THE UNIVERSITY OF ILLINOIS., i.: LIBRARY < o\0.G WcM The person charging this material is re- sponsible for its return to the library from which it was withdrawn on or before the Latest Date stamped below. Theft, mutilation, and underlining of books are reasons for disciplinary a0on and may result in dismissal from the University. UNIVERSITY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN m 28 m L161 — 0-1096 Digitized by the Internet Archive in 2016 with funding from University of Illinois Urbana-Champaign Alternates https://archive.org/details/transactionsofwoOOworl TRANSACTIONS OF THE WORLD’S CONGRESS OF nr Held under the Auspices of the M^orld’s Congress Auxiliary of the World’s Columbian Exposition, in / CHICAGO, ILL., MAY 29 TO JUNE 3, 1893. PUBLISHED BY THE AMERICAN INSTITUTE OF HOMOEOPATHY, AND EDITED BY ITS GENERAL SECRETARY, PEMBERTON DUDLEY, M.D. \ PHILADELPHIA: Sherman & Co., Printers, Seventh and Cherry Streets. 18 94 . AUTHORIZED DEFINITION, At the Annual Session of 1881, the American Institute of Homoeo- pathy ordered as follows : 1. That the President’s definition of the words “ Regular ” and “ Irregular/’ as applied to schools and practitioners of medicine, be adopted by this Institute as correct, 2. That hereafter this definition be conspicuously printed in all published documents and Transactions of this Institute, in order that the profession, of all schools, may the sooner be familiarized with, and led to adopt it. “A Regular Physician . — A graduate of a regularly char- tered medical college. The term also applies to a person practicing the healing art in accordance with the laws of the country in which he resides .” See Transactions of 1881, pp. 23, 68 and 71. (o\b t CONTENTS. Preliminary Session. Address by Hon. C. C. Bonney, Address by Mrs. Charles Henrotin, Address by Dr. J. H. McClelland, Address by Dr. Julia Holmes Smith, . " Address by Dr. Alfred E. HaWkes, Address by Dr. J. Cavendish Molson, . Address by Dr. Carl Bojanus, Address by Dr. P. C. Majumdar, , Telegram from Dr. Theodore Kafka, Telegram from Dr. Alexander Villers, Address by Eev. T. G. Milsted, D.D., Inaugural Address by Dr. J. S. Mitchell, Chai rman of the Congress, First Day’s Session. Introduction of President Mitchell by Dr. I. T. Talbot, the Honorary Presi- dent, Preparations for the Congress Described by President Mitchell Buies and Order of Business Adopted, Address by Dr. William Tod Helmuth on “Surgery in the' Homoeopathic School,” .... Discussion on “Surgery in the Homoeopathic School,” Address by Dr. Richard Hughes on “The Further Improvement of Our Materia Medica,” .... a ,, D ' SC ! ISSi ° ri 0n “ Tbe Farther Improvement of Our Materia Medica,” Address by Dr. F. Parke Lewis on “The Value of Specialties in Medicine,” Meeting of the Section in Surgery, Second Day’s Session. Report on Foreign Correspondence; by Dr. W. A. Dunn, Secretary, Discussion on “The Value of Specialties in Medicine,” Address by Dr. J. P. Dake on “ The Future of Homoeopathy Discussion on “The Future of Homoeopathy,” Address by Dr. I. Tisdale Talbot on “ Medical Education in the Homoeo- pathic Hospitals and Colleges of the United States,” Discussion on “Medical Education in the United States,” .’ Address by Dr. Alexander Villers on the “History of Homoeopathy in' Ger- many,” .... Discussion on “ Homoeopathy in Germany,” Meetings of the Sections in Surgery and in Ophthalmology, etc., Third Day’s Session. Address by Dr. T. F. Allen on “ The Selection of the Homoeopathic Remedy,” Discussion on “ 1 he Selection of the Homoeopathic Remedy,” . PACE 17 20 22 23 26 27 29 30 32 32 32 35 47 47 48 49 65 69 74 82 91 91 93 94 105 108 114 117 123 123 125 131 IV CONTENTS. PAGE Address by Dr. E. Ludlam on “ Homoeopathy and the Public Health/' . . 136 Discussion on “Homoeopathy and the Public Health,” * .... 143 Address by Dr. Alfred E. Hawkes on “ Homoeopathy in Great Britain/’ . . 148 Greetings to the World’s Congress from Dr. E. E. Dudgeon, of London, Eng., * with Presentation of a Copy of his new Translation of Hahnemann’s Organon, ... 151 Address by Dr. P. C. Majumdar on the “ History of Homoeopathy in India,” . 152 Address by Dr. Charles F. Fischer on “ Homoeopathy in Australia,” . . 159 Address by Dr. E. Vernon on the “ Progress of Homoeopathy in Ontario,” . 161 Address by Dr. J. Caver. dish Molsou on “ Homoeopathy in London, England,” 163 Meetings of the Sections in Materia Medica and in Obstetrics, . . . 166 FoupfH Day’s Sessio^. Address hy Dr. David A. Strickler on “Comparative Vital Statistics — Hom- oeopathy vs. Allopathy,” 167 Discussion on “Comparative Vital Statistics,” 189 Address by Dr. Martha A. Canfield on “The Development of Medical Sci- ence through Homoeopathy,” 193 Discussion on “The Development of Medical Science through Homoeop- athy/’ 204 Meetings of the Sections in Clinical Medicine and in Mental and Nervous Diseases, 204 Fifth Day’s Session. Eesolutions of Thanks Adopted, 205 Presentation of a Letter from Dr. Carlos Plata, 205 Address by Dr. Carlos Plata on “Observations on Some of the Axioms, Aphorisms and Eules of Homoeopathy,” ....... 207 Meetings of the Section in Ehinology and Laryngology, and of the Section in Paedology, . 209 Adjournment of the Congress, 209 Eeports of the Sections. Report of the Section in Surgery— Minutes of the Sectional Meetings, . . 213 Sectional Address in “Surgery;” by W. B. Van Lennep, M.D., . . 215 “ Ether or Chloroform /’ by Horace Packard, M.D., 227 Discussion, 240 “Surgical Shock hy T. L. McDonald, M.D., 251 Discussion, . .... 258 “A Contribution to Thoracic Surgery by Henry L. Obetz, M.D., . . 265 “Thoracoplasty;” by H. F. Biggar, M.D .286 “ Vivisection and Pulmonary Surgery;” by Walter F. Knoll, M.D., . . 294 Discussion 299 “The Treatment of Epilepsy, Idiocy and Allied Disorders by Cranial Excision and Incision hy G. F. Shears, M.D., , 305 Discussion, 315 “A Eeport on Orificial Surgery, Including an Analysis of 1000 Cases;” by E. H. Pratt, M.D., 324 Discussion, 343 CONTENTS. V PAGE Report of the Section in Ophthalmology and Otology — Minutes of the Sec- tional Meetings, 347 Sectional Address; by A. B. Norton, M.D., 349 “ Ophthalmic Therapeutics;” by E. H. Linnell, M.D., .... 357 Discussion, 368 “ The Refraction of the Eye ;” by Thomas M. Stewart, M.D., . . . 376 Discussion, 391 “Ophthalmic Surgery;” by Elmer J. Bissell, M.D., 399 Discussion, ............ 410 “The Study and Correction of Heterophoria ;” by Harold Wilson, M.D., 415 Discussion, ............ 428 “The Efficacy of the Vibrometer in Applying Vibratory Massage in Aural Diseases;” by Henry F. G-arey, M.D., 434 Discussion, 437 “The Homoeopathy of Aural Therapeutics;” by C. F. Sterling, M.D., . 444 Discussion, 449 “ Aural Therapeutics;” by Henry C. Houghton, M.D., .... 451 “Some Recent Advancements in Otology;” by Howard F. Bellows, M.D., 457 Discussion, 464 “Ocular Reflex Neuroses;” by James A. Campbell, M.D., .... 467 Report of the Section in Gynaecology — Minutes of the Sectional Meetings, . 478 • Sectional Address — “ The Sine-qua-non ;” by O. S. Runnels, M.D., . . 480 “ Homoeopathy in Gynaecology ;” by L. A. Phillips, M.D., .... 487 Discussion, 493 “ Some of the Clinical Aspects of Septic Invasion ;” by Edward Blake, M.D., 501 Discussion, 510 “The Relation of Surgery to Gynaecology;” by Charles E. Walton, M.D., 512 Discussion, , 516 “Plastic Surgery of the Vagina;” by W. E. Green, M.D., .... 521 Discussion, 528 “Caesarian Section ;” by H. F. Biggar, M.D., 536 Discussion, 551 “ Uterine Fibroids ;” by John W. Streeter, M.D., 558 Discussion, 565 “ Vaginal Hysterectomy ;” by J. M. Lee, M.D., 570 Discussion, ............ 577 “Removal of the Entire Uterus, Together with the Appendages, for Uterine Fibroids ;” by Homer I. Ostrom, M.D., .... 580 Discussion, 585 Report of the Section in Materia Medica — Minutes of the Sectional Meeting, 588 Sectional Address — “The Present Condition of the Homoeopathic Ma- teria Medica ;” by A. C. Cowperth waite, M.D., . . . . . 589 “ A Study of Sepia, Pathological, Clinical and Comparative ;” by A. L. Monroe, M.D., 594 Discussion, . 597 “My Bryonia Day ;” by Frank Kraft, M.D., 601 Discussion, 607 “The Revival of Therapeutics;” by William E. Leonard. M.D., . . 608 Discussion, 612 “ Practical Psychology in its Relation to Pathogenesy ; ” by Eldridge C. Price, M.D., 615 Discussion, 621 VI CONTENTS. PAGE “ Primary and Secondary Symptoms ; or the Opposite Action of Large and Small Doses by Charles Mohr. M.D., 625 ‘‘Phytolacca — Leaf, Fruit and Root. — The Value of Each;” by Robert Boocock, M.D., 643 Report of the Section in Obstetrics — Minutes of the Sectional Meeting, . 649 Sectional Address ; by T. Griswold Comstock, M.D., 651 “Scarlatina in the Gestative and Puerperal States;” by John C. San- ders, M.D., 663 Discussion, 666 “The Levator Ani as Related to Parturition;” by Henry E. Spalding, M.D., 671 “A Comparative Study of the Operative Procedures Applicable to the Commoner Varieties and Degrees of Pelvic Deformity;” by L. L. Danforth, M.D., 679 “The Rational Treatment of Certain Puerperal Disorders;” by George B. Peck, M.D., 691 Discussion, . 693 “ The Year’s Progress in Obstetrics ,” by Sheldon Leavitt, M.D., . . 700 Discussion, 706 “ Puerperal Fever ;” by J. B. Gregg Custis, M.D., 709 “Puerperal Eclampsia;” by L. C. Grosveuor, M.D., 718 “Puerperal Insanity ;” by M. D. Youngman, M.D., 723 Discussion on Puerperal Disorders, ....... 726 “Some of the Diseases Preventing and Complicating Pregnancy;” by Henry C. Aldrich, M.D., 728 Report of the Section in Clinical Medicine — Minutes of the Sectional Meet- ing, 734 Sectional Address. — “ Recent Discoveries in the Treatment of Disease by the Use of Disease-Products, and their Relations to Homoeopathy;” by Charles Gatchell, M.D., 736 “ A Plea for Early Operation in Pleurisy with Effusion ;” by J. Montfort Schley, M.D., 746 “ Prophylaxis in Cholera; ” by B. N. Banerjee, M.D., .... 765 Discussion, ............ 767 “Cholera — Its Curative Treatment ;” by P. C. Majumdar r M.D., . . 768 Discussion, 780 “ Some Observations on Neurasthenia and Its Treatment ;” by Conrad Wesselhoeft, M.D., 781 Discussion, 798 “ Bright’s Disease;” by P. Jousset, M.D., 803 Discussion, 819 “ The Scientific Clinician ;” by J. P. Sutherland, M.D., .... 825 Discussion, 830 “Biliousness ;” by F. H. Orme, M.D., 833 “The Curative Action of Homoeopathic Remedies in Cases of Organic Disease of the Heart ;” by John H. Clarke, M.D., .... 838 “ Moist Heat as a Therapeutic Agent ;” by W. A. Edmonds, M.D., . . 851 “The Study of Homoeopathy as a Distinct and Commanding Department of Medicine;” by John C. Morgan, M.D., 858 “ The Homoeopathic Treatment of Tabes and Pseudo-Tabes;” by Alexan- der Villers, M.D., 913 CONTENTS. vii PAGE Report of the Section in Mental and Nervous Diseases — Minutes of the Sec- tional Meeting, 923 Sectional Address — “Recent Work»and Progress in the Field of Psy- chology by Selden H. Talcott, M.D., 925 “Psychiatry and the Homoeopathic Medical Colleges;” by N. Emmons Paine, M.D., 937 “ The Octave (Septenary) in Nature and in Man as the Key to Psy- chology by J. D. Buck, M.D., 945 “ Puerperal Insanity by A. P. Williamson, M.D., 956 “The Causes of an increase in Melancholia;” by William Morris Butler, M.D., 963 “ Some Statistical Facts Concerning Insanity ;” by George Allen, M.D., . 969 Report of the Section in Rhinology and Laryngology — Minutes of the Sec- tional Meeting, 977 Sectional Address — “ Recent Progress in Rhinology and Laryngology;” by Horace F. Ivins, M.D., 979 Discussion, 991 “Nasal Epithelioma;” by Wesley A. Dunn, M.D., 993 Discussion, 997 “ Malignant Growths in the Larynx ;” by H. F. Fisher, M.D., . . . 999 Discussion 1006 “ New Suggestions in the Treatment of Constriction of the (Esophagus;” by D. G. Woodvine, M.D., 1009 Discussion, 1015 “Massage in the Treatment of Nasal Stenosis;” by William Dulaney Thomas, M.D., 1018 “ The Treatment of Phthisis ;” by Charles E. Jones, M.D., . . . 1020 “ The Treatment of Chronic Rhinitis by the Homoeopath ;” by Charles E. Teets, M.D., 1031 Discussion, 1038 “Nasal Surgery — Its Use and Its Limitations;” by Eugene L. Mann, M.D., 1040 Report of the Section in Paedology — Minutes of the Sectional Meeting, . . 1044 Sectional Address in Paedology ; by Emily V. Pardee, M.D., . . . 1046 “ Pre-Natal Medication ;” by Millie J. Chapman, M.D., .... 1050 Discussion, 1053 “ Rachitis ;” by Robert N. Tooker, M.D 1059 Discussion, . 1064 “The Awkward Gait of Children ;” by Sidney F. Wilcox, M.D., . . 1066 Discussion, 1068 “ Contagion in Public Schools and its Prophylaxis;” by Lucy Chaloner Hill, M.D., 1070 Discussion, 1074 “Some Notes upon Headache in Children ;” by Gerard Smith, M.R.C.S., 1076 Discussion, 1082 “ Albuminuria in Children ;” by Henry C. Aldrich, M.D. , . . . . 1084 “The Treatment of Meningocele, Encephalocele and Hydrencephalocele by Means of a Collodion Cap ; ” by J. Martine Kershaw, M.D., . . 1092 “Albuminuria in Children ;” by William W. Van Baun, M.D., . . 1094 Index to the volume, 1097 HISTORICAL NOTE. Soon after the organization of the Directory of the World’s Co- lumbian Exposition, to be held in Chicago, 111., U. S. A., in 1893, it was suggested, that in order to make the Exposition complete, and the celebration adequate, the wonderful achievements of the new age, in science, literature, education, government, jurisprudence, morals, charity, religion, and other departments of human activity, should also be conspicuously displayed as the most effective means of in- creasing the fraternity, progress, prosperity and peace of mankind. It was therefore proposed that a series of World’s Congresses for that purpose be held in connection with the World’s Columbian Exposition of 1893, and the World’s Congress Auxiliary was duly organized to promote the holding and success of such congresses. This organization was authorized and supported by the Exposition Man- agement, and approved by the United States Government. Ample audience rooms, wdth special facilities for sectional as well as general meetings, were provided by the Directory of the Fair in a magnifi- cent Art Building erected on the lake front. Upon the establishment of the World’s Congress Auxiliary, as above mentioned, its President, Hon. C. C. Bonney, invited the Homoeopathic profession to hold an International Congress in Chi- cago during the World’s Columbian Exposition in 1893. A local Committee was appointed and an Advisory Council selected, composed of prominent representatives of the Homoeopathic school in all lands. Acceptances were received from nearly all these physicians, and the plan suggested for carrying out the enterprise was cordially endorsed. At the same time there was appointed a committee for a Congress of Women, but subsequently it was agreed to hold the two con- gresses together as one body. At the meeting of the American In- stitute of Homoeopathy held at Washington, D. C., in June, 1892, it was unanimously voted to hold its next session in Chicago, and in conjunction with the World’s Congress; and instead of transacting its usual business, to devote its energies to the promotion of the sci- entific work and interests of the Congress. X HISTORICAL NOTE. At the request of the Local Committee, the Institute also appointed a committee of its own to act with the Local Committee in the inte- rests of the Congress. At a joint meeting of the Committees of the Congress and of the Institute and the Advisory Council, held in Washington City, there was appointed a committee consisting of the Chairman and Vice-Chairman of the Congress and the President and Vice-President of the American Institute, to prepare a general plan for the Congress and to invite distinguished representatives of the Homceopathic school to deliver addresses before it. The committees, after many meetings and consultations, decided upon the plans under which the Congress should be conducted, and the subjects and questions to which its consideration should be de- voted. They also secured the aid of those whose addresses, essays and discussions are herein presented. The title by which the con- vocation was to be known was “ The World’s Congress of Homoeo- pathic Physicians and Surgeons,” and its papers and discussions were to be the property of the World’s Congress Auxiliary. At the meeting of the American Institute of Homoeopathy, held in Chicago, 111., during the continuance of the Congress, it was urged that the publication of the papers of the Congress at an early day was much to be desired, and a question was raised as to the proba- bility of their early publication by the Congress Auxiliary. After a careful , consideration of the subject, a motion was offered and adopted providing : “ That the Executive and Publication Committee be empowered to confer with the authorities and officials of the Congress, and to act as circumstances shall permit and their own judgment shall dictate.” Under the authority thus conferred, the Executive Committee of the Institute received the manuscripts of the Congress from its offi- cials, and ordered that they be published and copies distributed to all persons entitled to the Institute Transactions , and to all foreign physicians who had contributed to the success of the Congress. COMMITTEES OF THE WORLD’S CONGRESS OF HOMEOPATHIC PHYSICIANS AND SURGEONS. Appointed by the World’s Congress Auxiliary. LOCAL COMMITTEES. Committee of the World’s Congress Auxiliary on a Congress of Homoeopathic Physicians and Surgeons. J. S. Mitchell, M.D., Chairman, R. Ludlam, M.D.. Vice-Chairman, W. A. Dunn, M.D., Secretary, R. N. Foster, M.D.. W. F. Knoll, M.D., T. S. Hoyne, M.D., J. R. Kippax, M.D., J. W. Streeter, M.D., T. C. Duncan, M.D., J. H. Buffum, M.D., A. K. Crawford, M.D. L. D. Rogers, M.D., C. E. Fisher, M.D. Woman’s Committee on Homoeopathic Medicine and Surgery. Julia Holmes Smith, M.D., Chairman, Emma C. Geisse, M.D., Elizabeth McCracken, M.D., Vice- Isadore Green, M.D,, Chairman, Corresta T. Canfield, M.D,, Julia Ross Low, M.D., Isabella Hotchkiss, M.D. Committee of Arrangements. A. K. Crawford, M.D., Chairman, T. S. Hoyne, M.D., J. H. Buffum, M.D., E. A. McCracken, M.D., C. E. Fisher, M.D., C. T. Canfield, M.D. Committee Appointed by the American Institute of Homoeopathy. J. P. Dake, M.D., Chairman, A. C. COWPERTH WAITE, M.D., Bushrod W. James, M.D., T. Y. Kinne, M.D., . T. F. Allen, M.D., . I. T. Talbot. M.D., . F. H. Orme, M.D., . J. H. McClelland, M.D., C. E. Fisher, M.D., . Millie J. Chapman, M.D., E. M. Kellogg, M.D., Thos. Franklin Smith, M.D. Pemberton Dudley, M.D., T. M. Strong, M.D., Nashville, Tenn. Chicago, 111. Philadelphia, Pa. Paterson, N. J. New York City. Boston, Mass. Atlanta, Ga- Pittsburgh, Pa. Chicago, 111. Pittsburgh, Pa. New York, N, Y. New York, N. Y. Philadelphia, Pa. Boston, Mass. xii world’s homoeopathic congress. THE ADVISORY COUNCIL. Foreign. Adolphus Gerstel, M.D , .... Fr. Klauber, M.D., P. Jousset, M.D A. Claude, M.D., R. E. Dudgeon, M.D.. J. J. Drysdale, M.D., Richard Hughes, M.D., Ernest H. Stancomb, M.B.C.M., . Alfred C. Pope, M.D., D. Dyce Brown, M.D., Alexander Villers, M.D., .... W. Albert Haupt, M.D., .... Th. Kafka, M.D., . ... C. Bojanus, M.D., B. N. Banerjee, M.D., Theophilus Bruckner, M.D., Oscar Hansen, M.D., Joaquin Gonzalez, M.D., .... Tommaso Cigliani, M.D., .... Garcia, M.D., W. R. Ray, M.D., Willis C. Hoover, M.D., .... G. Pompili, M.D., Charles W. Clark, M.D., .... E. T. Adams, M.D C. T. Campbell, M.D., G. E. Husband, M.D., Thomas Nichol, M.D., George Logan, M.D., G. G. Gale, M.D J. J. Gaynor, M.D., John Hall, M.D F. R. Day, M.D., George Bollen, M.D., American. F. F. De Derky, M.D., William E. Green, M.D., .... Hugo R. Arndt, M.D., George E. Davis, MD, Eugene F. Storke, M.D., .... Benjamin H. Cheney, M.D., . Joseph Paul Lukens, M.D. Franklin A. Gardner, M.D., Tullio S. Verdi, M.D., Henry R. Stout, M.D., Francis H. Orme, M.D., O, S. Runnels, M.D., Allen C. Cowperthwaite, M.D., . Peter Diederick, M.D., Vienna, Austria. Vienna, Austria. Paris, France. Paris, France. London, England. Liverpool, England. Brighton, England. Southampton, England. Grantham, England. London, England. Dresden, Germany. Chemnitz, Saxony, Germany. Carlsbad, Germany. Moscow, Russia. Calcutta, Ind. Basle, Switzerland. Copenhagen, Denmark. City of Mexico. . Rome. Montevideo. Melbourne, Australia. . Iquique, Chili, S. A. Rome, Italy. . Winnipeg, Manitoba, Can. Toronto, Can. London, Can. Hamilton, Can. Montreal, Can. Ottawa, Kan, Quebec, Can. St. John’s, Can. Vancouver. Honolulu, S. I. South Australia. Mobile, Ala. Little Rock, Ark. San Diego, Cal. San Francisco, Cal. Denver, Colo. New Haven, Conn. Wilmington, Del. N. W., Washington, D. C. Washington, D. C. Jacksonville, Fla. Atlauta, Ga. Indiauapolis, Ind. Chicago, 111. Kansas City, Kan . COMMITTEES XI 1 1 Andrew L. Monroe, M.D., W. H. Holcombe, M.D., . Rufus Shackford, M.D., F. C. Drane, M.D., . John Preston Sutherland, M.D., I. Tisdale Talbot, M.D., Conrad Wesselhoeft, M.D., . Henry C. Obetz, M.D., . Charles Gatchell, M.D., Chester G. Higbee, M.D., H. W. Brazie, M.D., .... James Campbell, M.D., . T. G. Comstock, M.D., Moses T. Runnels, M.D., Charles S. W. Thompson, M.D., . William Henry Hanchett, M.D., Ezekiel Morrill, M.D., . Theodore Y. Kinne, M.D., . Timothy F, Allen, M.D., Asa S. Couch, M.D., . William Tod Helmuth, M.D., Edwin M. Kellogg, M.D., Horace M. Paine, M.D., Thos. Franklin Smith, M.D., A. R. Wright, M.D., Samuel W. Rutledge, M.D., . T. C. Bradford, M.D., D. H. Beckwith, M.D., . J. D. Buck, M.D., . H. F. Biggar, M.D John C. Sanders, M.D., . C. J. Jones, M.D., .... Ammi S. Nichols, M.D., . Thomas L. Bradford, M.D., . John C. Burgher, M.D., . Pemberton Dudley, M.D., A. R. Thomas, M.D,, . Bushrod W. James, M.D., J. H. McClelland, M.D., George B. Peck, M.D., . James S. Bell, M.D., Owen B. Gause, M.D., Jabez P. Dake, M.D., Charles E. Fisher, M.D., H. H. Crippen, M.D., Henry E. Parker, M.D., Frank P. Webster, M.D., Charles Y. Young, M.D., H. B. Bagley, M.D., Oscar W. Carlson, M.D., Austin Frederick Olmstea Lewis Sherman, M.D., . , M.D. Louisville, Ky. New Orleans, La. Portland, Me. Baltimore, Mel.’ Boston, Mass Boston, Mass. Boston, Mass. Detroit, Mich. Ann Arbor, Mich. St. Paul, Minn. Minneapolis, Minn. St. Louis, Mo. St. Louis, Mo. Kansas City, Mo. Helena, Mont. Omaha, Neb. Concord, N. H. Paterson, N. J. New York City. Fredonia, N. Y. New York City. New York City. Albany, N. Y. New York City. Buffalo, N. Y. Grand Forks, N. D. Cincinnati, O. Cleveland, O. Cincinnati, O. Cleveland, O, Cleveland, O. Cleveland, O. Portland, Ore. Philadelphia, Pa. Pittsburgh, Pa. Philadelphia, Pa. Philadelphia, Pa. Philadelphia, Pa. Pittsburgh, Pa. Providence, R. I. Canton, S. D. Aiken, S. C. Nashville, Tenn. Chicago, 111. Salt Lake City, Utah, Barre, Yt. Norfolk, Ya. Lynchburg, Va. Seattle, Wash. Milwaukee, Wis. Green Bay, Wis. Milwaukee, Wis. XIV WORLD S HOMOEOPATHIC CONGRESS. Woman’s Council. Susan A. Edson, M.D., Washington, D. C. Harriet J. Sartain, M.D., Philadelphia, Pa. Prof. Adaline B. Church, M.D., Boston, Mass. Prof. Sarah E. Sherman, M.D., Salem, Mass. Emily V. Pardee, M.D., South Norwalk, Conn. Millie J. Chapman, M.D., Pittsburgh, Pa. Mrs. H. Tyler Wilcox, M.D., Eureka Springs, Ark. Anna H. Warren, M.D., Dennison, Tex. Genevieve Tucker, M.D., Pueblo, Colo. Nellie R. Harris, M.D Des Moines, la. Julia C. Jump, M.D., . ’ Oberlin, 0. Sarah Hicks, M.D., Atlanta, Ga. Sarah J. Millsop, M.D., Bowling Green, Ky. Margaret L. Sabin, M.D., Lincoln, Neb. Gertrude Gooding, M.D., Bristol, R. I. Lizzie G. Gutherz, M.D., St. Louis, Mo. Adele S. Hutchison, M.D., Minneapolis Minn. Flora B. Brewster, M.D., Baltimore, Md. Alice Burritt, M.D., Oakland, Cal. Pauline Emerson Canfield, M.D., .... Kansas City, Mo. Catharine Parsons, M.D., Cleveland, 0. ORGANIZATION. Hon. C. C. Bonney, President of the World’s Congress Auxiliary Mrs. Potter Palmer, President of the Woman’s Branch of the World’s Congress Auxiliary. Honorary Presidents. Richard Hughes, M.D., President j International Congress of 1881, J I. T. Talbot, M.D., President Inter- ) national Congress of 1891, i President. ,T. S. Mitchell, M.D., Vice-Presidents. R. Ludlam, M.D., Julia Holmes Smith, M.D., Honorary Vice-Presidents. J. H. McClelland, M.D., President Ameri- ) can Institute of Homoeopathy, J Galley Blackley, M.D., President British Homoeopathic Society. E. A. Rushmore, M.D., President International Hahnemannian Society. And Presidents and Ex-Presidents of all other National Homoeopathic Societies. Chicago, 111. Chicago, 111. Brighton, Eng. Boston, Mass. Chicago, 111. Chicago, 111. Chicago, 111. Pittsburgh, Pa. W. A. Dunn, M.D., . Secretary. Chicago, 111 COMMITTEES. XV Honorary Secretary. Pemberton Dudley, M.D., Secretary Ameri- j Philadelphia Pa can Institute of Homoeopathy, J Secretary World's Congress Auxiliary. Clarence E. Young, Chicago. 111. Recording Secretary. T. M. Strong, M.D., Boston, Mass. Chairman Committee of Registration and Statistics. T. Franklin Smith, M.D., New York, N. Y. Chairman Committee on Foreign Correspondence. Wesley A. Dunn, M.D., Chicago, 111. SECTIONS. Surgery. Wm. B. Yan Lennep, M.D., Chairman, .... Philadelphia, Pa. Gynaecology. 0. S. Runnels, M.D., Chairman, Indianapolis, Ind. Ophthalmology and Otology. A. B. Norton, M.D., Chairman New York, N.Y. Materia Medica. A. C. Cowperthwaite, M.D.. Chairman, Chicago, 111. Obstetrics. T. Griswold Comstock, M.D., Chairman, St. Louis, Mo. Clinical Medicine. Charles Gatchell, M.D., Chairman, . . . Ann Arbor, Mich. Mental and Nervous Diseases. Selden H. Talcott, M.D., Chairman, . Middletown, N. Y. Rhinology and Laryngology. Horace F. Ivins, M.D., Chairman, .... Philadelphia, Pa. Paedology. Emily V. Pardee, Chairman, South Norwalk, Conn. Committee on Business. T. Y. Kinne, M.D., Chairman, I. T. Talbot, M.D., C. G. Higbee, M.D., D. H. Beckwith, M.D., Paterson, N. J. Boston, Mass. St. Paul, Minn. Cleveland, 0. Committee on Resolutions. J. P. Dake, M.D., Chairman, Bushrod W. James, M.D., • 0. S. Runnels, M.D., R. Ludlam, M D., J. A. Albertson, M.D., Nashville, Tenn. Philadelphia, Pa. Indianapolis, Ind. Chicago, 111. San Francisco, Cal. RULES OF ORDER . 1. All Homoeopathic physicians attending the Congress shall have equal rights as members. 2. The President shall appoint and announce at the first session of the convention, committees on business and on resolutions, of five members each. 3. The Committee on Business shall consider and report such measures as it may deem necessary for promoting and expediting the work of the Congress. 4. The Committee on Resolutions shall consider the subject-mat- ter of resolutions and all other business that may be submitted to it, and shall report thereon at such times as the Congress may direct. 5. Addresses, except that of the President, shall not occupy more than thirty minutes in their delivery, and papers in each section not more than twenty minutes, except by general consent of the conven- tion. 6. Members, announced by the President to lead in discussions, shall not occupy more than ten minutes. Other members partici- pating in the discussion shall not consume more than five minutes. No member shall speak more than once upon any subject under dis- cussion. The author of the paper shall have the privilege of closing the discussion thereon. Debate on any single subject shall be lim- ited to one hour. 7. Presentation of reports on the condition and progress of Hom- oeopathy in foreign States and countries shall be limited to twenty minutes each. 8. Resolutions and motions having the effect of resolutions shall be read and referred to the Committee on Resolutions for acceptance. They shall be open for discussion when reported back by the com- mittee. 9. Reports and recommendations from the Committee on Business shall be first in order at the opening of each morning session. PROCEEDINGS OF THE CONGRESS. Chicago, III., May 29, 1893. The World’s Congress of Homoeopathic Physicians and Surgeons assembled in the “Hall of Washington,” in the Art Institute at eight o’clock p.m. The officers of the World’s Congress Auxiliary, and of the Con- gress of Homoeopathy, and also the officers of the American Insti- tute of Homoeopathy, occupied seats upon the platform, together with several delegates to the Congress from foreign countries. The large auditorium was well filled by physicians and their friends. The meeting was called to order by Hon. C. C. Bonney, Presi- dent of the World’s Congress Auxiliary, and at his request, Rev. T. G. Milsted, chaplain of the organization, led the audience, in prayer,, which was followed by President Bonney’s Opening Address^ It is what Mr. Milsted’s predecessor, thebeloved Robert Collyer, would call the simple truth, that the present occasion is the most interesting and in some respects the most noteworthy event of the history of Homoeopathic medicine and surgery. In every part of the world in which this body of the medical profession exists, the hearts of its members are turned towards this Art Palace to-night, with earnest wishes for the most brilliant and satisfactory success. Many are here to participate in these ceremonies, but for every one who honors them by his presence there are many hundreds who wish they were here, and who, though absent in body are yet with us in their hearts. Homoeopathy represents in the medical world' that which may be designated — borrowing and slightly paraphrasing a phrase from the new movement in literature in our kindred republic of France — as the spiritualization of thought in the world of medicine. Entering the medical world at a time when it was in many 2 18 world’s homceopathic congress. marked respects different from what it is to-day. Homoeopathy seemed, to the casual observer, to be working the most miraculous cures with nothing ! It was so startling in its claims and the re- sults were so marked when tested by the logic of statistics, that the advent of Homoeopathy into the world of medicine presently stimu- lated a new and zealous inquiry on the part of thoughtful medical minds into the mysteries and principles of the science and the art of medicine. This Homoeopathic movement emphasized, as nothing else had ever done before, and as nothing has done since, the marvellous medical power of nature. It immediately set the medical world to thinking that if agencies so delicate and subtle that they could neither be weighed nor measured ; neither felt nor heard, could do so much, there must be something deeper in the science of medicine than they had heretofore discovered; and to-day it is not my voice nor the voice of Homoeopathic physicians only, but also the voices of distinguished members of the general profession of medicine and surgery — as the presiding officer of this Congress heard in my pres- ence the other day — which declare that of all the blessings which the general profession of medicine and surgery has received, those derived from Homoeopathy are easily first and most useful. This is said, not in a spirit of rivalry, much less in a spirit of censure, but it is in the spirit of utmost cordiality, and brotherhood. For I can testify on this occasion, that of the persons instrumental in promoting the organization of this* Congress, some were members, not of the Homoeopathic, but of the general profession of medicine and surgery. The immense influence exerted by the Homoeopathic School of medicine and surgery on the general profession, did not end its in- fluence there. It exerted at the same time a tremendous influence on the mind of patients, and on public opinion generally. It awak- ened curiosity; it stimulated investigation; it excited research, and the result has been of the greatest benefit to physicians and surgeons the whole world over, without distinction of school. This agitation has produced an intelligent class of patients. No physician can deal most successfully with disease, without the co-operation of an intelli- gent patient. Ignorance stands the greatest barrier in the way of the success of the intelligent physician and surgeon. To overcome that ignorance ; to substitute for it a general appreciation of the ADDRESSES. 19 nature of the work to be done, a willingness in the heart of the patient to co-operate with his physician, is, as every wise physician and surgeon knows, of immense importance to the desired cure. We do not seek, the medical profession does not desire, that every one should become his own doctor any more than that every one should become his own blacksmith, his own tailor, his own dry- goods merchant, his own railway carrier. But only that patients shall be possessed of that degree of intelligence which will enable them to co-operate understandingly with the efforts made in their behalf. The results of the influences to which I have referred in other fields have been to promote what did not exist fifty years ago at all in any school of a popular nature, the study of the general princi- ples of anatomy, physiology, and hygiene, which has now become common all over the land. To know something of the laws of life and health ; to have some intelligent understanding of the structure of that most wonderful of all creations, the human body; to have some knowledge of the rules which must be obeyed if health would be preserved ; to know something of the conditions under which great toil can be endured and the system yet not break down ; these are things which every intelligent physician and surgeon to-day desires to have known by the whole body of the people. The organization of the World’s Congresses of 1893 has been effected by local Committees of Organization, one of men, and a cor- responding one of women. Recognizing the fitness of the advent of women into so many new fields of usefulness and honor, the World’s Congress Auxiliary in cases proper for the participation of women has appointed a committee to co-operate in the organization of the Congress with the corresponding committee of men. The two local committees which had the organization of this Congress in charge are represented respectively by Dr. J. S. Mitchell on the one hand and Dr. Julia Holmes Smith on the other. These local Committees of Organization however, could not undertake to organize a World’s Congress on Medicine and Surgery without the co-operation of repre- sentative minds selected from all countries where the profession has been established. For this reason an Advisory Council consisting perhaps of a hundred or more of physicians and surgeons, located in different States and countries, was selected to constitute the non- resident branch of these committees of organization. 20 world’s homoeopath ic congress. Medical organizations of the different States and countries were invited to appoint Committees of Co-operation, and act with these committees and Advisory Councils in perfecting the work. Nothing remains for me but to extend to you, as I now do, on behalf of the World’s Congress Auxiliary, and on behalf of the authorities, municipal, State and National which have co-operated to this end, a most hearty and cordial welcome to the World’s Con- gresses of 1893, especially to the World’s Congress on Homoeopathic Medicine and Surgery. It is also fitting that the representative of the Woman’s Branch of the World’s Congress Auxiliary should extend, in behalf of the women whom &he represents, the women of all States and countries represented here, her own welcome on this occasion. I therefore have the honor of introducing to you Mrs. Charles Henrotin, who will now address you on behalf of the Woman’s Branch of the World’s Congress Auxiliary. Mrs. Charles Henrotin’s Address. Mr. Chairman , Ladies and Gentlemen: Dr. Julia Holmes Smith and her committee have kindly given me this opportunity to extend the welcome of the Woman’s Branch to the gentlemen and ladies participating in this Congress,, and I have been asked by them also to speak a few words on medical women, from the standpoint of an outsider. I shall carefully refrain from doing that; but I may, if you will bear with me, try to voice what appears to me to be the salient points of the participation of women in this Congress. This is the first time in the medical profession in which women have obtained an equal recognition in the deliberations of any con- gress. Being represented as they are by the Woman’s Committee of the Woman’s Branch of the World’s Congress Auxiliary, which association is recognized by government, they are therefore taking part in the deliberations of a governmental congress. The congress of representative women which preceded this was apsean of praise as to what women had accomplished since the discovery of America, and also voicing their hopes for the future. But the truth of the matter is that women will be judged by the part which they will take in the series which is now inaugurated, because this series of congresses, commencing with the medical congresses, deals with specialized lines of light, as educational, industrial, professional, and it is along that line of specialization that modern life is tending. By their perception ADDRESSES. 21 and deliberations in these congresses, they will show on which points they are weak and on which they are strong ; and they will thus emphasize not only woman’s attainments but also what she has done along the line of specialized effort; and in this modern civilization, if women hope to compete at all, it is very necessary that they realize their position in this way. There must be some cause for the few women’s names which ap- pear on this programme. I leave it for the women participating in the Congress to say what. Is it because they so largely devote their professional efforts to practice among women and children, or do they, when they graduate, give up their studies, contenting themselves with a fair practice and without making their profession the love of their lives as well as the means of earning their daily livelihood ? This generous recognition of women in the profession, as shown by these congresses, should be the greatest incentive to them to prove themselves to be worthy of it, and to demonstrate their fitness to take an equal position with their brother physicians. It may be, however, that the future of the professions will prove that the love of the exact sciences is not ours, but that we will take up rather the general practice underlying the home, the perfection of medical appliances, the trained nurses, thus bringing into the profession the practical details on which depend after all half the success of the physician. With all modesty, I leave these suggestions to the women taking part in the deliberations of the Congress, and I reiterate my wel- come to you, ladies and gentlemen. Mr. Bonney : With a patience, skill, energy and devotion to duty worthy of the highest praise, Dr. J. S. Mitchell, Chairman of the General Committee of Organization of this Congress, has pur- sued the labor of organizing it during the past three years. I have now the pleasure and honor to present to you, as the presiding officer of this Congress, Dr. J. S. Mitchell, of Chicago. Dr. Mitchell, on taking the chair, was greeted with hearty ap- plause. He said : Ladies and Gentlemen: I take pleasure in introducing, as the next speaker, Dr. James H. McClelland, of Pittsburgh, Pennsylvania, President of the American Institute of Homoeopathy, the oldest national medical association in the United States. 22 world’s homoeopathic congress. Address of Dr. J. H. McClelland. Mr. Chairman , Ladies and Gentlemen, Members of the Congress: It affords me very great pleasure indeed to represent the American Institute of Homoeopathy on this occasion, and to add my words of welcome to those who have preceded me. You will all agree that our grateful acknowledgments are due to President Bonney and to President Palmer and her able coadjutor, Mrs. Henrotin, God bless them, that we have an opportunity, in these series of scientific con- gresses that have been inaugurated as a conspicuous feature of the sublime demonstration that will go into history as the Columbian Exposition. That there has been a most liberal expenditure of time and labor and money to complete the arrangements for this Congress, we well know^, and the committees represented by Dr. J. S. Mitchell and SfasJ^Tul ia Holmes Smith — God bless her too — merit our unqualified thanks. The work has been well and truly done. This Congress, unlike previous ones of our school, has been con- vened under the auspices and fostering care of the World’s Congress Auxiliary ; yet the American Institute of Homoeopathy maintains a cordial interest in its welfare, as the parent organization. This in- terest is further manifested by its adjourning over its scientific work until next year, that all efforts might be concentrated upon the work of the Congress. Under the auspices of our national body, which, many of you know, is the oldest medical association in this country, now entering its fiftieth year, there was held the memorable Con- gress of 1876, under the leadership of the immortal Dunham. Three others have been held since, the last under the leadership of that leader of men, Dr. I. Tisdale Talbot, which achieved even greater success than the gathering of 1876. We now inaugurate the Columbian Congress of 1893, and are gathered this evening under auspices most fair and auspicious, under an official patronage and fostering care of which we feel justly proud. We take our place in a line of scientific congresses unequalled in the world’s history, and from which will flow results far reaching and of great good to mankind. This Congress, let me suggest, stands for more than a report upon the medical sciences in general, great and important as they are. It stands for a reformation in the science of therapeutics more far reach- ing and important than any of ancient or modern times. While ADDRESSES. 23 this great Exposition represents the advance in every branch of human knowledge since Columbus touched our shores, four hundred years ago, this Congress will, in some measure, show forth the ad-’ vance in medicine since Hahnemann, our veritable Columbus, made his discoveries a single century ago. And I am not overstating when I say the changes are equally great. The world, indeed, owes more than it can ever repay to that great and good man whose mighty genius brought about this great reformation. I noticed in that imperial dome, which this wonderful people have erected in that white city by the lake, inscribed the names of such medical heroes as Hippocrates and Galen and Harvey and Hunter and so on, but the name most worthy to occupy a conspicuous place in that line of worthies was that of Samuel Hahnemann ; and, my friends, the time is ripe when suitable memorials should be erected to his memory. Not only in the interest of the governing princi- ples alluded to, however, are we assembled here this evening, but for the advancement of each and every branch of our beloved art ; and we commit this great task to the Congress now assembled with great confidence. It is, therefore, with the greatest good-will that the American Institute on this occasion gives place to the World’s Con- gress, and joins in the voice of welcome which flows in such generous measure here to-night. The Chairman : It is well known that these congresses have been conducted by the united and harmonious labor of men and women. I now introduce Dr. Julia Holmes Smith, who has worked so effectually as the Chairman of the Woman’s Congress. Address of Dr. Julia Holmes Smith. Mr. Chairman , Members of the American Institute and Men and Women Who are Interested in What is Going on Here : I come to greet you, and I come to thank you for your presence, because that presence means your interest, and I come to bespeak in your behalf a charity. A charity for what? For the minority. My chief, Mrs. Henrotin, has said to-night she was surprised to see so few names of women on the programme. Will you tell me why? Mrs. Henrotin is not a doctor. She does not know, she has never thought of the dark days and the anxious nights, and the hard work and the earnest toil and the great discouragement and the intense oppo- sition that we have had from our associates, from the men who take 24 world’s homceopathic congress. care of us, from the men who love us, from the men who thought we were most charming, and from the men who did not wish us to do anything else but to be sweet. Now that is a fact, and that is the only trouble that there are so few names on the programme. We had rather stay at home — the majority of us. We had rather be taken care of— the majority of us. We had rather do nothing at all but be what most of the men who love us wish us to be. It means a great deal when a girl says, I will be a scientist, I will be a doctor, I will be a chemist, I will be as Dr. Talbot’s daugh- ter has said she would be — a professor of coal economics. It means putting aside a lot of nice things — oh, so many nice things ! It means the sacrifice of so much — so much that we women love, and it means a regular travelling on to a Gethsemane, and it does not unfrequently happen that that Gethsemane ends in Calvary, because a woman’s ambition killed is a woman crucified. Now, you can feel that yourselves, and you know that yourselves, you men and women who listen to me to-night. That is why, Mrs. Henrotin, there are few names on the programme to-night. It means much to us. This century, this woman’s century, this century in which woman has had her apotheosis, and the apotheosis has been right here, in the city by the lake, in this new and unknown city, in the city which fifty years ago was almost a wilderness, — in this city women have had — what? The recognition we have here to- night from my peers. They have not had it before, and that is the reason why we have so few women’s names on the programme. We are rejoicing; and we are indebted to America, we are indebted to this Congress, we are indebted to this nation, we are indebted to the representatives of this nation, as we have them here in Mr. Bonney and Mr. Henrotin, that we women have an opportunity to say what we think here, to be what we please here, and to tell you what I am telling you now, the reason why there are so few women’s names on the programme. It is not for lack of ambition or study, but for lack of opportunity heretofore, and which now is open to us. This is our opportunity. This is what we have been waiting for, and when we have the leadership of a woman like this, a woman who is ready to say go, and to hold up the hands and the heels of the woman who is going, because some of the most beautiful pictures in the World’s Exposition are of women who are flying along, their arms outstretched and their feet in the air, because of her ambition, ADDRESSES. 25 earnestly, eagerly, patiently, painstakingly, going on and on ; and only God knows where she will succeed, if you will only not put weights on her heels. There are few names on the programme; but it is the fault of the past. If it ever happens — and please God, Mrs. Henrotin, in your time and mine it will — that we have another World’s Congress in Chicago, or anywhere under heaven, there will be many a name, so many that the woman’s congress — which we had just a little while ago, and whose badge I wear now, the confederated congress of women — will be a petty thing compared to what we shall have then, in our time and in your time. Now, I wonder if there are doctors down here, women doctors, and I wonder if they know just exactly what I mean by these words? I wonder if they feel as I feel, that it is a lack of oppor- tunity? We mothers — Mrs. Henrotin has said it is the domestic practice in which we excel — we mothers sit by the fire and spin. We conserve the money that our husbands bring in, and we do not say, this is for Jane, and this for Harriet. What do we say? John must go to college, and Harry must go into the navy; and so we save and we toil. Why? Because of this intense domestic instinct. I would not give it up; not for one moment would I give it up ; but it has been a disadvantage to all of us ; and sometimes it is a question in my mind whether any mother has a right to be anything but a mother; and whether any wife has any right to be anything but a wife. I would consecrate the professions to women who are in love with the professions. I would consecrate ambition to women who are in love with ambition. I would have women married to the thing. I would educate my children to the thing, if those children had any sort of sentiment for it. It must be a love, it must be an enthusiasm, it must be a consecration; it may be a martyrdom, for we have no right to say to any man, take this part of a woman to be your wife. I am very doubtful, indeed, whether a woman can succeed as a physician, as a surgeon, as a chemist, if she rocks the cradle with her foot while she studies her anatomy. When you go into a medical school you must write your- self a doctor. I was an old woman when I began, so I did not have the temptation. Another point, and it is a very serious point, and a very impor- tant thing, that I have come to say to-night, because this may be the 26 world’s homceopathic congress. last time that I will ever talk at a world’s congress, and I want to have my opportunity : Have women failed ? Have they really failed? Have they never been surgeons? Have they never been alienists? Have they never been chemists? Have they never been biologists? Is there no woman anywhere of whom we can say, she is a great woman in this line? I know a woman, of whom I spoke the other night in the Women’s Congress, who is now in an important position in the Chicago University ; Emily Nunn Whit- man. She is authority in biology, and all the scientific journals in America and Europe accept her contributions. She is typical. There are many others. I heard the other day of a young woman, a very young woman, who has not very many years seen the ink green on her diploma, who has been successful in ovariotomy and laparotomy. I know a woman, not very far from me, who does very good work in surgery, and we have name after name that we accept as authority. We teach our students the names of women who have discovered important matters and important methods in various branches of medicine and practice. We have not failed. We have done our best according to the opportunity that was given us, and we thank and bless and pray for all sorts of good things to come to the men who have given us that opportunity. The Chairman : I have the honor of introducing a distinguished representative of our school from abroad, Hr. A. E. Hawkes, of Liverpool, England, President-elect of the British Homoeopathic Congress. Address of Hr. Alfred E. Hawkes. Mr. Chairman , Ladies and Gentlemen: I am exceedingly obliged to you for your kind reception of me as representing some of the Homoeopaths of my own country. I am exceedingly glad also to have had the opportunity of coming to see this great gathering of those interested in Homoeopathy. I come from the city of Liver- pool where fifty years ago the revered Hr. J. J. Hrysdale, single- handed, fought the battle for the truth. One after another joined him until he became so strong in that city that some few years ago one of our greatest merchants, Henry Tait, offered to give us some twenty-five thousand pounds to build a hospital if the society of which I happened to be President, the Homoeopathic Medical Soci- ety of Liverpool, would carry on the work. That hospital was ADDRESSES. 27 built and is now in good working order, and we undertake any kind of work that turns up. I thank you for your kindness and I have only to say that Homoe- opathy is flourishing in Great Britain, or in the part of it with which I am familiar, and the question of medical women and their profession is being not very slowly settled. The Scotch examining board admit them, and they sometimes have to confess that the wo- men get more marks than the men. At Cambridge, as you know, Miss Fawcett obtained sufficient marks to head the head wrangler. Women are being examined in London by perhaps the stiffest ex- amining board in the whole world, possibly with the exception, as I am informed, of Vienna, and women there are gaining the highest honors that the University can give, and obtaining their degrees in medicine. I for one, wish the women Godspeed and I am quite sure that given fair play they will give a good account of themselves. My only further hope is that those women who graduate in medi- cine will turn their attention to Homoeopathy, which in so very many ways they are specially adapted to carry out. The Chairman then introduced Hr. J. Cavendish Molson, physi- cian of the London Homoeopathic Hospital, who addressed the meeting as follows : Address of Hr. J. Cavendish Molson. Ladies and Gentlemen : One of our great men on the other side of the water said years ago, “ some men are born to greatness, other men achieve greatness while others have greatness thrust upon them.” I come in under the third class. The President of the British Homoeopathic Society wrote to me only a few days ago ask- ing me if I would act as representative of that society at the World’s Congress of Homoeopaths. Where shall I begin and what shall I say ? I arrived in New York the other day. I simply rushed through the city, and went on hurriedly by the great Pennsylvania Railroad. Everthing was new to me ; the four line track, the stupendous engines, the marvel- lous railway cars, with all their well furnished appointments. These things arrested my attention. I went on and paused and took full breath at Washington. What did I see there? Such a city as I have seen nowhere else. I have been north and south and east and finally I have come west, and the west eclipses all. 28 world’s homoeopathic congress. Last year it was my pleasure to go to the summit of a continent, the North Cape, and there we were photographed by the light of the midnight sun. On arriving in America what has struck me most of all, next to the marvellous inventive genius displayed on every hand, is the cordial reception accorded to me. I have felt quite at home. In Washington one of the government officials placed him- self at our disposal and acted as our guide to your wonderful Ar- lington, and there spread out before us in panoramic beauty, lay your glorious capitol, with its beautiful obelisk in full view. When I arrived in this city the same welcome, the same kind- ness was extended to me as there, but I think I must say that I would rather live in Washington than in Chicago. I have been to the top of your Masonic Temple. It was a marvellous sight, but every man that could show a brick funnel seemed to vie with his neighbor to make the greatest smoke. If you ever have any clear days here, which way does the wind blow on those days? I have no doubt I will get an answer to all these questions a little later. Then your fair White City came in view, with all its glorious assem- blage of domes and minarets. But, ladies and gentlemen, nothing has impressed me so much as this assemblage. We are here to-night to honor the genius of Samuel Hahnemann. I say his genius. When one goes out yonder they see there marvels of the inventive faculty of man, but do not think of Hahnemann as an inventive genius so much as a discoverer ; and it seems to me that the discoveries of scientific men vie with the inventive faculty in man. Of all the dis- coveries potent for good, of all our philanthropic institutions is there one; yea I think I may throw down the gauntlet and challenge every man and woman here to mention one discovery which can be put on a par with the marvellous discovery of Samuel Hahnemann. One word in conclusion. On my return, of all that I shall have seen and heard, that which I shall wish most to convey to my col- leagues will be the kind and cordial reception which has been accorded to me all along the line. I have yet much to see before I return. The Chairman then introduced to the meeting Dr. C. Bojanus, of Samara, Russia, who addressed the Congress in his native language, a translation of which is here presented. ADDRESSES. 29 Address of Dr. Carl Bo j anus. My honored brethren will permit me to call, in a few words, their attention to the following subject, which may prove useful to the welfare of humanity. Whilst working at my answers to the ques- tions which had been sent to me by the Committee of the World’s Congress Auxiliary on Medico- Climatology, I involuntarily remem- bered what I had written myself about meteorological stations in my work, Homoeopathic Therapeutics Applied to Operative Surgery , published in Stuttgardt in 1880. The question to be answered in the programme of the Climatological Bureau was as follows : “ What more can the weather bureaus do to aid climatologists and disseminate climatological knowledge ? ” My answer has been given in the article sent to Dr. Duncan. What was it, then, which put me in mind of what I had written fourteen years ago about a work of the late Dr. F. X. Horn, of Munich, entitled About the Produc- tion of Diseases Through Magnetic , Electric , and Atmospheric Influ- ence s, a work which had been read by me with great interest in 1863? A most superficial look into the book will show at once its worth and its importance. I happened to hear that this was not the only work of Dr. Horn upon the subject. I tried to get the rest of his writings, but was informed that these works were all out of sale. I succeeded in getting, at an antiquarian’s store, the first mentioned work of Dr. Horn, and I had the pleasure of giving it to Dr. Dun- can. During my last stay in Wiesbaden, this spring, I became acquainted with Dr. Erwein, of Mainz, a Homoeopathic physician, who had studied and graduated in the College of Philadelphia some years ago. He happened to have in his library the works of Dr. Horn, which I had tried to get in vain. They consist of three pamphlets : 1. “ The Cholera is an Intoxication of Cyanic Acid, Ozone and Todosmon Miasma, Proved by Dr. F. X. Horn, Munich, 1874.” 2. “ About the Causes Which Call Forth an Individual Disposi- tion to Gain the Cholera, with Proofs Founded upon Magnetic and Electric Conditions.” 3. “ The Earth a Magnetic Pendulum. Proofs of the Causes of Cholera. Diminution of the Earth Magnetism a Second Important Agent for the Development of Cholera. Munich, 1874.” It seems to me that just at the present moment it would be impor- tant to save from oblivion the works of Dr. Horn, and verify the 30 world’s homoeopathic congress. experiments and observations upon which he bases his opinion, that the constitution of the air and weather are the principal agents in the appearance of cholera. This is the reason which has induced me to propose this subject to the attention of the honored assembly of the North American Institute of Homoeopathy, with the request of having these pamphlets translated into English and published. I have just heard that some parts of Dr. Horn’s works have already been made known to the public by the late Dr. Constantine Hering. The last news in yesterday’s papers, that the cholera is beginning to reappear in Europe, renders the moment still more appropriate for the study of these works, which may prove useful to the promotion of health and security. I will transmit these pamphlets to my honored colleague, Dr. Wes- selhoeft, of Boston, and will ask him to look over these pamphlets and communicate his opinion to the Institute. They have been lent to me by Dr. Erwein, with the condition of their being returned to him. Address of Dr. P. C. Majumdar. Dr. P. C. Majumdar, of Calcutta, India, was introduced, and ad- dressed the meeting as follows : Mr. President , Ladies and Gentlemen : The honor you have done me is done to a country once civilized and intelligent, but we have nothing now to say about India. We have the country left, but not the former grandeur and magnificence. Our people never travel to foreign lands, and when I left Calcutta I was not acquainted at all with the lives and the manners of civilized people in different parts of the world. One thing that brought me here is the system of medi- cine introduced by the immortal Samuel Hahnemann, and I think the honor that you have done me in selecting me as the representa- tive of India is through the instrumentality of that great man, the discoverer and the reformer of the medical science of the present day. We cannot boast of many Homoeopathic practitioners in our coun- try. I can count them on my fingers’ ends. There are only a few who are practicing in some of the big cities of India. We have only about a dozen in the city of Calcutta, and about another dozen dis- tributed throughout the whole of so vast a country and so vast a population. In fact, you may say that it is like one drop in the ADDRESSES. 31 ocean. But we have our ancient medical literature and we have our ancient medical system to be invoked in my country at the present day. Though the Homoeopathic system of medicine has been intro- duced in India, still they cannot destroy the whole of the physicians who practice onr system of medicine before the advent of the Euro- peans in that country, and that is the reason that we had a very good medical profession in ancient times. We are told that one of the gods is the promulgator of medical science in the world, and he took some poisonous substance into his body and made it a beautiful medicine. That is to say, he was not killed by that poison, but he became immortal, and he made that substance, which is the deadliest poison, one of the best medicines in the world. This, to my mind, shows the truth of what Hahnemann has said, that the deadliest poisons may be the best medicine if we can know how to prepare them and how to use them as medicinal substances. Arsenic, for instance, is one of the best medicines in Homoeopathy, but it is one of the deadliest poisons that we know of. Very recently we began to teach Homoeopathy in India. We have a school of medicine, and we have also established a Homoeo- pathic hospital only last year. I have no material facts to give you as to the brilliant prospects of Homoeopathy in India, but I wish to say that what we practice in India is pure Homoeopathy ; that is, such as Hahnemann taught, the purest in the world. I am pained and grieved to see in some of the countries in Europe and here that there is a mixture of Homoeopathy with Allopathy ; but that thing cannot happen in our country. If we go to practice a little bit of Allopathy, we are discredited that we do not know anything about Homoeopathy. The people have great belief in the system of Homoeopathy, so when they require their treatment to be Homoeopathic, they want pure and true Hahnemann from begin- ning to end. We have very few books on Homoeopathy in India; that is to say, very few books written by my countrymen there in English or in foreign languages. We have recently done something about this literature of Homoeopathy in India by publishing a few books in our own language, and in this way we are trying to popularize Hom- oeopathy among the vast population of India, and I think some dav 32 world’s homoeopathic congress. we will be able to say that we have done much for the cause of Homoeopathy in that vast country. I thank you for your kindness and attention. The Chairman : I have to announce’ the following cablegram just received : “Dr. J. S. Mitchell, Chairman World’s Congress of Homoeopa- thy : Greeting. — Theodore Kafka, Carlsbad, Germany.” Also from Dr. Alexander Villers, of Dresden, Germany: “ Regrets that I cannot be present at your meeting. I send best wishes for Congress and Homoeopathy.” It is sometimes interesting to see ourselves as others see us, and I call upon our chaplain, Rev. T. G. Milsted, to address us. Address of Rev. T. G. Milsted, D.D. Mr. Chairman , Ladies and Gentlemen , and Visiting Physicians of the Homoeopathic Congress: There will be many subjects discussed in meetings held in this building during this week, but I choose as my subject for to-night what I think is the most interesting of all, namely, the doctors themselves. I have nothing to say this evening about the medicine part of this meeting. I am going to say a few words about the man part. The man part, I hold, is more impor- tant than the medicine part, for it is the man that can take the poison, to which our brother from India referred, and make it into medicine. You will hear this week about wonderful operations that can be performed and have been performed. How were they possi- ble? Through the man that did them ? Now, in my profession, theology, the pill is everything. The pills are all made up for us, and all the minister has to do is to give them ; and it is heresy in my profession to attribute too much to the man. Everything must go to the theological pill. But I know that that is not heresy in the medical profession, where honor, when it is due to the man, is gladly rendered. A diploma cannot make a good physician. The physician, far from borrowing his honor from the diploma, lends it what it has. A bright child said that she could tell true jewels from false from the kind of people that wore them ; and so the diploma can be seen to be true or false according to the person that owns it, according to the name that is on it. A great French artist, when looking on a gathering of rather li- centious art students, said there were not half a dozen in all the ADDRESSES. 33 great assembly that would amount to anything, because, with all their technical skill, with their trained artistic ability, they had not the one great requisite for excellence in their profession, namely, character; that underneath all technical skill, underneath all smart- ness and ability, there was the deep substratum of life, character, out of which all good things proceed ; and that great scientific man, Huxley, has said, and Herbert Spencer has quoted with ap- proval the saying, “ that the great discoveries in the scientific world have proceeded not so much from men of intellectual acumen as from men of deep religiousness of nature, from men of deep character.” And so in the medical profession there must be such substratum of deep character for excellence. A newspaper editor once said to a minister who had had a good deaf of advertising, “Mr. Smith, the newspapers made you.” “Ah, in- deed,” responded the minister, “ make another.” How great is the power of the press ! The newspapers can make- and unmake a great deal, but I very much doubt, Mr. Chairman* whether even the newspapers can make a first-class physician. Great and good has been the character of the medical profession. The doctors, as a general thing, have been true to the great respon- sibilities placed in their hands. They have been faithful in the is- sues of life and death. They have kept the sacred trusts reposed upon them. In the literature of the Christian centuries the name by which the man of Nazareth, Jesus Christ, is oftenest called next to that of Good Shepherd, is the Good Physician, and that shows the regard which Christendom has for the physician. The physician is the friend of humanity. He is continually banishing suffering and disease. He is discovering the demons that men have feared in their own ailments and then in banishing those demons. The physician is finding out the laws of health and then giving their blessing unto men ; is finding out the laws and the forces of nature and applying them. Often, in the time of war, we are told that more men die in the hospital through the invisible foe than from the bullets on the field of battle ; and if more are dying in the hospital in the time of war, how great we see is the harvest of death in the time of peace; and yet it is the doctors who are fighting for us this invisible form of disease. The doctors are also philanthropists. They are more than the mere friends of man — they are lovers of men. They are self-sacrificing where human interests are concerned.. 3 34 world’s homoeopathic congress. It was said by an old Latin poet : “ Whatever is related to man is not foreign to me.” Such is the substance of it, and it is said that in old Rome the plaudits used to ring whenever that sentiment was uttered in the theatre. Those words of that old Latin poet have been adopted as the motto of one of the colleges here repre- sented and not in Chicago. Now, of course, all the good we have to say of the doctors belongs to the ladies as well as to the gentlemen. Indeed, if the women in the medical profession have the same experience that some of the men have had, the men will have to look out for their laurels. There is a woman preacher in our town who is very much beloved by her people, and they wouldn’t think of exchanging her for any man. It so happened that on one Sunday when she was out of her pulpit another woman preacher preached for her; but this visiting preacher was of a rather coarse and masculine nature, and when she had got through the people turned up their noses and said, “ We don’t want any more of her ; she isn’t much better than a man.” Now, with all due respect to the ladies and with all good wishes for their success, may that fate be spared you gentlemen. There is a connection more or less plain between the profession of medicine and that of theology. A great many people have gloomy views in general, and I think that springs from bodily ailments. A great many people think they are experiencing religion when they only have an attack of the dyspepsia. There is one church which in its Sunday service repeats every Sunday, u Good Lord, deliver us.” I think it would be a very good thing if they should say, and if it could be done, “ Good Lord, reliver us.” Then, I think their health would be very much better. In order that the doctors may always hold the high place in the future that they have in the past, progress is necessary. This is an age of progress which is just as possible in medicine as in nearly every other walk of life; and the physician must be a broad man of wide culture and knowing many things. He must ever be going onward. He must not be afraid of new discoveries as a great many physicians were afraid of the new discovery of Hahnemann. He must not be like the hunter who turned back when he struck the trail of the bear, because it was too fresh. A great many people turn back just where they ought to go on and achieve success. I heard of an old professor who was very successful when he started ADDRESSES. 35 out, but forty years afterwards his lecture-room was deserted, and he couldn’t understand it, because his lectures he said, were just the same as they had been before. The medical profession has had its full share of those who have advanced, from the time of Harvey down through Hahnemann, to many within our own day, and the mere fact that you physicians are gathered together here from all parts of the civilized world shows how much you desire progress. Now I wish to say to all you who have come from distances that we want you to stay with us a long time, we want to get acquainted with you and want you to get acquainted with us, and I have no doubt that when our brother from across the water is acquainted with us he will much rather to live here than in Washington. The Chairman, Dr. J. S. Mitchell, then delivered his inaugural address, as follows : Inaugural Address of J. S. Mitchell, M.D. Ladies and Gentlemen : When the proposition to hold a World’s Congress of Homoeopathic Physicians and Surgeons was first made by the World’s Congress Auxiliary, it was felt by the Committee addressed to be a duty which it owed the profession, to see that proper arrangements were made for the holding of such a Congress. The plan included the selection of an advisory council, consisting of representative men in our school, of all lands. Correspondence with these demonstrated that the project met with cordial endorsement on the part of all. When at the meeting of the American Institute at Washington, D. C., in June, 1892, it was decided to hold the next session in connection with the World’s Congress, its success was assured. It was hoped that the attractions of the great Exposition together with those of the Congress would bring no inconsiderable number of our distinguished foreign confreres. It has been learned that com- paratively few can be with us in person, but the responses to the re- quests of the committee for reports and scientific papers, have been hearty and extensive. Official and personal letters in large num- bers have been received, which will be submitted at a later period to the Convention by the Secretary. We are grateful to those who have honored us with their presence and extend a hearty welcome on the part of all connected with the Congress. 36 world’s homoeopathic congress. We call attention specially to an interesting historic parallel : At the time of the Convention in 1876, the venerable widow of the illustrious founder of our school, then residing in Paris, sent to the Homoeopaths of the world, with her greeting, a bronze bust of Hahne- mann, cast from the marble one by David d’Anger which was affirmed to be a perfect likeness of that distinguished man. To- night we have upon this platform a model for an heroic statue of Hahnemann, to be erected at Washington, D. C., as soon as the necessary funds can be obtained, sent also from Paris, the scene of Hahnemann’s latest triumphs. The 400th anniversary of the discovery of a new continent is being fittingly commemorated by many occasions, but among the most notable are those connected with the World’s Congress Aux- iliary. Long after the grand and imposing architecture of the “ White City ” has faded from memory, long after the beautiful, the costly, the useful and attractive exhibits it enshrines have been for- gotten, the records of these gatherings of prominent men and women of all climes and shades of belief will endure. In the tomes that will be left in every public library in the civilized world will be inscribed the best thought of the ablest minds in all departments of human activity. It was a fine conception to bring together so many representative men and women at a time when the highest products of art are being exhibited. No occasion could be more fitting and none more likely to effect desirable results. There is no standard by which we can measure the work of such a convention as the one we inaugurate to-night. Its programme outlining the week’s labors, by no means tells the whole story. Its general meetings, at which addresses on topics of wide interest will be presented and calmly discussed, its sections in which papers on special subjects will be read and de- bated with a completeness that no other method offers, its- committee meetings at which our most trained minds will quickly draw those conclusions which are- fraught with the best interests of the cause — these indeed are the main features. But we must realize that there is always in gatherings of men and women of such large propor- tions as we- now see, far more than can be estimated by actual re- sults. The casual remarks, the unspoken thoughts, the emulative spirit aroused, the constant interchange of views during interims, and that mental attrition which, though it gives immediately no ADDRESSES. 37 scintillation, yet at some time may electrify the world — aggregate in the end a train of forces from which, later, a universe gets the reflex. Most of the congresses that are to be held can boast of records ex- tending through a long series of years. Centuries sometimes count for but little in human thought. Medicine is as old as man. Charon taught his pupils in the recesses of a Thessalian grotto. To-day every civilized land has its medical colleges, and some of them are palaces of science. The school of medicine which is represented here to-night has only eighty-three years of existence. During this brief period it has a history whose page is more attractive than any other in the development of medicine; whether we take the personal career of its illustrious founder, the records of the labors of his dis- ciples — often conducted under disadvantages and trials that would have appalled the stoutest hearts — or the results that have accrued to humanity in many lands through his teachings. The reform in medical practice inaugurated by Hahnemann, and which his followers have so successfully carried out to a fruition acknowledged even by the testimony of opponents, constitutes one of the world’s epochs. Time is wanting, nor is the occasion opportune, for an adeqifate rhumb of Hahnemann’s work or an enunciation of his principal tenets. But we may be pardoned for a glance at the record of our school ; for an attempt to show the position it to-day occupies in the world of medicine and for a brief reference to its destiny. The first complete promulgation of Homoeopathy by the Organon , which has been termed the Bible of Medicine, was in the year 1810. Hahnemann, after his conception of its main truth, had devoted a number of years to long and patient study. His scientific spirit was sublime. He did not promulgate his law of cure until it had been tested by experiment and deduction to such an extent that his ad- mirers have always been amazed at his research. During fifteen years he proved on his own person more than sixty drugs, collated all the data concerning them, and then presented his views deduced from this long experience, tersely, logically and in har- mony with true scientific methods. Sir John Forbes, the acknowl- edged head of the English profession of medicine, who had no faith in Homoeopathy, had sufficient frankness to say in 1846, three years after the death of Hahnemann : “ No candid observer of his actions, or candid reader of his writ- 38 world’s homoeopathic congress. ings can hesitate to admit for a moment that he was a very extra- ordinary man — one whose name will descend to posterity as the exclusive excogitator and founder of an original system of medicine, as ingenious as many that preceded it, and destined probably to be the remote if not the immediate cause of more fundamental changes in the practice of the healing art than have resulted from any pro- mulgated since the days of Galen himself ; he was undoubt- edly a man of genius and a scholar; a man of indefatigable industry and of dauntless energy.” But all his contemporaries were not thus unprejudiced. The persecution of Hahnemann is one of those records of human experi- ence we would gladly blot from the page of history. It would be sad indeed to contemplate the life of a great reformer, even as late in the world’s history as Hahnemann’s day, did we not know that such noble souls are helped through their almost crushing trials by divine aid. The unpopularity, the danger, the ostracism endured is patiently, bravely, and almost cheerfully borne until the end, because such men are endowed with an heroic spirit that knows not depres- sion. The world has seen many heroes, but none so worthy of the immortality now assured, as that grand old man of medfeine, Samuel Hahnemann. The early progress of Homoeopathy was slow. Like all great reforms it had to encounter opposition, ridicule, and derision. Its inherent strength enabled it to survive all these, and its growth was steady during the first years of its existence. A great reform is like a sea. It may be calm at any time, but at others its force is irre- sistible. A successful reform must recognize the evils of its day with perfect clearness, and seek their remedy with determination. It must stimulate thought and action upon the part of intelligent sup- porters. It must appeal to reason and invoke the aid of logic. Our reform in medicine has fulfilled all these conditions. It is a marvel when we remember the short period the world has had before it this idea, that it now has its thousands of adherents, its long list of associations that requires page after page of the Ameri- can Institute proceedings to enumerate and its millions of believers. Even journalism claims to have been in existence since the days of Christ, although printing was not discovered until 1456. All the great reforms of the day will point through their advocates to periods dating from one to many centuries. We cannot even celebrate a ADDRESSES. 39 Centennial, and yet we are prepared to demonstrate that, measured by the amount of work accomplished, the benefit the world has received from Homoeopathy is incomparable. It has not alone been directly effected. Like all great reforms it permeates in more direc- tions than are manifest except by critical study. There is a reflex influence that extends to all classes of mankind. The modifications of existing parties which a new sect of any importance soon influences, is one of its most pronounced features, and one which oftentimes is not given due credit. No great idea was ever held by its adherents alone. The unconscious influence of Homoeopathy pervades many medical minds that would scorn to give it right expression. The silent thoughts of the people are woven into the mighty web of their existence. Since its firm establishment in America its progress has been in an ever increasing ratio. In 1876 the first World’s Convention was held in Philadelphia at the time of the Centennial Exposition. In his inaugural address, the President stated that there were then 5000 physicians in the United States. Less than two decades after, at this assembling, we are able to assert that there are 12,000 in this country. This makes an army whose presence is not to be despised. In many other countries the growth of Homoeopathy has been remarkable, but it should be noted that in this land where freedom of thought and political action is most pronounced, its adherents are most numerous. It sometimes looks as though this country would profoundly influence the spread of Homoeopathy throughout the world. Even now the isles of the seas contain our physicians educated in this country. The papers to be read at this Congress from Australia and the Sandwich Islands are by graduates of American colleges. We do not undervalue the labors of our colleagues in other lands than our own, but the exist- ence of our twenty colleges gives us a mighty power. The steady gain in our ranks, the increase in the number of our colleges, hospitals, dispensaries and journals, has done much to bat- ter down the opposition formerly urged against us and to establish for Homoeopathy a position equal to that so long enjoyed by the dominant school. We are recognized by the Government of a great nation in the various departments of this great Exposition. We have Homoe- opathic headquarters on the Exposition grounds upon land assigned 40 world’s homceopathic congress. us by the Directory, which we dedicated with appropriate exercises to-day. We have a collective exhibit of our colleges and hospitals in the Government building, a special college exhibit in the Depart- ment of Liberal Arts; in the Woman’s building an exhibit from the London Homceopathic Hospital, of the work of trained nurses, and a hospital under the charge of medical women of our faith ; and last, the recognition of our school by the World’s Congress Auxiliary. When, however, we enumerate the whole list of our adherents, when we have fully announced our present status everywhere, we can truly say Homoeopathy is not then completely demonstrated. There is something majestic in the steady flow of a mighty river, but grander still is the unconscious influence it unceasingly exerts upon the ocean into which it pours its mighty waters. Steadily, almost imperceptibly, Homoeopathy has forced its way into all forms of medical belief — it has modified the practice of the Old School, com- pelled it to make its drug form more minute and palatable, and even to admit, in a guarded way, its cardinal truths. It ought to be stated in every such assemblage as this, in simple justice to the illustrious founder of our school, that he did not de- nounce medical science except as it related to his own teachings, and that he did not believe after his works were published, that the evo- lution of medicine would cease. Homoeopathy has stood the severest of all tests ; that of time. Other medical faiths have usually perished with their founders. Herbert Spencer says : “ The failure of Cromwell permanently to establish a new social condition, and the rapid revival of suppressed institutions and practices after his death, show how powerless is a monarch to change the type of the society he governs.” Yet we see, fifty years after his death, the illustrious promulga- tor of this great medical reform still profoundly affecting the whole medical body politic, and accomplishing what a powerful ruler en- dowed with an iron will and sovereign ability could not. It is characteristic of genius that it possesses fulness. There is something wonderful in the works of the great men who have doub- ted the world of thought. The wisdom of Shakespeare shines just as clearly as it did when first enunciated. The lapse of time does not in the least dim its lustre. Milton’s great epic is not yet excelled. The discoveries of Laennec in auscultatiou have received comparatively ADDRESSES. 41 few additions since his day. Hahnemann’s reformation of medicine has had more influence upon practice in all schools than the combined results of the labors of all other discoverers in medicine. Who can predict, in the light of the wondrous growth of our cause since its first promulgation, what a few more decades will accomplish ? Time adds steadily to its laurels, to its influence and to its dissemination. Homoeopathy has passed the stage of discussion, of controversy, of argument; it is now a firmly established science. Do not confound it with arts and judge it by their standard of progress. It is a long period since the Centennial in Art, but in Science scarcely a day. Centuries of use of such familiar drugs as quinia and morphia de- velop the fact that our opponents still differ as to their application. Hahnemann’s inspiring spirit still rests upon his followers. Con- sider the work spent upon our Materia Medica. Science possesses few greater instances of human industry and research. Allen’s Encyclopaedia and the Cyclopaedia of Drug Pathogenesis will long remain as the monuments of those who created them. The thought- ful of our faith realize the imperfections that still exist, but so far from bringing any discouragement, they are incentives to further work. Science is always fresh ; in whatever paths you travel it, it leads to new facts and thoughts. Therein is one of its charms to its devotees. There are always “ new worlds to conquer.” It is proof that our science is not perfect, that we are here to-night in grand convention assembled, to testify to this fact and to take measures for its further development. Those who grow impatient and think our pace too slow should meditate on the rules that gov- ern progress in all departments of human thought. Instead of being behind in the march of civilization, we are continually at the fore. No charge that it is a laggard can be truthfully directed against Homoeopathy. It has grown from a little band of students of therapeutics to a great school of medicine. In our deliberations this week we shall convene in nine sections, embracing all the main divis- ions of medical science and art ; and complete as is this list, it would have been longer but for the fact that another Congress which em- braces climatology, meets this week under the chairmanship of a member of our school, and still later in the season, one on Public Health. At our first World’s Congress in 1876, few papers on sur- gery were presented. But they were of high order and indicated that our School was progressive. We shall now, in the different 42 world’s homoeopathic congress. sections have nearly the whole range of surgery covered. In the specialties in medicine we had little representation in 1876. To- day we have as skilled men in them all as may be found in any school ; and the creation of a new one by one of our number, chal- lenges the profound attention of medical minds. Jorg, the German professor, in 1825 sought to controvert Homoe- opathy by secret experiments with his pupils; However, as will always be the case when a judicial scientific investigation is made, he only served to establish it on a firmer basis. Coming years, it is now clear, will bring — not only on our part, but that of our oppo- nents — the application of every new test to the demonstration of its law and corollaries that modern science and the evolution of medi- cine will originate. But its believers stand in no fear. Whatever modifications may be effected, we rest with sublime confidence in the view that its methods will, in the main, be, eventually, universally adopted. This is not simply a hope; it is a conclusion based upon premises that careful consideration will, we feel sure, deem valid. In the possession of the elements of every successful reform, in its firmer establishment after the death of its founder, in its marvellous growth, in the intelligence of the clientelage its practitioners secure, in its consonance with the rigid requirements of science, lie the deep foundations of our convictions. And there is an immense amount of work still to be done. Ma- caulay sums up the vicissitudes that attend the building up of a new science when he says : “ The improvement of a science is gradual and slow. Ages are spent in collecting the material, ages more in separating and assign- ing them, and even when a system has been formed there is still something to add, alter or reject. Every generation enjoys the use of the vast hoard bequeathed it by antiquity, and transmits that hoard, augmented by fresh acquisitions, to future ages.” The development of any science being necessarily slow, that of medicine presents almost insuperable obstacles. It is based on the collation of an immense amount of data. These refer not only to a most complex organization, but one constantly under varying con- ditions; hence deductions from them must necessarily be varied and uncertain. Yet, in spite of this, while subject in the main to these impediments, Homoeopathy has developed fast in the number of years it has been in existence. This is due to the fact that it has ADDRESSES. 43 steadily been ruled by law. Empiricism has not governed its progress. As one illustration of the labor before us, we may instance that recent advances in medical science involve a new outlining of Hom- oeopathic provings ; it will, doubtless, be shown fully by the papers and debates during this week, that we shall now have to bring our distinctive work in relation to all new planes of thought and action. So vast is this undertaking that it will require separate colleges, with complete laboratories, for its successful culmination. Particularly is Homoeopathy in closer touch with that growing spirit in the profession — to give a larger attention to the unques- tioned source of a prominent part of all disease— the mind. It is on this very ground that Homoeopathy has won some of its proudest laurels. The success of our school in the State Insane Asylums at Middletown, N. Y. ; at Westboro, Mass.; at Ionia, Mich.; at Fer- gus Falls, Minn., has induced California to lately place one in charge of a Homoeopathic physician, and we trust will soon secure from the legislature of the State of Illinois another. Not matter, but mind, is to-day the world’s new balance-wheel. Our School will have to devote its energies further in this department which promises such brilliant advances in our treatment of disease. The Homoeopath of to-day is far different from the believer of seventy-five years ago. He has kept pace with the development of medicine, he has added to his armamentaria every other effective method of cure, no door is shut to him, he recognizes the value of physiological therapeutics, and that they are governed by principles that are often strictly scientific. No one can claim to be a physician in its widest sense unless he is of liberal mind and accepts the whole of medical truth. But we are obliged to cling with tenacity to our organization, both to maintain our existence and to extend our views among people of every land. Our position as a sect was forced upon us by oppo- nents. We are only battling for the enthronement of the principles of our own faith. Medical liberty is as sacred as political or religious liberty. Every encroachment upon it must be faithfully and zealously resisted by those who are entrusted with its preservation. Webster said : “We must fight the germ of unjust power.” It is 44 world’s homoeopathic congress. our duty to fight not only the germ of medical intolerance, but its whole horde of chemical combinations. The profession of medicine has but one great stigma — the perse- cution of Homoeopathy. It steadily keeps passing retroactive laws that are the opprobrium of justice. Like many other sad pages of human history, most of this opposition is based on misunderstand- ing. With a better conception of what Homoeopathy is and of its aim, it is probable that many of the bars now separating the great schools of medicine would be broken down. It will only take a few more World’s Congresses before this blot upon the fair escutcheon of a noble calling is forever wiped out. In all other directions the admiration and respect of the people of every land go out to the medical profession. It labors with an unselfish devotion to human interests to which the world furnishes few parallels. It lays down its life on the altar of duty. In the face of an epidemic from which even trained soldiers flee, it calmly and faithfully stands at its post. It shrinks from no risk which any exigency it may encounter neces- sitates. It sacrifices comfort, social life and recreation when human life is at stake. It brings light into all homes with its benign influence for every- thing good, for everything hopeful, for everything that can afford succor in time of distress. It is the comfort of the weary, the hope of the misanthrope, the deliverer of the sick and the rescuer from death. Will such a profession always manifest intolerance? We answer: No. Do you think me sanguine? Only last week, during a brief interview — and this incident so recently taking place con- firms some points already made in this address — a prominent mem- ber of the Woman’s Congress, the wife of an Old-School physician, in a three minutes’ speech, delivered one of the most eloquent, though terse panegyrics on Homoeopathy, from the standpoint of a non-be- liever, ever made. It would have graced this platform. It was from the lips of an earnest, noble woman, whose name is known in every household where the sweetest of all things, charity, is cul- tivated. We see the Hindoo, so widely differing from us in religion, in manners, in customs and in dress, yet in that character alone in which no one thinks it an affront to be considered — as a man — our peer. Upon this same platform, will soon sit the representatives of ADDRESSES. 45 all religions, discussing on common grounds its cardinal truths. With the leveling of caste, the battering down of deep-rooted pre- judices, the development of the brotherhood of man, which such congresses will secure, it is fair to assume that eventually we shall have our school of medicine recognized by the whole profession. He is a shallow student, and a man of narrow mind, who sees only in his little circle all there is of truth. Even the blind groping of the savage heart is to be noted and directed; for, many times in its yearnings, there are hopes that we, who are so much more favored, might have fulfilled. Hahnemann was a full century in advance of his time. Had Homoeopathy been sprung upon the medical profession of to-day, it would have eagerly seized it and investigated it with a calm, judi- cial spirit never yet manifested. Bergeon’s method, Koch’s lymph, Brown-Sequard’s elixir, and Organopathy, have had only brief and humiliating careers. In view of these, are we not justified in de- manding from our confreres of other schools a more critical, impartial investigation of Homoeopathy ? With effulgent light, in contrast to such uncertain methods, stands Homoeopathy, the science of Therapeutics. Hence its raison d’etre. The shafts of ridicule have not annulled its claims; the persecutions of former years only made more numerous its adherents; ostracism and proscriptive laws still more closely bind its followers, and weld them into so compact and determined a band that it is irresistible ; for, however lacking in numbers it may be, the strongest force that moulds this world is a party of men with a righteous cause — a cause whose alpha and omega is truth. We care not, as Homoeopaths, what rigid scientific investigation may lop off— for much that is called Homoeopathy has little relation to its main truth. We stand serene in the face of any test that may be applied, in the light of the experience of the master and his thousands of followers who have, all these years, patiently delved in the mine whose golden depths he first laid open. The iconoclasm of the nineteenth century, which so ruthlessly tears down one after another of our cherished idols, has thus far only served to place Homoeopathy on more solid ground. It stands comparison with the more intricate development in other departments. Music has grown much more complicated; it has taught us to resolve discords into harmony, it has evolved higher 46 world’s homoeopathic congress. coloring. Everything tends to be more subtle. Hence, we must have more artists in medicine ; men who can grasp fine points. We do not always get perfection, even in artists. They sometimes treat us to a faulty pose. We need not only artists, but artists of genius. Hahnemann was the first and greatest artist medicine has yet seen. He recognized the eternal fineness of everything human. In his abstraction from the crude and coarse, he was far in advance of his age; hence, medicine must yet come to him for inspiration. There are some of the profession who are much distressed because we are not agreed on all points. It is true, that wherever there is a difference it is likely to widen, but the different views which men hold often serve to make them more interesting, providing they manifest a tolerant spirit toward the opinions of others. Those who look for perfection will be continually doomed to disappoint- ment. There is no perfection except in an opening of new vistas. The higher the power of the microscope, the greater its revelations. The larger and finer the lens of the telescope, the more worlds it reveals. Homoeopathy stands pre-eminently fitted to adapt itself to the finer adjustments that are coming in all directions. It will blend with all valuable developments that the medicine of the future evolves, for its basis is truth. “Marble and recording brass decay, And like the graver’s memory, pass away. The works of man inherit, as is just, Their author’s frailty, and return to dust. But truth divine forever stands secure; Its head is guarded as its base is sure. Fixed in the rolling flood of endless years The pillar of the eternal plan appears, The raging storm and dashing wave defies, Built by that architect who built the skies.” The Congress then adjourned until 10 o’clock on Tuesday morn- ing, May 30th. ADDRESSES. 47 SECOND DAY’S SESSION. Tuesday, May 30, 1893. The Congress reassembled at 10 o’clock. Dr. I. T. Talbot, of Boston, Mass., said: Members of the In- ternational Homoeopathic Congress of Physicians and Surgeons, I am requested, as the honorary President of this body, to introduce to you, as the presiding officer of this Congress, one to whom we are indebted for the inception of the Congress and to whose labors we owe the successful manner in which it has been brought to this time — Dr. J. S. Mitchell, of Chicago. Dr. J. S. Mitchell : Ladies and Gentlemen : When the propo- sition for a World’s Congress was first made to the local committee by President Bonney of the World’s Congress Auxiliary it was de- cided that it would be w T ise for the Homoeopathic profession of the world to avail itself of the invitation. The local committee imme- diately went to work and at the meeting of the American Institute at Washington it was decided by a committee appointed by the In- stitute, together with its Executive Committee, and by the Commit- tee of the Auxiliary Council, that a committee consisting of the Chairman and Vice-Chairman of the two congresses — men and women — and the President and Vice-President of the American Institute should constitute a Committee to appoint distinguished members of the profession to prepare addresses and to take charge of the different sections. This committee, after many meetings, set- tled upon the arrangement which you will find in the programmes before you. The committee of the American Institute and the Exe- cutive Committee, together with the Committees of the Congress, have labored during the year and a half that have elapsed since the first inception of the Congress. Some thirty thousand circulars have been sent throughout the world announcing the details of the Con- gress. The World’s Congress Auxiliary sent to the ministers of our country in all lands official notification of the manner in which the work was to be conducted, with a request that such notifications be sent to all physicians of the Homoeopathic faith who could be reached in those countries. In addition, the Committee on Foreign Corre- spondence, consisting of the Chairman and the Secretary, have sent to all Homoeopathic physicians throughout the world embraced in 48 world’s homceopathic congress. Dr. Villers’s Directory, copies of the circulars and also official and personal letters, stating the objects and aims of the Congress and re- questing their co-operation. Many reports have been received from these. They have been very cordial and have expressed great hope that the Congress would be a success, and that its influence upon Homoeopathy will be marked for all time. It was moved and carried that the Rules of Order of Business, as given in the circular already issued, with the substitution of 10.30 for 10 a.m. as the hour of daily meeting be adopted as the order of business for this Congress. The Chairman: The next business on the programme is an address by Dr. William Tod Helmuth, of New York City. Dr. Helmuth is unavoidably detained and I will call upon Dr. A. S. Couch to read his address. SURGERY IN THE HOMOEOPATHIC SCHOOL. 