years of On examination, I found the usual thing: A large purple bleeding mass extending from the anus, causing the patient such terrible an- guish that he screamed and cried. He could neither sit, lie, or stand properly, but found least pain in lying on his side, with knees and chin considerably approximated. The size of the whole tumid mass. was about that of a man's fist, and there were small ulcers on the surface apparently suppurating excoriations. Besides "having a liver," and being of lax fibre, he was otherwise healthy, though not strong, and of rather small stature. I set to work in this wise: 1. I propped up the lower part of the body, so as to relieve the hypostasis somewhat. 2. I forbade all aperients, and any effort at going to stool: let the bowels absolutely alone. 3. He was ordered to live entirely on slops, rice and other pud- dings, and stewed fruit for dinner; porridge, with simple syrup (treacle), for breakfast; an ordinary English tea; and gruel for supper. Beef tea occasionally; fish every alternate day. No beef or mutton. C 4. Pure Pond's Extract of Hamamelis constantly applied to the hæmorrhoidal tumor, and subsequently the ordinary homo- opathic mother tincture very much diluted. 5. Internal medication. It would be very tedious to give the ups and downs of this case and my reasons for the various remedies employed, but for the ad- vantage of any young practitioner who may chance to read these pages, I will, nevertheless, give the bare skeleton of the treatment. Hahnemann's Materia Medica Pura will give him the why and the wherefore. Jan. 27th. R. Te. Aloes 12. At first a dose every half-hour for eight doses, and then every hour. Those who think the repetition of the dose too frequent, are re- minded that the poor fellow lay writhing in agony. 28th. Considerable relief as to pain, especially after each applica- tion of the Hamamelis. Swelling less tense. No motion; begs for MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 245 3 an aperient, and permission to try to obtain relief of his bowels. Both absolutely refused, and reasons given. 29th. Easier, but otherwise no change. R. Sulphur 30 every two hours, and continue the Extract. 30th. Same. 31st. Is getting frightened about his bowels, as they have not acted. R. Kali Carbonicum 30 every two hours. (He had a cough.) Feb. 2d. Easier, but still no sensible diminution in the size of the tumor; he is beginning to sleep better, and getting resigned to his fate, though he is afraid of an inflammation of the bowels from retained fæces. 3d. The Kali Carb. 30 is continued, and Sulphur 30 given in alternation with it. Feb. 5th. The tumor is decidedly less tense, and there is now but very little actual pain, and the part has a much healthier hue-not so purple. Bowels still locked, which alarms him, only my threat to throw up the case keeps him from using an aperient. R. Esculus Hippocastanum 6 every two hours. 9th. Notable amelioration. the Esculus. 12th. No action of the bowels; renewed complaints of patient thereat. No action of the bowels. Continue R. Tc. Esculus Hippocastanum 30 four times a day. ť 13th. Comfortable action of the bowels, with no straining at all. Hæmorrhoidal mass withering. Continue. 15th. The same. 17th. Making very rapid progress; bowels act daily, painlessly and easily, and the patient is able to put on his dressing-gown and lie on the sofa. The piles are vastly improved, and the prolapse has disappeared. Continue, 246 BURNETT'S ESSAYS. 23d. Continued progress. No change in medication. Drives out, and has white meat for dinner. March 2d. His condition is eminently satisfactory in all respects; the bowels act beautifully every day; of the whole anal trouble there is now scarcely anything to be seen beyond a thickening like a ring around the anus, and a large fold of skin in which the tumor had been incased. R. Ferrum Phosphoricum 12x trit. morning and afternoon. 17th. He is quite well. Nothing remains at the seat beyond a small fold of the skin, like a pucker, of the size of a hazel-nut, though patient is not conscious of its presence. He has now a daily motion as an act of pleasure-no piles, and no prolapse. Had not been in such a condition since his youth! R. Arsenicum album 30 twice a day, for its constitutional effect. April 28th. Continues in all respects well. Beyond the little pucker of skin at anus everything is normal, and this exists unknown to him, and is barely noticeable, being only a shrivelled fold of the skin about the size of a horse-bean; probably the large tumor had so stretched the skin that it cannot readily contract to its primitive condition. This case has given me very great satisfaction, and will, I trust, show those who are faint-hearted, whenever brought face to face with a bad case of hæmorrhoids, that even bad cases are perfectly amen- able to homoeopathic, postural, and dietetic treatment. rectum. At the end of the year 1876, while practicing at Birkenhead, I was requested to visit a gentleman residing in the neighborhood, and on arriving at his house was received by his wife, who told me the fol- lowing: For many years this gentleman, then about 55 years of age, had been a martyr to piles, difficult defecation and prolapse of the The bowels acted daily, but it was in the very deed a chi- rurgical operation in its actual etymological sense, as the fæcal mass could not be dislodged without manual aid, often after a syringe, and then the prolapsed gut had to be replaced together with an enormous hæmorrhoidal mass. It must be admitted that life at such a price is dear, yet the patient had got used to it, and did not even complain. He thought it inevitable, and naturally shrank from an operation, MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 247 which had been often recommended to him by men of both schools and by his experienced friends. But so long as the daily manual re- position succeeded and the bleeding was not excessive, he bore it; now, however, it had come to the usual pass, the tumor would no longer go back, simply because it was too large and in erection, for in severe cases of piles with prolapse the whole mass at times had the physical characters of a tense corpus cavernosum. He had borne it till it could be borne no longer, and had finally decided to send for Mr. B to cut the whole thing off, but his wife was afraid lest he should not get over the operation, and there- fore sent for me to learn whether medicinal treatment offered any hope. I explained my views, and, after very much deliberation, the patient decided to try the medicinal treatment to please his wife; he did not, himself, believe that medicines could touch such a severe case ; this was also, I was informed, the opinion of Mr. B—. Now, it happened that this eminent surgeon, and bitter hater of our blessed homoeopathy, had a very similar case just opposite in the same road, and the two families being friendly, and the cases similar, notes were compared about them. Mr. B-operated on his pa- tient, a lady, and I began to treat mine with medicine; he ridiculed me openly, and by name, and I had to wait, for my victory was not yet. Of course I was not sure of succeeding, I merely thought there was hope and promised to do my best, and my best is when I am sit- ting at the feet of Hahnemann. Bland soft diet was ordered, and patient put into the right posture, such as I have already explained. Hamamelis was applied locally, and Aconitum, Belladonna, Nux, Pulsatilla, and Sulphur came into play in succession. The first was on December 9th. At first we did not make much headway, and many were the doubts and fears at this period; I did not then sit so firmly in the saddle as I do now. On December 21st. Esculus Hippocastanum, third centesimal trituration, every 4 hours. This was continued till recovery, and its action was most brilliant; in six weeks my patient was well enough to go to his business in Liverpool. He was not only cured of his hæmorrhoids and prolapse but his bowels acted naturally and he felt himself stronger. It was now my turn to laugh at my chirurgical vis-à-vis, for his patient was longer recovering from the operation 248 BURNETT'S ESSAYS. than mine was from medicinal treatment, and twenty-two months. later she was as bad as ever, and then came over to homœop- athy, and was cured. But to return to the case under consideration; the patient remained under observation and took Acidum fluoricum 12 during the months. of March and April; in May and June Natrum Sulphuricum 3; and in July Hydrastis Canadensis 1. The Hamamelis was used with occasional interruptions for six months, to get rid of the thickening around the anus. Then all medicine was discontinued, as he was as well as if nothing had ever been wrong with his rectum and hæmorrhoidal veins. Some of the treatment in this case was directed to the liver. This gentleman has remained well to this day, and that is more than three years since. Believe me, my dear allopathic brother, you may deride homoeop- athy till the end of your life, but it is true nevertheless. In the end allopathy will have to kiss the dust, for . . . Magna est veritas et prævalebit. • CASE OF CYANOSIS. There will be no harm in giving the following practical case of Blue Disease for what it is worth: Morbus Cheruleus, Cyanosis, or Blue Disease. Whether this was due to a permanence of the foramen ovale and thus allowing the pas- sage of the venous blood from the right auricle to the left, or to other abnormal apertures in the septum of the auricles and ventricles of the heart, or any other maldisposition or abnormality, or to patescence of the ductus arteriosus, I know not, but the subject was a young man of 25 or thereabouts. He had been a laborer in Laird's ship- building yards for years, but latterly had become unable to work. On my visiting him, I found him sitting propped up in a chair, his face of a deep purple blue coloration, with which we are all familiar as Cyanosis, and considerable cedema of the lower extremities and hydrothorax; the dyspnoea was very great, and the distal ends of his fingers were clubbed in a most extraordinary degree, worse than I ever saw in the most advanced case of phthisis; a hacking cough, difficulty of speech; racking pains in all his bones and joints, so that he could neither move them nor yet remain quiet. That was just the MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 249 character of the pain; made easier by motion. A more perfect pic- ture of inhuman ugliness in a human being it was never my lot to behold, and this was rendered worse by the hanging jaw and large oedematous face, and glaring bloodshot eyes. And yet his mother fondled and petted him as only mothers can! After going over the case and learning that the cyanosis had been from his birth, and that he had only been so bad as at the present for a few weeks, I set about treating the most urgent symptoms, viz., the rheumatic pains. Rhus toxicodendron was given at frequent intervals. Now comes the strange part of the story. The Rhus not only gradually cured the rheuma- tism (which I expected) but it cured the cedema, the hydrothorax, the dyspnoea, and actually lessened the general venosity very consider- ably, and in the course of time even his clubbed finger-ends went a little smaller. As nearly as I remember he took the Rhus for about three months, and he then resumed his work as a laborer. That this was a mere fluke on my part I need not say, neither do I now comprehend how the amelioration came about, I merely nar- rate a most interesting clinical fact. During a period of about two years subsequent to this he used to put in an appearance at the Wir- ral Homœopathic Dispensary every month or two to be treated for various little colds, and the like, and then I left the neighborhood, so I do not know what became of him, but so long as I remained at Birkenhead he continued to work in Laird's shipyards. dodan I do not merely mean that this poor fellow got over his rheuma- tism, ædema, hydrothorax, and dyspnoea, and was then merely as blue as he had previously been, but his ordinary blueness had very materi- ally diminished-about one-half-as his mother and the neighbors very loudly and unanimously maintained. Here the choice of Rhus for the kind of pain was strictly scientific; its having brought about a remarkable amelioration in an old-standing case of morbus cæruleus is an empirical fact that I do not understand, and of which I there- fore can offer no explanation. This empirical use of Rhus I have since remembered with advan- tage. RHUS IN THE TREATMENT OF BLUE-FACED BABIES. I have never since met with another case of regular morbus cœru- leus, but I have had to treat very young babies with cyanotic faces, * 17 250 BURNETT'S ESSAYS. and have here used Rhus 3 with striking benefit. One was an eight- month child, whose circulation was apparently not quite normal, as its face was very pale and bluish. It was not purple by any means, still everybody remarked "how peculiar, bluish, its face was." Rhus 3 was given, one pilule three times a day, and the beneficial effect was unmistakable, for within a very few days the face assumed a normal coloration. In several other cases in little infants in whom I had noticed a bluishness of the face, or just of the lower lips only, I have used Rhus with undoubted benefit; the bluishness disappeared. Quite lately a little blonde of two with a blue lower lip was ordered Rhus by me, and the blueness disappeared in a fortnight. modo? Quo HÆMORRHOIDS IN CONNECTION WITH ENGORGED SPLEEN. A well-nourished healthy lady of fifty years of age came under observation in April, 1880, complaining of the following series of symptoms. . . Pain in the left side corresponding to the region of the spleen, so bad that she cannot lie on the left side; with this pain in the side there are two other disturbances, indicating that a kind. of vascular turgescence—an orgasmus humorum-underlies the whole, viz., palpitation of the heart and piles. With these also some indi- gestion and a feeling as if the visceral contents of the abdomen were being pulled down. R. Tc. Ceanothi Americani 3x. 3iv. Three drops in water three times a day. She came from the country, so I did not see her again, but as I asked for a report in a fortnight her husband wrote at the end of that period to say that she was well and needed no further attention. The case of this lady rather interested me, as some six years pre- viously she came under my care for chronic headaches that seemed climacteric; I treated her for these headaches, but could not make any impression upon them, and then on going over the various or- gans I found that the urine contained a small quantity of albumen. This our ordinary remedies removed in about two months, and the headaches disappeared. About a year later the albuminuria again returned in a very slight degree and with it some cephalalgia; both yielded at once to the same remedies, and she had remained well till MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 251 she came with the splenalgia and hæmorrhoids. I suspect, therefore, that the old albuminuria was not due to any kidney mischief, but to venous congestion of the kidneys. CASE OF VARICOCELE WITH VENOUS Zigzag. This was a well-nourished, healthy-looking gentleman of 29 years of age. He first came under observation on April 16th. He had sinned against his own body formerly and, being happily enlightened on the subject of bodily chastity, had for years given it up and ever since been seeking to regain his self-respect and bodily vigor. By the way, when will fathers become sufficiently manly to teach lads how to become men? On carefully examining him, there were four points that came out: 1. There was an endocardial bruit de souffle most audible at the xiphoid cartilage. 2. The before-mentioned venous zigzag line on the chest. 3. A left-sided varicocele these seven years; not very large. 4. He had once had a slight attack of piles-none now. Diagnosis: General varicosis expressed especially in the right heart, vena portæ, and spermatic veins. TREATMENT: Tc. Bellidis perennis 1. ziv. Five drops in water three times a day. June 2. Feels better in himself, the old feeling of blightedness left by the miserable habit of youth has gone. The effects of Bellis (common daisy) in this state, that I think of as auto-traumatism is, often, little short of marvellous. But I cannot go into that at pres- ent. The varicocele is better; the endocardial bruit is less audible, he feels his heart comfortable now; the venous zigzag is slightly better-less distinct, but I am not so very sure about this, having only the eye to go by. R. Te. Acidi fluorici 6. m. xxiv. Sac. lac. qs. Div. in p. æq. xxiv. To take one powder in a little water at bedtime, and report progress in a month. July 3. The varicocele is much smaller; it formerly became very much more distended towards evening, especially after having been on his feet a good deal all day, and notably worse in hot weather; but now he has no inconvenience from the varicocele even after being 252 BURNETT'S ESSAYS. on foot all day in this hot weather. The endocardial bruit can now be heard only with difficulty. I hear very well indeed with both ears, yet the acuity of the right one is greater than that of the left (is it so in everybody-i. e., do the ears differ normally?), and this quality of my hearing I make use of for differential diagnosis when using the stethoscope. Now I could formerly easily hear this bellows murmur with either ear, now I can barely hear it with the right aided by the stethoscope. By the way, we want some clinical acou- meter to aid us in coming to an opinion as to the quantitative value of endothoracic sounds, for many of these bellows murmurs proceed- ing from the heart do disappear under treatment; may be they are only haemic, but anyway we want to gauge them. Patient is informed that in my opinion he is well, and fully fit for marriage. To this end he had sought advice. Of course the re- sult requires consolidating with some further medicinal treatment, but taking a drop or two of Acidum fluoricum 6 at bedtime does not seriously interfere with any human duties even if they be marital. PART II. TH HE first part of this little treatise is just my own clinical chat : clinical chips from my own workshop, thrown together without any attempt at classification or order, such being deemed needless. For it must obviously be much the same thing whether all the cases of hæmorrhoids come together or not,—and a dilated vein is essen- tially the same pathological entity whether it be portal and miscalled liver disorder, or on the legs and termed varices, or at the anus and designated piles, or round the spermatic cord and known as varico- cele-it is the same thing in different localities bearing distinctive. names and resulting in varied morbid expressions yet all linked to- gether as dilated vein. This idea gives the beautiful unity in the pathology of Fletcher, but unfortunately lost sight of but too often in our cliniques and consulting rooms: nosological names becloud us, and in the very deed, .... wo die Begriffe fehlen, da stellt sich zur rechten Zeit ein Wort sich ein! Gla MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 253 Hence we consider dilated vein our central idea, because we should expect a priori that if vein medicines are a reality they will affect the veins in any part of the body, though, of course, local affinity or specificity of seat will of itself render any medicine a rein remedy, and experience teaches the truth of this. Special organ-remedies will also be often necessary to put right any consentaneous organ disease; and dyscrasia, such as psora, syphilis, sycosis, have the same value here as elsewhere. It is astonishing how many pegs there are on which therapeutic ideas may be hung: Paracelsus, Hahnemann, Rademacher, Fletcher, Grauvogl, Virchow, Schüssler, Guttceit-all help. Therefore we will consider general varicosis, varicocele, and vari- cose veins together, giving, however, hæmorrhoids special considera- tion, because of the peculiar anatomical and physiological relation- ship of the parts involved, but much that is said of hæmorrhoids will apply to other forms of dilated veins. It is needless to say to the man who has read and understood Hahnemann that the accurate individualization of each case is the true way to wander always, but generalizations and pathology must not be neglected, for they are most important in actual practice, and a diagnostic survey of the state of the various organs will be generally necessary. At least generalizations and pathology are tools I cannot do without. It is a silly proceeding to work out an elaborate homœopathic equation, in a case of scurvy for instance, and the prac- titioner who understands the constitutions of Grauvogl will, all other things being equal, have more success than he who pooh-poohs them. Furthermore, although we certainly cannot cure all that is curable with Dr. Schüssler's twelve tissue remedies, yet our knowledge of the spheres of action of these same remedies is vastly enlarged by his original way of working out his deductions. Withal a very careful consideration of these various notions and generalizations brings us back