49 ADDRESS. SURGERY IN THE HOMCEOPATHIC SCHOOL . By William Tod Helmuth, M.D., New York, N. Y. It is time that the early history of surgery as connected with the Homoeopathic School of Medicine, be placed upon *record. In an- other decade it is probable that the few desultory records of it which belong to the first period of Homoeopathy in this country will be lost. There can be no more fitting time, nor more appropriate occa- sion for this than our Columbian year, a year that will rear an everlasting monument upon the pathway of the history of medicine, and especially upon the history of Homoeopathy, throughout the world. It would be out of place even if it were possible, to attempt to produce in an address of this character, a detailed account of the surgery and surgeons of our school, as it stands in the United States to-day, or has stood for the last quarter of a century. It would be a work of supererogation. Our medical colleges flour^ ish all over this broad land, each teaching a full curriculum,, thus necessarily embracing instruction in surgical science. These institutions have their records, their published reports, their archives and their alumni to give the once- neglected branch her proper niche in the temple of AEsculapius. Our medical jour- nals and the published transactions of our societies furnish ample proof of the steadily growing interest in every department of sur- gery, and exhibit the undeniable ability of our surgeons. Such facts and such men need no mention here. The humble endeavor of this paper shall be: First, to rescue from oblivion some facts that belong to our surgery up to the year 1870, which, perhaps, are not very well known, and thus, by giving them place in the Transac- tions of this Congress, to ensure their safety for future generations and as a basis for a more extended history ; and, second, to speak of surgery as a factor — and a powerful one — for the extension of Horn- 50 world’s homoeopathic congress. oeopathy, and as a means for elevating it in the estimation of the community at large. After some careful study of the subject, I think I may be able to show, strange as it may appear, and meagre as are the sources from which information can be obtained, that certain of the great opera- tions of the last ten or fifteen years, which have so astonished both the profession and the public — with the details of which the medi- cal periodicals have teemed., and the results of which have been so brilliant, have been discounted by the earlier Homoeopathists with- out antisepsis, and some of them, perhaps without anaesthesia. I have no doubt, however, when I have recorded these cases, that a smile of incredulity, or a sneer of unbelief, or a sniff of ridicule, or a wholesale denial of facts, one or all of them will fall from the Old- School man who dares peruse our Transactions ; but I place the facts upon record, because the time will come when with the shout will reverberate u palman que meruit ferat.” When in 1825, Dr. H. B. Gram brought Homoeopathy to the notice of the profession, those gentlemen who first began to study and practice according to its precepts were all medical men ; and such surgery as came under their notice they eagerly turned over to any one who would take it. In New England, during the quarter of a century which elapsed between the landing of Gram and 1850, in which year 1 began to take cognizance of the field, Dr. Fuller (Homoeopathist) occasionally performed surgical operations for his friends and Dr. Winslow Lewis and Dr. George F. Gay, both skill- ful and liberal men — though belonging to the Old School — would render such surgical service as requested by the Homoeopathists. In New York, among the Old-School men who would hold sur- gical consultations with the Homoeopathists were Dr. David Hos- sack and Dr. Carnochan — honor to their liberality of spirit. There is the name of one, however, whom I must mention here, who., seeing the ostracism to which the Homoeopathists were subjected, and the difficulty in securing consultations in surgical or medical practice, suggested that the Homoeopathists should create specialists among themselves, and thus be better qualified for consultation with each other. I allude to Dr. John A. McVickar. Dr. McVickar was born in 1812, was graduated from the College of Physicians and Surgeons of New York in 1833, and was appointed to the chair of Clinical Midwifery in the University of the City of New York SURGERY IN THE HOMOEOPATHIC SCHOOL. 51 in 1839. The next year he embraced Homoeopathy, and was (such was the spirit of the times), shut out immediately from all the ave- nues of medical advancement, and the New York Academy of Medicine closed its doors upon him. He chose surgery as his specialty, re-matriculated at his Alma Mater, to perfect himself in anatomy and was of great assistance to his brother practitioners. He was a careful and skillful operator, and a warm personal friend of my own when I first arrived in New York. In Philadelphia where the strife was more concentrated and severe, perhaps on account of Hering’s growing popularity and suc- cess, the only Old-School surgeon who would consult with the Ho- moeopathists was Dr. Paul Beck Goddard, a brilliant and successful surgeon, who allowed to every man the rights he claimed to himself and hesitated not to consult with the then “ despised sect ” for which he received the maledictions of his Allopathic friends, who threatened to expel him from their societies and close the doors of their institutions upon him. I was but a boy then, and remember my pride when, just beginning to study medicine, the assistance that this liberal-minded man gave me in studying the surgical anatomy of Stone, through the medium of Dupuytren’s posthumous plates. Indeed, I may say it was through these investigations and the dis- sections that followed them that I determined to devote my life to surgery, a branch of science which, I grew to be painfully aware, was very much neglected by the Homeeopathists. Ten years after the arrival of Dr. Gram and on Hahnemann’s birthday — viz. : April 10th in the year 1835, the North American Academy of the Homoe- opathic Healing Art was founded at Allentown, Pa. In its first circular* in Article XXIX. among the list of studies which are considered indispensable for the complete education of the physi- cian, the word “ Chirurgini ” occurs ; and that is the only mention made of surgery in the entire pamphlet. Having learned that Dr. William Wesselhoeft was the incumbent of that chair I proceeded to make the necessary inquiries of one of his distinguished relativist and find that he was graduated by the University of Jena, in 1820, came to America in 1824, settled in Pennsylvania and began to * First circular of the North American Academy of the Homoeopathic Healing Art, Phila., 1835, p. 24. f Private letters of Dr. Conrad Wesselhoeft, Boston, Mass. 52 world’s homoeopathic congress. practice Homoeopathy in 1828. Dr. Wesselhoeft had a penchant for surgery ; and especially was he skillful in the management of frac- tures and dislocations. He was said to be pre-eminently semper paratus, and many are the traditious records of his skill that to-day float round the country where he resided. I have also learned from Dr. John Detwiller of Eastern Pennsylvania that his father, Dr. Henrich Detwiller* who was also connected with the Allentown Academy, performed many serious and capital operations in his vicinity. Dr. Detwiller came to America in 1817, and has the honor to be the first physician to prescribe a dose of Homoeopathic medicine in the State of Pennsylvania. His son, Dr. John Detwil- ler, with whom the author has a warm personal friendship, is the lithotomist of his district,, and his collection of vesical calculi is unique in its variety. It gives me pleasure to place on record, in this connection, one of the remarkable surgical procedures performed by one of our own school, and which perhaps is not widely known, and one which, as far as I know, has not yet been equalled anywhere. The operator was Dr. John Ellis, now in advanced age and retired from practice, but very well known to the older Homoeopathists for his zealous devotion to their cause when the strife raged fiercest. In these days of anaesthesia and antisepsis, with the use of animal ligatures and the better environment of the patient, many brilliant results have been secured in the ligation of arteries but, so far as I know, and so far as I can learn from considerable research, this double ligation of the common carotid below the omohyoid (the interval between the placing of the ligatures being only four and one-half days with recovery — and those last two words are important) has not been equalled in the world as yet. In the Gross tablef of thirty-six cases of “ ligation of both carotids ” I find Mott’s case “ interval of fifteen minutes, patient died.” Murdoch’s case,. “ interval of three days, patient died.” Lewis’s case of “ five days, patient died.” The first ligation was performed on October 21, 1844, at Grand Rapids, Mich. The patient, aged 21, was engaged in setting a trap in the woods, and was mistaken for a bear as he was stooping and received the contents of a rifle. The ball struck him on the left side above the * Private correspondence from Dr. John Detwiller, Easton* Pa. f Gross's System of Surgery, vol.. i., p. 7,84. SURGERY IN THE HOMOEOPATHIC SCHOOL. 53 spine of the scapula, passing out after making a flesh wound of 2J inches, and entering the neck at the centre and posterior edge of the sterno-cleido mastoid, passing up through the centre of the tongue, and out of it to the right of the medial line, knocking out several teeth and emerging through the upper lip. The wounds were properly dressed, but on the night of the seventh day, quite a severe haemorrhage occurred from the tongue, which was arrested by compression. The next night, another severe bleeding took place, and Dr. Ellis tied the left carotid below the omohyoid. On the eleventh day another severe bleeding followed which was arrested temporarily, by pressure, but the next day a second haemorrhage of such severe character followed, that it became necessary to ligate the right common carotid. The patient recovered, the ligature from the left vessel coming away on the seventeenth day, that from the right on the fourteenth day.* This is one of the cases I here offer for the consideration of all surgeons in all schools ; and would say that perhaps it was the treatment adopted afterward by the doctor, that assisted in relieving the congestion thatfollowed, and thus rendered the remarkable opera- tion a success. About four years after this surgical achievement the Homoeo- pathic Medical College of Pennsylvania was founded, viz., 1848, and its first Professor of Surgery was Francis Sims, M.D., a graduate of the University of Pennsylvania. Dr. Sims was a good lecturer, and did whatever operations came to him, which I must say were very few, — for in those days the people were not disposed to trust any one with a knife, who believed in the globulistic quackery. During my three years’ studentship in the old institution, I think there were but four operations performed before the class, and none of these could be classed among the capital ones of surgery. Dr. Sims was followed by Dr. Jacob Beakley, who afterwards held the Chair of Surgery in the New York Homoeopathic Medical College. On January 30, 1852, Dr. B. L. Hill, Professor of Obstetrics in the Homoeopathic College of Cleveland, Ohio, issued a circular to all Homoeopathic physicians, asking their assistance in the prepara- tion of a forthcoming work on surgery. Those who contributed articles on surgical subjects were Drs. Neidhard and Kitchen, of * New York Journal of Medicine and the Collateral Sciences , September, 1845, vol. v., No. XII., p. 187 ; also Velpeau’s Operative Surgery , vol. ii., p. 377. 54 world’s homoeopathic congress. Philadelphia, Dr. Shipman, of Chicago, Dr. Powell, Lexington, Ky., Drs. Teft and Beckwith, Norwalk, Conn., Dr. S. M. Cate, Augusta, Me., Drs. Babcock and Foote, Galesburg, 111., Dr. Rogers, Farm- ington, 111., Dr. Sharpe, England, Dr. Rosa, Painesville, Ohio, Dr. A. Bauer, Dr. W. Owens and Dr. Park, of Connecticut. This book did not appear, however, until 1855, about two months after the publication of my own work, and the complete title is as follows, The Homoeopathic Practice of Surgery , together with Operative Sur- gery, illustrated by two hundred and forty engravings. By B. L. Hill, M.D., Professor of Obstetrics and Diseases of Females, and late Professor of Surgery in the Western Homoeopathic College, and James G. Hunt, M.D., Professor of Surgery in the Western Homoe- opathic College, Cleveland, Ohio. J. B. Cobb & Co. 1855. The second part of this work, viz., the operative portion of it, was taken from the Lectures on American Eclectic Surgery , published several years before. This book comprises 653 pages. It never passed to a second edition. My own work bearing title of Surgery and Its Adaptation to Homoeopathic Practice , by Wm. T. Helmuth, M.D., illustrated with numerous engravings on wood. Philadel- phia: Moss & Brother. 1855. Comprises 652 pages. And I am happy to say, through the kindness of my friends, it is still in exist- ence, having gradually passed to its fifth edition. In 1851 Dr. B. L. Hill, on several occasions, successfully performed lithotomy and other operations. In those days the opposition of Allopath ists to everything Homoeopathic, handicapped those of our own school who attempted surgical performances. If an error should chance to be committed, or an operation prove a failure, or the patient succumbed, such results were given as additional grounds to prove the incompe- tency of the Homoeopath ists, and as another reason why they should be swept from the face of the earth. Suits for malpractice were in- stituted upon slight deformities after fractures, and every impedi- ment placed in the way of our school advancing in surgical practice. Dr. S. R. Beckwith, who in 1853 amputated at the hip-joint and in 1854 removed successfully a large ovarian tumor (quite an exploit in those days) had, on one occasion amputated the thigh of a patient of Dr. Wheeler, a venerable, dignified old gentleman, a brother-in- law of Gen. Wool. The second day after the operation Dr. Wheeler was visiting his patient at the Weddell House in Cleveland, when Prof. Ackley (Old School) entered the room, and ordered Dr. Wheeler SURGERY IN THE HOMCEOPATHIC SCHOOL. 55 to leave it, stating that “ It was damnable enough for little-pill doctors to be allowed to practice medicine, but they should not practice sur- gery.” Upon Dr. Wheeler refusing to obey the peremptory and unreasonable demand, Prof. Ackley seized him by the hair and dragged him into the hall. The affair ended by Dr. Ackley being placed under four thousand dollars bond to keep the peace, and by Dr. Wheeler ever thereafter combing his hair over a bald spot on the side of his head. * Dr. Beckwith was for a long time Professor of Surgery in the Western Homoeopathic College, and did much in that day to extend Homoeopathic surgery in the West. In 1855 Dr. I. T. Talbot performed, if not the first, among the first, successful tracheotomy in this country. By the term successful is here understood, not that the opening of the trachea and insertion of the tube were accomplished, but that the patient recovered f I draw attention to this success, as another to show how surgery flourished “ under the rose,” and to record the facts that here and there, important operations were done and remained unheralded, but like the truth when crushed to earth has risen again to testify to the abilities of men who loved Hahnemann and Homoeopathy. I need say no more of Dr. Talbot’s position and teaching since those early times. It is a matter of record. The man stands before you to-day covered with honor. I have already recorded two surgical triumphs : Let me proceed to a third. The surgical world, within the last ten years, has been deeply interested in the advancements made in abdominal surgery ; or, I should more properly say, intestinal surgery. The wonders that have been accomplished by intestinal anastomosis; the ingenuity exhibited in the invention of sutures, plates of animal and vegetable substances, the methods of sewing, etc., are esteemed among the “ most advanced of the advancements ” that belong to modern sur- gery. The records of these cases in the medical periodicals are so remarkable that the doctors are surprised and the laity astounded by them. Let me now recount to you the record of a case, in which four feet and ten inches of the intestines were resected, — an intestinal anastomosis skillfully made, with complete recovery, with the extra- ordinary addition that the patient underwent all the dangerous * MS. furnished the author by Dr. S. R. Beckwith, f Personal letter of Dr. I. T. Talbot to author. 56 world’s homoeopathic congress. symptoms of strangulation of the intestine, by two serious operations, being four months pregnant, went on to full term and was delivered of a healthy child. The operator was no other than Dr. George D. Beebe, to whom also I lectured on anatomy in the Homoeopathic Medical College of Pennsylvania, and who was a college chum of the late lamented Dr. George A. Hall. At the time this remarkable operation was done, nearly a quarter of a century ago, I was editing the Western Homceopcithie Observer in St. Louis, and as many comments were made upon it in both the secular and medical press, I wrote personally to Dr. Beebe for a brief description of the case. Here it is. He says : “ I hasten to accept your friendly invitation to communicate the notes of an operation for hernia recently referred to in the public press, and as the pages of your valuable journal are always full of useful material I will be brief. “On July 10th I was called to see Mrs. J. B. Childs, of Lee Centre, 111., who was temporarily in our city for a visit, and while at the house of a friend was taken with most violent pain in an umbilical hernia, from which she had suffered since the birth of a child, seven years previously. On reaching the patient’s bedside, I found a large tumor at the umbilicus, the thin integumental coverings of which were greatly discolored, and were on the point of yielding to the pressure of a considerable quantity of fluid therein contained. The patient had vomited for two or three days, and during the twelve hours preceding my visit the vomiting had been stercoraceous, with frequent hiccough. The skin and pulse did not show any marked peritoneal inflammation, but there seemed no apology for further delay in ascertaining the condition of the hernial mass. A careful incision of the integuments liberated a quantity of dark, bloody serum, and this escaping revealed a mass of gangrenous intestine. With a grooved director the hernial sac was freely laid open, when I was startled to find so much of the intestine involved and the entire mass not only black with discoloration, but at pointsyielding and emitting faecal matter. The situation was novel and without pre- cedent, but a moment’s reflection satisfied me that the patient’s chances for life lay in removing the devitalized tissue, and pursuing such further steps as would subject her to the least hazard possible under the circumstances. With the assistance of two or three of my medical colleagues, whom I could hastily summon to my aid, I SURGERY IN THE HOMCEOPATHfC SCHOOL. 57 traced the gut to the hernial ring and, finding sound tissues there, divided it, and passing a strong suture, secured the sound extremity to the margin of the incision. Then, with a pair of scissors, I cut the intestine away from the mesentery throughout its extent until sound intestine was found at the opposite side. Here it was again divided, and the sound extremity secured like the former. The mesenteric vessels, which were very numerous, as may be inferred, were closed by torsion and by ice until all haemorrhage had ceased. This was the most protracted part of the operation, but when ac- complished the hernia knife was brought to bear on the ring, and this was freely enlarged. Making sure that the bleeding did not recur on the removal of the pressure maintained by the ring, the parts were now returned within the abdomen, leaving the two divided ends of the intestine protruding from the abdomen and lying side by side, where they were secured to the integumental margin in such a manner as to form an artificial anus. The day following the opera- tion the pulse rose to a hundred and twenty, and there was some dis- position to singultus, but the cathartics, which had been freely ad- ministered by my predecessor in the case, were being poured out freely at the artificial anus, and in two days the irritation had begun to subside, and from that time the digestive functions became toler- ably well established. An examination of the intestine removed proved it to be of the jejunum, and to measure four feet ten inches. As soon as I could feel some assurance of the patient surviving the first operation, I began to prepare for the second, viz., the cure of the artificial anus. There was not wanting those in the profession who wisely shook their heads and thought this operation should have been deferred for several months to enable the patient to gain strength, etc., and influences were brought to bear upon the patient to that end ; but the patient seemed willing to rest her case in my hands, and so soon as my instrument maker could prepare the in- strument from drawings I furnished him, I was ready to proceed. A few days’ delay was asked by the patient’s husband on account of business, and then, on July 31st, a clamp was introduced, the blades of which were oval, three-fourths of an inch wide, and one and one- fourth inches long, and fenestrated, leaving serrated jaws one-eighth of an inch wide. One blade was passed into each end of the intes- tine until fully within the abdomen. Great care was exercised that only the intervening walls of these intestines should be embraced by 58 world’s homceopathic congress. the clamp, and the blades were then approximated by a set screw in the handles until slight pain was occasioned. Instructions were given that if nausea and vomiting occurred the clamp should be loosened, otherwise it should be very gradually tightened during the next two days. On the third day, the presumption being that adhe- sive inflammation had united the two intestines, firm pressure was applied by the clamp that the parts embraced might be caused to slough, and a free incision was made from one intestine to the other through the fenestral opening in the clamp. On the fourth day the clamp was gradually loosened and removed, and from that time the foecal matter passed freely into the lower bowels and regular evacu- ations occurred by the rectum. A digital exploration revealed the smooth, rounded edges of the opening made by the clamp, and it now only remained to close the integumental opening, which was done by deeply set quill sutures on the 8th day of August, and the patient departed for her home in the central part of the State, leav- ing my cabinet enriched by a pathological specimen which is as highly valued as it is rare. It is no less amazing than gratifying to witness the happy effects of Homoeopathic remedies in controlling the constitutional disturbances consequent upon grave surgical oper- ations, and seldom have these been more happy in my hands than in the present case, where Aconite and Arsenicum played so important a part in controlling peritonitis and enteritis. — Yours, truly (signed), G. D. Beebe.” This remarkable operation, the ingenuity of making the anasto- mosis and its results, which were published in the New England Medi- cal Gazette and the United States Medical and Surgical Journal, aroused the sententious spirit of many Old-School periodicals, and the Boston Medical and Surgical Journal* in a sneering editorial, stated : “ We are informed the patient died four days after the oper- ation. Whether the heart was or was not flabby or fatty, we have not heard.” I merely insert this opinion of the Boston Medical and Surgical Journal , not because it is of the slightest importance, but that we of to-day may understand the bigotry of the Old School twenty-five or thirty years ago.f I may mention here that Dr. Beebe was appointed brigade sur- geon by President Lincoln, and was on duty under Gen. Halleck * March 17, 1870. f Western Homoeopathic Observer, vol. vii., p. 162. SURGERY IN THE HOMCEOPATHIC SCHOOL. 59 and Gen. Grant, and was enthusiastic in his idea of the outdoor treatment of the wounded. Speaking of the War of the Rebellion brings to my mind the name of another of our surgeons who was very prominent during those times of bloodshed and disruption, no doubt the most distinguished of our military surgeons. I mean Dr. E. C. Franklin, who was born in 1822, became a private pupil of Dr. Valentine Mott, and was graduated from the medical depart- ment of the University of New York in 1846. During his Allo- pathic career he was made deputy health officer of California, and was given charge of the Marine Hospital at San Francisco. In 1857 he began the practice of Homoeopathy, and in 1860 came to St. Louis, where I was his fellow- laborer for many years. It was through my own instrumentality that he was made Demonstrator of anatomy in the Homoeopathic Medical College of Missouri. Dr. Franklin’s career in the army was remarkable. At the breaking out of the war he was appointed surgeon to the Fifth Regiment of Missouri Volunteers, and shortly after was made surgeon-in-chief to the first regularly organized military hospital west of the Mississippi River. He soon was created brigade surgeon, and organized the United States General Hospital at Mound City, 111. After the reorganiza- tion of the Homoeopathic Medical College of Missouri, in 1872, he received the appointment to the Chair of Surgery in that institu- tion. Finally he was called to the Professorship of Surgery in the Homoeopathic Department of the University of Michigan, but he returned to St. Louis before his death. Dr. Franklin was an author of the Science and Art of Surgery , which embraced two editions, the first published in 1867, the second in 1873. Dr. Franklin and myself were rivals in the surgical field at St. Louis, Mo., and many a dispute we have had ; but looking back, at this late date, to the contentions and discussions of those days, they seem so small, so little and so insignificant that they sink out of sight, and serve only as lessons to teach us how, in our selfish egotism, we are apt to mag- nify trifles connected with our own dear selves, which time soon effaces, leaving only the absolute wonder that such minutiae could in any manner weigh against the truer and better and more enduring efforts of our life’s work. During this period our much-lamented Liebold was also surgeon, and performed many linear resections and amputations, which are duly recorded in the Medical and Surgical History of the War of the Rebellion. During this period there was 60 world’s homoeopathic congress. in the navy of the United States a man who did good service. This was Dr. L. H. Willard, now one of the surgical staff of the won- derful Homoeopathic Medical and Surgical Hospital of Pittsburgh. He entered the navy, and did good service in 1865, was active in his duties on board both the Ottawa and the Mohawk, and was captured by the rebels. He edited the surgical department of my periodical up to 1870, when it was discontinued. Dr. H. F. Biggar, of Cleveland, in 1866, devised the Penostead flap in amputations and reamputations, and of this he says: “This operation, while original with myself, may have been adopted by others previous to 1866.”* Before I pass to the second division of my subject I desire to place upon record a case of brain surgery. I do this because, since cerebral localization has become such an interesting topic, the sur- gery of the brain has made such rapid strides that few are aware that, without this knowledge, one of our own men in the West was successful in removing a neoplasm from behind the orbit before 1870. This case was operated upon by Dr. N. Schneider at the hospital and before the class of the Homoeopathic Medical College at Cleveland, Ohio, and has never been recorded. Dr. Schneider thus writes :f “ I entered within the cranial cavity, removing what was probably angioma. It pressed upon the brain in such a manner and direction as to produce functional disturbances of sight and hearing on the right side, together with severe neuralgic pains and spasms of the muscles, terminating in epilepsy. I will not detail the symptoms leading to the diagnosis, but they were sufficient to induce the belief that there was a growth behind the right eye. I entered the cranium through the orbit, and found a tumor the size of a hickory-nut and attached to the dura. After a bloody and exhaustive operation I took it away. The patient recovered from the operation rapidly. By the tenth day he was sitting up; in two weeks he was walking about, and in six weeks was about the streets, free from pain and gaining strength steadily. About the 1st of April, upon getting up at night, he stumbled and fell, striking the occiput against the lock of the door, which produced, first, concussion, then meningitis, which was followed by death. Although the end was fatal, I never attributed it to the operation, * Personal letter from Dr. Biggar. f Personal letter from Dr. Schneider. SURGERY IN THE HOMCEOPATHIC SCHOOL. 61 and have always looked upon the case as a success.” Such, then, is another record of skill, which it gives me pleasure to record in its proper place to-day. In mentioning these items in regard to the early surgery of our school, necessarily many omissions have been made. I have endeav- ored to give an outline of facts up to about 1870, twenty-three years ago. Since then, as I have already mentioned, our surgeons 7 names and our surgeons 7 work are matters of history. Were I to begin from that date, the distinguished President of the Institute, Dr. J. II. McClelland, whose labors as a surgeon and a health officer are known both in this country and Europe, would head the list, and be followed by a list of names of which this Institute is proud. I desire now to inquire how came about the proverb, “ There is no surgery in the Homoeopathic School. 77 In those earlier times, even within my own recollection, the professors of the Homoeopathic faith abjured surgery and thus unwittingly laid the foundation for that opprobrium, the shadow of which continues in many sections of the country to-day. “ No surgery ; no surgeons among the Homoeo- pathists.” This was a logical sequence and should not be found fault with. The majority, — in fact, I may say all the men who first espoused the cause of Hahnemann were Old-School physicians (not surgeons, mark you). They were graduates of Allopathic colleges and had espoused the practice of medicine as their department. They had no especial taste (perhaps even a distaste) for surgery in the Old School. Why should they be expected to adopt it in the new? When the beneficent light of a specific law of cure began to illumi- nate the dark places of older and more uncertain methods, is it a wonder that these thoughtful men became more and more impressed with its reliability in the treatment of disease? Is it a wonder that they met together by day and by night, whenever opportunity offered, to exchange experiences, to verify symptoms, to declare clinical results, to prove new medicines, to discuss potencies, and all other subjects relative to Homoeopathy ? Is it a wonder when they were ostracised by the Old School, forsaken by their former friends, denied the rights of medical societies, refused consultations with those graduated in the same university and were branded as knaves, and quacks and fools, that they more closely bound themselves together and worked with redoubled energy to prove the truth of that law, for the adoption of which they were content to bear such miserable 62 world's homoeopathic congress. persecution? What did such men, with minds so involved, care for the setting of a broken bone or the extirpation of a growing tumor ? What was the mechanical treatment of any accident, or the perform- ance of any surgical operation compared with the verification of a law destined to revolutionize therapeutics. 4t Procul est profani” was their cry. Surgery at this timp, as they understood it, was a secon- dary consideration. The outside, or collateral branches of medical science, the disciples of Hahnemann regarded with a cynicism which would be ludicrous in these days. It was the Materia Medica Pura they studied ; it was Homoeopathic therapeutics pure and simple that they honored ; it was the recognition and propagation of the law of cure for which they fought. Well is it for us to-day that these zealous and courageous men did so devote their lives to the establish- ment of truth. They placed the star of Homoeopathy on high and it lights this century to-day. The enlightened professional men and women of all schools acknowledge “ Similia Similibus Curantur ” as a law of cure; and the crude medication of fifty years ago has given place to a new posology. But'** mark you now what follows.” As the years passed swiftly by and Homoeopathy became more widely disseminated, and the pioneers were “ passing to the other side” a serious question arose : What was to be done for those who desired to study medicine and who believed in the Homoeopathic law? No Allopathic college would receive such men, no Homoeopathic pre- ceptorship would be recognized ; no .compromise would be allowed. But one course remained, viz., the establishment of Homoeopathic colleges. The believers in the system in those days were all educa- ted men, graduated in acceptable universities at home and abroad. They loved knowledge as well as they loved truth. They believed in thorough medical training and so it came to pass that when the first colleges were established, surgery was an important branch of medical science ; necessarily it was embraced in the curriculum of study. I have watched its growth, watched it with a jealous eye for over forty years, and while I see around me in all the great cities, men brilliant and enthusiastic who are working with all their energy toward the establishment of surgical science, it seems to me that sometimes the shadow of the old opprobium hovers over us still. I feel that the great professors of Homoeopathy in their excess of zeal for Hahnemann’s law exhibit a careless disregard of surgery as a pow- erful auxiliary in securing honor, position and place for Homoeo- SURGERY IN THE HOMOEOPATH IC SCHOOL. 63 pathy, which is to me surprising. The surgery of to-day stands pre- eminently foremost among the sciences and arts, which with all their magnificence adorn the latter end of this nineteenth century. It absorbs the science of asepsis, which holds in its hands the theory of germs. It embraces in its intelligent practice the microscopic appearances of every tissue, normal, abnormal or extraneous, in the human body. It brings within its sphere of usefulness, many of the instruments of precision ; the newer chemistry is its hand-maiden, and bacteriology its invaluable assistant; and (speaking now from a purely artistic standpoint) it is my opinion that the world cannot show in any department of art, any more unrivaled workmanship than that exhibited by the surgeons, and especially the American surgeons of to-day. The question regarding artistic and ideal surgery is not “ What can it do ? ” but “ What can it not do? ” The world re- spects it, legislative bodies appreciate its worth to the communities they govern, and the people applaud it as the most progressive of all the collateral branches of medical science ; and I make the assertion here, that after a tolerably wide experience, until the value of sur gery as a means of the propagation of the interests of our own school is fully acknowledged by our own men , we can never obtain equal governmental and civil appointments with the Old School. Private practice may increase, but public recognition will remain in abeyance. I state further that it is only since our own surgery has been in a measure acknowledged, that a few public hospitals have been open to us. Great institutions will never be entrusted to our care., until those controlling them are satisfied that injuries can be cared for and all operations properly performed. The Homoeopath ists will never re- ceive appointments in the army and navy until sufficient proficiency in surgery is acknowledged. It is to these facts that I desire to call the attention of this Congress. There is something more to be studied in the Homoeopathic School than Materia Medica and Thera- peutics. There are other branches of medical science to be consid- ered by our great national and state organizations, for Homoeopathy can be carried into everything; into Surgery, into Obstetrics, into Paedology ; and the surgeon who amputates a limb, and prescribes homoeopathieally for the pain, or sets a fracture and prescribes Calc, phosphor, to assist in the formation of callus, or administers Silicea for a felon, or Hamamelis for haemorrhage, or Conium for cancer, must hold at least as high a rank among upholders of the system of 64 world’s homoeopathic congress. Hahnemann as the symptomatologist, the Materia Medica man or the therapeutist. This appeal I now make to those of my school whose feelings and inclinations prompt them to investigate only those branches of medi- cal science with which Homoeopathy is most closely allied, viz., Materia Medica and Therapeutics. I beg them to consider the im- portance of surgery, properly taught and properly practiced, as a factor in the wider dissemination of Homoeopathy. You must par- don this apparent importunity on my part, gentlemen. It is not that I desire to be litigious that I mention these matters here, but the generation to which I belong has topped the hill and it is facing the decline. As time speeds onward, never stopping, never waiting, I see my oldest friends in the service of surgery have well-nigh gone the way of all mortality. Even since the appointment of this lec- tureship, one of the foremost of our surgeons,* and one whom I have known and loved since I was a boy, to whom I lectured (although almost his own age), one who stood foremost in the ranks, a man of sound judgment, a fearless operator, and a generous friend, and on whose diploma my signature is written, has passed into the light of God’s day; and, as I recognize these things, the gladness of victory, the impatience of achievement, the fierceness of strife, are not what they once were ; and I say this to you, with the increasing light of experience and observation, that a full knowledge of the collateral sciences, among which surgery stands pre-eminently foremost at this day, is the only stepping-stone to the successful recognition of the Homoeopathic school, the bulwark wherewith to protect it “ from all assaults of the enemy,” the tutelary gods to shield it from disgrace, the potent power wherewith to place it on equal footing with the older and traditional school. In other words, we want more eru- dition in the collateral sciences (in which surgery stands pre-emi- nent), and less thrasonical talk concerning Homoeopathic cures, which, indeed, if we will let them alone, will talk for themselves. We want more general and specific knowledge, and we want, how we want ! the wisdom to know how to use it. “ Knowledge and wisdom, far from being one, Have ofttimes no connection. Knowledge dwells In heads replete with thoughts of other men, Wisdom in minds attentive to their own. Knowledge is but a rude and shapeless mass, * Dr. George A. Hall. SURGERY IN' THE HOMOEOPATHIC SCHOOL. 65 The mere material with which wisdom builds, Till formed and squared and fitted in its place, Doth but encumber him it seems t’enrieh. Knowledge is proud that it has learned so much, Wisdom is humble that it knows no more.” Discussion. The Chairman : I will call upon Dr. I. T. Talbot, of Boston, to discuss this paper of Dr. Helmuth’s. Dr. Talbot : Mr. President , Ladies and Gentlemen : I feel my- self utterly inadequate to say anything which can add to the value of this address. It is a resume of the progress of our School in this one subject. I may, perhaps, give one or two points which have not been included in this paper ; and first, let me speak of the first chair- man — for such he was called at the time — of the American Institute of Homceopathy. I refer to Dr. Flagg, of Boston — a Homoeopath who was so well acquainted with the subject, and who loved it to the last day of his life, and had such implicit confidence in it. He stood at that time the very first one to raise to a science and an art the- whole subject of dentistry. He was, at the time, a progressive, lead- ing man, and did much for it, and yet he was the first chairman of the American Institute of Homoeopathy. The consideration of the position of surgery during the early years of the American Institute, which was organized less than twenty years after the entrance of Gramm into this country, found a large number of Homoeopathic physicians who, in their earnestness for what Homoeopathy was to do — in their great belief in the efficacy of the globule — felt that surgery was a thing of the past; that it would be no longer needed; and it threw* a chill upon those who felt that surgery was yet to be cultivated among Homoeopathic physicians. There was still another point. When Homoeopathy began to achieve its first popularity, there unfortunately came a class of men who took the box and book, and felt that knowledge and science were entirely unnecessary in Homoeopathic prescribing, and they did’nt dare to use the knife; they had no knowledge of surgery, and therefore decried all surgical procedures. Now, it was at this time that the first Ho- moeopathic college was established, in Phi lade! phia, as Dr. Helmuth has told us; and there were no men, in the twenty- three years that had followed the introduction of Homoeopathy, competent, as Dr. Helmuth afterwards became, to be its instructor; and he has well said, that in the three years that he was there, but three or four operations were performed. I was a class-mate of Dr. Helmuth, and we at that time deprecated the condition of affairs in the school as related to surgery. We felt the necessity of it; we urged upon the Faculty at Philadelphia to erect a hospital, that surgery might 5 66 world’s homoeopathic congress. be properly taught and practiced ; but it took a good many years for that to be done. And thanks to the efforts that have since fol- lowed in Philadelphia, in that college where we and they saw in a year but a single surgical operation, and that a slight one, we have now a hospital which is a credit to our school and an honor to that institution. We have one of the best hospitals in the United States, where the operations are not by ones and twos, by dozens and scores even, but by hundreds — the most severe and difficult operations, with the most brilliant success. The same is true in all the Homoeopathic colleges of the United States. It is for us, ladies and gentlemen, as a body of physicians with a belief in Homoeopathy, that it shall advance in medical sci- ence — it is for us to set our standard to the very highest point at- tainable. It is, that surgery shall be taught and practiced in the very best manner. It is, that all the sciences which go to make up the great advancing science of medicine, and all the knowledge which goes to make the physician, shall be taught in all our col- leges in the best and most thorough manner. It is for you, ladies and gentlemen, it is for you, physicians of this country, holding to this belief, to put your hands to the work and your shoulders. to the wheel, to help these colleges in their efforts for the advancement of surgery, and of all the sciences that underlie the successful prac- tice of the noble art of Medicine. The Chairman : I will now call upon J. H. McClelland, M.D., of Pittsburgh, Pa., for further discussion. Dr. McClelland, President of the American Institute of Homoe- opathy : Mr. Chairman and Members of the Congress: As remarked by my distinguished friend, Dr. Talbot, I don’t see what I can add to what has been said by Dr. Helmuth. He, you know, is om parti- ceps princeps. He is first, and deserves to be. I really had not thought of speaking about this address of Dr. Helmuth’s because I had but heard it ; had no copy of it and, of course, knew nothing at all of its contents until I heard it read this morning. I was, I believe, to discuss a paper that was to be presented by Dr. Helmuth in the Surgical Section. I will add a word, however, in the same line as that taken by Dr. Talbot, and that is, that though the sur- gery of early Homoeopathy was very small indeed, I think we may justly say that the surgery of to day in the Homoeopathic School compares with that of any school or of any class. We have with us here men who have added lustre to surgical science, who have done credit to the Homoeopathic School ; and they are not here and there merely, as single workers in this important field, but you find them in every city and almost every hamlet of this great country, and the number is increasing. You find a surgeon here and a sur- geon thereon every hand, and they are doing excellent work. Now to say that the results are very much assisted and bettered by the SURGERY IN THE HOMOEOPATHIC SCHOOL. 67 therapeutic element of the case, I think, goes without saying. There is no doubt that the Homoeopathic surgeon receives very great assistance from Homoeopathic therapeutics. I believe that is the experience of every one. As a bit of personal knowledge I would say that I very well remember the beginning of small things in our own city. It is, I think, some twenty-five years ago that the first capital operation was performed in the Homoeopathic hospital of Pittsburgh, then in its first year. I had the honor of doing that capital operation, and it was counted in those days among us as a great one. It was the amputation of a leg. Well, of course the amputation of a leg ought to be done right, at any time, but that, you know, is a very simple affair now, and goes among the minor operations. As com- pared with that, our hospital now of 200 beds, which this last year has received $60,000 from the legislature for maintenance, is doing very much larger work. I think we have in the neighborhood of some two or three hundred capital operations in a year. Only this last year, for instance, we included, among others, three double am- putations and subjects that were very badly shocked and injured as well, and they all recovered. We had in one week three vaginal hysterectomies, which all recovered, and a fourth was added which recovered. We added one to the operation of Ctesarian section wherein the mother and child both lived ; and so I might go on to compare the day of small things with our standing to-day, and the experience I give in our own institution is repeated here and there all over this great country. I will be very glad indeed if we can hear from such veteran surgeons as Hr. Ludlam, who has added great lustre to our school in the line of surgery ; and there are others who, I think, could address you to much bettter advantage than I. The Chairman : The subject is now open for general discussion. Those who speak are limited to five minutes. R. Ludlam, M.D., of Chicago : Mr. Chairman, Ladies and Gen- tlemen: I don’t know what I can say in five minutes that would entertain you, but I may venture to give my approval of what has been said in the address and in the discussion thus far. This is one of the times I long have sought and mourned because I found it not. I have felt for many years that the surgical branch of our work did not receive a due share of attention at the hands of physicians of the Homoeopathic School, and that this specialty needs more con- sideration in the organization of our colleges and in our work. This subject has received great emphasis to-day. I believe it will do us great good. We need to be armed at all points in the practice of our profession, and to have gone the whole round of the medical compass. I cannot perceive how perfect knowledge of one branch of the healing art shall make us weak and worthless and willowy 68 world’s homoeopathic congress. in another. I never could conceive why a man who was a good surgeon in our school should be any the less a good Homoeopathic physician. A man — it has been proved of late years — may be a sound physician — a Homoeopath — and yet not be a fool at the same time. He may be, I think, a good surgeon and a good Homooopa- thist, a good obstetrician and a good gynaecologist. The long and short of it is, my prophecy I believe is coming true, and if I shall live, as Moses did, to see the promised land, I shall be delighted. I spoke of Moses yesterday ; Moses is an old friend of mine. He made some mistakes, I am told, but he was a good fellow. This is my point: We are cultivating specialties now and it always seems as if they were fads. They are not fads necessarily. If we keep on with the development of specialties that are germane to medi- cine, bye and bye the fashion will change; bye and bye the Old School will come to our camp to learn therapeutics as a specialty. They have almost abandoned the study of therapeutics. They give anything now-days in the most off-hand way. They are doing ab- solutely nothing with therapeutics. Wait a bit until these special- ties have been developed to their utmost and somebody has got to take hold of therapeutics and develop that as a specialty, and then they will come to somebody who knows something about it to start with. The Chairman : The next business in order will be the paper by Richard Hughes, M.D., of Brighton, England, and in his ab- sence it will be read by O. S. Runnels, M.D., of Indianapolis. We have with us E. Vernon, M.D., of Toronto, President of the Ca- nadian Institute, at Hamilton, who I will ask to take the chair during the reading of Dr. Hughes’s paper. THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. 69 ADDRESS. THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. By Richard Hughes, M . D. , Brighton., England. I have been asked to speak to you on this occasion regarding the “ Further Improvement of our Materia Medica.” The term “ fur- ther” implies that some improvement has already taken place, from which, as a resting-point we may note progress and survey the ground yet beyond us. The reference is obviously to the Cyclo- paedia of Drug Pathogenesy , and upon this I would say a few words at the outset. The work in question consists — as you know — of a collection of the provings of drugs not contained in Hahnemann’s own volumes, with a selection from cases of poisoning by them and of experi- ments made with them upon the lower animals. These provings, poisonings and experiments have been carefully translated or tran- scribed from their originals, and are presented in the primary nar- ratives w 7 herever these are given. The provings themselves are a selection, made upon rules approved by the two National Societies of America and England, and so framed as to exclude — as far as it is possible — all dubious matter. We thus have, in the four volumes of the Cyclopaedia , pathogeneses of as many hundred medicines,* as trustworthy as careful choice can insure, and as correct as knowl- edge and painstaking care can make them, with the additional ad- vantage that, wherever practicable, they are presented in an intelli- gible and interesting form. The result gained by the completion of this work is that the la- mentations over the unsatisfactory state of our Materia Medica, which for the last forty or more years have been heard from all parts of the Homoeopathic world, may now sink to silence, or rather be * The exact number is 413. 70 world’s homceopathic congress. exchanged for gratulation. They were well warranted when Jalir’s Manual , in its various forms, was our sole collection of pathogenesy. Symptomatology was there presented in a form most incredible, un- intelligible and repulsive, without ground for its statements or clue to its mazes: it was, as it has been called, “nonsense made difficult.” Nor were the groans evoked by it altogether assuaged by the appearance of the Encyclopedia of Dr. Allen, great advance though this was. Our scattered provings were there, indeed, brought to- gether and referred to their authors, besides being much enriched from general medical literature ; but they remained unsifted, and were all broken up into the categories of the Hahnemannian schema. Our Materia Medica, even in “ Allen,” continued to be dubious and unattractive. Now it is neither. The student can read the narra- tives of proving, poisoning and experiment contained in the Cyclo- pedia of Drug Pathogenesy with as much confidence and as lively interest as if they were cases of idiopathic disease; and the practi- tioner can, with firm reliance, utilize them in his practice. If doubt- ful matter still remains, as where, with little or no information as to their origin, we merely have a list of symptoms, the statements made as to their character, and (generally) the inferior type in which they are presented, will suffice to warn off from possible quicksands or quagmires. But I must not leave the Cyclopedia without a word as to the pathogeneses given us by Hahnemann himself, to which it contents itself with referring, evidently implying that they also should be possessed by the reader. Those of the Chronic Diseases , indeed, are still a sealed book to most from the lack of an adequate and accessi- ble version. The Materia Medica Pura, however, has been now re- translated for us by the competent hand of Dr. Dudgeon, and can be obtained by any one. There may be read the results of the master’s primal essays at drug-proving, with his own illuminative introduc- tions and notes. The symptoms are arranged in schema-form, in- deed, and there is little information as to how they were elicited ; but the latter deficiency is supplied from other sources, and many of the individual symptoms are themselves groups which have associa- tion and sequence. When I speak of our Materia Medica as we English-speaking nations have it, it must be understood that I in- clude these two volumes of Hahnemann’s as well as the four of the Cyclopedia which supplement them. THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. 71 And now, from the standpoint of what has been gained, let us in- quire what remains to be done towards the improvement of this Materia Medica of ours. Let us clear the way by seeing what should not be done. The first thing to be deprecated is the view that the narratives of the Cyclopaedia constitute so much “raw material” only, and must be worked up into a schematic symptom list before they can be made available for practice. Why should this be? For readiness of ref- erence, it is replied : when we want to know what spinal symptoms Cicuta induces, we can turn to them at once in Allen, but in the Cyclopaedia we have to hunt them through a number of records. My answer is, that this need should be provided for by an index, as it is in other books. We do not, in these, cut up the text into categories that individual items may be the better discovered ; nor should we do so here. Hahnemann unfortunately took this course with his own provings; and nothing, I think, has done more to rob him of his honor in the profession at large, to hinder conversion to Homoe- opathy, and to drive practitioners of the system into empiricism, than the distortion which has resulted. I maintain further that symptoms placed singly, divorced from their sequence and concomi- tants, often convey a false idea as to the pathogenetic action of drugs : so that the schema is not only unnecessary but misleading.* The abandonment of this mode of presenting our Materia Medica is one of the most important features of the Cyclopaedia ; and it would be no “ further improvement ” if we were to build again that which we had destroyed. It is under the influence of these considerations that I do not feel as sympathetic as otherwise I should be towards another plan for reconstructing our Materia Medica — that advocated from Boston by Drs. Wesselhoeft and Sutherland, and taken up (with some modifi- cations) by the Baltimore Investigation Club. It is mainly a trying of the symptoms of our pathogeneses by the test of their recurrence in more than one subject of the drug’s influence — only those which stand the ordeal being retained. I am not quite sure about the soundness of the method ; there must be some flaw in a mode of pro- ceeding which leads to the rejection of Cactus as inert, and to the * These theses are defended in detail in a paper on “ The Presentation of the Materia Medica,” read by me at the International Homoeopathic Congress of 1886, and published in its Transactions, p. 121. 72 world’s homceopathic congress. reduction of the symptom-list of Gelsemium (upon one proposed method) to four items only.* The principle, however, is excellent ; it is that upon which I am to a large extent acting in making the index to the Cyclopaedia. I am referring only to such apparent effects of drugs as “ by the force of their occurrence or the con- stancy of their recurrence witness to organic connection with their assumed causes.”f But suppose I were to write down these symp- toms as I indexed them, and, casting them into the categories of a schema, were to publish them as the tried residuum of our sympto- matology. Genuine they might be; but a Materia Medica so con- stituted would retain all the remaining faults of those of old; it would be as unintelligible, as repellent, as misleading as these were. One of our journals, in noticing the Cyclopaedia, says that “ it to- tally ignores a host of old Homoeopathic landmarks.” By this is probably meant the “ clinical symptoms” which swell the bulk of so many of our Materia Medicas — meaning by this term morbid states which have (not appeared, but) d/sappeared while their sub- jects were taking certain medicines. Hahnemann made some, though sparing, use of such symptoms only, however, when they occurred in provers of drugs, J and always noting that they were Heilwirkungen. Jahr introduced them more freely, 0 indicated their character by affixing a small circle (o) to each. So far little harm, if little good, was done. More recently, however, the practice has grown up of mixing pathogenetic and clinical symptoms, together with guesses, therapeutic suggestions, and hypothetical inferences, in one indiscriminate mass, and calling this conglomerate the Homoeo- pathic Materia Medica. Men imagine that they are applying the law of similars when they work with such books, whereas they are very often practicing the merest empiricism. I do not wish, on the present occasion, to go further into detail on this subject. I have often expressed myself upon it and always feelingly ; for I deplore the procedure in question as one of the * See New England Medical Gazette for December, 1888, and North Amer. Journ. of Horn, for June, 1889. f See “The Index to the Cyclopaedia ” in the Monthly Horn. Review for Novem- ber, 1890. t The symptom-list of Iodium in the Chronic Diseases is the sole exception to this statement. THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. 73 greatest calamities that has ever befallen us. My sole reason, how- ever, for mentioning it now is to support the opposition I would make to any vitiation of our symptomatology with matter of a clini- cal kind. It is not that I undervalue the usus in morbis or despise therapeutic suggestions; but I would have these kept separate from the pure pathogenesy. They may appear in prefaces and notes, as in Hahnemann’s publications; or they may occupy a separate vol- ume, as must be in our case. There they find scope for abundant usefulness; but mixed up with the results of provings and poison- ings they are confusing, illusory, and destructive of all scientific thought and practice. Not therefore by schematizing, by reducing in number, or by blending with clinical materials, the drug-effects on the healthy we have brought together, do I conceive that the Materia Medica of Homoeopathy will receive further improvement. In fact, I am of the same mind now as I was in 1879, when reviewing attempts at reconstruction by Drs. Jousset and Espanet.* I deprecated any at- tempt to substitute such studies of drugs for our existing symptoma- tology. “ Let this,” I wrote, “ stand as it is,f and let our work upon it be something like that of theologians upon their sacred books. As with them, let our best endeavors be made to enrich, to purify, and to illuminate the text. Then let those competent for the task give us commentaries upon it, elucidating its language. Let the teachers of Materia Medica in our schools publish from time to time their systematic lectures, embodying (as these must do) all the side- lights which from toxicology, from the physiological laboratory, and from therapeutic experience they can bring to bear upon its study. These will answer to treatises on doctrinal and practical theology; and then, for the sermons which expound and apply particular texts, let us have clinical records showing the bearing of patho- genetic symptoms upon the phenomena of disease. In this way, while we ’shall lose no grain of fact which can be made available in the comparison of drug-action with morbid conditions, there will be supplied to every student of the Materia Medica a general knowl- edge of its constituents, of their sphere and kind of action, of their * See British Journal of Homoeopathy , xxxvii., 257. f Of course, neither there nor here am I minimizing the need of fresh provings. But on this score I spoke so fully at the International Homoeopathic Congress of 1891, that it is needless to repeat myself on the present occasion. 74 world’s homoeopathic congress. characteristic features and ascertained effectiveness, which shall send him forth fully equipped for using them in the treatment of disease. There is thus abundance of work for all who desire to labor in the field of Materia Medica, and the more there is done of the kind the better for the future practitioners of our method.” Now that, in the Cyclopedia, the text of our Materia Medica has been enriched, purified and illuminated, I the more earnestly urge its being left alone, and no attempt being made to substitute for it the result of any extractive or other process. The rest of the work suggested remains open ; as it is adequately performed, the further improvement desiderated will accrue. I would especially call for commentaries, elucidative and exegetical ; and would suggest that those most competent for such a task are the specialists of our school — the neurologists, the oculists, the aurists, the gynaecologists. To the study by such men of the symptomatology of disease, aided by post-mortem examination and experiments on animals, we owe the great advances in pathology which have marked the last sixty years. May not similar investigation, when directed to pharmacology, achieve like results? The phenomena of drug-disease have also their meaning, and lend themselves to patient interpretation. They are not themselves to be forgotten, and the phrase which explains them substituted, any more than the clinical features of idiopathic disease are to be merged in its nosological name. But the explana- tion illumines them, makes them coherent, intelligible, memorable; they become part of our mental furniture, and are not mere strings of symptoms to be learned by heart. A series of studies, by experts in each department, of the neurotic phenomena of the oxalic and picric acids, of Agaricus, Bisulphide of carbon, Hypericum, Lathy- rus, Osmium, Phosphorus, Physostigma, Secale, Zinc. ; of the eye- symptoms of Ammoniacum, Aurum, Digitalis, Euphrasia, Macrotin, Naphthaline, Ruta, Santonine and Spigelia; the tinnitus of Quinine, the Salicylica, Coca and Chenopodium ; and the pelvic disorder oc- casioned by Ferrum, Lilium, Murex, Sabina and Xanthoxylum— a series of such studies, I say, would enrich the very life-blood of our practice, and make us all better fitted to deal with the morbid states that come daily before us. Discussion. The Chairman : Before the discussion of this paper I would like to announce that the section of surgery will meet in this room THE FURTHER IMPROVEMENT OF OUR MATERTA MEDICA. 75 at 3 o’clock this afternoon under the charge of Dr. John E. James, temporary chairman. I would also give notice on behalf of the World’s Congress Auxiliary that it desires all members in attendance upon the Congress to register in the basement at the official registry. This is distinct, ladies and gentlemen, from your registration in Room 2 under the auspices of the Congress and the American Insti- tute of Homoeopathy. The discussion on Dr. Hughes’s paper will be opened by Dr. J. P. Dake, of Nashville, Tennessee. Dr. Dake: Ladies and Gentlemen: It seems hardly necessary for me to say anything upon this paper of Dr. Hughes. Dr. Hughes and I have been associated in work for several years and we quite agree in our views. However, there are some points in which I must place a little dissent from the address. While I agree with him fully that the proper publication of all provings should be in the narrative form just as the symptoms have occurred from the first day or the first hour until the last; still, for the convenience of the profession and the busy practitioner, I hold that it is necessary to have some sort of minor arrangement or, as Dr. Hughes calls it, extractive work applied. I must confess that my use of the Materia Medica, as we have had it in its schematic form, has been useful to me, and I may not agree as yet to cast it aside. Of course, the cutting up of symptoms by an arrangement, as we have had from Hahnemann down, does separate them and take them out of their connection, but the physician, while using the schematic form to find what he is after, ought, in my judgment, to refer constantly to the original record, and particularly when he has a case that requires much study of remedies. There you have it in those connections, and we must look upon the effects of drugs as drug diseases. Bel- ladonna produces a Belladonna disease, and we ought to take it in its entirety as we do a case for which we are prescribing. I cannot entirely agree, therefore, with Dr. Hughes in what he says in regard to the work in Boston by Drs. Wesselhoeft and Suther- land, and in what he says with regard to the work being done in Baltimore by the Investigation Club. I have had in years past a little controversy with some of my English friends in regard to this matter. I hold that when the symptomatology of a drug is properly taken and properly studied that it is possible, by a study of those records, to know something of what are the characteristic symptoms of the drug. I hold that there is no other way safely to determine what are the characteristic symp- toms of a drug. To depend upon clinical experience will not do. We have been misled often by such attempts. I once made this point, in answer to some of my English friends, that while we may have a map of the United States in detail, giving every river and every county line, and the location of every city, and perhaps of 76 world’s homoeopathic congress. every village, still it should be possible to give an outline map of the United States that will not be misleading, even if it does not give us all the information that we may desire. For that reason I hold that it is possible, when provings are rightly made and rightly recorded, to have an abstract of Materia Medica that will comprise the characteristic or more prominent and persistent symptoms of each drug. I will not detain you, but wish to make this remark, that the future improvement of the Materia Medica depends not so much upon the arrangement of the material we now have as upon the pro- duction of better material. The provings should be made with all the care, and recorded with all the care, that you may see in any other department of science. This is a matter of experiment. Experi- ments ought to be performed with every precaution that is possible, against illusion, against error and corruption. It is a fact, that I may have occasion to mention again before we get through with our Congress, that provings have been made here and there and everywhere by busy physicians, by people who are full of theoretical ideas and of pathological notions, that make their appearance in their provings. Provings have been made by per- sons who are not even acquainted with anatomy, so as to be able to locate their symptoms in attempting to describe them. These are faults which must be remedied, and to do that we will have to have this matter conducted by persons competent to supervise it, by provers who are in the right conditions to have the effects of the drug re- flected properly, and to have all the symptoms recorded in a plain and proper manner. The Chairman : The paper by Dr. Hughes will be further dis- cussed by Dr. T. F. Allen, of New York City. Dr. Allen said : Ladies and Gentlemen : I have listened with the greatest interest to the reading of Dr. Hughes’s paper, but confess my disappointment that in it he alludes to the Cyclopsedia of Drug Pathogenesy f or the improved Materia Medica, standing as it is, as the sacred books of the Bible. At the meeting in Deer Park I, a minority of one, protested against the doctrine and the principles upon which this new Materia Medica was based. I have not since that time changed my opinion ; and the Materia Medica as incorporated in the Cyclopsedia of Drug Pathogenesy cannot stand, in my opinion, as the sacred books of the Bible. I do not now, and never have, believed in the method of arrangement as practical and adapted to the wants and necessities of the homoeopathic physician. In that respect I differ from Dr. Hughes when he says that he regrets that Hahnemann saw fit to put his Materia Medica into the schematic form, and perhaps that, there- fore, Homoeopathy suffered. I believe, as an humble follower of Hahnemann, that he did the best thing for Homoeopathy, and that THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. 77 if he had not put his Materia Medica into this schematic form it would have almost died in its birth. I differ now, have always and must always differ, from Dr. . Hughes on this point. I cannot conscientiously do otherwise as a teacher and practitioner of Homoeopathy. The narrative form is extremely valuable for study. The narrative form of the Cy- clopaedia is a book I prize most highly. It is on the front shelf of my desk. I consult it constantly, but in prescribing for my patients I use the Schema, not the Narrative form. In studying for the preparation of lectures, for the working out of the points, the char- acteristic features of the action, and study of the, if I might almost coin a word, the Pathognomenia of the drug, I use the Cyclopaedia ; but Hahnemann wanted to make it practical, and that is, I think, what the Homoeopathic profession of to-day needs. So Dr. Hughes’s paper goes on principally at first to speak of the arrangement of the Cyclopaedia. Next he states that, in his opinion, the improvement of the Ma- teria Medica will come not from the improvement of the Materia Medica, mind you, as he says, but from exigencies. That we must have lectures upon it; it must be eliminated; we must have talks and sermons upon this Materia Medica. But that is not an im- provement in the Materia Medica itself, and, therefore, I wish to submit a few words on the subject-matter of Dr. Hughes’s address, rather than on the address itself. The improvement of the Materia Medica has taken hold of the minds, I am happy to see, of many of the younger men as well as the older men in the profession, and Materia Medica clubs have been formed in various parts of our country; the Boston Club, the Baltimore Club, the New York Materia Medica Club, all having for their object the study and improvement of the Materia Medica. Dr. Dake has very properly, and in accordance with my own opinion, sounded the keynote of his approval of the course adopted by the Boston and Baltimore Clubs in conceiving the Materia Medica. I entered heartily into that work, and I believe it to be true, as Dr. Dake has just said to you, that the characteristic symp- toms of our Materia Medica will be found in the provings. • Yes, but only when the provings of a drug shall have been completed, as he himself modified his statement. There is not more than one or two drugs, perhaps, in the whole Materia Medica which have been completely proved. I would, perhaps, mention Lycopodium as one approximately complete. Most all of the drugs of our Materia Medica are extremely incomplete, and on this ground I base my ob- jection to the improvement of the Cyclopaedia , because it threw out isolated provings. Now, many of the most valuable symptoms to me for my use in practice have been derived from my study of isolated cases of poi- 78 world’s homoeopathic congress. soning or isolated provings. A single proving, a single case of poi- soning has given me most valuable indications. Symptoms for use at the bedside which I consider characteristic, and which I rely upon and must continue to rely upon. Those provings have not been duplicated. These observations, indeed, have not been dupli- cated. I cannot use the Materia Medica which leaves them out, and consequently my manuscript Materia Medica is a large and constantly accumulating one. I rely upon it. How, then, are we to know, except by symptoms, what to do with this enormous mass of Materia Medica? The making of a Materia Medica is really in its infancy; this proving of drugs is just commenced. As I said at the meeting at Atlantic City, we are laying the foundation, the ground-work for centuries of labor in proving drugs. It seems an almost infinite work, but until our proving is complete, so that we can prove a drug in every part of the body, upon every symptom, susceptible to its drug action, our work will not be complete and our Boston and Baltimore Clubs cannot group their symptoms. My own limited experience in proving teaches me that different condi- tions develop different symptoms. It is only when we have large masses of provers, over and over again, that we get the whole proof of the drug upon every part of the body susceptible to this drug action. It must necessarily be so; we cannot complete this work; it is in its infancy. I want to say to you, and should have spoken of it sooner, that, in my opinion, the improvement of the Materia Medica must come about through its application at the bedside. Improvement in methods of provings? Yes. Improvement in the interpretation of symptoms ? Yes. When an observation comes to my hand, an isolated observation of the effect of a drug, and I test it, and the test is repeated at the bedside, it fixes its value in my estimation and must do so in yours. We cannot yet dispense, I will say, with clinical symptoms — I do not believe in them ; but we cannot dispense with our experience obtained from the application of drug symptoms at the bedside. We all of us come to rely upon them. We all of us see more or less, perhaps, doubtful symptoms. We cannot depend entirely upon the book, because I may say that no drug is yet completely understood, and we do not know what may be developed in the future. The value of what has been verified repeatedly at the bedside cannot be overestimated. If a single observation of a single individual serves me well every time, I will hold to it as a good symptom, and my cure is Homoeopathic. So I think the course taken in the New York Materia Medica Club (of which, I am sorry to say, I am a very poor member, having never attended a meeting) meets with my hearty approval. Their course is able to test the symptomatology of our Materia Medica; it is practiced at the bedside, in the dispen- THE FURTHER IMPROVEMENT OF OUR MATERIA MEDICA. 79 sary, in private practice, and week to week coming with “this symptom and that symptom cannot be verified at th.e bedside; bat this symptom is always verified at the bedside.” We make notes- of' these; we underline them in our books; we rely upon them be- cause they have been repeatedly found to serve us well. Our im- provement in Materia Medica lies largely, it seems to me, in the clinical application of it. There is much more to say, but I will not detain you longer. Conrad Wesselhoeft, M.D., of Boston, Mass. : I shall only detain you a few moments. I want to make a few brief allusions to Dr. Hughes in reference to myself. He has honored me by ref- erence to my elimination or exclusion of Cactus, referring to the method which I have employed in coming to that conclusion. Per- haps I may be wrong, but what I want to discuss is the method by which it was done. He says there were flaws in the method, or else Cactus would not have been excluded. Likely there were flaws in the method. The method was simply that alluded to by Dr. Lane, Dr. Bates and others, of comparing the results of proving — making a careful comparison of provings. It is by comparison alone — a great number of comparisons — that any true results in science can be reached. The experiments were very painstaking and thorough. The reasons for which I threw some doubts upon the utility of Cactus was not only because comparisons of the prov- ings gave that result, but because I also made personal provings upon it with the same result. I was willing to sacrifice my valua- ble person to so valuable a medicine and for the good of mankind. Not I alone, but a good many of our students in Boston, have re- proved Cactus a good many times and very thoroughly since Dr. Ravenna, in Naples, first came out with his marvellous proving of Cactus. If there is error in my conclusions, very likely it is owing to the difficulty of the matter, but not owing to the principle upon which it was done. Why should not I exclude Cactus on careful examination, on careful proof, on careful reproof and careful com- parison, when Dr. Hughes takes it upon himself to deal with Natrum muriaticum in the way he does without any proving or reproving or comparison at all? He gives no reasons why; he has not made any comparisons or provings with Natrum muriaticum as I have done. He has made no reproving. If Dr. Hughes is justified in throwing out a medicine on such reasons as those, I think I should be justified in throwing some doubts at least upon the utility of the proving. I have carefully compared and reproved, and spent not only days, but weeks, in doing so myself. Now, there may be a great deal of good in Cactus. I have in my possession a two-ounce bottle of tincture of Cactus, presented to me by my old friend in Brookline, who obtained it in Naples from Dr. Ravenna. He brought this to me, and was very anxious that I should prove it, 80 WORLD S HOMOEOPATHIC CONGRESS. and I did so. I went carefully to work to make the provings, merely to show that I could get effects from it — from twenty to thirty, forty or fifty drops of that very powerful stimulant. Those of us who have proved it have done so not only with the potencies — first two, four and five tincture graduated doses — but have carried it to the ounce, and got no other results. I do not say that my provings are as good as Dr. Ravenna’s. He gives no provings at all. He states facts, makes statements, and when you read them you would suppose a person who had taken Cactus had fallen with an attack of epilepsy, in which he rolled and writhed on the ground. Others, again, there are who think the person died of heart disease or suffocation or of violent cough or tremendous haemorrhages, which, in reading, would appal even one accustomed to sights of horror. I say, from the proving of Cactus, at first thought, it might be haem- orrhage, heart disease, epilepsy — all these things they suppose I might be troubled with, but I got nothing of the kind. I said to Dr. Hughes: These are strong evidences of the value of the prov- ing. It has been ascertained that Dr. Ravenna took certain quan- tities. Some friends found among his papers that he had taken the third attenuation to get these symptoms. That was a good many years after Ravenna was dead that somebody wrote that; but Dr. Hughes don’t think such a statement is going to get into Materia Medica, that Dr. Ravenna, by means of the third attenuation, pro- duced these results. I do not believe them; I do not want to impugn anybody’s veracity, but I do not think they are correct. I merely suggest that Cactus, instead of being a medicine that would produce violent effects, was, on the other hand, an innocent potherb. Dr. Hawkes: Just one word or two upon this point. You would look in vain through all the works on Materia Medica for my name, but if I cannot claim to be a writer I can claim to be a reader and a user. I wish in this connection and under this state- ment to offer one word of warning, and that is this : That it may be, and is, a very honorable thing to notice a medicine which has been well tried and well proven ; but he incurs a very heavy responsi- bility who excludes from our Materia Medica certain medicines, because they have not been so fully used. There is one, Muritius Upia (?) that has served me in the very best possible way. I have learned to use it from just one word repertory, introduced by Drys- dale. I refer to Allen’s big book, and that contains a reference to Upia, and I followed that up, but now that drug is excluded from the Hand Book, which I use, by the way, alternately as a hand book and an Indian club. It is excluded also from other works, with reference to which we have heard this morning, but I wish to say a word, the symptom of a burning in the left ovary has proved to be of the very greatest value. My work, of which I must not speak now, has some connection with that part of the body. I would THE FURTHER DEVELOPMENT OF OUR MATERIA MEDICA. 81 not hesitate if occasion required it to open the abdomen, and if this were the proper place I could bring case after case before you that had been condemned for operation, and where operation — I am not saying now whether that was a virtue or not, but that operation has been saved. And amongst other things I would say that this drug, a description of which you will find in any of these Materia Medicas, but is fairly well and fully spoken of in the bigger work of Allen. I would say that this is a direct cause of evil ; that one solitary in- stance which I, as a user of the drug, rather than a writer of Materia Medica, would speak of and mention as a word of warning to those who are perhaps a little too ready to cut out from our Materia Medica. F. Parke Lewis, M.D., of Buffalo, New York, then addressed the Congress on the subject of “The Value of Specialties in Medi- cine.” 82 world’s homceopathic congress. ADDRESS. THE VALUE OF SPECIALTIES IN MEDICINE. By F. Parke Lewis, M,D., Buffalo, N. Y. While we are gathered together from widely separated parts of the world in this fair city where so much that is of interest is now centered, I am not insensible to the honor you do me in pausing even for a few moments to listen to the thoughts I have to offer upon the general subject of “ Specialties in Medicine.” Though the occasion is not one to warrant us in entering largely into details, both the time and subject are too important to permit superficial consideration. Let us therefore, first inquire briefly how the thing which we now know as specialization was evolved. When we resolve all the multiform effort of the world into elementais, we find that the one thing in the world is life. The one thing we are trying to do is live. All the isms and ologies are only a part of it, or helps to it. The effort of all who think and work truly is to increase the value of life, not to make life, that were impossible, but to render life more complete, more perfect. Broadly considered, human life can be perfect only when a power and faculty is fully developed in absolute harmony with every other. But, as it would be impossible to entrust to any one man or set of men, the guidance of the race in all of its wonderful and bewilder- ing individual capacities, man early came to be regarded as divided into three distinct entities, physical, intellectual and moral (or spiritual), and we have as a result three classes of men to whom the world looks for its uplifting. To physicians has been given the task of broadening and perfecting the physical life of the race. To the clergy the hardly more sacred work of enlarging the moral life and perfecting spiritual vision, and to the great army of teachers in every branch of science and art comes the glorious possibility of develop- ing the intellect of man into something yet more godlike. Medicine, theology, and philosophy, the first three specialties. THE VALUE OF SPECIALTIES IN MEDICINE. 83 But so complex and all comprehending a thing as intellectual life could never be brought within the bounds of one man’s power and knowledge, and so the educators have almost infinitely divided their work. Those to whom the care of souls was given soon discovered that no one expression of belief could be broad enough to provide scope for the infinitely out-stretching, constantly expanding indi- vidual spiritual life, and theology consequently divided and sub- divided, and took to itself creeds. While it is obvious how powerless any one man must be and must have been to cover with ever so great industry and genius the whole vast field of human possibilities, and while a division of labor was and is imperative, the greatest possible value can never be obtained by such division in any field without a right understanding on the part of those who undertake any branch of work of the economic reasons governing its divisions, and the great natural laws under which each man must work within his own lines. The more deeply we think and study into the things of nature and of life, the more we become aware of a central unity running through all things; a fundamental law with which all other laws must co-operate, with which all truth falls in line, to which all logic finally points as the needle to the pole. We are closely pressed in our industrial life in these days by failing to appreciate or to apply this law. The underlying prin- ciple of unity, in man as in nature, implies the most perfect har- mony, the fullest co-operation, and at the same time, and only in consequence of this, the most perfect expression of individual life and liberty. As the plant is dependent upon the sun and dew; as the tree is saved from death by the bird that lives upon the insect which would destroy it ; as the tide answers to the moon and the world itself to the motion of the spheres, so must man recognize his unity with man and nature, acknowledge his constant mutual interdependence, must serve and be served, or lose his highest and most harmonious de- velopment. The freest and most perfect expression of human power and life is possible, then, not by more and more separation, but by more and more unification ; by a deeper and surer perception of the laws of the world, and a living in harmony with them. This does not pre- clude special work. It does not deny to any man the right to work 84 world’s homoeopathic congress. out the best that is in him in his own way, to choose his work within very narrow lines if he will. But that he may attempt something like perfection in one direction, he must laydown as well as take up. Specialization means concentration. Emerson has somewhere said : “ You must elect your work ; you shall do what your brain can and drop all the rest. Concentration is the secret of strength.” Some apprehension of this truth, however dimly conceived, lay at the foundation of the first conscious division of work into what we call specialties. But specialization means also renunciation. “ Drop all the rest, lay down as well as take up.” Leave some work that one might do, that even might bring more generous results in its per- formance than the little bit that must be wrought at with such un- flagging care to bring it to its fullest beauty and perfection. One must leave to some one else the work that might have been his own ; he must relinquish some part of his inheritance; and if he would secure a true value in his exchange, let him see to it that what he gets is something more than a mess of pottage. His work will be to him little more than this if it is undertaken from motives of self- aggrandizement. If his object is a mercenary one, he will doubt- less make money, which means food and clothes, as good as, or a little better than, his neighbor’s; a little power and splendor, and a residuum, after careful analysis, of dust and ashes. His object has been separation, not unification ; he has striven against, not with, his brothers; he has undertaken a special work, not that he might do a little more perfectly than he could do more, and the thing that he has devoted his life to be, in consequence, of more value to the world, but that by doing some one thing better than any one else could do it, he might receive for himself more gain and glory. Both may become his, the gain and the glory. But cui bono. The greatest good will, of a surety, be denied him if he is content to seize these apples of Sodom. His work, I do not hesitate to say it, will fall short of that which is best. Therefore, the value, that is, the worth, the importance, the utility of specialties, in medicine as in anything else, depends less upon the thing specialized, or the necessity for its specialization, than upon the man who does it and the spirit he works in. In comparison with this, all other reasons and reasoning are vain. It has been said, and not without reason, that narrowness is a re- sult of specialization. THE VALUE OF SPECIALTIES IN MEDICINE. 85 But a broad man, liberally educated, does not necessarily become narrow by devoting his best energies to some one thing that he feels he can develop more power in than he could attain in any other di- rection. He may give himself up so completely to his chosen work as to almost exclude the possibility of any extended reading, not to say research, in any other direction. His time may become so ab- sorbed by the demand upon it in his limited field that he can rarely even meet with those whose work is carried on with larger lines. And yet, if he maintains his true relation to the world; if his mental attitude be a right one, I insist that he need not become narrow in the generally accepted sense of the term. There will be much that he cannot know, that he must voluntarily relinquish the possibility of knowing, but he will be broadly interested in it all. He may renounce frequent fel- lowship, but if in his work and growth he is constantly and consci- entiously one of the great human family, connected by the closest ties with every other, doing his part, however distinct it may be, not in isolation, not in the spirit of separation, but simply as his bit of the great whole, in all of which he has a personal interest, which is all his, and yet not his; which, but for the perfection of his, would be less perfect, which is never to be lost sight of in the exclu- sion of his own, — if, in a word, his special work, however absorbing it may be, does not get between him and life, he need not lose mate- rially, or beyond compensation, by his adoption of a specialty. He does not renounce the spirit of fellowship, he does not glorify his own work to the exclusion of any other, he does not fasten his eyes so exclusively upon that which is growing under his hand as to lose all power of seeing it in perspective. For, to reiterate, the value of any special work depends, first and chiefly, upon the power of the man who does it, to look at it con- stantly in its relation to that whole of which it is a part. From a failure to do this arises all the question as to the value of special- ties. Educators have recently been considering with much seriousness whether many of the most defective methods of our educational sys- tems might not be directly traceable to the arbitrary division of that which was never intended to be divided — the life of man — into physical, mental, and spiritual, the result being unequal, and, con- sequently, unnatural development. It would seem as if the divi- sion were an imperative antecedent on progress, the mistake being 86 WORLD S HOMOEOPATHIC CONGRESS. that in the division of work each worker should look upon his part as a whole in itself. He then might and did isolate it and himself from those to whom the work of perfecting the other parts had fallen, and the morbid conditions thus created have spread into every branch of study and of practice, and have worked endless disintegra- tion where wholeness should have been. You will bear with me if I seem to be dealing too long with ab- stractions. In the daily routine which absorbs our every faculty as physicians into one tremendous effort to restore and preserve such physical perfection as is possible to suffering humanity, we have little time or opportunity to think of that which it were worth our while not to forget, — which is not alien to the practical side of our work, but an integral part of it, — the fact that even before we are physicians we are men, and that the highest physical life is at its best but an expression of the intellectual and spiritual life. We who have chosen for our calling the physical redemption of man cannot look too broadly upon our work, and that will not be lost time which we spend in getting it so in focus that we can have indelibly printed upon our mental negative a picture of what we are doing, and the relation our work sustains to the moral and intellec- tual life of our race. Still more is this necessary if we have taken but a small part of the medical practice for our field. The same laws hold good here as those that work thronghout the whole wide range of human experience. Unity is strength, life ^ division is disintegra- tion, death. No one part of the human economy can be disturbed without affecting in some degree every other part ; and it would be at vari- ance with every law that we know in nature or in life to believe that, in studying thoroughly one branch of medicine, one might, without more than a very superficial knowledge of anything else, treat suc- cessfully the one part to which faithful attention has been given. In the practice of a specialty one may not do any work outside of certain lines, but one must do a vast amount of study and in- vestigation outside of those lines, and the work within must be constantly connected and fitted into that which lies without. One must work steadfastly in a restricted field, yet with constant refer- ence to the whole; must be able to work alone, yet in a spirit of fellowship, to work in accordance with the great world-law of uni- fication, and not against it THE VALUE OF SPECIALTIES IN MEDICINE. 87 When this has become not only possible, but habitual, then and then only is one in a position to understand and to prove the great value of specialization, by the concentration of force in one di- rection. This concentration of force develops power in two ways. It makes possible a more profound intellectual grasp of the subject specialized, and if it be in the line of technical work, it gives tactile fineness and manual skill to a degree impossible to derive from gen- eral work. The devoting of much time to one thing renders the research and the acquisition of facts in regard to it so complete as to often outrun all previous knowledge, and lead to discoveries and inventions, to new refinements of diagnosis, added instruments of precision, and to scientific methods of investigation and practice that seem little short of marvellous; and it is a wonderful power of eye and hand, a wonderful acuteness of sight and touch, that are developed by doing intelligently one thing over and over again. The value of this knowledge and technique is three-fold. First, to the specialist himself, since knowledge is power, and “ All power,’ 7 as Emerson says, “ is a sharing of the nature of the world.” Second (second only in order of sequence, not in importance) is the value to the large number of those whose increased soundness, and therefore increased power, is the direct result of the physician’s dealing with the things that make strength. And third (in order of sequence) is the value to the world at large; for all increase of knowledge and. power and strength becomes a part of the world’s inheritance, and this is perhaps the widest and most positive value of all. We see, then, the specialist taking his little bit out of the work that lies waiting for who can and will do it, giving to it the best of his time, his strength, his intellect, perfecting it more and more until he returns it to'the world again, as a sculptor might the stone into which he has wrought his brain, his heart, his life, and which has become, in the process, of a value immeasurable. The practical proof of the value of specialization in medicine lies, of course, in what has been accomplished through specialties that would not have been possible under the time and opportunities afforded by general medicine. This is somewhat difficult to specify with exactness ; but it is safe to say that the enormous results that have recently been obtained in surgery, gynaecology, obstetrics, neurology, and ophthalmology could 88 world’s HOMCEOPATHTO CONGRESS. not have been reached but by that deliberate concentration which is indeed the a secret of strength.” I need not dwell upon the work that has been done by the men in each of these different fields, al- though it would be pleasant to do so, for with much of it you are familiar, and to begin would make my task an endless one. But of the results of special work in bacteriology — a comparatively new field for specialization — I wish to speak a little more at length. Whatever a man’s work may be, whether generalist or specialist, whether Old School or New, bond or free, if he is a physician at all, one thing he must be familiar with, so far as study and investigation can make him so, and that is the nature of disease. This, I think, will be admitted without question, and no further argument will be necessary when it is remembered that no less a subject than that — the nature of disease — has come to be entirely reconsidered in con- sequence of the light thrown upon it by the investigations and dis- coveries of bacteriologists during the last few years. I have somewhere read that the “ new ” opinion which now obtains was held by some several centuries before Christ, and has found cre- dence in every age since, but it eluded proof, and consequently could not gain general acceptance until the specialization of bacteriology has brought knowledge on these lines to such a point of perfection as to establish as a fact what more than eighteen previous centuries failed to render more than “ probable.” The contest between the bacterium and the phagocyte has added a new factor to our study of disease, and has made necessary a re- statement of every pathological equation. It has robbed tubercu- losis of half its terrors by localizing its origin and making largely possible its prevention. It has lowered the mortality in surgery to a phenomenal degree. It has demonstrated the source of typhoid fever and diphtheria, and it has proven the germicidal character of cholera and enabled us to keep it at bay. It has elevated sanitation to a position of first rank, and makes it possible for us to deal more intelligently with matters of dietetics and hygiene. Not all our problems are yet solved, but we may now deal with them in a more direct and scientific way, and are much further advanced toward their correct solution by reason of the data put into our hands through bacteriological research. As brilliant and important as have been the additions to our medical equipment through the medium of specialism in the past, THE VALUE OF SPECIALTIES IN MEDICINE. 89 I cannot but believe that greater things are in store for us when we have learned more practically that specialization does not mean sep- aration, and when specialists work more constantly in unison. And now let us hear the conclusion of the whole matter, in words more strong and beautiful than I could hope to equal, words taken from the “ Ethics of the Dust / 7 by John Ruskin : “The highest and first law of the Universe, and the other name of life, is 1 help . 7 The other name of death is ‘ separation . 7 Gov- ernment and co-operation are, in all things and eternally, the laws of life; anarchy and competition, eternally and in all things, the laws of death. “ Exclusive of animal decay, we can hardly arrive at a more ab- solute type of impurity than the mud or slime of a damp or over- trodden path in the outskirts of a manufacturing town. That slime we shall find in most cases composed of clay (or brick-dust, which is burnt clay), mixed with soot, a little sand, and water. “All these elements are at helpless war with each other, and destroy reciprocally each other’s nature and power ; competing and fighting for place at every tread of your foot ; sand squeezing out of clay, and clay squeezing out water, and soot meddling every- where and defiling the whole. Let us suppose that this ounce of mud is left in perfect rest and that its elements gather together, like to like, so that their atoms may get into the closest relations possible. “ Let the clay begin. Ridding itself of all foreign substances, it gradually becomes a white earth, already very beautiful, and fit, with the help of congealing fire, to be made into finest porcelain, and, painted on, can be kept in king’s palaces. But such artificial consistence is not its best. Leave it still quiet, to follow its own instinct of unity, and it becomes not only white but clear ; not only clear but hard, but so set that it can*' deal with light in a wonderful way, and gather out of it the blue rays only, refusing the rest. We call it then a sapphire. “Such being the consummation of the clay, we give similar per- mission of quiet to the sand. It also becomes first a white earth ; then proceeds to grow clear and hard, and at last arranges itself in mysterious, infinitely fine, parallel lines, which have the power of reflecting not only the blue rays, but the blue, green, purple, and red rays in the greatest beauty in which they can be seen through any material whatever. We call it then an opal. 90 world’s HOlMCEOPATHIC CONGRESS. “In next order the soot sets to work. It cannot make itself white at first, but it comes out clear at last, and the hardest thing in the world, and for the blackness that it contained obtains in exchange the power of reflecting all the rays of the sun at once, in the vivid- est rays that any solid thing can shoot. We call it then a diamond. “ Last of all, the water purifies itself, contented enough if it only reach the form of a dew-drop ; but, if we insist on its proceeding to a more perfect consistence, it crystallizes into the shape of a star. And for the ounce of slime which we had by the political economy of competition we have, by political economy of co-operation, a sapphire, an opal, and a diamond, set in the midst of a star of snow.” In this wonderful description we have seen the earth elements struggling in the mire of discord, until the law of unity came to work and created, out of apparently hopeless confusion, the most transcendent harmony and beauty. You have noticed that all they require — these earth elements — that they may begin the work which is to lead them to the utmost perfection, is only that they shall be allowed absolute freedom of action, that no one should interfere with any other, and then they may work out their own salvation, each in his own way, not like any of the others, but each its best, and though separating itself, and accepting only what its own special developments require, still fol- lowing the law of unity, and proving that not in concentration alone, but in co-operation, there is strength. When we speak of law in nature, we mean the formulated results of close observation of the working of nature. Nature is behind and higher than law, or in other words, law is the right interpretation of nature. It is worth our while, therefore, to study nature and to observe how similarly she works in great things and small, so that beyond question the formulated result of our observation, that is, the law, which controls atoms, is the law which must govern all rightly directed life of man. The value of the widest collection of facts, the greatest achieve- ment of mechanical skill, the deepest insight into the source and operation of distinctive forces and its prevention, lies in the perfect application of such special knowledge to the needs of humanity, to its best physical development. “ What matters it,” says Longfellow, “ whether you or I or another did such a deed or wrote such a book, so that the deed and book THE VALUE OF SPECIALTIES IN MEDICINE. 91 were well done?” When something more of this high spirit shall permeate every branch of our medical practice, shall have become the highest directing force through which every man works, then will have dawned a new day in which the value of our work will be beyond all power of computation. The Chairman of the Committee of Arrangements made a number of announcements. The hour for adjournment having arrived, the discussion of the paper of Dr. Lewis on the Value of Specialties in Medicine was deferred until the morning session of May 31st. On motion the meeting adjourned. May 30, 1893. At 3 o’clock p.m., the Sectional meeting in Surgery was held in the Hall of Washington. In the absence of Dr. Wm. B. Van Len- nep, Chairman of the Section, Dr. George F. Shears of Chicago, 111., was chosen temporary Chairman of the Sectional Meeting. (For the Papers and Discussions, see the “ Report of the Section in Surgery.”) SECOND DAY’S SESSION. May 31, 1893. The second day’s session of the Congress of Homoeopathic Phy- sicians and Surgeons convened at 10.30 o’clock, pursuant to adjourn- ment, Chairman J. S. Mitchell, M.D., of Chicago, presiding. After making the announcements of the day the Chairman called upon Dr. W. A. Dunn, the Secretary, for his report on Foreign Corres- pondence, which report was accepted and was as follows: Report on Foreign Correspondence. The Secretary begs to report that the Foreign Correspondence connected with the Congress has been exceedingly extensive. Let- ters and circulars were sent more than a year ago to all foreign rep- resentatives of our school whose names could be secured. The aims and plans of the Congress were explained and letters have been re- 92 world’s homoeopathic congress. ceived of cordial endorsement and tenders of assistance from Dr. Richard Hughes, of Brighton, England ; Dr. John W. Hayward, of Liverpool, England ; Dr. A. C. Clifton, of Northampton, Eng- land ; Dr. Alfred C. Pope, of Grantham, England ; and Dr. Edwin A. Neathby, of London, England. Also, from Dr. Theodore Kafka, of Carlsbad, Germany; Dr. Emil Schlegel of Tubingen, Germany; Dr. Theophilus Buckner, of Basle, Switzerland; Dr. Tommaso Cigliano, of Naples, Italy ; Dr. P. C. Majumdar, of Cal- cutta, India; Dr. B. M. Banarjee, of Calcutta, India; Dr. C. Bojanus, of Samara, Russia; Dr. Oscar Hansen, of Copenhagen, Denmark; Dr. F. R. Day, of Honolulu, Sandwich Islands; Dr. Edward Adams, of Toronto, Canada; Dr. E. Vernon, of Toronto, Canada, and Dr. John C. Clarke, Secretary British Homoeopathic Society, and many others. The thanks of the Congress are due to Dr. Alexander Villers, of Dresden, Saxony, for copy of his Directory of Foreign Homoeo- pathic Physicians for the use of the Committee; to Dr. J. W. Hayward, of Liverpool, England, for copy of names of British physicians; to Dr. Edward Adams, of Toronto, Canada, for copy of names of Canadian physicians : to Dr. B. N. Banarjee, of Calcutta, India, for reports; Dr. Emil Schlegel, of Tubingen, for copy of the work of the Homoeopathic Clinic at Tubingen ; to Dr. Louis Paez, of Bogota, Colombia, for copies of works on Materia Medica; to C. Hurtado Curazoa for copy of his Compendium of Botany ; to Dr. Theophilus Buckner, of Basle, Switzerland, for Journal notice of the Congress ; to Dr. Tommaso Cigliano, of Naples, Italy, for copy of his grand Repertoire of Clinical Homoeopathy ; also for the copy of his Homoeopathic Materia Medica , and a paper upon Morphia. The Committee will move at the proper time that a vote of thanks be tendered these gentlemen. Your Committee would report that the requests for reports and papers from our foreign confreres have met with most generous response and that the interest shown in the Homoeopathic Congress throughout the world has been very great. The number of our for- eign confreres in attendance upon the session of the Congress testifies to this deep interest. Respectfully submitted, Wesley A. Dunn, Secretary. THE VALUE OF SPECIALTIES IN MEDICINE. 93 The Chairman : So many of the State delegates have already reported to the American Institute of Homoeopathy that this item of business will be passed, and we will proceed to the discussion of * Dr. F. Parke Lewis’s paper, “ The Value of Specialties in Medi- cine.” Dr. Julia Holmes Smith has the floor. Discussion. Julia Holmes Smith, M.D. : Mr. President , Ladies and Gen- tlemen: There are some things so dainty imcookery (being a woman, I naturally refer to that), so dainty that they can never be taken up a second time. The spirituality has gone out of things, the beauty of a thing has departed after it has been presented and furnished upon the table. Now, it seems to me a trying thing, indeed, to take up the discussion of this exquisitely scholarly paper with its sug- gestiveness all forgotten, because things go out of our mind after we have had a dose of ether in the afternoon. Just think of this won- derful paper, and I have got to come in this morning and talk about it. ‘‘The Value of Specialities in Medicine.” The ground was thoroughly covered, the arguments, pro et eon , well presented, and what can I say except that I approve ? What should we have for our Materia Medica but such men — men who have made a specialty like Dr. Dake and Dr. Hughes and Dr. Hale? What should we do about surgery except for the skilled surgeons who yesterday pre- sented us with their theories? What should we do for culture and colleges but for the men who have given their lives to education in medicine, the all-around men, and where would we be for our speci- alities but for the men who give their time to that? And I can only emphasize earnestly and imperatively the necessity, while we acquire, as far as one human mind can, the thorough knowledge of our profession that we should go beyond and chose some one thing in which we should excel. And I repeat what I said on Monday evening that the reason we have so few women on our programme is because it is difficult to find women specialists in our schools. Let us start young women who are going to woo and wed the profession of medicine. Let all of you — it is past my time — let you who are be- ginning in your career as medical women chose some particular line of work in which you will excel, and when the next World’s Con- gress is held you will rival the specialists among the men. The Chairman : Is there any further discussion of this paper? If not, the address of Dr. J. P. Dake, of Nashville, Tennessee, on “The Future of Homoeopathy,” is in order. Dr. Dake addressed the Congress as follows : 94 world’s homoeopathic congress. ADDRESS. THE FUTURE OF HOMCEOPATHY. By Jabez P. Dake, A.M., M.D., Nashville, Tenn. Mr. President and Members of the Congress : In proceeding to the discussion of the topic assigned for this oc- casion I pause to remark that expositions of the varied resources and products of nature and of art have been made in one country and another, but nowhere and at no time has there been one organized so well calculated to show the intellectual and moral, as well as the physical possibilities and achievements of our race, as the one in which we are now taking part. The series of Congresses devised by the Exposition Auxiliary for the display of the various departments of science, morality and re- ligion, which aim to elevate and ennoble, as well as prolong, human life, is destined to mark a new era in the advance of civilization on the globe. The step taken by America, in this Columbian year, toward a more free expression and interchange of views upon a recognized platform, the new beside the old, and the heterodox beside the or- thodox, must tend to soften harsh antagonisms and lead on to more united, as well as earnest, efforts for human welfare. As we approach the end of our Medical Congress, held at this time in commemoration of one of the greatest events noted in his- tory, it is well, in addition to the views and reviews relating to the past and present, to let our mental vision run on before to see what the future has in store for the healing art. That the condition of medicine and medical organizations is long to remain as we see it to-day is not to be expected, nor should it be desired. Well satisfied as we may be with much in the constitution and resources of Homoeopathy, we yet look forward to what is even better. It is my mission, in the brief address, to speak of some of THE FUTURE OF HOMCEOPATHY. 95 the better things therapeutic that continued observation and experi- ence may bring. Had I the gifts of a prophet, enabling me to look forward a few decades clearly to discern coming changes, my task would be easy and you would doubtless enjoy a rare intellectual treat. The Retrospect. — As it is, I must ask you, for a brief time, to cast the search-light of memory back upon the way we have come, and the eye of observation over the fields now occupied by our school of medicine, as we look forward only in the light of the past, calcu- lating what will be from what has been and what is. The retrospect at the outset brings to view one great fact, never to be forgotten, namely, that the discovery of the Homoeopathic principle was unlike any other discovery concerned in the art of healing, in that it brought to light a natural law, fixed and para- mount in therapeutics. It defined the relationship that must exist, between the medicinal agent and the disease to be overcome, in the words Similia Similibus Curantur. So many have been the changes for the better in the current medi- cal teaching and practice of the world since that day, it is not easy for us to realize the surprise and even consternation that prevailed upon the announcement of Hahnemann’s discovery. What was then feared, in due time became a reality, the knights of venesection, and the cup- ping and leeching barber, and the blister-spreading and heroic dose- mixing apothecary were sent into comparative retirement. With feelings of satisfaction we look back upon the steady develop- ment and spread of the therapeutic system based on the law of simi- lars, especially upon the decided triumphs over such great destroyers of life as the Asiatic cholera and the yellow fever. Had it done no more to demonstrate its worth down to this time, than the indubi- table records show it has done in the epidemics of those two well- marked and fatal diseases, it would deserve the confidence and es- teem of the world. The reception we see accorded to the new therapeutic doctrine by the medical men of the early part of the century, was hardly such as became scientific men. The attitude of medical journalism was decidedly adverse to its discussion. Hufeland was the only editor with magnanimity and courige enough to open his pages to Hahnemann. In his journal for 1796 had appeared the dawning of Homoeopathy, the first sugges- 96 world’s homoeopathic congress. tion of its basic principle. But even Hufeland afterward closed his columns, in deference to the wishes of medical men who were unable to bear the criticisms of Hahnemann, and in obedience to an authori- tative medical censorship. And the prevailing policy from that time on has been either to ignore or simply ridicule Homoeopathy. Hence the necessity for journals of our own, through which the new truth could reach the profession and the public, and by which its triumphs could be made known. But as time went on and the followers of Hahnemann became more numerous, a curious state of things, puzzling to men of the other learned professions, developed in the ethical attitude of the dominant school. Graduates from the old colleges were cut off from fellowship and declared no physicians because they had ventured to push their studies beyond the old curriculum and to give their pa- tients the benefit of the farther inquiry ; and some students, avowing their intention, after graduating, to investigate and probably adopt the Homoeopathic method, were refused diplomas. Doctors with a less complete education and less extended medical armamentarium, assuming an attitude of superiority, refused them professional aid. But the effect of such professional manners, while temporarily em- barrassing to the ostracised physicians and their clients, was after- ward very greatly in their favor. It led on to the organization of colleges and societies devoted to the new cause, while it revealed to the public a tableau anything but creditable to the good sense of the Old School — they on the one side looking down with apparent con- tempt on us of the other, and denouncing us as ignoramuses and quacks, when possessed of the same learning as themselves, plus a knowledge of Homoeopathy ! Beside individual and organized pro- fessional attacks, calling for organized means of defense, the New School had to contend, in many countries, with an unfriendly gov- ernmental censorship. Examining boards with assumed and arbitrary standards, author- ized by the State, have had a tendency to keep medical practice in the old ruts, and such will always be their tendency whether called Allopathic, Homoeopathic or Eclectic. And great military establish- ments with dictatorial surgical staffs and red-tape methods, have always been unfavorable to the careful consideration and ready adoption of new therapeutic measures. The traditional supply table for the army and navy surgeons and for hospitals under govern men- THE FUTURE OF HOMOEOPATHY. 97 tal control, have known little change from generation to generation. Considering the influence of great standing armies and of authorita- tive boards of medical censors, it need not be surprising that Homoe- opathy has had to make its way inch by inch, in Germany, Austria, Italy, France and even England. As might be expected the fairest field presented for its adoption and growth has been in America, away from the domination of military medical staffs and arbitrary censorships. But our retrospect, if it shows obstacles met with also shows ad- vantages enjoyed, in the progress of the new medical philosophy. We see that among medical men, not alone in this country, those who have been most ready to examine and adopt it, have been the well educated and most enterprising. Physicians weighed down by an inordinate sense of authority and “ regularity ” or industriously plying their art, as in a tread-mill, never looking or moving about to see what may be found that is better, are not the first to appreciate what is new. And among the people, the very first to comprehend the value of curative methods based on a law of nature, have been the educated and most cultured, classes. If the old medical journals were closed against us the columns of the public press were not. If unfair representations appeared in the daily papers calculated to mislead the public and create prejudice against our cause, the opportunity was freely accorded for reply and defense. If suits in court were instituted for our injury, judges and juries with few exceptions, sustained us in our rights. And in mat- ters of legislation where efforts have been made to check our progress or curtail our freedom, law makers have listened to our arguments and refused to deal unfairly with us. The Present Status. — In surveying the present fields occupied by the New School, much is to be seen that is encouraging. There are numerous journals indifferent countries and different tongues, devoted to the therapeutic measures of Homoeopathy and covering likewise every department of medical and surgical inquiry. More than a score of them are issued monthly in the United States alone. And our colleges, each with a full curriculum, and all up to the highest standard — indeed foremost in the extension of the general course and lengthening of annual sessions, are a source of credit and support to our cause. 7 98 world’s homoeopathic congress. In the matter of colleges, the disadvantages imposed by the cen- sorship system of the Old World is very plainly seen. They have prevented charters for our schools, so that we have not to-day a whole school of our own in Europe, possessed of the power to confer medical degrees upon its students. Even in enlightened and liberal England, our school based on the London Homoeopathic Hospital and conducted by some of the very ablest medical men in Great Britain, cannot grant a diploma after ever so much study or upon ever so thorough and satisfactory an examination. Hospitals and dispensaries extending the benefits of our practice to the poor are seen in nearly all parts of the enlightened globe. Fortunately boards of censors cannot always intervene between the people and the desired means of physical relief even in despotic countries. In its relations to other principles that have to do with the art of healing, I desire to say that Homoeopathy has no antagonism what- ever. What surgery can and should do, or chemistry or mechanics, to remove useless or burdensome tissues and products, or destructive parasites or poisons; and what palliatives should do to save life or mitigate useless suffering, we are agreed that they shall do. We are prepared to hail with pleasure every discovery and improvement in the ways and means of preventing or removing disease. If we hesi- tate and take time to consider, when the inventions of Brown- Sequard and Koch are heralded over the world, it is for the want of more affirmative proofs of their value. The Future. — I come now to the point where I must ask you to turn your gaze from the past and present of Homoeopathy to its future. Many and various have been the predictions made as to its destiny, some saying : “ Like other popular delusions it will have its day and pass away.” And others : u It will be the prevailing and exclusive mode of practice.” Applying analogy to the facts hurriedly passed in review, and reasoning from cause to effect, what do we really see before us? Let us consider : Unquestionably the future has in store more exact methods of ob- servation and clearer lines of reasoning, which must lead to a more definite understanding of the cases of disease amenable to the Hom- oeopathic remedy. 1. Taking this view, my first proposition is, that the true field or sphere of the Homoeopathic law will he more clearly defined . THE FUTURE OF HOMOEOPATHY. 99 The first and one of the most important questions presented to the physician in assuming the care of a patient, is as to the particular department of the healing art from which help must come. Is it a case for surgery, for chemical antidotes, for anti-parasitics, for change of residence, or occupation, or diet, or one admitting of palliatives only; or is it one requiring the Homoeopathic remedy? It is possible for a case to require help from two or more of these de- partments at one and the same time. In that case the agencies em- ployed must be such as to co-operate with and not antagonize each other. But in determining the question whether a Homoeopathic rem- edy is required, the physician must very definitely and clearly under- stand what affections come under the Homoeopathic law or within its domain. It is a childish view to suppose that the physician calling himself a Homoeopath is, in all cases, bound only to search his own Materia Medica for the needed remedy ; and it is criminal for him to shut his eyes to other means where the Homoeopathic remedy is not required and can do no good. Diseases, according to the help required, very readily fall into classes; and the Homoeopathic class is made up of all such as are similar to those producible by patho- genic means, existing in organisms having the integrity of tissue and reactive power necessary to recovery, the essential cause having been removed or having ceased to be operative in the case. For this class the Homoeopathic law is supreme and universal, while for all others it has no application and no meaning. Years ago, while lecturing upon the principles and practice of medicine in Philadelphia, for convenience I divided the great field of therapeu- tics into two parts — general and special — the latter embracing such cases only as call for the Homoeopathic remedy, and the former in- cluding all others. The special I also denominated the pathogenic, inasmuch as the curative agency in the sick was also the sick-making power in the healthy. In truth, the different principles presiding over the several measures concerned in the restoration of the sick and the injured are complementary and not antagonistic to each other. The ardent Homoeopath, conscious of the transcendent value of his method, need have no fear that a strict construction of the law he rests upon, and proper recognition of its limitations, will belittle its importance and weaken its hold upon the world. Confined to its legitimate sphere it covers ground enough and calls upon its ministers for enough 100 world’s homceopathic congress. work to employ the brightest intellect and most stalwart energies of a man for a very long life-time. 2. In regard to the future of Homoeopathy, my second proposition is, that its basis and governing principle will survive all changes that may come, only more clearly defined and strongly established by human experience . It cannot in future, more than now, supply to the physician fac- ulties to observe and note the symptoms of a case of disease on the one side nor of drugs on the other; nor can it furnish him with reasoning faculties rightly to compare them ; but it most unmistakably points out the relationship between the two sets of symptoms which must be present when cures result. 1 can conceive of no discoveries possible in any department of medicine that can supersede or invali- date the truth arrived at by Hahnemann’s generalization of facts, and over and over again confirmed in the treatment of the sick. So long as the human organism is what it is, and the impressions of morbific causes and the resisting efforts of the vital forces what they are, there is an everlasting necessity that the medicinal influence that proves curative shall make its impression upon the same tissues and in a manner similar to that of the morbific. That medicines acting otherwise may prove palliative or remove the causa morbi and thus be needed at times, we do not doubt, but most cheerfully ac- knowledge. The whole order of man’s physical nature must be reversed, so that reaction does not follow action, and so that the continuing or lasting functional condition is not opposite to that directly induced by pathogenic agencies, if a time ever comes when the Homoeopathic method fails. Terms may be changed, and explanatory theories may be different, but the essential relationship between the disease and the remedy will ever be Homoeopathic ; and, I may add, that such must be the case, however the curative impression is made, whether by a single drug or a combination of drugs, by heat or cold, by elec- tricity or massage. 3. My third proposition as to the future is, that the pathogenesy , or drug symptomatology constituting the Homoeopathic Materia Medica, will be more thoroughly obtained and carefully displayed. When Hahnemann came to understand the requirements of the Homoeopa- thic law, and saw the necessity of true drug pictures, for comparison with the various disease-pictures presented to the physician, he soon THE FUTURE OF HOMOEOPATHY. 101 realized how poorly adapted to his purpose were the current works on materia medica. The most he could there learn of the remedies related to their cathartic, emetic, antispasmodic, and other such gen- eral effects on the sick. Experimentation, to ascertain their physio- logical or positive influence on the healthy human organism, had not then been started. He soon announced the necessity of proving drugs upon the healthy instead of the sick, and himself became a prover. But, poorly supplied with means, and assisted at times by students of his method, he worked on with one drug after another, adding to the symptoms thus obtained what he could gather from reported cases of poisoning, till he was able to form a new Materia Medica, which he published in 1805 with the modest title Fragmenta de Viribus Medicamentorum Positivis. Good as were the results of his work, compared with the collec- tions of the old Materia Medica, they yet came short of the demand of similia. It must ever be regretted that he allowed symptoms taken from the sick, while using remedies, to be recorded as drug symptoms. And his neglect to preserve and publish the records of each proving in the narrative form has been a lamentable defect. His publication of drug symptoms in schematic form, disconnecting and putting them out of their natural order, left them less useful to the practitioner and the writer of Materia Medica than they would or should have been. In following the Homoeopathic principle, it is often quite as important to have a similarity in the order as in the other qualities of the symptoms compared. With regret I men- tion the fact, that subsequent pro vers, with few exceptions, possessed of superior advantages for the undertaking, have allowed the same defects to mar their work. Only of late has there been an attempt to gather and publish our drug provings in narrative form. The British Homoeopathic Medical Society and the American Institute of Homoeopathy, a few years ago, together secured the publication of the Cyclopaedia of Drug Pathogenesis , under the lead of the great Materia Medica scholar, Dr. Richard Hughes. The four large vol- umes contain all known records of reliable provings, except those embraced in the Materia Medica Pura and Chronic Diseases of Hahnemann, which it was thought best to let stand by themselves. Valuable as the Cyclopaedia is, it would have been yet more valuable had all the provings detailed been made, and the symptoms recorded, in a more thorough and discriminating manner. While it is the best we have, it is not equal to the future best. 102 world’s homoeopathic congress. At this point, I beg to be excused for a slight personal mention. Just thirty-six years ago, in this city, I read a paper before the American Institute of Homoeopathy upon the defects of our patho- genesy, and proposed for its improvement a college of drug provers — an institution under competent management, having a body of students, male and female, acting as subjects of drug influence while receiving medical instruction, during the long vacations in the ordi- nary medical schools : and, while under expert observation, all the means for detection and measurement of abnormalities, useful in diagnosing diseases in the sick, being employed. I showed the un- avoidable defects in provings made, here, there, and everywhere, by busied, wearied, and worried physicians, exposed to the vicissitudes of weather and sick-room influences, with little if any critical obser- vation of their symptoms. Again, and again, in after years, I urged the profession to take hold of the work, and make our Materia Medica more in keeping with our matchless therapeutic law. I am happy, on this great occasion, to say that the tendency is now toward more thorough and careful drug-experimentation, not only in our school, but in the Old School as well. Dr. T. Lauder Brunton, one of the brightest of all the orthodox teachers of Materia Medica in England, writing of the therapeutist, not long ago, said : “ Evidently it is his special province to find out what are the means at command, what the individual drugs in use do when put into the human system. It is seemingly self-evident that the physi- ological action of a remedy can never be made out by a study of its use in disease.” The increasing number of liberally educated young men in our ranks, who are critical and logical, not satisfied with observations casually made and experiments not properly guarded against sources of error and corruption, look with surprise upon the rank and file of the profession apparently satisfied to go on year after year, depend- ing upon a hash and rehash of what was not entirely sure and reli- able at the outset. It need not be surprising if, ever and anon, some of them become disgusted with the “Tithing of mint, anise and cummin” in those who are apparently heedless of the “weightier matters of the law.” If the plan of a college of provers is Utopian, and if the influence and power of drugs cannot be ascertained by direct and scientific experimentation, we may as well consider the abandonment of drugs. THE FUTURE OF HOMCEOPA TH Y. 103 One alternative is left, if the present encouraging prospects fails and the physiological laboratories and thorough drug provings do not come, the trade circulars of the great drug houses, displaying the refreshing romance of clinical experience, that are being showered upon our desks like the leaves of Vallambrosa, may enable us to practice empiricism with some hope if with no satisfactory fruition. But, jesting aside — the healthy vital test will not fail. I leave its consideration now, with the remark that the great uni- versity that shall lead the way by devoting its entire medical depart- ment to Original Research in Physiology and Pathogenies will cover its name with glory and bring to its regents and faculty and student- experimenters the gratitude of the world during all time. 4. Looking again to the future of Homoeopathy I remark that some changes are to come in matters of pharmacy and posology. While drug substance will be commuted far enough to render its particles susceptible of absorption and conveyance to the tissues to be im- pressed, or to expand its surface for more ready contact; and while it will be attenuated and mixed with neutral vehicle enough to render it easy of division into proper doses, it will not be treated by bottle- washing methods in the effort to get rid of the drug altogether and secure only its disembodied spirit. The unmerited odium that our peerless law of cure has been obliged to bear, these many years, by reason of the unwillingness of some of its adherents to employ the sensible doses with which the law itself was demonstrated and with which its most striking victor- ies were won, will be wiped away. I have now spoken of the leading changes destined to come in the interior economy of Homoeopathy and its practical applications, namely, as to its legitimate domain, its persistency or permanency, its pathogenesy and its posology. I must now briefly refer to its future position and relations in the general medical world. External Relations. — It is a great mistake to suppose that Ho- moeopathy is found only in the practice of men calling themselves Homoeopaths. Not only has its negative influence wrought changes in the therapeutic measures of the masses of medical men in all en- lightened countries causing them to abandon blood letting, blister- ing and heavy doses of poisonous drugs — it has brought the most intelligent of them to prescribe many of our remedies, as we do, in 104 world’s homceopathic congress. obedience to the rule of similars, and in small and pleasant doses. It has caused them to look upon the healthy human test as the proper mode for the study of drug influence in the formation of materia medica. It has also led them to pay a great deal more atten- tion to dietetics and general hygienic measures; and why, pray, should it not do so, since they have often attributed our undeniable cures altogether to such regulations? Our successes and evident favor among intelligent and influential people have gradually raised us in the esteem of our Old-School brethren, till their society doors are open to us on the simple condi- tion that we drop the qualifying term “ Homoeopath ” from our list of titles. And we are no longer regarded as beyond the pale of pro- fessional recognition and help by reason of our additional acquire- ments in therapeutic knowledge ! But, putting all levity aside, we hail with satisfaction the growing acceptance of our views and adop- tion of our measures, and would be far from saying one word calcu- lated to prevent so great an improvement in the current medical practice and such positive benefits to the sick under its care. We do not insist upon their calling themselves “ Homoeopaths” in order to enjoy the use of remedies that we know cure Homoeopathic- ally ; nor, on the other hand, do we see any occasion for us to drop that title from our institutions because we recognize and employ now, as always, surgical, chemical and mechanical, and other means which are neither Homoeopathic nor Allopathic. I fail to see why we should be any worse for the use of a name that indicates very cor- rectly our confidence in the principle similia, when no medical man can be so ignorant as to suppose that we do not understand and follow other principles and use other measures as occasion demands. In conclusion, upon our future name and relations, I would say that when the right of every educated physician to choose his method and means of cure becomes generally recognized, and his privilege to candidly state his 'views and temperately criticise the views of others on the floor of any medical society or in any medical journal, is accorded without reproach or abuse — then, and not before, may it be expected that the societies and institutions of the New School will be disbanded or known by no distinct sectarian title. It cannot be forgotten fhat our organizations, our journals, col- leges, hospitals and dispensaries were matters of necessity for the maintenance of our freedom to choose and apply the new therapeutic THE FUTURE OF HOMOEOPATHY. 105 measures and to extend their benefits to suffering humanity. But for them, the most important reform in the art of healing now en- joyed would have been arrested at the start. With the freedom existing in associations for scientific research and the promotion of social reforms, where each idea and proposi- tion may have a hearing and due consideration, there would be no excuse for different schools or separate organizations in medicine. The only unity possible among medical men and medical associations will be the kind that consists with diversity and with the liberty on all sides to think and work, with all due respect, each on his own lines. Physicians should be as free to criticise each other’s opinions and measures as are lawyers, whose sharp contests make them none the less personal friends to each other and none the less worthy members of the bar. As matters stand, the right forward step to secure unity is one of common politeness by one medical man toward another and by one association toward others. It requires no disagreeable concession or damaging compromise for one to treat another with the courtesy due among men equally educated and equally devoted to the same cause. There needs to come among us a “ Y. M. M. A. a Young Men’s Medical Association, that, like the “ Y. M. C. A.,” can practically solve the great problem of unity in diversity and secure working relations between medical men and medical organizations, which- with a common purpose in view, are now moving forward on dif- ferent lines. A special dispensation of mercy alone can save us, if we are more bigoted and touchy, or have less of practical sense than the religious sects, that the Christian young men are, even now, gradually pull- ing together. Discussion. The Chairman : This paper will now be discussed by Dr. B. W. James, of Philadelphia, Pa. Dr. James, of Philadelphia : Mr. Chairman ; This papers covers the ground so thoroughly that if I only said that I approve of all the views expressed therein, I think I might rest my discussion there. But I will say that I agree with him in several points, and yet there are other points on which he might have touched in which I think the future of our system in its development will be grand and progressive. I agree that it has nothing in opposition to other principles of medicine — other true principles of medicine — that will 106 world’s homceopathic congress. conflict with it in its progress. That its rise and the discovery of the law was peculiar — and its progress is peculiar simply because in past centuries there was no known scientific law, I might say of per- manency in the Old School, which could guide every physician in the application of his remedy to every known set of symptoms or to any known disease, and we know that whenever an epidemic occurs we care not for the man ; we care simply for the symptoms, and we treat those symptoms by the law of similars scientifically, and I be- lieve that the application of these remedies in diminutive doses is the proper mode, the only one, that will ever be demonstrated phys- iologically to be the true one. Anatomists and histologists tell us that the different organs are made up of tissues, and these tissues are sub-divided into minute forms, and these are built up of cells microscopically small, and that these minute cells have a special and definite action, not only in the formation of those tissues but in their ability to carry through these tissues the principle of life, removing the waste and supplying new material ; and when there is a disturbance in these minute micro- scopic cells we have disease. How are those cells to be brought again into harmony? I believe that remedies must be so diluted, or made so fine, that they must reach these microscopic cells, and that the method which came in along with the law of similars is the one which divides the remedy so that it can reach the cells. But beyond all that, these cells each have their own respective spheres of action, and you take the cell of one organ, for instance the cell of the pancreatic gland, and the cell of the liver, and of the salivary gland, and each will carry its own product. It will have the food which makes its impression upon the others individually and sepa- rately ; and I believe that such is the action of remedies in the prov- ings upon a healthy body. Each remedy selects certain tissues, just as the nutritious principles do, and there is the need of the proving of our remedies upon the healthy system as Dr. Dake has stated. The proving of these remedies upon the healthy tissues points out the definite ultimate cells upon which each remedy acts. Thus we know that some remedies act upon the nervous system; some upon another part. The scientific application of a remedy to these cells, and structures, and organs, must be upon some definite plan such as we have found out through Hahnemann’s law of similars, and the proving of drugs. But I will call your attention to the indelible nature of the impress which Homoeopathy has made upon the world. It has been made not only upon the profession, but upon the laity and I believe it will be permanent. Difficulties have arisen along the pathway of Homoeopathy but they have been all overcome ; and the future difficulties, as they may arise, will all be surmounted and our system in the future will grow and strengthen throughout the ages. THE FUTURE OF HOMOEOPATHY. 107 The Chairman : This paper will be farther discussed by Dr. Lizzie Gutherz, of St. Louis, Mo. Dr. Gutherz: Mr. President , Ladies and Gentlemen: A mother , in India once said to me: “ My dear, when the bread is not prop- erly baked and the meat is not thoroughly done, don’t call the atten- tion of your guests to it for they will probably never find it out.” And yet, after listening to the essayist saying that thirty-six years ago in this city he read a paper before a convention, I hesitate to discuss a paper written by so able and gifted a man as Dr. J. P. Dake, and on a subject so far reaching, so vast, so pregnant with in- terest to all as the future of Homoeopathy. The essayist takes the ground that Homoeopathy will be more clearly defined in the future, yet the principle of similia similibus curantur , taught by the im- mortal Hahnemann is the same to-day as it was in the past. He tells us that the governing principle will survive all the ages, only it will be more clearly defined and more strongly established in human experience. In this free land of ours the great future of Homoeopathy is to be placed before the world, and in our city the pharmacists and druggists tell us that where Homoeopathy has most thrived it has modified the healing art of the Old School, that they don’t give their poisonous doses in the same heavy way that they once did. It is through the colleges and their high standards that our cause will be benefited further. Examining boards, when com- posed of only one school, are political machines and ought to be abolished from the face of the earth. The educated people of the country are coming to the front and accepting our school in a way that never would have been acknowledged had it not been for this association. The intellectual men who compose this body, through their intellectual ability, purity and truth, have placed a gem in the diadem of Homoeopathy that no other school has ever known. The Chairman: Dr. I. T. Talbot, of Boston, will now discuss Homoeopathy in the medical colleges and hospitals of the United States. 108 WORLD S HOMCEOrATHIC CONGRESS. ADDRESS. MEDICAL EDUCATION IN THE HOMCEOPATHIC HOSPITALS AND COLLEGES OF THE UNITED STATES. By I. T. Talbot, M.D., Boston, Mass. At the Fourth Quinquennial Session of the Homoeopathic Con- gress held at Atlantic City in 1891, I had the honor to present a paper on “ The Duties and Responsibilities of Homoeopathic Col- leges as Leaders in Medical Progress.” This essay met with the approval not only of the Congress but of the American Institute of Homoeopathy and of its Intercollegiate Committee and some of its suggestions have been adopted by those bodies. The four years’ course of required study has been made the rule for all our recog- nized colleges. Without question, this single step was the most im- portant one ever taken in the cause of medical education in this country. With mature age, a thorough preliminary training, a year spent in the study of the collateral branches of medical science, and three subsequent years of solid work in properly equipped medical colleges, there can be no doubt of the great elevation thereby of the standards of medical education and of the rapid development of medical science in all its departments. In considering at this time the subject of “ Medical Education in the Homoeopathic Colleges and Hospitals of the United States,” I desire to refer to the paper mentioned as containing certain im- portant matters on which the subject of future medical education properly rests, and without repeating what was then said, to con- sider our present position and the proper methods for future pro- gress. In the first place let us consider and acknowledge the debt we owe to our medical colleges which, established and sustained at great effort and expense, have done so much for the development and MEDICAL EDUCATION IN HOSPITALS AND COLLEGES. 109 spread of Homoeopathy, and with it the advancement of medical science in this country. From these schools within the last forty -live years, about ten thousand physicians have been graduated and are scattered in vari- ous parts of this and foreign countries. The great majority of these have become good practicing physicians with a knowledge of Ho- moeopathy which, but for these schools, they probably would never have attained, while many have become distinguished in science as well as medicine. These medical schools and colleges have often labored under the greatest disadvantages. Not only have the instructors at times been unable to illustrate sufficiently their teachings by clinical results, but students have oftentimes been debarred from the chance of visit- ing hospitals in which they could practically study disease. With effort and energy these obstructions have been largely overcome, and the schools which from the first could find their counterparts in the greater number of other medical schools, have as a rule so utilized their possible opportunities that even their clinical instruction now equals the average amount, and in many cases far exceeds it. At the present time there are sixteen Homoeopathic colleges recognized by the Institute, and three or four others which have been organ- ized. While I shall not in this paper attempt to do justice to any college, those represented in the American Institute of Homoeopathy will be briefly mentioned. Of these, three are connected with State Institutions, viz. : The Homoeopathic Departments of the Universi- ties of Michigan, Iowa and Minnesota, and are supported by their several States. If these schools continue to be properly conducted and successfully managed, there is no doubt that the people of those states will feel sufficient pride in their success to contribute the necessary means for their support and proper equipment. The Hahnemann Medical College and Hospital, of Philadelphia, is the successor of the Homoeopathic Medical College of Pennsyl- vania, established in 1848, and while it has done valuable work from the beginning, it has within the last ten years made its greatest advance. It has secured an eligible location, and erected thereon a fine building for a college, dispensary and hospital ; and its success fully warrants the far-seeing policy which planned and executed these improvements. Of the work which is being done there, any college may well be proud, and its graduates are an honor to the medical profession. 110 world's homoeopathic congress. In Cleveland, the second Homoeopathic college was established in 1849, and though it has labored under many disadvantages yet it has made much of its opportunities, and the greatest credit is due to the courageous, self-sacrificing founders and supporters of that in- stitution. Earnest and faithful work has been done therein and upon its roll of graduates are to be found some of the ablest physi- cians of our school. Later a division of the school established a second college in that city, the Cleveland Medical College and though many regretted the division, yet we cannot say but what the stimulus of enthusiasm and determination which opposition some- times engenders may make both of these schools in the future more efficient than either would be alone. In 1858 the Homoeopathic Medical College of Missouri was estab- lished, and though it has met with many changes and alterations in fortune, yet there can be no question that much work of real value to the profession has been accomplished there, and at present its pros- pects are perhaps brighter than ever. In 1859 the Hahnemann Medical College of Chicago, chartered four years previously, opened its doors to students, and there are some here present who remember the severe struggles and sacrifices which were required to establish and support this school in its ear- liest years. The amount of energy displayed and the success which has attended it are only characteristic of the wonderful city in which it is located, and among its alumni are found many of the most in- fluential men of the profession. The experience of this school, like that of Cleveland, shows that differences of opinion may widely sep- arate friends, and the establishment, in 1876, of the Chicago Homoeo- pathic Medical College caused much severe criticism, yet the success which has attended it and the amount of good work done may per- haps justify its founders. In 1860 the Metropolitan City, New York, established the New York Homoeopathic Medical College, and from the large number of distinguished physicians in that city it has always secured an excep- tionally able faculty. That it has had its struggles goes without saying, but in the establishing of hospitals which could be used for clinical teaching, New York exceeds in number any other city. The wealth and influence of that city should give advantages to the col- lege which no other location in this country could excel. In 1863 the New York Medical College and Hospital for Women was established under favorable auspices, and though colleges for MEDICAL EDUCATION IN HOSPITALS AND COLLEGES. Ill women alone have met with strong opposition, even from their own sex, yet it has struggled on until it has obtained a success gratifying to its early friends. In 1872 the Pulte Medical College, of Cincinnati, was established, named for, and to a certain extent assisted by, our distinguished confrere, Dr. J. H. Pulte. That it has done much valuable work is certain, and many of its graduates are to be found holding prominent positions. In 1873 Boston University established its School of Medicine. It was not an easy matter, but it has proved a success, and from the first has maintained a high grade of scholarship. An entrance (?) which shall be in preliminary branches, — and during this first year students may be under special instruction of a physician, — after which three years must be spent, before graduation, in attend- ance upon the college courses. When we consider the great advance in the methods of medical study which has been made in the last few years, and see the very decided changes from didactic to clinical instruction ; when students who, not many years ago, were graduated simply in recompense for fees taken, while now examinations more or less stringent are required in every case, we can but feel that these changes in method are doing much for the improvement of medical instruction and the advance of medical science. The change has indeed been very great, and while the tendency is still in the direction of improvement, and the whole sentiment of the schools, the profession, and the community requires more thorough instruction, is it not well for us to consider how far we may progress in this direction to advantage, and not to hesitate or stop until we have reached the most useful limit? It has often been the case that the student who acquired his de- gree in the shortest possible time and knew the least of medical sci- ence was the most confident of his own superior knowledge, and was sure that he knew about all there was to be learned. On the other hand, the physician who has been thoroughly instructed finds open to him so many sources of learning and so much of the unknown in the ever- varying forms of disease, that he is the more ready to de- vote himself to study until he has mastered at least a modicum of what science has revealed in medicine. The ignorant u doctor,” if such a solecism may be allowed — in which to acquire all that is nec- 112 world’s homoeopathic congress. essary for his purposes; how much time is essential for the student to spend in acquiring the necessary amount of knowledge to make him the learned physician — the one who is to give such character and tone to the profession as shall command the respect of the com- munity and the confidence of his associates? The four years’ course as marked out by the Intercollegiate Committee of the American Institute of Homoeopathy is certainly excellent, but does it go far enough ? The first year is given to elementary medical study ; there are then but three subsequent years given to the whole of that sci- ence and art, than which none is more comprehensive and varied. After the most careful study of this subject in its various phases, this time seems altogether too short to accomplish the needed work, and at least five years should be required from the time of leaving the ordinary literary studies to acquire essential knowledge of a sub- ject so intricate as medicine. The following presents a comprehensive schedule of the required work : First Year. General Chemistry (Laboratory Course and Recitations). Physics (Laboratory Course and Recitations). Zoology (Laboratory Course and Recitations). Botany (Laboratory Course and Recitations). Microscopy (Laboratory Course). Medical History. Latin. Second Year. General Anatomy (Recitations and Dissections). Physiology (Recitations and Laboratory Work). Histology (Laboratory Course). Pharmaceutics (Laboratory Course and Recitations). Minor Surgery. Sanitary Science. Dietetics. Third Year. Anatomy of Nervous System and Special Organs (Dissections). Embryology. Physiology (Laboratory). MEDICAL EDUCATION IN HOSPITALS AND COLLEGES. 113 General Pathological Anatomy (Demonstrations and Recitations). General Surgery. Materia Medica. Obstetrics. Fourth Year. Pathology and Therapeutics. Special Pathological Anatomy (Laboratory Work). Operative Surgery (with Clinics and Laboratory Course). Topographical Anatomy (Dissections). Materia Medica. Obstetrics (Clinical and Operative). Diseases of the Chest and Throat. Clinics. Fifth Year. Pathology and Therapeutics. Diseases of the Nervous System. Diseases of the Skin. Diseases of Women. Diseases of the Ear. Diseases of the Eye. Electro-Therapeutics. Medical Jurisprudence and Ethics of Medicine. Dispensary Practice. Clinics and Clinical Reports. Thesis. In addition to the subjects already enumerated, there are con- stantly arising many points of practical instruction suggested by the different forms of disease and the accompanying circumstances, which can be discussed by the various instructors with great value. Time becomes an element of importance, and the student, however stupid, by continued contact with those well learned in the various subjects, will gain a large amount of knowledge. But it can be readily seen that a medical school for the proper teaching of all these subjects requires the most extensive facilities, which are necessarily attended with great expense. The hospital should be large and commodious, the dispensaries sufficient to afford the greatest amount of clinical work, the numerous laboratories 8 114 world’s homceopathtc congress. thoroughly equipped, with a sufficient number of competent in- structors to properly direct the course of the student, and clinical material should be secured to illustrate as fully as possible all the essential points in medicine. The very detail of this work is start- ling, almost appalling, but the end to be gained — the physical ad- vantage of the whole human race — makes the subject one well worthy of the greatest human effort. Is there any class of physicians to whom we could appeal for this with better reason than to those of our own school ? From the time of Hahnemann to the present, those who believe in his principles have, as a class, been independent, earnest, progressive men, not accustomed to shrink from sacrifice or personal effort ; are they not equally ready now? It is not a matter of a few months, or even years ; but it is for us to set our standard of what should be done as high as possible, and then bend our efforts to its accomplishment, whatever time it may require. We are now nearly at the close of the nineteenth century, envi- roned by mental activity and a rapidity of progress before unknown in the world’s history. Here in the City of Chicago, which stands pre-eminent for its energy and powers for great success, may we not take on some of the qualities of our surroundiugs, and determine that at the beginning of the twentieth century in all the Homoeo- pathic colleges of this country we will aim to reach the high stand- ard of medical education which five years of close study can alone give to the physician. Discussion. The Chairman : The address will first be discussed by Dr. O. S. Runnels, of Indianapolis. Dr. Runnels : Homoeopathy to-day holds pre-eminence in mat- ters educational, and we want to do nothing here that shall in any way take her down from that proud position. We must keep our forces well to the front and be the leaders in all educational matters, for it is a fact that the American Institute of Homoeopathy is the only national body that requires the high standard that she does. There is no college there recognized that does not require a four years’ course from her students. That is a great advance. And for several years students matriculating have been informed that they are to have a thorough education first, and that they can get their degree in no other way. I am sure that Dr. Talbot has taken the right stand here to-day in looking forward to a time when greater requirements must be had, when the student shall have to pass MEDICAL EDUCATION IN HOSPITALS AND COLLEGES. 115 five years in preliminary work before he can go forth to practice. A great deal depends upon the stand the laity takes in this mat- ter. Medical colleges can will to do certain things, but unless they are supported by the profession at large they will be powerless to accomplish that work. I think the medical profession should patronize no college which does not require the highest of their stu- dents. From the earliest times in Homoeopathy we have been friends of education. We look back to a founder who was not a mounte- bank, but who stood at the very top of medical requirement, and so all along down the line, our leaders have been men who have shone in the firmament of knowledge. The Chairman : The address will be further discussed by Dr. A. P. Hanchett, of Council Bluffs, Iowa. Dr. Hanchett : I feel illy prepared to discuss this question, for I have only heard the paper as you have heard it. I have a feeling of pride and of great satisfaction at all times to know that the repre- sentatives of our school of medicine could feel that their position was on firm ground, that we had taken the lead in the matter of a higher education. A few years ago when one of our Western States organized its board of examiners, and the question of schools and colleges came up, the diplomas from which should be accepted as credentials, the whole field of the medical colleges was thoroughly and carefully can- vassed. Something like 150 schools that issued diplomas were found to be in existence in this country ; of that number but fifteen were Homoeopathic. Ten per cent, of the Allopathic schools were ruled as unworthy to have their diplomas recognized, whereas 100 per cent, of the Homoeopathic colleges were pronounced by this non- partisan board as thoroughly reliable, and whose diplomas should pass current. It strikes me there was one point in this paper which was over- looked, and that was the requirement for preliminary education. Before a student approaches us we should say, are you ready young man, or young woman, to commence the study of medicine? have you, had the mental training that must precede it? And then if we should positively demand such preparation we would bring a better class of men and women into our colleges. I contend that the medi- cal profession must make the same requirement made by some of our religious denominations. I understand that in some of them they are not admitted to the theological schools until they bring a diploma showing a classical education and thorough mental train- ing. It is this preparation that I am laboring for, and I have many times expressed the conviction that I should accept no student who has not had a thorough training or a college course. In that way only I believe are we to bring the standard of our medical men up to where it should be. 116 world’s homceopathic congress. The Chairman : The paper will be farther discussed by Dr. T. G. Comstock, of St. Louis, Mo. Dr. Comstock : I was very much pleased with Dr. Talbot’s paper, and I thought the Congress might be proud to know that the Boston University was the first to insist upon a four years’ course of study, and if you will look over the catalogue of the Boston University you will find for several years that one- third of the students are A.B.’s. Now one year ago at Philadelphia I had the honor of being the Presi- dent of the Alumni of the Hahnemann Medical College, and made an address there in which I insisted that hereafter none should enter a medical college unless they had the degree of A.B„, and moreover, I made the prediction that within ten years from now every medical college would require a course of five years instead of three as at present. The Chairman : As there is no further discussion on this ad- dress the paper of Dr. Alexander Villers, of Dresden, Germany, on “ Historical Development of Homoeopathy in Germany,” will be read by the Secretary. HISTORY OF HOMCEOPATHY IN GERMANY. 117 ADDRESS. HISTORY OF HOMCEOPATHY IN GERMANY . By Dr. Alexander Villers, Dresden. At an international meeting, like our Congress in Chicago, I can- not, nor dare I, discharge the duty allotted to me, to give the “ His- torical Development of Homoeopathy in Germany,” in the ordinary manner as is customary with such retrospective work. You may read in all newspapers, of the numerical increase or decrease of the adherents and the representatives of Homoeopathy. The interest re- garding hospitals having been erected or having ceased to exist, does not extend beyond the respective country or city. But considering the total aspect of the development of Homoeopathy in Germany, we must be surprised at the fact, that Homoeopathy has made so little progress in the land of its birth, and why now, after existing almost a hundred years, its representation in medical circles in Germany is still so limited, whilst the general public is continually increasing its demand for it. If we compare other countries in this direction, especially the United States, we find that, since Homoeopathy has been introduced in America, a much stronger development has been accomplished there, in a much shorter period. Although we know from pathology, that fresh germs develop more rapidly than older ones, we cannot attribute this wide difference in the evolution in both countries to the “ need of expansion ” of the newly established medi- cal fraternity only. At the time when even here, the first disciples of the master came forward with apostolic inspiration, their number was small, their activity rarely exceeding their near surroundings. The progress of civilization is warranted by the continuation of intellectual work, not merely by single individuals, but also by entire nations, as soon as the love or the power to work, has weakened in the predecessor. Thus the entire medical science during the Middle Ages was under the influence of Humoral pathology delivered down from the Arabs, until German labor broke this spell, and the first 118 world’s homoeopathic congress. standard-bearers of a new medical era appeared in the persons of Vesalius and Paracelsus. While Vesalius introduced the anatomical investigation, and in consequence, the foundation of the objective proofs for medical conception, Paracelsus opened the way to a view of life and the living body, which we find a remarkable admixture of physical interpretation and purely philosophical speculation. It is natural to the average man that he is more attracted towards the fantastic centre of theoretical views, than toward the cultivation of dry, barren soil of thorough investigation. Thus the contemplative part of the teachings of Paracelsus were strongly brought forward, and the Archaeus Maximus still reigned supreme in Germany, whilst the Romans and Anglo-Saxons, already showed more interest for a physiological and anatomical basis of their theories. From the Archaeus , Stahl constructed the conception of a “ soul,” which was worthless to natural science, thus originating the school of the Ani- mists, and the main object of the natural philosophers at that time was the interpretation and formulation of life-force. At this period Hahnemann makes his appearance. He emphati- cally demands the experiment; only upon such a safe foundation will he erect the new structure of his Similia Similibus therapy. In this he is a follower of Vesalius and a most prominent pioneer of modern physiology and pathology. But on the other hand, he studies the life-force and its derangements and seeks to remedy the latter by the administration of medicinal potencies, which are to work only dynamically, not physically. At that time of philosophical speculation, his demands for experimental proofs were not under- stood, and later on when the experimental objective tendency of the French anatomical school became prevalent also in the medical sci- ence of Germany, his superabundance of views on life-force, dyna- mism, etc., prevented the appreciation which he fully deserved. If but only one of his many opponents had really read him and if this reader had taken pains to strip his arguments of the garments which they had to wear in accordance with the fashion of his day, it would have been long established, that Homoeopathy is the medicine of the future, because it always admits the proof of its assertions, thus rest- ing upon facts in the most modern sense. Naturally, Homoeopathy refrains from using rounded expressions, so to speak, scientific idioms like other therapeutic schools; as for these it is too clear and despises the cloak of phraseology or the finely formed technical terms for the designation of conditions of which the recognition is wanting. HISTORY OF HOMOEOPATHY IN GERMANY. 119 But the attempt, to adapt Homoeopathy to the dominant school of medicine, has been made repeatedly ; partly by competent students, partly by men who did not grasp their object. The Homoeopath- ische Therapie auf Grundlage der Pkysiologischen Schule, by Dr.’ Joseph Kafka is undoubtedly the most able attempt in this direction in German literature. Kafka possessed the knowledge,, the intelli- gence and the energy to accomplish such a task. If he did not suc- ceed, the failure was not due to his want of ability but because of the inadequacy of the object. Let us hope that Physiology will explain to us in the future, why certain remedies will affect various organs of our body ; for even if we recognize “ organic remedies” for con- venience, as for instance, heart, stomach remedies, etc., we only wish to thus indicate that we know their action on those organs more thoroughly than that on any other regions; but we have to insist on the totality of symptoms for prescription. Pathological names of diseases are least suited as guides in the difficult selection of a remedy, as they mainly refer to an artificially constructed conception. The best proof for this is the latest investigation of causes of dis- ease. None of the vital functions of diseased germs can influence our selection of drugs, nor even the setiological points which pre- dispose the body, for the development of the former will help us in this direction ; but still our therapeutic success vastly exceeds that of the Old School in the treatment of infectious diseases, even when we do not know the character of the infection. While Kafka’s work is an excellent one of its kind, there is an- other book by an anonymous editor, published by Wilmer Schwabe, the Homoeopathic pharmacist, at Leipsic, which has done much to injure Homoeopathy. It makes the attempt to adapt Homoeopathy to the physiological school in a purely mechanical way. It simply substitutes names of Homoeopathic remedies in the place of Allo- pathic ones, after each chapter on special diseases, after a fashion of the small domestic treatises written for the laity. This book has done a great deal of mischief, especially in the hands of younger physicians intending to study Homoeopathy. Iu Germany, as well as every where, the general progress of Hom- oeopathy vastly depends upon its practical success with the public. The patients and their friends induce its spread ; notwithstanding their gratitude they really do little to actually further it. Only in one state of the German Empire, in Wurtemberg, the local society, 120 world’s homoeopath ic congress. Hahnemannia, successfully agitated the state government and the legislature. Hundreds of other minor societies who bear the name “ Homoeopathic ” have done nothing, their only aim being to get their remedies and periodicals at wholesale prices. For decades the business centre of these societies has been the pharmacy of the above- mentioned Dr. Schwabe in Leipsic, who, as a thorough business' man, has furthered and assisted them in every possible manner until he founded a private polyclinic as a branch of his establishment for the benefit of his customers, and became at last the greatest publisher of German Homoeopathic literature. Thus Schwabe’s pharmacy, with its branches, appears to be the centre of all Homoeopathic in- terests in Germany in the eyes of those who stand outside the real Homoeopathic fraternity, but who incline towards them. Certainly five-sixths of those young physicians who became Homoeopaths during, the last ten years have there received their Homoeopathic training, or have at least spent some time there. Therefore, these young men have taken Schwabe’s book, with the anonymous editor for a guide in their studies. For those who have been so familiar with the Allopathic fashion of having the remedy fitting the disease, this book naturally seems very convenient and promising. Only later on, after they have become acquainted with a thoroughly edu- cated Homoeopathic physician, they begin to perceive that the study of Homoeopathic Materia Medica is something entirely different, and that real success can be gained only by the careful, dry study of symptoms. This is the reason why a large number of Homoeopathic physicians, now practicing in Germany, are not in the position to make a scientific propaganda for their method. They do not much exceed the enthusiastic laity in the defence of their views. But for this reason again our colleagues of the dominant school find no interest for a science in the public representatives of which they rec- ognize mainly laymen or half-educated physicians. In Germany it is the traditional duty of every Homoeopathic physician to first acquire all general medical knowledge like all his professional colleagues, and after the close of his studies receive the permit to practice as a physician by a state examination. We are not sorry for this indirect way, as we thus gain the proof that we are scientifically educated physicians, if doubted by our opponents. A future time may perhaps give us separate institutions for clinical in- struction, for until now we are still restricted to private studies for HISTORY OF HOMOEOPATHY IN GERMANY. 121 a specifically Homoeopathic education. There is only one clinical institution, aided by the state government, under the control of the Homoeopathic Central Society in Leipsic, but this is much curtailed by the flourishing private clinic of Schwabe’s pharmacy. The hospital of the Central Society in Leipsic is successful, but has not been assisted by general interest. Munich has a small Homoeopathic hospital, under the supervision of Dr. Koeck, but this is not generally known. Berlin has the funds for the erection of a hospital, but the society for its erection has not yet been granted the governmental permit, without which the undertaking cannot proceed. The government will not support Homoeopathy in the near future, although many persons of high rank are its adherents. Only in the state of Wurtemberg the official physicians are compelled to acquire a general knowledge of Homoeopathy. Homoeopathic literature in Germany is represented by one of the oldest existing Homoeopathic periodicals : Die Allgemeine Homceo- patisclie Zeitungun Leipsic; (2) Die Zeitschrift des Vereins Berliner Homoeopatischer Aerzte ; (3) Archiv fuer Homceopathie, founded by me ; (4) Die Leipzig er Populaere Zeitschrift fuer Homceopathie; (5) the publications of the “ Hahnemannia ” in Wurtemberg; and (6) Dr. Schlegel’s Wegweiser zur Gesundheix in Thuebingen. Of these periodicals, the first one has no programme any more, as it has three different editors. It also publishes, in the interests of a small circle, who congregated under the name of Epidemieological Society, which hopes to improve Homoeopathy by the teachings of Dr. Weihe, who adds a number of sensitive nerve points to the symptoms of individual remedies, at the same time attempting to revive the old theories of Rademacher with regard to epidemic remedies. The Berliner Zeitschrift tends to find a modern expression for the doctrines of Homoeopathy, hoping to advance the latter by adding pathological and physiological views in the selection of the remedy. The Archiv represents the older tendency of Homoeopathy, the purely symptomic selection, and the use of high potencies. It is the only paper which cultivates international relations as much as possible. The other publications are written for the laity and are excellently edited, although their views cannot always be accepted, but they all show a decided aversion to concede to the physicians the 122 world’s homoeopathic congress. leadership of the party, for they, as laymen, consider the laymen supreme. The pharmacies dispensing Homoeopathic medicines exclusively are good and flourishing. Most all the German drug-stores have Homoeopathic departments, and it must be admitted that the apothe- caries who are celebrated for their conscientiousness also try their best in this somewhat heterodox territory. There are a few fanatics and immature youths who try to spite Homoeopathy by preparing and dispensing Homoeopathic drugs in a careless manner; but it must be emphasized that such dishonorable conduct is rare. I, therefore, advocate that Homoeopathic physicians should cease to dispense medicines themselves. In Prussia, the physician can re- ceive a permit by passing an examination; in other prominent states such a law does not exist. However, with this view of giving up the dispensing of medicines by physicians, I stand isolated with a very small number of friends, although we argue that for diplomatic reasons also we should not insist upon a right which we use exclu- sively, and which has caused the enmity of the entire drug trade. We should at once assist in an agitation for all physicians to prepare and dispense their own medicines, but we do not wish that this de- mand should apply to Homoeopathic physicians only. If we now recapitulate all that is to be said about the position of Homoeopathy in Germany, it is that we are again at the beginning of a rising tendency. A younger generation with modern views and education has joined our party; individuals of all circles of society needing medical assistance show greater interest in the new method of the healing art, and even though it be the economical side of our treatment which rouses the interest of the general public, as, for instance, the shorter duration of disease and the greater cheap- ness of the medicines, this is sufficient to guarantee the gradual recognition which we deserve. We Homoeopathic physicians are scattered in all directions and are overworked ; therefore, it cannot be expected for some time to come that Homoeopathy in Germany will appear prominent upon the great battlefield of scientific labor, but also among us indications ap- pear of an increased interest for a thorough investigation of our knowledge and for the good-will to join actively in the development of our school. But, above all, after a period of hopeless decline, we are inspired with the consciousness that we, as Homoeopaths, need HISTORY OF HOMOEOPATHY IN GERMANY. 123 not care whether we are acceptable to others, nor how we might make ourselves agreeable to them, but that we may expect to be asked for advice, for we consider ourselves the standard bearers of medical progress, so long as we remain true disciples of our Master, who held up to his contemporaries the warning and admonition : Aude Sapere ! Discussion. The Chairman : This address will be discussed by Dr. Dake. Dr. Dake : I want to say that I am exceedingly sorry that Dr. Villers was prevented from being here to read this paper himself. I had the pleasure of meeting him two years ago, and know that he would be a very interesting member in this Congress. We are glad to hear something of Homoeopathy in that country ; we are glad of these notes of progress and to be assured that our cause is living and growing there. A few years ago I made the acquaintance of a phy- sician of our school who told me that the greatest trouble they had in Germany, and I believe in other European countries, has been the control of the surgical staff of the army. They like to dominate and they do dominate, and so Homoeopathy has a poor chance to progress compared with what it has in America. They won’t give them a charter; they cannot have a school of their own to educate men in their own way; they have to go through the mill of the Old School, with its autocratic methods, and hence are laboring under difficulties; and they have our sympathies. Dr. Fisher, of Sydney, Australia : A^ery many of the older men, and at that time the most scientific men of Germany, were charmed with Homoeopathy, for Hahnemann’s language was strong, power- ful, and good. At the Berlin University Homoeopathy was flour- ishing. Chairs of Homoeopathy were established even in Heidel- berg. We are not allowed to establish colleges for ourselves ; there- fore Homoeopathic colleges under that name are few, but I have just been travelling over Germany, and Homoeopathy has not diminished. The Allopath adopts most of our views, though not under the name of Homoeopathy. Every pharmacy in Germany and in Prussia is obliged to keep a Homoeopathic department, under the supervision of the government. The book on therapeutics, published by Schwabe, of Leipsic, has done a great deal of good, and I am astonished it has not been translated into English ; it gives every disease and its treat- ment, and has induced many to make further investigation into Ho- moeopathy. The Congress adjourned until the following morning at 10.30 a.m. The Sections in Surgery and in Ophthalmology, Otology, and Laryngology held separate sessions at 3 p.m. and at 8 P.M., at which numerous valuable papers were presented and discussed. (See the reports on these subjects.) 124 world’s homoeopathic congress. THIRD DAY’S SESSION. June 1 , 1893 . The Congress reconvened at 10.30 a.m. Chairman Mitchell pre- siding. Upon motion, the hour of meeting for Friday morning was changed from 10.30 to 11.30. The Chairman: The Address of Dr. T. F. Allen, of New York city, on “ The Selection of the Homoeopathic Remedy,” is now in order. Dr. Allen addressed the Congress as follows : THE SELECTION OF THE HOMOEOPATHIC REMEDY. 125 ADDRESS. THE SELECTION OF THE HOMCEOPATHIC REMEDY. By Timothy Field Allen, M.D , New York, N. Y. The method of selecting the Homoeopathic remedy, promulgated by Hahnemann, required that the effects of the drug selected should correspond as closely as possible, both in number and in character, to those of the patient. This rule, requiring Homoeopathists to study the totality of the symptoms of the patient, must certainly be re- garded as a safe one in practice, and a rule which must, in many cases, be carefully followed ; but, as Homoeopathic therapeutics has developed and its practice extended, we see that this rule is usually disregarded, and that some who have endeavored to apply it, have abandoned the practice of Homoeopathy, as too difficult or too labor- ious to be followed in ordinary prescribing, or have resorted to the use of polypharmacy. The obstacles to the application of the rule requiring a totality of the symptoms should receive careful attention. They seem to be : First. The exigencies of business. It is practically impossible for a physician to apply this rule and prescribe for many patients in a day. Even Hahnemann himself, it is said, was not only a careful prescriber, but usually a somewhat rapid prescriber, and it seems probable that he did not, in a majority of instances, apply this method. Since his time, it has been observed that the greatest prescribers our school has known have been very rapid prescribers. This was notably the case with the late Dr. Lippe, of Philadelphia, who is said to have been one of the most accurate as well as one of the most rapid prescribers in the world. Second. The difficulty in applying Hahnemann’s rule of totality is frequently noticed in the lack of a complete development of essen- tial symptoms in individuals, especially in epidemics ; and it often happens that the proper prescription in a given case must be based 126 world’s homoeopathic congress. upon additional symptoms observed in other somewhat similar cases of the prevailing type of disease. Third. The difficulty in applying the totality is nowhere so much experienced as in the imperfection of our symptomatology, due partly to the fact that the provings are insufficient in number to develop a complete parallel to the case in hand, or to the fact that the provers have carelessly observed and imperfectly recorded their symptoms. Incomplete symptoms may be said to be the rule in our materia medica. The above practical difficulties to the application of Hahnemann’s rule should lead to a revision in methods of teaching, of study, and of the application of our materia medica. Fortunately, other methods are available for many cases, and must, sometimes, be resorted to. To these I briefly call your attention. First. The impressionist method — for I can call it by no better name. A physician who has studied well the development of the pathogeneses of any drug, will obtain a more or less clear idea of its sphere of action, and of its peculiarities, which will produce an impression apart from the memorizing of individual symptoms. Thus, the study of the potashes produces a general impression of salts which give rise to depression and paralysis, without febrile ex- citement, with great sensitiveness to cold, a general impression of sharp pains, of catarrhal affections, and with secretions varying in quantity in the different salts rather than in character, etc. One who studies Aconite obtains a lasting impression of mental and physical distress, restlessness, sometimes with profound cardiac weakness, at other times with violent neuralgia, but always a picture of anxiety and distress; and so on, through the Materia Medica. These im- pressions of drugs, derived from a study of their provings or cases of poisoning, are of the greatest value, especially in the treatment of patients who cannot relate their symptoms, such as children, or insane people, or those in delirium ; and a drug may be prescribed from such vivid impressions, even when the symptoms may not be known to correspond with those of the drug; sometimes, it seems as though a correspondence of isolated symptoms was a matter of very little consequence, so long as the general characteristic indications for the drug are present. Some of the most brilliant prescriptions I have ever known have been made by this method, and our knowledge of the sphere of the curative power of the drug may thereby be greatly THE SELECTION OF THE HOMOEOPATHIC REMEDY. 127 extended. It is a method to be used only by a master of our art, and if used carelessly it leads to disaster and failure. A second method is the key-note system. A physician selects one, or two, prominent, distressing or peculiar symptoms in a patient, which he takes to be characteristic, and bases his prescription upon them. It may be, perhaps, a single symptom which suffices to in- dicate the remedy. This method, carelessly followed, will lead either to the removal, one by one, of the isolated symptoms, without any marked effect upon the totality of the symptoms, or, the selection is apt to be faulty, and the symptom taken as characteristic, or a key- note, proves not to be one about which cluster the majority of the patient’s symptoms, or even of those of the drug; all this may lead to discouragement, and to the selection of different remedies for dif- ferent symptoms, to alternation, or to polypharmacy. Right here I would like to say a few words about the selection of keynotes, for it seems to me that sometimes this method judiciously applied may lead to most important results. Its proper application, however, depends, in my opinion, upon a thorough appreciation of the pathological nature of the disease from which the patient is suf- fering. This may sound heterodox, but I thoroughly believe that the relative value of symptoms can only be appreciated by a knowl- edge of the special pathology of the patient. If you will permit me to illustrate, I will take the familiar ex- amples of the Homoeopathic treatment of epilepsy on the side of symptomatology and of chronic degeneration of the kidney from the point of view of pathology. In properly apprehending and classi- fying the symptoms for the cure of epilepsy, very small account should be made of the immediate symptoms of the paroxysm : to be sure, this explosion or fit enables one to make the diagnosis of epi- lepsy, and without these symptoms the disease could scarcely be diagnosticated ; but really these symptoms are of little or no value in the selection of the Homoeopathic remedy. Their development depends usually upon a more or less chronic cachexia which under- lies and determines the disease. A condition of malnutrition or, if you will, of psoric taint which has been inherited or acquired, which may have been of slow development, which must be studied, and from which only will one be enabled to obtain indications for the remedy which will remove it. The Homoeopathic physician who attempts to get his keynote from the character of the spasm will fail 128 world’s homceopathic congress. as a rule to cure his patient, while it may happen that one or two prominent characteristics of the patient, derived from its cachexia, will enable a physician to select the curative remedy. In chronic kidney disease we find also a history of ill-health pre- ceding the development of the kidney trouble, but this condition be- comes modified by the development of the kidney-lesion, owing to the fact that the disease of the kidney itself gives rise to a series of secondary modifications of health, which have nothing to with the prodromal symptoms which determine the development of this kid- ney lesion. A correct understanding of the kidney disease and of its effect upon the entire organism becomes necessary in order to separate, as far as possible, these later developments from the earlier determining and essential features of the diseased condition of the patient, which, alone, will furnish the characteristic symptoms from which to select the curative remedy, and one who bases his prescrip- tion upon these later developments from the kidney trouble, will only succeed in palliating his patient, because the essential disease determines the continuance of the original trouble. This difficulty in selecting characteristic symptoms is not infre- quently observed in the treatment of violent or acute diseases, es- pecially zymotic diseases. I presume it will be accepted by most of my hearers that persons in vigorous health, whose vitality is high, whose tissues are well nourished, and, in consequence, whose resistance to disease is at the maximum, will rarely, if ever, contract contagious or miasmatic dis- eases. These germs, which are ever about us, are ready to seize upon individuals of a lower condition of vitality, and which will at- tack and flourish in a vitiated constitution, can be expelled from the system only by the restoration of the system to its normal condition of resistance. So that, it is clear, that in some cases at least we must, in order to arrest the progress of the disease, look beyond the immediate development of the symptoms of the acute disorder to the underlying and predetermining ill-health of the patient, and seek therein the characteristics which must determine the selection of the remedy, and the physician to be successful must, for a time at least, cease the attempt to palliate the immediate distressing symptoms by the administration of the curative remedy. These and other considerations which might be mentioned, did time permit, lead me to the belief that reliance upon a single symp- THE SELECTION OF THE HOMCEOPATHIC REMEDY. 129 tom, or even upon a few isolated symptoms, is apt to lead the pre- scriber into discouragement, and while it must be admitted that sin- gle, distressing symptoms must at times be prescribed for, in order to give relief to the patient (parenthetically, it may be remarked that the greatness of the Homoeopathic law is illustrated by the fact that it enables one to relieve distressing manifestations of diseases without being able radically to cure apparently hopeless and incura- ble diseases), yet we are obliged to deprecate the habitual selection of supposed keynotes or characteristic symptoms as a basis for a proper Homoeopathic prescription. The third method which may he resorted to is the method of Boenninghausen, which was evidently appreciated and used by Hah- nemann himself, and which has stood the test of a great many care- ful prescribes from that time to the present. It consists essentially in the selection from the symptoms of the patient and from the symptoms of the drug of the elements of symptoms, rather than of the symptoms themselves. It may be said that a complete symptom should consist of a sensation, a locality and a modality (or condition of aggravation or amelioration), and it is noticed in the study of drugs, as well, indeed, as in the study of the symptoms of patients, that certain sensations, like cuttings or tearings, are apt to appear in various parts of the body, and are apt to appear in various provers,. sometimes becoming quite a characteristic feature of the provings of any given drug. The same thing may also be said of locality. Many drugs have their favorite localities in which symptoms of various sorts are apt to develop, and this remark is still more applicable to modalities. Drugs have their peculiar times or other conditions of aggravation or amelioration, and the modalities of a patient are very apt to be constant, not only for one sensation and locality, but for all sensations and for all localities affected. Thus, a Bryonia patient complains of being made worse by motion in every part. Lycopo- dium symptoms are very apt to occur at 4 o’clock in the afternoon, whether there be pains in the hips or distress in the stomach or feb- rile excitement. The Nux vomica patients are worse in the morning and directly after eating ; the Sulphur patients are worse at night — all sorts of things are worse at night, etc. Illustrations might be multiplied, but students of Materia Medica are sufficiently well aware of these facts, and it is unnecessary to 9 130 world’s homceopathic congress. dwell upon them. Boenninghausen states that the Materia Medica ought to be studied in this way ; that the prevailing modalities should be noted, and also the prevailing sensations and localities. But he complains, as we all have complained, that the symptoms are imperfectly recorded, and in many cases the provings are so insuffi- cient in number that our fragmentary knowledge must be supple- mented by clinical observation, and asserts that many of the imper- fectly recorded symptoms may be filled out by clinical observations of the curative effects of the remedy. He therefore combines thera- peutics with the Materia Medica in his “ Pocket-book.” He then studies the patient from this three-fold point of view, obtaining the chief modalities, sensations and locations, recombining them in a drug which has the prominent features of all three essentials ; thus, for a tearing pain in the left hip, aggravated during rest, he would select Lycopodium, not because Lycopodium has ever developed such a symptom in its provers, for it never has ; but because it ought to, and doubtless will in some future prover, because Lycopodium produces prominently “ tearing pains ” in various parts of the body, it affects the left hip most prominently, and its general symptoms are mostly relieved by motion ; therefore, he recombines these three essentials of Lycopodium and manufactures a new symptom for Ly- copodium. This removes the sciatica, it may be, and secures a new, verified, clinical symptom. We must all acknowledge that in the present incomplete condition of our Materia Medica, and for many years to come, perhaps for generations, clinical experience must be a decided factor in our thera- peutics, especially when based upon well-recognized Homoeopathic principles. I say “ Homoeopathic,” because it seems to me perfectly fair and legitimate to study drugs according to Boenninghausen’s methods, and to supplement our fragmentary knowledge by our clinical experience and observations. This is a matter for an interesting discussion, and to which, it seems to me, time can profitably be devoted ; namely, how far we are justified in taking the elements of our symptomatology instead of the fully developed symptoms themselves, and prescribe from these elements with the almost certain assurance that complete provings will develop the missing symptoms of the drug. THE SELECTION OF THE HOMOEOPATHIC REMEDY. 131 Discussion. The Chairman : Dr. Conrad Wesselhoeft will discuss this paper. Dr. Wesselhoeft: Mr. President, Ladies and Gentlemen : Dis- cussion means criticism. Some people think that criticism means fault-finding. It is nothing of the kind. If, therefore, I discuss this paper it is merely to say that I have nothing to add to it, noth- ing to take from it, but to express my full accord with it and the way in which it was written. It is a paper which well deserves reading over carefully. It is the multum in parvo. It embraces all the most important principles involved in our selection of remedies. I hope that when it is printed you will all study it carefully for you will find a great deal more in it than you can possibly catch in the rapid delivery necessary here. If I say anything about it it will merely be to supplement and explain, perhaps, a few points of the paper. We attach, in our selection of a remedy, too much importance to the words used by the prover. I never read through a proving in my life that I did not see the difficulty of understanding exactly what the prover meant, especially if I had been fortunate enough to have proved the medicine myself. I then saw the enormous difficulty in expressing exactly the same thing. I might have felt the same thing, others might have felt it, but the words which express it are very inadequate to convey the actual meaning and it is very difficult to do so. Something may be expressed in a variety of words used by the English or any other language, and I think that all of us, when we select a remedy, do so by an intuitive knowledge of it, that we acquire by reading not only the words but the meaning between the lines. We sympathize with the prover and put ourselves in his place, as we do in the place of the patient sick in bed. We doctors do not always get credit for feeling a great deal of sympathy, and the doctor who weeps over his patient has the credit of being very sympathetic, while one who listens attentively to the patient is said to be inattentive and unsympathetic when he is, perhaps, the most sympathetic, because he is digesting what the patient says, and feel- inginhisown life the sickness of the patient, and interpreting it with regard to the Materia Medica. Our knowleege then, of the Materia Medica and our ways of selecting medicine are often intui- tive and not fairly expressed in words ; hence, as Dr. Allen says, rapid prescribing is that intuitive prescribing which arises from a clear conception and sympathy with not only the words of the book, but the meaning of the remedy applied to the case. I do not believe I can make myself perfectly understood to you, especially to the younger members ; but those who have puzzled over cases must have felt that rapid prescribing is often intuitive and not to be explained in words. At the same time I do not want to encourage it. I do not want to say that it is the proper way to do. It is best to be 132 world's homoeopathic congress. very careful about it and not allow our intuitions to run away with us. Intuition should not take the emotional form entirely it should be governed by reason and intellect in the end, and for that we have no better means than the study of the wards of the provings. This is merely with regard to rapid prescribing. In regard to keynotes it applies to that and is intended to cover that ground and to supple- ment something of Dr. Allen's paper in which I concur most fully. A word more about Boenninghausen's Repertory. People say to me often, “ What do you think of it? " I have known it ever since I was a boy. It has been in our family long before I studied medicine. I value it as highly as 1 ever did, and I value it all the more because I now understand it.. I see its uses, and its faults. The faults are, as Dr. Allen has told you, in the imperfections of the Materia Medica ; not in the principles upon which the book was composed and written. I think the principle underlying the method of ar- rangement of the book is one of the best if not the best in our Hom- oeopathic literature. He gives generalities. He leaves out details, as Dr. Allen has told you, and as you know by the book — as you are acquainted with it. He gives you conditions and aggravations ; the time, place, condition, under which aggravations take place. Those are very important things. Those are the very things which come intuitively in our selection of a remedy, and which if taken into consideration, allow us to make rapid prescription. But the faults of the book lie in the imperfections of the Materia Medica. Boenninghausen has a very valuable preface to that book which every one should read.. I had the book in my office for years before I ever read the preface to it and I made a great mistake. Although Boenninghausen recognizes the incompleteness of the Materia Med- ica, he did not know exactly where the incompleteness was,, nor ex- actly how to get over it. He considered a great many things in it as facts which to us, to-day, do not appear. We cannot demonstrate them as facts. For instance, he will say in one place — I cannot find a very good example but I will make one for illustration — say, Pul- satilla, or the symptoms of aggravation at night. He will give half a page of medicines printed in different types,, some emphasized by black types and other forms, indicating his preference for certain medicines or for aggravations at night,. You turn over the book and you stumble across that same list of medicines under the head of “ improvements in the morning." That occurs very often. It is a deduction and general conclusion of his,, which does not arise from the Materia Medica, but which are merely conclusions which he thinks he is warranted in making, i.e., aggravations at night must have improvement in the morning. It doesn't follow at all. Look it over in the Materia Medica and you will find it difficult yourself. That is an imperfection in the book which, is misleading, and those who take books as inspired and unalterable make a mistake. There THE SELECTION OF THE HOMOEOPATHIC REMEDY. 