to . . . . the law of similars in its varied degrees. It will be better to take first: Cyanosis, or the Blue Disease. MORBUS CERULEUS. The Rhus-case narrated in the first part of this treatise warrants us in giving Rhus a trial in the blue disease. Of course it cannot be 254 BURNETT'S ESSAYS. expected to be a specific, but considering what it did in the case in question, and its equally undoubted beneficial effect in lower degrees of the same affection of which I have spoken, practical men will do well to give it a trial, as our therapeutic means in this ugly state are certainly not very numerous even with as good a title as that now being vindicated for Rhus. Then it may be remembered that Rhus causes palpitation of the heart that is so violent that the body be- comes moved thereby; tremor of the heart; pain in the chest as if the sternum were pressed in; dyspnoea and oppression of the chest. So we know that it affects the heart very powerfully. For the venous state of the blood itself the Chlorate of Potassium and the Peroxide of Hydrogen have been used with undoubted benefit. Ferrum is a most likely medicine indeed on theoretical grounds and from analogy; the sixth trituration of the phosphate is very potent in controlling the vascular system, and it simultaneously affects the blood mass. And referring again to Rhus, there is also not wanting evidence of its action on the venous system, which, though not great, still is there: "Swelling of the anal region, hæmorrhoidal tumors." It seems also to act pretty strongly on muscle. The best study of Rhus with which I am acquainted is Carroll Dunham's (Lectures on Materia Medica, 1879, p. 121, et seq.), and this eminent man says (p. 127): it produces an apparent passive con- gestion of the heart. That Rhus is an important cardiac may alone be deduced from its reflected action upon the skin. It is also undoubtedly a blood- medicine. VARICOCELE. The remedies called for in varicose conditions of the spermatic veins will be frequently the following: Acidum fluoricum, Pulsatilla, Silicea, Osmium, Acidum phosphoricum, Hamamelis and Esculus, according to the symptoms. Acidum fluoricum will be indicated when there are moist palms, pain in the left side, or a history of syphilis. Aurum, when the testicles are very small and weak, and in those suffering from mercurialism. MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 255 1 Silicea, when there are sweaty feet, or when there is a history of a suppression of the pedal perspirations, and when there are chil- blains. Osmium, when it had been produced or aggravated by a deep, hol- low, low cough, seemingly coming from low down in the body. Acidum phosphoricum, when associated with phosphaturia and pain in the testicle. Pulsatilla will suit many cases, and be especially called for in the obese, and those of lax fibre and tearful mood. Hamamelis is the prince of vein medicines, especially topically applied. PATHOGENETIC SYMPTOM OF HAMAMELIS VIRGINICA. I have quite lately had an opportunity of observing that Hama- melis is capable of producing phlebitis. I ordered a gentleman a lotion of Hamamelis to a painful knee, resulting from a crush caused by a neighbor's horse lurching against it, and fixing it against the saddle of the rider. Various applications had been previously used, and there remained no outward and visible sign that anything at all ailed the knee, but it was painful deep down. Instead of using a few drops of the tincture diluted with water in a compress, as I ordered, patient applied the tincture itself by rubbing it into the part, and there resulted considerable swelling of the whole region of the knee, and one vein swelled, stood out, and was intensely painful to the touch. Thinking he was overdoing it with the Hamamelis, and being, moreover, frightened, he left it off and let the inflamed and swelled part alone, and in about 24 hours it was quite well. Here I think the Hamamelis caused the cellular tissue to swell and the vein to became inflamed. Aconitum, Belladonna, Nux, Sulphur, and many other of our medi- cines will be needed in those cases in which their characteristic symp- toms occur. To give them all would be equivalent to transcribing portions of many pathogeneses, and under Hæmorrhoids this is more fully gone into. Ferrum phosphoricum is a most powerful vein medicine, although its action on the arteries is its prime sphere; it has cured a small aneurism in my hands (the sixth centesimal trituration), and a great indication for it is throbbing. It is also a beautiful hypnotic, but those who usually sleep well are often kept awake by it. 256 BURNETT'S ESSAYS. Kali chloricum is indicated in congestions, and especially in swarthy subjects. Digitalis, Ceanothus, Scilla, and Chelidonium will sometimes ob- trude themselves on general grounds, such as where the heart, spleen, liver, or kidneys are concomitantly wrong. In the hydrogenoid constitution, Natrum sulphuricum and Thuja will be thought of; the former when the motion is so large that it pains to pass it through the rectum, and the latter when there is a history of lues gonorrhoica, or a neuralgia of the testicles. Esculus hippocastanum has cured varicocele; disturbance in the portal system with constipation and hæmorrhoids would call for it. Lilienthal mentions the following remedies as having been found useful in varices: Aconitum, Aloes, Ambra, Antimonium, Arnica, Arsenicum, Belladonna, Calc. carb., Caust., China, Colocynth, Fer- rum, Graphites, Hamamelis, Hepar sul., Ignatia, Kreasotum, Lach- esis, Lycopodium, Nat. mur., Nux v., Platinum, Pulsatilla, Sepia, Spigelia, Sulphur, Zincum; Ammon. mur., Acid. fluoricum, Hydro- cot., Millefol., Pæon., Staph.; Ferrum phos. for young people, Flu- oric acid for old persons. (Homoeopathic Therapeutics, 1879, p. 799.) That Ferrum phosphoricum acts brilliantly in the old, and Acidum fluoricum in the young, I can vouch for from my own experience. HÆMORRHOIDS. This affection is probably as old as mankind, and is often mentioned in the Bible. The name is derived from the Greek alpopodes, its chief symptom being a flow of blood. Other names are Haimorosis, Proctalgia hæmorrhoidalis, Morbus hæmorrhoidalis, Piles, Emerods. Ancient peoples regarded affections of the genitals and anus as divine punishments. Thus . . . "The Lord will smite thee with the emerods" (Deut. 28: 27). But it is clear that many different diseases are meant under the name emerods, or hæmorrhoids, such as tumors, the morbus ficarius, and the endless ills of the pathici (Hip- pocrates; Aristotle; Rosenbaum's Geschichte der Lustscuche). The piles do not usually get well of themselves. Heart affections; imperfect aeration of the blood; liver affections; congestions in the portal system of veins; enlarged spleen; abdom- MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 257 : inal tumors; great accumulation of fat in the omentum, or of fæces in the intestines; in fact, anything that disturbs the reflux of blood to the right heart, vena cava inferior, vena portæ, tends to hypostatic hyperemia of the hæmorrhoidal veins. The successful treatment of piles involves an accurate appreciation of the topography and of the anatomical relations from the midriff to the pelvic outlet as first groundwork, and then a consideration of the etiology of each case. I cannot enter upon such an interminable path in this little tract, as I merely put in a plea for the exclusively medicinal treatment of dilated veins by what name soever they may be nosologically bap- tized. The bulk of my own knowledge on the subject has already been given, and I now bring together from various sources the reme- dies most frequently called for, together with, more or less accepted, indications for the same. REMEDIES FOUND USEFUL IN THE TREATMENT OF DILATED VEINS, PARTICULARLY OF Hæmorrhoids. Besides Gilchrist, Hughes, Hale, and Lilienthal, I have culled from a very able article on this subject in the Transactions of the Homoeopathic Medical Society of the State of Pennsylvania, vol. ii. The authors are the Allegheny County Homœopathic Medical Society, and the names of the special contributors are Drs. Childs, Martin, Caruthers, and Edmundson, the last named of whom says: "For the latest and most successful remedies used by the old school for the treatment of hæmorrhoids, we refer you to Naphey's Therapeutics, where a very full and complete résumé will be found; many of them you will recognize as well-known homeopathic remedies." Well, we had already previously gone to Naphey's Modern Medical Therapeutics, sixth edition, 1879, but did not find anything of the kind, and on again hunting therein we do not find even the words piles, hæmorrhoids, varices, varicosis, or varicocele, anywhere. So, probably, there must be another Naphey's Therapeutics. ACONITUM NAPELLUS.-When a febrile movement accompanies the piles, with dry skin and cephalic congestion. It is not often called for in practice in this affection, but in plethoric subjects in whom there is determination of blood to the head, a prompt use of this remedy may avert apoplexy. When this is done, see to your patient's diet. 258 BURNETT'S ESSAYS. • ACIDUM ACETICUM.-Profuse hæmorrhoidal bleeding; hæmor- rhage from bowels after checked metrorrhagia; constipation; malig- nant disease of rectum. ÆSCULUS GLABRA.—The greater pathogenetic power of this rem- edy should lead us to think of it especially when there is a paretic state of the legs, and the cauda equina is disordered. Carrying the nut on the person is said to cure piles, but I will not vouch for it. ÆSCULUS HIPPOCASTANUM.-Dr. Hale is of opinion that the cen- tral point of action of this drug lies in the liver and portal system. It is decidedly one of our most powerful remedies for piles and con- stipation. My own notion of its applicability points to those cases in which there are liver, portal, rectal, and spinal indications for its use. Hale says the absence of actual constipation differentiates between this and other pile remedies; to this I cannot assent, my own pretty extensive experience with it leads me to say with Dr. Hughes that it is indicated in constipation, and that very strongly. That it is a great rectal remedy is undoubted. Dr. Hart's special indication for it is throbbing in the abdominal and pelvic cavities. Lilienthal puts the following symptoms thus: DULL BACKACHE, PURPLE HÆMOR- RHOIDS. Sensation as if sticks, splinters, gravel were in the rectum are said to be characteristic of it. ALOES.-Protruding piles, with constant bearing-down sensation and prolapse of the bowel; paralysis of the sphincter ani. Aloes stood of old in evil repute in hæmorrhoidal affections, thus in Nathanael Sforzia's Neues Artzneybuch (Basel, 1684), we read, p. 34,-Alle purgierende Sachen, sonderlich von ALOE, alle gesalzenen und gewürtzten Sachen seynd schädlich (in piles). So that with our law to lead we know how to use Aloes. How is it Sforzia was so enlightened? He was in his day heterodox! ALUMINA. Hæmorrhoids worse in the evening; better after night's rest; clots of blood pass from anus; stools hard and knotty like sheep's dung. A AMBRA GRISEA.-Itching, smarting, and stinging at the anus ; increased secretion of urine, much more than the fluid drunk. Worse in the evening; also when lying in a warm place, and on awakening. Better from slow motion in the open air, and when lying or pressing upon the painful part. Presence of cholesterin in the fæces. MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 259 ? AMMONIUM CARB.-HÆMORRHOIDS PROTRUDE, INDEPENDENT OF STOOL. AMMONIUM MUR.-Hæmorrhoids sore and smarting after sup- pressed whites; hard, crumbling stools, requiring great effort to expel them; bleeding from the rectum, with lancinating pains in perinæum; especially evenings; stinging and itching in rectum before and during a stool; the piles surrounded by inflamed pustules. ANACARDIUM.-Lilienthal says: Internal piles, especially if fis- sured; painful hæmorrhoidal tumors; frequent profuse hæmorrhage when at stool; great and urgent desire for stool, but the rectum seems powerless, with sensation as if plugged up; great hypochondriasis. ANTIMONIUM CRUDUM.-Copious hæmorrhoidal hæmorrhage ac- companying a stool of solid fæcal matter; MUCOUS PILES; pricking burning; continuous mucous discharge, staining yellow; sometimes oozing away of an ichorous discharge; feeling of soreness in the rectum as if an ulcer had been torn open. APIS.-When there is much burning and excessive oedema of the parts. ARNICA MONTANA.-Blind hæmorrhoids, with painful pressure in rectum, constipation and tenesmus; worse when standing and from cold things. In prolapse from over-straining at stool and from vio- lent riding. ARSENICUM ALBUM.-Hæmorrhoids with stitching pain when walking or standing, not when at stool, with burning pain; burning and soreness in rectum and anus; rectum is pushed out spasmodi- cally with great pain, and remains protruded after hæmorrhage from rectum; BURNING IN ALL THE VEINS, restlessness and great debility, worse at night and from cold, better from warmth; HEMORRHOIDS OF DRUNKARDS. AURUM.-My own use of this polychrest in piles has been con- fined to syphilitic objects aggravated by mercurial symptoms. I should consider it especially called for in the aged and in pining youthful subjects. BADIAGA.—I have put down the river-sponge as an anti-hæmor- rhoidal remedy, because Hering says it is useful in the complaints of adults who had manifestations of scrofula in their youth, and be- cause it has a reputation in Russia for the cure of piles. Now there is a class of persons who are strumous and hæmorrhoidal, and hence 260 BURNETT'S ESSAYS. it may be worth remembering, especially when the lung or heart symptoms of Badiaga are present. BELLADONNA.-Bleeding piles; spasmodic contraction of sphincter ani; violent pains in small of back as if it would break; piles so sensitive that the patient has to lie with the nates separated; scanty red urine; congestion of blood to head; red, hot face; thirst and restlessness. BERBERIS VULGARIS.-Hæmorrhoids with itching and burning, particularly after stool, which is often hard and covered with blood; soreness in the anus, with burning pain when touched, and great sen- sitiveness when sitting; hard stool like sheep's dung, passed only after much straining; constant pulsating stitches in sacrum; fretful and weary of life. BRYONIA ALBA.-Hard, tough stool, with protrusion of the rec- tum; long-lasting burning in the rectum after hard stool; sharp burning pain in the rectum with soft stool; white and turbid urine; sensation of constriction in the urethra when urinating. Worse in the morning, also from motion and from heat. Better while lying down, or on getting warm in bed. CACTUS GRAND.-Constipation as from hæmorrhoidal congestion; swollen varices outside the anus, causing great pain; itching of anus, pricking in the anus, as from sharp pins, ceasing from slight friction ; copious hæmorrhage from anus, which soon ceases. CALCAREA CARBONICA.-Hæmorrhoids protruding, painful when walking, better when sitting, causing pain during stool; great irrita- bility of the anus, even a loose stool is painful; frequent and copious bleeding of the piles, or for suppression of habitual bleeding (after sulphur). Perspires a good deal in the head, especially at night. The Calcarea subject is light-haired. CAPSICUM.-Piles having swollen; itching, throbbing, with sore feeling in anus; the tumors are very large, with discharge of blood or bloody mucus from the rectum; blind piles with mucous dis- charge; suppressed hæmorrhoidal flow, causing melancholy; lack of reactive force, especially with fat people who are easily exhausted. CARBO VEG.-Discharge of an acrid, corrosive, viseid humor from the anus, causing much itching and some smarting; oozing of mois- ture from the perinæum, with soreness and much itching; protruding large bluish varices, suppurating and offensive, with burning pains MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 261 in the anus, stitching pains in the small of the back, burning and tearing in the limbs; constipation, with burning stools and discharge of blood; frequent determination of blood to the head, flatulence, slow action of the bowels; epistaxis; dysuria; especially called for in debauched, used-up subjects and in profound adynamia. CHAMOMILLA.-Bleeding piles, with compressive pain in the ab- domen, frequent urging to stool; occasional burning and corrosive diarrhoeic stools; tearing pain in the small of the back, especially at night; painful and ulcerated rhagades of the anus. COLLINSONIA CANADENSIS.-Dr. Hale believes that this remedy has the power of contracting the branches of the portal vein, indeed, he inclines to believe that it has this action on all the blood vessels and even on the heart. It is in common use in America as a vul- nerary. It claims a careful study and comes into very frequent use in general varicosis, and any of its varieties, such as hæmorrhoids, varices, or varicocele. And if Hale's view of its action is right those cases of dilated right heart, passive portal congestion, with hæmor- rhoids, would be its triune sphere, and hereby there is always consti- pation and the cases are chronic and obstinate. DIOSCOREA VILLOSA.-Dr. Burt got hæmorrhoids and yellow, thin, bilious stools with prolapse of the rectum, when he was proving the colic root. In another a hæmorrhoidal tumor of nearly four years' standing disappeared while proving it. Its reputation in enteralgia is now well established. Acute painful varicocele from excess in venery, or long-lasting unsatisfied desire, will make us think of Dios- corca or Dioscorein. Dioscorea is a powerful cardiac, and has cured a case of angina pectoris in the hands of Dr. Skinner. FERRUM.-Piles, copious or ichorous oozing, tearing pains with itching and gnawing; costiveness, stool hard and difficult, followed by backache. We heartily indorse Schüssler's recommendation of the phosphate, and that in the sixth centesimal trituration, but very irritable subjects must not take it at night, as it is very apt to keep such awake. It comes in specially after other rectal remedies have done their work to consolidate the cure by reason of its profound action on the whole systemic circulatory apparatus. GRAPHITES.-Piles with pain on sitting down or on taking a wide step, as if split with a knife, also violent itching and very sore to the touch; burning rhagades at the anus; large hæmorrhoidal tumors, 262 BURNETT'S ESSAYS. protrusion of the rectum, without urging to stool, as if the anus was lame; fissure of the anus, sharp cutting pain during stool, followed by constriction and aching for several hours, worse at night; chronic constipation, with hardness in hepatic region; moist humid eruption on scalp and behind ears; watery leucorrhoea at times of menstrua- tion; piles, accompanied by dizziness. HAMAMELIS VIRGINICA.-The use of this remedy is somewhat empirical, but its power over hæmorrhoids and other venous states is such that it stands facile princeps at the head of them all. The story of its introduction into our practice is thus given : Mr. Pond brought out his extract of Hamamelis as a remedy for piles. Dr. Constan- tine Hering was Mr. Pond's family physician, and was induced by the latter to try its efficacy in some diseases, particularly in painful bleed- ing piles. But its virtues as a pile medicine were well known to the aborigines of North America, and the earlier settlers got their knowl- edge of it from them. Speaking of it in a letter to Hering, in 1853, Dr. Okie says, "I next made use of Hamamelis in a number of cases of painful and bleeding piles. Those cases in which it has proved most beneficial in my hands are characterized by burning soreness, fulness, and at times soreness of the anus; in the back a weakness or weariness, or as the patients graphically express it, 'Doctor, my back feels as if it would break off."" It is our best topic in all forms of dilated veins. Almost all Americans en voyage seem to carry Extract of Hamamelis with them. HYDRASTIS. This plant has a reputation for many things. Un- doubtedly it is a great polychrest. I should think of it for hæmor- rhoids with jaundice and constipation, some other Hydrastis symptoms being present. I have known it to cause balanitis and yellow balan- orrhoea, with such a strong-smelling discharge that the unintentional prover had to keep away from society for several days, and so profuse that he fastened a piece of linen inside of his shirt to help absorb the discharge, and nevertheless his trousers were spoiled by the flux. The discharge was very yellow, and after it had lasted three days there was phimosis, and on my forcing the prepuce back it cracked in three places and bled. There had previously been nothing whatever wrong with the parts, and from my knowledge of the gentleman and a very careful ocular examination of the parts, I can say that there was no urethritis or urethral flux, and no chancre or chancroid, and --- MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 263 there had been no coition of any kind. At the height of the affec- tion one of the inguinal glands became painful and swelled; it all passed off in a week with no treatment but cleanliness. He had taken it about a week, some six or eight very yellow pilules a day, evidently or 1, and "for a stitch in the liver and dirty tongue." To the best of my knowledge and belief the whole series of phenomena. were pathogenetic. IGNATIA AMARA.-SUDDEN SHARP STITCHES IN RECTUM, SHOOT- ING UPWARD INTO THE BODY; evacuation of fæces difficult, because of seeming inactivity of rectum, every violent effort to expel them may produce prolapsus ani; after stool frequent spasmodic constric- tion of the anus; recurring pains in the anus, compounded of sore- ness, spasmodic constriction, and pressure; moderate effort at stool causes prolapsus ani; bleeding during and after stool; fissures of anus; hæmorrhage and pain are worse when the stools are loose. KALI CARBONICUM.-Passage of fæces difficult owing to their bulk; sensation as if the anus would be fissured; stinging, burning, tearing, itching, screwing pain, followed even a natural stool, setting the patient nearly crazy and depriving him of sleep; the tumors swell and bleed much; riding on horseback ameliorates the pain for the time being; hæmorrhoids complicating fistula in ano, especially in the poitrinaires. KALI SULPHURICUM.-Hæmorrhoids with catarrh of stomach, and tongue coated with yellow mucus; sensation of faintness in the stomach, and dull feeling in the head, fearing to lose her senses. LACHESIS.-Piles PROTRUDING AND STRANGULATED, or with stitches upward at each cough or sneeze; sensation as of a plug in the anus; rectum prolapsed or tumefied; hammering, beating in the rectum; worse at the climaxis, or with drunkards. LYCOPODIUM CLAVATUM.-Varices protrude, painful when sit- ting; discharge of blood, even with soft stool; itching eruption at the anus, painful to touch; itching and tension at the anus in the evening in bed; continued burning or stitching pain in the rectum; constipation; ineffectual urging from the contraction of the sphincter ani; flatulence; hæmaturia; pain in the sacral region, extending to the thighs, worse rising from a seat. Lycopodium has undoubtedly cured aneurisms of small calibre; it lessened one in my hands while I 264 BURNETT'S ESSAYS. was House-Surgeon at the Hardman Street Homoeopathic Dispensary, in Liverpool. Hence its power over bloodvessels must be admitted. MERCURIUS. LARGE BLEEDING VARICES WHICH SUPPURATE; hæmorrhage after micturition; hæmaturfa, with violent frequent urg- ing to urinate; prolapsus recti after stool; rectum black and bleed- ing; pain in sacrum, as after lying on a hard couch, great weakness, with ebullition and trembling from the least exertion. CYANURET OF MERCURY.—I have used this remedy in diphtheria with very satisfactory results, and hence it constitutes a part of my usual drug choice. The enormous activity of all the combinations of the metals with hydrocyanic acid leads us naturally to expect great things from the Cyanide of Mercury. It causes phlebitis and vari- cosis; it has a grand future. The sixth centesimal dilution is the lowest I ever use of this deadly drug-in this strength it may be given to the tenderest babies. German homoeopathic practitioners speak highly of Acidum hy- drocyanicum in varicose ulcers. MURIATIC ACID.-Piles, suddenly, IN CHILDREN; the hæmor- rhoidal tumors are inflamed, swollen, bluish, with swelling of anal region, sore pains, violent stitches, and great sensitiveness to contact, even of the sheets; prolapsus recti while urinating. NITRIC ACID.-Long-lasting cutting pain in rectum after loose stool, with hæmorrhoidal troubles; old pendulous hæmorrhoids, that cease to bleed, but become painful to the touch, especially in warm weather; HÆMORRHAGE BRIGHT RED, NOT CLOTTED, faint from least motion, bleed after every stool; spasmodic tearing during stool from fissures in rectum; HEMATURIA, shuddering along the spine during micturition, and urging afterwards. NUX VOMICA.—Blind, or bleeding piles, irregular piles; stitching, burning or itching of the anus; stitches and shocks in the small of the back, with bruised pains so that the patient is unable to raise himself; constipation, with frequent ineffectual urging to stool, and with sensation as if the anus were closed and constricted; frequent rush of blood to the head or abdomen, with distension of the epigas- trium and hypochondria; hæmaturia from suppressed hæmorrhoidal flow, or menses; ischuria, suppression of urine; backache, must sit up in bed. 0 MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 265 PETROLEUM.-Piles and fissures at the anus, great itching; scurf on borders of anus; stool insufficient, difficult, hard, in lumps. PHOSPHORUS.-Constipation, small-shaped, hard stool, and ex- pelled with great difficulty; discharge of blood from the rectum, also during stool; spasm in the rectum; paralysis of the lower intestines and of the sphincter ani; discharge of mucus out of the gaping anus; stinging or itching at the anus; the piles bleed easily; increased secretion of pale, watery urine; involuntary discharge of urine. Worse in the evening and at night, also when lying on the back or left side. Better when on the right side, from rubbing, and after sleeping. PODOPHYLLUM.-This is a remedy that I, myself, have used but very little, for the very good reason that of late years a veritable podophyllomania has raged in this country, and almost all patients with anything wrong between liver and rectum have taken it on their own account. This regrettable abuse of a potent remedy must not deter us from bearing it in mind in suitable cases. Hale says: "Hæmor- rhoidal affections are admirably under the control of Podophyllum. The specific affinity which this drug has for the liver, portal system, and rectum, as shown in the pathogenesis, enables it to cause hæmor- rhoids from portal congestion, chronic hepatic affections, and primary irritation, congestion and even inflammation of the veins, and mucous membrane of the rectum. It will be found useful in external piles, for those which bleed and those which do not. The sensations it causes in the rectum, anus, and hæmorrhoidal tumors are similar to the effects of Aloes of which it is a congener." Morning aggravation is characteristic of podophyllum. PULSATILLA NIGRICANS.—Painful protruding piles, with itching and sticking pains and soreness. RHUS TOX.-Fissures of the anus, with periodical profuse bleed- ing from the anus; sore piles, protruding after stool, drawing in the back from above downwards, pains in the small of the back as if bruised, when keeping quiet; frequent urging to urinate day and night, with increased secretion; sore blind hæmorrhoids, protruding after stool, with pressing in the rectum, as if everything would come Worse at night, from cold, pressure, or rest. out. SILICEA. HÆMORRHOIDS INTENSELY PAINFUL, boring cramping sensation from the anus up the rectum and towards the testicles ; M 18 266 BURNETT'S ESSAYS. protrude during stool; become incarcerated, and suppurate; piles protrude with the stool, and discharge bloody mucus; can only be returned with difficulty; fistula at anus with chest symptoms, aching, beating, throbbing in lumbo-sacral region; anus is constantly damp. SULPHUR.-Hæmorrhoids blind or bleeding, blood dark, with violent bearing-down from small of back toward the anus; lanci- nating pain from anus upwards, especially after stool; suppressed hæmorrhoids, with colic, palpitation, congestion of lungs; back feels stiff as if bruised; anal region swollen, with sore, stitching pains; considerable quantity of blood passed with soft easy stool; PAINLESS PILES; bleeding, burning, and frequent protrusion of the hæmor- rhoidal tumors; weak digestion, dysuria. VALERIANATE OF ZINC.-Dr. Dradwick noticed the fact that in a considerable number of patients troubled with piles, and who were taking Valerianate of Zinc for other troubles, the hæmorrhoids have, with few exceptions, been relieved. In cases of neuralgia, prosopalgia, spinal neuralgia, and proctalgia, together with hæmorrhoids, we may be glad to remember this happy union of valerian and zinc. VERATRUM ALBUM.-Hæmorrhoids, with disease of lungs, or pleura; painless discharge of masses of blood in clots, with sinking feeling; bruised feeling in sacral region. (Lilienthal.) ZINCUM.-Constipation; stool hard and dry, inefficient, only ex- pelled by hard pressing; sensation of soreness, and violent itching at the anus; tingling at the anus, as if from ascarides; violent desire to urinate; retention of urine when beginning to urinate. Worse in the afternoon and in the evening, also when in a warm room. Better in the open air. CONCLUSION. IN N the First Part of this little treatise I gave my own experience, and thus offered some evidence of the curability of vein affections. by medicines; I am by no means alone on this ground: hundreds of homoeopathic physicians were on it before me, and I trust, therefore, no one will suppose that I claim to have originated the notion of MEDICINAL TREATMENT OF DISEASES OF THE VEINS. 267 ! contracting dilated veins by medicines. Many of my medical friends are fond of the Surgery of the Veins; I prefer medicine, and these pages are meant to give the grounds of my faith; for me these grounds are sufficient; what they may be for you, critical reader, I know not. If you should prefer steel, either cold or hot, well, de gustibus non est disputandum. The Second Part is, for the most part, not my own, but is culled from numerous systematic and pharmacological works, and contains, I trust, all that will be needed to test the question of the curability of varices by medicines. - SUPERSALINITY OF THE BLOOD: AN ACCELERATOR OF SENILITY, AND A CAUSE OF CATARACT. "L'habitude émousse le sentiment."-BICHAT. PREFACE. THE writer having come to the conclusion that the habitual use of too much salt has a drying-up, a senescent, effect upon the organism, and that some cases of Cataract are likewise due to eating too much salt, he has brought together in the following pages some evidence tending to show that such is, at least, extremely probable. The in- gestion of too much salt renders the blood supersaline, and when in this state its specific gravity is too high and the tissues become too dry and hardened. The stroma of the lens being transparent, and the lens within visual observation, we are able to watch any changes that may take place in its physical characters, and if the lens become retrogressively metamorphosed we are warranted in concluding that what we see expressed in the lens is merely a sample of the quality of the other tissues which are beyond our field of direct observation. It is, of course, not maintained that all who partake of much salt necessarily become too soon senile, or that all cases of Cataract are due to eating too much salt, but that some cases only have probably that origin. Neither is the author able to say how much salt, or how little, a person in health should partake of, but that too much is dis- tinctly deleterious he thinks he will be able to prove. And the direction of the change wrought by salt is clearly not of a juvenes- cent kind, whatever else it may be for an opaque lens is not usually regarded as a youthful characteristic. The practical application of this view, if correct, is obvious. Any evidence on the subject, for or against, would be welcome. No single observer can settle any ques- tion, as he may be merely fondling a pet notion. J. C. BURNETT. 5, HOLLES STREET, CAVENDISH Square, W., January, 1882. SUPERSALINITY OF THE BLOOD: AN ACCELERATOR OF SENILITY, AND A CAUSE OF CATARACT. A STUDY of the causation of Cataract soon brings one to a consid- eration of the drying-up effect of salt upon the lens, and by deduction upon the tissues generally, and this leads us inevitably to think also of the salt-eating habit of mankind. I am myself a salt- eater, though I have no special fondness for salt; and I have always considered salt a very essential part of one's food. This is the all but universally accepted view. But there are a few thinking persons, who not only call that view of the subject in question, but actually affirm that our much-belauded salt is a great evil-doer. In fact, according to a fanciful few, it is nothing less than the forbidden fruit of earliest biblical times! We will not wander away into this fancy-land, and it would be quite foreign to the object of this little treatise were I to enter into the broad question of whether salt is, or is not, a food; those who may be desirous of studying the subject of salt in this wide sense will find Mr. Boddy's History of Salt not wanting in useful informa- tion and strong language; for him "salt is good," and that very emphatically so, and vituperation in plenty is poured on to the heads of the anti-salt people. At the other extreme, the late Dr. Robert Howard's Consequences of the Use of Salt may be read with advantage. Certainly salt is a very powerful agent, and any thought- ful and careful observer may readily satisfy himself that not a few persons suffering from grave forms of disease are, and have long been, great salt-eaters; whether the salt has anything to do with their ill- health is not easily determined, but is certainly deserving of inquiry. 272 BURNETT'S ESSAYS. In these pages we shall keep as nearly as possible to the subject of the title: "Supersalinity of the Blood: an Accelerator of Senility, and a Cause of Cataract ;" and we will try to avoid all controversy, and stick to scientific facts and logical deductions. We shall, how- ever, throw in a few hints and queries here and there as they may suggest themselves; so that this little treatise may, if possible, prove suggestive to others. Before proceeding, we had better arrive at an understanding with one another on two of the principal terms we shall use. SALT.-By this is meant the common salt of our tables-the Na- trum Muriaticum of old books, and the Chloride of Sodium or Sodic Chloride of the newer. CATARACT means, for us, an opacity of the crystalline lens of the animal eye, and under the term lens we shall generally include also the lens-capsule. At first sight, it might appear a very simple matter to determine the effects of salt upon the animal economy, or upon any particular part thereof; but experience shows that such is not by any means the In almost everything absolute certainty seems unattainable; think salt-eating a necessity of life, while others hold that it is a very hurtful habit. Many big books have been written thereon, but a really scientific treatment of the question has, as yet, hardly been attempted. case. many To begin with, the same substance affects different individuals dif- ferently; if not in kind, certainly in degree. For, generally speak- ing, salt in moderate quantities—say ten or fifteen grains at a meal— is well borne by any healthy adult or big child. It is said that an ounce at one dose has been known to prove fatal to a man, but it can hardly be maintained that an ounce is usually a fatal dose. Cer- tain persons are specially and peculiarly susceptible to the influence of certain substances, and these are the very people to be used as test- agents. As an example of a person having an extraordinary idiosyncrasy as regards salt, I will give the following: A friend, who had read my little monograph Natrum Muriaticum as Test of the Doctrine of Drug Dynamization, mentioned to me that a clergyman in a London suburb was unable to eat salt, as it made him ill. This clergyman was kind enough at my request to call upon me to tell me about it, SUPERSALINITY OF THE BLOOD. 273 and at my suggestion wrote out the following account of how salt affects him: 'LONDON, July 21st, 1879. "I have from childhood been unable to take more than a very moderate quantity of salt. Of course I must take some every day, in bread, potatoes, etc., but I never add any to my food from my salt-cellar, or miss it if altogether omitted; and I have to be careful to avoid everything which is over-seasoned with it. Of course, I am seldom, or never 'caught' now; and have to go back some years to remember the symptoms. In the first place, I find it difficult by the taste to distinguish salt from pepper in soups, etc. Both taste hot to me. The next sensation is that of burning in the throat and gullet. This is followed by dizziness and nausea, swelling and discoloration under the eyes, redness of the face, and a feeling such as, I imagine, those who have taken an irritant poison would experience. Raw brandy or strong vinegar relieves the immediate symptoms by causing violent sickness, but it is not for twelve hours or more, in the case of a good dose of salt (as from bathing in sea- water), that the system recovers itself, blood being frequently discharged both from the stomach and intestines. "F. W. . . . ." From this descriptive note it may be seen that salt is a very violent poison to this gentleman; that is his peculiar idiosyncrasy. Is salt qualitatively the same to us all, we being able to withstand it; or is this gentleman in a morbid state? He appears to be in good health. W But although my object in these pages is to study the physical effects of salt on the economy generally, still this will be almost im- possible unless we choose some special part of the body where its effect can with certainty be ascertained. For this the lens is pecu- liarly adapted, as the sequel will prove; therefore, instead of study- ing the general symptomatology of Natrum muriaticum, we will en- deavor to show how it affects the LENS, and, this done, we can deduce therefrom pretty certainly how it acts on the entire economy as a morbific agent, and this will give us also a therapeutic basis. Before proceeding I may be allowed to remark that the just narrated case of salt idiosyncrasy demonstrates that a sea bath is a means of actually getting salt into the system. This point is of some importance, as the direct scientific experiment to prove it is all but impossible; but thus utilizing such a person with an idiosyncrasy against salt renders such experiment unnecessary. This proof that salt really enters the organism by means of sea-bathing has a significant practical bearing, for we can now with certainty prescribe salt in this form. But salt likewise powerfully influences the body when persons live at the sea- side. This may be seen by observing the effect of sea air upon cer- 274 BURNETT'S ESSAYS. tain persons. Salt causes in some persons a deep crack in the middle of the lower lip; this symptom stands in the Hahnemannic patho- genesis-I saw a marked example of this lip-crack in an ancient mariner at Brighton last summer. Certain persons cannot live near the sea, as every observant physician knows. Some people get severe facial neuralgia at the seaside; they are commonly subjects of chronic psora. A lady of my acquaintance went last summer to Brighton with her children; she was quite well but rather low from nursing her sick children. The seaside air quite upset her, and brought on facial neuralgia; she thus described her symptoms to me: "I felt as though I were full of salt water, and when I took a small dose of Natrum muriaticum 6 it increased the feeling and filled my mouth with salt water. If I dipped my hands into the children's bath of sea-water it made my neuralgia worse. My lips always tasted salt while I was at Brighton." This lady finally, at the end of three weeks, became so ill that she had to leave the seaside and return in- land, where she at once recovered. It is a common observation that some people get obstinate constipation at the seaside, while others get diarrhoea. I have also noticed that a long residence at the seaside will cause a severe form of anæmia in certain idiosyncratic and deli- cate ladies, who finally sink into the condition commonly known as (6 decline," unless they are cured medicinally or removed inland- wards. Thus it is clear that "seaside" can be scientifically pre- scribed as a remedy. Let us now return to our text. In studying the etiology and pa- thology of cataract some years ago, I went over the experiments of Künde at second hand. Latterly I have done so at first-hand, by procuring the important little reprint entitled Ueber Wasserentziehung und Bildung Voruebergehender Katarakte von Dr. F. Kunde.* This Abstraction of Water, and the Formation of Transient Cataracts should mark an era in the natural history of lenticular opacities. These important experiments were confirmed by Köhnhorn,† in Ger- many, in 1858, and by Dr. B. W. Richardson (The Synthesis of Cata- ract) two years later in England. *From the Zeitschrift f. wissench. Zoologie von C. Th. v. Siebold und Kölliker. Viij Band, 4 Heft, 1857. † De Cataracta Aquæ Inopia Effecta. Dissertatio Inauguralis Gryphiswaldensis, Anni MDCCCLVIII.-Auctor Conradus Köhnhorn. SUPERSALINITY OF THE BLOOD. 