133 is nothing absolute in our knowledge of Materia Medica and I hope in the futnre editions of Boenninghausen the Materia Medica will be more carefully sifted before medicines are printed with capitals, and italics, and common types, to give the reader the impression that these are absolute medicines and that there is no doubt about the value of these symptoms. Those are the imperfections of the book arising from imperfections of the Materia Medica and too great faith in the result of provings which are imperfect. I merely want to call your attention and make a plea in a few words for the method of finding out how the value of provings should be determined. One swallow does not make a summer, one proving by one prover is almost worthless except to him who has a great deal of knowledge on the subject The principle of modern science is, that to determine a fact and get at the root of a thing a great many observations must be made. The result of these obser- vations must be compared, whether it is in mechanical science, elec- trical science, engineering science, in physiology or in anatomy. Numerous facts must be brought up before anybody can attach the slightest importance to them. Fifty years ago one fact stated posi- tively by one man was a law. That method is played out. We have got to have provings by a good many intelligent persons, and these must be compared, and with the greatest care ; that which is incongruous set aside in preference to that in which the provings agree. That is the method which I wish to impress upon you. The words of a proving may be the same, and yet mean different things ; but by that intuitive knowledge which we acquire by a long prac- tice of reading provings, as well as by studying our patients, we may find them of great service. The Chairman: The address will be further discussed by Dr. A. W. Hinman, of Dundee, Illinois. Dr. Hinman : Ladies and Gentlemen : When such a gentleman as Dr. Allen comes before us and makes the statement that we have incomplete provings, it is evident to me that there is something wrong. There have been times in my practice that I have asked myself: “Do I know? Is there a certainty that I am using the best means for my patients ? ” Then when Dr. Wesselhoeft says nothing to the contrary, and we find it a fact, doesn’t it seem that we ought to do something to remedy this deficiency? Isn’t there some way by which we can have our remedies reproved and brought up to a standard of certainty from some scientific standpoint? It seems to me that we are wasting time, and if Samuel Hahnemann were here to-day, he would say, “Gentlemen, what in the world are you doing?” We could not erect a monument to Samuel Hahne- mann that would be more telling than to get right down and have a corps of men here who are steadily proving remedies that should become authoritative — that we could stand upon. It would be cor- 134 world’s homoeopathic congress. roborative of what Hahnemann has done. For the Lord’s sake let’s do something. Let’s go into our pockets and get a corps of men. We have to pay men to work in these days. They don’t work in the same way Samuel Hahnemann did. He worked for the love he had in it. He had something to work at, and the mass of us cannot afford to work the way he did. He was a trained ob- server. We want men that are trained, and that will become more and more trained as they work at it. It seems to me that something could be done in this matter. We have seven hundred or eight hundred physicians here recorded, and the basis of their work is the Materia Medica. I don’t care what ology they belong to, or what particular department; they are prescribing every day and depend- ing on this thing, and still there is something that is incomplete. Let us eradicate that thing, and get down to some basis where we can say it is a certainty as far as possible. The Chairman : Dr. Allen will close the discussion. Dr. Allen : Mr. Chairman, I am glad of the opportunity of saying an additional word, partly in the line of the gentleman who has just spoken, for he has woke us up. I want to ask this question of you all: What are you doing about Materia Medica? Are you working, or are you playing billiards or doing surgery or some other sort of specialty besides materia medica? Every member of the Homoeopathic School is a specialist in Homoeopathy and in Thera- peutics, but I doubt if one physician in a hundred in this country does any systematic work in Materia Medica. The workers in Ma- teria Medica are so very few we can count them on our fingers, and you howl at us for not giving you a perfect Materia Medica. You can’t have it in a thousand years. It is impossible. What you must do is to study, and you don’t do it. Now I am scolding. If every one of you men and women would take an hour or half an hour or fifteen minutes a day, and take the Cyclopaedia of Drug Pathogenesy , and go through one proving after another, and take a few minutes at any conclusion of Symptomatology which is reliable like the Cyclopaedia , and mark down those three points, you would be doing something. Select a drug, and study that till you get through with it. Do you know anything about Eupian, which the gentleman spoke about? and I was delighted to hear it, for I was waiting to hear of that. Read that through, and mark down if there are any conditions of aggravation at night ; mark down those three points which Boenninghausen emphasized. That is the way I have to do it. I have a little card which I can carry in my pocket, and I note, “Conditions, so and so, with such and such pains; burning pains in such and such localities.” I have that in my mind, and I am ready for the patient that Eupian belongs to, and the next week take something else and do it ; but, for Heaven’s sake, do some work ! Why it seems to me as though members of the American Institute THE SELECTION OF THE HOMOEOPATHIC REMEDY. 135 and the Homoeopathic School just waited for half a dozen of us to cut up your food and put it into your mouths. That won’t do. You owe a little more than that to your patients. You make your living and reputation out of it ; so do some work in it ! The Chairman : The next business in order is an address upon “ Homoeopathy and Public Health,” by P. Ludlam, M.D., of Chicago. Dr. Ludlam addressed the Congress as follows ; 136 world’s homoeopathic congress. ADDRESS. HOMCEOPATHY AND THE PUBLIC HEALTH. By R. Ludlam, M.D., Vice-Chairman of the World’s Homoeopathic Congress. The public health is the counterpart of the commonwealth. That a system of medicine which has sustained itself independently and grown in a compound ratio for a hundred years ; which has its own literature and its schools, its clinics, societies, and hospitals, as well as its pupils and practitioners in every civilized community, is closely related to the health of the people is self-evident. To doubt this proposition would be like questioning whether Protestantism is related to Christianity, charity to benevolence, or the sunlight to the evolution of plants and flowers. If its recognition were commensu- rate with its deserts, and if its representatives had not been the vic- tims of a class-bias that so far as possible has excluded them from the army and the navy, the hospitals and the eleemosynary institu- tions of this and of other lands, I should have a more grateful theme and a better prospect of pleasing you in what I have to say on this occasion. Toleration has been defined as “ the dogma of the weaker party.” If the reformer did not insist upon it, he would never have a hear- ing. When he comes to be tolerateco fig 2 <13 o .2 W 55 O O -H co i.q t}< i-' eo to tjt oo to !>©®Tr<04iO>rH0040i-^ S © * m # O O r-^ CC I> iO i> CiCiOCiOCiCiCi 1 a V GQ c3 cc 2 of 1892.) 1892. 1891 and 1892. 1891 and 1892 * 1892. Cases Reported. Allop. Horn. Allop. Horn. Allop. Horn. Allop. Horn. Typhoid Fever 222 3 958 85 257 51 Scarlet Fever 688 66 1411 279 1167 384 679 209 Measles 664 57 1771 440 Diphtheria 1063 71 980 171 531 115 420 150 Births 2619 280 2861 846 1076 420 Totals 5256 477 2391 450 7288 1870 2432 830 Ratio, cases reported 11.02 1 5.31 1 3.89 1 2.93 1 Physicians reporting 450 60 (1) 349 49 (3) 277 53 (1) 234 55 Ratio, Physicians 7.5 1 712 1 5.23 1 4.25 1 St. Paul. Kansas City. Providence. Denver. 1890, ’91 & ’92. 1891 and 1892. 1891 and 1892. 1891 and 1892. Cases Reported. * Allop. Horn. Allop. Horn. Allop. Horn. Allop. Horn. Tvphoid Fever 258 43 118 31 1 Scarlet Fever 1000 220 353 70 389 93 878 170 Measles 90 12 ! Diphtheria 967 61 154 39 214 33 580 119 Births 4695 578 4073 299 Totals 6662 859 4580 408 861 169 1666 332 Ratio, cases reported 7.75 1 11.2 1 5.09 1 5 i i Physicians reporting (1) 172 27 (1) 267 37 (2) 107 30 (1)340 60 Ratio, Physicians 6.37 1 7.22 1 3.57 1 5.66 1 COMPARATIVE VITAL STATISTICS. 179 Table 8. — (Concluded). Cases Reported. Indianapolis. 1891 and 1892. Allegheny. 1892. Nashville. 1890, ’91 & ’92. Syracuse. 1892. Allop. Horn. Allop. Horn. Allop. Horn. Allop. Horn. 1 | 21 0 1 613 63 88 17 61 13 1460 51 95 60 1112 71 45 9 100 5 2267 184 1179 189 Totals 3185 185 0 0 2516 270 1340 207 17.22 1 9.32 1 6.47 1 Physicians reporting (3) 305 14 (1) 137 18 (3) 208 (3)11 166 19 Ratio, physicians 21.8 1 7.61 1 18.91 1 3.74 1 Dayton. Duluth. Seattle. Lincoln. 1892. 1891 and 1892. 1892. 1892. Cases reported. Allop. Horn. Allop. Horn. Allop. Horn. Allop. Horn. Typh nid Foyor 58 52 701 59 Scarlet Fever 6 7 109 11 66 9 Measles Diphtheria 70 56 254 36 116 35 Births 1206 133 404 96 Totals 134 115 2330 259 404 96 182 44 Ratio, cases reported 1.65 1 9 1 4.21 1 3.91 1 Physicians reporting (3) 103 12 (3) 50 7 (3) 115 16 (1) 62 15 Ratio, Physicians 8.58 1 7.14 1 77.19 1 4.13 , 1 Blanks ( ) indicate cases not reported. (1) Physician’s report. (2) Members of two State Societies. (3) From 3d edition Medical and Surgical Register (Polk). 180 WORLD S HOMOEOPATHIC CONGRESS, Table No. 9. — From Form No. 3, “ Deaths Cities. Year. Acute Stom’ch& Bowel Diseases. Death Ratio. Acute Respira- tory Diseases. Death Ratio. Allop. Horn. A. I H. Allop. Horn. A. H. St. Louis 1892 808 67 12.1 1 1415 83 17.1 1 Baltimore 1891 1083 42 25.8 1 1396 46 30.35 1 Baltimore 1892 1307 47 27.8 1 1107 42 26.35 1 San Francisco 1892 563 12 47.08 1 1966 49 40.12 1 Cincinnati 1892 464 44 10.54 1 902 61 14.78 1 Detroit 1891 314 33 9.52 1 328 41 8. 1 Minneapolis 1891 188 36 5.22 1 279 41 6.8 1 Minneapolis 1892 223 33 6.76 1 314 42 7.47 1 Rochester 1892 303 67 4.52 1 541 95 5.69 1 St. Paul 1890 230 15 15.33 1 197 32 6.13 1 St. Paul 1891 167 19 8.79 1 279 17 16.23 1 St. Paul 1892 205 12 17.1 1 256 32 8. 1 Kansas City 1891 133 7 19. 1 218 10 21.8 1 Kansas City 1892 154 7 22. 1 203 7 29. 1 Providence 1891 169 19 8.9 1 251 33 7.61 1 Providence 1892 219 26 8.42 1 280 47 5.96 1 Denver 1891 193 23 8.39 1 391 37 10.57 1 Denver 1892 179 9 19.9 1 175 19 9.21 1 Indianapolis 1891 178 4 44.5 1 285 1 285. 1 Indianapolis 1892 140 7 20.1 1 183 2 91.5 1 Allegheny 1892 349 15 25.27 1 387 24 16.12 1 Syracuse 1892 223 27 8.28 1 415 35 12.57 1 Nashville 1890 229 12 19. 1 125 6 20.8 1 Nashville 1891 193 9 21.44 1 229 9 23.1 1 Nashville 1892 183 7 26.14 1 175 13 18.5 1 Dayton 1892 124 5 24.8 1 116 13 9. 1 Duluth 1891 79 2 39.5 1 65 2 32.5 1 Duluth 1892 66 3 22. 1 35 4 8.75 1 Seattle 1892 39 3 13. 1 63 9 7. 1 Lincoln 1892 79 6 16.2 1 105 16 5.56 1 From all Ratio of cases Ratio of causes. Reported. Physicians. St. Louis 1892 3197 237 13.47 1 5.32 1 6.5 1 Baltimore 1891 9501 356 26.69 1 15.21 1 15.12 1 Baltimore 1892 9513 481 19.78 1 15.21 1 15.12 1 COMPARATIVE VITAL STATISTICS, 181 Table 9. — (Concluded). Cities. Year. From all Causes. , Death Ratio. Ratio of Cases Reported. Ratio of Physicians. Allop. Horn. A. H. Allop. Horn. A. II. 1892 6674 198 33.71 1 1 7.45 1 Cincinnati 1892 5150 381 13.52 1 11.02 1 7.5 1 Detroit 1891 1057 137 7.79 1 5.31 1 7.12 1 Minneapolis 1891 1601 295 5.42 1 3.89 1 5.23 1 Minneapolis 1892 1690 305 5.54 1 3.89 1 4.25 1 Rochester 1892 2068 460 4.5 1 2.93 1 4.25 1 St. Paul 1890 1440 154 9.35 1 7.75 1 6.37 1 St. Paul 1891 1628 141 11.54 1 7.75 1 6.37 1 St. Paul 1892 1464 137 10.6 1 7.75 1 6.37 1 Kansas City 1891 1620 82 19.75 1 11. 1 7.22 1 Kansas City 1892 1526 90 16.96 1 11. 1 7.22 1 Providence 1891 1692 273 6.2 1 5.09 1 3.57 1 Providence 1892 1734 302 5.14 1 5.09 1 3.57 1 "Dpnypr 1891 1 5. 1 5.66 1 Denver 1892 1 5. 1 5.66 1 Indianapolis 1891 1874 1873 25.66 1 17.43 1 21.8 1 Indianapolis 1892 2116 53 39.92 1 17.43 1 21.8 1 Allegheny 1892 1921 137 14.08 1 0 . 1 7.61 1 Syracuse 1892 1505 155 9.71 1 6.47 1 8.47 1 Nashville 1890 1152 78 14.77 1 9.32 1 18.91 1 Nashville.. 1891 1445 74 19.52 1 9.32 1 18.91 1 Nashvillf* 1892 1263 85 14.86 1 9.32 1 18.91 1 Dayton 1892 687 52 13.21 1 9. 1 8.58 1 Duluth 1891 1 9. 1 7.93 1 Duluth 1892 1 9. 1 7.93 1 Seattle 1892 346 51 6.8 1 4.21 1 7.19 1 Lincoln 1892 428 67 6.39 1 4.14 1 4.13 1 These tables, showing as they do the results of a very large amount of labor in many different cities, cannot be studied with any- thing like the care they deserve in the few minutes now at our dis- posal. It is out of the question for me to go into details, or to con- sider the cities separately in the short time allotted me. I will, therefore, simply call your attention to some general features of the 182 world’s homceopathic congress. different tables, leaving it for you to study them more in detail at your leisure. I invite you to make such study, as I believe you will find it both interesting and profitable. Taking the tables up in the order given, we have first, Measles. The only cities in which there is any pretence of reporting cases, are St. Louis, Baltimore; Cincinnati, Minneapolis, Kansas City, Denver, Indianapolis, and Nashville in 1891. These cities report totals as follows : Allopaths, 8656 cases with 297 deaths, mortality per cent., 3.43 ; Homoeopaths, 1098 cases with 7 deaths, mortality per cent., 0.64. It is questionable whether in Baltimore in 1891, Kansas City, Denver, Indianapolis, in 1892, and Nashville with an Allopathic total of 568 cases reported and 54 deaths, mortality per cent., 9.5; and a Homoeopathic total of 97 cases with 2 deaths, mortality per cent., 2.06 ; there is anything more than a pretence of reporting cases. In the rest of the cities named the reports may be approxi- mately correct. They show that the Allopaths reported 8088 cases with 243 deaths, mortality per cent., 3.04; while the Homoeopaths reported 1001 cases with 5 deaths, mortality per cent., 0.5. Of the cities reporting deaths alone we have reports from Phila- delphia, San Francisco, Detroit, Providence, Allegheny, Syracuse, Nashville, Duluth, and Lincoln giving total deaths, Allopaths 171 to the Homoeopaths’ 7. Ratio, 24.43 to 1. These cities report of other diseases and births — Allopaths 16,855 cases to the Homoeo- paths’, 2785 ; ratio, 6 to 1 and have of physicians; Allopaths, 3815 ; Homoeopaths, 637 ; ratio, 6 to 1. In no city is the Homoeopathic mortality as high as the Allo- pathic, and in only one of the cities named as perhaps approximately correct is our maximum mortality as high as their minimum. Table No. 2 deals with Typhoid Fever. Here we find a larger number of cities pretending to report cases. That it is largely a matter of pretence with many, a glance at the table will readily con- vince any one familiar with the facts, and the results in typhoid, but following the order laid down we find that Philadelphia, St. Louis, Baltimore, Cincinnati, Minneapolis, Rochester, Providence, Denver, Nashville, in 1891, Dayton and Duluth report — Allopaths, 8265 cases with 2037 deaths, mortality per cent., 24.65 ; Homoeopaths, 1131 cases with 224 deaths, mortality per cent., 19.71. Of these cities, Philadelphia, St. Louis, in 1892, Minneapolis, COMPARATIVE VITAL STATISTICS. 183 Dayton, and Duluth, in 1891, have apparently the fullest reports of cases attended. They report — Allopaths, 6502 cases with 940 deaths, mortality, per cent., 14.46 ; Homoeopaths, 941 cases with 131 deaths, mortality per cent., 13.92. The rest of the cities in the list report — Allopaths, 1763 cases, with 1097 deaths, mortality per cent., 62.22; Homoeopaths, 190 cases with 93 deaths, mortality per cent., 48.95. The cities reporting deaths alone, are San Francisco, Detroit, St. Paul, Kansas City, Indianapolis, Allegheny, Syracuse, Nashville in 1890 and 1892, and Lincoln. They report — Allo- paths, 801 ; Homoeopaths, 55; ratio, 14.56 to 1. These cities report of other diseases and births, Allopaths, 20,756; Homoeopaths, 2423 • ratio, 8.15 to 1, and have of physicians, Allopaths, 2336; Homoeo- paths, 284; ratio, 8.33 to 1. Table No. 3 deals with Diphtheria. The cities reporting cases of diphtheria are St. Louis, Baltimore, Cincinnati, Detroit, Minneapolis, Rochester, St. Paul, Kansas City, Providence, Denver, Indianapolis, Syracuse, Nashville, Dayton, Duluth and Lincoln. They report — Allopaths, 8765 cases, with 2996 deaths, mortality per cent., 34.07 ; Homoeopaths, 1141 cases, with 347 deaths, mortality per cent., 30.41. Cities in which both schools report 40 per cent, or less are St. Louis, Detroit, Minneapolis, St. Paul, in 1890 and 1891, Kansas City, Providence, Denver, Nashville, in 1890, Duluth in 1891 and Lincoln. They report — Allopaths, 4615 cases with 1356 deaths, mortality per cent., 39.37 ; Homoeopaths, 724 cases with 176 deaths, mortality per cent., 24.31. The rest of the cities reporting but, on account of high death-rates, not believed to be fully reported, give Allopaths, 4150 cases with 1630 deaths, mortality percent., 39.3; Homoeopaths, 417 cases with 171 deaths, mortality per cent., 41. Cities not reporting cases are San Francisco and Allegheny. They report deaths, Allopaths 334; Homoeopaths 18; ratio, 18.55 to 1. There are of physicians, Allopaths, 837 ; Homoeopaths, 112; ratio, 7.47 to 1. Table No. 4 treats of Scarlet Fever. Scarlet fever is without doubt the best reported disease, in nearly, if not quite every city represented in this report. I am sorry to have to say that there is plenty of evidence that it is not well reported in a vast majority of cities. The cities reporting cases of scarlet fever are Philadelphia, St. Louis, Baltimore, Cincinnati, Detroit, Minneapolis, Rochester, St. Paul, Kansas City, Providence, Denver, Indianapolis, Syracuse, 184 world’s homoeopathic congress. Nashville, Dayton, Duluth and Lincoln. They report totals as fol- lows — Allopaths, 17,340 cases with 1466 deaths, mortality per cent., 8.45 ; Homoeopaths, 3039 cases, with 157 deaths, mortality per cent., 5.16. Cities with 12 per cent, or less mortality report — Allopaths, 16,463 cases with 1317 deaths, mortality of 8 per cent.; Homoeo- paths, 2862 cases with 141 deaths, mortality per cent., 4.93. Detroit in 1892, Nashville in 1890, Dayton, Duluth in 1892, and Lincoln all report more than 12 per cent, mortality, and are probably not worthy of credence. They report — Allopaths, 877 cases with 149 deaths, mortality per cent., 17; Homoeopaths, 177 cases with 16 deaths, mortality per cent., 9. Cities reporting deaths alone are San Francisco and Allegheny. They report — Allopaths, 134 to the Homoeopaths 1. Physicians reporting are Allopaths, 837 ; Ho- moeopaths, 112; ratio, 7.47 to 1. Table No. 5, Obstetrical No. 1, deals with the number of cases of labor attended by members of the two schools, and the number of deaths from puerperal causes. In studying this table I would call your attention to the fact that it does not include the cases attended by midwives, and consequently if the number of cases here given seems small for the number of deaths given in Table 9, it is in part due to the large number of cases of labor attended by mid wives in every city reported. There is, however, good evidence that labors are not fully reported in a large number of cities. Of the cities reporting cases, we find that St. Louis, Baltimore, Cincinnati, Minneapolis, Rochester, St. Paul, Kansas City, Indian- apolis in 1892, Syracuse, Nashville, Duluth and Seattle report — Allopaths, 31,488 cases with 702 deaths, mortality per cent., 2.23; Homoeopaths, 4219 cases with 42 deaths, mortality per cent., 1. Of cities not reporting cases we find San Francisco, Detroit, Providence, Denver, Indianapolis, in 1891, Allegheny and Lincoln reporting — Allopaths, 315 deaths to the Homoeopaths, 23; ratio, 17 to 1, while the physicians are — Allopaths, 2000; Homoeopaths, 280 ; ratio, 7.14 to 1. Table No. 6, Obstetrical No. 2. — This table deals with the num- ber of deaths from the different puerperal causes reported by physi- cians of the two schools and should be studied in connection with the preceding table, Table No. 5, to be properly comprehended. Taking the cities mentioned as reporting cases of labor, we have COMPARATIVE VITAL STATISTICS. 185 seen that they report — Allopaths, 31,488 cases to the Homoeopaths’ 4219, or 7.46 to our 1. They report deaths as follows : from puerperal septicaemia, 190 to our 9 ; ratio, 21 to 1 ; from puerperal fever, 258 to our 11 ; ratio, 23.45 to 1 ; from puerperal eclampsia, 79 to our 9 ; ratio, 8.77 to 1 ; from affections of pregnancy, 97 to our 8; ratio, 12.12 to 1; from uterine haemorrhage, 27 to our 6 ; ratio, 4.5 to 1 ; and from dystocia, 67 to our 3; ratio, 22.33 to 1. Cities not reporting cases of labor are San Francisco, Detroit, Providence, Denver, Indianapolis, in 1891, Allegheny and Lincoln. They have of physicians: Allopaths, 2000; Homoeopaths, 280; ratio, 7.14 to 1 ; and report deaths as follows : puerperal septicaemia, 55 to our 2; ratio, 27.5 to 1 ; puerperal fever, 151 to our 7 ; ratio, 21.6 to 1 ; puerperal eclampsia, 26 to our 3 ; ratio, 8.66 to 1 ; affec- tions of pregnancy, 54 to our 6 ; ratio, 9 to 1 ; uterine haemorrhage, 21 to our 3 ; ratio, 7 to 1 ; and from dystocia, 11 to our 1. Table No. 7 (from Form No. 5). — This table gives the number of cases of pertussis reported, and deaths from the same. It gives also the number of deaths from cerebro-spinal meningitis and from ery- sipelas. Under the head of pertussis we find that St. Louis, Balti- more, and Cincinnati report — Allopaths, 675 cases with 230 deaths, mortality per cent., 34.1 ; Homoeopaths, 49 cases with 14 deaths, mortality per cent., 28.6. It is scarcely necessary to say that the reports of cases of pertussis are utterly useless. The cities reporting deaths alone are Detroit, Minneapolis, 1892, Providence, Indianapo- lis, in 1892, Allegheny and Nashville. They report deaths, Allo- paths, 117; Homoeopaths, 18; ratio, 6.5 to 1. St. Louis, Balti- more, Cincinnati, Detroit, Minneapolis, in 1892, Providence, Alle- gheny, Syracuse and Nashville report deaths from cerebro-spinal meningitis: Allopaths, 1064; Homoeopaths, 81; ratio, 13.13 to 1. The same cities report deaths from erysipelas: Allopaths, 165 ; Ho- moeopaths, 12 ; ratio, 13.75 to 1 ; and have of physicians: Allopaths, 3107 ; Homoeopaths, 403; ratio, 8.43 to 1. Table No. 8, Ratio of Work Reported and of Physicians. — This table is designed to show the relation between the number of cases of different diseases reported by the two schools, and also the rela- tive number of physicians of the two schools reporting work. From it, we learn that Philadelphia, St. Louis, Baltimore, Cincinnati, Detroit, Minneapolis, Rochester, St. Paul, Kansas City, Providence, 186 world’s homoeopathic congress. Denver, Indianapolis, Syracuse, Nashville, Dayton, Duluth, Seattle and Lincoln report from all causes: Allopaths, 72,477 cases to the Homoeopaths’ 10,570; ratio, 6.86 to 1. There are in these cities: Allopaths, 6649; Homoeopaths, 1008; ratio, 6.59 to 1. Cities reporting typhoid fever cases give cases reported : Allo- paths, 8265; Homoeopaths, 1131 ; ratio, 7.31 to 1. Physicians in the same cities are: Allopaths, 4979, Homoeopaths, 776; ration, 6.42 to 1. Cities reporting scarlet fever give cases reported : Allopaths, 17,340; Homoeopaths, 3039 ; ratio, 5.71 to 1. Physicians in the same cities are: Allopaths, 6534; Homoeopaths, 992; ratio, 6.59 to 1. Cities reporting measles give cases reported : Allopaths, 8656 ; Homoeopaths, 1098 ; ratio, 7.88 to 1. Physicians in the same cities are: Allopaths, 2988; Homoeopaths, 347 ; ratio, 8.61 to 1. Cities reporting diphtheria give cases reported: Allopaths, 8765; Homoeopaths, 1141 ; ratio, 7.68 to 1. Physicians in same cities are : Allopaths, 4498 ; Homoeopaths, 598 ; ratio, 7.52 to 1. Cities reporting cases of labor give cases reported: “ Allopaths, 31,488; Homoeopaths, 4219; ratio, 7.46 to 1. The same cities have of physicians: Allopaths, 3347; Homoeopaths, 434; ratio, 7.71 to 1. Table No. 9 (from Form No. 3). — This table deals with deaths alone as reported by the two schools, and for the reason that in all the larger cities a death certificate must be given before a body is permitted to be buried, this is the most reliable table given. The deaths are given under the headings of “ Deaths from Acute Stomach and Bow r el Diseases,” from “ Acute Respiratory Diseases,” and from “All Causes” (exclusive of deaths from violence, suicide, and coroners’ cases). Under the heading of “ Death from Acute Stomach and Bowel Diseases,” we find St. Louis, Baltimore, San Francisco, Cincinnati, Detroit, Minneapolis, Rochester, St. Paul, Kansas City, Providence, Denver, Indianapolis, Allegheny, Syra- cuse, Nashville, Dayton, Duluth, Seattle, and Lincoln report: Allo- paths, 8786; Homoeopaths, 618; ratio, 14.22 to 1. Under the heading of “ Deaths from Acute Respiratory Diseases,” we find the same cities report: Allopaths, 12,678; Homoeopaths, 866; ratio, 14.63 to 1. Under the head of “Deaths from All Causes:” Allo- paths, 64,287; Homoeopaths, 4854; ratio, 13.24 to 1. Compare COMPARATIVE VITAL STATISTICS. 187 the ratios with the ratios of cases reported in the same cities, 7.1 to 1, and of physicians reporting 7.5 to 1, and judge for yourself who are signing death certificates. Taking a general survey of the tables, there are a few points which seem to me to especially merit our attention. And of these I would place first the fact that with the exception of measles, our best showing is made on tables of the greatest apparent reliability, and the worst on those which, from their extremely high mortality per cent., we be- lieve to be the most imperfectly reported. It is a fact that any one who will make some inquiries can readily verify that typhoid fever cases are not recorded with anything like the care they should be. This is astonishingly true of our men in many cities, as note Balti- more, in 1891, reporting five cases and eight deaths; in 1892, re- porting no cases and seven deaths ; also note Cincinnati, with its three cases and eight deaths, — all reporting more deaths than cases. Different reporters stated that the Homoeopaths reported more cases after death than did the Allopaths. Diphtheria is almost an exact parallel of typhoid fever, both in relation to the number of cases re- ported and to the comparative results between the two schools. It should be noted in this connection that these are the only diseases in which the Homoeopaths do not report more cases per physician. If the death ratios are compared with the number of physicians report- ing, we make a much better showing than through percentages, as witness : All cities reporting cases of typhoid give death ratio 9.1 to our 1, while the ratio of physicians in the same cities is 6.4 to 1. In diphtheria, the ratios are: Deaths, 8.7 to 1 ; of physicians, 7.5 to 1. These two diseases will bear some study which we do not have time to give. It would be interesting to know something of the comparative success of men of our own school. This was out of the question, and at best would be very difficult to get at. It has incidentally come to my knowledge that in two cities with 325 Allopaths and 60 Homoeopaths, in one, one physician changed our mortality per cent, in typhoid from 16 to 28, and in the other city one physician changed our mortality in diphtheria from 13 to 43 per cent. In both instances the men are noted among their medical brethren for their crude and un-Homoeopathic methods of prac- tice, but they sail under the flag, and their work is included in these tables, as is the work of all physicians who claim to be Homoeo- paths. 188 world’s homceopathic congress. In Table No. 6, Obstetrical No. 2, it is interesting to note that our best relative showing is in connection with puerperal septicaemia, where the ratio is 21 to 1, and with puerperal fever wdth the ratio 23.45 to 1, while the ratio of cases treated is 7.46 to 1, or, in other words, their loss from the same number of cases of labor attended is 3 to our 1. In Table No. 9 we have seen that the Allopaths lost, from acute stomach and bowel diseases, 8786 to the Homoeopaths 618; from acute respiratory diseases, 12,678 to our 866; and from all causes, 64,287 to our 4854 ; while they reported of all diseases treated, 7.1 cases to our 1. At the same rate they have to account for 4396 or a little over 50 per cent, of their deaths from acute stomach and bowel diseases, for 6529 or 54 per cent, of their deaths from acute respira- tory diseases, and for 29,824 or 46 per cent, of their deaths from all causes. The population represented in this table is 4,607,066, or about j 1 ^ of the population of the United States. Those of a specu- lative turn of mind may find it interesting to figure what this means if applied to the whole of the United States, and what it means in dollars and cents at the average value of a human life as fixed by the United States courts — between $5000 and $6000. In conclusion, permit me to say, that while the elements of unre- liability in the health office records cannot be laid at our door, the records being almost wholly in the hands of our opponents, there is a work in this connection which we can and should do. We should individually and collectively report all of our cases, and insist that all others, irrespective of school, shall do likewise. We should also insist that these cases be properly recorded. Then will such investi- gations as this be valuable. Let us speed the day. Notes for Appendix. 1. Medical Reform , Cockburne. See Boericke & Tafel’s Catalogue, 1890, p. 128. 2. From Hardenstein’s work. See Boericke & Tafel’s Catalogue, 1890, p. 129. 3. Comparative Results in the Treatment of the Insane. See “ Homoeopathy and the Insane,” by N. Emmons Paine, A.M., M.D., New England Medical Gazette , 1892. Also reprint. 4. Hare’s System of Practical Therapeutics , vol. i. COMPARATIVE VITAL STATISTICS. 189 5. “Cholera Epidemic of 1873 in the United States.” Second Ses- sion Forty-third Congress, p. 35. 6. See Minneapolis Homoeopathic Magazine , June, 1892. Also reprint. 7. To Eld ridge C. Price is due the credit of interesting Dr. Thomas in this work. 8. The New York County Homoeopathic Medical Society took up the work of filling Form No. 1, was at first refused permission to see the records; was upon further demands permitted to see the records, but cases were found to be so indifferently reported that the committee appointed to do the work decided that the report would, of necessity, be not worth the labor. Dr. William Watts, of Toledo, Ohio, promised to report that city, but was positively refused per- mission to see the records of the Old-School health officer, and living outside of the city limits, could not gain access by recourse to legal courses. Philadelphia was at first granted the privilege, but later was refused, and up to this writing is debarred from the records. Chicago, Boston, and Cleveland commenced the w T ork too late to be completed for this report. Washington, D. C., reported records hard to get at and not reliable. Omaha, Buffalo, Louisville, and Memphis promised reports but forgot to fulfill their promises. Owing to circumstances not in our control, the reports in many of the cities are far from full. In some instances men who promised to do the work delayed until it was too late for them or any other to make full reports. The reports received are given in the different tables, and what any particular city reported, can be seen by examining the different tables. 9. In all tables the coroner’s cases are not included. City physi- cians are left out when ascertainable. 10. Cases are reported, but Dr. Keeler says, in such manner that he could not ascertain who reported them. Discuss ton. Dr. Beckwith : May I ask why Boston, New York, and Chicago were omitted from the table? Dr. Strickler : The Boston Homoeopathic Medical Society took up the subject in January, I think. The man who was to report was Dr. Porter, I believe. He wrote me long ago that he would send in a report. The report has not been received. New York attempted to get into the Health Office sometime in 190 world’s homoeopathic congress. January or February, and were at first refused permission to examine the records, but on further demand were given the privilege, but found them so imperfectly reported that it was not worth the time and trouble. There is somebody in this hall 1 presume who can answer about Chicago, but I had a definite promise that Chicago would be reported last June. I depended upon that promise until it was too late to find a^y one to report it. Dr. Beckwith : Cleveland ? Dr. Strickler: The same with Cleveland. Dr. Beckwjth : I was consulted by the committee, and I said, “ If we present papers, we want some authority.” Consequently they hired a clerk in the health office and she is at work on that now, and when it comes out it will be signed by the health officer. Dr. Peck : The importance of this subject no one will gainsay, but few have any idea of the amount of labor involved in the preparation of the paper to which you have just listened. I myself would not undertake it for any consideration. In compiling the statistics of Providence which had 135,000 in 1891 and 138,000 inhabitants in 1892, it took my copyist at least one month of working hours in order to prepare the returns simply for the chairman of the com- mittee. The difficulties I found in the health office and in the pre- paration of such a report were, that the facts are not to be found ordinarily in the health office. I had no trouble at all in getting the documents in my own city, but the trouble was the different systems of registration. I wonder at the table we have here. I never should have arranged such a scheme, but since the Empire City has decreed it, of course, I had to accept. To illustrate : The paper called for statistics on diphtheria, including membranous croup. I flatly refused to include membranous croup death certificates in those of diphtheria, because I do not believe the two diseases are any more alike than a rose and a cabbage. Both grow on a stalk, both have leaves, and both may be eaten ; therefore, they are identical. Furthermore, the cases of croup are not reported ; the cases of diphtheria are pretended to be. One of my particular friends who is a rising surgeon in my city, gives a number of deaths equal to the number of cases. His death-rate for typhoid fever for the year 1891 is 100 per cent. I think that he would feel very happy to have that statement publicly made. It simply shows how doctors generally neglect to comply with the law. There were two or three such cases. I found in one year that I continued the examination, that the Allopaths were fully as delinquent as the Homoeopaths, frequently not mailing their certificates of the disease until they had made out the death certificates. With regard to infectious diseases, this heavy mortality record is due to that fact. Ido not believe myself, while recognizing the fact COMPARATIVE VITAL STATISTICS. 191 that a person may be taken so ill with scarlatina that he is as dead the day he is taken sick as he ever subsequently becomes, that that disease is productive of serious results except from sheer neglect or carelessness. That is my experience. With regard to obstetrics in our State, the showing is very good, and I think it will be found so in every State, and I ascribe that to extra care that is undertaken from personal observation and knowl- edge of the practice of leading members of both schools. We live on terms of comparative harmony in our city, and while we have as poor specimens of doctors as the other school can show, yet the in- creased care and attention and fidelity to duty which characterizes the Homoeopath who is a Homoeopath from principle shows itself in the lying-in chamber, and that is the cause of our small mortality. Our showing is very good also in croup and in respiratory and bowel troubles. The reports of death certificates from our city are all taken only from members of the Rhode Island Medical Society, and Rhode Island Homoeopathic Society. Anybody can practice medicine in our state who wishes, and I thought the only fair way was to take the certificates of those who were recognized officially as members of their respective societies. The practical lessons to be derived from this paper are as follows : First, comply with the laws of the cities in which you reside; show yourself a good citizen, else you cannot expect to be rated as a good doctor. You don’t know who is going to examine your death cer- tificates, nor for what purpose they will be used; make them out, then, in this manner: If you are not sure, and you know we are not always sure of the cause of diseases; if there is any doubt — some- times, of course, the manner of death determines the diagnosis — always make it out for that cause which is considered incurable, un- less that diagnosis impairs the prospects of the family with regard to life insurance. Protect the interest of your school as you would your own interest. The Chairman : Further discussion will be by Dr. Beckwith, of Cleveland, Ohio. Dr. Beckwith, of Ohio : The State Board of Ohio, of which I was a member for five years, spent much of their time trying to gather statistics, and we found it impossible. I don’t believe there is a State in the United States that has statistics, neither do I believe that that report is correct. Details are reported which are not cor- rect. While this paper has required a vast amount of labor, I do not believe half of it is correct. I will admit that our school is much more successful, and why ? Because we have a better class of patients ; we have better nurses, and we have a better class of society to treat. We have every advantage that we possibly can have, con- sequently I look upon the statistics as rather unfair to the Old 192 world’s homoeopathic congress. School because they give but little medicine now. I think they are giving very little more medicine than our school, and their success is much better now than it was before. The mortality in those cases it seems to me is enormous and why? Because it is down among the lower classes — the Norwegians, Danish and Swedes that have no care or attention whatever. The only way to make the world and the Allopaths believe this is to get it from the health authorities. None of you would take my statement or that of any other physician in regard to such figures, especially when their views are different. Dr. Wilson, of Cleveland, spent one week with an assistant getting statistics ; then gave it up and wrote, as many others have done, to Dr. Strickler, that he would send it later. Then they got a clerk in the health office who is doing it correctly, taking every physician and his certificate. The Chairman: The paper will be further discussed by Dr. Edgerton, of Kansas City. Dr. Edgerton, of Kansas City : We have spent a great deal of time on this work in Kansas City. I got a lady to go to the health officers who very kindly allowed her the use of the books, but we found it very difficult work to make any creditable statement in puerperal cases, deaths due to confinement. The death was simply reported, giving the name of the disease from which the patient died, but saying nothing as to whether it was immediately following con- finement. I found a tendency, and I noticed it more among the Allopaths, to put down a disease which had the most dangerous form. For instance, a short time ago I was called to a case that an Allo- path had seen and he pronounced it cerebro-spinal meningitis, and I found a little rheumatism there. Cases that are simply German measles are called scarlatina and the ho-use is placarded. I believe the Homoeopaths are more careful about these things. The Chairman : The discussion will now be closed by Dr. Strickler. Dr. Strickler : I don’t know as I have much to say in closing this discussion. The conclusion of my paper will be ample. The Chairman : The next business is the paper by Dr. Martha A. Canfield, of Cleveland, Ohio, on “The Development of Medical Science through Homoeopathy.” Dr. Canfield addressed the Congress as follows : THE DEVELOPMENT OF MEDICAL SCIENCE. 193 ADDRESS. THE DEVELOPMENT OF MEDICAL SCIENCE THROUGH HOMOEOPATHY. By Martha A. Canfield, M.D., Cleveland, Ohio. The true scope of medical science is the healing of the sick, the relief of human misery. Tried by this test, there was no real medical science in the world until it was evolved from the law — similia similibus curantur. Before this all was blind experiment, all disorder and confusion, and to the pangs of disease were added the tortures of the damned. Disease was regarded as some evil spirit which had possessed the body. Some infarct, which had lodged in the bowels and must be driven out by purging or let out by the lancet. The wildest and most absurd definitions were given, e.g an infarct was defined by Kampf, in 1726, as an unnatural condition of the bloodvessels, which are plugged in various places by ill com cocted, variously degenerated, fluid bereft inspissated, viscid, bilious polypus and coagulated blood. Heinrech Speffens, who, in Oken’s periodical, 1822, is put on a level with Aristotle, Goethe, and Hum- boldt, thus defines hearing. It is the identity of the inorganic of the organization and its internal being, consequently identity of the ner- vous and osseous systems. Hunger is internal tension of the assimi- lation under the influence of the mass opposed external. — Ameke’s History of Homoeopathy. In 1803 physiological chemistry taught that blood consisted of nine ingredients : odoriferous matter, fibrinous parts, albumen, sul- phur, gelatine, iron, potash, soda, and water. The medical history of the times down to the date of Samuel Hahnemann’s appearance upon the field of action is a whirligig of theories, one following upon the other with astonishing rapidity. Stoll taught that disease was caused by gastric impurities, bilious conditions, and intestinal obstructions; therefore, vomit and purge was his watchword. 13 194 world’s homoeopath rc congress. Brown that sthenia and asthenia caused all disease, and “ allay irritation ” was his war cry. The antiphlogistic treatment contended for supremacy, but, whatever theory was uppermost, poor old humanity was blistered and bled and salivated and purged with in- tent to drive out some unseen, unknown evil thing which was sup- posed to be its enemy. All experiments of the actions of drugs were made upon the sick. Drugs were compounded in mixtures of from eight to fifty remedies, so that it was impossible to separate the action of one drug from the other or from the symptoms of the disease. In this absence of law and order, in this extremity of the human race, the phenomenon which always appears at such a crisis was repeated. A man was raised up who was equal to the emergency, Samuel Hahn- emann. He established a system of perfect law and order. The fact that the poisonous effect of drugs can be used as the determining indication for their selection in the treatment of disease was dimly seen by the ancients, but Hahnemann seized upon the fact and dragged it into the light t)f perfect day. He demonstrated that it was the foundation rock of medical science; that it was a fixed and perfect law which never can be altered or improved, though its methods of application may be almost endless. Upon this rock he built a Materia Medica. He was no common man who, in the error of his age, could see so clearly. It is true he partook somewhat of the color of his times, but illumined the age with a wondrous light. He adopted an entirely new method of determining the curative power of drugs, viz., prov- ing them upon healthy organisms, — the method now approved of and practiced by all scientists. He discovered that certain remedies had specific action upon cer- tain tissues and curative action in certain diseases. As a chemist, he far surpassed the age in which he lived. He discovered a test for metals which has stood the test of time, and is used in every labora- tory in the world to-day. He discovered several new products, among them the black oxide of Mer., our Mer. sol. He was the first physician in the world to advocate single remedies and small doses, to regard diet and hygiene as important in the treatment of the sick. Was not this a legacy to medical science? Was not this the birth of medical science? My second proposition is that there has been no progress in the THE DEVELOPMENT OF MEDICAL SCIENCE. 195 therapeutics of the dominant school since the glorious truth of Hom- oeopathy burst upon the world, except as it has been developed upon Hahnemannian principles or stolen outright from our system with- out credit being given. It is quite possible to set the world agog with some wonderful dis- covery, as did Brown-Sequard’s Elixir of life, and yet contribute nothing to medical progress, because it is soon proven to be not only worthless but harmful. All the so-called scientific discoveries, as Brown Sequard’s Elixir, the coal-tar compounds, and the late Dr. Hammond’s vital energizer, may be classed among the harmful dis- coveries, and therefore have no weight in the argument. Hahne- mann built the tramway upon which all great lines of thought have been projected in both the Allopathic School and our own. Rokitansky, Virchow, Klebs, and Koch are indebted to him for the principle upon which they elaborated their thought. Hahnemann had discovered, as before mentioned, that certain remedies had a specific action upon certain organs and tissues, as Digitalis upon the heart. And it was upon this basis that Virchow wrought out his locali- zation theory. Hahnemann anticipated the germ theory when he discovered the essential germ cause of cholera. Koch even wrought in the self-same methods as Hahnemann. He tested the poisonous matter upon healthy organisms, then diluting the poison infinitesi- mally, he tested it upon diseased organisms, differing only in the method of administration, using injection aided by the mechanical improvement of his day. The most recent discoveries of Koch re- garding the blood of diphtheria and typhoid containing elements which are curative in each of the diseases referred to show that the gleaner is going on in the fields already harvested by our school. Hering had proved the worth of Tuberculinum when Koch was in pinafores. He also advocated the use of Hydrophobin sixty years before Pasteur rediscovered it, also Psorinum. Homoeopaths have enriched medical science by proving drugs of commerce, which were before considered inert, to be capable of curing disease. They have antedated the use of the diseased products of the human body as curative agents. And another most wonderful development entirely due to Homoeopaths is the demonstration of the fact that various animal viruses will heal the sick. This was never dreamed of by the Allopathic School, and they have not yet 196 world’s homoeopathic congress. stolen these remedies, to my knowledge. This enables the Homoeo- path to wield incalculable vantage over them in a treatment of all malignant diseases, as typhoid fever, diphtheria, erysipelas, etc. The animal viruses, as Apis, Crotalus, Lachesis, Naja, Tarantula, Theri- dion, Bufones, etc., have proven of untold relief to human misery, and are entirely due to the heroic provings of Homoeopaths. Con- stantine Hering enriched medical science by his labors along this line. Hering, like many of Hahnemann’s followers, was a very learned man. He was a wonderful naturalist. The collection which he made at Surinam is preserved with great care in the Academy of Natural Sciences in Philadelphia. There are numbers of individual remedies which owe their use entirely to Homoeopaths, and are now used by Allopaths, no credit being given for their use, as Aconite, Pulsatilla, Rhus tox., Mercu- rius, Glonoine, Hepar sulphur, etc. Many of these remedies are recommended in their text-books — Ringer, Shoemaker and Phillips —with long paragraphs of Homoeopathic indications so plain that you would suppose you were reading Hughes or Arndt. These indications have been garbled from our literature with the most impudent kind of plagiarism, viz., Chamomilla is recommended by Ringer in summer diarrhoea of children, characterized by green, many-colored stools, Podophyllum in bilious morning diarrhoea. Dr. Aulde, of Philadelphia, recommends Rhus tox, in rheumatism in doses of one part to ten, but expresses diffidence in giving his opin- ion concerning a remedy so altogether new, notwithstanding it was carefully proven by Hahnemann, as every Homoeopath well knows. They give Rhus tox. for rheumatism, Pulsatilla for dysmenorrhoea, and Aconite for fever, but do not differentiate between these reme" dies and adopt the one which fits the individual case. Therefore, while they acknowledge the propriety of proving drugs upon the healthy, use our remedies and our dose. (Their medicine cases are full of semi-potentized triturate tablets and parvules.) They are not making the progress they would seem to be making, because they are not using these remedies homoeopathically but empirically. These facts are too well known to this Convention for me to enlarge upon the subject. In the face of the most unjust opposition and cruel persecution known in the annals of history, we have forced the dominant school THE DEVELOPMENT OF MEDICAL SCIENCE. 197 to reform its methods and adopt a gentler and more humane system, and have won to our belief such a majority of the power and intel- ligence of the laity that should the earth open to-day and swallow up every Homoeopath, public opinion would protect the world from the barbarism of the past. Our school has made wonderful strides of progress on its legiti- mate line, developing methods by which the fixed and perfect law may be perfectly applied. We have refined and regulated the dose; we have proven new remedies, thus narrowing down the list of in- curable diseases. Hundreds of volumes are monuments of the devo- tion and industry of our pioneers. See Bradford’s Bibliography. These works form a vast pyramid, with Hahnemann’s Organon and Materia Medica Pura as its base, with Jahr and Reckert and Teste and Hempel and Baehr and Carroll Dunham and Farrington and Hughes and Drysdale and Cowperthwaite and Hale and Arndt and Lippe and Burt building upon them, with Allen’s Encyclopaedia and the Drug Pathogenesy towering above them all. And now Hughes is fashioning the capstone, his repertory of the Cyclopaedia. Our literature is a stupendous growth. It embraces whole libra- ries of volumes which it would require a lifetime to peruse — not only exhaustive treatises upon our therapeutics, but elaborate dis- cussions of every phase of medical science, even dipping deeply into psychology and spiced with poetry. See Holcombe’s, Bane’s and Buck’s classical works and Crawford’s Kalevala and Bushrod James’s Alaskana. Bradford’s Bibliography , itself a notable book, chronicles the long list of authors too numerous for me to mention. Our growth may be compared to that of a grand oak, Hahnemann the central trunk, Similia the main root, his great followers the spreading branches, and the thousands of twigs the faithful practi- tioners who are devoting their lives to the application of Materia Medica to disease. Seventy years ago there was but one Homoeopath physician in the United States; to-day there are twelve thousand. We have sixteen colleges, graduating five hundred students annually. These colleges were the first medical colleges in the country to establish a four years’ course of study and demand a thorough preparatory examination. The American Institute was the first national medical society to de- mand of the colleges under its control a lengthened course and higher grade of scholarship. These colleges have adopted the most ad- 198 world’s homoeopathic congress. vanced methods of clinical teaching. They have always been in the front rank of progress. Let me here acknowledge that it was a Homoeopathic college which first opened the doors of medical colleges to women. We have seventy-six hospitals and fifty dispensaries. In these hospitals the average mortality is only 3.12, they are in perfect sani- tary condition, for Homoeopaths were first to advise strict care in regard to hygiene and diet, and Listerism is nothing more than ab- solute cleanliness. Our pharmacies have such a reputation for the purity and exactness of their preparations that they are patronized largely by careful physicians in the Old School. The law of cure is a grand central figure around which revolves lesser lights. Dr. Edwin Hale has discovered and demonstrated a law of dose which he deems a corrollary to the law of cure, viz., when the primary symptoms of a drug resemble the primary symp- toms of a disease the minimum dose should be used, and when the secondary symptoms resemble the secondary symptoms of disease, large or physiological doses must be used. The late Dr. Tessier placed on a firm basis the fact that individual attacks of disease owe their explanation to the definite predisposition w r hich exists in the individual. Dr. Woodbury, of Chicago, has elucidated a system of succession of remedies which is about to be given to the medical world in book form. Dr. J. S. Mitchell has given us a special treatment for cancer. He is not a cancer specialist, but by scientific investigation has discov- ered a method of treating this loathsome disease, which has been followed by wonderful results. His treatment is Homoeopathic, his method of applying the remedies only is original. See Medical Era , May, 1889. Dr. Henry Garey, of Baltimore, Md., has devised a system of massaging the sound-conducting apparatus of the middle ear, by which treatment he claims to have produced marvellous results in cases of deafness heretofore considered hopeless. — Transactions of American Institute, 1892. Dr. Pratt is the father of the orificial philosophy for which he claims that it is the discovery of the cause of chronic diseases as a class, and that by the aid of orificial surgery which it implies, it is possible to cure four-fifths of all forms of chronic disease. If this THE DEVELOPMENT OF MEDICAL SCIENCE. 199 is true, and testimony pours in from every quarter, this marks a marvellous progress in the prevention and cure of disease. Our French contemporaries have stamped out anthrax among cattle and sheep by the use of anthrax. Our Dr. Dudgeon has devoted much study to optics and written valuable works upon the subject. See British Journal of Homoeop t athy , 1882 to 1893. Our Dr. Blackley, Manchester, Eng., is the highest authority in the world concerning hay fever. By gathering atmospherical dust on glass with glycerine he de- termined the pollen origin of this disease. His work upon the same is classical. The late Dr. Drysdale, Liverpool, Eng., was one of the most emi- nent pathologists, biologists and microscopists of the age, as well as one of the most ardent lovers of Homoeopathy and logical expounders of its law (see British Journal of Homoeopathy ), during the last thirty-five years, all of which period he was the senior editor, and did a great amount of valuable work in the study of drug action. He made a study of the germ theories of infectious diseases as early as 1878, anticipating much of the work which Pasteur has since de- veloped. He gave eight years of his life to the study of the life histories of monads, now known as saprophytes. The words of his friend and fellow-student, Dr. Dallinger, give us an idea of this work. “ Our work in this inquiry, extending through night and day observations, occupied eight years, and during that time, by use of the most powerful and perfect lenses constructed, we were enabled to study the cycles of life in these minute forms, and to show that their life history was as definite and prescribed as the life history of a butterfly or a daphnia, although they were so small that a hundred million might revel in the space occupied by a millet seed. And this research proved that abiogenesis, or spontaneous generation, has nothing to hope from a thorough knowledge of saprophytic or- ganisms.” To show the versatility and eminently practical character of his genius, I cite the fact that he made a study of the subject of ventila- tion, and jointly with Dr. Hayward, a deeply scientific colleague, wrote a most valuable book on Health and Comfort in House Build- ing . No man in our age has added more to the sum of knowledge in medical art and science than John James Drysdale. For a com- 200 world’s homoeopathic congress. plete study of his work, see the British Homoeopathic Review, Sep- tember, 1892. Therapeutics and pharmacy will always be the legitimate field for Homoeopaths. The majority of our ablest men will devote their lives to adapting the Materia Medica to the cure of disease, and this is the height of wisdom, for, given the certain law of cure, close ap- plication of methods according to this law will in the majority of cases prevent the necessity for surgical interference, and when the surgeon takes up the scalpel it is an admission of weakness. He practically says I cannot restore the body to health, therefore it is better that it should lose one member than that the whole body should be lost. Surgery should be the dernier ressort and Homoeopathy has made it so. It has greatly modified Allopathic surgery. Mortality has greatly decreased under surgery, aided by our therapeutics and in our hospitals which are models of hygienic perfection. Our surgeons have performed many brilliant operations and have done much original work. Dr. G. D. Beebe was the first surgeon to remove several feet of intestine (58 inches) and get end-to-end union with recovery of patient. — United States Medical and Surgi- cal Journal, 1869. Dr. I. T. Talbot, of Boston, was the first surgeon in America to successfully perform tracheotomy. Van Lennep of Philadelphia, has done great things for intestinal surgery, experimenting on dogs, making resection of gut with end-to-end union, using rubber tubing as splint instead of decalcified bone, and has tested the method on human cases with the best results. He has improved the operation for fistula in ano and done much good original work. Dr. Flagg the first President of the American Institute, revolu- tionized the science of dentistry by his methods of operating and in- vention of instruments. Dr. Lungren of Toledo, was the first sur- geon to bring the peritoneal surface together in the closure of the uterine incision in Caesarian section and published the method several years before Sanger made use of it as the basis of his improved Caesarian operation, which is the approved method at the present time. Dr. Lungren also first ligated the fallopian tubes without removal to produce sterility after having twice peformed the Caesa- rian section upon the same patient. Biggar, of Cleveland, also has witnesses of his great skill in a THE DEVELOPMENT OF MEDICAL SCIENCE. 201 living mother with two fine children delivered at different births by Caesarian section. He has a new method of forming the flaps in exstrophy of the bladder. His method of repairing the perinaeum is worthy of note, and an original method of covering amputated bone with periosteal flaps for which he claims three benefits: 1. Protec- tion. 2. Medium of nourishment. 3 More rapid healing and less deformity. Dr. Knoll, of Chicago, has made several advances in surgery. 1. He has an original operation for radical cure of fistula in ano by dissecting out all the diseased tissue which forms the canal and stitching up the parts, first advocated in 1887. 2. An operation for the radical cure of hernia, consisting in opening up the canal to the peritonaeum, freshing the edges of the whole ring and stitching the parts together with heavy silver wire . — Medical Era , July, 1888. This operation he claims is in advance of any other operation of the kind even up to the present date. 3d. His treatment of eccentric stricture of the oesophagus by the stylet and dilators method of using and cut of the instrument. — Sharp and Smith’s Catalogue , Chicago, 1893. Lee, of Rochester, has a wonderful record in laparotomies. See Transactions , American Institute, 91. N. Schneider, of Cleveland, has the honor of being the first sur- geon in America to remove a tumor from the brain with recovery of patient. This tumor was the size of a walnut, situated back of the orbit. The operation was reported in 1860, in the Ohio Medical Reporter , and was copied in the New York papers and acknowledged to be unique. Dr. Schneider introduced to the profession the use of carbolized oil in the dressing of wounds. It used to be known on the road, in his days of railroad surgery, as Schneider’s oil. It is probably true that the modern treatment of wounds is a growth which all surgeons have nourished and cultured, but the fol- lowing statement was made to me by Dr. Dudgeon, of England, in reply to recent inquiries as to the part taken by our foreign brethren in the development of medical science, viz., that Dr. Bolle, a Homoeo- pathic physician of Aix la Chapel le was the father of the modern treatment of wounds. In a recent number of an Allopathic journal, the Medical News , there appears a Columbian article upon the work of American sur- 202 world’s homoeopathic congress. geons, which, in the usual style, ignores the work of Homoeopathic surgeons. Well might Helmuth sound the tocsin ; it is time the history of Homoeopathic surgery was written. But they cannot de- ceive the dear public. It well knows that we have a galaxy of sur- geons, with Helmuth as Nestor, who have made Homoeopathic sur- gery honorable the world over. In mechanical therapeutics, our surgeons have invented many ap- pliances of recognized value. Dr. Dudgeon’s sphygraograph is acknowledged to be the very best instrument of the kind in the world. Garey, of Baltimore, has invented the instrument called the vibrinator, for massaging the sound apparatus of the inner ear, which is destined to be of incalcuable value to the afflicted. The protection sheet which is now used in all the hospitals for the insane, and which has banished camisoles, cribs, anklets, strait- jackets, and all other cruel restraints of iron, wood and leather was invented in the Middletown, New York, State Homoeopathic Hos- pital, under the suggestion of Dr. Seldon H. Talcott. Dr. Edwin Hale has invented, a bivalve expanding speculum which is now used by both schools in the United States. Also the pistol- handle forceps for which he claims that the line of traction and the curve of the handles make it equal if not superior to Tar- nier’s. Dr. Griswold Comstock has invented a pair of obstetrical forceps which are a great favorite with many physicians. Dr. J. C. Mor- gan, of Philadelphia, has invented an apparatus for fracture of the clavicle which is acknowledged to be the best ever devised. He was also in advance of all others in using and publishing the alumi- nium probe now in universal use. He also invented a vectus which has saved the lives of many babes after uniform previous mortality, and many other instruments. Dr. Campbell, of St. Louis, has in- vented many eye and ear instruments. Dr. Pratt, of Chicago, whole sets of orificial instruments. The late Dr. Sebold devised the neatest and most ingenious speculum forceps and scissors for operating upon the eye that ever was invented. Dr. Harold Wilson, of Detroit, has invented several important eye and ear instruments. Dr. Knoll has invented several valuable instruments ; 1. The large bivalve rectal speculum, which with slight modifications is now sold everywhere and frequently is called the Pratt speculum. 2. An THE DEVELOPMENT OF MEDICAL SCIENCE. 203 artery forceps which is the strongest, most reliable instrument of its kind made. 3. A punch forceps for skull operations. — Century , January, 1893. 4. The stylet and dilators for stricture of oesopha- gus and urethra. Dr. S. L. Hall, of Cleveland, has devised a very ingenious appa- ratus for remedying a deflected nasal septum. It is able to meta- morphose a badly deformed nose into one of the purest Grecian type. Dr. George Gorham, Albany, N. Y., has invented an apparatus for treatment of Pott’s disease which is acknowledged to be a valua- ble appliance. Dr. E. D. Baun, of Passaic, N. J., has invented an attachment for the bedstead with ropes and handles for the use of women in labor, which is valuable, also an insufflator for the resuscitation of asphyxiated infants at birth which is very successful . — North Ameri- can Journal of Homoeopathy. Horace Ivins, Philadelphia, has a nasal speculum which is good. See his recent book on Nose and Throat , p. 15. Bushrod W. James has invented several good things. Dr. Edward Blake, of England, has introduced a rhinometer for measuring the depth of the nasal cavity and destroying adenoid growths. Dr. Horace Packard, of Boston, has improved and invented a number of surgical instruments, but is known of all schools for his appliance for administering ether. By his method the same effect is produced by a drachm which formally required ounces; thus he became a benefactor to the thousands of suffering humanity, who must take the risks of anaesthetics. To recapitulate, there was no true medical science until Homoe- opathy was introduced. Allopathy was not true medical science because it did not cure the sick, or alleviate human misery, but rather added to it new tortures. Homoeopathy discovered a true law of cure, proved hundreds of drugs, animal viruses, and diseased products to be able to relieve human misery. It built up and is constantly improving a Materia Medica, which applied to disease, is capable of restoring the sick to health. Allopathy has made no progress except as it has developed Hahnemannian principles or stolen outright from our system. Ho- moeopathy has made wonderful strides of progress and greatly influ- 204 world’s homoeopathic congress. enced all medical practice. It has written libraries, founded colleges for the teaching of its system, and hospitals for its practical demon- stration, and the relief of human misery. It has compelled the dominant school to cease its vampireism and to adopt our methods, our remedies and our dose ; it has educated the laity in regard to their own physical being and the superior claims of Homoeopathy ; it has improved surgical therapeutics and enriched mechanical thera- peutics; and in short has been of more benefit to humanity than all other discoveries the world has ever known. Discussion. The Chairman : Dr. Hawkes, of Liverpool, England, wishes to speak on this paper. Dr. Hawkes : I am exceedingly sorry that I was away when I ought to have spoken, Nothing illustrates the completeness of this paper more than the few touches our friend has given of our la- mented friend’s work, which is as complete as anything I could have written. If we were to speak in our country of lady doctors and the work that thay can do, or discuss that matter in our medi- cal societies and tell them of this paper to which I have just lis- tened, it would be almost incredible to them. Not that our friends there, as a body, or as Englishmen, do not appreciate the abilities of women ; but it is not yet conceded over yonder that medicine is exactly her sphere. If they could have heard that paper read that argument would lose very much of its force. I am astonished to gather from her paper what has been done by Homoeopaths in this country, and, although I profess to know a little of medical literature, I must admit that very little could be added to the paper by anybody with whom I am acquainted. Skin- ner, as you know, invented that apparatus that I see is used very much here for giving chloroform, but that was before he became a Homoeopath. I think we must go back to this fact that what Hah- nemann taught us and what his followers had insisted upon is this : the proving of medicines and the application of those substances that were never employed as medicines at all until Homoeopathy came to the front, which feature of things they ought to be most thankful for. What Homoeopathy has gained will go to form a monument to Hahnemann which no power can destroy and which no time can efface. The Chairman: The hour for adjournment has arrived, and the Congress now stands adjourned. At three o’clock p.m., meetings were held by the Section in Clinical Medicine and the Section in Mental and Nervous Diseases. THE DEVELOPMENT OF MEDICAL SCIENCE. 205 FIFTH DAY’S SESSION. Saturday Morning, June 3, 1893. The final meeting of the Congress was called to order at 10.30 by Dr. J. S. Mitchell, of Chicago, President. On motion, the following resolutions were unanimously adopted : Resolved , That the thanks of the Congress be extended to Dr. J. S. Mitchell, our President, for his very successful efforts in prepar- ing for, and dignity in presiding over, our sessions; also to Dr. Wes- ley A. Dunn, our Secretary, for his very efficient labors. Resolved , That our thanks are due to the editor and publishers of the Daily Medical Century for their enterprise in the publication of our proceedings and roster from day to day. Resolved , That the thanks of the Congress be tendered Dr. Emil Schlegel for copies of his report on the Clinic at City of Tubin- gen ; to Dr. C. Hurtado, of Curacoa, for copies of works on Botany; to Dr. Louis Paez, Bogota, for copies of reports; to Tommaso Cigliano for copies of works on Materia Medica; to Dr. Alexander Villers for copy of directory of foreign physicians; to Dr. B. N. Banerjee for reports; to Dr. Richard Hughes, of Brighton, England, J. W. Hayward, Liverpool, Edward Adams, of Toronto, for special work to insure the attendance of foreign delegates. Dr. James: Mr. Chairman, it seems there is very little work for this morning, and this afternoon’s business might as well be included in this morning’s session, so that we can finish up our work and ad- journ. I would move that we go into sectional meeting, and take up all the unfinished work, and remain in session until both the morning and afternoon’s work is completed. The Congress so voted. The Chairman : The Section of Rhinology and Laryngology will meet in this room, and the Section of Paedology will meet in hall 29. The papers at hand will be passed by their titles. Dr. E. M. Hale then presented a paper by Dr. Carlos Plata, of Bogota, S. A. In introducing the subject, Dr. Hale said : Mr. President and Gentlemen: I have the honor and the pleasure of presenting to you a short paper prepared for your consideration and sent to me by Dr. Carlos Plata, of Bogota, Colombia : For many years, perhaps twenty-five, I have been inscribed an 206 world’s homoeopathic congress. Honorary member of the Homoeopathic Institute of Colombia, but, I regret to say, that my acquaintance with the country has scarcely gone farther. Let me remind you, as well as myself, at this moment, that the United States of Colombia includes within its territory the only continental ground touched by the foot of Columbus, he having given the name of Veragua to what is now the northwestern prov- ince, on the Isthmus of Panama, from which province he and his descendants (one of whose distinguished members we have now among us) took their ducal title. Colombia is not insignificent in size, being equal to our New Eng- land and Middle States, the V ; rginias, the Carolinas, Ohio, Tennes- see, and Kentucky ; having a coast-line of a thousand miles, an enormous river system, and mountains rising to a height of 23,000 feet, although under the equator. Consequently, all varieties of cli- mate are here exemplified, although there are no seasons, strictly speaking, the name of summer being giveij^to the dry, and winter to the rainy periods, which alternate at intervals of sometimes three months, sometimes six months, while, sometimes, summer is almost unceasing. There are nine departments, or states; the capital, Bogota, being situated in about the middle, at an altitude of 8564 feet, with a charter granted by Charles V., and a population of 140,000. From the valuable bulletin on Colombia, issued by the Bureau of Ameri- can Republics, at Washington, I learn that, besides its elegant cathe- dral and one of the handsomest theatres in America, it contains a university, with faculties in medicine, law, natural sciences, and en- gineering; a large central pharmacy, and two Homoeopathic jour- nals; a museum of antiquities, and an astronomical observatory founded by a celebrated scientist named Mutis. The capitol build- ing is handsome and well kept; the dwelling houses are comfortable, the streets are paved, and there is a good system of sewers. There are three parks, in one of which is a monument to General Bolivar. The city is abundantly supplied with water, and the climate is de- licious. It has a notable literary life, which is the more remarkable as both intellectual and commercial communication with the outside world is most difficult and expensive. But, in spite of being so in- accessible, its people seem to reach out to the life of the world, and we welcome to this Congress from Bogota a message from so earnest and thoughtful a colleague as Dr. Carlos Plata. Bogota, Colombia, March 1, 1893. To the President of the Congress of Homoeopathic Physician \s and Surgeons at Chicago , Sir : Through the kindness of Dr. E. M. Hale, I present to this honorable body some remarks on Homoeopathic medicine. In doing so, I modestly beg your indulgence for my little contribution, which I pray may be for the good of humanity and the service of science. AXIOMS, APHORISMS AND RULES OF HOMOEOPATHY. 207 ADDRESS. OBSERVATIONS ON SOME OF THE AXIOMS, APHO- RISMS, AND RULES OF HOMOEOPATHY. By Carlos Plata, M.D., Bogota, Colombia, S. A. “ Life is the result of the incessant action of an invisible, imma- terial, essential, and dynamic principle, of which the regularity and harmony of the functions constitute health, while their derangement and discord constitute disease.” This definition necessarily implies that if this functional har- mony does not exist, in either its organic or spiritual relations, we must have discord. To me, this law appears almost universal. In towns from 1000 to 100,000 or more inhabitants, and in such a city as Bogota, where I live, which has 140,000, I have investigated the state of health of many undoubtedly robust persons with the general result that they did not feel quite well ; one had a headache, an- other indigestion, chills, remittent pains, etc. ; apart, of course, from mental complaints of melancholy, forgetfulness, and hypochondria; all of which investigations prove my proposition. A rule of logic teaches us to infer the unknown from the known; as by analogy, given the condition of a people living in certain climates and hygienic surroundings, we may infer the conditions of other peoples in the same circumstances, or as we may infer that pa- thological causes are more prolific in the city than in the country with its purer air, water, and food. What conclusions can be drawn from these observations ? Simply, that mankind, as a body, is physically and mentally diseased, although a good external appear- ance may indicate perfect health, just as happens with fruits of good color, the interior of which is unsound. In man, the two forces of conservation and destruction, health, and disease, are in ceaseless warfare, the end of which is death. The pathological state, whether latent or active, moral or physical, is a natural one. Can the provings of medicines be obtained on a healthy person, since we have demonstrated that disease is inherent in life itself, and 208 world’s homoeopathic congress. that the very word life is relative to death, or merely a synonym for the constant transformation of matter? Most probably until now, medicines have had to be proved on dis- eased persons, and the pathogeneses have not been obtained from healthy ones, consequently the diseased state produced was not artifi- cial but rather a union with an organic pathological state. Moreover, account must be taken of the purity or impurity of water, and the chemical atmospheric agents that may have an influ- ence in producing new, or modifying old symptoms, and we must especially consider the individual temperament, the climate, customs, etc. How, therefore, shall we distinguish natural from induced dis- ease, and how shall we obtain an absolutely pure drug in every sense of the word ? If two symptomatologies are recorded, one before, the other after taking the drug, the result will be particularized so as to destroy any general pathogenesis. In the Organon of the immortal Hahnemann occurs this statement, “ Only by means of repeatedly verified observations on a great num- ber of individuals of both sexes suitably selected, can we arrive at a knowledge of the ensemble of morbid conditions which a drug is able to produce; that is to say, successive provings must give nearly identical results.” This rule is very important, because it necessi- tates accuracy as to the symptoms produced by a medicinal agent or as to the power of a drug to alter and modify health. The microscope has shown us that earth, air, light, and water, and even stones contain innumerable animalculse, which chemistry can reduce to the original elements of carbon, oxygen, hydrogen, and nitrogen. How shall we know for certain, when we administer a drug, that it is this drug which has produced the cure, and not the chemical atoms which the drug contains ? All that we are sure of is that the drug was not absolutely pure; hence we may conclude: That ideal health does not exist, and that provings do not constitute laws ; that drugs cannot be prepared pure, and that pathogeneses cannot be generalized. The vehicles for preparing Homoeopathic drugs are alcohol, sugar of milk, starch, etc., because they are considered inert, but as we have shown that they contain, or themselves may be, medicinal substances, they cease to be inert and innocent to the economy, and for that reason they cannot serve as vehicles for pharmaceutical preparations. AXIOMS, APHORISMS AND RULES OF HOMOEOPATHY. 209 According to the definition of physics inertia is a purely negative property, that is to say, it does not exist. Inertia is, in a certain sense, activity, hence any combination, however weak, develops a new body with a greater or less amount of released electricity, as, for example, the formation of a neutral salt by the union of sulphuric acid and an alkali. It has been likewise proved that each molecule has its own atmosphere ; this being so, it is clear that each one of them is complex, although in an infinitesimal proportion ; therefore, each molecule is an example of polypharmacy, since each, however small, is divisible into its elements which goes to prove that there can- not be inert or innocent substances. if, in spite of all these obstacles, Homoeopathy cures with such brilliant and surprising results, its triumphs will be still greater when these defects are overcome. It will be of immense advantage toward this end to publish a Homoeopathic dictionary, well illustrated in the botanical and anatomical sections, and in at least four languages, Eng- lish, German, French, and Spanish. In conclusion we may state : 1. That man’s natural condition is that of disease. 2. The word health is relative to the greater or less degree of disease. 3. An absolute proving is impossible where health is only relative. 4. Generalized pathogeneses are inaccurate. 5. Drugs are never absolutely pure, and this prevents certainty in effects. 6. Nevertheless, Homoeopathy, the law of similars, is the only science which, by reason of its exact data, gives us more accurate results than the systems opposed to it have been able to obtain. President Mitchell announced that the Section in Rhinology and Laryngology, and the Section in Paedology would hold their sessions at once. He then declared the World’s Congress of Homoeopathic Physicians and Surgeons adjourned sine die. Wesley A. Dunn, M.D., Secretary. 14 REPORTS OF THE SECTIONS, INCLUDING THE MINUTES OF THE SECTIONAL MEETINGS, TOGETHER WITH THE SECTIONAL ADDRESSES, SCIENTIFIC ESSAYS AND DISCUSSIONS. . ' REPORT OF THE SECTION IN SURGERY. Chicago, Ii/l., Tuesday, May 30, 1893. The Surgical Section of the World’s Congress of Homoeopathic Physicians and Surgeons convened in the Hall of Washington at two o’clock p.m,, and was called to order by Dr. J. S. Mitchell, President of the Congress. President Mitchell announced that Dr. John E. James, of Phila- delphia, Pa., Acting Chairman of the Section, was not yet present, and that, therefore, it would be necessary to elect a temporary chairman. Dr. George F. Shears, of Chicago, 111., was thereupon chosen temporary Chairman. The Chair called on Dr. Horace Packard, of Boston, Mass., to read a paper on “ Anaesthesia.” (At this moment Dr. John E. James entered the room and as- sumed the duties of the chair.) Dr. Packard gave a brief resume of his paper, and illustrated it by anaesthetizing a patient before the Section. (For these remarks, see the discussion following the paper.) The subject was discussed by Drs. S. B. Parsons, of St. Louis, Mo. ; H. L. Northrop, of Philadelphia, Pa., whose remarks were pre- sented by title ; H. F. Biggar, of Cleveland, O . ; N. Waldo Emer- son, of Boston, Mass. ; J. G. Gilchrist, of Iowa City, la. ; G. F. Shears, of Chicago, 111.; Alonzo Boothby, of Boston, Mass.; Geo. W. Bowen, of Fort Wayne, Ind. ; Emory B. Johns, of Lexington, Ky. ; E. H. Pratt, of Chicago, 111., and Dr. Packard, author of the paper. Dr. Thomas L. MacDonald, of Washington, D. C., read a paper entitled “ Surgical Shock.” It was discussed by Drs. I. T. Talbot, 214 world’s homoeopathic congress. of Boston, Mass.; L. H. Willard, of Allegheny City, Pa.; A. Boothby, of Boston, Mass. ; W. F. Knoll, of Chicago, 111. ; S. B. Parsons, of St. Louis, Mo., and by Dr. MacDonald, the author of the essay. The Sectional Address, by Dr. W. B. Van Lennep, the Chairman of the Section, was then presented by title. Next followed a contribution to “ Thoracic Surgery,” by Henry L. Obetz, M.D., of Detroit, Mich. The meeting of the Section was then adjourned, subject to the call of the Secretary. Wednesday, May 31, 1893. Pursuant to adjournment and the call of the Sectional Secretary, a further meeting of the Section in Surgery was called to order by Dr. J. E. James, the acting Chairman, at 8.35 o’clock, p.m. The first paper read was by Dr. H. F. Biggar, of Cleveland, O.? entitled “ Thoracotomy and Thoracoplasty.” Dr. W. F. Knoll, of Chicago, 111., was called on to discuss the paper, but obtained permission, instead, to read a paper on “ Vivi- section and Pulmonary Surgery.” The whole subject of Thoracic Surgery was then discussed by Drs. C. E. Walton, of Cincinnati, O. ; Sidney F. Wilcox, of New York, N. Y., whose remarks were presented in writing and without reading, and by Dr. H. F. Biggar, of Cleveland, O. Dr. Geo. F. Shears, of Chicago, 111., read an essay on “ The Treatment of Epilepsy, Idiocy and Allied Disorders by Cranial Excision and Incision.” Discussion on the paper followed, which was participated in by Drs. DeWitt G. Wilcox, of Buffalo, N. Y. ; Clarence Bartlett, of Philadelphia, Pa., whose remarks were referred by title ; W. F. Knoll, of Chicago, 111., and by Dr. Shears, the essayist. Dr. E. H. Pratt, of Chicago, 111., read a paper entitled “ A Report on Orificial Surgery, Including an Analysis of 1000 Cases.” The essay was briefly discussed by Dr. W. E. Green, of Little Rock, Ark. SECTIONAL ADDRESS IN SURGERY. 215 SECTIONAL ADDRESS IN SURGERY. By W. B. Van Lennep, M.D., Philadelphia, Pa., Chairman of the Section. The instructions of the executive committee were that the chair- men should give a review of the literature of their respective de- partments for the past year or two. Such a review of the surgical work, if any justice were done to the subject, would require more time than the utmost limits of courtesy could accord even a chair- man. We were also instructed to give the utmost possible latitude to the discussion of the various papers, and, as far as possible, to have the latter of such a character as to invite comment. The essays were therefore to deal with live subjects, to be suggestive and not too exhaustive. To further this end a number of gentlemen have prepared themselves to discuss or, better, to enlarge the scope cov- ered by the different essays. In this way practically two or three papers are assured on each subject, which is viewed from as many different standpoints. Surgery in general will be the theme of an address to the Congress by our eminent colleague, Dr. Helmuth, who will undoubtedly handle it as he only can. Again, the essays presented by the bureau cover a number of the most important di- visions of the domain of surgery: Anaesthesia, Shock, The Brain, The Thorax, The Bladder. Each of them will necessarily review the literature more or less completely. It has therefore been deemed advisable by your chairman, for the sake of brevity, and, particularly, with a view of eliciting discus- sion, to confine himself to one of the subjects that has not been touched upon by the members of the bureau, the Surgery of the Intestines. The aids to intestinal suture inaugurated by the work of Senn have been extensively used and modified in this country. In Eng- land the decalcified bone plates were popularized mainly by Dr. Jousset, but, on the Continent and particularly in Germany, these 216 world’s homoeopathic congress. devices were looked upon with suspicion, and, after considerable dis- cussion and experience, there seems to be a revulsion of feeling, until the ideal method is getting to be one that depends on the un- aided suture. This is particularly true of lateral anastomosis which has come to stay apparently, the great drawback to plates and rings of any kind being the small communicating opening, which in time contracted to a dangerous extent. To avoid this a four-inch anasto- motic opening seems indispensable, and the technique is as follows : The intestinal surfaces are united by two parallel rows of continu- ous Lembert sutures, a quarter of an inch apart and an inch longer than the proposed opening. The ends of the threads are left at- tached to their needles. The bowel is open to the extent of four inches, a quarter-inch from the two rows of sutures. Bleeding points are clamped until caught up by a whip-stitch running around the opening and including all the intestinal coats. The two rows of continuous sutures first applied are then carried around this and the opening is complete (Abbe). Weir and Markoe report successful cases by this method. To avoid the danger of infection from opening the intestinal canal, an anastomosis in two tempos has been proposed, the second, however, being carried out by nature. While intended particularly for gastro- enterostomy, the principle is applicable to any portion of the intesti- nal tract. The serous surfaces being united by a linear suture, an oval piece is cut out from each intestine a quarter of an inch from the suture, leaving the mucosa intact. The free edges of this open- ing are united on one side, and the bulging mucous membranes are drawn out, and a ligature tied tightly around them. The remaining free edges of the opening are then stitched, and the field of operation enclosed by a continuation of the first serous suture. By sloughing of the ligated mucous membrane the anastomosis is completed bv the third or fourth day (Postnikow). The importance of the firm fibrous submucosa as an anchoring ground for any suture is to be particularly borne in mind, and prac- tice will teach the surgeon to recognize the resistance that shows it has been entered. While it is indispensable to the firmness of a su- ture that it should include a few fibres of this coat, great care should also be exercised not to perforate it and enter the intestinal lumen, as fatal leakage would result (Halstead). Another valuable principle which has a great range of applica- SECTIONAL ADDRESS IN SURGERY. 217 bility ,e.g. } pyloric excisions, gastro-enterostomy, intussusception, end- to-end union, high rectal excisions, etc., consists of tacking together the lumina to be united by two stitches, one being applied at the mesenteric junction when that is to be included. An opening is made in the bowel a short distance from the ends to be united, which are then invaginated and drawn out of this opening by traction On the two sutures above mentioned. By passing a dozen or more in- terrupted stitches through the tube that is thus drawn out, picking them up in the middle and dividing and tying them, intestinal ends may be united at twice as many points. The sutured gut is then drawn back and the temporary opening closed. In this manner all the sutures are passed from the inside (Maunsell). A case of intus- susception with carcinoma has been successfully treated by this method (Hartley). A somewhat similar procedure has been practiced for irreducible intussusceptions. The intussusceptum and intussuscipiens are united at the point where the former enters the latter by a fine silk suture which includes the mesentery. The intussuscipiens is opened two inches below this point and the intussusceptum amputated. The stump is sewed with a whip-stitch arresting all bleeding, and the opening closed (Barker). Another modification consists of amputation of the intussuscep- tum in the same manner, ligature en masse of the stump, and an an- astomosis between the intestine above and the opening made to get at the intussusceptum (Bier). The principle of the Heineke-Miculicz method of pyloroplasty has been extended to intestinal constrictions of a cicatricial nature in which resection is not deemed necessary (Pean, Hacker). The danger of leakage after intestinal perforation or suture has been shown, experimentally, to be obviated by closing the opening or protecting the suture, by covering it with a neighboring loop of intestine or omentum. This has been found safer, and, of course, of wider applicability than the omental grafts so extensively used of late (Chaput). The same writer closed openings made in the intestines of dogs with five or six thicknesses of iodoform gauze in the shape of pads, the edges of which were stitched around the orifice. The gauze acted temporarily, working its way gradually into the intestine, the opening being closed by adhesions to neighboring coils of intestine 218 world’s homoeopathic congress. or omentum. He also found that strips of iodoform gauze were an efficient protective to any intestinal suture. It has also been shown experimentally that a part of the small intestine could be transplanted between two ends of the colon and replace the latter when extensive resections of it have been made (Mitcheli). In resections for malignant disease, while one of the several cases may be cited in which the caecum, ascending colon, and several inches of the ileum were successfully removed (Lowson), the ten- dency is toward an operation in several stages. 1. The growth is first isolated by resection, the two ends of its intestine being drawn out of the wound. 2. The continuity of the intestinal canal is es- tablished by anastomosis or end-to-end union. 3. The isolated growth is excised (Bloch, Hochenegg). This method can often be practiced when hitherto we only had physiological exclusion by an- astomosis at our disposal; it is a curative instead of a mere pallia- tive measure, when primary excision is unsafe. Among the substitutes for the bone plates may be mentioned plates of raw potatoes (Dawbarn) and raw Swedish turnip (von Baraez). They have the advantage of being obtainable in emergen- cies and can be cut to any size desired, so as to insure a large open- ing. The sutures are fastened by being knotted and drawn through rubber tabs cut from drainage tubing, much as carpet tacks are armed or protected. The stomach has received considerable attention. Gastrostomy appears to be particularly indicated in cicatricial narrowing of the oesophagus, when tubage fails, as it offers a curative inducement in the shape of retrograde dilatation. For malignant diseases it is dangerous and prolongs life but a short time (Senn). The rectus muscle and the eighth intercostal space are the points of election for the fistula. In the former location leakage is prevented by a sphinc- ter-like action (Allingham). This may also be avoided by the use of two inflatable rubber bags, one inside and one outside, connected by a rubber tube. The operation is best done in two tempos. It is claimed that the movements of the stomach are seriously interfered with, and considerable stagnation occurs ; also, in all probability, the peptic function is impaired if not destroyed, nutrition being car- ried on by the intestines (Ewald). Gastro-enterostomy has been quite extensively practiced with SECTIONAL ADDRESS IN SURGERY. 219 not altogether satisfactory results. It is after all but a palliative measure and owes its popularity largely to the dangers of pylorec- tomy. With a view of lessening these it has been combined with excision and closure of the opening in the stomach and duodenum. Another palliative plan has been suggested, i.e., jejunostomy. The jejunum a short distance below the duodenum is drawn out, divided, and the distal end sewed into the wound while the proximal end is implanted into the distal, a few inches from the fistula, to allow the pancreatic juice and bile to flow into the intestine (Maydl). Digital divulsion (Loreta) has resulted fatally from rupture, although not carried to the extent recommended by its originator (Swain). Pyloroplasty (Heineke-Miculicz) has been successfully practiced a number of times for cicatricial pyloric stenosis (Page, Kohler, etc). A novel plan has been followed for the relief of dilatation of the stomach, i e., folding or plating its walls inward by rows of sutures which do not include the mucous membrane (Weir). It is a generally acknowledged fact that an operation for bowel obstruction is not complete until the intestinal paresis is relieved by puncture of the distended intestine. As a substitute for this, lavage of the stomach is proposed and has been successfully used (Lund). Post-operative obstructions have been in several instances success- fully operated by section and separation of adhesions (Lucas- Championneire). From the fact that these are soft and easily sepa- rated within the first few days, the attempt has been made to break them up by first washing out the stomach, and then pouring into the tube a half ounce of castor oil. Flatus and then copious stools were soon passed (Klotz). Both lavage and opium are looked upon as dangerous from their masking effect in intestinal obstruction, although the former is of value immediately before an operation to relieve reversed peristalsis and prevent actual “ drowning ” of the patient (C. M. Thomas). Early operations or exploratory section as soon as the diagnosis of obstruction is made, have been more than ever emphasized. The term “ exploratory ” is used because, the pathognomic symptom being faecal vomiting, this should not be waited for, but the section made “ on suspicion.” Every condition, aside from faecal impaction, which can produce the clinical picture, calls for a like treatment. In cases where the cause of the obstruction is hard to find, a short 220 world’s homoeopathic congress. circuit by lateral anastomosis has given gratifying results (Atkinson). Unnecessary and often fatal delay and handling of the intestine is avoided in this manner. Nelaton’s enterostomy has also been resorted to in desperate cases. A rapid method of forming the artificial anus consists of attaching the intestine to the parietal peritonaeum by 8 or 10 haemostats, which are removed in 24 hours, when adhesions will have formed (Chaput)- In spite of the fact that the respective advocates of the clamp and cautery, and those of the ligature in the treatment of haemorrhoids have partly ceased their invective against the more surgical methods of excision (Pratt and Whitehead), and directed their abuse to those who dare suggest any but the operation they have recently learned, colotomy, nevertheless the excisions of malignant rectal neoplasms have increased their hold on the profession. And justly, too, for every physician should strive after curative rather than palliative measures. The plan proposed by Kraske has, with certain modifi- cations, been extensively and successfully practiced and advocated (McCosh). The results are as satisfactory as could be expected with cancerous disease. The sphere of the operation has been extended to attack the uterine adnexa (Montgomery) and the terminal portion of the ureter (Cabot). In oonsequence of the incontinence frequently resulting, to allow of more extensive enucleation, and to insure an asepsis of the wound, the writer has successfully practiced the following method : 1. The formation of a permanent anus by inguinal colotomy, the intestine being drawn well down to leave an abundance of signoid flexure below. 2. Complete and thorough extirpation through the anus, through the sacrum, or by opening the peritonaeum and drawing down the gut. Usually two or all three of these steps have been combined. 3. Closure of the resulting wound by granulation aided by suture. In cases where the growth is not readily accessible from the ab- domen or through the sacrum, Maunsell has made use of the prin- ciple already referred to : the abdomen is opened and the peritonaeum around the bowel incised. The growth is then drawn out of the dilated anus by invaginating the gut. It is excised by amputating the intussusceptum, and the stump sutured in the manner already described. The intestine is drawn back into the abdomen, and SECTIONAL ADDRESS IN SURGERY. 221 the peritoneal incision closed. The proposition is based on experi- ment. Inguinal colotomy, or colostomy, or sigmoidostomy is the opera- tion of election and has been very extensively used, the well-known methods of suspension with a rod or suture, together with previous drawing down of the intestine being followed. When no time is to be lost the gut has been simply suspended with a rod, the wound being stuffed with gauze (Maydl, Reeves, etc.). When immediate opening was necessary a tube has been introduced and the bowel tied around it (Jones), or the intestine has been punctured with a trocar and a rubber drain attached to the canula to carry off the discharges (Robson). In this way contamination is prevented until safe adhesions take place. The subject of appendicitis has naturally received considerable at- tention; and, while but little that is new has been published, what is already known has been well emphasized, and, better still, the pro- fession generally have been aroused to realize the importance of this affection. The impossibility of an idiopathic peritonitis, the fre- quency of appendical trouble, its fatality, and the importance of a study of each case from its incipiency by the surgeon as well as the physician are becoming pretty generally realized. It was a healthy sign of the times to the writer, when he offended the physician and disappointed the family by advising against an operation between at- tacks in a recent case. The advisability of such operations between attacks has been strongly emphasized, and the cases, which were but few and far between when the writer gave his experience on the sub- ject at the last Congress, have been indefinitely multiplied and have shown most satisfactory results (Morris and others). The indica- tions are : frequency of recurrence, increasing severity of attacks, and, particularly, continuance of pain and tumor between attacks- Persistent colicky pains, with tenderness in the region of the ap- pendix, have been relieved by excision of the organ, which was found to be moderately diseased. Distinct attacks were absent (Hochstetter). The writer has opened three such cases and has been surprised at (1) the slight changes in the appendix ; (2) the suffering resulting from such lesions, amounting at times to complete invalid- ism ; (3) the complete and permanent relief following excision. While almost every case of so-called typhlitis is dependent upon a diseased appendix, an occasional report is published of lesions in 222 world’s homoeopathic congress. the caecum which produce much the same phenomena and results. In one instance a circumscribed faecal abscess was found to be due to a perforating caecal ulcer. The onset of the trouble was more insidious, diarrhoea having preceded it and being present; the initial vomiting was also absent; the appendix was normal (Hartley). As to the pathology of appendical disease, catarrh, beginning at the caecal junction, is still considered the usual cause. This is fol- lowed by the well-known changes : thickening, stricture, ulceration, perforation, or the formation of faecal concretions (Kiimmel). Foreign 'bodies are rare, although occasionally met with (Pinnock). Tubercular disease has also been known to be a not infrequent cause of this affection (Delorme), and actino-mycosis may affect this organ (Lang). The importance of early operating has received due attention, some going so far as to recommend it as soon as a diagnosis is made (Hurd, Marshall). Persistence or aggravation of the symptoms after twenty-four hours, and, particularly, the characteristic signs of peritoneal infection, are the indications mainly relied on. An occasional cure, after general septic peritonitis has been lighted up, gives encouragement to try to save life even in this desperate con- dition. Cocaine as an anaesthetic (Tachard), and rectal puncture without anaesthesia, have been resorted to in very weak patients (Richardson). That attacks that subside even should be watched with care and suspicion is shown by a case of the writer’s. A young man got over a severe attack so completely that he was allowed to go about the house. A little exertion was followed by dangerous constitutional symptoms and the rapid development of a large tumor. A small well encysted abscess had ruptured, and the whole right side of the abdomen was filled with a stinking fluid, only feebly protected by adhesions. But for these adhesions he would have quickly died of fulminating septic peritonitis. As to the technique, Iodoform gauze to protect the general abdomi- nal cavity, together with a light pack of the same and a drain for the abscess, are universally used. The appendix, unless readily acces- sible, is usually left alone in these abscesses. Occasional cases of peritoneal infection have been met with in which the appendix was not perforated or gangrenous (Poucet). The operations for the radical cure of hernia have been performed SECTIONAL ADDRESS IN SURGERY. 223 frequently, and, on the whole, with improved results, but the ten- dency is a revolution from the enthusiasm that has led to indiscrimi- nate operation and early reports of so-called cures by new methods. The ultimate results of a number of procedures have been reported, which, particularly, show the failures after the method that claims to substitute a cicatrix for a truss (McBurney), and which has been very extensively practiced (Bull). The tendency now seems to be toward a restoration of the normal relations of the tissues as laid down in the method of Bassini. The principles of this procedure are, excision of the sac with obliter- ation of the peritoneal dimple, closure of the internal and ex- ternal rings, and narrowing the canal, which has been split by a close approximation of the different layers of muscle and fascia. The narrowing of the external ring has been still further com- pleted by chiselling a groove in the pubic bone, laying the cord in this, and covering it with the periosteum, which has been preserved (Frank). The presence of the cord as an invitation to recurrence has been studied too. Its removal to prevent relapse once led to such a uni- versal practice of castration as to call for special legislation. The sac being excised and sutured or tied, the ends of the ligature are passed through the muscles above the internal ring to draw up and smooth the peritonaeum. In this connection it is worthy to note that Tait’s proposition to reduce the hernia and close the sac and ring from the inside through an abdominal incision has been prac- ticed occasionally. The cord is hooked up, while the muscles and fascia are closely united, obliterating the inguinal canal. By fasten- ing it in the outer angle of the wound, its direction of exit is changed from that of the inguinal canal to directly forward or for- ward and outward. The cord is then laid outside the muscles, and the skin and fat closed over it (Halstead). By carrying an incision upward from the internal ring the direction of the cord may also be changed to an upward one, whence it comes down into the scrotum as above (Fowler). To lessen the size of the opening, all but one or two of the spermatic veins, which are apt to be enlarged, are ex- cised (Halstead). As aids to closure of the opening, decalcified bone has been used; also the outer pillar of the external ring has been detached, together with a bit of bone furming its insertion, and carried across to the 224 world’s homoeopathic congress. inner pillar and nailed to the symphysis. In this way the opening is reduced to a mere slit (Landerer). The sac has also been used as an external plug in contradistinction to Macewen’s internal pad. After being isolated it is drawn out of an opening opposite or exter- nal to the inner ring, thus changing its direction. It is then twisted to obliterate the peritoneal dimple (after Ball), and fastened outside of the aponeurosis of the external oblique (Kocher). Following the observation that the mesentery of the protruded • gut is usually lengthened in hernia, and that the presence of this condition invites recurrence, it has been proposed that it be short- ened by folding and suture (Shimwell). To avoid infection of the wound, particularly in children, the urine has been diverted through a perineal wound (Gerster). The treatment of femoral hernia, hitherto either entirely ignored, or relegated to a hurried postscript after an elaborate description of a new method for the cure of inguinal hernia, has received more at- tention. The stump of the sac may be tacked well up inside the abdominal wall through which the suture ends are passed ; or the isolated sac may be drawn through an opening above Poupart’s ligament, twisted and incorporated in the lower wound, serving in this way as a plug to fill the femoral canal (Kocher). The need of such a plug or barrier has led to the turning up of a piece of the fascia of the pectineus muscle where it is thick and tough (Salzer), or the fascia and a flap of this muscle itself (Cheyne). In this manner' the femoral canal is completely closed. As the results of operations for the cure of inguinal hernia have been far superior to those for the femoral variety, an attempt has been made to transform the latter into the former. The tumor is incised and the sac freed, the inguinal canal is split and its posterior wall incised ; the sac is drawn into this opening, tied off, and both wounds accurately sutured (Ruggi). The indications for an attempt at radical cure are, 1, ineffectual, partially effectual, or painful trusses; 2, irreducible hernia; 3, oc- cupation tending to force out the rupture ; 4, proposed occupation which is precluded by hernia ; 5, strangulated hernia where the local and general condition permit of such an undertaking (Bennett). Hernia in women, particularly when young, with the child-bearing age before them, seem to merit a trial of operation (Lucas-Cham- pionniSre). SECTIONAL ADDRESS IN SURGERY. 225 The treatment of gangrenous or suspicious bowel still calls forth a diversity of opinion. Relief of the constriction, warm applications, or temporary replacement with an anchor thread attached, should be tried in all uncertain cases. If a doubt still remains, the intestine is fastened outside the abdomen, dressed warmly and antiseptically, and observed. In a case in which this plan was followed, the gut was found normal on the fourth day and successfully replaced (Rov- sing). In similar cases it is suggested that the gut be well drawn out, an anastomosis made above the suspicious area, and, after sloughing has taken place, the two openings be closed and the gut replaced (Helferich). In general, however, primary resection is to be preferred to the formation of an artificial anus, and gives, on the whole, a lower mor- tality. It is, of course, understood that the patient’s condition and the surroundings permit such a procedure, and that the surgeon has the requisite skill. As to the method of uniting the two ends, the weight of opinion seems to be in favor of the end-to-end plan, with or without aids. These artificial aids may be in the shape of rubber rings or splints to hold the ends together; a rubber tube or decalcified bone drains to hold the intestine open and prevent invagination. When the two lumina are unequal, several plans may be followed: lateral anasto- mosis, lateral implantation (the small end into the side of the large tube), or slitting up the smaller tube on the surface opposite the mesentery until the openings are of equal size, when they are united. The dangers of the persistent use of taxis have received well- merited attention (Bennett). Bruising or rupture of the bowel are often produced and much valuable time is lost. These two factors are largely responsible for the mortality of from 32 to 46 per cent, in the large English hospitals (Southam). The local application of ether, followed by gentle and intelligent taxis for not more than five minutes, and that only when a true hernial impulse is perceptible, will obviate the above-mentioned dangers. Immediate recourse to operation after the failure of such procedures cannot be too strongly emphasized. The persistent application of sulphuric ether to stran- gulated hernia has brought about reduction when taxis under an anaesthetic has failed (Finkelstein). Although, as a rule, the presence of an undescended testicle in a hernial sac calls for castration, Depage reports a case in which it was 15 * 226 world’s homoeopathic congress. drawn down into the scrotum and the hernia treated in the ordinary way. Cases of strangulation symptoms from the appendix, omentum and testicle are also reported. Of the special varieties of hernia a number have been published : 1. Littre’s hernia with no tumor, the partial nipping of the bowel in right femoral ring being found and reduced through a median abdominal incision (Keen). 2. An obturator hernia, strangulated and made out by a tumor, was successfully operated by Wyman. Anderson opened the abdo- men for persistence of obstructive symptoms after an operation for femoral hernia, and found a knuckle of gut in the left obturator foramen. Examination by the rectum or vagina, as well as the dif- fuse deep swelling and pain, are the diagnostic points (Berger). 3. Ischiatic hernia has also been accidentally found : (а) . Through an abdominal section after persistence of symptoms in spite of a femoral herniotomy (Garve). (б) . On removing a fibro-lipoma to which two hernial sacs were found attached (Schwab). 4. Hernia into the foramen of Winslow was made out but not reduced by abdominal section, recovery following a large enema (Neve). 5. Diaphragmatic hernia has been met with but only diagnosed after death. 6. The writer has operated two cases of hernia of the urinary bladder recently. Pain was a prominent symptom, but vesical symptoms were absent. No truss could be worn. In one the atten- uated diverticulum was opened for the sac, the bladder drained, and the wound allowed to heal by granulation. In the other the viscus was recognized, and the abdominal wound was treated in the ordi- nary way. Both recovered and have not had relapses so far. ETHER OR CHLOROFORM. 227 ETHER OR CHLOROFORM f By Horace Packard, M.D., Boston, Mass. Introduction. — It is the purpose of this paper to discuss some questions relative to ether and chloroform anaesthesia. I need hardly refer to the fact that at the present time chloroform, or some modification of it, is the anaesthetic which is used for surgi- cal purposes in nearly all European countries, and that it is also the favorite anaesthetic in the western portion of the United States. On the other hand sulphuric ether is used almost exclusively in New England and the Middle States. It is my purpose to discuss : First . — The reasons for this wide divergence of practice. Second . — The reasons for the diverse opinions which are still held by the adherents to these two forms of anaesthetic preparations. Third . — To place before you an improved method of Ether anaes- thesia. Sulphuric Ether. — Sulphuric ether was brought into use in 1846 and the first practical demonstration of it was made October 17th of that year at the Massachusetts General Hospital, in the city of Boston. We need seek no further reason for an explanation of its preva- lent use in New England and the Middle States. The natural pride and glory which a community shares in such a beneficient dis- covery is quite enough to give it an impetus, and result in almost universal adherence to it. The method of administration of Sul- phuric ether for surgical purposes has remained substantially the same, during all these fifty years, as that utilized by Morton on that historic occasion in the Massachusetts General Hospital. To this day an ordinary cup sponge almost identical with the original, is utilized at that institution. Two to four ounces of ether are poured at a time in it, or upon it, and an average total of from eight to sixteen ounces of ether is consumed at each seance. Every device and every form of inhaler 228 world’s homoeopathic congress. for ether administration has been some simple or complex modifica- tion of the original sponge, i.e. y the employment of a cap, hood, or cone to cover the nose and month, in which liquid ether is placed or poured, and over or through which the tidal air of respiration passes. What are the objectionable features to surgical anaesthesia with sulphuric ether? Individuals differ vastly in the way they succumb to ether anaes- thesia by any method of administration, but the following is a sum- mary of the disagreeable complications usually met : First . — Immediate rebellion by the respiratory tract to the strong fumes of sulphuric ether, such as result from evaporation from a sponge or any of its modifications, with unbearable feelings of suffo- cation, and if the patient be a child, an ignorant person, or one de- void of great self-control, fright results, with effort to escape. Second . — Ether vapor is an irritant to the respiratory mucous membrane, and in many cases causes a profuse secretion of mucus, with coughing, spasm of the glottis, cataleptic spasms of the respira- tory muscles, with cessation of respiration and cyanosis. It is claimed that anaesthesia with ether is attended with greater danger in infants and the aged, on account of the greater fatality of bronchitis at those periods of life. This is based on the supposition that bronchitis is a frequent result of ether anaesthesia. Third . — As a rule ether anaesthesia is followed by nausea, retch- ing and vomiting, with headache and feeling of malaise for twenty- four to thirty-six hours. Fourth . — It is claimed, but I am not sure that this claim is well substantiated, that sulphuric ether is a violent irritant to the kidneys. That kidneys which are already crippled in their functional activity, especially suffering from that form of disease characterized by albu- minuria, may be still further crippled by the action of sulphuric ether to such a degree as to cause death. Fifth . — Ether anaesthesia is said to induce mental aberration in those who have a special tendency to insanity, or who have already suffered from melancholia. Sixth . — Sulphuric ether is a dangerous anaesthetic, though in skillful hands, deaths are very infrequent. I have during the past two or three years kept a careful record of reported deaths from ether which I herewith append. A Death From Ether. — Death from the administration of sul- ETHER OR CHLOROFORM. 229 phuric ether is of such rare occurrence that the case about to be nar- rated seems to merit a place on the records.* The patient was a Frenchman, aged 46. For a year or more he had been suffering from tubercular disease of the tarsus of one foot. At the time of his admission to the French Hospital the disease had become widely diffused. The general appearance of the patient was bad. There were aortic and mitral systolic murmurs, and the heart-sounds were feeble. The urine contained a moderate amount of albumin. The patient’s condition appeared not only to justify but to demand removal of the tubercular foot, and I prepared, therefore, on January 25, 1889, to do a Syme’s amputation at the ankle-joint. In the presence of the attending staff and internes, after the ad- ministration of half an ounce of whisky, the etherization was com- menced. In a few minutes the respiration faltered and the patient became deeply cyanosed but this somewhat alarmingcondition quickly passed away. About five minutes later the assistant having the pulse under observation suddenly announced that it had ceased. Im- mediately hypodermatic injections of brandy, ether and sulphate of atropine were given; amyl-nitrite was applied to the nostrils, artifi- cial respiration was practiced, and the head and shoulders were de- pressed by elevation of the foot of the table; but all was in vain ; the patient was dead. The ether used was the aether fortior manufactured by Squibb. The following is the report of the autopsy made by Dr. G. G.Van Schaick, pathologist to the French Hospital, in the presence of the coroner : “ No rigor mortis. Body well nourished. Lungs, very small, otherwise normal; left pleura, a few adhesions, no fluid; right pleura, no fluid, many adhesions. Lungs slightly congested. Heart, hypertrophied; pericardium everywhere adherent ; coronary arteries of small calibre; slight atheroma of the aorta; mitral valve stenotic. Spleen, enlarged. Kidneys, left atrophied, capsule adherent, mark- ings indistinct, sclerosis above the pyramids ; pelves filled with fat. Right kidney in about same condition ; both surrounded by a thick layer of fat. Stomach, normal. “ The most striking revelation of the autopsy was the complete * Paper by W. Duncan McKim, M.D., New York Clinical Society, March 26, 1889. 230 world’s homoeopathic congress. adhesion of the two surfaces of the pericardium. The death seemed due, then, to syncope, the heart being so fettered that it could not respond to the unusual strain thrown upon it. When beginning the inhalation of ether, the patient seemed very nervous, there was rather more struggling than usual, and a struggle closely preceded the dis- appearance of the pulse. The heart was in a condition to suffer permanent arrest of its function upon any slight increase of labor, and any occasion for unusual mental or physical excitement would, I think, have been as fatal as the ether. Had much more than ordinary care been exercised to quiet the patient’s nervousness, and to restrain his jactitation by moral suasion and the gentle and gradual administration of the ether, I can readily believe that this feeble heart might have successfully emerged from its ordeal.” A Death from Ether.* — A death from ether is reported in a patient undergoing an operation for haemorrhoids. The patient, a man of 65 years, healthy heart, always in good health except the haemorrhoids, temperate in habits except being an inveterate smoker. The administration of ether was entrusted to a druggist who claimed to have had experience. In the midst of the operation the surgeon became conscious that something was wrong and found the patient pulseless. Artificial respiration, suspension, hypodermic injections of brandy, etc., were of no avail. The Recent Death of Colonel Elliot Shepard. — This death from ether is so widely known and has gained such publicity through the public print, that I need but barely refer to it. At the present writing I have seen no authentic report from the physicians in charge of the case. Unfortunately no autopsy was made. It will always be regretted that such was denied, since knowledge of great value might have been attained thereby. Until I know all the circumstances of the case, I shall be unable to divest my mind from the suspicion that there may have been in- competency in the administration of the anaesthetic. Some years ago a British medical journal reported as the result of statistical research, one death to 23,203 ether inhalations. Professor Guerlt of the German Surgical Congress reports one death in 8431 cases. About three years ago the Director of Public Assistance of Paris * New England Medical Gazette, April, 1892. ETHER OR CHLOROFORM. 231 caused a report to be made on the surgical operations of the preced- ing ten years in the hospitals of that city.* As a result of this report ether was shown to have caused death once in 12,581 cases. An editorial in the Medical Record of May 30, 1891, states that the prevailing belief is, that statistics will show about one death in 25,000 anaesthetizations for ether. With this array of disagreeable and dangerous features of ether anaesthesia before us, let us turn to its Virtues — First . — Its inhalation abolishes memory of painful sen- sations, in a very short space of time, two to three minutes. Second . — Muscular relaxation usually follows in from five to seven minutes. Third . — The cautious anaesthetist is always apprised of impend- ing danger from impeded respiration, by coughing, labored action of the respiratory muscles, and the first sign of cyanosis, sufficiently early to so modify the ether administration as to stop the progress of such threatening symptoms. Fourth . — The heart’s action does not appear to suffer materially from ether anaesthesia. In threatening and fatal cases, it continues to pulsate for a time after all voluntary respiratory efforts have ceased. It would appear that labored action of the heart in ether-anaesthesia is a result of carbonic acid poisoning, rather than any inhibitory in- fluence of the ether itself. Fifth . — The exigencies of the practice of medicine and surgery frequently demand that the administration of an anaesthetic shall be conducted by a person possessing little or no practical knowledge of the matter, while the physician busies himself with the operation, with a more or less watchful eye over the progress of the anaesthesia. While we must deplore the necessity of entrusting a dangerous agent in the hands of an unskilled person, yet, if such must be done, all experience thus far points to sulphuric ether as possessing the least dangerous qualities of any anaesthetic now known. Chloroform. — The value of chloroform as a surgical anaesthetic was placed before the profession by Sir James Y. Simpson, of Edin- burgh, November 10, 1847, about one year after the advent of sul- phuric ether. Here, the glory of a new discovery, the discovery of an anaesthetic agent which appeared to possess all the desirable qualities of sul- * Medical Record, April, 1890. 232 world’s homoeopathic congress. phuric ether, and, perhaps, lack many of its faults, was enough to cause its adoption throughout Great Britain and on the European continent, so that sulphuric ether fell into disuse ; and, to the present day, chloroform, or some admixture of it with alcohol or ether, or both, is the anaesthetic most widely used in all European countries; and, I am prone to believe, in the western part of the United States. The Dangers of Chloroform Anaesthesia — First. — Chloro- form is a dangerous anaesthetic. It kills quickly ; how quickly no one realizes unless he has administered it to an animal for lethal purposes. Two instances in my personal experience have served to impress me with the lightning-like rapidity that chloroform can get in its fatal work. Case I. — In the early part of my career as a surgeon, a child was brought to my office by a physician for the reduction of a fracture. I administered an anaesthetic ; and chose chloroform on account of its supposed quicker action. The child struggled, the physician held him, while I crowded the cone wet with chloroform close over the patient’s face. After several deep inspirations, there was com- plete anaesthesia, but with it such syncope that, for several minutes, while I was instituting artificial respiration I was under stress of groat anxiety lest his heart would never resume its action. Case II. — I was conducting some experimental operations upon dogs. A female bull-terrier was being chloroformed. In the course of her struggles the cone was crowded close over her nose, and com- plete anaesthesia promptly followed, but she was dead beyond all efforts at resuscitation. Once in the course of a laparotomy when a chloroform mixture was being used, the progress of the operation was interrupted by the sudden syncope of the patient. Respiration and pulse had ceased without warning. Almost every accidental death during chloform anaesthetization shows that when danger comes, it comes without warning. During the past two or three years I have kept a careful record of reported deaths from chloroform, the most characteristic of which I here append. Dr. Sherman’s case.* — On July 2, 1889, a boy, aged five years, was chloroformed at the Children’s Hospital for the little operation * ‘‘ Report of Two Cases of Death in Young Children During Administration of Chloroform .” — Medical Record, March 15, 1890. ETHER OR CHLOROFORM. 233 of curetting some tuberculous sinuses. The chloroform was given in the usual way, on a towel held a short distance from the face. An- aesthesia was easily produced, and the sinuses curetted. At the bot- tom of these was found a small patch of carious bone, and, as the child began to move, a little more chloroform was put on a towel, and the scoop applied to the bone. At this moment the child ceased to breathe, and the haemorrhage from the wound also stopped. The chloroform was removed, the child inverted, artificial respira- tion done for a few moments, when the functions were restored. Color returned to the face, and the danger seemed past. It was only for a short time, however; after fifteen or twenty respirations, they again ceased, though no more chloroform was used. The heart stopped, the face blanched, the pupils dilated. Artificial respiration was again practiced, the child inverted ; stimulants, such as whiskey, ammonia, Digitalis, and Nux vomica, were given by the hypodermic, hot and cold water alternately applied to the chest, and the battery was used — but nothing had the slightest effect, and after an hour’s work the case was pronounced hopeless, and further efforts aban- doned. Dr. Gibney’s case. — A female child, two years of age, with a sacral spinal bifida , was put under the influence of chloroform at myelinic on June 19, 1889. The patient was in excellent health, hearty and robust. The mother said it had never been sick. The chloroform was of good quality, and was administered in the usual way : that is, a small towel was saturated with the drug and held over the nose and mouth, but not in contact with the face. Within five minutes the child came under its influence, the pulse and respiration good The hypodermic needle was thrust into the base of the tumor, and between six and seven drachms of serum mixed with a little blood were evacuated. The sac was injected with two drachms of what is known as Morton’s fluid (iodine, ten grains; potassium iodidi, one- half drachm ; glycerine, one ounce). The whole operation lasted about ten minutes, during which time the child was not profoundly anaesthetic, but cried out occasionally. The needle was withdrawn, and collodion on cotton placed over the opening, a flannel roller ap- plied around the body preparatory to a more snug dressing. At this time, however, the lips became blanched, the pulse feeble, and three minims of Magendie’s solution of morphia were injected hy- podermically. The breathing at once became more regular, pulse a 234 world’s homoeopathic congress. little better. Very soon after this, almost immediately, the pulse grew feeble again, and forty minims of brandy were injected, when the patient ceased to breathe ; and efforts at resuscitation, such as lifting the child by the feet, head down, artificial respiration, far- adism, etc., proved of no avail. Deaths under Chloroform.* — At an inquest recently held, the particulars were given of the death of a child, about six years of age, who succumbed to chloroform at the Victoria Hospital for Children. The child was admitted for treatment of disease affect- ing the left hip-joint. He had taken chloroform successfully upon two previous occasions, but on the day upon which the operation was to be performed, the boy died after having inhaled the anaes- thetic for fifteen minutes. A post-mortem examination was held, and the medical officer is reported to have said that there was fatty degeneration of the heart, liver, spleen, and kidneys. The death recorded illustrates the fallacy of two popular beliefs : first, that a person that can take chloroform with impunity upon one occasion will subsequently enjoy an immunity from danger ; and secondly, that children, who proverbially take chloroform so well, are less liable to fatal accidents from its effects than are adults. In this same article, the last paragraph, we have the following: Almost before the ink is dry with which we record the above fatality, the report arrives of the death of a woman in a Dublin hos- pital, to whom it was proposed to administer chloroform as a pre- liminary to amputation of the thumb. It appears that before she was fully anaesthetized she collapsed and died. Death During Chloroform Administration. f — The late Dr. Parkes reported, in the Journal of the American Medical Associa- tion for February 14th, an unfortunate case, in which the patient, a healthy girl about eleven years old, died during an operation for removal of a mole from the face performed under chloroform anaes- thesia. The operation was practically completed, and no chloroform had been given for at least five minutes, when she was seized with general convulsions. She ceased to brea he, and her heart ceased to beat. Death from Chloroform. J — The patient was a female, forty-one * London Lancet , October 19, 1889. f N. Y. Medical Journal , April 4, 1891. J British Medical Journal, December 21, 1889. ETHER OR CHLOROFORM. 235 "years of age; the operation was trachelorrhaphy , and was duly com- pleted. On removing the “ face piece ” retching occurred ; more chloroform given. Suddenly, breathing ceased. The heart, ex- amined before the operation, was declared healthy. No autopsy was made. Accidental Death of a Physician from Chloroform.* — Dr. Justus E. Gregory, a well-known physician of Brooklyn, was killed on October 25th by an overdose of chloroform. He had been accus- tomed to inhale this anaesthetic for the relief of facial neuralgia. On the evening of his death he inhaled a dose of twenty drops on a handkerchief. He felt some relief, but called for another dose, and five minutes later was found dead. Dr. Gregory was forty-nine years of age. He had been a surgeon in the army during the war of the rebellion. Three deaths from chloroform have recently occurred in London. One in a man, aged twenty-seven, about to be operated upon for cellulitis of the leg ; another in a man, also young, with varico- cele; and the third in a young girl with an abscess of no great size , — all three cases in which, without the chloroform, the young people would doubtless be alive to-day. It does take people a long time to learn that ether, dangerous as it may be, is a safer anaesthetic than chloroform. f A death from the administration of chloroform is reported in the Cincinnati Lancet-Clinic by Dr. William L. Muzzey. The patient was an apparently healthy man , thirty years of age.j Another death from chloroform has been reported in London at the King’s College Hospital. The operation to be performed was a trivial one for suppurative cellulitis of the leg. The patient, a male tramp, aged twenty-six, was recovering from a drinking bout, and had not partaken of food for three days. At the autopsy, fatty liver and fatty heart were discovered. Death was sudden and without warning.§ Death During Anaesthesia. || — An inquest on a case of death from chloroform at St. Mary’s Hospital is reported this week. * Medical Record , November 1, 1890. f Medical Record, January 16, 1892. X Medical Record , October 26, 1889. \ Medical Record, December 5, 1891. || British Medical Journal, December 20, 1890. 236 world’s homceopathic congress. The operation was for the removal of a crushed finger. A mix- ture of ether and chloroform was administered. The patient gave suddenly, according to the report, two deep inspirations while under operation, when breathing ceased. The verdict recorded was death from syncope. A statistical research by Dr. Lawrence Turnbull shows that since the work of the Hyderabad Commission, held in 1888, forty-three deaths have occurred in the course of anaesthesia ; of these, thirty- nine were from chloroform and four from ether.* I think no further quotations are necessary to substantiate the statement made earlier in this paper, viz., that chloroform is dan- gerous; that it kills quickly. Second . — Beside this immediately fatal action of chloroform, recent pathological investigations seem to indicate that deaths not infrequently occur some hours, or even days, after chloroform anaesthesia. Effects of Prolonged Chloroform Anaesthesia. f — Some obser- vations, made about two years ago by Dr. Ungar, pointed to fatty degeneration of the heart and liver as the cause of death after repeated prolonged administration of chloroform. F urther experiments on dogs have recently been made by Dr. Strassman, which appear to confirm this view. Dr. Strassman found that the first organ to be affected was the liver, then the heart, and after that other viscera. The nature of the morbid change was not a fatty degeneration, but fatty infiltration. The actual cause of death in fatal cases appeared to be the cardiac affection, as in all such a very marked degree of change was found in the heart. In non-fatal cases the morbid change was found to have disappeared in a few weeks’ time. When morphine was given previ- ous to the chloroform, less of the latter was required, and, consequently, the changes produced were not so considerable as when the ordinary amount was given. Animals suffering from hunger, loss of blood, etc., were especially predisposed to the morbid changes due to chloro- form. Death After Chloroform. f — Thiem and Fischer’s ZJeber todliche * “On Deaths from Chloroform and Ether since the Hyderabad Commission,” by Lawrence Turnbull, M.D. f London Lancet , 1889. J British Medical Journal , September 13, 1890. ETHER OR CHLOROFORM. 237 Nachivirkung des Chloroforms , published last year, tends to attribute otherwise unaccountable deaths following a few days after prolonged administration of chloroform, to fatty degeneration of the heart actually caused by the anaesthetic. A case is described where Thiem operated upon a robust and temperate man, aged 36, for fracture of the patella. The patient took just half an hour to get under, and the lengthening and suturing of the opposite fragments of the bone took seventy minutes; 150 grammes of chloroform were inhaled. The patient was slightly delirious for two nights, on the third day the wound looked well ; the temperature was 100.5°, the pulse 96, and rather feeble. In the course of the evening the pulse grew much weaker, the delirium increased, and the patient died. At the necropsy the muscular walls of the heart were found in a state of extreme acute fatty degeneration ; a similar change had attacked the hepatic cells. The patient was a miller’s man, and had been accustomed to carry weights till the day on which he broke his patella ; there was no previous evidence of any form of heart disease. Professors Thiem and Fischer observed similar changes in the heart and liver in ani- mals kept under chloroform, especially when the dose was repeated for two or three days. It is to be hoped that surgeons will not be too ready to attribute their fatal cases to these distant effects of chloro- form; but they will do well, in these days of long and severe opera- tions on the abdominal viscera, to bear in mind that the prolonged administration of chloroform mav be in itself a source of danger which is not passed when the patient is restored to consciousness. Third . — Vomiting usually occurs after chloroform anaesthesia. The Desirable Qualities of Chloroform. First . — Chloroform has a sweetish odor, not unpleasant to the respiratory tract, and can be inhaled without special feelings of discomfort, and rarely any in- terruption in breathing from spasm of the glottis or irritation of the respiratory mucous membrane. Second . — It is rapid in its action, complete anaesthesia ensuing in from five to seven minutes. Third . — But a small quantity is required to induce anaesthesia, two to three drachms, and an operation of an hour’s duration may be conducted with less than an ounce. 238 world’s homoeopathic congress. Tabulation, Ether. 1. A dangerous anaesthetic. 2. Ratio of deaths to inhalations: 1 : 23,204 (Andrews). 1 : 16,542 (Lyman). The ratio of deaths from ether is from 5 to -j as great as from chloroform. Ether kills rarely. 3. Ether is rapid in its action, inducing anaesthesia in from 5 to 7 minutes. Ether is an irritant to the respiratory mucous membrane, and in susceptible subjects may cause violent and fatal bronchitis. Ether stimulates the heart’s action. Ether is claimed to be an irritant to the renal tissue, and may produce fatal results if the kidneys are already crip- pled by disease. Ether may provoke attacks of melan- cholia in susceptible subjects. The administration of ether is likely to be followed by nausea and vomiting. Chloroform. 1. A dangerous anaesthetic. 2. Ratio of deaths to inhalations : 1 : 5860 (Lyman). 1 : 2500 to 3000 (Richardson). The ratio of deaths from chloroform is 4 to 5 times that from ether. Chloroform kills frequently. 3. Chloroform is rapid in its action, inducing anaesthesia in from 5 to 7 min- utes. Chloroform is a bland anaesthetic as far as its action on the respiratory mucous membrane is concerned. Chloroform depresses the heart’s action. Chloroform is said to have no per- ceptible influence upon the kidneys. Chloroform is said to be devoid of in- jurious influence on the mental faculties. The administration of chloroform is likely to be followed by nausea and vomiting. Conclusion. — It would appear from the foregoing, that certain facts regarding surgical anaesthesia have been established. First . — There is some danger attending anaesthesia, whatever anaesthetic or method of administration be employed. Second . — Sulphuric ether is the safest anaesthetic for general sur- gical use, in all periods of life, from infancy to old age. Third . — Chloroform may be advantageously used in place of ether in cases of renal disease, characterized by albuminuria, and in per- sons having inherited or other tendency to melancholia. Fourth . — In cases of weak heart, with dilatation from valvular disease, or other cause, any anaesthetic carries extreme danger with it. Valvular disease, with good compensation, does not contra- indicate the use of ether. Fifth . — If an anaesthetic must be administered to a patient suffer- ing with bronchitis, in the absence of other contraindications, chlo- roform is preferable; but, in such cases, it is better to defer the ad- ministration, if possible, until the bronchitis has been cured. * ETHER OR CHLOROFORM. 239 In closing, I wish to refer to one other matter, and this I will in- troduce by quoting a paragraph from a paper by H. C. Wood, M.D., delivered before the International Medical Congress, in Berlin, Au- gust, 1890. Speaking of ether and chloroform, he says: “The comparative advantages and disadvantages of the two anaes- thetics, in practical medicine, are so well known that only one or two points seem to force themselves upon our present attention. I cannot see that the surgeon is justified in putting the life of the pa- tient to the unnecessary risks of chloroformization, except under special circumstances. I believe, moreover, that much of the un- popularity of ether is due to its improper administration. It is so easy to embarrass the respiration seriously by the folded towel, as commonly used, that not only are the struggles of mechanical as- phyxia almost invariably produced, but probably death itself is sometimes caused. Especially, is there danger of death being thus caused mechanically in the advanced stages of etherization, when the patient is too thoroughly etherized to struggle, and when the atten- tion of the etherizer is, it may be, attracted by some novel and diffi- cult operation. I, myself, confess to having once nearly killed a patient in this way.” It will be observed that I have underscored the portion of the above quotation referring to “improper administration.” This matter has so profoundly impressed itself upon me, that dur- ing the past few years I have devoted much time and thought to the devising of an improved system of ether administration. This has resulted in the method which I have been pleased to term “Anaesthesia with Etherated Air,” a full description of which was presented to the American Institute one year ago, and is now printed in its Transactions for 1892. I would here emphasize what has been forced upon me from prac- tical experience, viz., That surgical anaesthesia should be conducted by an expert. It is an injustice to the patient, as well as to the operator him- self, to entrust so important a matter as the administration of an anaesthetic to an inexperienced student, a nurse, or other incompe- tent person. The expert in anaesthesia observes the first warning of danger, and trouble is thus avoided. The ignoramus sees nothing, because he knows nothing, and his first consciousness of impending danger 240 world’s homoeopathic congress. is likely to be after the patient has ceased breathing or the heart is pulseless. Discussion. Dr. Packard, of Boston: With the permission of the Congress I will simply give a resume of my paper, hoping thereby for more time for simple experiments which I wish to show you, and the anaes- thetization of a patient. My paper is a defence of ether as a general surgical anaesthetic. At the outset, I will make the declaration, which I hope to prove to you ere I am through, that sulphuric ether is the best surgical anaesthetic which we possess, falling short of the ideal in but very few details. Ether’s only rival in the field of surgical anaesthesia is chloroform. In spite of the virtues of ether, chloroform is still the anaesthetic in prevailing use over a large portion of the earth. This seems a little strange, since the discovery of sulphuric ether as an anaesthetic antedates chloroform by about one year. It is still in prevalent use in New England and the Middle States, and the reason for this we find in the pride and glory of a community which attends the discovery of such a beneficent material. With the dis- covery of chloroform in New England, and the impetus which En- glish, French, and German surgery have given to the world, and the adoption of chloroform and its subsequent use by those countries, explains why chloroform, or some mixture of it, is still so widely in use in Great Britain and on the Continent, and I think in the west- ern part of the United States. My belief is, that the reason that chloroform has continued to be the prevalent anaesthetic, and that ether still is used by a comparatively small number, is because it has not received the scientific study which it deserves. To-day, forty-seven years after the discovery of sulphuric ether, it is utilized and applied in substantially the same way, and by the same method, that it was on that memorable occasion in the Massachusetts General Hospital in Boston — simply by saturating a sponge and placing it over the patient’s face. To-day, that hospital has the very same kind of a sponge as was used forty-seven years ago, and all the forms of inhalers, which are modifications of the simple sponge or towel, embodies the same principle that was utilized in the use of the sponge. So I may. say, that there has been, practically, no progress in the method of administration of sulphuric ether. I will here skip over a large portion of my paper, which is de- voted to somewhat dry facts regarding the comparison of the anaes- thetical effects of ether and chloroform, and will briefly refer to a tabulation near the close of my paper, comparing these two rival anaesthetics. •> Ether, a dangerous anaesthetic, not very dangerous, but once in a while we hear of a death. Chloroform, a dangerous anaesthetic, ETHER OR CHLOROFORM. 241 much more dangerous than ether. The ratio of deaths by ether in- halation, by one author, is 1 to 23,204 ; by another author, 1 to 16,542. The ratio of deaths by inhalations of chloroform by one author, 1 to 5860; by another author, 1 to 2500. The ratio of deaths from ether is from one-quarter to one-fifth as great as chlo- roform. The ratio of deaths from chloroform is from four to five times that of ether. Ether kills rarely, chloroform kills frequently, and the deadly action of chloroform never can be realized until one has seen a death from it. Try to kill an animal with chloroform. I never was so impressed with the fatal action of chloroform as at one time when, in the course of some experimental operations, I was chloroforming a bull terrier. In the midst of the struggles I pressed the hole closely down over her nose, excluding the air. In a moment her struggles ceased. She was absolutely dead, beyond resuscitation, and that is just what we meet with every now and then in a human being — a death occurs like that. Ether is rapid in its action, inducing anesthesia in from five to seven minutes. Chloroform is rapid in its action, inducing anesthe- sia in from five to seven minutes. Here they stand equal. Ether is an irritant to the respiratory mucous membrane, and in susceptible subjects may cause violent and fatal bronchitis. Chloroform is a bland anesthetic as far as its action on the respiratory mucous mem- brane is concerned. Ether stimulates the heart’s action and chlo- roform depresses it. Ether is claimed to be an irritant to the renal tissue, and may produce fatal results if the kidneys are already crippled by disease. Chloroform, it is said, has no perceptible influence on the kidneys. Chloroform is said to be devoid of injurious influence on the mental faculties. The administration of ether is likely to be followed by nausea and vomiting, the same as chloroform. Conclusion. — It will appear from the foregoing that certain facts regarding surgical anaesthesia have been established. First. There is some danger attending anaesthesia whatever method be em- ployed. Sulphuric ether is the safest anaesthetic for general surgical use in all periods of life from infancy to old age. Chloroform may be advantageously used in place of ether in case of renal disease, or other cases, characterized by albuminuria, or those having a tendency to melancholia. In cases of weak heart, with dilatation from valvular disease or other cause, any anaesthetic carries extreme danger with it. Valvular disease, with good compensation, does not contraindicate the use of ether. I will briefly refer to the fact that for the past six years I have made a study of ether which has modified the notions originally pre- vailing and the method of administration. I would like, if I can have the time, to show you one or two little experiments, and then to etherize a patient. In the first place, I throw into an empty bottle 16 242 world’s homoeopathic congress. a few minims of sulphuric ether like that, putting the cork in, and in a moment it disappears. They say it evaporates. At any rate, there has been some union of the ether with the air contained in the bottle. I don’t know just what that change is, whether it is a chemical or a mechanical change, but an explosive compound has been formed, as you will see in a moment. Y ou observe that, with a slight explosive action, the cork flies out of the bottle. It simply shows that the combi- nation of ether and air results in a compound which has a much greater volume than the air which has been saturated with the vapor. I found by this experiment that the injection of more than one minim to the cubic inch of air overcharges that air. This bottle contains about fifteen ounces. The injection of fifteen minims of ether results in the observation at once of the disappearance of that liquid ether. If more than that be injected, there is a residue left, so that we have the fact established that a saturation of air with ether takes place at the rate of one minim to the cubic inch of air. The next thing was to pass air through a column of ether like this (indicating). It makes its exit at this tube, and on experiment I found that the compound makes its exit just the same as it is formed in this body ; that it is a compound consisting of one minim of liquid ether to one cubic inch of air. Now what is the property of that compound? Has it an anaesthetic property ? The next thing was to accumulate that compound in a bag and apply it to the human respiratory tract and this was the result. It was so strong and power- ful, so pungent, that 1 he human respiratory tract would not tolerate it, although I had been told that previous experiments of this kind have been made, that the resulting compound from the mixture of ether with air would not produce anaesthesia. The next step was to find out how much dilution with air it needed, to be tolerated by the human lungs, and if that would produce sur- gical anaesthesia ; and it was learned that it would do so, more promptly than we ever conceived sulphuric ether could do. In from five to seven minutes complete surgical anaesthesia is induced by the resulting compound. I will now anaesthetize a patient with this compound. I have an apparatus different from anything that has ever been used. It com- bines some principles which have existed heretofore. This bottle is just the same as the Junker method, which is used for chloroforming. This portion which goes over the face is similar to other inhalers with the exception of the compound. I call this “etherateH air.” The etherated air is pumped into this bag and the strength of that which reaches the patient’s lungs is graduated by this valve which is opened or closed according to the circumstances of the case. After all anaesthesia is but little more than an abolishment of ETHER OR CHLOROFORM. 243 memory, the memory of painful sensations ; and the moment that memory is abolished we may say that that patient is anesthetized. I will ask this patient to signal to you so that you may know the moment that memory is abolished. He will do it by making signals with this “snapper.” After the abolishment of memory there is usually a moment or two which ensues before complete surgical anesthesia follows. By surgical anesthesia I mean a relaxation of the muscular system. If some one will kindly time the point at which memory fails from the time that I begin to see the ether pass through we will know the time that anesthesia begins. (After three minutes the patient produced before the Section failed to make use of the snapping instrument, which he had heretofore done in a rapid manner, and in seven minutes was apparently anaesthetized. He was restored to consciousness by the doctor in a little over one minute, and after acting in a bewildered manner and exhibiting some nervousness, was removed from the room). S. B. Parsons, M.D. : Mr. Chairman , Ladies and Gentlemen : When I was asked to open the discussion on anaesthesia, I felt that perhaps I was incompetent to do so. There were many who were better able than myself to discuss this question, for I consider it one of the most important of the questions that can come before a medical association. I do not believe, Mr. Chairman, that in the list of surgical subjects that will come before this body to-day, there will be one of so great importance as that of anaesthesia. We have just had a beautiful illustration of how easily some persons can be put under an anaesthetic. But let me tell you one thing that you can- not always get males and females under an anaesthetic as easily as this one was put under. It is very pleasant when you can, but the majority of them will require from four to a dozen men to keep them quiet during the process, whether it be ether or chloroform* The very fact of the patient lying on the table and quietly submit- ting to an anaesthetic, inhaling it regularly without fear, without nervous excitement, is one very great advantage, I can assure you. But when you go into an operating room, whether it be an old per- son or young person it makes no difference, and find their hearts going like a trip-hammer, their minds and bodies in a state of agita- tion, afraid of their lives, not knowing what is going to be done to them — afraid they will die — I tell you you have got a subject entirely different from the one we have just witnessed. You will find that you have got something to do before you give the anses- thetic, and it is a very important point, I assure you, to determine how to overcome that, and to quiet that nervous excitement. The very first thing an operator should do in going into an operating room is to allay the fears and quiet the nervous excitement of the patient. Before an ansesthetic is given, before an inhalation is taken, the nervous excitement should be overcome and the fears quieted and pacified. 244 world’s homceopathic congress. The paper that Dr. Packard, of Boston, has presented, I had the pleasure of looking over, and he has given us the relative statistics of the frequency of deaths under chloroform and ether, and he tells us it is from five to ten times greater under chloroform than ether. Now then, if that is a fact, chloroform has a ten-fold power greater than ether in paralyzing the nervous system, for etherization is simply paralysis. First , It is, what? A stage of excitement. Second , Loss of consciousness. Third , Loss of voluntary movement, and Fourth, Loss of reflex action. Your patient is not in a fit con- dition for you to go on with a capital operation until these all occur. It is .all right if you want to open a felon or perform some minor operation, but I assure you that the patient never will submit, with- out a good deal of struggling, to an operation of amputation. This case before us was not a full and complete anaesthesia in my belief. Ether is the safest ; there is no question about it. Ether is the safest, but the doctor has told you that you cannot use it always. There are times and conditions when you cannot use ether. Now, ether is not a good thing in the obstetric room, for one thing. Chloroform takes preference there. Then again, there are organic changes he told us ; trouble with the respiratory tract, organic changes in the heart, and in the renal structure, and in the brain. Now we cannot use ether with a degree of safety, or any anaesthetic, under these conditions. It is true, I will admit, any anaesthetic is an unsafe anaesthetic. Ether cannot be used at these times, but you can use chloroform where you cannot use ether. Now, ether paralyzes one set of nerves, you may say, and chloro- form another. The symptoms of ether narcosis, profound narcosis, or the incidents which accompany or attend ether narcosis, almost always — ninety-nine times out of a hundred — will give you warn- ing before the dangerous period has arrived ; and those symptoms are what? Interference with and obstruction of respiration. With chloroform it is the opposite. It does not give you any warning; it takes the patient off as quick as a flash. On the one hand it is failure of respiration, as they call it, causing death under ether, and on the other, it is a failure of heart action under chloroform. Those are the two conditions, and those are the two symptoms. There are many little things that tend to make anaesthesia very unpleasant. To give an anaesthetic where there is a very irritable mucous tract, or where you are going to operate upon the niouth, or larynx or pharynx, ether is not a good anaesthetic to use. Chloro- form is by far the best.. If you use ether, you will have the throat filled up with mucus in a very little while. It seems to paralyze, I might say, the vaso-motor nerves, and we have an unusual amount of mucous flow which fills up the throat and obstructs your view, and you are obliged to keep wiping it out, and the operation is de- layed while your patient is not benefited. Oftentimes you cannot get along and you have to give it up. With chloroform it is differ- ETHER OR CHLOROFORM. 245 ent ; you don’t have that abundant flow. There are other things that conduce to make anaesthesia pleasant or unpleasant. Tempera- ment sometimes has something to do with it ; and peculiarities of constitution, where they are known to exist, should always be done away with before the operation. Sex also has something to do with it. Women take an ana?sthetic a great deal better than men. They are more reconciled to the condition, more reconciled to the circum- stances ; they have less fear and nervous excitement. They lie down and take it quietly, and they come out from under it a great deal better. With males we have a greater number of deaths than with females. It is not all because the operations are so much more frequently had on males than on females, but it is on account of the sexual condi- tions, I believe. Now as to the question of chloroform being used in preference to ether in different parts of the country, perhaps cli- matic changes and conditions may have something to do with it. We have found one thing, that ether does not produce that profound relaxation that we sometimes need. (At this point, Dr. Northrup’s discussion of the paper was pre- sented by the chairman. This part of the discussion has not been received by the editor.) H. F. Bigg A r, M.D. : Mr. Chairman, Ladies and Gentlemen : I have listened to this paper, and have seen the clinic and also listened to the discussion with a great deal of edification. It has been a question with me for years just the proper thing to use — chloroform, ether, or the A. C. E. mixture. For years I used the A. C. E. mixture. I never have had so good results since, but I was com- pelled to give it up because if an accident should occur the coroner was after us, and we had no person in this country to assist in get- ting us out of the dilemma. The popular idea was then, ether. I gave ether a trial for one year, determined to find out its merits or demerits. With the most perfect instruments and most perfect appliances, I had six patients to go right down almost to death before they were saved. I read up chloroform, and I am a friend of chloroform. When you can perform difficult operations with two grammes of chloroform, I am a friend of chloroform. There is a great deal in statistics, but I take exception to the statement that more die from chloroform than ether. I dispute it, and challenge it, and I tell you why. When they die from chloro- form they die on the table. When they die from ether they die af- terwards in the room where they are taken from the table. It may be two days before they recover from it. I really think there are more dying from ether than from chloroform, for the very reason I gave you. One point more, and that is this : we ought to be care- 246 world’s homoeopathic cong-ress. ful and study our cases. We cannot make a rule for every case as a law unto itself, and I use ether and I use chloroform, and wish the law would protect us in the use of the A. C. E. mixture, which in my estimation has been the safest and quickest, and by all means gives the best satisfaction ; but there is this difficulty about it: when you pre- pare it, prepare it fresh. Dr. Tait uses it, and he asks nothing better than that mixture. I know there is a diversity of opinion about it, but as long as I am practicing I shall use my own judgment as to what I give, whether it shall be ether or chloroform. I dare not give the A. C. E. mixture in this country, because I wouldn’t get any support if the patient should die. I have been a victim of this. I have been accused of losing two patients, one was by chloroform, which was never inhaled, and the other was by chloroform which she did inhale. I would not let the patient get up and sit up after an anaesthetic so soon as this one did. I would be afraid of paralysis. Keep your patient quiet, get him in good condition, and if there is any likelihood of vomiting, get a large dose of some cathartic down him as soon as possible. You want it to work down, and as soon as you get it down you will have no vomiting. Question by Physician in audience : Where do you get your theory of vomiting ? Dr. Biggar : I am indebted to Dr. Thayer. He says he has no trouble about vomiting. He gives them a good dose of citrate of magnesia. I don’t want to exceed my time ; but one moment, if you will allow me. The reason I lost a patient from chloroform was this, and it was a lesson to me, and will be a lesson to you, per- haps : after the operation had been completed, the patient com- menced vomiting, and the vomiting was so severe that she had stasis in different parts of the brain from undue pressure caused by the vomiting. That was why she lost her life. I think we ought to carefully study that point and prevent vomiting, and by all means get a movement of the bowels if possible before the person really comes out of the anaesthesia. They want to know what the A. C. E. mixture is ? It is one part alcohol, one part chloroform, and one part ether. Dr. Emerson : I am here to say a word for Dr. Packard’s ap- paratus. I am very familiar with the working of it, and could say some things he wouldn’t feel like saying. I will say that the patient he has had to-day is the worst one I have ever seen him experiment with. It took seven and a half minutes to etherize the patient. As to Dr. Packard allowing his patient to sit up so soon, I would also say it is entirely safe for him to do so, for the reason the patient had taken so small a quantity of the ether. His patient was entirely etherized. One could have performed amputation or any other op- eration. I simply take this opportunity to speak in behalf of Dr. Packard. ETHER OR CHLOROFORM. 247 Dr. Gilchrist, of Iowa City : I have one word to say on the subject of anaesthetics. We have been using the A. C. E. mixture entirely for a number of years, and find it a very satisfactory agent. There is one point we haven’t brought out in the testimonials. Isn’t it possible that ether and chloroform and all anaesthetic agents are to be looked upon as remedies ? Is any anaesthetic agency univer- sally to be approved ? There are many cases, I think, where we dare not use ether. There are many cases, I think, where we would hardly dare to use chloroform. It certainly appears to me that there will be a time when we will cometo understand anaesthetics perfectly. With reference to the rapidity with which anaesthesia can be pro- duced, we have been keeping some records, and we find that the av- erage from the A. C. E. mixture is about eight and three-quarter minutes for complete anaesthesia. I want to give another remedy to add to the one that Dr. Biggar gave, and one I think of even greater value, and that is Bismuth, given in the third and higher attenuations. I have had one or two cases where Bismuth has acted wonderfully. One case occurred but two or three weeks ago, of abdominal complication. I want to call attention to that as one of the remedies we have not given special attention to in abdominal complications. I have used it in the third attenuation. Dr. Shears: I want to take exception to the statement that ether is the best general anaesthetic. I don’t think it is an anaes- thetic that should be most generally used. It should be confined to a very limited number of cases. It is not applicable where there is any disease of the rectum, or taken in an operation on the larynx, the mouth or the nose. It is very difficult to use ether with any degree of satisfaction. It is not applicable to the treatment of ure- thral inflammation, or inflammation of the kidneys, or stone in the bladder. In all those cases I think ether is not a safe anaesthetic. It is not a good anaesthetic in operations on the brain ; it induces greater congestion, and is more difficult to control. I find, in a large number of instances of operations upon the brain and head that ether is not of service, and is not useful as an anaesthetic in operations on the abdomen. It is the cause of very frequent vomiting. It is very difficult to control the patient for a long period of time. I believe it is the more dangerous anaesthetic in the long run. Pneumonia follows in two or three days, or what is supposed to be pneumonia, or some other trouble, will show its effects from ether. I say this, because there is a general feeling among experts that if the patient dies after chloroform, the physician has not used the safest anaes- thetic. I think we should be assertive of the idea that we are using safe anaesthetics. I believe much danger from chloroform arises from its improper administration. It has been shown that danger arises from interrupting respiration. The physician pays all his at- 248 world’s homceopathic congress. tention to the pulse, and if he would pay his attention to respiration and see that the patient does not take in too large an amount of the anaesthetic, then I believe there would be fewer cases of death from chloroform. Chloroform has been put over the face in the same careless way that ether is applied. I believe it is a rare case in which you find the heart cease to beat before the patient ceases to breathe. If we paid more attention to respiration there would be fewer cases of death from chloroform. Dr. Boothby: I wish to say a word in favor of ether. I am induced to do this because of the remark of the gentleman who has just spoken. The inference would be that we have many deaths after our operations — some time afterwards. That was intimated by Dr. Biggar’s remark ; but if you will consider that matter more carefully and consider the results of those who use ether you will find it is entirely erroneous; that it is an assumption; that they haven’t the slightest evidence to base it upon. It is a positive fact that ether can be used in almost every kind of operation. I know from my own experience and from the experience of my Brother Packard and many others. I always use ether myself, and I believe the remarks here have been intended to discredit ether. The appa- ratus that has been shown has given very satisfactory results with the use of ether in small quantities in a large number of cases that it has been used in. There has never been an accident that could possibly be referred to ether, either at the time of the administration of it or later. Dr. Bowen, of Indiana: I kept one patient under the influence of chloroform continuously for two nights and a day. I was called to treat a gentleman who hadn’t swallowed a particle of food for three days and nights. He had terrible pains, and his brother came and placed himself under bond that if I killed him he would guar- antee me against damage, and told me to give him chloroform. I gave him two pounds of chloroform and kept him under the influ- ence of chloroform two nights and a day. His respiration was five or six in a minute and his pulse kept up. When I let him out from under the chloroform the neuralgia had given way. That was the longest time I had ever kept a patient under the influence of chloro- form. Since the grippe had made its advent in the country I found it very imprudent to give chloroform in all cases. Dr. Johns, of Lexington, Ky. : On the question of vomiting after anaesthesia there was suggested here the third of Bismuth as a remedy for it. I want to say I would rather use the one hundred thousandth of Ipecac. I would put it in a little pellet, and put that into about three gallons of water, and pour it down the patient rapidly in full quantities, and start him to vomiting, and he will get up a heat. I would put another in about as much water, and I w y ould cleanse the bowels from below. Now, whether the medicine ETHER OR CHLOROFORM. 249 or water would do it is a question. I am not a Hydropath, but a Homoeopath. I have never had any trouble along these lines. I want to state that all the benefits of this cure we have found out by Homoeopathy. E. H, Pratt, M.D. : There are several reasons why I do not wish to speak. One is I do not want to break the rules governing the time that is allowed. In the next place, if I was to speak upon this subject, I would want fifty minutes instead of five. As it is, I will put in the five minutes as best I can. In the first place, let me say that I had nothing to do with the construction of the human body. I never made any suggestions as to the way it was to be built. I never had anything to do with the telephonic wires that ramify through it. I had nothing to do with its mechanism. I had nothing to do with the causes that make the milk come in the woman’s breast at just the right time for the baby. I had nothing to do with these things, and I am not to be held responsible for them. I wish to escape punishment, you see. I will make this suggestion, however, that when a person struggles in anaesthesia he needs rectal dilatation. Rectal dilatation would shorten the time of that anaesthesia by fifty per cent. With reference to the forms of the anaesthetics employed, I agree with the popular idea that ether is dangerous, and I think that chloroform is dangerous. I use a mixture of the two, and have no respect for the heart, lungs, kidneys or anything else, simply be- cause I know this fact, and know it beyond any question, so far as my judgment goes, that what is needed is rectal dilatation and flush- ing of the capillaries. By rectal dilatation and flushing of the cap- illaries we will remove the congestion from the kidneys and relieve the pressure upon the heart which chloroform will cause. I don’t know why the medical profession ignores the fact that rectal dilata- tion is the greatest resuscitator from narcosis. I do not understand why they don’t wish to investigate. A gentleman from the oppo- site school came to me from Mississippi. He had made some obser- vations and some study of this question. He came here to learn a little more, and wished to compare what he saw and knew with other physicians. He visited one of the clinics of this city, and it ought to be published throughout the length and breadth of this land that any human being would allow a patient to die for the reputation of “ legitimate” measures, rather than to save him by what they didn’t know anything about. They ought to be placarded as unfit for the practice of medicine. They were operating for laceration of the perinseum. The patient didn’t respire for five minutes, and was apparently a corpse. He stood there and saw the operation, and he had seen cases of Bright’s disease and dropsy ; and, forgetful of the stigma that would be placed upon him if he failed, he sprang into the arena, into that tremendous stillness, and said, “ This is a case 250 world’s homoeopath ro congress. for rectal dilatation.” The operator stood dumbfounded, and said, “We have no speculum.” He says, “ Have you any objection to my dilating the rectum?” They said, “We have not any specu- lum.” He put his finger into the anus. This happened to be a good case, and soon he had the satisfaction of hearing the welcome sound ; the groan of the patient greeted his ear, and she was revived, and they went on and finished the operation, and the reputation of the school was saved. What was the result? The next day they published upon the blackboard a notice that “ Hereafter all who wished to obtain tickets to the clinics must obtain the tickets below.” In fact, they weren’t grateful that the patient was saved. They would rather she would have died under the legitimate idea than be saved by rectal dilatation. Dr. Packard : I will take a few moments to close the discussion. I wish to correct a few erroneous ideas, and, first, that there is great danger after the anaesthesia from ether. It is just the opposite with chloroform. Death occurs in twelve, eighteen or twenty hours, be- cause of the result of fatty degeneration. That is one of the dan- gers of chloroform. It is a danger that follows very frequently. We grant that there is sometimes pneumonia and violent bronchitis, but it is extremely rare. I would like to speak of the deaths from ether in comparison with chloroform. I make the statement that in the Massachusetts general hospital since its organization, twenty- three years ago, nothing but sulphuric ether has been used, and there never has been a death attributed in any shape or manner to ether. I cannot wonder that the West likes chloroform. Chloroform has always had the reputation of being so fast. Abroad, human life is not held for as much. If the patient dies in a case of anaesthesia, it don’t amount to so much. Chloroform will be relegated to a few cases which present some form of nephri- tis and those other rare cases that will succumb completely to mus- cular relaxation. In the 250 cases that I have tried with that instrument there have been but two in which I have not secured complete anaesthesia. Cases of execution and capital punishment are the cases for chloroform. It will kill a good deal more quickly and a good deal more humanely than the gallows or electricity. SURGICAL SHOCK. 251 SURGICAL SHOCK. By T. L. Macdonald, M.D., Washington, D. C. Thanks to anaesthesia and antisepsis, pain and poison have been eliminated from operative surgery, and the most formidable compli- cation now remaining for the surgeon to cope with, is shock. Its paramount importance, and the meagreness of the subject, make its further study eminently advisable. As here considered, the subject has nothing to do with “ railroad spine ” or “ litigation symptoms,” but is to deal with the immediate constitutional phenomena pro- duced by local traumatism, and will be used synonymously with col- lapse. It will not be understood by this that shock cannot be pro- duced by psychic as well as traumatic influences. The interdepend- ence of the mind and body is shown by the influence of impressions that fall upon the retina from without. Let a patient who is to be operated gaze upon an elaborate array of instruments, and in some cases the effect is most pronounced. Through the mind the knees quake with terror, the hair stands on end, the brain reels, the heart beats tumultuously, the respiratory apparatus stammers and gasps, the perspiration oozes from every pore, the urine is voided or sup- pressed — in fact any of these organs may be transiently disturbed or even paralyzed. These are familiar illustrations, but serve to show that psychical disturbances mav act powerfully upon our physical being; and who can tell (and I ask it in all charity and kindness) how much this had to do with the death of Col. Shepard ? The above examples would seem to indicate that, turn and twist it how we will, we cannot escape from the fact that the mind is a power within our muscular being (Mueller), or that the psychical and physical are practically one, and that the normal status of our grosser structures is more or less dependent upon the mind as well as the heart or lungs. Although shock of this variety may be pro- found, it is not necessarily surgical, but the varieties which are the accompaniment of visible trauma, and especially if coincident or 252 world’s homceopathic congress. subsequent to surgical operation, are of special interest to us. Be- cause the symptoms of shock are so familiar, they may wisely be omitted ; but, on the other hand, its pathology is so obscure that it demands further study. The most advanced work on surgery takes up surgical shock, and dismisses the subject of its pathology with the statement that it consists of paralysis of the vaso-motor sys- tem. Other works, devoting several pages to the pathology, add nothing to the above except what is conjectural. We know that peripherally the capillary resistance is diminished ; so, too, is the motive power of the cardiac centres. If the vaso-motor supply be cut off from one part of the body, the vessels therein dilate, but in a few days recover their tone, although future contraction and expansion are dependent upon local stimuli. The abdominal ves- sels may or may not be dilated. Further than this, everything at present lies beyond the range of human perception. We may say that in shock there is a disturbance of the molecular equilib- rium, which can no longer liberate force, but this is of little sat- isfaction to the analytical mind. Autopsies teach us nothing of the pathology, no post-mortem traces ever having been discovered. The whispering of molecular vibrations, which constitute human agony, is lost in the roar of hurrying dissolution. The clinical phenomena, however, corroborate the vaso-motor theory, and the consequent relaxed vascular system. It is borne out especially by the intense thirst and the incredible quantities of water that many of these patients drink during profound col- lapse. Case I. — Removal of four and one-half inches of rectum for epithelioma. The operation was tedious but not very bloody, only two vessels being ligated. The operation was completed, and the patient, in the most profound collapse, was placed in bed. The pulse was but an occasional flicker, the respiration faint; features pinched and ghastly, pupils dilated. The ears and supra-sternal fossa were filled with cold sweat, and the body and limbs wet and cold. Hypodermic stimulation brought about little or no improve- ment, and as there was fortunately no vomiting, I decided to try stimulating fluids by the stomach. Brandy and hot water was ad- ministered, at first a few drops at a time, but it was soon given freely, when it was perceived that deglutition was unimpaired. Suffice it to say that during that night he drank nearly five quarts SURGICAL SHOCK. 253 of the liquid, though much of the time too weak to do more than turn his eyes appealingly toward the glass. He rallied the next day, the temperature not running above normal. In such cases the de- sideratum seems to be to give the relaxed vascular system something to contract upon. The proneness of intestinal lesions to produce shock is worthy of attention, and so is the deception in its manifestations, especially during the period preceding dissolution. It is characterized by ces- sation of pain and sometimes vomiting, both of which may have been persistent, and the patient becomes perfectly easy and rational and the temperature may be normal. This is augural of collapse, which is precipitated by operation. Case II. — I was called hurriedly to the suburbs, and went pre- pared to operate for suspected intestinal obstruction. Found the patient able to sit up, feeling perfectly comfortable and having a normal temperature. The history as well as condition upon exami- nation corroborated the tentative diagnosis, and after giving the family a most guarded prognosis the patient was hastily prepared for operation. The abdomen was quickly opened and a quantity of dark brownish fluid came to view, and instantly the patient was col- lapsed. The pulse was lost and the respiration consisted of an occa- sional gurgling in the throat. Inversion and subcutaneous stimula- tion were quickly resorted to. A hasty examination of the abdomen revealed a twist in the small intestines lying in the left hypochon- drium. Below this the gut was collapsed ; above it, markedly dis- tended and five or six feet of it black and gangrenous. Holding the intestines in with hot sponges, we placed her in a warm bed and surrounded her with artificial heat and continued the stimula- tion, the abdominal wall being sutured in the meantime. She ral- lied slowly, only to die seven hours later, and another death was registered, hastened by operation, and yet preventable by earlier interference. Here life is unstable, and the slightest molestation is sufficient to destroy the equilibrium, but humanity prompts us to attempt to aid while yet the fingers of our surgical instincts are palpating the lean possibilities that lie beneath the abdominal wall. Before going further, I wish to wring the neck of a moss-grown delusion. There has been much teaching to the effect that surgical shock is in proportion to the extent of the injury received. This is 254 world’s homoeopathic congress. not true ; the extent of the injury is no standard by which to estimate the intensity of the shock. It has been said that “shock is the measure of the ability of an individual to resist hurtful influences from with- out.” In a general way this is good, but it is far more likely that it is a measure of the power of resistance possessed by certain organs or structures. Case III. will illustrate my meaning. A female about forty, with a hydatid cyst of the liver as large as a cocoanut. Being incapaci- tated for household duties, she desired an operation. The abdomen was opened freely, but the cyst was non-removable (en mass) because firmly adherent in all directions save toward the line of incision. The intestines were pushed aside and a passage to the tumor main- tained by a firm packing of Iodoform gauze. In spite of the rather free handling of the abdominal contents (because of a desire to ex- tirpate if possible), there was little or no shock following the oper- ation. During the next few days her general condition improved, and when sufficient time had elapsed to allow the bowels to be walled off firmly the cyst was opened, and this simple procedure was fol- lowed by the most pronounced disturbance of all the vital functions. The pulse was a mere thread, and running one hundred and seventy- six to the minute, and vomiting was quite troublesome. It was evi- dent that her life was greatly imperilled, and I was quite doubtful as to the issue. A pint of hot black coffee in the rectum and hypo- dermic injections of twenty minims of Digitalis tincture brought the pulse down in two hours to one hundred and twenty to the minute. She was then complaining of the strong taste of the coffee, and was tided over the danger of the hour. Case IV. is even more suggestive. Mrs. G., set. 51, suffering from a large ovarian cyst. The abdomen was opened and the tumor, weighing fifty-five pounds, removed. There was no post-operative shock, and she laughed and joked with the return of consciousness. A few days later an enema of warm water was given by a competent nurse, and was promptly followed by profound shock. It was a very good picture of Travers’s “ prostration with excitement.” She tossed wildly, the respirations were quick and shallow, pulse lost in one wrist and flickering in the other, skin clammy and cold. She complained of nothing definite, but the face was expressive of inde- scribable anguish. Arsenicum 3x was administered, and, aided by sharp stimulation, she made a good recovery. SURGICAL SHOCK. 255 There was a suspicious flabbiness about this patient that I did not like, and on this account the operative work was conducted with all possible dispatch in order to avert shock. The significant fact, however, is that she could withstand a laparotomy but not a rectal injection. The examples showing that the extent of the injury is not in pro- portion to the shock might easily be multiplied. Opening a digital abscess has produced death ; a slight blow upon the testicle or epi- gastrium will result in alarming depression of all the vital forces. I have seen simple skin plantation for an ulcer of the leg followed by severe shock, from which the patient did not recover for forty- eight hours. In one particular, shock has not been sufficiently dwelt upon, either by writers, teachers, or operators, and that is, that sudden cessation of life in an individual does not, of necessity, mean cessa- tion of cellular life in the tissues. This is a legitimate conclusion, and is based upon investigations in physiological chemistry, corrob- orated by observations in natural history and by the experiences of surgical clinicians. We may say that, grossly, the animal life is extinct, but histologically there is yet life and function in the tissues. This is shown by the fact that muscle removed from an animal killed suddenly will for some time give off carbon dioxide, absorb oxygen, and respond to electric stimuli. Even after rigor mortis has occurred, tremblings, elongations, and contractions have been observed. After cross section of a tadpole the tail will not only live for some time, but will actually grow if allowed to remain in the water (Vulpian). For more than twenty-four hours after removal from the animal the pancreas continues its fermentation, and the liver also produces sugar slowly after death. Surgeons know that ends of fingers severed and left upon the block have been sent for and made to live and grow upon their stumps, and that skin from recent corpses has been successfully grafted upon the living. Now, if the cellular structures of the grosser muscles and glands thus continue their function, so must the histological elements of the heart muscle, or the respiratory apparatus or nervous system. How often have we seen, upon the operating table, extinction of life which would be eternal were the surgeon to turn his back to the patient, and how often the operation resolves itself into a question, not of obtaining primary union, removing the tumor, or preventing a hernia, but of saving a human life. 256 world’s homoeopathic congress. The ghastly but tranquil features bedewed with tomby mist, the motionless thorax, the pulseless wrist — all these shape themselves into a picture with which almost every surgeon is familiar. In this case life. is extinct, and from death to dust the pathway is straight, and all that lies between the patient and the grave is a death certifi- cate. The following I take from our hospital records : Case V. — Patient 60 years of age and quite feeble. Heart, lungs and kidneys sound. Small, hard tumor in Douglas’s cul de sac, which causes much suffering. Prognosis very grave. Treatment: rapid abdominal section. The growth, an ovarian carcinoma, lifted, and a ligature passed through the broad ligament, when it was an- nounced that both respiration and circulation had stopped. The heart was still, and not the faintest sign of respiratory effort could be detected. The patient was inverted and artificial respiration re- sorted to, and was accompanied by hypodermic stimulation. For some time all effort seemed in vain, but slowly and faintly the pulse reappeared, and in about ten minutes she began to breathe and life was resumed. Actual time of operation a little over fifteen minutes. There is no more tragic scene in human life than sudden collapse on the operating table. To know that one’s hand has shortened the life of a patient, even though doomed by some pre-existing disease, is a horribly unwelcome sensation, but to know that resuscitation is possible, even when life seems extinct, robs operative surgery of much of its horror. While we regret exceedingly that with our present knowledge we are unable to give the rationale of the phenomena of surgical shock, the great and absorbing question should be its prophylaxis, and I believe there is no other means by which so much can be accom- plished in this direction as by rapid operating. Remember, that upon the operating table it is often impossible to differentiate trau- matic shock from the toxic effects of our anesthetics ; that this period is usually characterized by subnormal temperature ; that beyond a certain point every inhalation of the anesthetic increases the depres- sion ; that, at best, operative insensibility means the establishment of a tendency toward death, and that the culmination of this ten- dency may occur during one single minute which is unnecessarily added to the time of operation. This thought should underlie all our surgical procedures, but I am afraid we may justly be charged with more or less disregard of this principle. There is not enough SURGICAL SHOCK. 257 attention devoted to the pre-operative arrangements, and conse- quently too much dilly-dallying during the operation. How often have I seen an hour and more consumed in a simple trachelorraphy which could easily be accomplished in twenty minutes, or even twelve or fifteen minutes, with competent assistants. This must not be re- garded as a reproach to beginners, but to those who have been ope^ rating long enough to possess much better technique. I would not be understood as desiring to sacrifice methods (good methods) for ra- pidity, but that I plead for better methods in order that the opera- tive period may be reduced and with it the tendency to shock. The preparation of the patient for a state of invalidism, too, is all important, and this having been done it should be a part of our pro- fessional ritual to operate in the morning whenever possible. I am well aware that there are lesions that can neither wait for preparatory treatment nor the morning hours, but the fact that this is just the class most prone to shock but shows the importance of the above observations — when they can be carried out. Tranquilizing the patient’s mind, the administration of medicine before operation and the maintenance of proper temperature during the operation are too familiar to bear comment. Nineteen years ago it was taught that inflammation and suppura- tion were reduced to the minimum, and that they were the inevit- able accompaniments of operative surgery. Let us hope that our present ideas may be as abruptly changed, and that shock may yet be dispelled from the list of surgical complications. At present, however, it must be admitted that shock cannot be positively averted and that the best the surgeon can do is to equip himself for the com- prehensive grasp of critical emergencies. Collapse on the table has been sufficiently dwelt upon already. I might add that in two cases I fancied I obtained relief by Maass’ method of rapid and rhythmic compression of cardiac region, but I cannot speak with any degree of positiveness of this method. In one case I obtained an abrupt renewal of respiration by anal dilata- tion. It has failed me in many others. In post-operative shock we can find a place for our Homoeopathic remedies, and while I never omit the general measures deemed necessary or at least essen- tial, I have acquired an immense amount of faith in Camphora (low, of course). I would give more for this drug than for all the rest of our Materia Medica. Arsenic is good, and so is Veratrum alb., 17 258 world’s homoeopathic congress. but often the vitality is so low that the stomach is inactive and we can obtain no results by this route. In such cases a favorite resort with me is enemata of warm and strong black coffee; from a half pint to a quart, and repeated as fast as it is absorbed or till reaction is secured. Dr. Van Lennep has obtained good results from enemata of whiskey and Valerianate of ammonia — a teaspoonful of each. After all, our main reliance is upon cardiac and respiratory stimu- lants, artificial respiration and artificial heat. Copious intra-venous or intra-cellular saline injections will always be remembered, especi- ally if there has been much haemorrhage. The most manifest indications point, with imperative necessity, to tiding the patient over the perilous but brief period and our success in obviating the tendency to death will be in proportion to our ability to distinguish the direction from which death is threatening. Discussion. I. T. Talbot, M.D. : The subject of shock is one of great interest to every surgeon. First, because it may render a simple operation fatal, or in grave operations, suddenly turn the surgeon’s victory into defeat ; and second, because he can never know beforehand the liability of the patient to shock, or the extent to which it may attain. This paper of Dr. Macdonald’s suggests certain points of great importance to the surgeon, and among these the surgical character of the affection. We all appreciate the great difference in which dif- ferent persons are affected by syncope or fainting. Some may with- stand the most violent injuries and yet retain their consciousness, while others faint on slight exhibitions of pain, or the sight of blood, or even the thought of injuries; and the effect upon the circulation, even to the almost complete cessation of the pulse ; the pallor ; the cold, clammy sweat ; and the entire unconsciousness, are familiar to us all. The symptoms, except in degree, are quite similar to those of shock, and it is difficult to determine beforehand the patient most liable to be affected by it. As a rule we expect it more in those of a highly nervous, active, or sanguine temperament, while those of a plethoric or sluggish condition are more exempt. Yet even this does not always hold true. Under my care a strong, highly plethoric man, who felt most fully able to go through the operation without ether, yet finally thought it best to take it for opening a palmar abscess, took the ether very favorably with little or no struggling, and after the operation had been performed, and he had partially rallied from the ether, sud- SURGICAL SHOCK. 259 denly went into collapse from which it was quite difficult to resusci- tate him. On the other hand, we have all met most nervous and excitable men and women who have gone through the severest and most long continued operation without any symptoms of shock or collapse. That the mind may affect the patient unfavorably I believe to be quite certain, and in looking over my notes I find several cases in which the patient had previously exhibited great dread of an opera- tion feeling quite certain that she would not recover, in which although in no case fatal collapse occurred, yet it required during the operation and afterwards, careful watchfulness to relieve the first apparent symptoms. In cases, then, of persons subject to easy syncope, I think it of great importance from the first to see that as far as possible their systems are in good condition physically, that they should have previ- ously quiet rest, good food, and cheerful surroundings ; that how- ever much their friends, or the family may be informed of the pos- sible dangers, the patient should only look to the most hopeful and encouraging prospects. I fully approve of the use of Camphor as a stimulant, as suggested by Dr. McDonald, yet the most rapid and successful measure 1 have ever adopted has been the hypodermic injection of the finest quality of brandy. The motion of the patient, friction, and encouraging words on the first appearance of consciousness, will do much to speedily restore the patient. L. H. Willard, M.D.: We have all listened to Dr. Macdonald’s paper on “ Surgical Shock” with interest and attention both because the subject is of great importance and because of its able presenta- tion. The subject is of especial interest as the opinions of surgeons differ widely not only as to treatment but as to the proper time to operate after an accident involving serious shock. I wish to discuss briefly this latter phase of the subject. Before doing so, however, let me present in a few words our method of treating shock at the Pittsburgh Homoeopathic Hospital, a method which is not new in any essential particular, but which has rendered excellent results. Our hospital, being in the vicinity of many mills and manufacto- ries, and having a railroad patronage, we are familiar with all varie- ties of shock from the slightest nervous depression or exaltation to the most profound collapse. A case of serious injury being received is at once taken to the operating-room, if the injury requires opera- tive treatment, and the surgeons of the staff being sent for, vigorous restorative measures are begun and kept up continuously. These consist of, briefly: 1. Control of haemorrhage, by tourniquet or ligature. 2. Heat — hot water bags, etc. 3. Stimulation — by means of brandy, Digitalis, or the alkaloid by 260 world’s homceopathic congress. hypodermic injection, Sparteine, Strychnine, Atropine. But espe- cially have we found efficacious a mixture of brandy, ether and spirits of Camphor, equal parts, which administered by hypodermic injection, seems to have a salutary effect on the circulation in the state of collapse incidental to profound shock. If there has been loss of blood we use hot water by mouth or rectum, and other ordinary means, such as bandaging the limbs, de- pressing the head and shoulders, etc. — Rectal injections of warm water seem to have been especially beneficial in many cases even where there was no appreciable loss of blood, having apparently a stimulating effect on the circulation and promoting the freer action of the kidneys which are especially prone to be affected. The addition of a little salt facilitates absorption by raising the specific gravity more nearly to that of the blood. Our custom is to inject 4-8 ounces every 1-3 hours depending upon the necessities of the case. If the sphincters are lax a smaller quantity is used. Many cases of serious and seemingly fatal shock have been saved, I believe, by this means more than by any other. As instances in point I might cite two or three recent cases of crushed limbs requir- ing double amputation, one case of leg and thigh amputation having been brought ten miles to the hospital on the guard of an engine after a delay of two or three hours from the time of the accident. In this instance amputation was performed at once and restorative measures were kept up for many hours after. The state of a patient’s vitality is indicated, of course, by the condition of the pulse and respiration, and by the temperature. Operative measures, if not of immediate necessity, are delayed only long enough for the pulse, res- piration and temperature to indicate a beginning reaction — not until full reaction has taken place. And it is in this particular that I wish to hazard an opinion at variance with the generally accepted belief. When I have a patient suffering from shock caused by an acci- dent, the first thing necessary, it seems to me, is to relieve the de- pression, sustain his strength, and perform any operation that may be necessary as soon as possible and as quickly as can be done. This we know is the generally accepted belief of a great many surgeons, who give as reasons for such procedure that an operation, when the vitality is so low, would surely be fatal. No one who has waited patiently for his patient to recover fully from shock can help but feel that this waiting should be avoided. It is certain that the older surgeons, in times before anaesthesia was known, were right in laying down these rules in regard to shock, for in those times and under such conditions it would have been fatal to operate when the vitality of their patients was so low, thus intensifying the shock. But now, when we have anaesthetics to deaden the pain and even to improve the heart action (as it seems to do at times), and Camphor and other SURGICAL SHOCK. 261 remedies to assist in stimulating the circulation, I cannot think it necessary to wait until full reaction has taken place before oper- ating. By so doing we nearly always produce a second shock, which may throw the patient into a condition beyond any help we may be able to render. In a given accident — a patient with crushed arms or legs, for example — tourniquets are applied to the part to prevent haemorrhage; and they not only control the haemorrhage, but they also cut off the entire circulation of the part. The nerves are pressed upon, and, in fact, the limb below the tourniquet is for the time being practically dead, and remains so until after the operation. Now it seems to me that the mere fact of an amputation when the patient is in a condition of shock, can do little harm to a part virtually dead. Mangled tissues are generally cut off and splintered bones removed. It is but little more to take away the entire crushed mass, sawing off the bone, and completing the necessary dressings, thus ending at once the pain and irritation caused by a mangled limb. We are now speaking of crushed limbs and of operations done in the quickest possible manner, care being taken, of course, to insure complete antisepsis, and the pulse and respiration being sustained by all necessary means. There are at times cases requiring long and tedious operative interference where it would be advisable to wait until the patient’s condition shall better enable him to withstand such a trial of his vitality. Many cases, such as abdominal injuries, with protrusion or lacer- ation of any of the viscera, require immediate surgical attention. Such cases do not seem to be markedly affected either by the use of an anaesthetic or by the operation itself, so that even in cases not re- quiring immediate attention it is my custom to operate at once if the pulse shows any sign of returning vitality, rather than submit the patient to the risk of a second shock. And in this line let me say that I believe the anaesthetic, especially chloroform, to have rather a stimulating than a depressing effect on the circulation in such instances. The Chairman : The subject is now open for general discussion. Dr. Boothby : Mr. President , it seems to me that it has not been made clear to us just what is considered surgical shock. We must distinguish between surgical shock and the shock from an injury, as has been spoken about in the last one of these discussions. In regard to surgical shocks proper, we have to distinguish between a true shock and the case that Dr. Talbot referred to. My opinion is that a surgical shock is a very rare occurrence. In the first place, I believe that a great cause of surgical shock is having the room too full, or the patient entirely denuded over a large portion of the body, and that the chill that comes from that is the cause of a great deal 262 world’s homceopathic congress. of the shock. I speak from my own experience and from the experi- ence of my brothers, Packard and Emerson. We have almost never had a case of true surgical shock. We have done our operating in a very warm room, w r ith a temperature as high as 85°. I have almost had it 90°, and while it is uncomfortable to the operator, and very uncomfortable to those looking on, it is decidedly beneficial for the patient. In the case of No. 1 in the original paper, while it is distinctly said that there was comparatively little haemorrhage, I believe that the collapse was due to the haemorrhage. I don’t see how an operation can be made without considerable haemorrhage if the patient is susceptible to fainting. In Cases 2 and 3 I have no doubt the septic condition of the system, and the changes the opera- tor made in the anaesthetic, caused the trouble. I want to say one word in regard to the suggestion in the paper that the operation should be made as rapidly as possible. Perhaps I wouldn’t agree with Dr. Packard, for he operates very rapidly. I do not and can- not. I take a great deal of time for my operations. I believe if you are careful with your anaesthetics, and don’t give too much, and keep your patient just over the line and no further, you will have no trouble to keep him under the influence of ether. In regard to the administration of coffee, I hope you won’t use it. I have no argument in its favor, and I wouldn’t use it. W. F. Knoll, M.D. : This subject of shock after operation or in- jury is a very important one to any surgeon who has done work a great while in public hospitals or railways. When such a complica- tion arises in the course of an operation, it always goes far in the mind of our surgeons, and they have tried to find out its causes and what shock is. And after careful investigation of the subject, and from pathological observation, I have concluded that a shock is a sudden suspension of nerve forces. Now, shock is produced in one patient very easily and in another not so easily. I have seen it caused from dilatation of the rectum. I have seen shock from pull- ing a tooth. I have seen shock from a man simply washing out his ear. I have seen a patient upon whom I have amputated three limbs of the body, not affected a particle by shock. I have seen a patient at the age of 90 upon whom I have made an operation where there was scarcely any variation in the pulse. You never can say when a patient is going to have shock ; it depends altogether upon the nervous organization of the patient, and taking that as a basis, what is the term “ shock?” Take your patient as you find him. What do you see? You find a slow or a rapid pulse. You see that respiration is superficial. You have general relaxation and sometimes a discharge of urine. There is complete relaxation, the nervous system has been so profoundly affected that you have mo- mentary paralysis. What you want to get at is to preserve the tem- perature of the body. Heat is an important thing; it is one of the SURGICAL SHOCK. 263 main things. And in the second place, you want to give a medicine which in a certain measure will restore the operation of the brain and the nerve centres, and the best thing is Strychnine. We have received from the hospitals some profound results from hypodermic injections of grain of Strychnine. I believe in something that will have a stimulating effect also upon the circulation and upon the brain, and for that I believe Camphor is the best remedy. I believe it is a very good thing to place the head below the rest of the body. I believe hypodermic injections of some stimulant, especially brandy, and the flushing of the bowels with warm water with whiskey in it, is a very good thing. If you can find out the peculiarities of the patient, you can very often prevent shock. If you have a patient that is of a very highly nervous organization, by preparing the mind you can stop a great many complications that may follow operation. Now, the treatment that w T e have used with so much success can be summed up in this way : First, prepare your patients for the opera- tion mentally and every other way ; assure them they are going through their operation nicely ; don’t have a great struggle with them under anaesthetics. In the second place, if shock takes place, keep up the temperature of the body at once. In the third place, use some hypodermic injection like Strychnine; in the next place, give something that will stimulate the heart’s action. S. B. Parsons, M.D. : Perhaps I am laboring under a wrong im- pression but it strikes me that Dr. Macdonald’s paper referred to shocks from accidents, more particularly than shocks from operative measures; therefore shocks from operative measures are not to be discussed at this time. There is one point that has absolutely been overlooked in the paper and discussion — one that has not been touched upon, yet one that has a more direct effect upon the patient than all the other matters that have been spoken of, and that is re- flex action. We all know that sudden excitement of the sensory nerves will disturb the heart’s action and may arrest its movement. If the patient is undergoing the operation and has only been parti- ally anaesthetized when the operation began, or when he is partially under it and it has been continued for some little time, then the sensory nerves will reflex painfully and affect the heart’s action, and its inhibitory movement. That is why we see sudden collapse dur- ing operations. There is another reason and that is the vitality of the patient. The energy is so far below par that they are not able to stand both the shock and the anaesthetic without great stimulation. The heart is the thing to be looked after, not the warmth of the body ; it is the heart. You have your collapse coming on suddenly ; it is the action of the reflex movement upon the heart. That is all I have to say. The Chairman : If there is none other Dr. Macdonald will have an opportunity of saying anything he may desire in closing the dis- cussion. 