275 Intervening between Kunde, and Köhnhorn, and Richardson, are the experiments of Dr. S. Weir Mitchell, as set forth in his paper in the American Journal of the Medical Sciences, for January, 1860; these I have not read, but they were, it appears, with sugar, and do not concern us here. More than twenty years have elapsed since Kunde did these experiments, showing that a form of cataract can be produced in the lower animals by the ingestion of salt, and yet I have never read or heard of their having raised the question as to whether this substance, which almost everybody eats with his daily food, may be accused of producing cataract or of otherwise deteriorating the general state of the human tissues. This subject has occupied my mind at odd intervals during the past few years, and I have been trying to solve the problem. That salt will actually produce cata- ract in the lower animals, has actually been experimentally demon- strated and experimentally confirmed. If, now, we could try the direct experiment on man, the question would be settled thereby definitely; but there are difficulties in the way: there are no human beings who would give themselves up for the experiment, and even though there were, it might be thought unjustifiable. Failing, there- fore, the direct experiment, we must proceed deductively and clin- ically. Cases of idiosyncratic persons are to me most instructive, for I regard such as delicate reagents of great value, but many will re- ject all such cases as unscientific and fanciful. They must, however, accept the data obtained by the direct experiment. Therefore let us start with a consideration of the experimental proof of Kunde, that cataract can be produced in healthy animals by salt introduced into their bodies. KUNDE'S EXPERIMENTS. Kunde enters upon his subject by remarking that the greater part of the earth's crust is made up of water, and hence it is no wonder that the products of this earth's crust, man and the lower animals, as the quintessence of earthly materials, should also consist principally of water. Wherever organic matter is to maintain itself, or the inor- ganic is to become organized, there must be water, for no chemical process can take place without its aid. Corpora non agunt nisi fluida. Every animal, he asserts, is only in a normal condition when it " 276 BURNETT'S ESSAYS. takes up a definite quantity of water into its organs, and we should certainly get a clearer conception of many physiological and patho- logical processes if we were able to determine the quantity of water normally held by any given organ. Whether we look upon water as a solvent, as imbibitionary mate- rial, or, probably, as a chemical agent, it plays such an important part in the functions of the organism that a plus or a minus of it must be of the greatest consequence. But, unfortunately, we do not know how much water must be present to constitute the physiological norma. We have been so long accustomed to look upon water as an indif- ferent body that we require to be reminded that water may be an exceedingly deleterious stuff. Kunde then passes to a consideration of Eckhart's theory "that a concentrated solution of salt abstracts water from the nerves, and thereby causes twitchings of those muscles which they innervate, and suggests that a chemical action may have something to do with it. در A nerve deprived of too much water ceases to react, but takes on its function again as soon as the necessary quantity of water is restored to it. But too much water also deprives the nerve of the power of reacting. Kunde proceeds to show that if a living frog be deprived of too much water it dies. But if the process be stopped at a certain stage, and the half-dried-up animal be placed in a moist atmosphere, it comes round again completely. The lethal point is not so much de- termined by the absolute quantity of water that is abstracted, but by the time occupied by the process; the organism can accustom itself to a considerable loss of water, provided it be abstracted slowly. To prove this, Kunde instituted various experiments on frogs by drying them in a draught, or in very dry air, and then restoring the humid- ty, or not, at will. If they were kept in the dry they died, but if restored to a moist place they gradually recovered. But this drying process is a slow one, and so Dr. Kunde bethought himself of another and more rapid way of abstracting water from the living organism. He says, "There is a means of abstracting water from animals in a very short time, and that is SALT." He made use of rock salt in substance, putting it into the stomach or rectum, or under the skin. SUPERSALINITY OF THE BLOOD. 277 After its application the animals were convulsed* so violently that it almost approached to tetanus, but he only observed tetanus once in many hundred cases. The next important symptom to the convul- sions was sweating, followed by profound debility, exhaustion, pa- ralysis, and death. When the salt was applied under the skin, a large quantity of fluid collected under the skin, but there was no such ac- tion in the intestines unless the salt was put either into the stomach or rectum. Put into the stomach it caused considerable hyperæmia of the mucous lining of the mouth, vomiting, secretion of bloody mu- cus from the stomach and bowels, and the animal would soon cease to breathe. But if the animal was put into water all these phenomena soon ceased. We may fairly compare the effects of salt on these frogs and those symptoms observable in the idiosyncratic clergyman men- tioned just now. And this is interesting also as bearing on the fact that salt, as we all know, causes thirst, for we can now see why it does so. Salt causes a loss of fluid, and it must be replaced, or mis- chief ensues. But even left in the air a frog poisoned with salt can yet come round under favorable circumstances. Dr. Kunde's object with these experiments was not to study the effects of salt on the an- imal organism; but he was studying the effects of loss of water there- on, and he made use of salt as a rapid means of depriving the animals. of this fluid, but in the course of his experiments he observed the for- mation of cataract as one of the effects of the salt, and he thus de- scribes his important discovery (p. 9). . KUNDE'S GREAT DISCOVERY. "If you take a frog weighing 30 grammes and give it a 0.2–0.4 dose of salt either under the skin or in the rectum, you will, in a short time, observe a bulging out of the cornea, with an increase of the aqueous humor, and, sooner or later, an opacity of the lens, which will begin sometimes anteriorly and at other times posteriorly. This opacity increases in proportion as the animal gets weaker, and attains to such a degree at last that the lens takes on a light ash-gray appear- ance." * Hence the homeopathicity of Natrum Muriaticum to certain convulsions. Query-Are the spasms of hydrophobia due to want of water in the nerves? The mode of death from hydrophobia is similar to that of a small animal from salt- poisoning; so are the ante-mortem symptoms. 278 BURNETT'S ESSAYS. The value attached to this cataract formation by Dr. Kunde is primarily, because it affords a means of judging how far the poison- ing with salt has progressed; for, says he, you can pretty well judge from the look of the lens in which stage of the poisoning the animal is, and whether it be still possible to stop the poisoning and restore the animal to its normal state. If not carried too far all the symptoms disappear when water is slowly restored to the organism, and then the salt cataract also disappears. He concludes—“We can therefore succeed by the alternative ab- straction and restoring of water, in producing and causing to disap- pear, in the same animal, opacities of the lens and paralysis of the nerves." And he thinks that the organs are only able to perform their func- tions when they have a certain amount of water, and that the presence of a superabundance of salt in the organism is not felt so long as it contains sufficient water. The nitrate of sodium has precisely the same effect on the lens as the chloride, but the nitrate of potassium does not, according to Kunde, cause any lenticular opacity. Kunde is compelled, by the results of his experiments, to admit that salt is a powerful poison to the animal economy, or at any rate a very deleterious substance. How, then, is to be explained the fact that so many partake of such large quantities of salt without any ap- parent ill effects? We say in English that habit is second nature and the Germans express the same thing in their proverb, Die Gewohn- heit ist des Menschen Amme, i.e., habit is man's nurse; and Kunde adopts Bichat's saying L'habitude émousse le sentiment as explanatory hereof. At any rate we may learn herefrom the practical lesson that those who eat much salt must necessarily drink much fluid. There- fore in the case of inebriates salt should be forbidden. And anyone observe for himself that thirsty souls use much salt with their food. Now, Hartwig gave large doses of salt to horses, cows, and dogs, and observed the following phenomena: Convulsions, coldness* of the whole body, paralysis, and even death. Kunde noticed paral- ysis in the hind legs of guinea pigs to which large doses of salt had been given; and young cats, weighing from one to two pounds, would may * Coldness is a capital and characteristic indication for Natrum Muriaticum, and which I have very often verified clinically, but, to be curative, it must be adminis- tered in dynamic dose. (See my little monograph on this drug.) SUPERSALINITY OF THE BLOOD. 279 get vomiting, convulsions, paralysis, and even die from doses of only one or two grammes. (Schüssler is, therefore, homoeopathically cor- rect in recommending Natrum Muriaticum in "vomiting of watery stuff.") On the other hand, some people can undoubtedly partake of a con- siderable quantity of salt and seemingly remain in good health. We may now note more fully the effects of salt upon the eyes of cats and other animals. Two grammes of rock salt was introduced into the stomach of a young cat and it killed her in three hours, but the lens had turned opaque before death; the aqueous humor was increased; the iris was paralyzed at the end of two hours, so that the strongest sunlight had no effect on the pupil. Two other young cats, each one twelve days old, got each about a gramme of rock salt, per rectum, and the anus being tied up; in two hours cataract had formed in each in both eyes. Kunde repeated the experiment many times, but always with the same result: the lens became opaque. This may be a purely physi- cal phenomenon or chemical. Kunde thinks it is due to the abstrac- tion of water. In any case, it is certain that salt causes a beclouding of the lens-substance. Let us now consider one or two of Kunde's experiments in detail; their study will repay the trouble; A frog, weighing 54.5 grammes, had on Friday at 10.50 a piece of rock salt weighing 0.32 grammes put into its rectum, and was placed under a dry glass globe. The temperature of the room was 16° R. At 11.20 there was a beginning opacity in the anterior part of the lens (Linsenwand). Considerable secretion of fluid. At 11.55 consider- able opacity of the lens. The frog was rather debilitated, but still hopped about. It was put into water. At 4.15 status normalis. The opacity of the lens had disappeared. At 4.45 a fresh portion of 0.36 CINa was placed in the rectum and the frog put into the dry. At 5.35 considerable opacity in the anterior part of the lens. The animal was exhausted, for being placed on its back it had not the power to get up. Pulsation of the lymph-hearts barely visible. Heart-beat and respiration still present. Sensibility much diminished. Its toes being sharply pinched it made a little jump. It was put into At seven o'clock the opacity had diminished and the animal water. 280 BURNETT'S ESSAYS. was more lively. On Saturday morning at 8.40 the animal was in its usual health. No trace of opacity of the lens. Again 0.365 Cl Na put into the rectum. At 9.15 the opacity had again begun. At 10 o'clock the lens was ash-gray. The animal did not stir when laid on its back. Sensibility almost entirely lost, mechanical and galvanic irritation only fitfully responded to. The lymph-hearts had ceased to pulsate. Heart-impulse no longer visible, but could be felt. No respiratory movements. The animal was put into water. Sun- day morning at 7.30 the animal was in its usual health. There was just a trace of lenticular opacity at the back part, but this also disap- peared. Now let us give a couple of experiments with cats. Two grammes of rock salt was put into the stomach of a cat weigh- ing one pound four ounces. In three hours the animal was dead. In the interim an opacity of the lens had become developed, and on the surface of this opacity the usual tripartite figure could be seen. The aqueous humor was increased. Two hours after the salt was given the iris was already paralyzed so that the strongest sunlight produced no reaction. Two other kittens, each twelve days old, got each about a gramme of salt put into the anus, which was then tied up. Already in two hours cataracts had formed in both eyes. These experiments were oft repeated, and gave always the like result. Kunde did not succeed in producing cataracts in coneys. We need not follow these experiments any further; our point is gained: Salt is capable of producing cataract in frogs and cats. Kunde finally concludes from his many experiments: 1. A very slight increase in the quantity of salt in the blood is capable of producing considerable changes in the optic media. 2. The lens is being constantly changed. 3. The exchange of fluids in the lens extends to its deepest layers. To those who know that Kunde in these experiments was aided and controlled by Kölliker, Virchow, H. Müller, and von Graefe, it will be quite needless to offer evidence confirmatory of his con- clusions. KÖHNHORN'S EXPERIMENTS. That this startling discovery of Kunde, that the ingestion of com- mon salt is capable of producing cataract, should at once arouse fur- SUPERSALINITY OF THE BLOOD. 281 ther inquiry in science-loving Germany is what every one would an- ticipate. Accordingly we find the Westphalian student Köhnhorn going over the same ground soon afterwards choosing it for the sub- ject of his graduation thesis, which is entitled De Cataracta aque inopia effecta (Gryphiae, MDCCCLVIII). The eminent physiologist Budge led him to undertake the experiments and aided and controlled him. Köhnhorn arrives at substantially the same conclusions as Kunde: Salt introduced into the bodies of certain of the lower ani- mals produces cataract of the lens, but he did not observe any in- crease in the quantity of the aqueous humor of the anterior chamber of the eye. With Kunde the cornea bulged out, supposedly in con- sequence of the increase of the aqueous humor, but Köhnhorn says he often observed that the cornea was very flat, and hence he con- cludes that the aqueous humor is diminished in quantity. Those who are familiar with experimental pharmacology will understand that both conditions may obtain according to circumstances and idiosyn- crasies. I will not detail the experiments of Köhnhorn, but will merely give one sample experiment performed by him on frogs (p. 10). Frog A, weighing 30.275 grammes, got, per os., 0.12 grammes of salt with the result that already in four hours the lens became opaque and the opacity increased as time went on, and beginning sometimes at one part of the lens and sometimes at another, and being in color either snowy-white, yellowish, or ash-gray. < On the twelfth page of his dissertation Köhnhorn narrates the fol- lowing very curious fact, which besides being very curious is also, from the standpoint maintained in this little treatise, especially in- structive. He quotes from the Ephemeris Guestfalica, which I think means the Westphalian newspaper press, or it is perhaps a special publication. "Königshorn, March the 12th (year not given, but it is probably the year of the date of the thesis, namely, 1858). The Sesecke or Siske takes its rise above Unna and debouches into the Lippe near Lünen. This burn, at that part of its course which is near Camen, contains so many bleaks, or blays [Bleier], a kind of whitefish, that the inhabitants of Camen get a nickname therefrom. But now a circumstance has occurred which will render this nick- name of doubtful application. Already, as long as twelve years ago, a spring in connection with our salt mine one day discharged such a 19 282 BURNETT'S ESSAYS. quantity of salt lye into the Sesecke that the blays, which are solely a fresh-water fish, entirely disappeared. After years of litigation the owners of the salt mine had to pay respectively eight hundred and one hundred and twenty thalers damages to two owners of fish- ing rights in the Sesecke. The same thing has occurred again lately, but a great deal worse. The fish, not only blays, but also pike and perch, swim about as if stunned, and can be caught with the most primitive kind of tackle, single individuals having landed as much as half a hundred weight in one day. Experts declare that these fish are not stunned but blind; for when they hit against anything they at once seek to escape in the opposite direction. Ill they cer- tainly are, for they can only stand this condition a few days, and then they die." Köhnhorn opines that these fishes were first rendered blind by the formation of cataract, and then finally succumbed, and the large amount of salt thus conveyed to the river is credited with being the cause. Proved, of course, it is not; but it is extremely likely. RICHARDSON'S EXPERIMENTS. Before closing this part of our subject we will just glance at the confirmatory experiments of Dr. B. W. Richardson, F.R.S., who about the year 1861 published the results of his experiments under the title of the Synthesis of Cataract. The copy from which I quote is apparently a reprint from a French source. The experi- ments were performed in 1860, and Dr. Richardson's first communi- cation on the subject was to the Medical Society of London in that year, but the first were with the sugars. There is one important difference between these experiments: Kunde and Köhnhorn used rock salt in substance, as we have already seen, whereas Richardson made use of saline solutions, so that Kunde's and Köhnhorn's results were not due to the anhydrous con- dition of the salt. Let us take one or two of Richardson's experi- ments: On April 10, at 4 P.M., three drachms of a solution of chlo- ride of sodium, of specific gravity 1.150, were injected under the skin of a large frog. The creature became immediately tetanic. The limbs were drawn up forcibly to the body; and in twenty min- utes the whole body was fixed; at the same time there was a con- SUPERSALINITY OF THE BLOOD. 283 stant and general twitching of the muscles,-jactitation-which con- tinued actively for an hour, although the animal itself seemed to be really dead. Previous to death, indeed within fifteen minutes after the injection, there was opacity of the lens on both sides, and the lenses assumed a denseness and a peculiar whiteness such as he had not before seen. The appearance was more like that of a lens which had been subjected to boiling than aught else. On removing the cornea he found it clear and the parts surrounding the lenses also clear. On making section of one lens, it cut firmly, and the opacity was extended throughout its structure from the circumference to the centre. The other lens, submitted to water, became soft in structure but not clear. On April 10th, at 4.15 P.M., two drachms of the solution of chlo- ride of sodium, of specific gravity 1.150, were injected under the skin of another frog. The animal was immediately convulsed, and in twenty minutes was tetanic. Death occurred in a little more than an hour after the operation, jactitation of the muscles continuing to the last. The opacity of the lens on each side commenced within half an hour after the injection, and continued rapidly to increase to total eclipse of vision. The change in the lens was identical with that which had been observed in the last experiment. Richardson's other experiments had a like result, viz., the lenses became opaque, and the opacities slowly cleared up when the creatures were put into water. Other saline solutions likewise produced cata- racts, viz., chloride of ammonium, chloride of potassium, lactate of soda, carbonate of soda, carbonate of potassa, and sulphate of potassa, but the phosphate of soda gave a negative result, as also did blood serum. The chloride of calcium and the chloride of barium also rendered the lenses opaque, but the iodide of potassium did not. Dr. Richardson also got Mr. Miller, of Bethnal Green, to place a pig under experiment for him, Dr. Ritchie making notes of it. The pig at the commencement of the experiment was in good health. It was placed alone in a sty, and was fed on the ordinary food for fattening these animals—a solution of common salt having been made, consist- ing of two ounces of salt in six ounces of water, one ounce of the solu- tion was added to the food each day from the 18th to the 24th. From the 24th to the 30th one ounce and a half of the solution was given. Sp 284 BURNETT'S ESSAYS. Up to this time it was observed that the animal, although taking food as usual, did not improve in condition. The crystalline lens in each eye continued clear. On May 1st, the dose of the salt solution was increased to four ounces daily, and on the 3d to six ounces. On the 7th, four ounces of undissolved salt were added to the food, and this quantity was continued daily until the 19th. The animal ate its food well and showed no signs of being affected by it. About the 11th Dr. Ritchie thought there was some lenticular dulness, but this effect soon passed off. The skin also remained free from blotches, and the strength of the animal remained as usual. The only change that could be observed was that he did not increase in weight and fatness like other animals fed at the same time and place on the same kind of food without the common salt. Dr. Richardson's experimental summary is pregnant with signifi- cance from our present standpoint. He says: "It is to be observed that the success of the experiment in producing the cataractous con- dition turns on the specific gravity of the fluid injected. It required, in every example, that the specific gravity should exceed 1.045, in other words that it should exceed the specific gravity of the blood. But so soon as a condition of the blood was attained, so soon as the circulating fluid could afford secretions, having an abnormal density, then the cataractous change was induced, and lasted so long as the blood retained its abnormal state." We have seen that Kunde and Köhnhorn regard the lenticular opacities as due to mere exsiccation, but Richardson says: "The mode by which the cataractous state is produced must be accepted, I think, as osmotic in character, i. e., as a direct physical effect on the lens through its surrounding and internal fluids, by which the arrange- ment of the lens, fibres, or tubes is changed. I have confirmed the observation of Dr. Mitchell that this effect is distinct from that of mere exsiccation." It is a pity that Dr. Richardson does not tell us how he wrought this confirmation; to my mind it is indeed an exsicca- tion, for, else, why should the opacity disappear when water is added? And regarding the relations of these researches to cataract in the human subject, Dr. Richardson very sensibly remarks that no syn- thesis could be more perfect than that of cataract, and it is therefore impossible not to see that a relationship exists between the artificial and the natural disease. This is now admitted in regard to artificial sugar-cataract and diabetic cataract, but the production of artificial A SUPERSALINITY OF THE BLOOD. 