264 world’s homceopathic congress. Dr. Macdonald. Mr. Chairman , Members of the Congress: I will keep you just a moment. Something was said about Camphor. I don’t want to be misunderstood as to the use of Camphor or any other internal remedy, or as excluding stimulation. I believe hypo- dermic stimulation of importance. Something has been said with reference to chloroform as a heart stimulant in cases of shock. My experience has been very different ; where I have used chloroform and the heart has become dangerously depressed I immediately use ether as a heart stimulant. I think that ether is a better heart stimu- lant than chloroform. I say I had some cases that collapsed. I want to say that all these cases were anaesthetized. You have been warned against the use of coffee. I admit in Boston there is a well- known way of using coffee, which is much better than putting it into the rectum. My experience is, as far as aesthetic matters go, it is better not to give it in that way. This is a matter of human life, and I don’t think of small matters like that. I am looking after the patient and human life. One of the cases I reported was said to have been influenced by septicaemia. It was charged by Dr. Boothby with having caused the collapse ; that it was probably due to septicaemia, and that it was a dangerous operation. Let me say that it was a case of either performing the operation or losing the patient. So I felt that the operation was justifiable. But I don’t want to be knocked down by the chairman, because he has an old grudge against me, and I will stop now. Dr. Biggar : What objection is there to preparing the patient and anticipating the shock by giving a small quantity of whiskey or a hypodermic injection in proper quantities in the proper time? Dr. Macdonald : I don’t know of any objection to it. In my paper I spoke of the use of medication before operation. It seemed to me so common and so ordinary that it didn’t require any comment at all. I use coffee, strychnine and brandy ; in many cases I deem it advisable to use stimulants of alcoholic nature. Dr. Nielson, of Michigan : What shall we do with that large and growing class of people who object 'to alcoholic stimulants in any shape or form. Dr. Macdonald: From my acquaintance with the members of this Congress I think we should have to go outside of it to find them. A CONTRIBUTION TO THORACIC SURGERY. 265 A CONTRIBUTION TO THORACIC SURGERY. By Henry L. Obetz, M.D., Detroit, Mich. In the wonderful progress of modern surgery, every anatomical field has been worked over until at this time there remains but one where the principles are undeveloped and where experimental re- search and increased clinical experience must develop new paths before we can relieve humanity of many ills, cured in other parts of the human body by local operations, and which, reasoning from an- alogy, should be cured by like means in this. The field is that of “Thoracic Surgery.” Every accessible point of the cranium has been invaded, the outer bony covering ignored, and found not to be in the way of reaching deeper parts; exploration of the brain finds it tolerant, abscesses can be aspirated or incised and drained; new formations, not only on its surface but in its substance, can be safely removed ; convolutions of the brain found diseased or abnormally irritated have been boldly excised, and the patients not only live but return to the walks of life restored to health and usefulness. It was found that certain diseases of the kidney were amenable to operative influence, but this did not cure certain other supposedly incurable conditions which, after great suffering on the part of the patient, always ended in death. The new fact that a kidney could be removed and the other could and would do its work, broadened the regional operative field until now tuberculosis of the kidney can be cured with relative certainty by its excision. A single ovarian cyst successfully removed by abdominal section demonstrated the feasibility of attacking an intra-peritoneal disease. From this small beginning has grown up the great field of abdominal surgery. The death-rate was high at first, but as compared with the death-rate of the diseases sought to be cured meant the saving of thousands of lives which would have been lost or doomed to hopeless invalidism. First one, then both ovaries, then the uterus and ova- 266 world’s homoeopathic congress. ries were removed, and the operations perfected and classed among remedies for the relief of disease. Next, the liver, stomach, spleen and intestines came in for their share of attention, until now, given a condition affecting any abdomi- nal viscus and we have the remedy at hand, in a carefully planned operation, depending on experimental research and clinical experi- ence of the broadest and most elaborate kind. I might go on into other fields, all of which have been as carefully worked and the re- sults recorded for the benefit of the profession present and future. Regional surgery, then, is in its infancy when applied to the tho- rax, but I feel confident that the day is not far distant when we shall see many supposedly incurable affections of the thoracic viscera cured by practical operations, based on sound principles, to be established in the near future. The need for pushing operative work to a greater degree of perfec- tion here is very great, and thousands of lives, now lost, may, with a material advance, be saved. Experience in general teaches us that tuberculosis is for the most part a local disease in its first stages, and can be eradicated by radical local treatment. If by any possible means we ever arrive at a point where the ravages of this disehse can be stayed by surgical means when it attacks the lungs, the saving of human life resulting will be greater than from any other single ope- ration known to surgery. Many other conditions here demand mechanical interference, and the principles governing some of the operations, and the operative technique, is more or less definitely established at this time ; but no operation here has the same wealth of experimental observation and clinical experience based on it as in the examples cited in other re- gions amenable to surgical treatment. The reasons for the hesitancy and delay in attempting surgical in- terference in this region are partly anatomical and partly clinical. The structural difficulties are to be found in the conformation and make-up of the chest. In the inverted cone containing the vital organs, we have the flexible yet practically immovable spinal column as a centre, flanked on either side by the ribs and their attached muscles; the ribs are elastic and movable in some respects, firm and resistant in others; so imbedded in the thin muscles attached to them as to be a part of a general whole, leaving the chest cavity but thinly covered when removed. If the ribs are not removed they A CONTRIBUTION TO THORACIC SURGERY. 267 prevent collapse of the chest- wall and the physiological rest so essen- tial to the healing of any area after operation. Clinical reasons are found in the insidious onset of many chest affections, the extreme difficulty of locating and determining the first stages of the formation of abscess, and of determining the exact location and extent of the diseased area. Patients having pulmonary tuberculosis are, as a class, most hope- ful, and underestimate the dangers confronting them ; they have no fear of death as a rule, though threatened with impending dissolu- tion, and insist that they are better, and have great hope of cure as soon as this or that refractory organ, usually the stomach or liver, shall have been toned up and made to do its duty. Operations on the chest are the most formidable ones the surgeon is called on to do. The stoutest-hearted observer of such an opera- tion is appalled at the struggles of the patient for breath, at the con- vulsive cough caused by the reflex irritation resulting from the injury inflicted on the structures of the chest-wall, or lung. Blood is blown through the opening into the pleural cavity by the convulsive efforts of the patient, and the operator and assistants are covered with its crimson spray. Syncope may threaten and the deathly pallor but too plainly indicate the presence of the grim de- stroyer. Again, fluids are drawn or forced into the trachea and the livid, bloated countenance and cessation of pulse and respiration show that death is threatened from asphyxia. In no other class of cases have surgeons been called on to record so many sudden and unac- countable deaths, from slight operations. No wonder that patients shrink from such measures even when life is in danger and the procedure is a necessity, nor is it a wonder that the medical adviser hesitates, and is loth to urge operative measures in chest affections, as long as delay seems possible. It is this very delay, the putting off until the very last chance of the patient is gone, which gives the high death-rate to the operation of dernier ressort in this region. Experience and experimental observation teach that aside from the effects on the lung caused by free air pressure, the size of a wound in the chest makes no difference. Thus after a small opening in the chest- wall the lung may not collapse; if the opening in the chest-wall is larger than the opening in the trachea of the patient the lung does collapse. 268 world’s homoeopath ic congress. It is also a fact borne out experimentally and by the history of accidental injuries of the chest, that both pleural cavities may be opened at the same time without ending in the death of the person so injured. We have numerous examples of this in the history of gunshot-wounds, both in civil and military practice. A case of this kind came under my observation in which a pistol- bullet of large size entered the chest under one armpit and came out at the same point on the opposite side, completely traversing both pleural cavities and by some means missing the great vessels of the chest. The patient had abundant evidence of injury to the lungs followed by some traumatic pneumonia but after a time recovered and since has been perfectly well. South, in his notes in Chelius’s Surgery relates the case of a man pinioned by the shaft of a chaise, which was thrust entirely through both pleural cavities and after a severe illness he recovered and lived ten years. He further quotes a conclusive case of a gun-shot injury from Home, who relates the case of a man shot through both lungs, who recovered and lived thirty-two years. After death, post-mortem examination verified the fact of the wound of both lungs by the bullet. In part first of the Surgical History of the Late War, we have a number of such cases reported but it is unnecessary to repeat them here. I only wish to give evidence of the single fact that both pleural cavities can be opened at the same time, and both lungs wounded as well, and yet the patient recover. Parts of the lungs have been removed after injury of the chest- wall leaving a hernial protrusion of the lung. I refer to these cases, that we may study the methods by which this was done and the results which followed. In his chapter on wounds of the lungs, I find the following cases cited by Cooper. See Dictionary , p. 485. He says, the protrusion of a portion of the lungs, in consequence of wounds penetrating the chest, is a very unusual case ; but there are some instances recorded by writers. Schenekius relates an example taken from Rolandus. He was called to a man who had been wounded in the thorax six days before. A portion of the lung protruded in a state of mortification. Rolandus extirpated it, and the patient soon recovered. Tulpius has recorded a similar fact. A man received an exten- A CONTRIBUTION TO THORACIC SURGERY. 269 sive wound just below his left nipple. His naturally gay disposi- tion led him to neglect the injury ; and on the third day a piece of the lungs three inches in length protruded. The patient went to Ams- terdam which was two days’ journey, for the purpose of receiving aid in one of the hospitals of that city. The protruded piece of lung which was already mortifying, was tied and cut off with scissors. It weighed three ounces. The wound healed in a fortnight, and the patient experienced no complaint afterwards, except a slight cough, with which he was occasionally troubled. He survived the accident six years, leading a wandering drunken life. After death nothing particular was observed in the thorax, except that the lungs had become adherent to the pleura, in the situ- ation of the wound. Hildanus related another case ; a man was wounded with a knife between the fifth and sixth ribs near the sternum. As a piece of lung protruded at the opening and was of a livid color, it was extir- pated with the actual cautery. The wound was then dilated, and the ribs kept apart with a wooden wedge, under which plan the portion of lung girt by the opening shrunk within the chest. The patient was soon completely well. A fourth example of a protrusion of a piece of lung through a wound in the thorax is among the cases recorded by Ruysch. The servant of a seafaring man was wounded in the anterior and inferior part of the chest, and was immediately attended by a surgeon who mistook the protruded piece of lung for a portion of omentum and applied a tight ligature around it. Ruysch, who was consulted, soon detected the mistake which had been made, but he delivered his opinion that the wound would heal very well as soon as the tied piece of lung was detached. The event justified his prognosis and the patient recovered. He continues : “ After the battle of Waterloo I had a patient with a protrusion of a piece of lung four or five inches in length. The part was much bruised and could not be easily reduced. I therefore ap- plied a ligature round its base and cut it off. Previously, how- ever, I made an incision in it in order to ascertain whether it would bleed freely, which, being the case, induced me to use a ligature. I was afterwards informed by my friend, Mr. Collier, that the man died.” A more recent case is reported in the London Lancet for the year 270 world’s homoeopathic congress. 1886, p. 466, where a case is reported by Dr. Demons, of Bordeaux, France, of resection of a portion of the left lung with the ecraseur, followed by haemorrhage, which was controlled with the thermo- cautery. The patient had been injured, during a quarrel, with a knife. After the operation on the lung it was also found necessary to remove the left kidney. The patient recovered. Thus, of six cases here cited, five recovered and one died. The lung was removed by ligature three times with two recoveries and one death. The remaining other cases, which all recovered, were removed by excision, by cautery, and by the ecraseur. These were all clearly operations of necessity, but convey information which must prove useful and instructive as to method in develop- ing operations of choice undertaken for the relief of disease. I cannot refrain here from calling attention to the fact that numerous cases are reported where patients having phthisical symptoms are said to have been cured by gun-shot and other accidental wounds of the chest. Thus well-marked symptoms of phthisis, asthma, and chronic cough are reported to have been radically cured or greatly relieved by the rough medium of a gun-shot wound. (See notes, Medical and Surgical History of the War of the Rebellion.) Some tabulated lists of cases are reported of operations on the lungs for tubercular and other diseases. I shall not attempt to col- lect them, but rather to select such cases as serve to give the technique now in vogue, and by comparison with some of my own cases show wherein I think the present methods are faulty and subject to criti- cism. I shall further suggest measures which I think, if adopted, will give us a better command on the field and lead to a more ex- tended practice. The most valuable and comprehensive account of thoracic opera- tions up to this date is embraced in the lectures of Rickman J. God- lee, published in the London Lancet , vol. i., for the year 1887. In his first lecture he asserts that in some forms of pulmonary abscess surgical interference is obviously inadmissible ; nothing, for instance, can be hoped from it in treating the lung, which is riddled by numerous tubercular cavities or the multiplied gangrenous foci which occur in the course of embolic pyaemia. Those in which surgery has been, or may be, attempted, may be thus classified: A CONTRIBUTION TO THORACIC SURGERY. 271 1. Tubercular cavities. 2. Cavities resulting from gangrene of the lung. 3. Cavities resulting from the bursting into the lung of abscesses or other collections of irritating matter from without. 4. Bronchiectasis, from whatever cause arising, and including those which depend upon the presence of a foreign body in the air- passages. He follows with an interesting detail of historical references on the subject, showing the various attempts made by surgeons to cure abscesses and pulmonary cavities left by them by operation. Of the cases cited by him, the following alone can be quoted here as being in the direct line of thought I wish to pursue. He says : 1. F , aged forty years. Advanced phthisis, with large cavity at left apex. Resection of the third rib to allow the chest-wall to fall in. The patient lived a little more than a fortnight. Some retraction is said to have occurred. 2. F , aged fifteen. Advanced phthisis, with consolidation and excavation of lower lobe of the left lung. Parts of the second and third ribs were excised, and threads were passed through the pleura into the lung in order to insure adhesions if these were not present. Four days later an attempt to reach a large cavity resulted only in the discovery of a small one. The operation appears to have had but little influence on the progress of the disease. The patient died three weeks after the first opera- tion. 3. F , aged twenty-five. Advanced phthisis; cavities in the left upper lobe. Parts of the second and third ribs were removed and a large cavity was opened. The cough and expectoration were very much relieved, and the cavity decidedly contracted, the patient living five weeks after the operation. A far more heroic method of dealing with tubercular lung has been in recent years suggested by certain Italian surgeons who have made this subject a specialty, though it has been followed up by some observers in Germany. Dr. Domenico Biondi showed first the possibility of an animal surviving the complete extirpation of a healthy lung, and then pro- ceeded to demonstrate that the same might be done in an animal, 272 world’s homoeopathic congress. the lung of which had been previously inoculated with some of the sputum of a tubercular patient, and had actually become the seat of tubercular changes. A very considerable proportion of the animals (rabbits, cats, and dogs, twenty-one in all) died as the result of the first or the second operation, but some survived and lived for a very considerable time afterward. The dogs and cats were not very favorable subjects for the devel- opment of tuberculosis, but it is remarkable and interesting that in some of the rabbits tubercle was actually developed in the lung, which was removed, and after the removal the animal remained free from further development of the disease. The conclusion that the author wishes to draw is obvious, but he hardly ventures to hint at the application of the treatment to the human subject, and it can scarcely be suspected that it will ever be placed among the recognized surgical procedures. It could only be applied in the early stages of phthisis, when the disease may be con- sidered within the possibility of a practically permanent cure by other and simpler means. And, indeed, the same may be said of another possible deduction, namely, the removal of tumors of the lung. Diagnosis must clearly reach a much greater pitch of refine- ment before the physician could counsel or the surgeon attempt the removal of a primary tumor of the lung, rare as it is, and difficult as it must always be to discover in its earlier stages, when alone it could conceivably be extirpated. It must, however, be stated that in two cases of phthisis, parts of the lung have been actually re- moved by Ruggi, one of the patients dying in a few hours, and the other on the ninth day. And not only so, but tumors of the lung also have been removed, though it must be owned that the expe- rience of the surgeons who undertook the operation is not very encouraging. Weinleicher, in 1882, removed a round tumor as large as a man’s head from the thoracic wall of a man aged 37, leaving a huge gaping opening into the chest and taking away a part of the lung to which it was adherent; the patient died twenty-four hours afterwards. Kroenlein also removed a recurrent sarcoma in the same situation from a girl aged 18, taking away part of the sixth rib and some adherent lung. The end of this case is not reported in the interest- ing article of Albert’s from which the reference is taken. A CONTRIBUTION TO THORACIC SURGERY. 273 Gangrenous Cavities Resulting from Pneumonia . — These cavities are perhaps the most promising with which the surgeon is called upon to deal, especially if operation be not too long delayed. In the course of time, if the patient survive, the surrounding lung be- comes condensed and inelastic; but in the earlier stages of the dis- ease it retains more or less its normal characters, and the walls of the cavity are able to fall together like those of an abscess in the soft parts elsewhere. But delay is almost unavoidable, on account of the great difficulty of localizing the position of the cavity with precision and the still greater difficulty of ascertaining the absence or the presence of adhesions. I do not think that the second point should be allowed to influ- ence the surgeon in the direction of delay, and certainly should not interfere with an exploratory puncture, because, in the first place, experience shows that even adhesions which have been accurately diagnosed by the most competent observers may, after all, be found to have no existence, and in the second place, it seems clear that ex- ploration with an aspirator needle may be safely made through a patent pleura, even if the instrument pass into a collection of putrid pus. I do not say that mischief will never follow this procedure, and I am sure that it is wise to ascertain for certain the condition of the pleura before making a free incision into a lung containing septic pus; for if the non-adherent pleura be opened, and through it a drainage-tube be passed into a putrid cavity, very serious symptoms may result. This was well illustrated in a case of bronchiectasis, where we had ascertained a week or two previously, that there was some clear fluid in what was thought to be merely a remnant of the pleural cavity. On cutting through the intercostal space, it was found that the two layers of the pleura had become adherent since the preliminary puncture, but only by very weak adhesions, which easily broke down under the pressure of the finger and the expira- tory efforts of the patient whilst the opening was being made into the bronchiectatic cavity. This led to the opening up of a large remnant of the pleural sac, the walls of which were non-adherent, and the consequence was that the pus from the bronchiectasis, escaping into the pleura, set up a septic pleurisy from which the patient nearly died. It will be well, therefore, to consider at the outset what should be 18 274 world’s homoeopathic congress. done when these adhesions, so commonly but yet not invariably found, are wanting. One plan would be that mentioned above, as recommended by De Cerenville as a precautionary measure — namely, to pass needles armed with silk through the pleura into the lung; but as in almost all cases the lung is solidified, and will, therefore, not fall away to any extent from the thoracic wall, even if no adhe- sions at all be present, I do not think that this, though quite unob- jectionable, can be considered to be a necessary precaution. The right method of procedure, though I confess it is not a very easy one, is carefully to stitch the lung up to the opening which has been made in the chest-walls. It is a difficult proceeding, because the parts are in a constant state of movement from the act of respiration, and because the lung itself is but ill suited to retain the stitches that are placed in it, and also because the hole in which the manoeuvres have to be carried on is a rather deep one, and mostly obscured by the presence of blood. I have only once had to put this plan into prac- tice, and though here it was only partially successful, it was suffi- ciently so to show that, with a little more care, the closure of the pleura might have been effected. We found in this case, at the end of a few days, that a part of the stitching had given way; but as no cavity was reached, no evil consequences as regards the pleura resulted, the wound remaining aseptic. Of course, after the stitches have been placed, the attempt to open the cavity must be postponed for at least a week, and at the end of that time the instruments used must be sharp, and their employment gentle, lest the accident which it is intended to avoid may, after all, happen. In his second lecture he quoted the following cases from Copeland and closes with the remarks which follow the report of the cases. 1. A boy, aged seventeen, swallowed a bone in November, 1883. He developed bronchiectasis, but completely recovered after cough- ing up the bone in February, 1884. This I think, is most instructive, not only as showing that the bronchiectasis and induration of the lung, which had taken four months to develop, could be completely recovered from, but as in- dicating the line of treatment in such cases. 2. I)r. Magrath’s case, where a piece of grass became impacted in the right lung of a boy of seven. Death occurred after ten weeks. The lower lobe of the lung was riddled with abscesses. The dia- A CONTRIBUTION TO THORACIC SURGERY. 275 phragm (as in one of my cases) had been perforated by the abscesses, and there was secondary caries of the spine. Dr. Cayley’s case, which was one of a low form of pneumonia, re- sulting in a basic cavity containing five or six ounces of offensive pus and sloughs of lung substance. He had only been ill for five weeks, but had the appearance of a man in the last stages of phthisis. The cavity was opened in the ninth interspace, but the case ended fatally, being already too far advanced. There were signs of old tubercular mischief in the lungs. 4. Dr. Solomon Smith, of Halifax, records a case where gangrene followed acute pneumonia, and where death followed an incision into the abscess after nine days. 5. Dr. Cayley’s case of a gangrenous abscess following ear dis- ease, in which Dr. Gould punctured the abscess with a trocar, but on introducing the tube, failed to drain the abscess at first ; it after- wards, however, burst into the artificial opening, and the patient made a good recovery. 6. Some cases are recorded in a paper read by Dr. Mosler before the German Medical Congress at Weisbaden in 1883, in which he recommends the incision of the lung with the actual cautery for the extraction of foreign bodies. I am not able to strongly endorse this advice (though with deep incisions it may possibly be advisable) for the use of the knife does not, as a rule, lead to formidable haemorrhage, and the charring of the tissues must cause considerable difficulty in any exploration with the finger. 7. Dr. Ed. Bull, of Christiana, records a case of circumscribed gangrene of the lung which was opened successful ly. It may be taken for granted then, that the majority of the cases of gangrenous abscess which come into the hands of the surgeon are the result of acute pneumonia, and are situated near the base of the lung; and it may be added that his aid is most likely to be needed in those cases in which the gangrene is not very extensive, so that the patient survives the immediate effects of this process. Some of these cases, it is well known, recover spontaneously, the pus being expectorated ; but in others a condition of things results such as is often met with in abscesses bursting spontaneously in other parts of the body — namely, that the opening being insufficient, and perhaps unsuitably placed, the sac is always more or less filled with the dis- 276 world’s homoeopathic congress. charges, which in the cases we are considering are always highly septic, and therefore irritating. The abscess, consequently, shows no tendency to close, but on the contrary, increases in size. It is not a good plan in such cases to wait long before making the external opening — that is, if the position of the abscess can be accurately determined — because as was pointed out when the subject of em- pyema bursting into the lung was discussed, the presence of foetid pus in the bronchi and trachea is very likely to lead not only to seri- ous consequences in the diseased lung, but also in the sound one ; but, at the same time, it is not often wise to make an incision through the chest- wall until the situation of the abscess has been ascertained by means of an exploring trocar, and even then the troublesome question of the presence or absence of pleural adhesions has to be settled before the lung itself is incised. Another case in point is the following: Resection of the lung in incipient tuberculosis and operation for hernia of the lung. On May 5, 1891, M. Tuffier resected the lung of a man, aged 25, with incipient phthisis, apparently limited to the right apex. He made an incision in the second intercostal space and exposed the pleura. In order to draw the apex more easily through the small incision he produced an extra pleural pneumothorax by separating the parietal pleura from the chest-wall around the apex ; the mem- brane was lightly torn, but the hole was stopped with the finger and then with gauze, so that but little air entered the pleura. The apex of the lung was then seized with special forceps and drawn out. The area of consolidation, which was about the size of a large hazelnut, firm in the centre and slightly granular at the circumference, could be distinctly felt and defined. A silk ligature was then tied tightly around the protruding lung, five centimeters from the apex and two beyond the area of consolidation ; the lung was cut otf and the pedi- cle accurately sewn to the periosteum of the internal surface of the second rib, so as to avoid the production of pneumothorax. The divided muscles, layer by layer, were then carefully sutured with catgut; Florence hair sutures were used for the skin wound, and an iodoform wool dressing was applied. The patient was under chlo- roform for thirty-five minutes, and there was no disturbance what- ever of the breathing or the circulation. An excellent recovery fol- lowed without fever, cough, or any sign of reaction, local or general. A CONTRIBUTION TO THORACIC SURGE BY. 277 The dressing was first changed on the sixth day, and beyond slight weakness of the breath-sounds over the whole lung, no abnormality could be detected. The dressing was left off* on the ninth day, when the patient was well enough to be exhibited. On November 30, 1890, he also performed an operation for radical cure of a sponta- neous hernia of the lung, returning the lung and sewing up the wound. The patient was well by the seventh day.” I shall include resection of the lung, or pneumonectomy, and in- cision of the lung, or pneumotomy, under the same heading, as I be- lieve the same method of attack should be made in each. “ A patient presented himself at London Chest Hospital, with pain, cough and shortness of breath. Examination showed absence of movements of left side of chest, with anterior and posterior dul- ness; tubular breath' sounds, with vocal resonance and fremitus in- creased ; right side healthy. In the course of a few days the tem- perature ran up from normal to lOOy 8 ^, but soon fell again; night sweats, with a free, foetid expectoration, set in. At the suggestion of Dr. Samuels an aspirator needle was inserted between the fifth and sixth ribs, and two ounces of foetid pus drawn off. Considerable tumefaction at the point of aspiration followed, and a free incision was decided upon. About three ounces of pus escaped, and a drain- age-tube was inserted. Until this time it was thought the pus came from the pleural cavity, but when, a few days later, a portion of the seventh rib was resected and the thickened pleura incised, it was shown that an abscess of the lung about the size of an orange was the source of the pus. The cavity was washed out with a solution of perchloride of mercury 1-500, and a drainage-tube inserted. The patient began to improve in every respect, but on the evening of the fourteenth day he was suddenly seized with an epileptiform attack, followed by paralysis of the right arm. In an attack similar to this, a few days later, he became unconscious, was completely paralyzed, and died five days later. Post-mortem showed healthy granulations in the cavity of the lung. Smaller abscesses were found in the up- per portion of the lung. “The disease undoubtedly originated in pneumonia, and the close proximity of the pleura caused an extension of the inflammation and adhesions. Abscesses of the brain, the cause of death, were undoubt- edly embolic in origin, which is claimed to be the rule in abscesses of the lung or pleura.” 278 world’s homoeopathic congress. I have now done some twenty operations on the thorax, major and minor. Of these but two could properly be reported here as illustrating some points which I urge in the text further on. They are as follows : April 9, 1888, was called by Dr. F. X. Spranger to see Mrs. F , aged 40. History . — Seven weeks previously, while visiting in a southern city, was taken with fever of a continued type. The doctor in at- tendance pronounced the disease “ malaria,” and treated the case on general terms as a common case of malarial fever. As the patient did not improve, she was advised to come to her home in the North, trusting that the change might be of benefit. On Dr. Spranger’s first visit he found the patient emaciated, weak, pulse and respira- tion quickened, respiratory murmur faint in lower lobe of left lung, although not entirely absent. Marked tenderness on pressure, and the patient stated that there had been a deep-seated soreness and a little pain in this side from the first. This had been ascribed to the stomach by her attendant. Morning temperature, 101 ; evening, 102 to 102 J. Percussion elicited some dulness over lower lobe of left lung; no increase in size of side or bulging of the intercostal spaces. There was some cough, with expectoration of muco-puru- lent type. During the whole sickness the patient had experienced light chills at irregular intervals. After consultation we decided that the condition was one of localized empyema, or pulmonary ab- scess affecting lower lobe of the left lung, and decided to attempt to locate it with the aspirating trocar. April 12th, under the influence of chloroform, the exploration was undertaken. I selected the space between the seventh and eighth ribs in the centre of axillary line as being at about the upper level of the area of tenderness. Introduction of aspirating needle two and one-half inches straight in gave a negative result, then the needle was with- drawn from the lung and reintroduced downward and backward again with no result. Again I withdrew it, and this time thrust it downward, inward and forward and this time , was rewarded with a few drops of thick foetid pus. It was determined at this consultation to operate on the case, and the operation was fixed for the next day at two o’clock. Operation . — The anaesthetic used was chloroform, and beyond the effects of shock and irregularity of respiration during the last part A CONTRIBUTION TO THORACIC SURGERY. 279 of the operation there is nothing in regard to the anaesthetic worth recording. I commenced to make a four inch incision over the seventh rib from the axillary line forward. I next removed the periosteum and attached muscles ; for cutting the rib I used the common rib shears. I now attempted to open the pleural cavity in the rib space but found at the point of attack the union between the pleural surfaces so intimate that this was impossible. Explorations further up gave me an opening through which I thrust my index finger. I found the lung intimately adhered to the chest-wall at all points. I now dissected the lung from its attachments, opening the cavity to the full length of the space from which I had removed the rib. I now directed my finger towards the diaphragmatic attach- ment of the chest- wall, dissecting my way carefully and {thrusting back the lung. The struggles of the patient at this time were very great and the bleeding as the adhesions gave way quite free, as the edge of the lung folded up. I found the adhesions continued over the surface of the diaphragm. Suddenly I broke into a large cavity having its base on the diaphragm and its apex in the base of the posterior lobe of the left lung. There now came a great gush of badly smelling and very thick matter. During this part of the ope- ration Dr. E. P. Gaylord who had charge of the anaesthetic pro- nounced the patient very weak, and stopped it temporarily lifting out the tongue to aid respiration. Dr. Spanger held the ribs well apart with stout curved retractors. I now with the finger separated all adhesions to the diaphragm, and costal pleura as far up on the upper side of the wound in the chest-wall as I could. I did this to allow the lung to collapse and thus get it up out of the way in order to better drain the cavity. The lung was partly infiltrated with in- flammatory matter and contracted some, but to no great degree. With the finger as a curette, I removed all flakes of fibrin and granulations in sight. With the finger I drew the lung into the opening and trimmed the abscess edges just as I would have done in any other region. We were satisfied that the cavity had an opening into a bronchus and the great problem now was whether it would do to wash out the cavity. This I did with a mild boracic acid solution at a temperature of 100, keeping the wound fully dilated all the time, and allowing a free outflow of the water. This done I inserted a flanged drainage-tube at the lower angle*of the wound, left the wound open and enveloped 280 world’s homoeopathic congress. the whole side of the body in an ample antiseptic dressing consisting of gauze, mackintosh over this to distribute the discharge, and lamb’s wool over all. The patient reacted well, the pulse improved, the temperature fell to normal. On the seventh day the dressing began to smell and the first change was made. Found the cavity smelling quite badly, but little discharge. With the patient in a sitting posture we used a claret-colored solution of permanganate of potash. We allowed the cavity to fill from below until the patient coughed when we stopped the flow and allowed all the liquid to escape; the cough brought sufficient of the solution through the bronchus into the mouth to color the saliva. After this as often as the cavity became foul we repeated the irrigation and to the very last time, the patient was able to raise some of the solution. The general progress of the case was good, and by the middle of May the opening had granulated, and the patient was well. Her health has remained good. A. M., aet. 19, patient of Hr. Isaac Bentley was one of the victims of the Tilden school fire, and was severely burned about the hands and face. Inhaled flame and smoke and complained constantly of left lung for months afterwards. In July, 1890, was taken with several other members of his family with typhoid fever. The fever in his case was rather more severe than in the others, and about the middle of August he was taken with a sudden op- pression of breathing and constitutional symptoms of haemorrhage. On examination Dr. Bentley found a large accumulation of blood pushing down the diaphragm and filling the left pleural cavity. It was at this time that I was first consulted. I confirmed the diag- nosis, and as the bleeding had stopped I advised delay for the present. August 19th, the oppression of the breathing having in- creased to such an extent as to cause great embarrassment of respi- ration and circulation we decided to tap him. This was done under strict antiseptic precautions, and three pints of liquid blood drawn off. The patient was much relieved and seemed better for some days. Ten days later was again called and found the patient again suffering from oppression of breathing. Tapped again and drew off about the same amount of blood. I left with Dr. Bentley, the patient being very comfortable. Two hours later I was hastly sum- moned and found the patient had suffered from another severe haemorrhage, the side being tightly distended, and diaphragm pushed A CONTRIBUTION TO THORACIC SURGERY. 281 down making a rounded fluctuating tumor in left hypochondrium. The patient was suffering from combined blood loss and pressure, and his friends were told to prepare for the worst. His death seemed sure. After hard work on the part of his attending physician he rallied, and except for the pressure symptoms his condition was much improved. At the request of the family Dr. E. L. Shurley was called in for consultation September 4th, and after examination agreed that the bleeding proceeded from an abscess of the lung, and advised a third tapping. This the patient and friends refused to allow, the friends being particularly against doing anything further. Four days later I was again called, and found the pressure symp- toms much worse, the patient being in such agony that he not only consented, but demanded that something should be done to relieve him. The patient was given chloroform, and on introducing the trocar the contents of the thorax was found to be pus. Free inci- sion was decided on and the space between the seventh and eighth ribs in the axillary line chosen to make the opening. Incision made, measured three inches, and a full gallon of pus flowed slowly through the wound. The patient rallied well and was much relieved. Dressing changed four days later, some discharge; new tube inserted and wound redressed. Patient seemed to do fairly well until October 11th, when I was again called. The tube was still continued by Dr. Bently, but on examination it was found that it no longer drained the whole cavity. Adhesions had formed a second cavity, which occupied the upper half of the pleural space. The patient was again placed under chloroform and the space between the fourth and fifth ribs selected as the base of accumula- tion. Opening two and one-half inches long entered a cavity holding a quart of very offensive pus. Both the old and new cavities were now thoroughly washed out with claret-colored permanganate of potash solution. Daily irrigation with calendulated water was kept up. The patient did not seem to improve, the pulse being weak and as high as 140 beats per minute, respiration ranging from 24 to 36. Temperature from 102 in the morning to 104 in the evening. The patient seemed in desperate straits and I decided on radical measures; accordingly on December 2d, one month and twenty-one days after my last operation, under chloroform, I resected four inches of the fifth rib. I now opened the upper cavity through the rib space and with my index finger broke down the adhesions dividing 282 world’s homoeopathic congress. the pleural space as far back as the finger could reach. I next turned my attention to the stump of the lung in the posterior part of the upper cavity. It seemed firmly adherent in all parts, and com- pletely solidified. With the finger I broke up all adhesions and pockets around it and finished by washing out the cavity with a warm boracic acid solution. The patient’s surroundings were not the most favorable, his parents living in a small cottage heated by soft coal stoves. After much urging he was removed to St. Mary’s Hospital and placed in charge of the sisters. The upper opening now ceased to discharge and tube was withdrawn. His general condition began to improve, and by the middle of January he returned home cured. Examina- tion at this time shows the lung to have fully expanded and no trace of the trouble left but the scars which mark the lines of incision. Operation . — May be undertaken, when there is a lung-cavity, due to bronchiectasis, gangrene or hydatid, and it is evident that drainage is imperfect. The case is urgent when the expectoration is profuse, foul and irritating, when the cough is constant and exhausting, when sleep is interfered with, appetite is poor, or lost ; when there is diarrhoea, night-sweats, chills, or the commencement of hectic fever. The operation should be undertaken before the whole lung is in- fected, and when only one lung is diseased. Anaesthetic . — I have now imperfect notes of more than twenty cases of thoracic surgery and have used chloroform in most of the cases. In those with weak heart action I have used narcosis from whiskey, using from 6 to 12 ounces according to the age and condi- tion of the patient and the degree of effect desired. In every case the whiskey is supplemented with small doses of chloroform as needed to keep the patient in the operative stage of narcosis. Care should be taken not to allow the patient to rise up suddenly during the excitement from the anaesthetic, and in lifting the patient from the bed to the operating table, care should be exercised lest the patient be doubled up, or the chest constricted, thus forcing fluids into the trachea. I have seen at least two patients almost drowned in this way. Incision . — It will be seen from the cases taken from current litera- ture that small incisions have so far been the rule. Much stress is laid on the fact of determining the existence of adhesions, and A CONTRIBUTION TO THORACIC SURGERY. 283 where these are absent it is advised to first stitch the lung to the costal pleura, and wait until adhesions form before proceeding to open the cavity. It has always seemed to me to be timid, unsurgi- cal, if w 7 e have sufficient grounds upon which to base the operation, in the first place. In the cases reported by me I violated all these rules, and now looking back I do not think I did as good work in either case, as I might have done with a larger opening. In both my cases I freed the lung from the chest-wall, by tearing up all adhesions; in the first case it would have been necessary to incise the lung, ip order to reach the cavity ; it would then have been imperfectly drained, from its shape and situation, and could not have contracted as rapidly as it did after loosening it from its attachments to the diaphragm. In the second case the patient did not improve but remained very ill until I tore up the adhesions and from that time on he constantly improved. T think all adhesions should be broken up, and the whole cavity thoroughly drained. I do not think we have greater cause to fear septic pleurisy after thoracic operations than we have cause to fear septic peritonitis after abdominal operations, where pus or other irritating fluids escape into the peritoneal cavity, and we avert all trouble by thorough irrigation and complete drainage. Now as to the opening in the chest-wall. Is it not possible that in the future if we can find a feasible way to open the lung cavity, that the ex- ploratory operation for purposes of diagnosis, will be both more common and more useful than it is now in abdominal surgery? How then shall we make even a guess at the way this can be done, so as to avoid the most important structures and yet give room to work with ease? The opening should be so planned and so large, as to give us complete control of the field, thus allowing us with the eye and finger to examine every part of the pleura and every portion of the pulmonary tissue. I have long been convinced that the ribs are the only bar to the complete mastery of the situation here ; if there were no ribs, or if these could be dispensed with, dealing with the lung and its diseases would present no special difficulties other than those arising from its structure and physiological functions. We need an opening here like that in the linea alba in abdominal surgery, one giving the minimum of danger and the maximum of 284 world’s homoeopathic congress. usefulness. What this will eventually be, we can no more than conjecture now, and it will take many trials and much work to finally perfect it and make it stand the test of practical experience. In a case of gangrene of the right lung resulting from whiskey- drinker’s pneumonia, which presented itself in the charity ward of Grace Hospital, Detroit, I determined to open the chest after the following plan if necessity demanded operative interference. The case began to improve and I decided to wait, after a consul- tation with a number of my colleagues. Three days after we came to this decision, the patient while sitting up in bed, became faint, fell back on her bed and expired. Post-mortem examination re- vealed the pleural cavity foul, full of blood and covered with decomposed fibrin; the lower lobe of the lung necrotic. Death was caused by haemorrhage, from the bursting of a bloodvessel in the lung. Plan of Operation . — To avoid the mammary gland I decided to commence an incision in front of the line of the coracoid process, and carry it straight across the ribs to the scapular line between the sixth and seventh ribs. In order to miss the superior intercostal I decided to commence the incision over the second rib, but to make the third rib the upper margin of my flap. From the commencement to the end of my proposed line of incision I intended to divide all structures down to the ribs, and after controlling all haemorrhage, to resect portions of each rib from the third to the sixth. I now proposed to carry an incision between the sixth and seventh ribs with a scissors far enough forward to give plenty of room, even if this point was at the junction of the costal cartilages with the ribs. By now carrying the incision along the junction of the cartilages and ribs to the upper border of the third rib, and from this point to the place of com- mencement, at the point where this rib had been resected, I would have my opening complete. I planned to allow the integument to be one inch broader than this flap around the whole margin so that when the flap was laid back and stitched in place, the integu mental suture line should not correspond with the line of incision into the chest-wall. The great question, of course, was how to deal with the bloodvessels; I hoped to manage these with plenty of catch forceps, and to avoid the internal mammary by keeping well away from the sternum. I argued that my carrying my lower incision to the point A CONTRIBUTION TO THORACIC SURGERY. 285 of election would give me a perfect drainage-point; that by resecting the ribs in the proposed line I should make a trap-door flap with all the ribs in it, which could be lowered and thus completely open the cavity; that the free opening would allow collapse of the lung, thus rendering it easier to manage than when it does not collapse and moves with each movement of the chest as it does in the small opening. Observation at the post-mortem examination convinced me that no smaller opening could possibly have enabled me to manage the gangrenous lung tissue. I intended to clamp and ligature it in mass, and then sear the stump with the cautery, or, by imitating the cases of hernia cited above, drag the diseased lung through the chest wall, confine it there, and allow nature to slough it off at the line of con- striction. If this plan can be carried out at all, it may be possible to include the second rib when necessary, or a central section of this rib may be removed to allow it to contract and help to contract the chest- wall after operation. With this kind of an opening caseous masses could be felt and removed, dilated bronchi, when obstructed and filled with secretion, incised, drained, irrigated, the foreign body removed and the opening in the bronchus continuously drained by sewing in a bone drain, or closed with catgut. Abscesses could be incised, curetted and closed or cauterized to control bleeding and left wide open to drain into the pleural cavity and heal by granulation. If, according to Godlee, we may never hope to see a whole lung successfully removed, we may yet hope that large portions of necro- tic tissue may be removed and the patient recover. A word more about the sudden deaths from slight operations, and even from simple irrigation of the pleural cavity. In many of the reported cases death occurred after irrigation had been practiced many times. I think some of these patients are killed from shock caused by fluids too warm or too cold ; others are drowned by fluids going into the trachea through an open bronchus; or that, the lung floated on top of the fluid like a cork, empties partly pent-up secretions into the trachea suddenly, and thus causes death from asphyxia. Thus, one of my cases became faint and livid, but, on coughing, brought up much pus and mucus, and at once felt better. Every portion of a thoracic operation and after-treatment should be guarded by strict observation of Listerian principles. 286 WORLD S HOMOEOPATHIC CONGRESS. THORACOPLASTY. By H. F. Biggar, M.D., Cleveland, O. At Ventnor, in the Isle of Wight, is a consumptive hospital. The location is very suitable, as the island is formed of limestone rock covered with a few inches of light soil. The drainage is so perfect that no mould collects in dark closets or deep cellars. At this beau- tiful island hamlet I found patients suffering from pulmonary dis- eases greatly relieved, and some who were apparently incurable re- stored to health by surgical procedures upon the walls of the chest or upon the deeper structures within. The operations were for removal of portions of the shafts of ribs, for hydrothorax, pyotho- rax, pneumonic abscess and growths of a sarcomatous and hydatid character. Estlander has improved the surgery of the chest, and it is now abreast with the advancement of surgery of the abdomen and of the brain. To-day the ribs are separated from the cartilages or sternum or resected along the axillary line for adhesions of the deep struc- tures, for the purpose of freeing the lung from its abnormal encase- ment. The ribs thus severed will fall forward and meet the lung tissue, and permit the development of the lung. Where these adhe- sions exist the ribs act like parallel hoops and must be separated. Thoracoplasty will restore many who are now hopelessly con- demned. It has already given new life to patients afflicted with osteo-chondroma of the chest- walls, to exostosis of ribs, to neoplasm of the mediastina, and to gangrene of the lungs. May we not hope that in foreign bodies in the bronchi, where tracheotomy has proven useless, th it ere long bronchotomy through the chest-walls may not be an anatomical impossibility? If bronchotomy can be performed with success, many lives will be saved. It will then do what tra- cheotomy has not been able to do, as in that recent notable case of the Rev. Dr. Bothwell, of Brooklyn, N. Y., who inhaled a small cork. Although his surgeons could reach the cork below the bifur- THORACOPLASTY. 287 cation of the trachea through the bronchus, and even fixed the screw into the cork, yet they were unable to extract it, and thus a valuable life was lost. Experiments are going on with reference to this ope- ration, and it is found that the position of the arm upward and for- ward will separate the scapula from the vertebrae sufficiently to permit the resection of ribs, and by skillful dissection avoid the aorta and nerves, and thus reach the primary bronchi. As yet, these experiments on dogs have proved fatal. Were bronchotomy re- sorted to before any other operation, the chances of success might be better. The question arises, would the surgeon be justified in first operating for bronchotomy without resorting to tracheotomy? The following is a report of five clinical cases demanding surgical interference. One case recovered without an operation, and one recovered where two operations were performed without accomplish- ing the end intended, except that he was benefited in the operation per se. Case I. — Resection of a portion of the shaft of the sixth rib. Mrs. , set. 37, mother of five children, had a history as follows: A retro-mammary abscess of the left side, with necrosis of the sixth rib. The abscess had appeared fifteen months previous to my first visit. General health impaired and patient ansemic. Douglas’s pouch contained fluid. I removed the necrosed part of the rib, aspi- rated Douglas’s pouch per vaginam, and removed two ounces of pus. Gave Silicea 30x. Recovery. Query: Did the pus burrow from the left mamma to the diaphragm, thence through the ligamentum arcuatum externum, by way of the quadratus lumborum, or may it have followed the sheath of the abdominal aorta to the pelvis, filling Douglas’s pouch ? Case II. — Thoracoplasty. Resections of portions of the shafts of the sixth and seventh ribs. October, 1892, J. B., set. 43, laborer. In February, 1892, had pleuro-pneumonia, which terminated in pneumonic abscess with per- foration of the chest-wall, at the sixth space, two inches below the nipple and to the left. Previous to coming to me, while in another hospital, drainage was attempted. The health was much impaired, the urine albuminous. The probe could touch the chest-wall at a point corresponding to the inferior angle of the scapula. Removed three inches of the sixth and seventh ribs. The fistula was a guide to the abscess, which was very large, as determined by the probe. 288 world’s homoeopathic congress. The abscess was irrigated with a 1 per cent, solution of carbolic acid and drained. The patient did not do well, so changed the irri- gation to an injection of bichloride of mercury in the proportion of 1 to 10,000 and 15,000; still no improvement; then gave perman- ganate of potash for awhile, which was followed with boracic acid. The general health did not improve, and, being suspicious of the medicated irrigations, they were omitted. Washed with sterilized water, and the patient gradually improved ; the cavity filled up and the left chest increased coequal with the right. The case was tedious, for he was very indiscreet in regard to intemperance and exposure. Remedies, Hepar and Bryonia. The abscess was connected with a bronchus. Method of Operation . — The operation was performed as follows : The patient was given a general soap bath the day before the opera- tion. A thorough action of the bowels the night before, and the morning of the operation the axillary cavity shaved. Examination of the water showed albumen. At the time of the operation the chest was washed with bichloride of mercury 1 to 2000, and the sur- rounding parts protected with towels saturated with the mercurial solution. A vertical incision of four inches was made over the opening of the fistulous tract and down to the intercostal muscles; the parts were forcibly retracted and the periosteum of the sixth and the seventh ribs split in the middle line of the long axis of the shafts. With the staphylorraphy periosteum peeler of Mr. Thomas Smith, the periosteum is easily separated from the inner surfaces of the ribs to the extent desired. Removing the periosteum in this way, the intercostal arteries are better secured, and we avoid any haemorrhage. The ribs were severed with a Hayes saw; a broad metal retractor was placed under the rib, protecting the pleura; the edges of the cut ribs were smoothed with bone forceps, and the peri- osteum of both ribs cut through the middle with blunt-pointed scis- sors, and used as coverings to the ends of the ribs, after the manner of periosteal flaps in amputations. The pleura is in full view. A soft metal probe is put into the fistulous tract, which serves as a guide, and the opening gradually enlarged by dilators sufficient to insert a large drainage-tube. The abscess is thoroughly cleaned with carbolic acid solution of 1 per cent., drainage-tube inserted and held in position by the eyelet of the flange ; the edge of the external in- cision is sutured with a silkworm-gut; the mouth of the tube pro- THORACOPLASTY. 289 tected with sterilized gauze, covered with a rubber dam, and the dressing is complete. The patient was given Hypericum 3x every two hours. The next day the outside soiled dressings were removed, the cavity washed out with a carbolic acid solution of 1 per cent., and the sterilized gauze applied and covered with the rubber dam. The same manner of dressing was continued for ten days, with the exception of the medicated washings. The carbolic acid , solution was changed to the bichloride, 1 to 5000, then 1 to 15,000. This was continued for four days, when permanganate of potash was sub- stituted for three days ; then boracic acid for three days. These medicated washings seemed to retard the process of healing. Finally,, sterilized water was used, but the chest-pains were not relieved. All were abandoned and the patient began .to improve. The drainage- tube was changed every three days, and at the end of six weeks re- moved, the patient being virtually well. On examination, the urine was normal. The diet was sustaining and nutritious. Case III. — Thoracoplasty. Resection of four inches of the shaft of the seventh rib. Mrs. , set. 29, married, one child. Fell down a flight of stairs and struck the newel post, injuring the seventh rib of the right side immediately below the nipple. The accident was followed with peri- ostitis and necrosis. The rib was curetted to the healthy tissue, the disease of the bone returned, and I resected four inches of the seventh rib with recovery. Case IV. — Thoracocentesis, followed by thoracoplasty. Resec- tion of the shafts of the sixth and seventh ribs. Miss L., set. 23. In August, 1886, 1 removed a 47-pound ovarian tumor. In May, 1887, her physician, of the opposite school, called me in consultation for pleuritic elfusion. Thoracocentesis was de- cided upon, and we removed fifty-two ounces of serum. Did not completely empty the cavity. Drainage was established by another opening above at the fifth space. Septic symptoms followed, and we resected three inches of the sixth and seventh ribs. The patient im- proved for a few weeks, but died, twelve weeks after the resection, from tuberculosis. Case V. — Thoracostenosis, thoracoplasty. Resection of the shafts of the sixth and seventh ribs. Lilly S., set. 10. Four years before operation fell against a door- knob, injuring the left side. Pneumonic abscess formed, involving 19 290 world’s homoeopathic congress. lobes of the left lung, with spontaneous perforation at the sixth space. There was deformity of the left chest from collapse of the entire lung. The thoracometer showed four inches difference in the semi- circumference, lateral curvature of the spine; the patient was ema- ciated and hectic; temperature, 102.4; pulse, 135; the fingernails were clubbed ; the pyrexia was continuous; oedema of the skin pro- nounced ; and the urine albuminous. I resected three inches of the sixth and seventh ribs, and explored the lung cavity, which was so large that the finger could easily surround the apex of the heart. Curetted the cavity, washed out with sterilized water, and gave Ar- senicum. Good recovery, with partial reduction of the contour of the chest and a lessening of the curvature of the spine. The abscess was connected with bronchus. Case VI. — Thoracoscopy. Mr. , set. 19, unmarried, attempted suicide by shooting with a revolver in the left chest. The ball entered the fourth intercostal, midway between the nipple and the middle of the sternum, and was imbedded in the walls of the heart , perhaps in the septum, between the left ventricle and auricle. The physicians who arrived before me probed and found the location of the ball. By keeping the probe on the ball, the probe was moved corresponding to the heart’s contraction. Did not interfere surgically. The patient was care- fully nursed and all inflammatory symptoms kept in subjection with Hypericum, Aconite and Bryonia. In two weeks he left the hospital and is now living, though eleven years have passed since the shoot- ing. Case VII. — Tracheotomy for foreign body. Master C., set. 13, had a bone collar-button lodged in his air- passage. He came to the hospital eleven months after the accident. The boy was emaciated and hectic, and the right lung was seriously implicated. I performed tracheotomy low down, but failed to find the button. Within four days after the operation the patient began to improve in his general health, yet we felt certain that the button was not dislodged by the operation. The parents were solicitous for another trial. After the lapse of six days the tube was removed from the trachea, and exploration carefully and thoroughly made. The second attempt was also a failure as to the finding of the button, yet the patient continued to improve, and returned to his home in Virginia, having been in the hospital a month. About two months THORACOPLASTY. 291 after his return, during a violent fit of coughing, he expectorated the button. His health is completely restored. Suggestions . — Before the operation, let the patient and operator closely observe antiseptics and have the technique of the operation perfect. If an aspirator is to be used, boil the needle in soda or liquor po- tassse before sterilizing. Before inserting the needle, pull the skin a little to one side be- fore cutting, and make a valve-like flap, which may be of service later. Before inserting the aspirator, use a hypodermic syringe ; it will determine the character of the fluid, if any. If there are pus clots, or if the discharge is foetid, wash out the cavity after excision with boracic acid, permanganate of potash, Labbarraque sol., or carbolic acid 1 per cent. When clots or foetid discharges are removed, cease the irrigation. The thoracic fistula will assist in determining the parts of the ribs to be resected. If there is no fistula, try and establish drainage along the axillary line, in front of the latissimus dorsi muscle, where the pleura is more prominent, and between the eighth and fifth ribs, in front of the angle of the scapula. The pleura may be very thick, so guard the trocar or knife, that it may not puncture the lung. The semi- or recumbent position is the best. If merely thoracocentesis, watch the pulse, for fear of syncope. If blood appears in the fluid drawn, or the patient coughs, stop. Never empty the cavity at the first drawing. Examine the urine for Bright’s disease or amyloid changes. The safest and best irrigant is sterilized water. For foetid dis- charges use carbolic acid, permanganate of potash, Labbarraque sol., or boracic acid. Recollect that a small diseased area may secrete large quantities of pus. If the space between the ribs is so narrow as to interfere with proper drainage, remove an inch of a rib. Let the dressings be enveloped with rubber dam. If the abscess is large, two openings are better by resection of the ribs above and below. 292 world’s homoeopathic congress. Avoid the intercostal artery ; it lies along the inferior border of the rib. In punctured wounds of the lung, if hemorrhage exists, carefully examine the intercostal artery. Higgins’s empyema-tube, with flange, is the best thoracic drain- age-tube. A corrugated white rubber tube is next best.. Use the thermo-cautery in deep-seated disease. In gangrene of the lung the only hope is in thoracoplasty. After resection of the ribs use the thermo-cautery in its removal. The mortality is large, but without it the case is hopeless. Beware of the drainage-tube. A physician failed to guard a tube with a safety-pin. It slipped into the pleural cavity, and I had to resect a portion of a rib to remove the lost tube. Exclude air from the operations upon the chest-wall as far as pos- sible. Blunt knives are preferable to sharp ones. In foreign bodies in bronchi, statistics are in favor of non-surgical interference. Do not remove the drainage-tube too soon. It is not always necessary, though it is safer, to excite adhesions of the pleura before operating. Chloroform is the best anaesthetic.. If cavities are to be opened, if possible do not enter from behind for fear of haemorrhage, from severing vessels which mainly lie along the posterior part of the bronchi. In injuries to the chest from bullets be cautious in probing, and carefully deliberate before attempting the extraction of the ball. I have found that washings of lung cavities, as a rule, are inju- rious, and not demanded after pus-clots and foetid discharges cease. For thoracocentesis I use Tiemann & Co.’s aspirator. Do not “ incise a putrid cavity of the lung unless the pleural sur- faces are adherent.” In “ localized gangrene, if it has already lasted some time, the danger is not so great ; adhesions are usually present under these conditions, and the lung is so consolidated by inflammation that it is in but slight danger of collapsing.” “ In acute cases and in bronchiectasis it is impossible to be cer- tain. An attempt may be made to find out by ascertaining the mo- bility of the lung. If a needle be driven through an intercostal space into the pulmonary tissue, it will show to a certain extent by THORACOPLASTY. 293 its movement whether the lung is fixed or not. In some instances it may be possible to suture the two surfaces together and wait for a week, or to procure adhesions by means of the cautery applied to the intercostal muscles.” Are tracheotomies necessary for the removal of foreign bodies from the air-passages ? 294 world’s homoeopathic congress. VIVISECTION AND PULMONARY SURGERY. By Walter F. Knoll, M.D., Chicago, III. Modern surgery has made it possible to safely enter every cavity of the body except the thorax. Except for a few simple lesions and under very special conditions, it keeps a closed door, and the faith- ful and aggressive surgeon must pass by and leave his patient to the few meagre chances which nature parcels out to him. The many methods which have been adopted and tested for surgical interference with the organs of the thorax have been in a large measure unsatis- factory. It is only in diseases of the thoracic wall and the pleurae that our ideal has been imperfectly attained. The names of Est- lander, Koch, and Bull are inseparably connected with the progress which has been made in this direction. When the surgeon has at- tempted to go beyond these structures there were two serious com- plications which have confronted him, and which have in a measure barred his further progress. The first of these is haemorrhage and the second is collapse of the lung. The former is now fairly well managed with the actual cautery and aseptic ligature, but the latter remains an unsettled problem. About ten years ago, when pulmonary surgery was a subject of special study, I became intensely interested, and from that time to the present I have carefully noted the experiments and the reports of clinical work of other men, and in all my thorectomies for pleural and costal diseases, and in my vivisections for class demonstrations, I have tried to discover some means by which the lung and pericar- dium could be operated upon without danger from haemorrhage or collapse of the lung. The enthusiasm which was then manifested in this work is well- known to the members of this Congress, and it perhaps has lost none of its interest even at the present time. The large number of localized lung diseases which are untouched by remedies or climate, and which in spite of all the known means at our command gradu- VIVISECTION AND PULMONARY SURGERY. 295 ally progress until they destroy the life of the patient, has made pul- monary lesions in all time the most interesting and important subject in the category of diseases. Every surgeon at that time was testing his skill, and the surgical journals were reporting with each issue new cases of pneumotomy and pneumectomy. A young Italian sur- geon was so confident of the efficacy of his art that when his fiancee was blushing with the fire of an incipient phthisis, tested his skill, and when he was rewarded with a bitter failure ended his existence with his own hand. The interest did not abate until the cool and logical statistician published the reports of cases and showed the futility of the efforts which had been made. But from these statistics a few important deductions may be drawn, and they clearly point to a road which ultimately must lead to success. Of the successful cases reported there were present antedating the operation certain pathological changes in the pleurae, and they were produced either as a part of the disease for which the operation was made or else as independent processes. In 80 per cent, of the successful pneumecto- mies reported there were firm adhesions betwten the costal and pul- monary pleurae, and to-day it is a law well established in pulmonary surgery never to attempt to operate upon the lung unless there are extensive pleuritic adhesions, and Dr. Koch has given us a reliable test by which this can always be known before the operation is undertaken. He says, thrust a long needle into the lung, and re- quest the patient to breathe. If the outer end of the needle rises with inspiration and falls with expiration, there are no adhesions. If the outer end of the needle does not change its relation to the body with respiration there are adhesions. Firm pleuritic adhesions are an absolute prerequisite before lung tissue can be safely interfered with surgically. When this is accomplished the lung falls within the dominion of surgery, and he deals with it as he does with the rest of the organs of the body. During the past few years I have slowly worked out a method by which these adhesions can be produced by artificial means, and the lung tissue entered and operated upon without fear of collapse of the organ or great danger from haemorrhage. While some authors teach that the collapse of a lung during an operation is no serious compli- cation, yet those who have had the unfortunate occurrence have fears which are not founded upon theory. The immediate shock aud the subsequent sepsis and countless other coincidences make it 296 world’s homceopathic congress. imperative upon the surgeon never to court such a danger. The means by which I have produced pleuritic adhesions and the results which I have obtained upon the lower animals, I shall briefly recount. The animal w T hich is selected for the experiments is a dog. The side upon which the operation is made is shaved and rendered clean and aseptic. The operator, assistants, instruments and materials used during the operation and for the dressing are prepared with all pos- sible care. The animal is placed under an anaesthetic, and when the region over the particular part of the lung which is to be operated upon has been selected, an incision is made along the course of the rib through the skin and adipose tissue about four to six inches in length. This tissue is dissected from the muscles on either side of the line of the incision for about one and a half inches. The folds are held back with two retractors in the hand of an assistant, a needle made especially for this work, threaded with number 8-10 catgut, is held in a strong needle holder. The operator places the thumb and index finger of his left hand on a rib at a point which marks the outer border of the area which the adhesions are to take place. The needle is then passed close by the thumb through the intercostal tissue down into the lung, carried through a section of the lung tissue and out through the intercostal space on the other side of the rib. The stitch includes a rib, inter- costal muscles and lung tissue. It is tied with only a mild amount of tension for fear of tearing the lung tissue. A second one is passed in the same manner as the former, and only a quarter of an inch from it, a third and so on until the lung has been stitched to the rib for two or more inches. Now, on either side of the rib and corres- responaing with it the intercostal tissue is stitched to the lung by a back and under-stitch so placed as to include all of the pulmonary pleura and fasten it to the chest wall. If it is desired to remove more than one rib or extend the operation, a second rib and inter- costal space can be treated, as the former and the field are made almost indefinite in size. The intercostal stitches are placed at right angles with the costal ones. The kind of stitch used is the con- tinuous, as it answers every purpose and expedites the operation. In the centre of the field of operation a silk thread is carried around the rib to serve as a landmark in making the second operation. Catgut absorbs rapidly, and in several secondary operations I could not find a vestige of the catgut. The wound was made clean and VIVISECTION AND PULMONARY SURGERY. 297 thoroughly asceptic. Iodoform is sprinkled over it, a piece of iodo- form gauze laid over the stitches, the end of which hangs out of the lower end of the wound. The skin is loosely fastened over the gauze with a loose continuous suture, and the' wound closed with a vo- luminous antiseptic dressing. This latter need not be removed for from five to seven days unless there are evidences of sepsis, and in such an event it is treated the same as an infected wound. There is no danger of septic material entering the thoracic cavity. At the end of from six to eight days the secondary operation can be made, which consists usually of the resection of a rib and the entrance through the pleura into the lung with the actual cautery. It is not neces- sary in all cases to remove the rib, but since generally one requires more space than can be obtained between the ribs the method which I have mentioned is the best. The depth which one can go in the lung with the cautery depends upon the size of the subject. It seems safe to go fully one-half the thickness of the lung, and the incision should be in line with the ribs to avoid cutting into the adjoining lobes which may be in close proximity to the spine. To accomplish this work easily it is necessary to state some of the rules which have been learned by experience. In my early attempts I resected the rib first and then tried to stitch the costal to the pulmonary pleura, but the tissue was so thin and yielding that air invariably followed the track of the needle, and either collapse of the lung or sepsis re- sulted, and sometimes both. Then I removed all of the muscles except the internal intercostal and stitched without resecting the rib; this also was a failure for the same reasons as the former. Then finally no muscular tissue was removed, the stitches introduced as recommended, and every trial was successful. I am of the opinion that in the human subject where there is much emaciation, one can stitch through skin and all without making the primary incision and dissection. There must always be enough extra pleural tissue to close the tract of the needle. The number of stitches which one uses has nothing to do with the results so long as enough are applied. The ordinary needle is of little value in this work. The curve is not correct, and the cutting surface reaches too far along the shaft. For ray last experiments I used a needle which I had constructed especially for this work. It is made of round steel wire with a spear point, the edges of which extend only about one-eighth of an inch along the side. All the tissues are easily punctured and the long 298 world’s homoeopathic congress. tapering cutting point of the ordinary surgical needle did an amount of wounding which was wholly unnecessary. These needles are bent on a perfect circle, and they extend T 9 g of a complete circle. The diameter of the circle is one and a half to two inches. They can be obtained from Truax, Greene & Co., of Chicago. Before the operation is begun the pulmonary lobes must be outlined and their limits avoided unless one wishes to stitch two of them together and produce adhesions between the lobes as well as between the pleurae. But fortunately for surgery in a large percentage of the diseases for which this treatment is indicated the difficulty is primarily intra-lobar. There is no part of the chest which cannot be entered so long as the rules which I have given are carefully observed. In pericarditis with effusion, where the fluid cannot be removed with an aspirator, preliminary stitching followed by resection and drainage may some day be considered advisable and proper. The results which I have thus far obtained upon dogs are emi- nently satisfactory. The specimens which I will show you prove how absolutely harmless it is to both lung and pleurae. There are no traces of pneumonitis and the pleuritis is confined wholly to the tissues enclosed in the suture. The adhesions are firm, and if the suturing had been done as thoroughly as in the later cases the ad- hesions would cover the whole area. The animal was killed eight days after the preliminary suturing. What inferences may we draw from these experiments, and what value are they to humanity ? In my judgment it furnishes a new hope to a large number of our race who by the aid of our present knowledge of therapeutics are under sentence of death. The child with a foreign body in a bronchus, the athlete with a ruptured lobule and subsequent infection and abscess, the victim of a localized tuberculosis, the pysemic with a metastatic pulmonary abscess, the victim of a pulmonary cyst or tumor, and indeed many others which could be mentioned are subjects which under this treatment can find relief and cure. If opening a tubercular joint and removing the colonies, followed by perfect drainage, cures the limb when all other methods have failed, is it not reasonable to believe that the same treatment applied to lungs will give equally good results ? The great reason why lung tissue, when it begins to degenerate, shows so little disposition to repair is because the drainage at best is imperfect and difficult. VIVISECTION AND PULMONARY SURGERY. 299 I have known several cases in my practice, and there are perhaps members in this Congress who, by lowering the head and chest, have evacuated a pulmonary abscess, and which marked a change in the tide of their diseases. Drainage properly established is the greatest remedy for restoring degenerating tissue, and by the methods here outlined it can always be accomplished. However, I have no boast- ful claim to make. I shall carefully submit it to time and test, the two elements which ultimately settle the intrinsic value of every innovation. Discussion. C. E. Walton, M.D., of Cincinnati, who had been assigned to a discussion of Dr. Biggar’s paper, then presented his views as follows : The papers just presented are valuable for two reasons: first, on account of what they specifically state and illustrate, and, secondly, on account of what they leave unsaid, but suggest. The subject of thoracic surgery is both new and old — so old, in fact, that having been well-nigh forgotten, it comes to us in its recent resurrection with all the impetus of a novelty. We have been kindly spared the recital of the history of thoracic surgery, and have been introduced at once to one of its most modern phases. I cannot forbear, however, al- luding to the first authentic operation of rib resection, done ages ago, under the influence of a profound anaesthesia, and, judging from the results, according to the principles of an enlightened antisepsis : “ And the Lord God caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof .’ 7 This operation, however, has not been reported as forming a basis for surgical imitation, but those who always want authority for their procedures can find some warrant in this bit of history for the so-called mutilation of the human form divine. What was done with that rib is “ another story , 77 and foreign to the subject in hand. Passing from sacred to profane history, we find that Hippocrates defined the technique of thoracic puncture for the treatment of lung abscess two thousand years ago, and to-day his principles remain unchanged. It is not to be expected that the discussant of a paper from so eminent a gentleman as Professor Biggar shall accept unchallenged all his statements, even though they come from such a distinguished source. I gladly take issue with the announcement of an anatomi- cal impossibility when of a possible bronchotomy he says that the position of the arm upward and forward will separate the vertebras sufficiently to permit the resection of ribs, etc. He taught me better anatomy than that more than twenty years 300 world’s homceopathic congress. ago, and I know that back-bones do not grow limber with age to such an extent as to warrant this declaration unless based upon his own personal experience. That position of the arm will widen the space between the inner border of the scapula and the vertebral column, and thus render the ribs more accessible, but the vertebrae will interlock as closely as ever. Again, I question the location of pus in the case recited where it is said to have been found in Douglas’s pouch. The pus was aspi- rated per vaginam, it is true, but that pus was extra-peritoneal or else his patient had established a most unheard of tolerance of pus in the peritoneal cavity. Pus has been known to separate the dia- phragm and strip up the peritonaeum and thus appear in the pelvis, but it would scarcely find its way through the peritonaeum without setting up a most violent inflammation. These papers emphasize what is to be done for empyema, what is to be done for gangrene of the lung, and what is not to be done for foreign bodies and gunshot wounds. The conclusions reached seem to me to call for hearty approval. The empyemic cavity is an abscess from which sound surgical principles demand that we remove the pus; in which we are to limit and prevent the formation of pus ; and to which we are to restore as far as possible the intra-thoracic pressure. The principle which demands the amputation of a gangrenous area is novel only from the location of the field of operation. In regard to the removal of foreign bodies, whilst statistics of more than a thousand cases show that non-interference has met with the best result, the truth seems to me to lie very close to the statement that every case both of foreign body and of gunshot wound is a unique case and its management will depend upon its own peculi- arities. Not every sinus indicates a thoracic cavity opening. Not every foreign body can be shaken out by the heels. Not every bullet is an instrument of death even though it takes up its residence in the very structure of the heart. The behavior of Prof. Biggar’s Case No. 3 contains a most valu- able lesson on the subject of irrigation and we learn again, and how many times we have to relearn that nature is a most important factor in our work. She can be coaxed but not coerced — led but not driven. Irrigation and irritation are many times synonymous, and irritation in surgical work has many times meant death. Thoracoplasty has been on trail for nearly fifteen years and as a surgical procedure has an established foundation. It does away with blind work with its uncertain results, and we should not be slow to learn that a stab in the dark even though done by a surgeon is some- times as fatal as the thrust of the assassin. VIVISECTION AND PULMONARY SURGERY. 301 The value of these papers to the profession lies in the emphasis they give to the worth of operative procedure in the treatment of disease. The practitioner accustomed to the management of cases purely from a therapeutic standpoint is quite apt to stop at the therapeutic limit and consider that all has been done when medicine has exhibited all its possibilities. Many a patient has been sacrificed to this point of view. Many a patient too has been sacrificed to surgical rashness, but when we consider the number of cases turned over to the knife as a last resort when they should have been pre- sented for initial treatment, the therapeutic pot will hesitate long before it upbraids the blackness of the surgical kettle. Has no one seen a pleuritic effusion pass over into the dangerous empyema, or seen a fatal peritonitis follow fast upon the heels of a temporized appendicitis? Has a strangulated hernia never called upon death to witness the defeat of a tardy operation demanded at the hands of a rash conservatism ? Has the ruptured sac of an ectopic gestation never confronted the obstetrician while calmly con- sulting his patent calendar to see upon what day the bursting waters shall announce the time for him to remove his coat? If not then are these papers written in vain and our discussion of them is an untimely event. Not all physicians can trap-door the thorax or the cranium, but it is of value to know that such work can be done and that sometimes even the patient shares in the triumph of the operator. Sidney F. Wilcox, M.D., New York City : In attempting to dis- cuss a paper like the one before us, giving as it does such a range of pathological conditions and showing such excellent results, one can but feel that the writer himself is the best fitted to judge as to the correctness of the methods and technique employed. In reviewing one’s own experience one is frequently struck with the fact that in a long series there has been a remarkable similarity in his cases; so that although a surgeon may have opened the thorax a good number of times, the opportunity for a variety of methods of operating has been limited. Unfortunately (or perhaps fortunately) this has been my experience ; for nearly all of my cases of thoracic surgery have been those in which an accumulation of fluid, either serous or purulent has followed disease of the pleura. All of them have recovered, and with two exceptions all have been treated by making a slit between the ribs, introduction of a drainage-tube and irrigation, or simple aspiration has been employed to remove the fluid. The good results have not been due to the fact that the cases have been simple and easy, but several of them have been desperate in character, as for instance the case of a little girl eight years of age. The amount of purulent effusion into the left pleura was enormous, so much so that there was a complete transposition of the thoracic 302 world’s homoeopathic congress. viscera to the right side of the chest. The child was so weak that an aspirator was first used to remove a portion of the pus as a tem- porary measure and 22 ounces were drawn off. A few days later it was found necessary to make permanent drainage and as the heart’s action was so weak, and the breathing capacity so limited, it was deemed unsafe to use either chloroform or ether as an anaesthetic. Cocaine was then just becoming prominent as a local anaesthetic, and so a few drops of a five per cent, solution were injected over the site of the intended incision. The result was appalling, the child imme- diately went into a state of collapse and it was an hour before we could feel that she was in a safe condition. When she had sufficiently recovered from the effects of the Co- caine, the ether spray was used as a local anaesthetic, a rapid slit was made along the seventh intercostal space and three quarts of pus evacuated at once without any distressing symptoms. A drainage- tube was introduced and the cavity washed out with a bichloride of Mercury solution, and the wound dressed antiseptically. The dress- ings were changed as frequently as they became saturated and the cavity only irrigated when a rise of temperature indicated a condition of sepsis. Then the bichloride solution was used. The child made a perfect recovery, and examination over a year after revealed only the slightest difference in the two sides of the chest. My other cases, which required incision, have been very similar, except that in this case the amount of pus removed was greater than in any other. In one case, in a child, I was obliged to remove portions of two ribs on account of the impossibility of otherwise obtaining sufficient drainage; in one other case a portion of one rib was removed for ab- scess following an accident, and in a third case, what appeared to be a cystic tumor of the breast proved to be a cold abscess connected with a carious rib resulting from an undiscovered fracture. Aspiration is of no use as a curative measure except where the fluid in the pleural sac is serous. Where pus is present it may be employed to gain time, as has been remarked in Dr. Biggar’s paper, for diagnostic purposes. Formerly my method was, after induction of anaesthesia, either general or local, to feel for the upper border of the rib, introduce the knife through the chest wall, and make a rapid slit along the inter- costal space. This only requires a second, and has always been sat- isfactory ; but in the last few cases, for fear that I might be surprised by a troublesome haemorrhage, I have modified the technique, al- though it requires more time. First, an incision is made through the skin and subcutaneous tissue ; next, the muscular tissue is cut through, keeping near to the upper border of the rib. This is done without hurrying, and all bleeding vessels are compressed and tied. VIVISECTION AND PULMONARY SURGERY. 303 Then the point of a director is pushed through the remaining struc- tures into the sac ; the director is quickly withdrawn, and the blades of a uterine dilator introduced in its place, and the opening can be stretched to any extent desired without danger or fear of haemorrhage. This operation is better adapted to cases where it is possible to induce general anaesthesia ; where that is unsafe, and the ether spray has to be employed, the more rapid operation of slitting with the knife’ is preferable. In recent cases of empyema I do not think, as a rule, it is neces- sary to resect the ribs. ISo far as my experience goes, the contour of the chest is better preserved without resection, and the lung seems to slowly expand and again fill the thoracic space as the cavity closes up. Various forms of drainage-tubes and methods of fastening them have been devised. A very simple arrangement which I have employed has given perfect satisfaction. Take a short piece of stiff, soft rubber-tubing and pass two safety-pins through the walls on the opposite sides of the tube. These pins simply pass through the walls and do not en- croach on the lumen of the tube. Then take two strips of rubber adhesive plaster and fasten one to the back wire of each safety-pin. Each strip of adhesive plaster should be long enough to go nearly half round the body. The tube is introduced into the wound, the two strips of adhesive plaster pulled in opposite directions and stuck to the skin. This arrangement is made in a moment, costs almost nothing, and holds the tube firmly in place. With regard to antiseptics, I have always used bichloride of mer- cury and have never had any trouble, but have only irrigated the cavity as often as the temperature indicated its necessity. Dr. Biggar : I will not detain you but a moment. The paper was not concluded, as it was longer than I expected. I have en- joyed very much the paper by my new friend, Dr. Knoll. I want to say this in regard to Dr. Walton’s criticism about the position of the scapula. He evidently misunderstands the paper, or else I have made some clerical errors, and I say this, that the paper, I think, reads, that the position of the arm will bring the scapula forward along a certain space, between the border and the vertebrae, so as to permit of the chance of the resection of the rib in bronchotomy. That was the intention of the paper, and no person supposed that the po- sition of the arm — and I think that my good friend Walton does not absolutely mean it to himself, except as a little joke upon me — would displace the vertebral column. He knows better, but I always admire him whether he is pro or con. Another point is this — and if the paper had been continued we would have come to that point — let your cavities alone. We have tried the medicated irrigation there, and irritants, and where we have 304 world’s homoeopathic congress. abandoned the irrigation and left it alone the formations have recu- perated much better and much faster. I must say this, that I was greatly pleased by the masterly effort of the paper which was read yesterday by my good friend, Professor Obetz. It was a masterly effort on a subject which is of great import to-day, more important, I think, than almost any other branch of surgery. My first introduction to this branch of surgery was about eight years ago, as I told you, in the Isle of Wight, at this consump- tive hospital, which gave me the inspiration that there was a great deal in resection of the ribs for pulmonic diseases and for diseased conditions. I never was so pleased in results as I was in one of the cases that I narrated of that little girl ten years of age who came with all the conditions of a lung completely destroyed — a lung which had been degenerated and which you could put your finger inside of. When, with the condition that existed in that little girl, with her spinal curvature and the contour of the chest showing tour inches difference between the right and left sides — the left side being four inches smaller — when you can restore such a case to almost a normal res- piration, with a greatly improved contour and complete apparent physical condition, you can understand that the joy which that poor little girl gave me was worth more than gold, and well repaid me for the time which I devoted to the study of thoracoplasty. THE TREATMENT OF EPILEPSY, ETC. 305 THE TREATMENT OF EPILEPSY , IDIOCY AND ALLIED DISORDERS BY CRANIAL EXCISION AND INCISION. By G. F. Shears, M.D., Chicago, III. At the annual meeting of the American Institute of Homoeopathy,, held in 1889, the Surgical Bureau took for its topic Brain Surgery, and presented exhaustive treatises covering almost every phase of this subject. I do not intend, in this brief article, to compete with the report there submitted, but rather to supplement several divisions of the subject, by considering the present position of certain surgical pro- cedures and by presenting some personal experience. In no other department of surgery, not excepting the surgery of the abdomen, have more new methods been introduced or more startling innova- tions than in brain surgery, and a large part of this history has been made within the last few years. The time is so brief that much of the work done has not been- recorded, and sufficient data is not at hand to determine its value or its attendant dangers. It is only by the trial and comparison of the results obtained that the true value can be determined. It is the duty, then, of every one to record his results, and thus contribute the more rapidly to a safe surgical practice ; for surgical practice is the result of the consensus of surgical opinion rather than the prac- tice of one man, as Nancrede aptly puts it. It is in this spirit that I review the disorders which have been selected as the subject of this paper, and append thereto some surgical cases. The disorders se- lected are epilepsy, cephalalgia, paralysis, insanity and microcephaly. Epilepsy. — Removal of a portion of the cranium for traumatic epilepsy is not a new operation. In 1705 La Motte made, I believe, the first recorded operation. From that time, for almost one hun- dred years, the operation languished. Although made from time to time during the earlier part of the present century, it was not until 20 306 world’s homoeopathic congress. the advent of antiseptic surgery and the closer study of cerebral localization that it began to be generally employed; Even during this period the operation was confined to such cases of traumatic epilepsy as were accompanied by marked depression of the cranium and in which the history of a compound fracture was undoubted. Within the last four or five years the sphere of the operation has been extended, and operations have been made upon non-traumatic cases classed under the head of Jacksonian and focal epilepsy. Some of the more venturesome have even advocated the use of the trephine in general epilepsy — if such a term may be employed. It is in traumatic cases in which a decided depression is present that the greatest number of operations have been made and in which the best opportunity for determining the value of an operation exists, yet medical opinion differs widely as to the ultimate result of the procedure. Dr. O. Laurient reports 102 cases of trephining for trau- matic epilepsy: 54 per cent, cured, 17 per cent, unimproved, 20 per cent, improved, 2 per cent, worse, 7 per cent. died. Agnew, in his review of work of Philadelphia surgeons — in which I see no notice is taken of the work of surgeons of the Homoeopathic School — reports 54 cases, of which 32 experienced temporary benefit. 