285 J cataract by salt has heretofore led no one to suggest the possible con- nection of the salt-eating habit of mankind and the presence of cat- aract in the salt-eaters. It is true that Dr. Richardson thus concludes: "Neither must we, in fairness, confine ourselves to the mere idea of sugar cataract from osmotic cause. It must be remembered as the primitive fact, not only that the increase of the specific gravity of the fluids of the eye by sugar will destroy the refracting power of the lens, but that, what- ever soluble substance will increase the specific gravity of the fluids, will induce the same condition. THERE MAY BE THUS SALINE CAT- ARACT AS WELL AS DIABETIC." [The small capitals are mine.] Here we see that Dr. Richardson arrives at the possibility of the existence of salt-cataract by induction from his experiments on the synthesis of cataract aided by a knowledge of the long-known exis- tence of sugar-cataract, but whether he is thinking of a saline cataract from a salt-disease of the body, analogous to the sugar-disease or di- abetes, or of a salt-cataract from eating salt, does not appear, but he must, I should suppose, have had the salt-eating habit in view, for salt is an inorganic substance and could hardly be made within the body. I may say that when I conceived the idea of this little trea- tise I had never seen Dr. Richardson's Synthesis of Cataract, and I had nearly finished my MS. before I came across this remarkable sen- tence of Dr. Richardson's, "there may be thus saline cataract as well as diabetic." It occurs to me to write to Dr. Richardson to ask what his meaning was, and if I get a reply before this quite leaves the press I will append it. [I am glad to be able to clear this point up before this leaves the press. I wrote on January 30th, 1882, to this great physician and greater physiologist, suggesting whether he meant that there must exist in man a salt disease analogous to the sugar disease or saccharine diabetes. Dr. Richardson very kindly at once replied to my sugges- tive query, and for which I beg hereby publicly to thank him. The answer runs thus: "25 MANCHESTER SQUARE, W., January 31st, 1882. "DEAR SIR: You have correctly divined what I meant. I was of opinion, when I wrote the paper you name (and I am of the same opinion still) that there is a cataract produced by the accumulation of some saline substance in the blood. ** "DR. BURNETT."] g Faithfully yours, "B. W. RICHARDSON. 286 BURNETT'S ESSAYS. This settles the point, for my contention is not that there exists a saline substance which, by accumulating in the blood, causes cataract; but that eating too much salt, or salt-containing food, acts upon the human lens as salt, just the same as the above narrated experiments show in regard to certain animals. I do not admit the existence of any "saline substance," but I lay the blame upon the salt itself; its physiological effect is to dry up, and when any portion of the living tissue gets too dry, then, if the exsiccation persists, the vital state of the tissues is altered and morbid metamorphoses may ensue. It has long been clinically known that many diabetic patients suffer from cataract, and this variety is now commonly called diabetic cataract, and its dependence upon a constitutional condition is admitted. It follows that diabetic cataract should be treated constitutionally, die- tetically, and by medicines, and not extracted. This paper will throw some further light on the pathology of cataract tending also in the same direction. Let us, therefore, hope that we are near the dawn of a new era in the treatment of cataract generally. Now as to the general effect of salt upon the body-the senescent effect as I shall call it-Dr. Richardson's remarks are important. We have seen that he says that the artificial cataract formation de- pends upon the specific gravity being higher than that of the normal blood: 66 So soon as a condition of the blood was obtained, so soon as the circulating fluid could afford secretions, having an abnormal density, then the cataractous change was induced, and lasted so long as the blood retained its abnormal state." He continues: "This fact was further brought out by those ex- periments in which the opacity of the lens was either quickly re- moved, or was prevented altogether by the immersion of the animal in water." : And then "The fact was further supported by the general effects of the dense fluid on the tissues of the body. There was scarcely a case in which the lenticular opacity was strongly marked in which there was not therewith a shrinking of the tissues, followed in most cases by convulsions, amounting even to tetanus." That is just the condition in certain senile changes: the tissues. shrink, become dense, dry, and semi-mineralized. Let me now approach the subject analytically and from the clinical side. It was a clinical observation that led me first to think of the SUPERSALINITY OF THE BLOOD. 287 possible connection of salt-eating and cataract, as I will presently relate. The connection of cataract and saccharine diabetes was known and taught years ago by Dr. Craigie, of Edinburgh. And Mr. France, Günzler, Hastner, Arlt, von Gräfe and others had dem- onstrated the thing clinically long before the saccharine synthesis of cataract had been physiologically proved. THE PROBABILITY OF THE EXISTENCE OF SALINE CATARACT IN THE HUMAN SUBJECT. Up to this point I have mainly considered the subject inductively; we will now pass on to its clinical aspect, and then draw our conclu- sions from analogy. We have noticed that the existence of diabetic cataract was long known clinically before Kunde, Köhnhorn, Weir Mitchell, and Richardson showed that sugar is capable of producing lenticular opacities. not. When I first fell to working out the thought that salt-eating might play a part in the causation of cataract I had not yet, as before stated, read Richardson's surmise that there may be such a thing as saline cataract; and I did not then know whether he refers to salt-eating or His letter shows that he was not referring to the salt-eating habit of mankind but to some hypothetical saline substance accumu- lating in the blood, and as twenty years have elapsed since the pub- lication of the Synthesis of Cataract, it is evident that this thought has not yet borne any clinical fruit, at least, so far as I have read, no saline disease has as yet been demonstrated or even surmised except by Dr. Richardson. Indeed, unless the possibility of the curability of cataract by medicines be admitted and taught, and this is not the case, all the physiologists and biopathologists of the world will work in vain at its synthesis. I was first led to surmise the possible connection of salt-eating and a variety of cataract by the following incident: Early in the year 1879 I was conversing with a lady on the sub- ject of salt-eating; she had cataract of the right eye, and I had been treating her for it for a good while with no very great benefit, and she was telling me about the clergyman whose strange susceptibility to the influence of salt I have narrated. Observing that her right eye watered a good deal, I said: "Are you fond of salt?" and learned ← 288 BURNETT'S ESSAYS. to my astonishment that she was extremely partial to it, being in the habit of putting salt into her drinking-water at dinner after the pudding. As nearly as I remember she took almost a teaspoonful to a tumbler- ful of water! I recommended her to discontinue this practice on ac- count of the power of salt to produce cataract in the lower animals; she followed my advice, and her cataract at once began to improve, and six months later she could see quite well with the eye. She was taking Dulcamara 3 a part of this time. The watering of the eye was the first symptom to disappear. It seems to me probable that her cataract was due to her salt-eat- ing; but this, of course, cannot be proved. According to Dr. Richardson's experiments, the formation of cata- ract begins as soon as the specific gravity of the blood has been raised above the normal sufficiency to admit of secretion and consequent osmotic change. After this I did not think 'much of the part played by salt in the synthesis of cataract, but in taking the cases of cataract patients during the past few months I gradually got into the habit of asking my patients the question . . Are you fond of salt? The answer to this question is very frequently, though not always, in the affirma- tive. Let me give you some examples. I will not give very many— indeed I could not if I would, for I have not thought of the subject sufficiently long for that-because it will not be possible for me to prove my proposition. If I were able to bring a thousand such cases, it would still, at the best, be only a question of probabilities; how- ever, these which I do bring have been sufficient to carry conviction to my mind. A conviction, namely, that inasmuch as salt can cause cataract in animals, it is barely conceivable that the same substance can be ingested by human beings in largish portions during many years with no effect at all. Granting that no effect was permanent in the animals so long as there was enough water within the organ- ism to carry it off; still there must, in all likelihood, arrive a time when the in-put of salt will exceed the out-put, and then human salt-eaters must necessarily be in the same plight as Kunde's frogs and cats. , FIRST OBSERVATION.-Miss fifty-two years of age, came under my observation in January, 1881, suffering from cataract of A SUPERSALINITY OF THE BLOOD. 289 both eyes. It had been several years coming, and the appearance of the iris, a beclouded blue, is peculiar. She is rather fond of salt. SECOND OBSERVATION.-Miss about fifty-five years of age, came some time ago under treatment for cataract and very severe chronic dyspepsia. She had scars on the neck, and her eyes were sus- ceptible to the cold air. As a child she was a very great salt-eater, and still eats it, but no longer cares specially for it. She was weaned of this excessive fondness for salt by the advice of a physician she thinks. Having taken such a large quantity of salt in her early years, and a moderate quantity of it ever since, it is likely that the salt may have aided in the production of her dyspepsia and of the cataract. She is still under my care and improving a little. THIRD OBSERVATION.—Mr. has been under my care for several years, off and on, with hæmorrhoids, prolapse of the rectum and cataract of both eyes, much worse in the left. With his meat, he takes "Sunday Salt," he always eats salt, though not excessively he thinks. He is between seventy and eighty years of age, and other- wise hale and active, but he is in a very mineralized condition; and at his age, of course, everybody is more or less so. For many years he has been in the habit of drinking a strong saline aperient, a por- tion of every summer. If salt can cause cataract at all one might very naturally attribute that in this gentleman to its effect, for besides the daily use of a "moderate" quantity, he must have imbibed many pounds of salt in his long-used saline aperient. FOURTH OBSERVATION.-Miss -, seventy-four years of age, came under my care a short time since with a mature cataract of the left eye and an incipient one in the right one. She is very subject to diarrhoea and eats a great deal of salt. On July 21, 1881, I ordered her pilules of Natrum muriaticum 30. One pilule night and morn- ing. She, however, had to discontinue them as they upset her so much. She did not know what she was taking. She is a hale old lady, and fresh for her age. It might, not unnaturally, be objected to my theory that much salt has a senescent effect upon the economy that this case militates against it, or even overthrows it entirely. But I call attention to the fact that she is very subject to diarrhea, and hence the organism may have cast out the surplus of salt by the bowels, indeed must have done so to a large extent. FIFTH OBSERVATION.-The Rev. sixty-four years of age, € 290 BURNETT'S ESSAYS. came under my observation a short time since. He is a scientific man, and has devoted not a little attention to the eye and to optics on account of being himself the subject of cataract of both eyes. His case is one of very unusual interest, and I must notice that his eyes began to fail twenty years ago, and that he had purpura hæmorrhagica six years later. He is a great egg-eater, partaking daily of two regu- larly, and with each he takes a small teaspoonful of salt. Other than with eggs he is a moderate salt-eater only. But is it probable that two small teaspoonfuls of salt taken daily for a long period could have had no effect in causing the lenses to degenerate? - SIXTH OBSERVATION.-Mrs. sixty-one years of age, came under my care a few weeks ago with a skin affection, double cataract, dyspepsia, pyrosis, palpitation, and alopecia. As to salt, she tells me she is a big salt-eater, partaking of two good saltspoonfuls at each meal. Although not directly bearing on the present subject, still I cannot omit to interpolate here a note or two of a young lady whom I have long treated for complete suppression of the menses. Except this she complained of nothing beyond some indigestion. Having prescribed various remedies with such scant success, I inquired very closely into her mode of life, and elicited the certainly interesting fact that she had been a very great salt-eater for eight or nine years. She eats about two teaspoonfuls of salt a day, and actually puts salt into her coffee! She is very chilly. The salt-eating habit of this young lady may have had nothing to do with her menstrual suppression, but liking salt to such a degree that it is taken in coffee is, at least, a curiosity. It will not be possible for me to give an exact scientific proof that salt-eating actually does cause cataract in man, but if I bring a cer- tain amount of evidence tending to its proof, I may induce other practitioners to investigate the subject, and those who happen to have cataractous lenses, being largish salt-eaters, might leave off the habit and try the effect of the change. I take here the opportunity of stating that practical information on the subject would be welcome to me. The question is too difficult for any one person to settle, but a careful and unprejudiced investiga- tion of the question cannot fail to be of advantage to mankind and to science. I will now return to my case-book and give a few more observa- SUPERSALINITY OF THE BLOOD. 291 tions on the subject of the coincidence of fondness for salt with the presence of cataract. SEVENTH OBSERVATION.—Mrs. —, cet. 61, formerly a patient. of Dr. P, came under my observation in September, 1881, with cataract of both eyes. She first noticed something the matter with her eyes five or six years ago, when Dr. P diagnosed lenticular opacities. She was waiting for the cataractous process to mature, when a friend of hers got cured of cataract under my care, and this determined her to try homoeopathy in her own case. She had watched her friend's case, and would have sought the aid of homoeopathy be- fore, but her brother, an allopathic physician of standing, laughed her out of it. But I am digressing: Mrs. has cataract of both eyes, worse in the right, and she is a big salt-eater, she likes salt very much, and eats two good saltspoonfuls thereof at a meal. Besides being fond of salt she is also partial to eggs and also to pepper. On my recommending her to give up salt with her food, she declared it would be impossible, as she was sure she could not live without it. came to me in November, 1881, from a provincial town, complaining of her eyes. She informed me that she had had rheumatic fever twice, the last time about five or six years ago. Ever after this last attack her eyes failed her, first the left and then the right one, was for some time under Mr. B- who, eighteen months ago, diagnosed incipient cataract of both eyes, which is now readily demonstrable with the ophthalmoscope, but not with the naked eye. Patient is now fifty-two years of age; is par- tial to sweet things, and is decidedly fond of salt, eating, at a rough guess, about a teaspoonful of salt a day with her food. EIGHTH OBSERVATION.--Mrs. " NINTH OBSERVATION.-Mrs. æt. 62, came under my ob- servation on December 1st, 1881, suffering from opacities of both lenses. She thinks they began four or five years ago after a carriage accident; the horses bolted, she became alarmed, and jumped out of the carriage, and received a great shock to the cerebro-spinal system. She was long indisposed thereafter with notable neural symptoms. The drinking-water of her house is very hard; she is very fond of sugar, and consumes a good deal of salt, although she is really not partial to salt she says. But experience has taught me that "fond- ness of salt" may be in all good faith denied, and yet the person so denying the soft impeachment may in reality partake of a great deal. 292 BURNETT'S ESSAYS. Thus Mrs. says that she is very partial to salt herrings, and eats a great many of them. Moreover she uses salt at every meal; she puts it on her plate, and, besides, she makes use of a muffineer (a salt-cellar with a perforated top like a pepper-box), and sprinkles salt upon her bread and butter and vegetables, etc. Her own esti- mate of the quantity of salt she consumes daily is one teaspoonful, but she does not admit any special fondness for salt. Of course it is not so much the fondness for salt that comes into consideration, but the quantity of salt actually eaten. Three hundred and sixty-five teaspoonsfuls of salt eaten every year, and year after year, not to men- tion the salt herrings, may fairly be charged with the power of af- fecting the lenses, especially after a severe traumatic shock. Natu- rally, I can not prove anything of the kind; the direct scientific proof is impossible, and trauma alone may have been the sole factor in the lenticular change. To my mind, however, it offers a certain amount of vraisemblance. TENTH OBSERVATION.-Mr. " æt. 79, came under my care on August 24, 1881. Had been operated on for glaucoma two years previously. The whole of the lens of the left eye is opaque and looks whitish, that of the right partly so. Moreover he is almost stone-deaf. He is highly mineralized-if I may so express myself. He is fond of salt and eats a great deal of it, and puts salt into his morning tub for a long time past. He is a fine old gentleman, but from the feel of his pulse, which also intermits, and from his general look it is clear he is a moving mass of mineral. How much his salt- eating and salt-bathing may have conduced thereto I cannot say-- perhaps not at all. But this is certain: there is improvement in his vision since I began to treat him; he is sure he sees better, and his eyes do not tire so readily. He has left off his salt almost, and thus far (December 7, 1881) has had Chelidonium majus 1x ; Sticta pul- monaria 3x; and Pulsatilla Nuttalliana 2. He has a little psoriasis of the lower extremities. This having been delayed in the press, I am enabled to add a later note in this case from my case-book. While taking the Pulsa- tilla Nuttalliana his deafness almost disappeared, and the ameliora- tion holds good. It was given because of oedema of the left upper eyelid. The intermittency of his pulse has disappeared, and he is fresher in his general look. On my advice he no longer puts salt SUPERSALINITY OF THE BLOOD. 293 into his morning tub, and has reduced his salt-eating to a minimum. I do not think it necessary to give it up entirely, because a certain quantity can without doubt be eliminated, and then it would not do any harm, and so enough may be partaken of just to give taste to otherwise tasteless food. GLAUCOMA. In connection with this tenth observation, it is to be noted that the eye-disorganization began with glaucoma, of which he was re- lieved by an operation. Now, glaucoma has, as its most essential character, an increase in the ocular tension, presumably from fluid within, and in this old gentleman there may have been salt-glau- coma as a start, with consecutive cataract. This is the more proba- ble as the experiments of Kunde on frogs show that the intraocular tension was first increased when salt was put into their bodies. once unsuccess- } Another case of glaucoma that came under my observation, and that had been several times operated on by Mr. fully on the left eye (which was then excised), and thrice on the right, which then collapsed ;-this other case was one in which there were many remarkable features, and one was the lady's excessive fondness for salt, whereof she partook very freely indeed. I treated her per- sistently with medicines and rigid diet, from which salt was almost excluded, and that one remaining eye is now a useful organ, sufficient for all the practical purposes of life, including reading and writing. In fine, I am much disposed to charge the excessive use of salt with the power, in certain cases, of causing glaucoma as well as cata- ract. Let those, whose opportunities are larger than mine, prove that I am wrong. ELEVENTH OBSERVATION.-Miss, cet. 50, by profession a teacher, came under my observation quite lately. She complains that the sight of her right eye is weak, i. e., the right eye waters when she uses it a good deal. An ophthalmoscopic examination shows that the lens of this eye is diffusely opaque; the retina is only obscurely visible. Patient is fond of salt; she eats it with most of her food. Although fond of salt, she does not like salty things. The aunt of Miss has also cataract, and is even a much greater salt- eater than Miss as she even puts salt on her bacon. A lady > on a visit noticed this aunt's fondness for salt, and said: “You 294 BURNETT'S ESSAYS. should not eat so much salt, now you are old, as it dries up the blood so." This is an example of how great truths are often current in the mouths of the people. TWELFTH OBSERVATION.-Mr., cet. 52, a hale and hearty- looking farmer, came at the beginning of the year under my care. Fourteen years ago had rheumatic iritis, which ended in a closure of the pupils. Then iridectomy was performed by a provincial eye- surgeon of good-repute; it failed. Subsequently, a well-known Lon- don oculist performed iridectomy four times with very indifferent results; as soon as each operation was done, the part inflamed and became opaque. There is, however, a rudimentary artificial pupil in the left eye, and through this the left lens appears like a little whitish ammonite a mere dried-up mass. With this left eye he can just distinguish between a horse and a cow, or between a pig and a sheep. It is eleven years since he last saw to read a little. What state the right lens may be in is beyond view, as the cornea of this eye is also opaque. Patient is particularly fond of salt. He thinks his daily average of salt is about two teaspoonfuls. Thirty-six years ago he had the itch (caught from a servant); it was cured (?) by what he calls "a nasty, stinking ointment." The thought occurs to me very frequently that psora seems to taint many of the individuals who have cataract, and are fond of salt; is the psoric person specially susceptible to the influence of salt? And has he also a special liking for it? Now, I think I may conclude my little treatise; I have shown that common salt is capable of producing cataract in healthy lower animals, and I have shown that persons suffering from cataract are very apt to be fond of salt. It may be said that fondness for salt, being present in many who have no cataract, cannot be any evidence. that it really is to be blamed just because a cataractous person hap- pens to eat a good deal of salt. This is granted. Yet I must sub- mit that, quite apart from my little bit of clinical evidence, if salt can cause cataract in the lower animals, it may be fairly inferred that it possesses a like power over the human body. Phosphorus pro- duces granular degeneration, as 'well in animals as in man, and the sum of human experience tends to show that drugs affect man and animals very much alike. There are, it is true, notable exceptions, SUPERSALINITY OF THE BLOOD. 295 especially in the neurotics; but, put broadly, what causes tissue de- generation in animals, will cause precisely the same thing in man. W CONCLUSIONS. 1. Salt causes cataract in the lower animals. 2. As many persons suffering from cataract eat a good deal of salt, it is probable that the salt may have some causal connection therewith. 3. Therefore persons suffering from cataract should eat but very little salt, or give up the salt-eating habit entirely. 4. Cataract is usually considered an evidence of senile decay, and as salt causes cataract, may we not infer that excessive salt- eating tends to make us aged-perhaps even prematurely? IS SALT A FOOD? I have just said that salt-eaters, being the subjects of cataract, should eat but very little salt, or give up the habit entirely. Here I shall doubtless be met with the question: "But is not salt an abso- lutely essential part of one's food?" This is a broad question that I have just hinted at in the beginning of this little treatise. I am not in a position to answer the question absolutely, but I may offer a few remarks upon it. Individually, I usually eat salt with my food like other people, but not very much. I do not care specially for it, though salted provisions are grateful to my palate. By way of ex- periment I have gone without salt for three months at a time, and felt none the worse. I know a little girl seven years of age, who has never tasted salt as such; of course it is in most of her cooked food. She is very bonny, of large build, very powerful, enjoys very excel- lent health, and has no worms. I know a London gentleman, about forty years of age, who has not eaten any salt for fifteen years; he enjoys excellent health, and is a fine handsome man, with a singularly healthy look, and he has no worms. It is, therefore, quite sure that there is no danger in very much limiting the quantity of salt par- taken of. These remarks I offer merely to show that there is, so far as I have 296 BURNETT'S ESSAYS. been able to observe, absolutely no danger in entirely giving up salt as a food; respectively as a condiment with one's food. SUPERSALINITY OF THE BLOOD AN ACCELERATOR OF SENILITY. When much salt is partaken of, or whenever the output of salt, plus what is used up within the organism, is less than the input, the blood must necessarily become supersaline; when the blood is super- saline its specific gravity is raised above the normal, and then the senescent effect of the supersalinity must take place. In the lens we have traced this drying-up effect, and we have seen that consentane- ously therewith there is a drying up and shrinking of the tissues of the body. In the habitually excessive salt-eater the almost constant pres- ence of a plus of salt in the blood as it courses all over the body, must affect the tissues in the same way. It may affect one part of the body more readily than another, i. e., it may have an elective affinity for any given organ or part, but when any given substance is capable of effecting tissue degeneration, that degeneration is the same in kind in every part, though it may differ in degree. Supersalinity of the blood causes a senile change to take place in the lens-that is proved, for it can be seen and demonstrated. The process that visibly takes place in the lens goes on invisibly in the other tissues at the same time; there is no escaping from this con- clusion. It therefore follows that the excessive ingestion of common salt, and of other substances that raise the specific gravity of the blood, must tend to mineralize the tissues and thus accelerate senility. Hence "Supersalinity of the Blood" is an "Accelerator of Senility, and a Cause of Cataract." L BOERICKE & TAFEL'S →Homœopathic Publications.< ALLEN, DR. T. F. The Encyclopedia of Pure Materia Medica; a Record of the Positive Effects of Drugs upon the Healthy Human Organism. With contributions from Dr. Richard Hughes, of England; Dr. C. Hering, of Philadelphia; Dr. Carroll Dunham, of New York; Dr. Adolf Lippe, of Philadelphia, and others. Ten vol- umes. Price, bound in cloth, $60.00; in half morocco or sheep, $70 00 This is the most complete and extensive work on Materia Medica ever attempted in the history of medicine-a work to which the homoeopathic practitioner may turn with the certainty of finding the whole pathogenetic record of any remedy ever used in homoeopathy, the record of which being published either in book form or in journals. The volumes average about 640 pages each. ALLEN, DR. T. F. A General Symptom Register of the Homo- opathic Materia Medica. BY TIMOTHY F. ALLEN, M. D., Author of the Encyclopedia of Pure Materia Medica. 1340 pages in one large volume. Price, in cloth, $12.00; in sheep or half morocco, $14 00. This Index to the Encyclopedia of Materia Medica is at the same time the best arranged and most complete Repertory ever attempted. Its inge- nious selection and arrangement of different kinds of type greatly facilitate its use. ANGELL, DR. H. C. A Treatise on Diseases of the Eye; for the Use of Students and Practitioners. By HENRY C. Angell, M.D., Professor of Ophthalmology in the Boston University School of Medicine, etc., etc. Sixth edition, enlarged and illustrated. I 2mo. Cloth, $3.00 The sixth edition of this standard work has just been issued from the press, and shows that the whole work has been thoroughly revised and brought up to the latest dates in oph- thalmology. Exquisite clear photographic illustrations have been added, and an exposition given of the dioptric or metric system, as applied to lenses for spectacles. BAEHR, DR. B. The Science of Therapeutics according to the Principles of Homoeopathy. Translated and enriched with nu- merous additions from Kafka and other sources, by C. J. HEMPel, M.D. Two volumes. 1387 pages, $900 “In short Dr. Baehr has presented us with the results of his observations at the bedside rather than of his researches in the study. It is this which renders his work valuable, and which at the same time accounts for his occasional imperfections. We know 2 of no work of the kind in homoeopathic literature where the suggestions for the choice of medicines are given in a fresher or clearer manner, or in one better calculated to interest and inform the practitioner. We have only to add that the two volumes are highly credit- able to the publishers. The type is good, the paper is good, and the binding excellent."- MONTHLY HOMEOPATHIC REVIEW. BOERICKE & TAFEL'S BELL, DR. JAMES B. The Homoeopathic Therapeutics of Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera Infantum, and all other loose evacuations of the bowels. Second edition by DRS. BELL and LAIRD. 275 pages. I2mo. Cloth, $I 50 This little book had a very large sale, and but few physicians' offices will be found with- out it. The work was, without exception, very highly commended by the homoeopathic press. BERJEAU, J. PH. The Homeopathic Treatment of Syphilis, Gonorrhoea, Spermatorrhea, and Urinary Diseases. Revised, with numerous additions, by J. H. P. FROST, M.D. 256 pages. 12mo. Cloth, $1 50 This work is unmistakably the production of a practical man. It is short, pithy, and contains a vast deal of sound, practical instruction. The diseases are briefly described; the directions for treatment are succinct and summary. It is a book which might with profit be consulted by all practitioners of homeopathy."-NORTH AMERICAN JOURNAL. BREYFOGLE, DR. W. L. Epitome of Homœopathic Medi- cines. 383 pages, $1 25 $2 25 (6 Interleaved with writing paper. Half morocco, We quote from the author's preface: It has been my aim throughout, to arrange in as concise form as possible, the leading symptoms of all well-established provings. To accomplish this, I have compared Lippe's Mat. Med.; the Symptomen-Codex; Jahr's Epitome; Benninghausen's Therapeutic Pocket- Book, and Hale's New Remedies." BRYANT, DR. J. A Pocket Manual, or Repertory of Homœo- pathic Medicine, Alphabetically' and Nosologically arranged, which may be used as the Physicians' Vade-mecum, the Travellers' Medical Companion, or the Family Physician. Third edition. 352 pages. 18mo. Cloth, $1 50 BUTLER, DR. JOHN. Electricity in Surgery. Pp. 112. Cloth, $1.00. These few pages are intended as a practical guide for the use of the specialist and general practitioner, and aim at showing the necessity of attaining accuracy of detail in all electro- surgial operations. The scope of the work precludes the possibility of more than cursory allusion to clinical cases, but is based almost entirely upon the author's own personal experience, and is for the most part composed of articles written from time to time for different periodicals, revised and condensed. BUTLER, DR. JOHN. A Text-Book of Electro-Therapeutics and Electro-Surgery, for the Use of Students and General By JOHN BUTLER, M.D., L.R.C.P.E., L.R.C.S.I., Second edition, revised and enlarged. 350 pages. 8vo. Cloth, Practitioners. $3.00 "Butler's work gives with exceptional thoroughness all details of the latest researches on Electricity, which powerful agent has a great future, and rightly demands our most earnest consideration. But Homoeopathia especially must hail with delight the advent from out the ranks of her apostles of a writer of John Butler's ability. His book will also find a large circle of non-homoeopathic readers, since it does not conflict with the tenets of any thera- peutic sect, and particular care has been bestowed on the technical part of electo-therapeia." -HOMOEOPATHISCHE RUNDSCHAU. etc. HOMEOPATHIC PUBLICATIONS. 3 DAKE, DR. WM. C. Pathology and Treatment of Diphtheria. By WM. C. DAKE, M.D., of Nashville, Tenn. 55 pages. 8vo. Pa- per, 50 cts. This interesting monograph was enlarged from a paper read at the Third Annual Meeting of the Homoeopathic Society of Tennessee, held at Mem- phis, September 19, 1877. It gives a report of one hundred and seventy-six cases treated, during a period of eleven months. It well repays a careful perusal. DUNHAM, CARROLL, A. M., M.D. Homeopathy the Science of Therapeutics. A collection of papers elucidating and illustrating the principles of homoeopathy. 529 pages. Half morocco, Svo. Cloth, $300 $4 00 "After reading this work no one will attempt to justify the practice of alternation of remedies. It is simply the lazy man's expedient to escape close thinking or to cover his ignorance. The one remedy alone can be accurate and scientific; a second or third only complicates and spoils the case, and will inevitably ruin a good reputation. But to come to more practical matters, more than one half of this volume is devoted to a careful analysis of various drug-provings. It teaches us Materia Medica after a new fashion, so that a fool can understand, not only the full measure of usefulness, but also the limitations which surround the drug. We ought to give an illustration of his method of analysis, but space forbids. We can only urge the thoughtful and studious to obtain the book, which they will esteem as second only to the Organon in its philosophy and learning."-THE AMERICAN HOMEOPATHIST. DUNHAM, CARROLL, A.M., M.D. Lectures on Materia Med- ica. 858 pages. 8vo. Cloth, $5 00 Half morocco, $6 00 "Vol. I is adorned with a most perfect likeness of Dr. Dunham, upon which stranger and friend will gaze with pleasure. To one skilled in the science of physiognomy there will be seen the unmistakable impress of the great soul that looked so long and stead- fastly out of its fair windows. But our readers will be chiefly concerned with the contents of these two books. They are even better than their embellishments. They are chiefly such lectures on Materia Medica as Dr. Dunham alone knew how to write. They are pre- ceded quite naturally by introductory lectures, which he was accustomed to deliver to his classes on general therapeutics, on rules which should guide us in studying drugs, and on the therapeutic law. At the close of Vol. II we have several papers of great interest, but the most important fact of all is that we have here over fifty of our leading remedies pre- sented in a method which belonged peculiarly to the author, as one of the most successful teachers our school has vet produced. Blessed will be the library they adorn, and wise the man or woman into whose mind their light shall shine."-CINCINNATI MEDICAL ADVANCE. EATON, DR. MORTON M., on the Medical and Surgical Dis- eases of Women, with their Homœopathic Treatment. Fully illus- trated. Pp. 781. 8vo. Sheep, ´. $6 50 This work is received with great favor by the profession, and is com- mended by the homoeopathic press as being the best and most complete work on the subject hitherto issued. "This is a large, handsome volume of 781 pages, beautifully printed on good paper, and strongly bound in leather. The illustrations are numerous and good and well bring out the anatomical relationship of the parts, and put the various dislocations before the mind very clearly indeed; in fact, almost too clearly, for he who learns thus, and then tries to carry his knowledge into practice, will feel rather disappointed at the less obliging disposi- tion of nature herself. Drawings of almost all the principal instruments are given, and the whole subject brought down to date. There is an air about this work that commends it very much to our judgment for the use of the student, and of the general practitioner, and 4 BOERICKE & TAFEL'S hence, we believe, it is destined to become the class-book in homoeopathic colleges for many years to come. There is a healthy absence of the scissors and paste business. The author holds the candle of his own experience, and thus affords a reliable aid to the gynecological path-finder in all his freshness and inexperience."-From the HOMEOPATHIC WORLD for January 1881. EGGERT, DR. W. The Homeopathic Therapeutics of Uterine and Vaginal Discharges. 543 pages. 8vo. Half morocco, $350 The author brought here together in an admirable and comprehensive arrangement everything published to date on the subject in the whole homo- opathic literature, besides embodying his own abundant personal experience. The contents, divided into eight parts, are arranged as follows: Part I. Treats on Menstruation and Dysmenorrhea; Part II. Menor- rhagia; Part III. Amenorrhea; Part IV. Abortion and Miscarriage; Part V. Metrorrhagia; Part VI. Fluor albus; Part VII. Lochia; and Part VIII. General Concomitants. No work as complete as this, on the subject, was ever before attempted, and we feel assured that it will meet with great favor by the profession. The book is a counterpart of Bell on Diarrhoea, and Dunham on Whooping-cough. Synthetics Diagnosis and Pathology are left out as not coming within the scope of the work The author in his preface says: Remedies and their symptoms are left out, and the symp- toms and their remedies have received sole attention that is what the busy practitioner wants. The work is one of the essentials in a library." -AMERICAN OBSERVER. "A most exhaustive treatise, admirably arranged, covering all that is known of thera- peutics in this important department"--HOMEOPATHIC TIMES, GUERNSEY, DR. H. N. The Application of the Principles. and Practice of Homœopathy to Obstetrics and the Dis- orders Peculiar to Women and Young Children. By HENRY N. GUERNSEY, M.D., Professor of Obstetrics and Diseases of Women and Children in the Homoeopathic Medical College of Pennsylvania, etc., etc. With numerous Illustrations. Third edition, revised, en- larged, and greatly improved. 1004 pages. 8vo. Half morocco, $8 00 This standard work, with the numerous improvements and additions, is the most com- plete and comprehensive work on the subject in the English language. Of the previous editions almost four thousand copies are in the hands of the profession, and of this third edition a goodly number have already been taken up. There are few other professonial works that can boast of a like popularity and with all new improvements and experiences diligently collected and faithfully incorporated into each successive edition, this favorite work will retain its hold on the high esteem it is held in by the profession, for years to come. It is superfluous to add that it was and is used from its first appearance as a text book at the homœopathic colleges. GUERNSEY, DR. E. Homœopathic Domestic Practice. With Full Descriptions of the Dose to each single Case. Containing also Chapters on Anatomy, Physiology, Hygiene, and an abridged Materia Medica. Tenth enlarged, revised, and improved edition. 