9 no relief, 4 passed out of observation, 4 were cured and 4 died. Briggs reports from Stephen Smith’s table 92 American operations, with 63 cures; from Bartholomew Hospital reports 130 cases, 75 cures, and of his own, 30 cases, with 25 cures. Personally, I report the following cases : Case I. — Young man, set. 29 years; nine years before had been kicked by a horse in the forehead, sustaining a compound fracture; three years later he was badly scared; this was followed by convul- sions, which gradually ceased ; four years later convulsions returned, and at the time of the examination had continued two years, occur- ring regularly two or three times a week. The depression was found in the left frontal region beginning two inches above the supraorbi- tal ridge and extending two and a half inches upward toward the median line. The entire depressed bone was removed. It was closely adherent to the superior longitudinal sinus, and was dissected off with the knife. During the operation the sinus was punctured, and for a time the haemorrhage was profuse. It was controlled by sponge pressure, and eventually by suturing with catgut. Convul- sions ceased after the operation, and did not return for six months. THE TREATMENT OF EPILEPSY, ETC. 307 At the end of that time he began drinking heavily, and the convul- sions returned. Upon stopping the use of alcohol they ceased. Case II. — Man, set. 42 years. Five years previous was struck by a locomotive, sustaining a fracture of the right parietal bone ; also severe injuries and possibly fracture at some other point of the cranium. The patient remained in a comatose condition for three weeks, and did not fully recover consciousness for six weeks. All previous knowledge was obliterated. Three years after the injury he began having convulsions, two or three times a week. The spasms were ushered in by the patient turning to the right; then the head turned toward the right, followed by contractions of the right fore- finger and thumb; then the arm, face, and leg. An irregular de- pression was found on the right side about two inches above the ear. Some question arose as to the best locality to trephine. Although the depression was found on the right side, the symptoms seemed to indicate an irritation of the left motor tract. The history was of little assistance. For some time after the injury the patient was in such a critical state that he was expected to die every moment, and a careful examination was not made. Severe contusions were found all over the head, any one of which might have been accompanied by a fracture. It was therefore decided to make the operation over the depressed bone. The entire area was removed.. The dura was much thickened and inflamed. The patient did well for a few weeks, having no convulsions. Subsequently they returned in full force. Case III. — Young man, set. 30 years. Three years before was struck on the head with a hammer; wound never healed completely, a fistulous opening remaining. Two years after the injury convul- sions began, and continued until the present time. They occur two or three times a month, the patient remaining unconscious for half an hour after each one. The frontal bone was uncovered and a small fistulous tract was found under it. The trephine was applied at its upper portion, and a small sequestrum and pus sac found on its under surface, both outside the dura. They were removed. No convulsions occurred for one year, when the patient was lost sight of. Case IV. — Man, aet. 39 years. Kicked by a horse in the left frontal region, producing a compound linear fracture; the patient never lost consciousness ; the wound healed promptly. Three weeks 308 world’s homceopathic congress. later had a convulsion, followed in two weeks by another. Trephin- ing was performed over the seat of injury. The bone was not de- pressed, but a thin blood clot was found between the skull and the dura. This was removed. The patient made a prompt recovery. No convulsions have since occurred. Case V. — Man, set. 46 years. Fifteen years ago a trap-door fell on him, striking his head a little to the left of the median line, pro- ducing a contusion of the left parietal bone. The skin was not broken. The spot has remained sensitive and the skull seems more prominent at this point. Five years ago he began to have a twitch- ing of the right arm. He loses consciousness but does not fall. The sensitive part was exposed and the one-inch trephine em- ployed. The bone was found to be very hard and much thickened. No diploe existed. No depression was discernible, and the mem- branes seemed normal. The patient recovered, and was free from the convulsions when last heard from, three months after the opera- tion. Jacksonian Epilepsy . — In this form of epilepsy the convulsions are confined to a single group of muscles, and are not accompanied by loss of consciousness. Whether the cause is largely traumatic or idiopathic is not known ; that some cases are due to cerebral trauma- tism seems certain, but that others have no such history seems equally positive. The limited muscular involvement indicates that the brain lesion is of limited extent. Our study of brain localization enables us to locate the centres involved. Very naturally the thought arises, that if the irritant in the shape of a scar or in non-traumatic cases the irritable centre were removed, the spasm might be prevented. The plan has been carried into execution, but while the theory is sim- ple, and, upon first thought, it would seem the plan should be fol- lowed by good results, there are certain reasons why the prospect of a cure by operation in this form of epilepsy is not encouraging. In those cases in which no lesion is apparent, our present knowledge is not sufficient to locate the real cause of the trouble. Even if w r e locate approximately the discharging centre according to the rules of cerebral localization and by means of the electrode applied to the cor- tex of the brain determine the exact centre of discharge, we have no assurance that the irritation which causes the discharge is in the centre itself, and that its removal will remove the irritation. In those cases in which a real lesion exists, as shown by cicatricial tissue, THE TREATMENT OF EPIEEPSY, ETC. 309 the removal of the same might be followed by relief. Even in these cases the healing is necessarily followed by a scar, which in all prob- ability will give rise to the same irritation as before. That many more cases are due to traumatism than is generally admitted, I have no doubt. In this connection, an interesting article by Dr. Ira Van Gieson, showing the changes that had taken place in the brain, ns proven by the microscope in the case of a patient wdio had had epi- lepsy as the result of a skull injury, but in which there was no frac- ture of the inner table, could not but make me consider how many opportunities there are for brain traumatism in the injuries of child- hood, even where fracture does not occur, and that possibly many cases usually considered as idiopathic may be in truth traumatic. In seventeen cases of Jacksonian epilepsy which I have collected in my reading, only three are reported as cured. Two of them were from traumatic causes, and were only a short time under observation. The mortality was large, about 47 per cent. My own experience is limited to the following case, in which a complete operation was not made : Girl, set. 17 years; convulsions occur two or three times a week, commencing in the hand and then extending to the neck, ending with a wagging motion of the jaw. No history of fracture of the cranium could be elicited and no scar could be found upon the scalp. The mother remembered, however, that the girl had fallen down stairs six or seven years before and had complained for a long time of a pain in her head. Believing that a more severe injury had taken place than was at first supposed, and with the determination that if any visible lesion existed that the discharging centre should be removed, an operation was advised. The symptoms indicated the irritable centre to be the middle third of the ascending frontal con- volution, and accordingly the trephine was placed a little in front of the middle third of the fissure of Rolando, the method employed to determine this line being that recommended by Professor Chiene. Although the dura was incised and the brain carefully examined, no scar nor inflammatory patch could be found. The removal of brain substance was therefore abandoned, and the wound closed in the usual manner. To my delight the patient had no more convulsions while under my charge, some three weeks. Whether this result was due to shock, relief of intracranial pressure, or the removal of some irritable point in the skull, I do not know. 310 world’s homoeopathic congress. Cephalalgia . — The results of operations undertaken for this dis- order, when due to traumatic causes, are very encouraging, both as regards benefits derived and the slight mortality of the operation, if we may depend upon the reports made in our medical literature. Of some twenty cases which I have noticed in my reading, relief was obtained in all, even in those in which no appreciable lesion could be found. How permanent the result could not be determined. The following case published some time ago in the Clinique is the only patient upon whom I have made the operation. A young man, set. 23 years, was struck on the head with a stick, sustaining a scalp would. For twelve weeks was never in full pos- session of his faculties ; was violent, and for six weeks in an insane asylum. A discharge of pus relieved the insanity ( Clinique , vol. xiii., p. 518), but headache remains ; cannot focus the eyes; is unable to follow his business. The cicatrical tissue was excised from the scalp with the hope that this would relieve the irritation, but no relief was obtained. The scalp is sensitive for some distance around the scar. The scar was excised and the periosteum underneath it, which was adherent, also excised and a button of bone removed from the sensi- tive area. No thickening of the bone or lesion of the dura was dis- covered, and yet a perfect cure followed. In a somewhat similar case reported by me in the Clinique, but not reported under this head because there was no operation made upon the bone, the headache was relieved by the removal of the scar, but in the above case the removal of the scar alone failed to affect a cure. Insanity . — Excision of bone or trephining for insanity is an opera- tion which has rarely been done. That such an operation is war- ranted when the insanity follows a depressed fracture rests upon the same basis as that of the operation for epilepsy, yet although the number of cases of insanity following fracture is considerable, I was surprised to find that few cases of operation for the relief of insanity Are on record. Prof. Briggs reports two cases, one of which died, *nd the other improved. Dr. Boyd reports one case with no im- provement, and two other cases reported in journals were quoted as not improved. The most favorable cases are those in which depres- sion is present and some symptoms indicating local pressure are prominent. My only operation for this trouble is recorded in the following case : Young man, set. 22 years ; four years previous was kicked by an THE TREATMENT OF EPIEEPSY, ETC. 311 unshod horse, cutting a gash about two inches long nearly trans- versely across the posterior portion of the right parietal bone. It was not determined at the time whether the bone was fractured. The* patient was unconscious for four hours after the accident. Three months later the first symptoms of insanity were noticed. He would mutter and gesticulate while at work, and when unemployed was restless and irritable. For some time previous to his being brought under my care he had been violently insane. No appreciable inden- tation of the skull could be found. The seat of injury was uncovered by a horseshoe-shaped incision, the old cicatrice excised and a button of bone removed from the cranium just under the scalp wound. No indentation of the internal plate was noticed. The dura seemed normal and upon opening it and examining the cortex no injury could be detected. The patient made a good recovery, but the only benefit was an increased tractability and a lessened violence. This condition remained three months after the operation. Paralysis . — Local paralysis following injury to the skull has been treated by excision of the depressed bone, although the number of such cases recorded are very few. In general paralysis operative treatment has been believed to be of no service. Hey argues that in the early period of general paralysis the intense congestion in- creases the volume of the brain as well as diminishes the endocra- nial cavity by thickening bone. The removal of the resulting com- pression by an opening at some point may set aside some of the gen- eral phenomena, but in confirmed cases surgical interference would be powerless to hinder the change due to chronic meningic enceph- alitis. The following case was operated upon by me December 19, 1892: Man, set. 41 ; fifteen months previous was struck on the right parietal bone with an axe. The exact extent of the injury was un- known. Eight months later he began to feel a numbness in the left arm and leg accompanied by some impairment of motion. This increased rapidly until in a short time he was confined to his bed. He lost the power of speech, control of the urine and faeces. About three months before I saw him the right leg and arm commenced to jerk. Professor Fellows saw him in consultation with his physician and saw no hope of benefit, unless it might result from operative interference. When seen by me the left side was paralyzed, the arm completely, the leg partially; the right arm and leg were in a state 312 WORLD S HOMOEOPATHIC CONGRESS. of contraction. The head and body inclined to the right side, swal- lowing difficult, eyes unaffected, conscious but could not speak. The progress of symptoms indicated to m} r mind a lesion in the right motor area extending over into the left, presumably meningis-enceph- alitis. The lesion seemed so extensive that an operation was not ad- vised, but the friends were so anxious that some effort should be made, that with the hope that pathological changes might be limited to the right side and the symptoms of left sule involvement might be due to sympathy, an operation was attempted, a large button was removed from the upper portion of the right motor tract and the dura found to be very much thickened and so full of bloodvessels that for a time it was supposed a new growth was present. The opening was rapidly enlarged with the cutting forceps and a large area exposed extending over the median line. The inflamed dura extended over into the left motor tract. The dura was. incised and the cortex ex- amined. The pia mater, while not adherent, was inflamed and the cortex of the brain had a yellowish hue. While separating the in- flamed dura from the cranium a large vein close to its entrance into the superior longitudinal sinus was opened and haemorrhage was profuse. It was controlled by pressure and subsequently by liga- tion. The patient never fully recovered from the shock of the ope- ration and died twenty-four hours later. Microcephaly . — One of the most unpromising conditions which has recently been attacked by the surgeon is that known as micro- cephalic idiocy. It is believed that a certain number of cases of idiocy may be due to the pressure of a prematurely ossified cranium. In these cases Lannelongue proposed and has practiced the excision of a groove in the skull in order to permit of brain expansion. He reports twenty-five cases, one case died; most of the remaining showed marked improvement. My own experience is confined to the following case : Girl, set. 6 years, idiotic, cannot walk ; moves a few steps and falls; cannot stand still without support. Has no control over the urine or faeces ; cannot talk or make known her wants except by screaming ; eyes convergent. Has no decided convulsions but at times very restless and excited. Head is irregular in shape and no- ticeable for its lack of frontal development. No cause could be as- signed by the parents. At birth labor was normal except that it was a footling instead of a cephalic presentation. Do not know whether THE TREATMENT OF EPILEPSY, ETC. 313 the fontanelles closed early or not. Following the plan suggested by Lannelongue a section of bone three-eighths of an inch wide and extending in a curvilinear line from a little to the left of the occi- pital eminence to a point a little below the frontal eminence, was excised. By this means a long flap, U-shaped, with the base below was formed over the whole motor tract. The wound healed promptly and the child showed signs of improvement. Three months after she had control of urine and faeces, was able to walk and use three words. More than this could hardly be expected in so short a time. A review of my own work shows five cases of traumatic epilepsy, with four successes and one failure; one case of Jacksonian epilepsy, with one success; one case of cephalalgia, with complete relief of the symptoms; one case of insanity, not improved; one case of paralysis, with one death, and one case of microcephalus, with de- cided improvement. In the fatal case the result was due to the shock of operation during the active progress of encephalitis, and in esti- mating the dangers of operative interference in non-inflatnmatory cases, such as epilepsy, cephalalgia and microcephaly, ought not to be taken into consideration. In the other cases no evidence of a se- rious operation having been made was evinced. In every instance the wound healed with suppuration, the patients were up at the end of one week, and often discharged at the end of two ; indeed, I know of no operation in which so rapid recovery takes place, and I am inclined to believe with Dr. Roberts, who expressed himself some time ago before the American Surgical Association to the effect that the operation of trephining added no more risk than the ampu- tation of a finger. A consideration of my own cases and a careful reading of the results obtained by others lead me to several conclusions. 1. That after a careful removal of all other exciting causes that may produce epilepsy, cephalalgia, paralysis or insanity — especially when a history of cranial injury is obtained — the surgeon is in duty bound to attempt the removal of this possible exciting cause. 2. That there is a good probability of success attending his efforts in traumatic epilepsy, cephalalgia and localized paralysis, and, in lesser degrees, in insanity. In this connection it must be remem- bered that in the production of these brain disorders there are two conditions present — an acquired or hereditary abnormal excitability 314 world’s homoeopathic congress. of the reflex centres and a peripheral irritation from depressed bone, inflamed dura, clot or scar. The removal of the exciting cause leaves still the acquired abnormal excitability of the reflex centres, and some other irritation may occasionally reproduce the convulsion. Again, the habit once acquired becomes in a degree independent of the origi- nal lesion. For this reason one must not be discouraged or deter- mine the operation a failure if convulsions do not immediately cease. The anatomical cause may be removed, but therapeutic measures are still necessary to remove the tendency. Many cases given up as failures might have been classed as successes if careful treatment had followed the operative procedure. The earlier, then, the opera- tion, the less the probability of an acquired habit and the greater the prospect of success. 3. That the operation for microcephalic idiocy is still an experi- ment, but one that, considering the deplorable condition of the pa- tient and the little risk undertaken, warrants further trial. Although possibly not a logical conclusion from the consideration of the treat- ment of epilepsy, idiocy and allied disorders as outlined in the cases reported, I have been deeply impressed with the fact that so many cases report an imperfect examination of the original cranial injury, or so timid a treatment of a serious injury, and I feel warranted in advising, in the interest of primitive measures, a bolder treatment of cranial injuries. It may have been wisest before the time of anti- septic surgery to treat all cases, except those showing evidence of compression, by conservative measures: but with our present methods, and basing my conclusions on the excellent results that have followed this plan of treatment in my own practice, I feel it my duty to urge thorough examination and trephining in all cases of fracture of the cranium attended with depression, and in all compound fractures, whether accompanied by depression or not. It may not be inappro- priate to add a few words regarding the technique of the operation. It is my custom to shave the entire scalp, scrub it with soap and water, wash the skin with ether, then bathe with a 1-2000 solution of bichloride of mercury, and apply a skull-cap of gauze wet in the solution and covered with gutta-percha tissue. This is done twenty- four hours before the operation, and the dressing left until the mo- ment of operating. I invariably use chloroform, unless contraindi- cated by some trouble, as an anaesthetic, as there is, I believe, less venous congestion and less haemorrhage. The opening is made with THE TREATMENT OF EPILEPSY, ETC. 315 the trephine, and subsequently enlarged with the cutting forceps or chisel. If upon the removal of the bone, the brain pulsates natu- rally and the dura appears normal, the latter is not incised. If, how- ever, the dura is inflamed, if pulsations are absent, or if there is no cranial lesion to account for the trouble, the dura is incised about a quarter of an inch from the bony boundary and the brain examined. Until the excising of the dura the bichloride solution is used. Upon exposing the brain, boiled water only is used. I have, however, used the 1-2000 solution in accident cases in which the brain substance was exposed, with no bad effects. Before closing the scalp the dura is united by catgut sutures and rubber drainage-tubes placed between the dura and the scalp. If there is any tension from the excision of the scalp scar, the scalp is united by silver wire sutures rather than with catgut. A simple dressing of iodoform and sterilized gauze is employed ; no ice cups or lotions are applied. The wound is dressed in twenty-four hours, and not again until the seventh day. I do not replace the bone discs or chips, believing that we desire to re- move all possible sources of irritation. Discussion. DeWitt G. Wilcox M.D., was called upon by the chairman to discuss Dr. Shear’s paper, and responded as follows : Mr. President , Ladies and Gentlemen: I have listened to this paper with much pleasure and pride — the pleasure because it has been so interesting and instructive, and pride because such excellent results have been attained by a member of the school which is accused of knowing little of surgery. One statement that was made early in the reading of the paper I most heartily endorse; that it is the duty of every surgeon to record carefully his operations, with their results. I believe it the duty of every surgeon, and indeed of all surgical practitioners, to keep a record of all cases. What we need in our surgical literature of to- day is an accumulation of records, with their results; and it seems to me that one of the most childish mistakes that the physicians of the Old School make in their records, such as the annual, and the year book is the omission of these operations performed by Homoeo- pathic surgeons. Or, perhaps if they do mention them, it is in some such way as that in which a recent author alludes to them in his work. He says : u Strange results of this operation have been brought to a culmination by a Homoeopathic practitioner,” referring to our Van Lennep, and he goes on further to say that though found in curious company yet the paper bears evidence of credibility and 316 world’s homceopathic congress. knowledge. Such idiocy seems to me to bear evidence of a micro- cephalic condition that calls certainly for the surgeon’s knife. This operation is not one of technique, but of pathological knowl- edge. In the early days of* abdominal surgery the question hinged largely upon the manner of doing it. If a tumor existed, either the tumor was removed or it was not removed. Were it removed suc- cessfully, the patient recovered, if unsuccessfully, likely he did not. There are two conditions to be considered in the discussion of this question. First, have we made any advances in the discovery of the first causes of epilepsy, and second, what do the practical results of operations show as to whether any advances have been made. We need only to refer to our text-books of not later than ten years ago ; for there we find almost universal mention made of the cause of irritation being in the spinal cord or in the deeper structures of the brain. Although we have not learned all that is to be learned about epilepsy, yet regarding its cause there is much we do know with tolerable certainty. Now by this operation are we going to lessen the frequency of the seizures of epilepsy ? Are we going to increase and bring intelligence in idiocy ? As I say, we must not pass one of these questions. When it comes down to a practical consideration of the question as resolved and obtained from operations, again we must come back to the record. Having gone carefully over the record we have been able to obtain, I think, that we have the greatest reason for encour- agement regarding this operation, that it is practical and it is going to become more so. Dr. Shears has referred you to the record of Agnew, wherein he mentions fifty-four cases with an improvement of thirty-two, and a cure of four. It seems to me that that was a good result in a condition which heretofore has been regarded as almost absolutely hopeless, where even four out of that number have been absolutely cured and at least thirty-two have been improved. The valuable additional chapter that Dr. Shears has given us will add greatly to our encouragement in this respect. He has shown, by the records of most of the cases, that the best results are to be ob- tained from those of a traumatic history, for even there, I think that we will have more encouragement, notwithstanding we find a strong history of heredity attached. If that be the case there may yet be a history of traumatism that will give us some encouragement for an operation. We do know this, that a patient who has a strong can- cerous history may receive an injury or a sudden irritation which will result in a cancer which in a person not so inclined will have no effect whatsoever. In these cases if there be an epileptic ten- dency in the family and an injury however slight to the brain is occasioned, it will very likely result in epilepsy. I think that we should not regard a case as absolutely hopeless, even though there may be this hereditary history of epilepsy. THE TREATMENT OF EPILEPSY, ETC. 317 Another encouraging feature the doctor has brought out in the recital of his cases is that a number of the cases have been improved, even though they are beyond the period of childhood. It has been generally considered that very little is to be expected in these cases of insanity, and particularly of epilepsy, if the operation be under- taken in adult life. That, I say, is reason for further encouragement, because all of his cases were beyond the period of childhood and yet there was a decided improvement. So little has been written on the subject of cephalalgia that any case in the way of it is received as an eye-opener and an encourage- ment for the future. Baker, in his annual report of 1892, says : “ In the present light of surgical knowledge we need expect nothing in the treatment of insanity from surgical means.” It seems to me that a man must be a good deal of a medical pessimist who would make such a statement regarding any complication in the present light of surgical progress. Dr. Shears’s one case shows that there can be some improvement made in this most discouraging disease. In the condi- tion of microcephalic idiocy, as lie has reported, there are twenty- five cases with only one death. This is certainly encouraging to an extreme, in a condition which we have regarded heretofore as abso- lutely hopeless for there has been no attempt whatsoever, in these conditions of idiocy, to secure improvement by any operation ; and now that the surgeon’s knife has attacked this disease, it seems to me that from the recital of these twenty-five cases, and the additional cases of Dr. Shears’s as presented in his paper, that they also justify a feeling of very great encouragement. Clarence Bartlett, M.D. : The privilege of aiding the dis- cussion on the address by Dr. Shears is to me a most pleasant one, being, as I am, in close accord with the conclusions he adopts. Al- though not a surgeon the treatment of epilepsy, both medical and surgical, has for some years past been to me a most interesting as well as very unsatisfactory one. A rapidly increasing experience (during the year past over 75 cases) makes me very conservative in stating whether or not a given case has been cured. I cannot say exactly how many cases of epilepsy have been operated upon by my advice. I can say, however, that all so far as I know received more or less temporary benefit from the same. In some instances, the seizures ceased at once, while in others a number of convulsions oc- curred for the few days succeeding the operation, when they disap- peared. The permanent results from these operations are, on the other hand, far from satisfactory. In the majority of cases, seizures recur at intervals ranging from two or three months to as many years. I believe with Seguin that no case of epilepsy can be regarded as cured by an operation until the patient had passed through a period of two years without any attacks whatever. These remarks apply with equal force to the surgical treatment of 318 world’s homoeopathic congress. traumatic epilepsy. It is the generally accepted idea among the profession that trephining in traumatic epilepsy is tantamount to cure. This is an error. A clinical study of these cases shows that almost invariably the epilepsy does not develop for months or years after the injury. In other words there develops within the cranial cavity a something that did not exist shortly after the accident, a something that is the actual cause of the so-called traumatic epilepsy, I believe with Sachs that secondary changes in the brain substance take place, and thus occasion the epilepsy. Under such circum- stances it is almost the height of absurdity to expect a cure from any operation. Especially is a cure improbable in those cases, and these in my experience are the majority, in which the convulsions are general. If on the other hand, the convulsions are localized, and the seat of the cerebral lesion is evidently beneath or in the vicinity of a depressed fracture, I should most certainly look for a good re- sult. A review of Dr. Shears’s cases of epilepsy treated surgically bears out the views I have expressed. In Case I., there was a re- turn of the convulsions following a debauch. In the majority of cases it will be found that the first convulsion attending a relapse has an exciting cause. In Case II. there was temporary improve- ment when the convulsions returned in full force. In Case III. there was a very material cause for the convulsive seizures in the abscess which was so successfully evacuated. Here I believe a permanent cure is to looked for. In Case IV. there was an extra-dural haemor- rhage, the proper treatment of which led to a cure. Both cases (III. and IV.) should not to my mind have been included as cases of epi- lepsy, to which disease they bear but little resemblance. In Case V. the ultimate result must remain in doubt because sufficient time since the operation has not yet elapsed. The failure to cure traumatic epilepsy by surgical means is rightly attributed by the essayist to the generation of the epileptic habit. I have already reverted to another reason, the occurrence of organic cerebral changes, and I would now mention a third, the failure on the part of the profession to give these cases proper medical and hygienic treatment, they expecting that the operation will act unaided. It may seem to my hearers that I am decidedly iconoclastic in my sentiments. I have reason to be. I have seen case after case remain free from convulsions for months, and then relapse into its former deplorable condition. In May, 1890, I reported a case of dural epilepsy, in which the improvement was little short of mar- vellous, and I and my associated surgeon gloried in a wonderful cure. Just thirteen days ago I learned from a New York neurologist that this identical case had turned up in his clinic, and was now as bad as before. THE TREATMENT OF EPILEPSY, ETC. 319 At the present time I have in mind the case of a child but three years old, a sufferer from epileptic seizures, fourteen or fifteen occur- ring each day. They were of local commencement. Trephining over the appropriate motor area was performed by Dr. W. B. Van Lennep, with the expectation of excising the same should it be found diseased. It was found to be healthy. Several convulsions occurred during the few days succeeding the operation, since which time the child has been entirely free from them. Again, a case was admitted to the Hahnemann Hospital for study. The actual number of seizures per day being over sixty, if the state- ments of her father can be accepted. The child was put on an ex- clusive milk diet, and for several weeks had no attack of any kind. Then she relapsed, though not as bad as before her admission to the institution. Then she was seized with measles, during the course of which she had numerous convulsions. After convales- cence, the fits remained away until her discharge from the hos- pital, four weeks later. Concerning her subsequent career, I am in ignorance. The temporary improvement in epilepsies by trephining I attribute to two causes. The first of these, and by far the most active one, is the effect of operation per se. Although this subject has been formally introduced to the profession within a few years, its import- ance has been recognized for a number of years. It matters not what the operation be; it may even be a severe traumatism, a frac- ture, or a burn, or a contusion, and the fits are temporarily suspended thereby. One of our Cincinnati physicians has proposed to take ad- vantage of this fact in the treatment of epilepsy. Even intercurrent diseases, measles, as in the case just reported, may act as very efficient anti-epileptic remedies. A second cause for the improvement is the relief of intracranial tension. In the majority of cases I have seen operated, the membranes have been abnormally tense. The magnificent results reported by Laurento, as quoted bv Dr. Shears, namely, 54 per cent, cured, I can only account for by reason of insufficient observation. This is a crying evil in the surgical lit- erature of epilepsy. Standard critical journals, as the British Medi- cal and the Lancet , contain the reports of many cures, which in reality are not cures, for they often are reported even before the wound of the operation has healed. The excision of cortical centres for the cure of Jacksonian epilepsy has borne some good fruit in the shape of amelioration, but the cures are in the minority. In all of my cases relapse has occurred. Many of these cases have as their origin the so-called spastic hemiplegia of epilepsy, the pathological conditions at the foundation of which are of a varied as well as of a most serious character. It is hard to ex- pect a cure under such circumstances. The question of the removal of irritable cicatrices has been raised 320 world's homoeopathic congress. by Dr. Shears. I think it, very wise indeed to remove any such source of irritation ; at the same time I must warn against too ready an acceptance of the idea that a cure will certainly result. In my case of dural epilepsy a very irritable cicatrix existed, and this was removed. The surgical treatment of insanity is worthy of close study. Tem- porary improvement in cases of general paralysis of the insane has been effected by a few English operators. The cases subsequently relapsed. It has been urged by some that these reports teach nothing, for the course of general paralysis of the insane is remarkable for the spontaneous improvements which may ensue. Numerous insanities have been known to recover under the influence of a severe traumatism. Trephining may act curatively and is a wise measure, substituting a scientifically performed for an accidental and bungling traumatism. The surgical treatment of abscess of the brain admits of no dis- cussion. If pus exists in the brain, it must be removed, or the pa- tient will die. Our course must be guided by the reliability of our diagnosis. Dr. Shears, in closing his paper, makes a very important point, so important, indeed, that I desire to emphasize it as much as may be in my power to do. He pleads for an early and efficient treat- ment of cranial injuries. For years the profession has been guided by a doctrine that I regard as decidedly antiquated, if not actually inhuman, that of concussion of the brain. It has been customary, whenever cerebral symptoms persisted for any length of time and there is no external evidence of bone injury, to attribute the trouble to cerebral concussion. No more dangerous theory exists in medicine to- day, making, as it does, the surgeon inefficient by reason of masterly inactivity. In the vast majority of such cases, proper methods will show that fracture, intra-cranial hsemorrhage, meningitis, or other gross lesions exist. So far as relying upon a depressed fracture, I believe in almost invariably making an exploratory incision ; if a fracture is discovered, then trephine, whether there be a depression or not. Many times small extra-dural haemorrhages will be discov- ered, the removal of which is unquestionably good surgery. Such cases make far more rapid recoveries than do the head injuries in which operation is refused. I have in care at the present time two of the latter class : oue a case in which the location of the lesion is undoubted, and which has pursued a very slow course; the other a basal fracture, which has improved, though after a tedious conva- lescence. In both instances permanent mental changes will probably ensue. My colleague, Dr. Van Lennep and myself have been working on this line, the radical treatment of head injuries, for some time past. The results thus far have been all that the most fastidious 321 THE TREATMENT OF EPILEPSY, ETC. could desire. Every case of head injury is examined from a twofold standpoint, that of the neurologist and the surgeon. Many cases that would have died under a conservative or expectant (more prop- erly speaking) treatment, have made most satisfactory recovery. In the early, in the thorough primary treatment of head injuries, lies the proper treatment of traumatic epilepsy, i.e ., its prevention. While speaking thus pessimistically concerning the results from the surgical treatment of epilepsy, I still advise operation in a se- lected few cases. All traumatic cases with localized seizures should be operated. No case should be treated surgically unless there is an indication for such treatment. In every instance the patient and his friends should be made to distinctly understand that the operation must be supplemented by proper hygienic and medicinal measures. This, I am sorry to say, is rarely done; indeed, it is well-nigh im- possible to impress its importance on the lay mind. As to microcephalus and craniectomy, it is yet too early to speak positively. The operation is a serious one, more serious the longer the time occupied in its performance. Successful ultimate results can only be expected when the operation is supplemented by proper educational methods. The bulk of the evidence at present at our disposal goes to show that but little will result, although in the last case in which I was associated there was apparently considerable improvement during the patient’s stay in the hospital. Cases se- lected for operation should be individualized most carefully. There should be no doubt concerning the smallness of the head and the closure of the sujtures, and the patient should be reasonably young. In none of the cases in which I have been associated has the patient been more than five years of age. If in these remarks I have painted the results in too sombre hue, it is not because I believe there is no future for cerebral surgery, but rather to check a reckless enthusiasm. I sincerely trust that I have induced my hearers to favor early efficient treatment of recent inju- ries, while they spare their enthusiasm in the treatment of the old ones. W. F. Knoll, M.D. : In the last few years I have made brain sur- gery quite a study, and I have now quite a number of cases which I could report if I had them properly tabulated. But I want to say that I am very thankful to Dr. Shears for what he has said in regard to operations upon the brain. There has been a complete change in the ideas of neurologists, and what a while ago was considered to be an uncontrollable irritation has to-day a reasonable and scientific ex- planation, and that which has given us this reasonable and scientific explanation is surgery. The experiments which have been made by the vivisectionists and the results which have come from their past examinations have laid the foundation for practical surgical investi- gation and operations, and to-day we have enough cases tabulated of 21 322 world’s homoeopathic congress. nervous diseases to show that the brain, in a large number of cases, is the seat of disease, and that it can be reached successfully by the knife. Now there is no doubt whatever that a large per cent, of the cases of epilepsy are purely traumatic in nature, in their origin ; in- deed, the largest part of them. We rarely ever find a case of epi- lepsy which, when followed from first to last, has not a traumatic history in it somewhere. A large per cent, of the cases of micro- cephalic disturbances also have traumatism as a starting-point. It is either traumatism received during birth, or it is traumatism re- ceived after birth. A large per cent, of the cases that we have of cephalalgia are the result of traumatism, and I believe that those cases, in time, will be attainable, and we will have such reliable cases to go by that a diagnosis can be made in the majority of them, and in the cases that are of a surgical nature surgical means will be ap- plied successfully. One point especially that I wish to speak about is in regard to the different methods of operating and of removing the bone from the skull — the ease with which it can be done and the safety with which an operation can be made. I have here some instruments, a descrip- tion of which has appeared in print, for removing the skull-bone after a primary opening has been made through the skull with a chisel and hammer. I have brought these instruments with me this evening so that I can show you how easily an examination can be made. (Dr. Knoll then illustrated the use of the instruments to the au- dience in detail and answered several questions put to him by va- rious members of the Congress, concluding his remarks with the statement that he did not believe in trephining.) Dit. Shears: I have nothing to take back that I have said, and I don’t know that I have anything to say that is very different from what has been said. Dr. Knoll and I will never agree upon the subject of trephining and the chisel. We have had that out before; that is, to our own satisfaction. We have trotted it out for society meetings, and the Doctor has trotted it out again upon this occasion. Now I want to say that, notwithstanding the statement that the Doctor has made, I believe the trephine is a much more useful in- strument, and a safer instrument, and a more rapidly-working in- strument than is the chisel, and I believe also in the hands of others, possibly in those who are not so skillful. There is no need whatever of cutting the dura when you are using the trephine, if you use it properly. There is not that jar to the brain that there is when the chisel and hammer are used. Now I know it is a Germau fad to use the chisel and the hammer, and I have seen it used and tried it, and I can make a hole through the skull with some celerity, but I don’t propose to use it, and I am not going to recommend it to any- body else. 323 THE TREATMENT OF EPILEPSY, ETC. So far as removing the bone is concerned, of course we all use these cutting forceps in various forms and shapes, yet I assure you, that when you have your patient down upon the table and are not able to get the bone up in a position where you can get your forceps on it, that it does not get out with that same ease that it does here. Now that is not a criticism on Dr. Knoll. He gets it out easily and readily and rapidly, but I use the trephine first, and that is a very nice little instrument. I think, however, that in a large num- ber of instances you want a larger groove than that cut in this in- strument. I had hoped that something might be said here concerning pre- ventive measures in the treatment of epilepsy resulting from trau- matic causes. My paper, which was not concluded, had something to say about the preventive measures. I am inclined to advise very radical measures in the treatment of fractures of the cranium, and I believe if more radical measures were instituted there would be fewer cases of epilepsy, fewer cases of insanity, etc., for if every case of com- pound depressed fracture was trephined, if every case of fracture of the cranium was trephined, especially when it was not compound, whether there w r as depression or not, there would be fewer cases of insanity. I don’t know that I should advise every case to be tre- phined, but I certainly should advise all compound cases, whether there were symptoms of compression present or not. 324 world’s homoeopathic congress. A REPORT ON ORIFICIAL SURGERY , INCLUDING AN ANALYSIS OF 1000 CASES. By E. H. Pratt, M.D., Chicago, Iliu. The preceding generations of medical men, in their struggles with pathological conditions, have almost invariably attacked them at the points of manifestations. The testimony of the body itself has been taken as authentic, and its points of discomfort, wherever located, have been considered the proper places for the application of remedial measures. If the head ached, the head was carefully examined, and the story which the head had to tell for itself was patiently listened to and considered and remedial measures, internal or external, were directed headward. The same is true of the heart, lungs, liver, stomach, and other organs. The coming generations of doctors will do better work, because they comprehend more clearly not only the nature of pathology, but also its underlying principles. Our predecessors have struggled merely with effects; our successors will manipulate causes. In the past much suffering has been relieved ; in the future relief will be more general and sure, and, at the same time, the age of prevention will be ushered in. There is now a class of scientific workers which, by dissections and the aid of the microscope, is seeking to solve the riddles of dis- ease on the theory of physical causation. There is also another class of workers which, by an opposite process, preferring telescopes to micro- scopes, synthesis to analysis, is scanning the realms of force for an explanation of matter. The analysts have discovered, classified, and are seeking to annihilate the hordes of microbes which swarm all air, and water, and food, and which await upon the decay of the body as birds of prey hover about a carcass, premeditating and ac- complishing its annihilation. The synthesists are hunting for a God and the laws by which the judgments of life and death are prescribed. The first class of students, in searching for causes of disease have A REPORT ON ORIFICIAL SURGERY. 325 stumbled upon some wonderful effects of disorganization. The other class of students, in contemplating morbid conditions have accidentally discovered that the manifestations of disease, which for so long a time have been regarded as causes, are really nothing but effects, and that the causes of all disease lie in deeply hidden princi- ples which hitherto have been unobserved. Both classes of students have served humanity well, for the one has established cleanliness, and the other has ushered in godliness; and with these two advances in medical practice the future is made big with hope that the coming generations of men may be enabled to escape the pests and plagues of their ancestors and enjoy the unalloyed happiness of healthful lives. The orificial philosophy, the subject of the present report, is a product of synthetic thought and observation. Its principles are applicable in all forms of chronic ailments. The testimony of the microscope, of the stethoscope, of percussion, of the clinical ther- mometer, of chemical analysis, and of all forms for diagnosing con- ditions, are necessary as furnishing items for a general inventory of the case. But it matters not what organs or tissues of the human body may be ill-conditioned, what functions may be disturbed, what local or general bodily discords may prevail, the possibility of their existence is explained upon a basis of one common predisposing cause. The orificial philosophy does not consider questions of in- herited or acquired tendencies, of smouldering poisons and blood taints ; it simply furnishes an explanation for the manifestations for these as well as for all other possible forms of pathology, and suggests a remedy. The essential questions in any case of sickness are : Is the whole body or any part of it chronically diseased ? Have other remedial measures proved ineffectual? Is the reactive power of the system so poor that it permits lingering illness in spite of all efforts at relief? Is the case, in other words, one of the so-called incurable forms of disease? If so, then there must necessarily exist (1) blood stasis or congestion ; (2) weakened peristaltic action ; (3) wasted sympathetic nerve power. Always, and without exception under such circumstances, upon examination will there be found pathol- ogical conditions at the lower openings of the body sufficient to account for the lowered vitality which alone could explain prolonged pathology. The removal of whatever orificial irritation may be encountered invariably enhances sympathetic nervous force, increases 326 world’s homoeopathic congress. the reactive power of the system, restores its susceptibility to the action of other remedial measures, and thus supplements in a most satisfactory manner the otherwise ineffective measures which the pro- fession has had to offer for the relief of the chronically sick. The anatomical and physiological facts upon which this philos- ophy is based have been so repeatedly presented to the profession as to render superfluous an additional presentation of them in the preseut report. Let us take it for granted, therefore, that these well-established facts and theories are universally known and recognized, and that in all forms of chronic disease there will always be found orificial pa- thology sufficient to account for the sympathetic nerve waste which the existence of these conditions implies. What we shall attempt on the present occasion, is to present to the profession, in general terms, what is to be expected from the application of orificial principles in the various forms of chronic dis- eases. Thousands of cases,, which heretofore were regarded as in- curable, have now been restored to health by orificial measures. Thousands of cases have also failed to respond satisfactorily to the treatment, and many have received lasting injury. The results of the work thus far obtained have proven beyond question (1) the uni- versality of the need of orificial work in chronic diseases ; (2) the unmistakable power of orificial surgery; (3) that greater care must be exercised in its employment, also that its methods must be so im- proved as to add to its efficiency as a remedial measure, and to deprive it of its power for harm. All remedial measures known to the profession may be productive of untold mischief when wrongfully applied. Drugs can kill as well as cure, so can electricity; so can heat and cold ; so can exter- nal applications, so can mental forces ; but in the hands of the skill- ful and competent even edged tools should save life and not cost it. In spite, however, of the imperfection of present methods of apply- ing orificial principles to the cure of chronic diseases, and in spite of the too numerous mistakes which have arisen from ignorance and meddlesome propensities, so much good has already been accom- plished and so little harm, that the subject of orificial surgery de- mands the attention of the profession,, demands to be enrolled upon the list of legitimate and scientific measures, and demands still far- ther to be added to the curriculum of all schools of medicine. A REPORT ON ORIFICIAL SURGERY. 327 In the practice of orificial surgery, it must be remembered that the same principles of pathology which prevail elsewhere in the body must be recognized in examining its lower openings. The surgeon must not only take cognizance of hypertrophy, but must also recognize atrophy. He must not only look for abnormal sten- osis, but also for abnormal dilatation. He must not only consider hypersesthesia, but must observe likewise ansesthesia, and whatever orificial work he indulges in must be directed to the successful cor- rection of whatever forms of pathology he may encounter. It is now a well-established fact, which none but the ignorant will deny, that in all forms of chronic disease, there is invariably present some form of orificial irritation. It is also a fact, just as thoroughly established, that the removal of orificial pathology economizes the sympathetic nerve force, equalizes the capillary circulation, stimulates a universal nutrition, and favors a reaction from morbid conditions not only in the body generally but in each part of it in particular. When the hands of a watch fail to desig- nate the correct hour of the day, the watchmaker is immediately persuaded that there is something wrong with the works of the time- piece. So, too, when the human body is disturbed in its functions, when the hands of this great clock of time point to a disorded eye, ear, nose, throat, heart, lungs, liver, stomach, spinal cord, skin, mucous membrane, kidney, or any of its other organs, the orificialist imme- diately understands that there is something wrong with the interior machinery. The peristaltic actions must have been disarranged, sympathetic nerve force must have been disturbed, and in the con- ditions of the lower openings of the body he will find ample excuse for the lowered vitality which has permitted the disorder to linger as a lasting condition. What then may we expect from the application of orificial prin- ciples to chronic diseases ? The proper answer to this question is another question. What may we expect in a given case from the universally improved capillary circulation and the increased nutri- tion involved? A dead body cannot be restored to life, neither can dead cells. An irritable body can be soothed, and so can irritable cellular structures. Sleepy organisms can be aroused to activity, and so can torpid cell-life. An engorged general system can be reduced, and so can congestion of tissues. A hungry human being can be fed, and so can starved structures. The commerce of the body, 328 world’s homceopathic congress. which must have been imperfectly performed to permit the existence of local pathology, can be re-established and health restored just in proportion to the integrity of the cellular structure involved in the existing disease. The orifieial philosophy, therefore, does not merely introduce methods of correcting local pathology, but is more ambitious, and aspires to no less an achievement than the restoration of equilibrium to the circulation of the blood in its comprehensive expansion, thus dealing in detail with the active forces of life in all the cellular structures of which the body is composed. The methods at present in vogue for correcting orifieial pathology are not a proper subject for consideration in this report, and we must refer those who are not familiar with them and who desire to inves- tigate the subject to the orifieial writings, which are now sufficiently abundant to furnish the desired information. Our present object is to consider some of the results of the application of orifieial princi- ples to the various forms of chronic disease. Realizing then that in applying orifieial principles to chronic dis- eases we are dealing with general nutrition, affecting the depth of respirations, influencing the volume and rapidity of the pulse, stir- ring up dkbris, and thoroughly changing all bodily habits, we are prepared for a rehearsal of the effects of the work in the various forms which pathology assumes. Affections of the skin and mucous membrane are the quickest to respond to orifieial methods. Eczema, even in its most repulsive and chronic forms, is usually permanently cured in from one to four weeks’ time. Psoriasis yields more slowly, and in some cases is not materially benefited by the work. Acne in its various forms is almost invariably cured in a few days’ time. Chronic erysipelas and herpes also respond very satisfactorily to orifieial treatment. Sec- ondary syphilitic affections of the skin yield with remarkable rapidity to the treatment, especially when assuming the form of ulcerations. Urticaria disappears rapidly, but lupus and other forms of malignant disease are usually intractable. The mucous membranes are the next tissues affected by orifieial work in point of time. Catarrhal affections of the different mucous membranes vary exceedingly in their persistency after orifieial treatment. Chronic ophthalmia, ul- ceration and opacity of the cornea usually yield speedily, but noth- ing positive can be promised in cases of catarrhal conditions of the A REPORT ON ORIFICIAL SURGERY. 329 eustachian tube and middle ear. Many cases of deafness from this cause have, however, been cured, but there also have been many failures. Nasal catarrh is usually benefited by the work, but it is generally necessary to supplement orificial treatment by the applica- tion of local measures and internal medication before permanent and satisfactory results can be secured. Chronic pharyngitis and laryn- gitis are always benefited, and frequently speedily exterminated. Bronchitis in a large majority of cases very speedily disappears. Gastric and intestinal catarrh are occasionally obstinate, especially catarrh of the colon, but usually they succumb rapidly to the appli- cation of orificial methods. Pernicious vomiting, even in cancer of the stomach, usually responds quickly to the work ; and constipation and diarrhoea find in it their panacea, with, of course, an occasional exception. Bilious and renal colic, jaundice, and catarrh of the urethral tract are also successfully handled. Mere functional derangements of the internal organs, such as the brain, liver, stomach, heart, kidneys, etc., where the trouble lies in passive congestion and the consequent functional derangement, be- fore interstitial changes have taken place in the organic tissues, re- spond with such marvellous rapidity to orificial measures as to consti- tute the most brilliant cures in the history of the work. Where mal-nutrition has been long prevalent, and serious structural changes have resulted, curative effects are necessarily much slower, and fre- quently a cure of such cases involves a complete change in nutrition ; and it is impossible to restore life to cells wdiich are dead and merely waiting their burial. The work is full of surprises, however, even in this class of cases, as many troubles w T hich heretofore have been considered incurable, such as spinal sclerosis, hypertrophy of the heart and liver, incipient stages of diabetes and Bright’s disease, etc., are capable of repair to a greater extent than anybody has supposed ; and in most of these cases the prognosis, as recorded in the standard text-books, must be rewritten in the light of orificial accomplish- ments. The universal truth that the irritation of an organ starts at its mouth, is not only true of the body as a whole, but also of its parts in particular. And although in bad cases of asthma, catarrhal deafness, conjunctivitis., dyspepsia, laryngitis, and so on, the general orificial work is first in order ; before a cure can be effected, local attention will be required to the nose, ear, pharynx and larynx. In 330 world’s homoeopathic congress. chronic cellulitis and deep-seated abscesses, the results of orificial treatment, although slower than those obtained in skin and mucous membrane affections, are yet surprisingly satisfactory. In tubercular joint troubles the results of the work are necessarily slow because of the poor capillary supply of these parts. It is a matter of common experience, however, to obviate by the aid of orificial surgery, sup- plemented by other measures which influence capillary circulation, the necessity for many of the major surgical operations which would otherwise be required to make life tolerable for such patients. Nodosities upon bone surface, even in syphilitic and tubercular subjects, are usually absorbed in a few weeks or months after the application of orificial methods. Conditions of necrosis and caries are checked and stimulated to repair, although they usually call for local surgical interference as heretofore. In such cases it is well to do the general work, and immediately after it, at the same sitting, correct what orificial irritation may be found. The condition of the sexual organs has long been considered im- portant in hip-joint disease, but it is equally important in affections of all joints. Renal colic has been repeatedly relieved by the use of urethral steel sounds. The tendency to bilious colic has been repeatedly cured by orificial methods, but I am not able to re- port the action of the work in acute cases. The reaction from orificial methods in sciatica, tic douloureux, and other forms of neu- ralgia, varies greatly as to the length of time. Some cases are spontaneously relieved, while in others many months elapse before a cure is effected, and in such cases orificial surgery seems but a basis for other remedial measures, its action being merely to increase the reactive power of the system, and render the measures already stand- ard in the profession more readily effective. Spinal cord and brain affections vary, as does the rest of the body, as to time required for repair. When paralysis is due to spinal or cerebral congestion, speedy cures are effected. When due, how- ever, to structural changes, the action of the work is slower, and of course frequently ineffectual. Paresis yields in most cases slowly, although surely. Nevertheless, decided improvement can usually be secured in from one to three months. The action of orificial surgery in epileptics is sometimes instantaneous and permanent, sometimes tardy, and sometimes entirely ineffective. A few cases of blindness from atrophy of the optic nerve, and several A REPORT OX ORIFICIAL SURGERY. 331 from paralysis have been speedily restored to sight. Atrophy and paralysis of the auditory nerve have also been cured, but it is not safe to promise restoration of hearing or sight in any case, as there have also been numerous failures. In insanity, orificial surgery has already done a great work, al- though it is quite common for such cases to be aggravated for a few days or weeks after submitting to the treatment. A few cases of insane tendency have been precipitated into pronounced insanity by orificial treatment, but there is usually a satisfactory reaction in such cases, and convalescence can be relied upon after a longer or shorter period. If there are latent poisons lurking in the system, as malarial or typhoid, orificial work is very liable to arouse them into activity, but only for a short time, and a speedy convalescence soon fol- lows. In a cure by orificial surgery, as in any other radical measure, chronic cases usually experience a return of their former symptoms in inverse order to their first appearance. When chronic syphilis begins to disintegrate any portion of the physical man, its manifestations are speedily checked by orificial work, and a longer lease of life thus obtained. Several cases of exophthalmic goitre have been cured, and I do not now recall a single failure. Tuberculosis of glandular structures is usually an intractable disease. Orificial surgery, however, has made a surpris- ingly satisfactory record in pulmonary tuberculosis. In such cases there is always atrophy of the orificial tissues. In tubercular subjects, the wounds upon the sexual organs usually heal satisfactorily, but those of the rectum require thorough and persistent treatment to prevent progressive ulceration, which, if not controlled, would exercise a detrimental influence upoft the patient. In this class of patients, more than in any other, must the work be followed to a finish in order to secure satisfactory results. The reason of this, in all probability, lies in the fact that every cough is accom- panied by a spasmodic contraction of the anus, which keeps the parts in motion and interferes materially with repair. The bad record which the operation for fistulse in consumptives has made, was prob- ably due to three things : (1) other rectal pathology, which is always present in such cases, was not corrected ; (2) the methods of hand- ling the fistulse have been defective ; and (3) no attention whatever 332 world’s homoeopathic congress. has been paid to pathology of the sexual organs. As the result of an extended experience in this class of patients, I have learned to place a high estimate upon the application of orificial principles, and to have more confidence in their operation than in any other one remedy yet suggested for pulmonary tuberculosis. In cancers, the work has little action except to reduce to a consid- erable extent the zone of congestion about the cancer, and to increase the efficacy of other remedies. No permanent cure can be promised in cases of malignant tumors. Sterility, endometritis, amenorrhoea, and dysmenorrhcea — in fact, the whole domain of gynaecology — must look to the application of orificial principles for the solution of its problems. The action of thorough orificial work is very profound upon every part of the human body, and it requires a nicety of judgment which only time, experience, and natural qualifications on the part of the surgeon, can give, to decide in a given case the form and extent of orificial treatment that will be required to secure a desirable degree of reaction on the part of the patient, and at the same time avoid the danger of harmful or fatal shock. The time when satisfactory reaction may be expected varies, not only with the tissues diseased, but also with the individuality of the patients. Coughs, headaches, nau- sea, asthma, and numerous other derangements, when merely func- tional, frequently disappear instantaneously ; and, on the other hand, it is often months, and sometimes a year, or even two years, before the good effects of orificial treatment become manifest. In a large percentage of chronic cases, orificial surgery will be a sufficient rem- edy, unaided, for a complete restoration to health. But it is a com- mon experience to secure no other results from the work than merely a susceptibility of the system to other measures which will be required to complete §ie cure. I have now applied the principles of orificial surgery to several thousands of chronic cases, and the preceding statements are based purely upon this experience. In conclusion, I beg leave to present to you a brief analysis of one thousand cases which I have operated upon between the dates of June 1, 1890, to October 28, 1892, with a view to throw some light upon the classes of cases to which orificial surgery is applicable, and the relative frequency of the various forms of orificial pathology as they are encountered in the ordinary practice of orificial surgery, A REPORT ON ORIFICIAL SURGERY. 333 and of the different methods employed for their relief. These cases are not selected ones, but taken consecutively as they applied for re- lief. Of these 1000 cases, 515 were men and 485 were women. Twelve of this number were fatal cases. A brief description and analysis of these cases may be of interest, especially as in the light of more recent observation most of the deaths were unnecessary. Of the men who died, the first was suffering from progressive paralysis, and died a few days after the American operation and cir- cumcision. The second was a desperate case of locomotor ataxia. He died in ten days after submitting to the American operation. The third man was suffering from locomotor ataxia and tuber- culosis, and died in one week after the American operation and cir- cumcision. The fourth and last case was in the last stage of locomotor ataxia, and survived the American operation and circumcision, and the re- moval of two cystic tumors from the testes, for six days. Of the female fatal cases, the first one died of cellulitis, after dila- tation of the rectum and uterine packing. She was a very delicate case, suffering from chlorosis. She had already been considerably improved in health under the American operation and uterine pack- ing, but after the second packing, which was undertaken about a month after the first operation, she was taken with cellulitis and died. The second female case, 35 years of age, suffering from chronic cystitis, had been operated upon ten years previously for laceration of the cervix by a skilful operator in a neighboring city. She had never menstruated since, and upon careful examination, the upper half of the uterine cavity was found completely glued together as a result of adhesive inflammation, evidently of years’ standing. She was placed under an anaesthetic, and her rectum operated upon by the slit method, and the false adhesions broken up in the uterine cavity until it was of its normal size. As a result of this work hei menstruation returned, and she attained an almost perfect degree ot health. As her menstrual periods, however, were painful, and her irritation of the bladder was not entirely relieved, three months after the first operation she was again placed under an anaesthetic and the uterine cavity packed. This second work resulted in septicaemia and death. 334 world’s homoeopathic congress. The third female case was suffering from fibroid tumor and ovarian cyst of small size. After the American operation and uterine pack- ing inflammation and death followed. A post-mortem revealed the fact that one of the cysts containing pus had ruptured into the peri- toneal cavity. The fourth female case was a subinvoluted uterus, measuring five inches in diameter, and retroflexed to an extreme degree. It was a case of nervous prostration. She was operated upon for laceration of the cervix. Her rectum was also trimmed and dilated. She died of peritonitis two weeks after the operation. The fifth female case was one of mental depression and spinal irri- tation. Uterine packing and rectal dilatation were followed by sep- ticaemia and death five weeks after the operation. The sixth female case was one of chronic peritonitis and nervous prostration. The American operation and uterine packing resulted in fatal peritonitis. The post-mortem examination revealed an ab- scess of the ovary, which had broken into the peritoneal cavity. The seventh female case was one of extreme nervous prostration and of tubercular tendency. She suffered from an extreme retro- flexion and prolapsus. After the operation for laceration of the cervix and rectal dilatation she was attacked with pernicious vomit- ing, which was followed by peritonitis and death in six days after the operation. The eighth and last case was a case of chlorosis, accompanied by a mild form of anaemia. After the operation for laceration of the cervix and rectal dilatation she developed peritonitis and empyema, and the chronic anaemia became acute. She died seven days after the operation. In explanation of the death of the male patients, I have no com- ment to make except that they were all of them extremely desperate cases and very near their dissolution, and the operation was a forlorn hope. Their reactive powers were so feeble that they did not respond to the measures and their lives were unquestionably short- ened to some extent as a result of the operative interference. It would undoubtedly have been better in the cases of the men to have subjected them to the milder forms of orificial treatment before the severer measures were undertaken. This precaution might pos- sibly have proved more satisfactory and spared the necessity of plac- ing their names on the list of those who have been injured by the work. The lesson is certainly a profitable one. A REPORT ON ORIFICIAL SURGERY. 335 For the death of the female cases, however, there is a very good reason, which does not appear in the statement of the cases. At the time these cases were treated, in performing the toilet of the endo- metrium, after dilating the uterus I was in the habit of injecting into the uterine cavity a weak solution of chloride of zinc, and in cases in which the packing was used, the packing was saturated with glycerin. Suspecting that these two substances had something to do with the unfortunate results, and hesitating to believe that curet- ting and cleansing the uterine cavity and packing it after free dila- tation was a measure dangerous to life, I have since omitted the employment of the chloride of zinc solution and introduced an anti- septically prepared packing, perfectly dry, employing bichloride of mercury, 1-4000 solution, previous to the packing. In each case I am now also in the habit of packing the uterus twice ; once to soak up all that remains in the uterus of the bichloride solution, and once to get the effect of a longer dilation than I could obtain from merely the use of sounds. I am very glad to report that since this change in the treatment, which has now been nearly a year, I have not only escaped the pain of a fatal case, but have not even induced either metritis or cellu- litis. The seventh of the female cases reported did not owe her death, I am satisfied, entirely to the manner of treatment, but in part at least to the extreme retroflexion, aggravated by uncontrollable vomiting. A wiser judgment in this case would have decided to shorten the round ligaments, or by some other procedure to have held the uterus in proper position while she was recovering from the operations. In the light of what is now known, therefore, this list of deaths of the female cases would probably have been reduced to one, and pos- sibly not that. The first and second cases I consider examples of meddlesome surgery. The cases were doing well and should have been let alone. Instead of that, while in a sensitive state they were subjected to severe secondary work, which, with the other causes mentioned, re- sulted to their harm. There have been no deaths from the employment of an anaesthetic, although, as will be seen later on in this report, it was given indis- criminately to cases suffering from heart, kidney, lung, brain, and spinal cord troubles of a serious nature. In view of these facts 336 world’s homoeopathic congress. there is every reason to hope that the record of the next 1000 cases will not be marred by the blemish of fatality even in a single in- stance. Of these 1000 cases 107 were placed under an anaesthetic a second and sometimes a third time for what may be called finishing work. In chronic metritis it is very frequently impossible to secure satis- factory results from simply one treatment, even if thoroughly per- formed. Granulations will reform and require oftentimes two or three vigorous curettings and packings before a satisfactory condition of the endometrium is secured. After the American operation in some cases there is a tendency to stricture. This may be overcome either by systematic and re- peated dilatations as they can be borne by the patient, or by one or possibly two thorough dilatations under an anaesthetic. It is necessary that all orificial work should be followed to a finish until an ideal condition is attained, in order to obtain universally satisfactory results. If those cases which are reported as failures should be examined to-day officially, they will be found to present an abnormal condi- tion of the orifices, perhaps in a more extended form than before they were first operated upon. In such cases this condition is either the result of poor work or unfinished work, and, of course, should be charged to these accounts rather than reported as arguments against the philosophy. After the first work has been performed, patients should never be treated to secondary work so long as improvement in their condition continues. The time of reaction from orificial work varies not only with the disease with which the patient is afflicted, but also with different individuals suffering from the same disease. Marvellous improvement will oftentimes be instantaneous, and the list of most brilliant cures conceivable is a long one. It is quite common, how- ever, for three, six, nine, and even twelve months, or longer, to elapse before satisfactory reaction takes place even in cases which finally recover as a result of the work. The following is a list of chronic diseases under which these 1000 cases have been classified. Many times a patient would be suffering from more than one trouble, but they have been registered under the most prominent difficulty. A REPORT ON ORIFICIAL SURGERY. 337 5 cases of acne; all of which were cured. 1 case of acromegalgia ; which was greatly improved by the work. 4 cases of amenorrhoea; 3 cured, 1 unaffected. 18 cases of anaemia; 15 cured, 3 improved. 5 cases of aphasia; 2 cured, 2 improved, 1 unaffected. 20 cases of asthma; 12 cured, 6 improved, 2 unaffected. 5 cases of blindness; 3 cured, 1 improved, 1 unaffected. 5 cases of bronchitis; all cured. 43 cases of cancer; some of them improved for a time ; no cures. 2 cases of caries of the femur; 1 improved, 1 unaffected. 5 cases of chronic cellulitis; 4 cured, 1 unimproved. 3 cases of chorea; 1 cured, 1 improved, 1 no better. 342 cases of constipation; 308 cured, 10 improved, 14 unim- proved. 32 cases of cystitis; 29 cured, 3 unimproved. 5 cases of deafness; 1 cured, 3 improved, 1 no better. 1 case of delirium tremens; cured. 5 cases of diabetes; no cures, but all improved. 15 cases of diarrhoea; 14 cured, 1 unaffected. 1 case of dropped wrist; no better. 8 cases of dropsy; 7 cured, 1 unimproved. 195 cases of dysmenorrhoea ; 174 cured, 10 improved, 9 unim- proved. 123 cases of dyspepsia; all cured. 14 cases of dipsomania and morphia habit; all improved, but no radical cures. 13 cases of eczema; all cured. 1 case of empyema ; improved. 3 cases of enuresis ; cured. 11 cases of epilepsy; 5 cured, 6 improved. 10 cases of fibroids; 3 cured, 7 improved. 150 cases of headaches ; 135 cured, 10 improved, 5 unaffected. 14 cases of heart disease; 8 greatly improved, 6 partially so. 302 cases of haemorrhoids; all cured. 5 cases of hip-joint disease; all improved and progressing to recovery. 16 cases of hysteria; 10 cured, 4 improved, 2 unimproved. 13 cases of impotency ; 11 cured, 2 relieved.. 23 cases of insanity; 18 cured, 6 failures. 22 338 world’s homoeopathic congress. 36 cases of insomnia; 18 cured, 9 improved, 9 unaffected. 1 case of jaundice; cured. 128 cases of liver derangement; 122 cured, 2 improved, 4 unaf- fected. 46 cases of locomotor ataxia; 20 cured, 15 improved, 11 unaf- fected. 1 case of lupus; no improvement. 51 cases of melancholia; 46 cured, 5 improved. 1 case of meningitis ; no improvement. 10 cases of nephritis; all improved. 15 cases of nervousness; 10 cured, 5 improved. 345 cases of nervous prostration; 300 cured, 25 improved, 20 unaffected. 29 cases of neuralgia; 26 cured, 3 unaffected. 50 cases of ovarian irritation ; 41 cured, 9 unimproved. 31 cases of paralysis: 16 cured, 10 improved, 5 failures. 2 cases of paralysis agitans; both failures. 13 cases of paresis; 10 cured, 2 improved, 1 unaffected. 1 case of phlebitis; cured. 24 cases of proctitis; all cured. 6 cases of prolapsus of the rectum ; all cured. 8 cases of prostatitis; 6 cured, 2 improved. 5 cases of pruritis ani ; cured. 2 cases of pyaemia; unaffected. 17 cases of rheumatism; all improved. 48 cases of spermatorrhoea; 44 cured, 4 unaffected. 28 cases of spinal irritation ; 20 cured, 8 improved. 12 cases of sterility; 10 cured, 2 unaffected. 8 cases of stricture of rectum; all cured. 2 cases of salpingitis; both cured. 47 cases of tuberculosis; 40 cured, 3 improved, 4 unaffected. The oldest patient operated upon was 84 years of age ; the youngest was a child of 2 years. As to the methods employed in the preceding cases, they were selected with reference to the general condition of the patient rather than the form of local patholoyg encountered ; the severer measures being employed, as a rule, in the more desperate conditions. As all the cases were submitted to all- around work, and usually, at the same sitting, each patient was sub- jected, as a rule, to several operations, one upon the rectum and one A REPORT ON ORIFICIAL SURGERY. 339 or more upon the sexual organs. The summing up of the opera- tions, therefore, will be greatly in excess of the cases reported upon. The following is a list of the operations performed : American operation, 435 Circumcision, . . . . . . . . • • .135 Laceration of the cervix, 199 Loosening of the hood of the clitoris, 279 Slitting of the hood of the clitoris, . 13 Removal of the hood of the clitoris, 21 Fistulse, 33 Clipping of the frasenum, 351 Excision of haemorrhoids, . 258 Enlarging meatus, - 343 Uterine packing, . . . .178 Removal of papillae, 373 Removal of pockets, .......... 392 Dilatation of the male urethra, ........ 237 Trimming and dilatation of the female urethra, .... 271 Cutting of the sphincters, . 65 Removal of the hymen, .42 Hyperspadies, 5 Varicocele, 21 Hydrocele, 8 Secondary operations, .107 One word concerning severing the sphincters. As this work resulted in several cases of incontinence of faeces, which required secondary operations to cure, and some of which remain still uncured because unwilling to submit to further treatment, I have abandoned the practice except when operating for certain cases of fistulse in ano and operating for laceration of the perinseum. Cases of inconti- nence of faeces from severed sphincters can all be restored to a nor- mal condition if patients are willing to undergo a secondary opera- tion. But as there is frequently difficulty in obtaining their con- sent to this, I thought best to rely solely upon dilatation in future, except in the cases mentioned. In operating upon the cases of tu- berculosis, heart disease, affections of the kidneys, and paralysis, which have been regarded as dangerous subjects for the employment of anaesthetics, it has been my custom to precede the operation by the dilatation of the anus more or less thoroughly, according to the effect which it produced upon the respiration. During an operation upon such cases, when the blood becomes dark, indicating poor 340 world’s homoeopathic congress. oxygenation, the operation and the anaesthetic were suspended, and dilatation was again practiced until the blood was again arterialized. There has not been a single case in which the anaesthetic has seemed to be productive of even the slightest degree of harm, but rather of benefit. And in view of the marvellous action of rectal dilatation as a means of resuscitation from a too profound anaes- thesia, the application of anaesthetics in every form of case seems to be perfectly devoid of danger. The knowledge of this fact should be widely spread, as it will speedily put an end to the record of deaths from chloroform and ether. The anaesthetics employed have been in fully 95 per cent, of the cases a mixture of one part chloroform to two parts ether. It has been necessary, especially in cases of spinal sclerosis, insanity, and those addicted to the morphine and liquor habits, to employ pure chloroform instead of the mixture. It has never proved necessary, even in heart trouble, to employ ether alone. In kidney troubles chloroform has been preferred as an anaesthetic. The large percentage of the cases operated upon have been ex- tremely difficult ones, and oftentimes desperate. And it has been no fault of the cases that the death-rate has not been greater and the percentage of failures a much larger one. As a rule, patients have been subjected to the operation without any previous line of treatment, in order to immediately stop the nerve waste, flush the capillaries, and increase the re-active power of the system. The after-treatment of these cases has been not only local but general, and all means of cure at my command have been employed to aid in securing satisfactory results. These measures have included the pneumatic cabinet, eleetricity, massage, sun baths, Turkish baths, skin frictions, spinal cuppings, Swedish movement cure, dieting, ab- dominal respirations and light calisthenics combined, mental thera- peutics, and as skillful prescribing as I was capable of. The local after-treatment has consisted of douches, ointments, the local appli- cation of drugs, and general measures useful in the healing of wounds, and in the subsequent use of rectal dilators and male and female urethral and uterine sounds, colon flushings,, bladder and uterine douchings, as they seemed to be required. The local treat- ment, except that for the healing of the wounds, has not been routine, but based upon the reactive power of the patients, always giving the case ample time for reaction between treatments. A REPORT ON ORIFICIAL SURGERY. 341 It would be a great advantage in many of the cases, if it were possible, to subject them to preparatory treatment before they were operated upon, even where operative treatment is essential to re- covery. The reason that this practice has not been followed more extensively has been because of the patients themselves. Their im- patience of delay, their impetuosity, their inability to spend the requisite amount of time and money which such a procedure im- plies, has seemed to demand an early and radical interference. Almost all of the patients have been under treatment of some kind for a series of years, and have lost faith not only in doctors but in humanity, and they are not in a frame of mind to brook delay. They must see an immediate change or they speedily become dis- satisfied. As the death -record which we have presented to-day was almost entirely the result of faulty methods, which I have since cor- rected, I cannot condemn the practice of proceeding at once with whatever operation is required as soon as it is decided to be neces- sary. This report, which I now submit for your consideration, presents the subject of orificial surgery in the light purely of a last resort. In these cases it has simply been employed after all other tried measures have failed. The methods called for in such cases have necessarily been extremely severe, but should never be dangerous if proper judgment is exercised in selecting cases and methods of oper- ation. If orificial surgery can cure and relieve such large percentages of the abandoned cases of professional practice, it will certainly demand consideration at the hands of the profession as a means of preven- tion. The measures which it has to offer for this purpose are so much milder as to escape the censure of those who are prejudiced against surgical measures as aids to the health and happiness of mankind. What can be cured can be prevented, and when the first or predisposing causes of chronic disease once becomes thoroughly appreciated by the medical profession, they will speedily busy themselves more energetically in making use of whatever is calcu- lated to save the communities under their charge from the discom- fort, unhappiness, agony, and premature dissolution which results from ignorance or neglect of the causes which slowly but surely sap vitality, undermine constitutions, destroy reactive power, and pre- 342 world’s homoeopathic congress. dispose humanity generally to its numberless varieties of unnatural disaster. This report is now respectfully submitted for your consideration : 5 Acne, Cured. Per cent. . 100 Improved. Per cent. Unimproved. Per cent. 1 Acromegalgia, 100 4 Amenorrhoea, . 75 25 18 Anaemia, . 83£ 16§ 5 Aphasia, . 40 40 20 20 Asthma, . 60 30 10 5 Blindness, 60 20 20 5 Bronchitis, 100 43 Cancer, . Some improved. 2 Caries of femur, 50 50 5 Cellulitis, 80 20 3 Chorea, . 33J 33£ 33| 342 Constipation, . 90 6 4 32 Cystitis, . 90 10 5 Deafness, . 20 20 20 1 Delirium tremens, . 100 5 Diabetes, . 100 15 Diarrhoea, 93 7 1 Dropped wrist, No improvement. 8 Dropsy, . 88 12 195 Dysmenorrhoea, 90 5 5 123 Dyspepsia, 100 14 Insomnia, Morphia, 100 13 Eczema, . 100 1 Empyema, 100 3 Enuresis,. 100 1 1 Epilepsy, 45 55 10 Fibroids,. 30 70 150 Headaches, 90 6f H 14 Heart disease, . 57 43 312 Haemorrhoids, 100 5 Hip-joint disease, . 100 16 Hysteria, 62£ 25 12j 13 Impotency, 84J 15J 23 Insanity, . 74 26 36 Insomnia, 50 25 25 1 Jaundice, 100 128 Liver derangement, 95 2 3 46 Locomotor ataxia, . 43J 32 25 1 Lupus, 100 51 Melancholia, . 90 10 1 Meningitis, 100 A REPORT ON ORIFIC1AL SURGERY. 343 Cured. Improved. Unimproved. Per cent. Per cent. Per cent. 10 Nephritis, . 100 15 Nervousness, . . 66f m 345 Nervous prostration, . 87 7 6 29 Neuralgia, . 90 10 50 Ovarian irritation, . . 81 19 31 Paralysis, . 51 33 16 2 Paralysis agitans, . 100 13 Paresis, . . 77 9 4 1 Phlebitis, . 100 24 Proctitis, . . 100 6 Prolapsus of rectum, . 100 8 Prostatitis, . * . 75 25 5 Pruritus ani., . 2 Pyaemia, . 17 Rheumatism, . . 100 100 100 48 Spermatorrhoea, • 91| ihIco GO 28 Spinal irritation, . 72 18 12 Sterility,. . 83i 16§ 8 Stricture of rectum, . 100 2 Salpingitis, . 100 47 Tuberculosis, . . 85J 6 9 2357 84.85 9.46 5.69 Discussion. W. E. Green, M.D., of Little Rock, Ark. : It is with considerable misgiving, that I undertake to discuss a paper of such great im- portance, and written by so distinguished a clinician as the one just heard. This, like every other article that emanates from the pen of Dr. Pratt, is full of solid fact that will be instructive to the entire profession. Every member of this body, who has practiced orificiai surgery to any extent, can verify from personal experience the truth- fulness of his teaching, and thousands of patients, who have been cured by its methods, will speak praises in its behalf. It is a mode of treatment based upon the theory of reflexes, and deals with dis- eases surgically. A successful orificialist must be an accomplished physician of good judgment, and a likely operator; he should not alone be able to clip away pockets and papillae, but he should be competent to execute dexterously, and manage the most important surgical operations. He should be able to decide at once, when operating, the demands of every case and perform well the operation that will give the best results. It will not answer to treat the rectum and leave a lacerated cervix, or to dilate the cervix, and neg- lect an endometritis; repair a perinseum and overlook a cystocele. Nor will it answer to do a trachelorrhaphy when an amputation of 344 world’s homceopathic congress. Ihe cervix is demanded. Neither should a patient be submitted to an excision, if a less formidable procedure will answer as well. Sometime ago, I was called to see a lady, who had been ailing for months: she remarked that she had undergone orificial treatment; both her womb and rectum had been operated upon (the womb di- lated and pockets removed from the rectum), but without benefit. Her trouble was neuralgia of the stomach. Upon an examination, I found a badly lacerated cervix, with the lips everted, thickened and eroded ; there was a severe endometritis and consequent uterine enlargement; a profuse, glairy discharge issued from the os, besides a bad hsemorrhoidal condition existed. I anaesthetized her, dilated and curetted the uterus, repaired the cervix, dilated the urethra and cut away excrescences from about the meatus and did an excision of the bowel. The recovery was prompt and satisfactory. I know 7 of no class of operations w T here more is required of the surgeon, and there are none where experience counts for more. A perplexing feature of the practice, is to know in just what cases it will prove curative; at best, we are often doomed to dismal disap- pointment, for as long as the human mind is prone to mistakes, ac- curate knowledge in this particular, cannot be acquired. However, with study and experience, we can hope to approximate a reasonable degree of certainty. The orificialist cannot ignore pathology. The more thorough our knowledge of pathology, the more perfect our powers of diagnosis, and the more extensive our experience the more confident will we be of our results. For in diseases and conditions known to be incura- ble, orificial surgery would certainly not be applicable; though, even in some of these cases it will often prove palliative. I was recently called to see a case of advanced uterine cancer. The patient was suffering so intensely, that large doses of morphine, f to one grain, were necessary to quiet her pains; she had also bad haemor- rhoids, so I did an orificial operation upon her rectum. Her suffer- ing was so greatly relieved from it, that she quit the morphine and gained in both flesh and strength. The influence of a properly conducted orificial treatment reaches remote organs through its action upon the sympathetic nervous sys- tem, and its ganglionic connection, stimulating capillary circulation, thereby relieving congestion of parts, improving nutrition and in- ducing tissue changes necessary to recovery. Through this means, a failing heart will take on fresh vigor bv being relieved of the burden imposed through a sluggish circulation. In the same way, congested and hypertrophied organs will be relieved, and healthy action restored ; but functional disturbances yield most readily to its influences. For the benefit of the oculists that are present, I will relate a case of hyperphoria that I cured by an orificial operation. Hanssel con- A REPORT ON ORIFICIAL SURGERY. 345 eludes, after careful clinical study, “ that this is a real affection, and that in highly sensitive subjects reflex functional disorders may be produced by it.” May he not be reasoning from effect to cause? The patient, a maiden lady, of about 35, was suffering from a most severe headache of long standing, with great disturbance of vision. After treating her for some time without success, I referred her to an oculist, who diagnosed hyperphoria and recommended tenotomy for its relief. As there was evident uterine and rectal disorders, I proposed an orificial operation, which was conceded. After anaes- thetizing her, I dilated the vagina, removed the hymen, dilated the urethra, slit up the hood of the clitoris, dilated and curetted the uterus, removed pockets and papillae and haemorrhoids from the rectum and dilated the sphincter ani muscles. She promptly re- covered from both the headache and eye affection ; besides, a con- gested and sensitive condition of the tubes and ovaries was relieved. She is now strong and well. Though I am a firm believer in orificial surgery, there are some conditions in which my experience does not carry me to such a state of enthusiasm as does Dr. Pratt’s. Should I see permanent benefit derived from an operation upon a patient suffering from advanced paresis, atrophy of the optic nerve, locomotor ataxia, cancer and some other diseases mentioned, I would simply conclude that I was mistaken in my diagnosis. Nor have I ever seen a latent typhoid or malarial condition develop; I have always designated such cases, septic. Three or four years ago, I reported a case of locomotor ataxia greatly and permanently improved by an orificial operation. Some time ago, after again indulging in excessive drink, the severity of symptoms were redeveloped. Upon a more careful and systematic investigation, I decided the trouble was not locomotor ataxia but multiple neuritis. I have in the past two years operated upon other cases of undoubted locomotor ataxia, without permanent benefit in any case. I deem it of as much importance to report failures as successes. Atrophied tissue, where the structure has been entirely destroyed, certainly cannot be relieved. While I concede that some cases of nasal catarrh may be benefited, or even cured, I do not believe that operations upon the lower orifices will remove hypertrophic rhinitis, especially where there is ecchondrosis or much thickening of the turbinated bones. I would bespeak greater certainty in effect were the conditions attached in situ. But why exclude operations upon the nose and throat from the domain of orificial surgery ; are they not as much orifices of the body as are the lower openings? I am quite certain that I have seen just as magical results follow the re- moval of diseased conditions here, as I ever have from operations upon the rectum, uterus or penis. I have frequently witnessed an 346 world’s homoeopathic congress. entire restoration to health after removing hypertrophied tonsils or relieving a stenosis of the nasal passage. I have often had children brought to me that were dwarfed both mentally and physically, brighten up and grow strong, after suclT treatment. Headaches, asthma, coughs, bronchitis, pulmonary troubles, visual disturbances, neuralgia, vertigo, tinnitus aurium, deafness, dyspepsia and anaemia, in fact, almost every disorder that may be produced through the re- flexes. If our efforts are, to correct malnutrition caused by vaso-motor disturbances, why neglect this source? If a perverted rhythm, or peristalsis as the doctor says, implies disease, and this rhythmical part of man’s existence is governed by the sympathetic system, why may not the trophic lesion be located in the nose as well as the anus? Anatomy teaches us that these parts are supplied with sensory fila- ments that connect through their ganglionic relations with every other part of the human organism. May not a motor impulse for good or bad, started here, extend its energy to all distant organs ? Take up the sympathetic nervous system from above, and trace it through its various plexes to the different ganglia and see what your conclusions will be. You will find that a perverted force may be transmitted to the eyes, face, throat, ear, brain, heart, lungs, abdomi- nal viscera, etc. It is a cardinal principle in orificial surgery, to let no diseased orifice escape. The work must be “all round” and thorough. REPORT OF TEE SECTION IN OPHTHALMOLOGY AND OTOLOGY. Chicago, Wednesday, May 31, 1893. The Section in Ophthalmology and Otology assembled in Hall No. VIII. of the Art Building, at 3 o’clock p.m. The Section was called to order by A. B. Norton, M.D., of New York, N. Y., Chairman, who then delivered the Sectional Address. At the suggestion of the Chair, a motion was offered and adopted, providing that those papers whose authors are present at the meeting be first presented and discussed in the order in which they appear on the published order of business, and that the remaining papers be then presented and considered so far as time might permit. Dr. E. H. Linnell, of Norwich, Conn., read a paper on “ Exoph- thalmic Goitre.” At the conclusion of the reading, the Chair asked for a decision by the Section regarding the time to be allowed for the reading of each paper, and for each member taking part in the discussion. On motion of Dr. Wm. B. King, of Washington, D. C., the time for the reading of a paper was limited to twenty minutes, with ten minutes for each of those appointed to lead in the discussions, and five minutes for other speakers. Dr. Linnell’s paper was then discussed by Drs. J. H. BufFum, of Chicago, 111., and F. Parke Lewis, of Buffalo, N. Y. Dr. Thomas M. Stewart, of Cincinnati, O., read a paper entitled “The Refraction of the Eye.” It was discussed by Drs. Charles H. Helfrich, of New York, N. Y., D. A. MacLachlan, of Ann Arbor, Mich., Myron H. Chamberlin, of Council Bluffs, la., Harold Wil- son, of Detroit, Mich., E. H. Linnell, of Norwich, Conn., E. Elmer Keeler, of Syracuse, N. Y., Wm. R. King, of Washington, D. C., and by the author of the paper. Dr. King moved that when the meeting adjourn, it be to meet at 8 o’clock this evening, in order that the papers remaining unread at 348 WORLD S HOMCEOPATHIC CONGRESS. the close of the present session may then be considered. The motion was adopted. The next paper read was by Dr. Elmer J. Bissell, of Rochester, N. Y. It was on the subject of “Ophthalmic Surgery/’ and was discussed by Drs. B. B. Veits, of Cleveland, O., C. H. Vilas, of Chicago, 111., A. F. Randall, of Port Huron, Mich, Harold Wilson, of Detroit, Mi eh., F. Parke Lewis, of Buffalo, N. Y., A. B. Nor- ton, of New York, N. Y., and Dr. Bissell, the author of the paper. The session then adjourned until 8 o’clock p.m. The Section reconvened at 8 o’clock — Dr. Norton in the chair. Dr. Harold Wilson then presented a paper on “ The Study and Correction of Heterophoria.” He read portions of the essay, and gave a brief resume of the remaining portions. A discussion fol- lowed, participated in by Drs. John H. Payne, of Boston, Mass, (whose remarks, in the absence of Dr. Payne, were read bv the Secretary), E. PI. Linnell, of Norwich, Conn., Wm. R. King, of Washington, D. C., Thomas M. Stewart, of Cincinnati, O., M. H. Chamberlain, of Council Bluffs, la., and by the author of the paper. Dr. Henry F. Garey, of Baltimore, Md., read an essay on the “ Efficacy of the Vibrometer in Applying Vibratory Massage in Aural Disease.” Its discussion was by Drs. Wm. R. King, E. H. Linnell, Harold Wilson, Henry C. Houghton, of New York City, and by the Section Chairman, Dr. A. B. Norton. The Chair suggested that the paper by Dr. C. F. Sterling, of De- troit, Mich., on “The Homceopathy of Aural Therapeutics,” should now be taken up. In the absence of its author, Dr. H. C. Hough- ton, of New York City, gave a careful abstract of the essay, with brief comments thereon. The paper, together with a written dis- cussion of the subject by Dr. Hayes C. French, of San Francisco, Cal., was then accepted and referred for publication. Dr. Houghton then read his paper on “Aural Therapeutics,” which (he said) was adapted to follow the paper of Dr. Sterling. A paper by Dr. Howard P. Bellows, of Boston, Mass., enti- tled “ Some Recent Advances in Otology,” together with a written discussion of the subject by Dr. Francis B. Kellogg, of Tacoma, Wash., was then presented by title and accepted. Also a paper by Dr. James A. Campbell, of St. Louis, Mo., on “Ocular Reflex Neuroses.” The Sectional meeting then, on motion, adjourned. INAUGURAL ADDRESS. 