653 pages. Half leather, $2 50 GUERNSEY, DR. W. E. The Traveller's Medical Repertory and Family Adviser for the Homeopathic Treatment of Acute Diseases. 36 pages. Cloth, 30 cts. This little work has been arranged with a view to represent in as compact a manner as possible all the diseases—or rather disorders-which the non-professional would attempt to HOMEOPATHIC PUBLICATIONS. LO prescribe for, it being intended only for the treatment of simple or acute diseases, or to allay the suffering in maladies of a more serious nature until a homeopathic practitioner can be summoned. 5 HAHNEMANN, Dr. S. The Lesser Writings of. Collected and Translated by R. E. DUDGEON, M. D. With a Preface and Notes by E. MARCY, M.D. With a Steel Engraving of Hahnemann from the statue 784 pages. Half bound, of Steinhauser. $3.00 This valuable work contains a large number of Essays, of great interest to laymen as well as medical men, upon Diet, the Prevention of Diseases, Ventilation of Dwellings, etc. As many of these papers were written before the discovery of the homoeopathic theory of cure, the reader will be enabled to peruse in this volume the ideas of a gigantic intellect when directed to subjects of general and practical interest. HAHNEMANN, Dr. S. Organon of the Art of Healing. By SAMUEL HAHNEMANN. "Aude Sapere." Fifth American edition, trans- lated from the Fifth German edition, by C. WESSELHEFT, M.D. 244 pages. 8vo. Cloth, SI 75 This fifth edition of "Hahnemann Organon" has a history. So many complaints were made again and again of the incorrectness and cumbersome style of former and existing editions to the publishers, that, yielding to the pressure, they promised to destroy the plates of the fourth edition, and to bring out an entire re-translation in 1876, the Centennial year. After due consideration, and on the warm recommendation of Dr. Constantine Hering and others, the task of making this re-translation was confided to Dr. C. Wesselhoeft, and the result of years of labor is now before the profession, who will be best able themselves to judge how well he succeeded in acquit- ting himself of the difficult task. "To insure a correct rendition of the text of the author they (the publishers) selected as his translator Dr. Conrad Wesselhoeft of Boston, an educated physician in every respects and from his youth up perfectly familiar with the English and German languages, than whom no better selection could have been made." That he has made, as he himself de- clares, 'an entirely new and independent translation of the whole work', a careful compari- son of the various paragraphs, notes, etc., with those contained in previous editions, gives abundant evidence; and while he has, so far as was possible, adhered strictly to the letter of Hahnemann's text, he has at the same time given a pleasantly flowing rendition that avoids the harshness of a strictly literal translation."-HAIINEMANNIAN MONTHLY. HALE, DR. E. M. Lectures on Diseases of the Heart. In Three Parts. Part I. Functional Disorders of the Heart. Part II. Inflamma- tory Affections of the Heart. Part III. Organic Diseases of the Heart. Second enlarged edition. 248 pages. Cloth, SI 75 HALE, DR. E. M. Materia Medica and Special Therapeutics. of the New Remedies. Fifth Edition, revised and enlarged. In two Volumes. • Vol. I. Special Symptomatology. With new Botanical and Pharmaco- logical Notes and Appendix. 1882. 746 pages. Cloth, Half morocco, Vol. II. Special Therapeutics. With Illustrative Clinical Cases. 900 pages. Cloth, Half morocco, $5 00 $6 00 $5 00 $6.00 6 BOERICKE & TAFEL'S "Dr. Hale's work on New Remedies' is one both well known and much appreciated on his side of the Atlantic. For many medicines of considerable value we are indebted to his researches. In the present edition the symptoms produced by the drug investigated and those which they have been observed to cure, are separated from the clinical observations, by which the former have been confirmed. That this volume contains a very large amount of invaluable information is incontestable, and that every effort has been made to secure both fulness of detail and accuracy of statement. is apparent throughout. For these reasons we can confidently commend Dr. Hale's fourth edition of his well-known work on the New Remedies' to our homoeopathic colleagues."-MONTHLY HOMEOPATHIC REVIEW. C "We do not hesitate to say that by these publications Dr. Hale rendered an inestimable service to homoeopathy. and thereby to the art of medicine. The school of Hahnemann in every country owes him hearty thanks for all this; and allopathy is beginning to share our gain.' The author is given credit for having in this fourth edition corrected the mistake for which the third one had been taxed rather severely, by restoring in Vol. II. 'the special therapeutics', instead of the characteristics' of the third edition."-BRITISH JOURNAL OF HOMEOPATHY. • HALE, DR. E. M. The Medical, Surgical, and Hygienic Treat- ment of Diseases of Women, especially those causing Ster- ility, the Disorders and Accidents of Pregnancy, and Pain- ful and Difficult Labor. By EDWIN M. HALE, M.D., Professor of Materia Medica and Therapeutics in the Chicago Homoeopathic College, etc., etc. Second enlarged edition. 378 pages. 8vo. Cloth, $2 50 "This new work embodies the observations and experience of the author during twenty- five years of active and extensive practice, and is designed to supplement rather than super- cede kindred works. The arrangement of the subjects treated is methodical and convenient; the introduction containing an article inserted by permission of Dr. Jackson, of Chicago, the author, upon the ovular and ovulation theory of menstruation, which contains all the obser- vations of practical importance known on this subject to date. The diseases causing sterility are fully described, and the medical, surgical and hygienic treatment pointed out. The more generally employed medicines are enumerated, but their special or specific indications are unfortunately omitted. The general practitioner will find a great many valuable things for his daily rounds, and cannot afford to do without the book. The great reputation and ability of the author are sufficient to recommend the work, and to guarantee an appreciative reception and large sale.”—HAHNEMANNIAN MONTHLY. HART, DR. C. P. Diseases of the Nervous System. Being a Treatise on Spasmodic, Paralytic, Neuralgic and Mental Affections. For the use of Students and Practitioners of Medicine. By CHAS. POR- TER HART, M.D., Honorary Member of the College of Physicians and Surgeons of Michigan, etc., etc., etc. Pp. 409 8vo. Cloth, $3 00 "This work supplies a need keenly felt in our school-a work which will be useful alike to the general practitioner and specialist; containing, as it does, not only a condensed compilation of the views of the best authorities on the subject treated, but also the author's own clinical experience; to which is appended the appropriate homoeopathic treatment of each disease. It is written in an easy, flowing style, at the same time there is no waste of words. * * * * * We consider the work a highly valuable one, bearing the evidence of hard work, considerable research and experience."-MEDICO-CHIRURGICAL QUARTERLY. "We feel proud that in Hart's Diseases of the Nervous System' we have a work up to date, a work which we need not feel ashamed to put in the hands of the neurologist or alienist for critical examination, a work for which we predict a rapid sale."-NORTH AMER- ICAN JOURNAL OF HOMEOPATHY. เ HELMUTH, DR. W. T. 568 Engravings on Wood. tion. 1000 pages. Sheep, A System of Surgery. A System of Surgery. Illustrated with By WM. TOD HELMUTH, M. D. Fourth edi- $8 50 This edition of Dr. Helmuth's great work is already in appearance a great improve- ment over the old edition, it being well printed on fine paper, and well bound. By in- creasing the size of the page, decreasing the size of type, and setting up solid, fully one-half more printed matter is given than in the previous edition, albeit there are over 200 pages • HOMEOPATHIC PUBLICATIONS. less; and while the old edition, bound in sheep, was sold at $11.50 by its publishers, this improved third edition is now furnished at $3 less, or for $8.50. The author brought the work fully up to date, and for an enumeration of some of the more important improvements, we cannot do better than to refer to Dr. Helmuth's own Preface. HEMPEL, DR. C. J., and DR. J. BEAKLEY. Homœopathic Theory and Practice. With the Homœopathic Treatment of Surgi- cal Diseases, designed for Students and Practitioners of Medicine, and as a Guide for an intelligent public generally. Fourth edition. pages, IIOO $3.00 HERING, DR. C. More condensed, revised, enlarged, and improved, Condensed Materia Medica. Condensed Materia Medica. Second edition. $7.00 In February, 1877, we were able to announce the completion of Hering's Condensed Materia Medica. The work, as was to be expected, was bought up with avidity by the pro- fession and already in the fall of 1878 the author set to work perfecting a second and im- proved edition. By still more condensing many of the remedies, a number of new ones could be added without much increasing the size and the price of the work. This new edition is now ready for the profession, and will be the standard work par excellence for the practitioner's daily reference. 66 7 HEINIGKE, DR. CARL. Pathogenetic Outlines of Homœo- pathic Drugs. Translated from the German by EMIL TIETZE, M.D., of Philadelphia. 576 pages. Svo. Cloth, $3.50 This work, but shortly issued, is already meeting with a large sale and an appreciative reception. It differs from most works of its class in these respects: 1. That the symptomatic outlines of the various drugs are based exclusively upon the pathogenetic" results of provings. 2. That the anatomico-physiological arrangement of the symptoms renders easier the understanding and survey of the provings. 3. That the pathogenetic pictures drawn of most of the drugs, gives the reader a clearer idea and a more exact impression of the action of the various remedies. Each remedy is introduced with a brief account of its preparation, duration of action and antidotes. HOLCOMBE, DR. W. H. Yellow Fever and its Homœopathic Treatment, IO cts. What is Homœopathy? A new ex- 28 pages. 8vo. Paper cover. Per dozen, 15 cts. HOLCOMBE, DR. W. H. position of a great truth. $1.25, "Prove all things, hold fast that which is good.”—ST. PAUL. HOLCOMBE, DR. W. H. pages. 8vo. Paper cover. HOLCOMBE, DR. W. H. 28 15 cts. Special Report of the Homeopathic Yellow Fever Commission, ordered by the American Institute of Homoeopathy for presentation to Congress. 32 pages. Svo. Paper. Per hundred, $4.00, 5 cts. This Report, written in Dr. Holcombe's masterly manner, is one of the best campaign documents for homoeopathy. The statistics must convince the most skeptical, and every homoeopathic practitioner should feel in duty bound to aid in securing its widest possible circulation. How I became a Homeopath. Per dozen, $1.25, • HOMEOPATHIC POULTRY PHYSICIAN (Poultry Veteri- narian); or, Plain Directions for the Homoeopathic Treatment of the 8 BOERICKE & TAFEL'S most Common Ailments of Fowls, Ducks, Geese, Turkeys and Pigeons, based on the author's large experience, and compiled from the most re- liable sources, by Dr. Fr. Schröter. Translated from the German. I 2mo. Cloth, 84 pages. 50 cts. We imported hundreds of copies of this work in the original German for our customers and as it gave good satisfaction, we thought it advisable to give it an English dress, so as to make it available to the public generally. The little work sells very fast, and our readers will doubtless often have an opportunity to draw the attention of their patrons to it. HOMOEOPATHIC COOKERY. Second edition. With Additions by the Lady of an American Homoeopathic Physician. Designed chiefly for the Use of such Persons as are under Homœopathic Treatment. 176 pages, 50 cts. HULL'S JAHR. A New Manual of Homeopathic Practice. Edited, with Annotations and Additions, by F. G. SNELLING, M. D. Sixth American edition. With an Appendix of the New Remedies, by C. J. HEMPEL, M.D. 2 volumes. 2076 pages, $9 00 The first volume, containing the symptomatology, gives the complete pathogenesis of two hundred and eighty-seven remedies, besides, a large number of new remedies are added by Dr. Hempel, in the appendix. The second volume contains an admirably arranged Re- pertory. Each chapter is accompanied by copious clinical remarks and the concomitant symptoms of the chief remedies for the malady treated of, thus imparting a mass of in orma- tion, rendering the work indispensable to every student and practitioner of medicine. JAHR, Dr. G. H. G. Therapeutic Guide; the most Important Re- sults of more than Forty Years' Practice. With Personal Observations regarding the truly reliable and practically verified Curative Indications. in actual cases of disease. Translated, with Notes and New Remedies, by C. J. HEMPEL, M.D. 546 pages, เ $3.00 With this characteristically long title, the veteran and indefatigable Jahr gives us another volume of homeopathics. Besides the explanation of its purport contained in the title itself, the author's preface still further sets forth its distinctive aim. It is intended, he says, as a guide to beginners, where I only indicate the most important and decisive points for the selection of a remedy, and where I do not offer anything but what my own individual experience, during a practice of forty years, has enabled me to verify as absolutely decisive in choosing the proper remedy. The reader will easily comprehend that, in carrying out this plan, I had rigidly to exclude all cases concerning which I had no experience of my own to offer. We are bound to say that the book itself is agreeable, chatty. and full of practical observation. It may be read straight through with interest, and referred to in the treatment of particular cases with advantage."-BRITISH JOURNAL OF HOMEOPATHY. JAHR, DR. G. H. G. The Homoeopathic Treatment of Dis- eases of Females and Infants at the Breast. Translated from the French by C. J. HEMPEL, M.D. 422 pages. Half leather, $2 00 This work deserves the most careful attention on the part of homoeopathic practitioners. The diseases to which the female organism is subject are described with the most minute correctness and the treatment is likewise indicated with a care that would seem to defy criticism. No one can fail to study this work but with profit and pleasure. · INDEX to the first eighteen volumes of the North American Journal of Homœopathy. Paper, $2 00 JONES, DR. SAMUEL A. The Grounds of Homœopathic Faith. Three Lectures, delivered at the request of Matriculates of the Department of Medicine and Surgery (Old School) of the University of J HOMOEOPATHIC PUBLICATIONS. 9 Michigan. By SAMUEL A. JONES, M.D., Professor of Materia Medica, Therapeutics, and Experimental Pathogenesy in the Homœopathic Medical College of the University of Michigan, etc., etc. 92 pages, Cloth. Per dozen, $3.00; per hundred, $20.00, I 2mo. 30 cts. Lecture first is on THE LAW OF SIMILARS; ITS CLAIM TO BE A SCIENCE IN THAT IT ENABLES PERVERSION. Lecture second, THE SINGLE REMEDY A NECESSITY OF SCIENCE. Lecture third, THE MINIMUM DOSE AN INEVITABLE SEQUENCE. A fourth Lecture, on THE DYNAMIZATION THEORY, was to have finished the course, but was prevented by the approach of final examinations, the preparation for which left no time for hearing evening lectures. The LECTURES are issued in a convenient size for the coat-pocket; and as an earnest testi- mony to the truth, we believe they will find their way into many a homeopathic household. JOHNSON, DR. I. D. Therapeutic Key; or, Practical Guide for the Homœopathic Treatment of Acute Diseases. Tenth edition. 347 pages. Bound in linen, $I 75 Bound in flexible cover, $225 This has been one of the best selling works on our shelves; more copies being in circu- lation of this than of any two other professional works put together. It is safe to say that there are but few homeopathic practitioners in this country but have one or more copies of this little remembrancer in their possession. JOHNSON, DR. I. D. A Guide to Homeopathic Practice. De- signed for the use of Families and Private Individuals. 494 pages Cloth, $2 00 This is the latest work on Domestic Practice issued, and the well and favorably known author has surpassed himself. In his book fifty-six remedies are introduced for internal ap- plication, and four for external use. The work consists of two parts. Part I is subdivided into seventeen chapters, each being devoted to a special part of the body, or to a peculiar class of disease. Part II contains a short and concise Materia Medica, i. e., gives the symptoms peculiar to each remedy. The whole is carefully written with a view of avoiding technical terms as much as possible, thus insuring its comprehension by any person of ordi- nary intelligence. A complete set of remedies in vials holding over fifty doses each is fur- nished for $7, or in vials holding over one hundred doses each for $10, or book and case complete for $9 or $12 respectively. Address orders to Boericke & Tafel's Pharmacies at New York, Philadelphia, Baltimore, Chicago, New Orleans. JOSLIN, DR. B. F. Principles of Homœopathy. In a Series of Lectures. 185 pages. I 2mo. Cloth, 60 cts. KREUSSLER, DR. E. The Homeopathic Treatment of Acute and Chronic Diseases. Translated from the German, with Im- portant Additions and Revisions, by C. J. HEMPEL, M.D. pages, vid 190 60 cts. The author is a practitioner of great experience and acknowledged talent. This work is distinguished by concise brevity and lucid simplicity in the description of the various diseases that usually come under the observation of physicians, and the remedies for the various symptoms are carfully indicated. Dr. Hempel has interspersed it with a number of highly useful and interesting notes, which cannot fail to enhance the value of this work to American physicians. LAURIE and MCCLATCHEY. The Homeopathic Domestic Medicine. By JOSEPH LAURIE, M.D. Ninth American, from the Twenty-first English edition. Edited and Revised, with Numerous and Important Additions, and the Introduction of the New Remedies. By R. J. MCCLATCHEY, M.D. 1044 pages. Svo. Half morocco, $5 00 "We do not hesitate to indorse the claims made by the publishers, that this is the most complete, clear, and comprehensive treatise on the domestic homoeopathic treatment of dis 10 BOERICKE & TAFEL'S eases extant. This handsome volume of nearly eleven hundred pages is divided into six parts. PART ONE is introductory, and is almost faultless. It gives the most complete and exact directions for the maintenance of health, and of the method of investigating the con- dition of the sick, and of discriminating between different diseases. It is written in the most lucid style and is above all things wonderfully free from technicalities. PART TWO treats of symptoms, character, distinctions, and treatment of general diseases, together with a chapter on casualties. PART THREE takes up diseases peculiar to women. PART FOUR is devoted to the disorders of infancy and childhood. PART FIVE gives the charac eristic symptoms of the medicines referred to in the body of the work, while PART SIX introduces the repertory."-HAHNEMANNIAN MONTHLY. "Of the usefulness of this work in cases where no educated homoeopathic physician is within reach, there can be no question. There is no doubt that domestic homoeopathy has done much to make the science known; it has also saved lives in emergencies. The prac- tice has never been so well presented to the public as in this excellent volume."-NEW ENG. MED. GAZETTE. A complete set of remedies of one hundred and four vials, containing over fifty doses each, is furnished for $12, put up in an elegant mahagony case. A similar set in via's con- tiining over one hundred doses each, is furnishe1 for $18, or book and case complete for $17 or $23 respectively. Address orders to Boericke & Tafel's Pharmacies at New York, Philadelphia, Baltimore, Chicago, New Orleans. LILIENTHAL, DR. S. Homeopathic Therapeutics. By S. LILIENTHAL, M.D., Editor of North American Journal of Homo- opathy, Professor of Clinical Medicine and Psychology in the New York Homœopathic Medical College, and Professor of Theory and Practice in the New York College Hospital for Women, etc. Second edition. 8vo, $5 00 $6 00 Half morocco, "Certainly no one in our ranks is so well qualified for this work as he who has done it, and in considering the work done, we must have a true conception of the proper sphere of such a work. For the fresh graduate, this book will be invaluable, and to all such we un- hesitatingly and very earnestly commend it. To the older one, who says he has no use for this book, we have nothing to say. He is a good one to avoid when well, and to dread when ill. We also hope that he is severely an unicum."—PROF. SAM. A. JONES IN AMERI- CAN HOMEOPATHIST. CC It is an extraordinary useful book, and those who add it to their library will never feel regret, for we are not saying too much in pronouncing it the BEST WORK ON THERAPEUTICS in homoeopathic (or any other) literature. With this under one elbow, and Hering's or Allen's MATERIA MEDICA under the other, the careful homeopathic practitioner can refute Niemayer's too confident assertion, 'I declare it idle to hope for a time when a medical prescription should be the simple resultant of known quantities.' Doctor, by all means buy Lilienthal's HOMOEOPATHIC THERAPEUTICS. It contains a mine of wealth.". PROF. CHAS. GATCHEL IN IBID. LUTZE, DR. A. Manual of Homeopathic Theory and Prac- tice. Designed for the use of Physicians and Families. Translated from the German, with additions by C. J. HEMPEL, M.D. From the sixtieth thousand of the German edition. 750 pages. 8vo. Half leather, $2 50 This work, from the pen of the late Dr. Lutze, has the largest circulation of any homoeo- pathic work in Germany, no less than sixty thousand copies having been sold. The intro- duction, occupying over fifty pages, contains the question of dose, and rules for examining the patient, and diet; the next sixty pages contain a condensed pathogenesis of the remedies treated of in the work; the description and treatment of diseases occupy four hundred and eighteen pages, and the whole concludes with one hundred and seventy-three pages of reper- tory and a copious index, thus forming a concise and complete work on theory and practice. MALAN, H. Family Guide to the Administration of Homœo- pathic Remedies. 112 pages. 32mo. Cloth, 30 cts. HOMEOPATHIC PUBLICATIONS. MANUAL OF HOMOEOPATHIC VETERINARY PRAC- TICE. Designed for all kinds of Domestic Animals and Fowls, pre- scribing their proper treatment when injured or diseased, and their par- ticular care and general management in health. Second and enlarged edition. 684 pages. 8vo. Half morocco, $5 00 "In order to rightly estimate the value and comprehensiveness of this great work, the reader should compare it, as we have done, with the best of those already before the public. In size, fulness and practical value it is head and shoulders above the very best of them, while in many most important disorders it is far superior to them altogether, containing, as it does, recent forms of disease of which they make no mention."-HAHNEMANNIAN MONTHLY. • 11 MARSDEN, DR. J. H. Handbook of Practical Midwifery, with full instructions for the Homeopathic Treatment of the Diseases of Pregnancy, and the Accidents and Diseases in- cident to Labor and the Puerperal State. By J. H. MArsden, A.M., M.D. 315 pages. Cloth, $2 25 "It is seldom we have perused a text-book with such entire satisfaction as this. The author has certainly succeeded in his design of furnishing the student and young practitioner, within as narrow limits as possible, all neccessary instruction in practical midwifery. The work shows on every page extended research and thorough practical knowledge. The style is clear, the array of facts unique. and the deductions judicious and practical. We are par- ticulary pleased with his dicussion on the management of labor, and the management of mother and child immediately after the birth, but much is left open to the common-sense and practical judgment of the attendant in peculiar and individual cases."-HOMEOPATHIC TIMES. MOHR, DR. CHARLES. The Incompatible Remedies of the Homœopathic Materia Medica. By CHARLES MOHR, M.D., Lec- turer on Homœopathic Pharmaceutics, Hahnemann Medical College, Philadelphia. (A paper read before the Homeopathic Medical Society of the County of Philadelphia.) Pamphlet, in cover, IO cts. This is an interesting paper, which will well repay perusal and study. It gives a list of fifty-seven remedies and their incompatibles, diligently collated from the best-known sources. • MORGAN, DR. W. The Text-book for Domestic Practice, being plain and concise directions for the Administration of Homœo- pathic Medicines in Simple Ailments. 191 pages. 32mo. Cloth, 50 cts. This is a concise and short treatise on the most common ailments, printed in convenient size for the pocket; a veritable traveller's companion. A complete set of thirty remedies, in vials holding over fifty doses each, is furnished for $4.50, in stout mahogany case; or same set in vials holding over one hundred doses each, for $5.50; or book and case complete for $5 or $7 respectively. Address orders to Boericke & Tafel's Pharmacies, New York, Philadelphia, Baltimore, Chicago, New Orleans. MURE, DR. B. Materia Medica; or, Provings of the Principal Ani- mal and Vegetable Poisons of the Brazilian Empire, and their Applica- tion in the Treatment of Diseases. Translated from the French, and arranged according to Hahnemann's Method, by C. J. HEMPEL, M.D. 220 pages. I2mo. Cloth, . $I 00 This volume, from the pen of the celebrated Dr. Mure, of Rio Janeiro, contains the pathogenesis of thirty-two remedies, a number of which have been used in general practice ever since the appearance of the work. A faithful wood-cut of the plant or animal treated of accompanies each pathogenesis. 12 NEIDHARD, DR. C. On the Universality of the Homeopathic Law of Cure, 30 cts. NEW PROVINGS of Cistus Canadensis, Cobaltum, Zingiber and Mer- curius Proto-Iodatus 96 pages. Paper, 75 cts. NORTH AMERICAN JOURNAL OF HOMEOPATHY. Pub- lished quarterly on the first days of August, November, February and May. Edited by S. LILIENTHAL, M.D. Vol. XIII, New Series, com- menced in August, 1882. Subscription price per volume, in advance, $4.00 Complete sets of the first twenty-seven volumes, in half morocco bind- ing, including Index to the first eighteen volumes, $90 00 Index to the first eighteen volumes, $2 00 BOERICKE & TAFEL'S OEHME, DR. F. G. Therapeutics of Diphtheritis. A Compila- tion and Critical Review of the German and American Homœopathic Literature. Second enlarged edition. 84 pages. Cloth, 60 cts. • CO This pamphlet contains the best compilation of reliable testimony relative to diph- theria that has appeared from the pen of any member of our school."-ÖHо MEDICAL AND SURGICAL REPORTER. < "Although he claims nothing more for his book than that it is a compilation, with critical reviews' he has done his work so well and thoroughly as to merit all praise." HAHNEMANNIAN MONTHLY. "Dr. Oehme's little book will be worth many times its price to any one who has to treat this terrible disease."- BRITISH JOURNAL OF HOMEOPATHY, "It is the best monograph we have yet seen on diphtheria,”—CINCINNATI MEDICAL ADVANCE. Diseases of the Head. PETERS, DR. J. C. A Complete Treatise on Headaches and I. The Nature and Treatment of Head- aches. II. The Nature and Treatment of Apoplexy. III. The Nature and Treatment of Mental Derangement. IV. The Nature and Treat- ment of Irritation, Congestion, and Inflammation of the Brain and its Membranes. Based on Th. J. Rückert's Clinical Experiences in Homeopathy. 586 pages. Half leather, $250 PETERS, DR. J. C. A Treatise on Apoplexy. With an Appendix on Softening of the Brain and Paralysis. Based on Th. J. Rückert's Clinical Experiences in Homoeopathy. 164 pages. Svo. Cloth, $1 oo PETERS, DR. J. C. The Diseases of Females and Married Females. Second edition. Two parts in one volume. 356 pages. Cloth,. $I 50 PETERS, DR. J. C. A Treatise on the Principel Diseases of the Eyes. Based on Th. J. Rückert's Clinical Experiences in Ho- mœopathy. 291 pages. Svo. Cloth, . $I 50 PETERS, DR. J. C. A Treatise on the Inflammatory and Or- ganic Diseases of the Brain. Based on Th. J. Rückert's Clinical Experiences in Homœopathy. $I 00 156 pages. 156 pages. 8vo. Cloth, HOMOEOPATHIC PUBLICATIONS. 13 PETERS, DR. J. C. A Treatise on Nervous Derangement and Mental Disorders. Based on Th. J. Rückert's Clinical Experiences in Homœopathy. 104 pages. 8vo. Cloth, $I OO PHYSICIAN'S VISITING LIST AND POCKET REPER- TORY, THE HOMOEOPATHIC. By ROBERT FAULKNER, M.D. Second edition, $2 00 met. "Dr. Faulkner's Visiting List is well adapted to render the details of daily work more perfectly recorded than any book prepared for the same purpose with which we have hitherto It commences with Almanacs for 1877 and 1878; then follow an obstetric calendar; a list of Poisons and their antidotes; an account of Marshall Hall's ready method in As- phyxia; a Repertory of between sixty and seventy pages; pages marked for general memo- randa; Vaccination Records; Record of Deaths; Nurses; Friends and others; Obstetric Record, which is especially complete; and finally pages ruled to keep notes of daily visits, and also spaces marked for name of the medicine ordered on each day. The plan devised is so simple, so efficient, and so clear, that we illustrate it on a scale just half the size of the original (here follows illustration). The list is not divided into special months, but its use may be as easily commenced in the middle of the year as at the beginning. We heartily recommend Faulkner's List to our colleagues who may be now making preparations for the duties of 1878."-MONTHLY HOMEOPATHIC REVIEW, LONDON. RAUE, DR. C. G. Special Pathology and Diagnosis, with Therapeutic Hints. Half morocco. 1072 pages. Svo. Second $7.00 edition, This standard work is used as a textbook in all our colleges, and is found in almost every physician's library. An especially commendable feature is that it contains the application of nearly all the NEW REMEDIES contained in Dr. Hales work on Materia Medica. REIL, DR. A. ACONITE, Monograph on, its Therapeutic and Physiological Effects, together with its Uses and Accurate Statements, derived from the various Sources of Medical Literature. By A. REIL, M.D. Translated from the German by H. B. Millard, M D. Prize essay. Prize essay. 168 pages, 68 cts. CA This monograph, probably the best which has ever been published upon the subject, has been translated and given to the public in English, by Dr. Millard, of New York. Apart from the intrinsic value of the work, which is well-known to all medical German scholars, the translation of it has been completed in the most thorough and painstaking way; and all the Latin and Greek quotations have been carefully rendered into English. The book itself is a work of great merit, thoroughly exhausting the whole range of the subject. To obtain a thorough view of the spirit of the action of the drug, we can recommend no better work."-NORTH AMERICAN JOURNAL. RUDDOCK, DR. Principles, Practice, and Progress of Homo- opathy. 5 cts. ; per hundred, $3; per thousand, $25 00 RUSH, DR. JOHN. Veterinary Surgeon. The Handbook to Vet- erinary Homœopathy; or the Homeopathic Treatment of Horses, Cattle, Sheep, Dogs, and Swine. From the London edition. With numerous additions from the Seventh German edition of Dr. F. E. Gunther's "Homeopathic Veterinary." Translated by J. F. SHeek, M.D. 150 pages, 18mo. Cloth, 50 cts. SCHAEFER, J. C. New Manual of Homeopathic Veterinary Medicine. An easy and comprehensive arrangement of Diseases, adapted to the use of every owner of Domestic Animals, and especially designed for the farmer living out of the reach of medical advice, and ¿ 14 BOERICKE & TAFEL'S showing him the way of treating his sick Horses, Cattle, Sheep, Swine, and Dogs, in the most simple, expeditious, safe, and cheap manner. Translated from the German, with numerous Additions from other Veterinary Manuals, by C. J. HEMPEL, M.D. 321 pages. 8vo. Cloth,. $2 00 SCHWABE, DR. WILLMAR. Pharmacopoeia Homœopathica Polyglottica. Second edition. Cloth, $3 00 SHARP'S TRACTS ON HOMEOPATHY, each, Per hundred, 5 cts. $300 No. 1. What is Homœopathy? No. 2. The Defence of Homoeopathy. << No. 3. The Truth of No. 4. The Small Doses of " CC No. 5. The Difficulties of No. 6. Advantages of << 66 No. 7. The Principles of Homœopathy. No. 8. Controversy on No. 9. Remedies of No. 10. Provings of No. 11. Single Medicines of No. 12. Common-sense of 46 66 CC "C SHARP'S TRACTS. Complete set of Twelve Numbers, Bound, SMALL, DR. A. E. Manual of Homeopathic Practice, for the use of Families and Private Individuals. Fifteenth enlarged edition. 831 pages. 8vo. Half leather, $250 SMALL, DR. A. E. Manual of Homeopathic Practice. Trans- lated into German by C. J. HEMPEL, M.D. Eleventh edition. 643 pages. 8vo. Cloth, $250 SMALL, DR. A. E. Diseases of the Nervous System, to which is added a Treatise on the Diseases of the Skin, by Dr. C. E. TOOTH- AKER. 216 pages. 8vo. Cloth, $1 00 This treatise is from the pen of the distinguished author of the well-known and highly popular work entitled, "Small's Domestic Practice." It contains an elaborate description of the diseases of the nervous system, together with a full statement of the remedies which have been used with beneficial effect in the treatment of these disorders. 50 cts. 75 cts. STAPF, DR. E. Additions to the Maderia Medica Pura. lated by C. J. HEMPEL, M.D. 292 pages. 8vo. Cloth, Trans- $1 50 Ι This work is an indispensable appendix to Hahnemann's Materia Medica Pura. Every remedy is accompanied with extensive and most interesting clinical remarks, and a variety of cases illustrative of its therapeutical uses. VERDI, DR. T. S. Maternity, a Popular Treatise for Young Wives and Mothers. By TULLIO SUZZARA VERDI, A. M., M.D., of Washington, D. C. 450 pages. 12mo. Cloth, $2.00 "No one needs instruction more than a young mother, and the directions given by Dr. Verdi in this work are such as I should take great pleasure in recommending to all the young mothers, and some of the old ones, in the range of my practice."-GEORGE E. SHIPMAN, M.D., Chicago, Ill. "Dr. Verdi's book is replete with useful suggestions for wives and mothers, and his medical instructions for home use accord with the maxims of my best experience in prac- tice."--JOHN F. GRAY, M.D., New York City. VERDI, DR. T. S. Mothers and Daughters; Practical Studies for the Conservation of the Health of Girls. By TULLIO SUZzara Verdi, A.M., M.D. 287 pages. I 2010. Cloth, $I 50 i HOMEOPATHIC PUBLICATIONS. ، "The people, and especially the women, need enlightening on many points connected with their physical life, and the time is fast approaching when it will no longer be thought singular or Yankeeish' that a woman should be instructed in regard to her sexuality, its or- gans and their functions. Dr. Verdi is doing a good work in writing such books, and we trust he will continue in the course he has adopted of educating the mother and daughters. The book is handsomely presented. It is printed with good type on fine paper, and is neatly and substantially bound."-HAHNEMANNIAN MONTHLY. VON TAGEN. Biliary Calculi, Perineorrhaphy, Hospital Gan- grene, and its Kindred Diseases. 154 pages. 8vo. Cloth, $1 25 "Von Tagen was an industrious worker, a close observer, an able writer. The essays before us bear the marks of this. They are written in an easy, flowing, graceful style, and are full of valuable suggestions. While the essay on perineorrhaphy is mainly of interest to the surgeon, the other essays concern the general practitioner. They are exhaustive and abound in good things. The author is especially emphatic in recommending the use of bio- mine in the treatment of hospital gangrene, and furnishes striking clinical evidence in sup- port of his recommendation. "The book forms a neat volume of 150 pages, and is well worthy of careful study.". MEDICAL COUNSELOR. 15 WILLIAMSON, DR. W. Diseases of Females and Children, and their Homeopathic Treatment. Third enlarged edition. Cloth, $1 00 256 pages. I2mo. This work contains a short treatise on the homoeopathic treatment of the diseases of fe- males and children, the conduct to be observed during pregnancy, labor, and confinement, and directions for the management of new-born infants. WINSLOW, DR. W. H. The Human Ear and Its Diseases. A Practical Treatise upon the Examination, Recognition, and Treat- ment of Affections of the Ear and Associate Parts, Prepared for the In- struction of Students and the Guidance of Physicians. By W. H. WIN- SLOW, M.D., Ph.D., Oculist and Aurist to the Pittsburg Homœopathic Hospital, etc., etc., with one hundred and thirty-eight illustrations. Pp. 526. 8vo. Cloth, $4.50 66 • ta . C4 We hail with pleasure the advent of this work. There is perhaps no branch in the science of medicine in which there has been so little advance as in that of otology. Our author has treated his subject very systematically, giving first the anatomy then the physiology, as at present understood, methods of examination, morbid changes and injuries, and finally the therapeutics. This last is of especial value to us, as our provings are singu- larly deficient in reference to symptoms of the ear. This book is a move in the right direction, and we earnestly hope it will prove a stimulus for other specialists of our school."-NEW ENGLAND MEDICAL GAZETTE. • Moreover, he has literally crammed the work with thoughts and suggestions of a practical kind, such as could only be the outgrowth of a large personal experience and long-continued habits of close and careful observation. The work is thoroughly practical throughout; theories are left in the background, and the hard facts of the business of the otologist are portrayed with a distinctness and force which characterize all the writings of this author. - HAHNEMANNIAN MONTHLY. WORCESTER, DR. S. Repertory to the Modalities. In their Relations to Temperature, Air, Water, Winds, Weather and Seasons. Based mainly upon Hering's Condensed Materia Medica, with additions from Allen, Lippe, and Hale. Compiled and arranged by SAMUEL WORCESTER, M.D., Salem, Mass., Lecturer on Insanity and its Jurisprudence at Boston University School of Medicine, etc., etc. 160 pages. I2mo. Cloth, 1880. $1 25 16 馨 ​BOERICKE & TAFEL'S HOMOEOPATHIC PUBLICATIONS. This Repertory to the Modalities' is indeed a most useful untertaking, and will, without question, be a material aid to rapid and sound prescribing where there are promi- nent modalities. The first chapter treats of the sun and its effects, both beneficial and hurt- ful, and we see at a glance that Strontium carb., Anacardium, Conium mac., and Kali bich. are likely to be useful to patients who like basking in the sun. No doubt many of these modalities are more or less fanciful; still a great many of them are real and of vast clinical range. "The book is nicely printed on good paper, and strongly bound. It contains only 160 pages. We predict that it will meet with a steady, long-continued sale, and in the course of time be found on the tables of most of those careful and conscientious prescribers who admit the philosophical value of (for instance) lunar aggravations, effects of thunder-storms, etc. And who, being without the priggishness of mere brute science, does not ?"-HOMO- PATHIC WORLD. WORCESTER, DR. S. Insanity and Its Treatment. Lectures. on the Treatment of Insanity and Kindred Nervous Diseases. By SAMUEL WORCESTER, M.D., Salem, Mass. Lecturer on Insanity, Ner- vous Diseases and Dermatology, at Boston University School of Medi- cine, etc., etc., $350 Dr. Worcester was for a number of years assistant physician of the Butler Hospital for the Insane, at Providence, R. I., and was appointed shortly after as Lecturer on Insanity and Nervous Diseases to the Boston University School of Medicine. The work comprising nearly five hundred pages, will be welcomed by every homoeopathic practitioner, for every physician is called upon sooner or later to undertake the treatment of cases of insanity among his patrons' families, inasmuch as very many are loth to deliver any afflicted member to a public institution without having first exhausted all means within their power to effect a cure, and the family physician naturally is the first to be put in charge of the case. It is, therefore, of paramount importance that every homoeopathic practioner's library should contain such an indispensa- ble work. "The basis of Dr. Worcester's work was a course of lectures delivered before the senior students of the Boston University School of Medicine. As now presented with some altera- tions and additions, it makes a very excellent text-book for students and practitioners. Dr. Worcester has drawn very largely upon standard authorities and his own experience, which has not been small. In the direction of homoeopathic treatment, he has received valuable assistance from Drs. Talcott and Butler, of the New York State Insane Asylum. It is not, nor does it pretend to be an exhaustive work; but as a well-digested summary of our present knowledge of insanity, we feel sure that it will give satisfaction. We cordially recommend it."-NEW ENGLAND MEDICAL GAZETTE. JUST ISSUED! THE AMERICAN HOMEOPATHIC PHARMACOPIA, Compiled and Published by Boericke & Tafel. Pp. 523, 8vo. Cloth, $3.50. No physician, busy or otherwise, can afford to neglect a correct knowledge of the forms and preparations of his armament against disease. This knowledge is as necessary in con- trolling legitimate operations on part of the pharmacist, as in preparing remedies individually. In point of general information and especially of minute and unmistakable directions, the work stands alone among the recent publications on this subject. 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