349 INAUGURAL ADDRESS. By A. B. Norton, M.D., New York, N. Y., Chairman. Mr. President , Members of the Congress : My first duty is to express my sincere appreciation of the high honor conferred upon me in selecting me to preside over such an important section as that of Ophthalmology and Otology. The de- liberations of this body, composed as it is of the brightest lights in our special department of medicine, are destined to redound to the credit of our school, and to the benefit of humanity. The sessions of this section will be devoted to the study of two of the smallest yet most important organs of the human body, for none are of more value, none more useful, and none capable of conveying keener emotions of pleasure to the soul, than the eye and ear. How fitting, therefore, that this should have been the first-born of the specialties in medicine; and what advances it has made since the late Dr. E. Williams, of Cincinnati, the pioneer among the specialists of this country, less than forty years ago commenced the exclusive practice of the diseases of the eye and ear. At that time the discovery of the ophthalmoscope, which was the real stepping-stone to our pres- ent-day knowledge of the eye, and which has done more toward the preservation and restoration of sight than any one other discovery either before or since, had just been made by the renowned Helmholtz, and heralded throughout the world by all interested in this speci- alty. At about this same period the works of Von Graefe, Helm- holtz, Donders, and others, gave an impetus to the study of ophthal- mology which is still felt and can never be checked. While our Old-School friends can claim to have been the pioneers in the exclusive practice of this specialty, Homoeopathy was but a few years behind them, and it seems to me appropriate to briefly refer at this time to the early history of this special department of medicine in our own school. Following close upon the footsteps of 350 world’s homceopathic congress. Drs. Williams, Agnew and others, who commenced the exclusive practice of diseases of the eye and ear, from 1855 to 1860, we find that Dr. C. H. Angell, of Boston, was the first man in our school to commence the exclusive practice of this specialty. Dr. Angell graduated from the Homoeopathic Medical College of Pennsylvania, in 1852, and first located in Salem, later in Lynn, Mass., and in 1857 removed to Boston. In 1861 he visited Europe, and studied with Profs. Arlt and Jaeger, of Vienna, Yon Graefe, of Berlin, and in the eye clinics of both Paris and London. He returned in 1864, and since then has practiced exclusively as an oculist and aurist. In 1870, Dr. Angell brought out the first work upon Dis- eases of the Eye from the standpoint of a Homoeopathic oculist ; the fame of this work, and consequently of its author, is simply told in the fact that it has reached its eighth edition. Dr. Angell, as Pro- fessor of Ophthalmology in the Boston University School of Medi- cine, still continues to teach the value of Homoeopathy in diseases of the eye. Dr. C. Th. Liebold, who, with Dr. Angell, were the earliest ex- clusive specialists in our school, commenced to devote his exclusive study to diseases of the eye and ear in the old Bond Street Dispen- sary, in New York, soon after the close of the war, during which he had served with honor as a general surgeon. In 1867, he was ap- pointed surgeon to the New York Ophthalmic Hospital, where he remained in continuous faithful and skillful service until his death in December, 1885. In 1870, Dr. Liebold was made Professor of Ophthalmology in the New York Homoeopathic Medical College, which chair he still filled at the time of his death. As an ophthal- mic surgeon Dr. Liebold was equalled by few and excelled by none, while as a Homoeopathic physician his knowledge of and reliance on the action of drugs saved many an eye that would have otherwise been lost. In 1867, the Board of Directors of the New York Ophthalmic Hospital placed the medical control of that institution in the hands of Homoeopathic physicians, Drs. T. F. Allen and C. Th. Liebold constituting its surgical staff. The New York Ophthalmic Hospital of to-day, treating upwards of 14,000 patients annually, bears a living testimony of the value of Homoeopathy in the diseases of the eye and ear, and of the thoroughness with which its work was in- augurated by Drs. Allen and Liebold. INAUGURAL ADDRESS. 351 Dr. Henry C. Houghton, graduating at the New York University Medical College, in 1867, became at once interested in the ear as a specialty. He has been associated with the New York Ophthalmic Hospital since its opening as a Homoeopathic institution, and is to- day the senior surgeon as well as a director of that hospital. In 1873, Dr. Houghton commenced to practice exclusively as an aurist, and in 1882 was made Professor of Otology in the New York Ho- moeopathic Medical College. His work on Clinical Otology , issued in 1885, is to-day the standard text-book of our school. Dr. W. H. Woodyatt, graduating in 1869, immediately went to New York to make a special study of diseases of the eye and ear, spending his time at the New York Ophthalmic Hospital, at Dr. Knapp’s clinic, and the clinics of the Manhattan Eye and Ear Hos- pital, and the New York Eye and Ear Infirmary. In 1871 he lo- cated in Chicago, and was appointed Professor of Ophthalmology and Otology in the Hahnemann College, and subsequently in the Chicago Homoeopathic Medical College. Dr. Woodyatt was one of the ablest men in our specialty, a thorough diagnostician, a skilled surgeon, a true homoeopath. His untimely death in January, 1880, robbed our professon of one of its brightest men. Dr. George S. Norton, graduating at the New York Homoeopathic Medical College, in 1872, and the same year at the New York Oph- thalmic Hospital, was immediately appointed resident surgeon, later becoming a surgeon, senior surgeon, and director to the New York Ophthalmic Hospital, was the next one in our school to enter into the exclusive practice of eye and ear diseases. In 1876 Dr. Norton, in conjunction with Dr. T. F. Allen, brought out the Oph- thalmic Therapeutics , the second edition of which, issued in 1881, was by Dr. Norton alone. In 1886 Dr. Norton succeeded Dr. Liebold as Professor of Ophthalmology in the New York Homoeopathic Medical College, and in 1889 commenced the publication of the first special journal of our school, The Journal of Ophthalmology , Otol- ogy , and Laryngology . In addition to these, Dr. Norton was also at the time of his death, January 30, 1891, consulting ophthalmic sur- geon to several hospitals and institutions. Following in rapid order, our corps of exclusive specialists was, within a few years, increased and strengthened by such men as Campbell, of St. Louis; Phillips, of Cleveland; Winslow, of Pitts- burgh; Vilas and BufFum, of Chicago; McDermott, of Cincinnati; 352 world’s homoeopathic congress. Boynton, of New York; Lewis, of Buffalo; and so on, until to day we find in every large city, and many of the smaller ones, one or more Homoeopathic oculists and aurists. Those of us who have more recently commenced the practice of this specialty should be, and I believe are, grateful to our predecessors for the work they have done, They laid the foundations on which we are building, and we do them honor for the thoroughness in which that work was done under the many difficulties of the time. We who have to-day our special ophthalmic colleges, journals, and text-books from which we can learn the special applications of our Homoeopathic reme- dies in diseases of the eye and ear, little realize the difficulties experienced by the pioneers in the field who had to discover and make a special Materia Medica for the varying diseases of the eye and ear. The status of the Homoeopathic specialist of to-day, in this de- partment at least, is certainly equal to, and we believe in the ma- jority of cases excels, that of the Old School. I say this because the majority of the Homoeopathic oculists and aurists of to-day are graduates of a special college giving a legal degree as eye and ear surgeon to physicians only, and that after a most thorough didactic and clinical course of six months. In the Homoeopathic School is the only special college in this country having a right to grant the legal degree as eye and ear surgeon, while the very large majority of the Old-School specialists are such after a course of from six weeks to three months only, apparently believing that skilled specialists can be made in this short time. Therefore I claim that our Homoeopathic eye and ear specialists are better and more thor- oughly educated as a body than are those of any other school in this country. To the question, What has Homoeopathy accomplished in this de- partment of medicine? we would answer, a great many more things than time will allow us to refer to on this occasion; hence, we must content ourselves with the mere general mention of a few. First, in cataract, that most important of all the diseases of the eye, of which the simple mention of its name calls up visions of blindness to us all. Experience teaches us that in the early stages of senile cata- ract, upon which every authority, with possibly one exception, agrees that if left to itself will inevitably progress, and sooner or later lead to blindness, it can be held in check by the use of Homoeopathic INAUGURAL ADDRESS. 353 remedies, and the vision be held intact for years, thus avoiding the necessity of the knife. In suppurative inflammations of the uveal tract our remedies, especially Rhus tox., have proven of incalculable ♦ value. In some cases that seemed destined to total destruction of the eye, both its structure and function have been restored to normal again by the administration of this drug. In nearly all the inflam- mations of the eye, especially of the cornea, conjunctiva, and iris, the use of Homoeopathic remedies will cut short the disease several days earlier than the most approved Old-School treatment of the present day. In the ear, every Homoeopathic specialist has seen cases of acute inflammation of the middle ear, and even threatened involve- ment of the mastoid, cut short and prevented by such remedies as Ferrum phos., Capsicum, Bellad., Hepar, etc. In chronic catarrhal deafness, improvement in the hearing is often secured by the admin- istration of the Calcareas, Kalis, Mercuries, etc., and frequently in cases that have been through the hands of our Old-School friends with no benefit. The value of Homoeopathy in the treatment of dis- eases of the eye and ear is easily demonstrated to any unbiassed ob- server who will give our remedies a fair, conscientious trial. Take, for example, the different varieties of keratitis or conjunctivitis; let a given number be treated under the most approved local, operative, and constitutional treatment of the Old School of to-day, and then by comparing the average duration of the diseases with a similar number of cases of each disease treated by the administration of Homoeopathic remedies alone, and the results will certainly show a greater saving of time to the patient under Homoeopathy. The same is true in iritis and other diseases of the eye. In iritis the use of a mydriatic to overcome the mechanical effects of the adhesions is, of course, necessary under all modes of treatment, but, in addition to the employment of the mydriatic, the use of Homoeopathic remedies will control an attack of iritis in from one to ten days earlier than by any other method of treatment ; or, instead of using narcotics to control the severe pains of iritis, let one but see the effects of the properly selected Homoeopatlrc remedy in relieving those pains in a few cases, and any unprejudiced observer must necessarily be con- vinced of the value of Homoeopathy in eye diseases. As Homoeo- pathic oculists and aurists, we do not claim to cure all diseases of the eye or ear by the administration of the Homoeopathic remedy alone. Not one member of our ranks would think of treating an iritis with- 354 world’s homceopathic congress. out a mydriatic, glaucoma without a myotic or an iridectomy, ma- tured cataract without extraction, or mastoid disease without opening the mastoid; but as scientific men, as well as Homoeopathic physi- cians, we claim it to be our right, privilege, and duty to employ all* other scientific methods used by any school for the safe and speedy cure of our patient. We base our claims of superiority as Homoeo- pathic oculists and aurists on the fact that in addition to all other scientific methods for the prevention of blindness and deafness, we employ the only scientific law for the administration of drugs. We must also at this time again deplore the fact that our knowl- edge of the action of drugs upon the healthy eye and ear is still so limited, and must emphasize the necessity, in order to perfect our materia medica in this department, of thorough examination of the eye 2 nd ear by competent specialists in all future provings, both before, during and after the proving. Take for example the symp- tom of dimness of vision which we find recorded as existing in the provings of 209 different drugs, or vision lost in 121 drugs. Now how can these symptoms be of the slightest possible value in any given case when we know that there are over 100 different diseases of the eye in which there may be more or less dimness of vision. To be sure we have found clinically that Kali bich. is the remedy in the dimness of vision of descemetitis, Gelsem. in serous iritis, Bellad. and Duboisia in retinitis, Aurum mur. and Kali iod. in choroiditis, etc. We believe that these drugs, if given to a person in health, will produce pathological changes in the eye that will result in some impairment of vision, but with one exception we know of no proving where pathological changes have been seen during the proving by a competent oculist, merely because the eyes have not been under the careful examination they should have been. So with the symptom, hearing impaired, which occurs under 109 differ- ent drugs, or hearing lost which is found under 61 drugs. How have these remedies caused this deafness? By their action on the membrana tympani, the middle or internal ear or upon the auditory nerve itself? In this direction there lies a great field for future investigation and the path leading to a more exact and more scien- tific administration of drugs for the various diseases of the eye and ear. We trust that hereafter no proving of a new drug or reprov- ing of an old one will be made except under the direction or ex- amination by the oculist and aurist as well as by the other specialists in medicine. INAUGURAL ADDRESS. 355 At the present day much is being said and written of the over- doing of specialties in medicine, and that the specialist is crowding out the general practitioner. Representing as I do one of the specialists, I desire at this time to enter my protest against this popular clamor. Let one halt for a moment and look around at the other departments of science, arts, mechanics, etc., and he will very quickly find that medicine is no more, if as much, subdivided into specialties as are the many other professions. I can no better illus- trate the tendency of the age in this respect than by a brief quotation from Mr. Grant Allen who in an appreciative article on “ Specialists in Science,” gives a bit of a conversation with Bates of the Ama- zons which illustrates the modern tendency towards specialization. Said that scientist: “ When I was a young man I wanted to be a naturalist; but very soon I saw the days of naturalists were past and that if I wanted to do anything, I must specialize. I must be an entomologist. A little later I saw the days of entomologists, as such, were numbered, and that if I wanted to do anything, I must be a coleopterist. By and by, when I got to know more of my sub- ject, I saw no man could understand all the coleoptera, and now I am content to try and find out something about the longicorn beetle.” Specialization is a necessity, but it needs a broad founda- tion, or the individual runs into a very narrow type. Who are the men that are advancing the science of medicine in its various branches? Is it the general practitioner? No, it is the surgeon, the neurologist, the gynaecologist, the ophthalmologist, etc. The necessity for the oculist and aurist we believe will be fully demon- strated by the essays and discussions to be presented at the sessions of this section, as the scope of the work in this department has been so arranged and divided as to cover as much as possible of the sub- ject within the limits set by the Congress. Much within the do- main of ophthalmology and otology should and does fall within the scope of the general practitioner. Professor Helmholtz once said, “ that if an optician were to send him an instrument with so many easily avoidable defects as the human eye has, he would feel bound to censure him severely.” Many of these slight defects and the more external or superficial forms of inflammation of the eye should be treated by the family physician and could be were he to devote as much time and study to this branch as he does to the other specialties in medicine, but where is the specialist even, who can to- 356 world’s homoeopathic congress. day say that he knows all the hidden mysteries of sight and hear- ing? And yet this, the first-born of the specialties in medicine, is now nearly forty years old. If then, the life of these the smallest organs of the body cannot be absolutely solved in forty years, who can expect in one short lifetime to master all the functions of the human body? Therefore we say give us more and better specialists in all the departments of medicine. OPHTHALMIC THERAPEUTICS. 357 OPHTHALMIC THERAPEUTICS. By E. H. Linnell, M.D., Norwich, Conn. It is quite unnecessary, as it would be inappropriate, for me to present to this audience, composed as it is of representative Homoe- opathic physicians gathered from all parts of the civilized world, any arguments to prove the superiority of Homoeopathic therapeutics over all other methods of healing. On the other hand, in this Co- lumbian year, when all religious, educational, and scientific bodies are holding congresses, it is fitting that we should show to the world what Homoeopathy has accomplished, and what it has to offer in contrast to Old-School teaching and practice. It has devolved upon me to prepare a review of Homoeopathic therapeutics in our special department, that of ophthalmology. So much has been written lately upon this topic, that it is with diffi- dence I venture to discuss a subject so ably treated by others, and I crave your indulgence if much that I have to say seems trite. This is an age of exact scientific investigation. Men demand facts, and not theories ; and I propose to give you the facts of oph- thalmic therapeutics, Homoeopathically considered, as compared with the treatment of the Old School. It will not be inappropriate on this occasion for us to inquire what Homoeopathy has accomplished in this special department, and whether it offers any advantages over other methods. If Homoeop- athy is, as the illustrious Dunham expressed it, the “ Science of Therapeutics , ” then the Homoeopathic specialist should be more sci- entific in the choice and application of curative agents than one who relies simply upon traditional, or physiological and empirical uses of drugs ; and he should be correspondingly more successful. Does experience demonstrate this to be true? Our first duty is to our patients ; our first motive is to cure them as speedily and as surely as possible. We should “ prove all things, and hold fast that which is good.” We want the best. Is Homoeopathy the best?. If not,. 358 WORLDS IIOMCEOPATHIC CONGRESS. let us know it. And if it is, then let us demonstrate it so conclu- sively as to compel universal acknowledgment. It would be inter- esting and instructive to compare the results of the treatment of an equal number of cases of a given disease under the two systems, were reliable statistics available. We can contrast the ordinary treatment of eye-disease, as recommended in recent Old-School treatises, with the Homoeopathic treatment outlined in the latest and best work on the subject — Dr. Norton’s Ophthalmic Diseases and Therapeutics. That we may intelligently discuss the question, let us first clearly understand what we mean by Homoeopathic therapeutics as applied to ophthalmic affections. If we mean only the application of those drugs for the cure of morbid conditions which have actually caused similar functional disturbances and pathological lesions, then our resources are very much restricted; although in this limited inter- pretation of the subject, we have a number of valuable remedies. There are several reasons why our armamentarium is so much cur- tailed in this particular. In the first place, the records of poisoning furnish us with but few specific effects upon the eye, and our provings have not, in many cases, been pushed to the extent of pro- ducing actual tissue changes. But the most important reason is the lack of skilled and accurate observation, which is apparent in the pathogeneses of drugs. Most recorded eye-symptoms are subjective, and frequently unreliable, because not rightly interpreted. Had every prover been subjected to a careful examination by a competent ^and experienced oculist, before and after a proving, and the condition of refraction, ophthalmoscopic appearance of fundus, etc., been ac- curately recorded, the provings would have been infinitely more valuable to the specialist. The proving of Duboisin by Dr. Deady, published in the Trans, of Am. Horn. 0. and 0. Society , 1880, is a model worthy of imitation, although we cannot help wishing that the eyes of the provers had been previously examined, and conditions noted. Eye-diseases are rarely purely local, especially those serious affections which endanger vision ; but are usually the result of some systemic disorder, and require constitutional treatment. Similarly drugs do not affect the eye alone, but produce, in connection with eye-symptoms, indications of disturbance of remote organs and general constitutional effects. If, then, certain morbid conditions of the eve disappear under the exhibition of a remedy prescribed OPHTHALMIC THERAPEUTICS. 359 in strict conformity with the law of “ Similia,” for general con- stitutional symptoms or for affections of other organs, is it not fair and logical to accept these eye-symptoms as reliable indications for that remedy in another similar case, even if the constitutional symptoms of the first case are lacking? Is it not also probable that such a remedy, if fully proved in suitable doses, would cause the symptoms which it cures ; and is not a verified symptomatology, acquired in the way suggested, a logical basis of Homoeopathic ther- apeutics ? With this understanding of our topic, and I think it is a rea- sonable one, we have an extensive armamentarium of specific rem- edies. Allen and Norton’s Ophthalmic Therapeutics was compiled in this way from verified and trustworthy symptoms, and w’e owe an immense debt of gratitude to the authors and to the other faithful and skillful surgeons of the New York Ophthalmic Hospital, to whose labors we are largely indebted for the development of the resources of our school in this special department. In the posses- sion of these specific remedies the Homoeopathic oculist has a great advantage over one of the Old School; but a thorough knowledge of drug effects upon the whole system , is a requisite for successful prescribing, as well as a familiarity with general diseases. We can- not successfully prescribe for eye-symptoms alone, nor can we ignore the relationship between ocular affections and diseases of other or- gans, or the frequent dependence of eye-diseases upon constitutional dyscrasife. For this reason an extended experience in general practice is very desirable before undertaking special work. The Homoeo- pathic oculist, with these added means of cure at his command, — I say “ added” for of course all resources of the healing art, from whatever source, are his to choose or to refuse, — can achieve results impossible without them. When all mechanical, local, and surgical measures are powerless, the suitable Homoeopathic remedy will often preserve or restore sight and cure disease, when Old-School medicine is confessedly of no avail. Many an operation can be obviated, and many an unfortunate sequence of operation be averted. Pain, in the large majority of cases, can be controlled without the use of narcotics, with their attendant unpleasant and sometimes dangerous effects, and the course of many diseases be materially shortened. I promised to give you facts rather than theories, and in order to prove the truth of my assertions, let us critically examine and com- 360 world’s homoeopathic congress. pare the therapeutic measures of the two schools in various affec- tions. First, What does Old-School medicine offer for the relief and cure of eye diseases ? In order to answer this question intelligently, I have carefully read and reviewed a recent text-book by a recognized authority — Noyes’s Diseases of the Eye — and noted every remedy recommended, with the indications for its employment. I have, of course, not noted local or surgical treatment, or the correction of refractive or muscular errors. The purely therapeutic resources, as therein out- lined, comprise forty-three remedies, almost all of which are pre- scribed upon the most general principles, and where specific indica- tions are given, they are most meagre in contrast with our methods of careful individualization. To particularize : “ appropriate ” gen- eral or constitutional treatment, such as alteratives, derivatives, stimulants, etc., are sometimes advised without explicit mention, and in other cases Cod-liver oil, Iron, Quinine, Arsenic, Malt and Hypophosphites, especially in ansemic debility, scrofulosis, etc. The following table shows a list of other medicines mentioned, and the diseases for which they are recommended. Diuretics and Purgatives , especially Rhubarb and Soda, Sal soda, Rochelle salts. — Phlyctenular keratitis, scleritis rheumatica, iritis, cataract, retinitis (apoplectica and albumiuurica), amotio-retinse, neu- ritis, neuro-retinitis. Salicylate of Soda, Lithates, Liquor potassce and other alkalies . — Rheumatic and gouty affections generally, particularly in iritis, neu- ritis, neuro-retinitis, periostitis, tenonitis, acute phlegmonous eczema of the lids, staphyloma of the sclera. Antifebrine, Antipyrine , Sulphonal, Morphia , Opium, Bromides, Chloral and Phenacetine. — To relieve pain. Iodide of potash. — Spasm of orbicularis, episcleritis, iritis, to arrest development of cataract, to clear opacities of the vitreous, choroi- ditis, retinitis apoplectica et syphilitica, neuritis, neuro-retinitis, retro- bulbar neuritis, atrophy of the optic nerve, periostitis orbitse, tenon- itis, generally in syphilitic and rheumatic affections. Mercury. — Syphilitic affections, diphtheritic conjunctivitis, inter- stitial keratitis, iritis, opacities of vitreous, sympathetic ophthalmia, choroiditis, acute and chronic, retinitis albuminurica, neuritis, neuro- retinitis, atrophy of the optic nerve. Arsenic, Zina, Argentum nitricum,. Phosphorus. — Various affections of the nerve and retina. OPHTHALMIC THERAPEUTICS. 361 Strychnia. — Neuroparalytic ophthalmia, cataract, retinitis pig- mentosa, amblyopia, amaurosis (genuine and hysterical), exophthal- mic goitre. Digitalis , Phosphoric acid , Ergot , Atropia , Strophanthus , Tonics and Sedatives. — Exophthalmic goitre. Digitalis. — Diseases characterized by feeble circulation and weak heart, such as ischaemia retinae, retinitis albuminurica, with vascular degeneration (also calling for Carbonate of ammonia), amblyopia, amaurosis. Muriate of pilocarpine , Infusion of jaborandi. — Amotio-retinae, staphyloma of sclera (in gouty patients), iritis, sympathetic ophthal- mia, acute choroiditis, neuritis, neuro-retinitis. Quinine. — To check threatened inflammation after cataract opera- tions, cellulitis, iritis. Aconite , Gelsemium , Conium. — Blepharospasm. Bromo-cqffein. — Hysterical amblyopia. Nitro- glycerine in gr. doses. — Retinitis apoplectica with high arterial tension. Mineral acids. — Cellulitis orbitae. Turpentine , Colchicum. — Iritis. Phosphoric acids , Phosphates. — Cataract. I believe this to be a fair and impartial resume of ophthalmic therapeutics from the Old-School point of view. It is not difficult to recognize the unconscious Homoeopathicity of many of their more specific applications ; at least, we use the same drugs in attenuated doses, with success, in the same diseases, only studying the particu- lar and minute indications for them according to the law of “similia.” The essential difference between their therapeutics and ours is no- ticed here as in all departments of medicine, viz., they prescribe for diseases while we prescribe for the individual. Which is the more scientific? In contrast with this array, I will «imply call attention to the detailed and specific symptomatology of the one hundred and forty remedies mentioned in the latest and best Homoeopathic treatise, that of Dr. Norton, already mentioned. While this list does not com- prise all the resources of our school — for almost every remedy in the Materia Medica may be found curative of eye diseases under appro- priate conditions — I offer it as a fair exponent of Homoeopathic treat- ment in contrast with the resume of Old-School therapeutics just 362 world’s homoeopathic congress. given. It is not a compilation of theoretical and empirical indica- tions, but is made up of thoroughly trustworthy and, for the most part, verified, indications. Experience has demonstrated them to be reliable guides for the choice of the remedy. But it may be argued that this is mere assumption on my part. It certainly would be presumptuous to expect any one to accept such an assertion without satisfactory evidence, and while I cannot demonstrate to the skeptic here and now the truth of my statement by adducing overwhelming evidence in proof of the value of remedies prescribed upon such a basis, yet I can affirm what the Homoeopathic treatment of eye dis- eases has accomplished, what it is accomplishing every day in hospi- tal and private practice, and what can be demonstrated to the satis- faction of any fair-minded investigator who cares to give the matter sufficient time and thought. What, then, are some of the verities of Homoeopathic ocular thera- peutics? I. — The action of constitutional remedies, such as Ars., Graph., Calc., Sulph., Nat. mur. and Sil. in hereditary or acquired conditions of malnutrition and in the various dyscrasise. II. — The action of Aeon., Bell., Apis, Verat. vir. and Rhus in controlling inflammatory conditions, erysipelas, cellulitis, etc. III. — The action of Hepar, Sil. and Rhus in suppuration, of Gels, in serous, and of Bry. in plastic exudations. IV. — The action of Arnica, Crotalus, Ham., Lach. and Ledum in arresting and absorbing haemorrhages. V. — The action of Sil., Calc., Aururn, Kali iodide, etc., in dis- eases of bone and orbit, morbid growths, periostitis, etc. VI. — The action of Amyl nit., Ferrum, Lycopus, Spongia, Nat. mur. and Ars. in exophthalmic goitre. VII. — The action of Puls., Apis, Alum., Merc., Ars., Euphrasia, Argent, nit., Rhus, etc., in catarrhal conjunctivitis, ophthalmia neo- natorum, specific blenorrhoea, etc., arresting inflammation, moderat- ing discharge, preventing corneal complications and averting many cases of blindness. VIII. — The action of Aurum, the Iodides, Baryta, the Kalis, Sil., Graph., Hepar and Merc, on corneal tissue, healing ulcers, resolving infiltrations, clearing nebulae, and thus often avoiding minor operations, such as scraping of ulcers and phlyctenules, the use of caustics and the galvanic cautery, and of paracentesis. OPHTHALMIC THERAPEUTICS. 363 IX. — The influence of Merc., Bry., Cedron, Rhus, Clem., Col., Spigelia and Potash in iritis, shortening very much its course under Old-School methods, averting sequelse and rendering narcotics un- necessary. X. — The undoubted influence of Caust., Sulph., Sepia, Phos., Sil. and Iodoform in arresting and delaying the development of cataract, and even clearing opacities of cortex. XI. — The influence of Bell., Bry., Gels., Aurum, Phos., Merc., Kali mur. and Kali iod. in various forms of choroiditis and retinitis. XII. — The beneficial effects of many remedies, especially of Nux and Phos., in inflammatory affections of the optic nerve and in atrophic conditions, cerebral and spinal. These are some of the solid facts of Homoeopathic therapeutics which cannot be controverted. As our knowledge of Materia Medica increases, especially as the pathogeneses of drugs are more accurately and scientifically devel- oped, our success will be measurably increased. There is some evi- dence as to the efficiency of Gels., Bry., Col. and other remedies in glaucoma, but the well-known influence of eserine and iridectomy makes it unjustifiable to withhold them in the majority of cases. The symptomatology of Osmium gives us a very suggestive picture of glaucoma. It ought to be helpful, though I am not conversant with any positive clinical evidence in proof of its efficacy. When a careful record of the tension, of the acuity and of the field of vision and of the ophthalmoscopic appearance of the fundus appears in our provings, then we may hope to dispense with myotics and iridectomy in the treatment of this disease. The influence of some of our remedies in checking the develop- ment of cataract, and of materially improving vision by the resolu- tion of cortical opacities has been abundantly proved, and affords a striking instance of the superiority of Homoeopathic ocular thera- peutics. Where do we find any such results from Old-School treatment as those published in recent years by some of our special- ists of recognized ability, whose statements are trustworthy, and whose diagnoses are beyond question ? The experience of Dr. Wm. R. King,* of Washington, with Iodoform is especially noteworthy. The treatment of cataract with remedies must, of course, rest upon * See Journal of 0., 0. and L., April, 1891. 364 world’s homoeopathic congress. a constitutional basis. Eye-symptoms alone do*not afford sufficient data for the choice of a drug. The underlying condition is the im- portant point to consider. An interesting illustration of the value of such a method of pre- scribing, and also of the fact previously noted, that a remedy may cure an eye-affection when indicated by constitutional symptoms, even though its pathogenesis contains nothing to indicate its special action on the eye, is afforded by a case of ptosis cured with Bromine 6x by Dr. Bissel, of Rochester, reported in the Journal of 0., 0. and L., for October, 1889. Bromine was selected on account of diarrhoea, eructations, pain like needles at the epigastrium and physo- metra. Bisulphide of carbon is worthy of trial in retrobulbar neuritis. Cases of poisoning suggest it Homoeopath ically to this affection. It has produced in several cases, “ diminution of vision, central scotoma, vision better in the evening, loss of appreciation of color, central scotoma for colors, and narrowing of eccentric field,” without oph- thalmic changes in the fundus oculi. Hirshberg described in one case “ an alteration of the macula characterized by the presence of whitish nodules.” These visual disturbances are associated with nervous symptoms, such as muscular weakness of the limbs, cramps in the legs and abdomen, diminution of hearing and headache.* Malignant growths of the eye and lids have seldom been materi- ally influenced by remedies, yet we now and then see a gleam of light in this direction which encourages us to hope for better results in the future. Such hints from accurate observers should be care- fully noted and remembered, and therefore I desire to call your attention to the report of a case of sarcoma by Dr. W. S. Searle, of Brooklyn. f A blind eye had been removed, and microscopical examination demonstrated the correctness of a previous diagnosis by Dr. H. Knapp, viz., spindle-celled sarcoma of the choroid. Ten days after removal, a secondary growth “ of the size of a chestnut ” was removed from the orbit, and Phos. and Tarantula cubensis were prescribed. The former was chosen on account of general con- stitutional indications, and the latter from its reputation in inflam- matory affections of connective tissue, especially in boils and car- buncles. After their use there was no return for nine months. * See article by H. H. Crippen in 0., 0. and L., April, 1891. f Journalof 0., O.and L., February, 1892. OPHTHALMIC THERAPEUTICS. 365 Then the growth again returned to a slight extent, but under a re- newal of the former prescription the nodule shrivelled and dropped off within a week, and the doctor wrote me recently that there had been no recurrence of the disease up to the present time, a period of two years since the second operation. These remedies are worthy of trial in similar cases, and I would also remind you of the published experience of the late Dr. George S. Norton and of Dr. French in the treatment of glioma retinae with Ceanthus Americanus, the fluid extract of red clover blossoms.* The value of Cinnabar as a remedy for ciliary neuralgias has been often demonstrated, where the indication of “pain extending from the inner canthus around the brow ” is present, but we owe to Dr. H. C. French a confirmation of the following indication for its employment, viz., a a full, heavy feeling in the whole head, tempo- rarily lessened by pressure.” “ Dull pain in the forehead over the eyes, increased by use.” “Shooting pains in the forehead.” “Stick- ing and itching in both canthi and in the forehead.” The patient had been under Old-School treatment for two years, and Dr. French gave him great relief in a few hours, and cured him in less than three weeks with Cinnabar. The curative influence of Agaricus in spasmodic affections of the lids and ocular muscles has long been recognized, but its influence in amaurosis and hysterical amblyopia was first suggested to me by an article by Dr. Rounds, f Some slight impairment of vision is suggested in the proving of the remedy, but that a total blindness of both eyes — “only slight perception of strong light remaining” — should be entirely cured, and perfect vision restored after the patient had been blind for several years, is certainly surprising and worthy of note. The sight of the right eye was suddenly lost after a blow upon the head four years before treatment was commenced, and that of the left eye as suddenly and completely failed after exposure to rain. For two years she could not tell night from day. The only other treatment employed was galvanism, and as this was used with- out avail for two months before prescribing Agaricus it seems reason- able to attribute the recovery in large measure to the medicine, although electricity was continued at irregular and increasing inter- vals during the time of treatment. Nystagmus, nictitation and other * See 0., O.andL ., April, 1890, and Trans. Am. Inst , 1884. f See Journal of 0., 0. and L., October, 1891. 366 world’s homceopathic congress. nervous and hysterical symptoms led to the choice. The ophthal- moscopic examination was negative. Fifteen drops of the tincture of Agaricus were taken daily in divided doses for a period of eight months, when the patient was discharged with perfect vision in each eye, and entirely free from nystagmus, etc. She has since earned her own living as a stenographer and typewriter. Experience has repeatedly proved the efficacy of Gelsemium in various diseases of the eye, especially where serous exudation exists, and in paretic affections of the muscles, but its Homoeopathicity to amaurotic affections is suggested by the following observation of Dr. W. A. Phillips. In a certain patient, 5 gtts. doses of the tincture invariably produced the characteristic symptoms of giddiness, head- ache and heaviness of the lids, followed by almost total loss of vision. At one time the accommodation failed first, while at another the sensibility to retinal impressions seemed to precede the loss of adjust- ment. In forty minutes after the five drops were taken the vision was reduced to It could not be improved by lenses, and this diminution continued from five to fifteen minutes. Normal vision returned in from one-half to two hours. No ophthalmoscopic changes were observed.* Paris quadrifolia is a valuable remedy in certain cases of asthen- opia. The sensation “as if the eyes were being drawn back into the head by cords” is a reliable indication for its employment, and led the writer to select it, and to effect a gratifying cure of chronic headache. Dr. French cured with Paris a paralysis of the external rectus where this symptom was present. He also emphasizes the following as trustworthy guides for its use, viz., “ inability to fix the eyes steadily upon anything; eyes seem swollen, as if their orbits were too small, so that the eyes could not be easily moved. ”f Kalmia is helpful in certain cases of asthenopia. Dr. Boyle has had gratifying success with it in episcleritis and tenonitis, J where the patient complained of “soreness of the eyeballs to touch and motion ” “Injection of the conjunctiva, chemosis around the cor- nea.” “ Feeling of stiffness of the muscles.” The pathogenesis of Cannabis sat. and Cannabis ind. exhibit a striking similarity to pterygium, and they ought to be curative of * See 0. and 0., April 1, 1890. f See Journal of 0., 0. and L ., January, 1889. | See Trans. N. Y. State Soc. } 1891. OPHTHALMIC THERAPEUTICS. 367 that condition. They have been curative in vascular conditions of the cornea, and Dr. Wanstall cured with Cannabis ind. a case of pustular keratitis, with pterygium-like injection of the conjunctiva.* Chrysophanio acid should be remembered in cases of chronic ciliary blepharitis, especially in scrofulous, ill-nourished children. The writer on one occasion prescribed an ointment composed of eight grains of the acid to an ounce of vaseline, to be cautiously used on the edges of the lids. The patient, thinking if a little was good a great deal was better, applied it freely over all the lids and conjunc- tiva. A very violent inflammation followed, but the blepharitis was permanently cured. The Homoeopathicity of Colocynth to iritis characterized by burn- ing, sticking, cutting pains, extending from the eyes into the head, increased at night and by stooping, lessened by pressure and walk- ing in a warm room, was exemplified by an experience of the writer, where the disease, if not primarily caused as there seemed reason to believe, was without doubt markedly aggravated by the use of a hair wash containing Colocynth. j* The successful use of Hypericum in injuries of parts rich in nerves, and in pains from old cicatrices, led Dr. Moffat to prescribe it with benefit in pain arising from anterior synechiae after the patient had suffered several years. In conclusion, let me again emphasize the need of careful exam- inations of the eyes of persons, and the accurate record of variations of tension, of visual disturbances, of muscular conditions, of ophthal- moscopic changes and so forth, by skilled specialists, in order that subjective symptoms may be correctly interpreted, and our sympto- matology be more scientific and reliable. Every committee of provers, every Materia Medica laboratory should have a competent oculist. Let me urge upon our specialists the duty of careful prescribing, of painstaking detailed records, and of publication of successes and of failures with remedies Homoeopathically prescribed, that we may attain greater accuracy in prescribing, that our knowledge of the positive effects of drugs may be extended, and that we may achieve greater success in the treatment of eye-affections according to the law of “ Similia Similibus Curantur,” and relegate operative measures * See Norton’s Ophthalmic Diseases and Therapeutics. f See North Am. Journal of Homoeopathy, 1887. 368 world’s homoeopathic congress. and local treatment more and more to positions of a secondary im- portance. The day is surely coming when Homoeopathy will be universally recognized as the “Science of Therapeutics,” and when the Homoeopathic specialist will be the exponent of the highest de- gree of scientific and skillful treatment. Discussion. J. H. Buffum, M.D. : Dr. Linnell has presented to the Congress an able epitome of the present status of ophthalmic therapeutics, which must carry with it the conviction of truth. Perhaps, in no department of medicine have such advances been made in diagnosis, prognosis, and pathology, as in that of ophthalmology, until it has now become one of the most exact and scientific in the domain of the healing art. Small as the organs of sight are, as compared with other organs of the human body, their relation to the whole animal economy is such as to carry with it need for a full knowledge of not only the anatomy, physiology, and pathology, of all organs, but also their dependence, in health or disease, to the various affections of the eye. On the other hand, the ophthalmologist has been able to determine the exact relation which certain conditions of the eye, either physio- logical or pathological, bear to various diseases which are termed re- flex and general. As Homoeopathic ophthalmologists, we should carry our Homoe- opathy into our practice, not only as followers of the wisdom and philosophy which emanated from Hahnemann, who gave us a uni- versal law of cure, but also, because we owe it to our clients who confide their cases to us and expect to be cured homoeopathically, primarily, and secondarily only, when we have failed from a want of knowledge of our Maieria Medica Pura. The ophthalmic practitioner of our school has had, until the last few years, but little to aid or encourage him in his adherence to the tenets of his faith, owing to the fact that the basis of his knowledge of drugs in their active relation to eye diseases has been uncertain, as too often the pathogenesis, as set forth in the provings of the remedies was found thoroughly unreliable when applied to the treat- ment of the eye. Hence, the older ophthalmic surgeons of our school have had to acquire from close study and observation of the clinical effects of our drugs, a system of ophthalmic therapeutics derived from our knowl- edge of our Materia Medica, and their own clinical observation, which is now rapidly being augmented by the increased number of workers in this department. Eventually, in the coming years, when the true laborers in the field of Homoeopathic ocular therapy have brought in the harvest of pathogenetic, clinical, and curative OPHTHALMIC THERAPEUTICS. 369 symptoms, we shall find, when the grain is separated from the chaff, that but little remains to desire, save the proper application of this accumulated knowledge to the scientific Homoeopathic cure of all ophthalmic diseases. It is difficult to supplement the careful rbsurn'e, of the verified ac- tion and indications of the Homoeopathic remedies which have so ably been demonstrated in the paper which is before us for discus- sion. Dr. Linnell has, with the utmost care, culled from our litera- ture the most valuable verifications of Homoeopathy as applied to the treatment of ocular diseases. It remains, then, only for me to add what may have come to my knowledge as a result of my own individual experience and observation in ophthalmic practice; am- plifying here and there, and presenting perhaps, now and then, a grain of pure gold, which years of study and observation have en- abled me to separate from the dross which surrounded it. The poverty of the armamentarium medicum of the Old-School in its application to ocular therapeutics is manifested, not so much in its lessened number of drugs for internal medication, as in the want of specific indications for their use. The richness of our drug armament stands out in glittering contrast, not perhaps by the greater number of remedies, but by the knowledge of our Homoeo- pathic law which enables us to prescribe these drugs with an assurance of the curative results which inevitably must follow their proper administration. It is not necessary to discuss seriatim the list of verities of Ho- moeopathic ocular therapeutics which Dr. Linnell has presented, as they are no longer in doubt. We should all endeavor, as soon as possible, to increase their number by adding to those mentioned others rich in possibilities, but which yet lack that confirmation which must come from repeated trials. In the list presented I desire to emphasize the actions of Homoe- opathic so-called constitutional remedies in lessening and dissipating the various dyscrasias mentioned, and thus enabling us to cure the alternate effects as exhibited in the eye. The actions of those remedies mentioned as controlling inflam- matory effects of the eye, we all daily prove the truth of in our prac- tice. In reference to the action of Rhus tox. in promoting, controlling, and limiting various traumatic and surgical inflammations, perhaps little need be said, but for Hepar sulph. which has exhibited such marvellous action in controlling, limiting, and absorbing pus within the eye, too much praise cannot be given. With these two remedies eyesight and eyeball have been saved time and again, when no other known treatment could possibly have controlled the inflammation, lessened the pain, saved tissue, and caused the absorption of the products of inflammatory attacks. To watch the action of either, 24 370 world’s homoeopathic congress. when indicated in these affections of the eye makes one feel that our remedies have an action only short of the miraculous. In iritis the action of Terebinth, which, in the Old School, finds a place of value, is with us too often neglected, as, like Asafoetida, it has a specific action upon the inflamed iris, and both not only lessen the ciliary neuralgia but shorten and cure the attack. In controlling the inflammatory and degenerative changes in the lens which result in cataract, the action of our remedies presents often in my experience the further proof of the Homoeopathic law of cure. In the lens, as well as in the cornea, iris, vitreous, retina, and cho- Toid, we can watch from day to day the limiting, absorption, and sight-restoring effects of our remedies. Glaucoma, when presenting a mechanical obstruction of the excre- tion of the fluids of the eye, cannot come under the domain of medi- •cine.; but for those glaucomatous conditions which are dependent upon the hypersecretions resulting from neurotic irritations, the reme- dies mentioned by Dr. Linnell often afford us brilliant results. In simple non-inflammatory glaucoma of chronic type, Sulphur, Nux vomica, and Phosphorus have controlled the disease and saved the vision in cases where neither iridectomy, sclerotomy, or myotomy had been allowed, and also in cases where some or all of these operations had been made without control of this sight-destroying disease. In addition to those that have been mentioned in the paper, there are some affections of the eye and the therapeutic means for their re- lief to which I desire to call attention as exhibiting the desired action of our remedies. Hyperiemia of the retina, while usually symptomatic, is, I believe, more often idiopathic than we are inclined to think. While this con- dition is difficult of diagnosis, owing to the variableness of the cir- culation of the retina within physiological limits of the individuals, and in cases where such immediate causes as refractive errors, foreign bodies, or inflammation of the contiguous tissues of the choroid and iris have been excluded, we are justified in making such a diagnosis. I find that taking the increased capillary circulation of the optic disk as an indication, rather than that of the retinal vessels, together with the subjective symptoms of asthenopia, a safe guide to the diagnosis of a condition which often presents a series of symptoms extremely annoying to the patient and often difficult of relief, unless we find in such remedies as Belladonna, Cactus, Cimicifuga, Duboisia, Amyl nit., and Phosphorus the similimum. Cases of temporary amblyopia which arise from spasm of the retinal arteries or result from vaso-motor irritation of the cerebro- retinal circulation, and thus temporarily disturb the nutrition of the optic nerve and retina and destroy its function, more fre- OPHTHALMIC THERAPEUTICS. 371 quently come to the notice of the general practitioner than to the ophthalmologist. Such amblyopias, while often temporary and symptomatic of the cephalalgia which follows, sometimes tend to be persistent, and even when the amblyopia has disappeared we may find scotomas, which become sources of discomfort or causes of subjective symptoms, which make difficult the diagnosis of the eye condition. In these cases, where there is found a migraine history, recent or remote, there are three remedies which cover a multitude of discomforting symptoms, namely, Gelsemium, Physostigma, and Strychnia phos. For the amblyopia which precedes the attacks of headache, and which itself is often preceded by symptoms, more or less marked, of irritation of the retina, perhaps no remedy is more valuable than Amyl nitrite by inhalation, which, while shortening the attack as far as the disturbance of the vision is concerned, yet lessens not the ten- dency to recurrence nor removes the cause. As an example of what may be accomplished by remedies which, as far as we know, have shown in their pathogenesis no direct action upon such conditions yet exhibit their curative powers in a remarkable degree, I take from my case- book the following record of Miss P., set. 23, who consulted me in 1888, with a history of temporary amblyopia, which usually oc- curred only in the right eye, but occasionally in the left, the attacks coming on in the morning after breakfast or on awakening, if she had suffered from insomnia. During the years before consulting me she had had six attacks, whose duration lasted from an hour to four or five. At the time I saw her a central scotoma of the right eye was evident, but a diagnosis of circulatory changes in the eye was doubt- ful. In the inception of the attack, a point of light was observed by her on the temporal side, which increased until it became a wave of light. In some of the attacks the waving of the light became rapid and caused vertigo. The attacks were modified by lying down. Her eyes were emmetropic and the vision normal. Has no special head- aches. Bryonia was prescribed, and there was no return of the trouble for a year, when she again had a recurrence of the trouble, and came for some more of the remedy. In the four years since there has been no return of the trouble. Some sixteen years ago, after reading the experience of Bell and Kiihne in their efforts to demonstrate the retinal purple, I was im- pressed with the fact that Muscavine and Pilocarpine seemed to have the peculiar property of increasing the secretions of the light dis- coloring matter which is formed about the base of the rods of the retina. Acting upon the suggestions thus presented by the physio- logical provings of these drugs, I have used them for many years with success in cases of amblyopia, where I have been able to deter- mine by exclusion of other causes that the deficient vision was de- 372 world’s homoeopathic congress. pendent upon a probable functional derangement of the retina and optic nerve. While I have already reported the good results follow- ing the administration of Agaricus and Jaborandi in restoring the vision in many cases of what might be termed torpor-retinae or func- tional anaesthesia, I have also observed that Agaricus has a curative result in cases of hyperaesthesia retinae. In regard to the action of Agaricus in optic nerve atrophy, I regret to say that I have been unable to get an improvement in the vision from its use. Some cases of toxic amblyopia arising from nicotine poisoning, where the atrophy was only partial, have certainly been benefited by it. Such remedies as Gelsemium, Ignatia, Phosphorus, Sulphur, arid many others might also be mentioned as having directly or indirectly a marked action in improving the functional activity of the retina. In hypersesthe- tic conditions of the retina, where all local, refractive, and reflex causes have been removed, the action of the Homoeopathic attenuated drugs, such as Macrotin, Hyoscyamine, Atropine, Conium, Agaricus, Nux vomica, and Ignatia, are often marvellous in the rapidity of their action. The results obtained from the proper administration of the indicated remedies in these cases where the failure from the more general treatment of the opposing school of medicine is com- mon, are the more remarkable, and tend to give one new effort and a desire to place again and again fresh laurels upon the already well crowned head of Hahnemann. The results obtained by the Homoeopathic administration of Physostigma, Jaborandi, Gelsemium, Agaricus, in cases of spasm of the accommodation associated with refractive errors, have enabled me for the last ten years to do away with the use of Atropia, Homa- tropin, Hyoscyamine, and other mydriatics which are commonly considered necessary for the paralysis of the accomodation in the prescription of glasses. It has been my experience that the results of my prescriptions for correcting lenses have been much more sat- isfactory than when I have used mydriatics, and where the reflex symptoms arising from eye-strain, such as neuralgia and headaches and other more remote neuroses, were often relieved before the glasses were prescribed. Again, it may be said that these and other remedies relieve the eye strain of both the intrinsic and extrinsic muscles of the ball, as reflexes, when the total optical defect has been corrected by the prescription of glasses, based upon the supposed complete paralysis of the accomodation under Atropia or some other drug similar in action. In the insufficiencies of the recti muscles, whether the cases ex- hibit an exophoria, esophoria, or a hyperphoria, we find that a close study of our cases with the prescription of such remedies as Argent, nit., Nat. mur., Gels., Senega, Physostigma, Agaricus, Mercurius, and Phosphorus, we are able time and again not only to relieve the OPHTHALMIC THERAPEUTICS. 373 discomfort attendant upon the muscular deficiency, but also to avoid the aftermath of graduated tenotomies which daily confront us in search of relief which even our Homoeopathic law cannot repair. Thanks to the increasing intelligence of the medical profession the fad of to-day, whether in our department of medicine or in any other, is dead to-morrow, but while our colleagues in general medi- cine and surgery may bury their dead, ours too often with practically useless organs of sight confront us with their tale of woe in their tenotomized and be-prismed eyes. Careful study, the painstaking prescription of the Homoeopathic remedy in our department of medicine, not only gives us the satis- faction of cure where other methods have failed, but also enables us to thus make a more enduring monument to Hahnemann than that of bronze which we design to erect to him. F. Parke Lewis, M.D. : Mr. President , Ladies and Gentlemen : Everything that Dr. Linnell writes is written with care. I never yet have seen anything from his pen that was not truly worth read- ing. It follows, as a matter of course, that the summary of the value of drugs which he has given us is one which has a very definite and distinct value. The thesis of this paper, however, is one in which in an interrogatory way he asks us if we may not accept. It is this: He says: “Knowing that certain constitutional symptoms are accompanied with morbid conditions, and having cured this con- dition by the exhibition of the similimum, are we not justified in saying that any subsequent case, in which the morbid condition of the eye alone appears, we may assume that had the drug in the prov- ing been given long enough the condition of the eye would have dis- appeared, and that we may take that as a basis for subsequent prescriptions of that drug?” Can we? I wish I could believe absolutely that that were true, because it would give us a basis for the exhibition of our Homoeopathic remedies, a very true and very sure one. In other words, if it were always possible to say that because certain conditions have been cured by the exhibition of a certain remedy, we may assume that when these conditions of the eye ap- pear independent of the constitutional conditions that appear in the first place, that we will also cure that disease. I think we would have a certainty in the application of our Materia Medica that would be very desirable, a certainty in prescribing, which I am sorry to say I do not always feel, and I question whether we may accept in its entirety the thesis of Dr. LinnelPs paper. The case he cites, for instance, of Dr. BisseFs, is, it seems to me, a classical one. Bro- mium was given for certain constitutional troubles, accompanied by ptosis — the ptosis disappeared. We had a definite Homoeopathic prescription, followed by a cure; but are we justified in presuming that, should ptosis appear without these constitutional symptoms, Bromium is going to cure that ptosis? I do not believe that 374 world’s homoeopathic congress. we can alwa) T s do that. The consequence is that we have in our Materia Medica a great many symptoms which we accept as verifi- cations, about which, in my mind, there is question. Immensely valuable suggestions, immensely valuable to us in our prescriptions, but not symptoms upon which we can pin our faith with absolute reliance. For instance, I have frequently given Gelsemium in iritis, and have not cured my case; therefore I have concluded that Gel- semium is not the remedy for iritis. It may be, but it is not always. The reason I believe that we have such a small proportion of definite symptoms connected with the eye in our Materia Medica, is only partially due to the fact that we have not had skilled specialists to make examinations of these conditions ; it is only partially due to that. I come more and more to believe that the eye is not, in a very large proportion of cases, directly and specifically acted upon by drugs administered internally. I wish to be understood in this matter. I am not in any degree under-estimating the immense value of Homoeopathic therapeutics in diseases of the eyes ; I am simply questioning the application of this therapeutics. I am by’ no means criticising the results which have been obtained in the hands of our careful prescribers. That those results have been obtained, I also have no doubt; but I do believe that a large proportion of the dis- eases of the eye (if we exclude traumatism, refractive and muscular troubles — I mean traumatism of bright sunlight on the retina) — are the results of diseases of some of the other organs of the system ; some of the great organs of the nervous system, or of the circulatory sy r stem. And unless we take into account the power which each of these conditions may have upon the disease of the eye, I am inclined to think that we lessen ratherthan increase our knowledge of the thera- peutic action of drugs upon the eye. I hope I make myself clear in that, because I have such an unbounded faith in Homoeopathic remedies in diseases of the eye that I do not wish to be wrongly understood in the matter. But as to the methods we sometimes adopt in determining the action of drugs upon the eye, I think there is room for frequent error. It is unnecessary to talk to those who are thoroughly informed — as thoroughly informed as those are to whom I am speaking — in regard to the nature of diseases of the eye, and the necessity of exact diagnosis ; and yet I believe that in the administration of drugs therapeutically, an exceedingly exact diagnosis must be made, otherwise we are apt to be led into error. To explain what I mean more particularly : I remember trying for a long time to treat a peculiar form of cataract (a dotted condition of the lens, which I have seen in several instances), and without any appreciable effect. I subsequently found that there was present in that case a refractive condition, which had been overlooked, a slight difference in the foci of the two eyes, and the correction of which absolutely corrected the whole difficulty. In OPHTHALMIC THERAPEUTICS. 375 other words, it relieved the strain on the ciliary muscle, it relieved the nutrition of the eye, and the eye cleared in consequence. I don’t mean to say that that kind of cataract comes inevitably as a result of muscular or ciliary strain, but I do mean to say that in a very large proportion of these cases the correction of muscular and of refractive errors will eliminate the necessity for the exhibition of internal medication. I am very much interested in what Dr. Buffum has said in regard to the action of drugs in relieving and curing ciliary spasm. I was very much interested twelve or fifteen years ago when Dr. Woodyatt announced the value that he had obtained from Argentum nitricum in those troubles, possibly because I have not had opportunity of following those cases as I would like to ; but I never have had the entirely satisfactory results in internal medication, in focal and refractive troubles, which others seem to have had. Where there is a muscular condition which is not benefited, I have almost always found those conditions return for further treatment. 376 world’s homoeopathic congress. THE REFRACTION OF THE EYE. By Thomas M. Stewart, M.D., Cincinnati, O. By invitation from the Chairman of the Section of Ophthalmol- ogy to prepare the paper on the general topic of “ refraction ” we are acquitted of any undue assumption in coming before you. While the chairman is thus responsible, both for our presence here and our topic, we must say that it would have been difficult to select a ques- tion in the whole range of ophthalmology more important than that of how to deal with errors of refraction, for, after all, this is the practical basis of the general topic which it is our privilege to dis- cuss at this time. To treat this subject satisfactorily two things are requisite: The one is, an understanding of the conditions of accurate vision ; the other, an understanding of the appliances for estimating the re- fraction of the eye. What, then, are the Conditions of Accurate Vision? Two conditions must be fulfilled in order to see an object dis- tinctly.* In the first place, an inverted but well-defined image of the object must be formed on the layer of the rods and cones of the retina. In the second place, the local irritation here excited must be conveyed to the fibres of the optic nerve, communicated to the brain, and again, in an inverted direction, projected outwards. We may say, therefore, that every disturbance of vision depends upon a derangement in one of these two conditions, or both together. If the projection outward be deranged by disturbances in the retina, in the optic nerve, or in the brain, the affection belongs to the domain of amblyopia or amaurosis. If no image be formed, or if the image be distorted through diffusion of light in the eye, obscurities in the way of the radiation of light through the organ are the foundation * Refraction and Accommodation of the Eye. Donders, London, 1864. THE REFRACTION OF THE EYE. 377 of the mischief. Finally, if the image of objects placed at the ordi- nary distances of distinct vision be not formed on the layer of rods and cones, or even if, through abnormal curvature of the surfaces of cornea or lens no defined image is on the whole produced, anomalies of refraction or of accommodation are developed. In order, then, to proceed in some systematic manner to do justice to this subject in the light of modern methods and instruments, we will suppose that we have an eye in which vision is impaired. From the foregoing we have one of these three kinds of disturbance with which to deal. The opthalmoscope and the oblique illumination will at once show whether obscurity of the light refracting media or some pathological change in the nerve or retina be present or not. If such be not found, we may infer the existence of either amblyopia or of a disturbance in refraction and accommodation. If now with the aid of the different methods of estimating the refraction of the eye, perfectly defined vision can at no distance be obtained, the case is one of amblyopia. If, on the other hand, vision is clearly defined at one distance or another, we have to deal with an anomaly of re- fraction or accommodation. It is understood that the anomalies of refraction are to be sought in the form and structure of the eye with the accommodation at rest. The anomalies of accommodation have their basis in the abnormal action of the internal and external muscular system, for accommo- dation and convergence are associated functions; neither is to be ignored if the best results are to be secured. In dealing with the anomalies of refraction we must take note of the Appliances for Estimating the Refraction of the Eye. In addition to the trial lenses and the ophthalmoscope, we now have the ophthalmometer and Dr. Lambert’s discs of lenses for use in retinoscopy. The full consideration of these instruments, their range and application in the service for which they have been de- vised, would alone carry us far beyond the time appropriate for the presentation of the subject of this paper for your discussion. The determination of the state of refraction by the glass giving the most distinct vision at twenty feet, with uniform illumination, is the method with intelligent patients, less open to objections than any other, the possibility of the physician’s bias being likely to in- vite criticism in ophthalmoscopic and other objective tests. 378 world’s homceopatiiic congress. But before we make use of any one or all of the appliances herein mentioned we must dispose of the subject of Mydriatics. The question, whether or not, the ciliary muscle of the eye should be paralyzed in estimating the refraction is still an open one. The reasons for this are many: first, the time taken to thoroughly sus- pend accommodation ; second, the doubtful efficacy of Homatropine as a substitute for Atropine; thirdly, the questioned value of the ophthalmometer in measuring corneal astigmatism ; fourthly, the questionable value of the direct and indirect ophthalmoscopic exam- inations. To solve the question requires a knowledge of that which a my- driatic is supposed to do, together with the reasons and necessity for doing it; this knowledge must be supplemented by an apprehension of the relative merits of the different mydriatics, together with the principles, mathematical and optical, underlying the uses of the oph- thalmometer and the ophthalmoscope. It is fair to assume that a mydriatic exercises three functions : first, to paralyze the ciliary muscle, because accommodation is equiv- alent to increased refraction; secondly, to dilate the pupil, and hence to facilitate a thorough examination of the refractive media and the periphery of the eye ground ; and thirdly, to place the eye at com- plete physiological rest, so that the lesions so commonly present as the result of eye-strain may subside — not alone, we take it, merely because there is physiological rest, but a distinct sedative influence exercised by the drug. The following table, compiled from private and published records from 1888 to 1893, of 2000 eyes examined without mydriasis, and the ametropia thus found compared to the ametropia of the same eyes examined under full mydriasis, is an object-lesson relative to this question. Without With Mydriasis. Mydriasis. Per Cent. Per Cent. Emmetropia, .... . 16* 1 Myopia, . 9 4 Hyperopia, .... . 10* 31* Simple hyperopic astigmatism, . 15* 5 “ myopic “ . 23 2 Compound hyperopic . 10* 41 “ myopic “ . 12 10 Mixed astigmatism, . 3 5* 100 100 THE REFRACTION OF THE EYE. 379 Therefore, in answer to the question, is it necessary to paralyze the accommodation in order to prescribe the most suitable glasses, I answer, yes. The second point for solution — the best agent to use for the pur- pose of paralyzing the accommodation — is also in dispute. Iiydrobromate of homatropine, because of its rapid action and transitory effect, is the favorite mydriatic for refractive purposes. Its efficiency is questioned ; ophthalmologists of equal eminence hold diametrical opinions upon the subject. Those who think it sufficient to produce complete paralysis of the accommodation state that it should be instilled every five or ten minutes, and three or four in- stillations practiced, and that the examination should be made within one or two hours. Using it in this way, and following it by another mydriatic without alteration in the result, are the statements of such reliable observers as Dr. Edward Jackson, of Philadelphia, Dr. Henry Gradle and Dr. F. C. Hotz, of Chicago. Those observers who oppose the efficacy of homatropine to properly suspend the ac- commodation, do not, it seems to me, use it as directed. Their pub- lished statements say, “ Frequently used a 4 per cent, solution of Homatropine from twice to four times in an hour, and by the sub- sequent use of Atropine determined accommodation had not been completely abolished ; for a greater degree of hyperopia appeared under the latter.” A series of twenty-five cases examined as follows: At the first consultation the usual record was made of the condition of the eyes and appendages, apparent refraction, vision, and whether the latter could be improved by lenses or not.* The eyes were then subjected to the influence of Homatropia. For this purpose a fresh l per cent, solution was employed, and of this one drop was instilled into each eye five times in the course of fifty minutes, and the examination begun in an hour from the time of the first instillation. A record was made of the time of each in- stillation and of the time of commencing the examination. Then a record was made of the state of refraction, and the patient directed to return the next day. In the meantime a drop of a 1 per cent, solution of Sulphate of atropine was to be instilled in the eye every three hours. It was so planned that at least four instillations of Atropine should be secured. * Eye Records, Pulte Medical College, Cincinnati, 1892. 380 world’s homceopathic congress. When practicable, the Atropia solution was continued for two or three days, with daily notings of the condition of refraction, and in some cases where there were other indications for Atropia this was continued for several weeks. In each case the state of refraction was determined by the glass giving the most distinct vision at twenty feet, with good and uniform illumination. Control tests by ophthalmoscopic and keratoscopic methods were also employed. In the analyses of the cases they were divided into four groups: 1. Those in which there was no difference in the effect produced by Homatropia and Atropia — fourteen cases of the twenty-five, or 5d per cent. 2. Those in which the use of Atropia for twenty-four hours showed a diminution of refraction, without further change by longer continuance of Atropia — two cases, or 8 per cent. The addition of a -f.25 D. cylinder was required for the right eye in one case. 3. Those in which the use of Atropia for twenty-four hours showed no change from the relaxation produced by Homatropia, but in which change developed by longer use of Atropia — three cases, or 12 per cent. These three cases were of simple hyperopia, and required from .25 D. to .50 D. stronger convex glasses. 4. Those in which there was change from Homatropia to Atropia used twenty-four hours, but in which there was also additional change by longer use of Atropia — four cases, or 16 per cent. Three of these four cases were of mixed astigmatism, the changes in the glasses being represented by one of the strength of 0.25 D. ; the fourth case was of hypermetropia requiring convex lenses of 0.50 D. stronger than shown under the test of twenty-four hours. The use of atropia after homatropia and the use of atropia be- yond the period of twenty- four hours shows the additional refraction revealed to have ranged between 0.25 I). and 0.50 D. The records of thirty-two eyes carefully analyzed by the author, in which the examination under homatropia was made with a four per cent, solution used four times in an hour, followed by atropia used at least three times in twenty-four hours, gives the following : 1. The ages varied from 16 to 26 years. * 2. Refraction, hyperopia or hyperopic astigmatism. 3. No difference in the refraction under homatropia as compared with atropia, two eyes, or 6J per cent. THE REFRACTION OF THE EYE. 381 4. A diminution in refraction under atropia after the use of homatropia noted in all of the remaining thirty eyes, or 93} per cent. 5. The additional refraction revealed ranged between 0.25 D. and 0.75 D. ; in one case the difference was 1.50 D. Comparative tests of atropine and hyoscyamine have shown the latter to paralyze the accomodation in from twenty to thirty minutes, strength of solution one part to one hundred of distilled water, one drop in each eye. In five cases the methods employed were as fol- lows, apparent refraction ascertained ; hyoscyamine instilled, in thirty minutes near point found to coincide with far point, refraction ascertained by trial lenses and control tests; atropia used three times in twenty-four hours, refraction ascertained as before. In all of the five cases the results coincided. The effects of the Hyoscyamine, in another series of five cases, were found to pass off in from three to eight days; the accommodation was interrogated to determine this point accurately. In none of the cases were disagreeable symptoms noticed. The ages ranged between 12 and 29 years. The second point, the mydriatic best adapted for general use, seems to be hyoscyamine because of its rapid action, the readiness with which the ciliary muscle recovers its power, and the uniformity of results in comparison with atropia. Risley (S. D.) on Hyoscyamine as a Mydriatic . — The superiority of the solution of the white salt of Hyoscyamine as a mydriatic over the other solanacese is so great that the writer uses it for all refractive work except in selected cases. The reason why many are disappointed in its use is a lack of care in selection of the specimens of the salt. In all cases where its use was followed by smarting and too long persistence of mydriasis, it was found, where the history of manufacture could be followed, that it had been made from the amorphous semi-fluid salt, and not from the white, dry crystals. Hyoscyamine is isomeric with Atropine and Duboisine, and so is very closely related to the others. Indeed, W. Will has shown that, under certain conditions only, Hyoscyamine can be extracted from Belladonna, and then turned into Atropine by simply heating to the melting point, treating with an alkali, or heat in the presence of hydrochloric acid. One grain of a 10 per cent, solution of Hyoscya- mine was completely converted into Atropine by one drop of soda solution in two hours. The writer concludes, first, that for ophthal- 382 world’s homoeopathic congress. mological purposes only the pure crystals of Hyoscyamine skillfully prepared should be used; second, that in dispensing it the solution should be strictly neutral, that only moderate degrees of heat, if any, should be used, and, when filtered, this should be done through neutral paper . — Annals OphthaL and Otol . , Kansas City, Janu- ary, 1892. In all cases requiring the use of a mydriatic it is well to follow Dr. Edward Jackson’s advice; that is, to place the drop on the upper part of the cornea, allowing it to flow down over its surface; prevent the lids from closing, and thus carrying part of the drug away, and to prevent the drug from entering the puncta lachrymale. The Ophthalmometer.* It is just a century since the English philosopher, Thomas Young, observed the asymmetry of the dioptric system in his own person, and who is accepted as the discoverer of regular astigmatism. Nearly fifty years passed before this knowledge influenced the prac- tice of prescribing glasses. In 1827, England’s Koval Astronomer, Airy, described the asymmetry of his own eye and considered it as a defect. He was the first to have used cylindrical glasses for the cor- rection of the error he himself discovered. The invention of Helmholtz’s ophthalmometer gave a new impetus to the study of this imperfection of the human eye. Many famous physicists with the aid of this instrument studied the dioptric system of the eye. Fundamental points were settled, as, for instance, that the curvature of the cornea is not changed by accommodation ; that astigmatism is almost exclusively due to the form of the outer surface of the cornea ; that all eyes, with but few exceptions, have a certain degree of astigmatism ; that the meridian of strongest refraction is the vertical one in the great majority of cases. Notwithstanding all this, the ophthalmometer did not come into general use, and practice contented itself with subjective tests. To Javal’s energy and perseverance we are indebted for the special * “ The Determination of Astigmatism with the Ophthalmometer.” Carl Kel- ler, M.D., Journal Am. Med. Ass’n, September 13, 1890. “Javal’s Ophthalmometer and Atropine.” N. Y. Med. Journ., September 10, 1892. “The Main Defects of Javal’s Ophthalmometer.” Carl Weiland, M. D., Medical News, June 4, 1892. THE REFRACTION OF THE EYE. 383 form given to the ophthalmometer that bears his name. The prin- ciple of the instrument was, of course, well known before JavaPs time. Taking his starting point from the general stock of knowl- edge, Javal gave the bi-refracting prism a definite place in the tele- scope, then made the calculation for the refractive power of the cornea, and added the arc and two reflectors. The calculation and the arc, as well as the two reflectors, are not absolutely correct, hence variations noted by different observers and the necessity for increas- ing or diminishing the findings of the ophthalmometer by from one- quarter to one-half dioptre. In the first place, Javal makes the relation of the object to the image depend upon the formula ~ = — , which is the formula used I r by Helmholtz in his calculations, but he placed his object at 2000 mm. from the cornea, while Javal makes the distance equal only 270 mm. This formula is right, if the object lies so far from the mirror that its image falls at the focus of the mirror, which is at V 2* To prove the inaccuracy we must remember that JavaPs instru- ment that the image, i, is always a constant quantity as soon as the two reflectors have been adjusted so that their two inner images touch. Working out the problem we see, therefore, ^ = ^becomes ? = as r ’ ^ )e average radius of curvature of the cornea, equals o 7.0 7.8 mm. Then 0 = 215.13 mm., whereas the instrument makes O = 200 mm., to say nothing of the result obtained by using the v if we desire to fulfill the correct more correct formula 1 r condition stated above. Another source of error in the instrument arises from the fact that the reflectors slide on an arc, consequently the distance of the object from the cornea undergoes a change in the adjustment necessary to get contact of the images. While this error is small yet it helps to show that the instrument is not as accurate as we are led to suppose from statements of some observers. The remedy for this defect is simple and no doubt will soon be applied by the makers of the in- strument. In the calculations for finding the refractive power, or the radius 384 world’s homoeopathic congress. of curvature of the cornea, certain values not absolute in themselves, have to be adopted. Another observer using exactly the same formulae but adopting different values for the index of refraction of the cornea and aqueous, and for the radius of curvature of the cor- nea, will of course arrive at different results. But as we are dis- cussing the mathematical principles applied to the special form of the ophthalmometer of Javal, we must use the formula he himself has indicated, together with the values thereto attached. Javal’s formula for finding the refractive power of the cornea, in the different meridians expressed in dioptrics, is : _ 100 0 (n — 1 ) 350 v v Here n = 1.35, index of refraction of cornea and aqueous; and r = 7.8 average radius of curvature of cornea. But as we want to find the refractive power of the cornea for rays coming from the outer world, we must take account of the refractive index of the cornea in addition to its radius of curvature, for this alone tells us how far back from the anterior surface of the lens, parallel rays from distant objects would meet. Hence, the correct formula ex- pressed in dioptrics should read : _ 1000 (n — 1) _ 350 r n rn According to these formulae we have the following table illustrat- ing the differences : 35 j D of Javal ought to be 26.4 D for r = 10 mm. 43 D of Javal ought to be 32.2 D for r = 7.8, etc. Although the question is not as to the absolute refractive power of the cornea, but the difference between those powers in the differ- ent meridians, in other words the amount of astigmatism. But the amount of astigmatism is affected also, for example: 1 D astigmatism of Javal only = 0.75 D of the cornea. 2.5 D astigmatism of Javal only = 2 D of the cornea. 3.5 D astigmatism of Javal only == 2.6 D of the cornea. 6 D astigmatism of Javal only = 4.5 D of the cornea. THE REFRACTION OF THE EYE. 385 From the formulae given above for finding the refractive power of the cornea we see that all the values of Javal for the amount of refractive power of the cornea and the amount of corneal astigma- tism are n times too large if n = index of refraction = 1.35. Hence we see a reason for Javal’s instruction to subtract half a dioptre when the astigmatism was with the rule, or give the full correction or add half a dioptre when the astigmatism was against the rule. In giving this instruction, which is a recognition of the variation of the instrument, Javal assumed the variation to be a constant one. While this is so, we must not forget that half a dioptre does not always make up for the difference, and so not be led to expect more of the instrument than it is capable of giving. This instruction of Javal has been followed in all of the statistics of refraction examined with the instrument that have come under my observation, and to my mind is the reason for the good results obtained with the instrument in clinical work. In concluding this brief study of the ophthalmometer I have to> reiterate among other of our criticisms made at the meeting, one year ago, of the American Institute of Homoeopathy, viz., the very principle of the instrument is defective, because the bi-refracting prism is not achromatic, which makes it impossible to get the accu*- rate contact of the images so necessary for an accurate result, for the simple reason that a sharp definition of the images cannot be ob- tained. It is not uncommon experience to find the indications of the oph- thalmometer exactly reversed by subsequent use of other objective tests. For instance three cases recently examined in which Javal’s instrument indicated an astigmatism with the rule requiring for its correction either a convex cylinder axis 90° or a concave cylinder axis 180°. Retinoscopy, or the “illumination test” according to Schweigger, indicated the opposite conditions, the patients requiring for correction a convex cylinder axis 180°, which latter glass they accepted, getting perfect vision and comfort. From the foregoing we may summarize the use of the ophthal- mometer as follows : 1. It shows the meridians of greatest and least refraction with certainty. 2. By its use mydriatics may be dispensed with in a greater propor- tion than is the case with other methods of estimating astigmatism. 25 336 world’s homoeopathic congress. 3. From reasons stated at length in the body of the paper its form and principle do not warrant us in relying upon it exclusively. The objective test just referred to is one to which we wish to draw especial attention. AVith its history and various names you are quite familiar. Some ophthalmologists attach but little importance to it as a test, others practice it constantly and value it accordingly. We shall not rashly claim it as an infallible test, nor recommend it to the exclusion of others, but it can be shown to be the most convenient and accurate objective test for estimating astigmatism, particularly astigmatism of small as well as of larger degree. In this particular it differs from the ophthalmometer, in that the latter is most useful in the adjustment of astigmatism below about 1.5 dioptres. Relative to the use of mydriatics in the practice of retinoscopy, we may state that it is our practice to suspend the accommodation, be- cause spasm of the accommodation is frequently present in cases of astigmatism. Here, as elsewhere, accurate correction of errors of refraction requires skill and practice, and a knowledge of refraction. This allusion to retinoscopy is not for the purpose of describing it in theory and method of practice, but to call your attention to Dr. W. E. Lambert’s apparatus to obviate the tedious process of chang- ing glasses in front of the patient’s eye.* His apparatus “ consists essentially of two discs, about 12 inches in diameter ; in these discs concave and convex spherical lenses are so arranged that by adjusting one of the discs for a certain range of glasses, the strength of the glass in front of the eve-piece is increased or diminished 0.25 D. by turning the other disc either to the right or to the left. The cylinders are arranged in consecutive numbers from 0.25 D. up, in slides which fit into a clip on the front of the eye-piece that revolves, so that the cylinder can be placed in any axis, the same being indicated as on trial frames; the strength of the cylinder can then be increased or diminished by pushing the slides through the clips.” In this connection reference should be made to Dr. Elmer Starr’s instrument for quickly determining errors of refraction. In this in- strument the important condition of ascertaining the visual acuteness * “ Retinoscopy as a Means of Estimating Astigmatism,” by W. E. Lambert, L.R O.P., N. Y. Med. Journ., August 27, 1892. THE REFRACTION OF THE EYE. 387 and refraction simultaneously is met, for the retinal images of all eyes examined by it have the same size.* It would not be in keeping with our high regard for the genius of such men as Helmholtz, Mauthner and Loring, to pass this portion of our subject without a reference to the ophthalmoscope as an aid to the determination of refraction. The difficult “direct method” of examination bids fair to be superseded by the use of the ophthalmometer and other objective tests, unless the young men in our department of special study keep ever in mind the high quality of ophthalmoscopic work heretofore. Briefly this method, like that of retinoscopy, recommends itself be- cause it offers a means to determine the refraction of the eye inde- pendent of its visual power or the statements of the person exam- ined, and it gives us a means to measure the amount of elevation or depression of different parts of the fundus. This classical method requires long practice in overcoming one’s own accommodation, and skill in the use of the instrument, the ophthalmoscope. The practi- cal men look upon the direct method of examination with the oph- thalmoscope as of very doubtful value, but to the lovers of the ideal, this method cannot be neglected. We have thus far concerned ourselves more with the methods of estimating the refraction of the eye than with the details of correct- ing its errors. Coincident with this latter a train of interesting and important questions present themselves; the whole subject of eye- strain and its attendant symptoms falls legitimally within its scope. The province of writers upon ophthalmic subjects is at the present time to bring into order such as has been discovered relative to the general subject, eye-strain. This term has become quite generally used and its application must now be sought before any intelligent discussion can take place regarding headache due to refractive errors, nervous phenomena definitely related to faulty refraction, muscular insufficiencies with errors of refraction, and kindred questions. In beginning, we shall of necessity have to clear our ground, not because the facts about to be presented are new or strange ; the facts are old ; the fault is in the use of the terms in which they are clothed. We read much about eye-strain as a cause of headache, and yet few * “A New Instrument for Quickly Determining Errors of Refraction,” by Elmer Starr, M.D., N. Y. Med. Journal , April 9, 1892. 388 world’s homoeopathic congress. have sufficiently examined the meaning and application of the term.* There are many reasons for this; the discovery of reflex neuroses has come about slowly and silently. No one man has made it, and yet, paradoxical as it may seem, there are but few men that proclaim the importance and realize the value of the discovery. In properly introducing this part of our subject, we shall have to dwell for a moment upon the action of the ciliary muscle, which is a muscle closely allied in its anatomy and physiology to the sphincter muscles elsewhere placed in the economy. We do this because the intelli- gent management of such parts of the body possessing muscles of this class is a matter of great importance. All Homoeopathists, we use the term advisedly, at once see in this a reference to a depart- ment of surgery, which owes its existence to the skill of a surgeon of our school well known to you all. We value the orificial methods because they deserve it, believing them to be therapeutic measures, however, that depend for their exercise upon an exact knowledge of delicate physiological functions that few possess, and upon a discrimination and judgment with which few are endowed. The promulgation of knowledge of the influence of over-work of the ciliary muscle depends upon the ophthalmologists, and unfor- tunately it is the fashion of great numbers to sneer at specialism, and especially at the specialist who puts forth a new truth he knows, and at first only he can know. Refraction work is becoming of more and more importance, and the future routine work of the specialist will be largely in this line. Do we exaggerate when we state that the more common complaints of half of the patients that apply to the general physician are of headache and digestive disorders? It is for the general practitioner to say how many of these get permanent relief. Do we not know that a large proportion of women hopelessly suffer from these com- plaints? Of this large proportion how many have had the eyes in- terrogated as a possible cause. Do you, specialists, not know of many such cases permanently relieved by the correction of an astig- matism, perhaps compound hyperopic, and unsymmetrical at that. Consult the current literature and if these things are true to the extent indicated, may not the general standard of health be lowered ? * “ Headache and Eye-Strain.” By Thomas M. Stewart, M.D., Trans. Homoeo- pathic Medical Society of Ohio , 1891. THE REFRACTION OF THE EYE. 389 You may say we attribute too much importance to eye-strain and that these are but the statements of another enthusiast. Stop for one moment and consider the statements. Headache — disturbed function of the organ closely related to vital functions — and dis- ordered digestion — nutrition the basic function, the source of vital power — and we are accused of over-valuation of the prime cause of their existence. For many, many years specialists have been constantly speaking of eye-strain due to faulty refraction, as the chief causes of head- ache. Personal inquiry of the leading specialists in Europe but three years since, showed this fact to be almost unsuspected, very generally disbelieved, and so far as therapeutic use of it, unheard of. Even in the United States sufficient has not yet been said. After all other means known to the medical profession for the relief of headache have failed to re-establish functional activity, refraction work can in the majority of cases produce such startling and satis- factory results as to be a perpetual surprise even to those familiar with them. As regards headache, that is only one-half the truth. We have seen that with headache there is also nutritional disturb- ance. The influence of eye-strain upon the general system will not be fully realized until there is a general recognition that such dis- turbances of the general health as we have mentioned are frequently due directly to eye-strain. Proof of this is ready :* Let the doubter put on a pair of lenses fitted to a trial frame, such as every oculist uses every day. At the very most, but a few hours will elapse when the artificial ametropia in this manner produced will bring on headache, and not only nausea, but probably vomiting. Another test suggested in the article above referred to : Paralyze the accom- modation for a week or ten days in a young patient suffering from suspected ocular reflex. The frequent relief will be an objec:- lesson in differential diagnosis. It seems well nigh impossible to become sufficiently familiar with the brilliant and far-reaching effects of refraction work in functional nervous diseases, to entirely escape the feeling of astonishment at the immediate transformations which are the common experience of refraction ists. When a patient has suffered from sick-headache for twenty years to a distressing degree, to see entire relief quickly * The Pulte Quarterly , October, 1891. 390 world’s homoeopathic congress. obtained from a pair of spectacles, will always astonish one, no matter how many times it may be observed. In generally impaired nutrition, in the nervousness of neurasthenics, we may have the worst result of eye-strain. Even in health, during waking hours the eyes are never at rest. The muscles of the eyeball and lens de- mand innervation at least sixteen hours daily. Binocular vision is a very complex performance, demanding for its performance on the harmonious co-operation of several cerebral centres. The second, third, fourth and sixth cranial, and the sympathetic nerves are con- stantly called upon to furnish the nervous force for this important organ. Now, if one or more parts of this system be defective, an extra strain is thrown upon the other parts. The organ of vision is the only one in the human body where perfect functional activity depends upon exact form. This is by reason of its dependence upon the laws of refraction of light. Many questions present themselves at this point : the correction and treatment of hyperopia, always an important one; the full correction of myopia, and its effect on the eyes ; the correction of astigmatism, and what is the best means to this end ; the value of the 0.25 D. cylinder in head- ache and eye-strain ; amblyopia, and its systematic treatment with gradual increasing lenses ; muscular insufficiencies, and'their relation to errors of refraction, and a host of subjects relative to refraction work. But as the central idea in our essay thus far has been the discussion of principles, we may find, in closing with some reference to the reason for so much eye-trouble in modern life, sufficient to cause us to mend our methods of handling refraction cases in the first instance, and many questions now hotly discussed on both sides, may lose entirely their identity. With Gould, we say: reflection upon what history tells us, will show that up to the present century the clearest possible distant vis- ion was alone demanded of the human eye. The progress of civ- ilization demanded close and continued use of the eyes at the near point, due to the wonderful progress in the art of printing, to the multiplication of schools in compliance with compulsory educational laws, and the close application demanded of the commercial man of to-day. All this is of the present century ; in the midst of all this, what of the human eye ? An organ habituated by centuries to perform- ing certain work, cannot, without harm, be forced in an hundred THE REFRACTION OF THE EYE. 391 years to a usage exactly opposite. There is no doubt in our mind that the labor to which the eye is put brings ocular congestion, with consequent variation in tension. Furthermore, this is certainly of some influence in producing astigmatism, the factor in eye-strain. Accurate vision is a necessity in this day; because of the slavish continuance of long ocular and physical labor, there is increased demand on the ciliary muscle and nerve centres supplying the eye, and as a conse- quence the manifold reflex and local ocular disturbance. Any physiologist will say that the eye is an organ greatly over- worked, an organ intimately associated with every mental and phys- ical act — its adjustment to perform its various functions being the perfection of delicacy. In the light of all this, is it too much to lay down the following: that every child should have his eyes ex- amined, to detect any existing abnormality before harm is done. And at this point comes the question, how shall this examination be conducted ? It seems to me that the changes of the present century, as contrasted with the preceding, indicate the lines along which the examination should be conducted. It is needless to insist upon its being done by a trained ophthal- mologist, with the help of mydriatics. The refraction to be worked out with the trial lenses to within a quarter of a dioptre, and that care be taken to examine the optician’s work in the quality and the centering of the lenses, and in the adjustment of the frame. Discussion. Charles H. IIelfrich, M.D. : The doctor says that ITydro- bromate of hyoscyamine is in his opinion the best mydriatic for general use. Personally I think its use ought to be so restricted that it should never be used in people over thirty-five years of age. The alarming symptoms it frequently produces in people above that age, such as partial paresis, vertigo, heart failure and delirium, should teach us to be rather cautious in its use. As it produces rapid and complete paralysis of the accommodation and its effects pass off usually in about three days, it is a favorite my- driatic, but I have been taught by some very unpleasant experi- ences to select my cases. It is my practice to drop it in the outer canthus while the patient tilts the head toward the side of the eye being thus instilled, and to immediately dry it with a piece of soft linen. In this way I have had less ill effects than when dropped on the upper surface of the cornea as the doctor directs. 392 world’s homceopathic congress. He speaks of the beneficial results obtained from using mydriatics, by not only putting the eye completely at rest but on account of their sedative action also. My experience has taught me that this is of the greatest impor- tance, and is not secondary even to the difference in results obtained between the tests with and without their use. A large number of cases of simple and compound hyperopic astigmatism, tested under the influence of mydriatics, do not differ sensibly from the test with- out. By this I mean the axis and the strength of the cylinder re- mains unchanged, and we have added only the latent hyperopic which was expected, of course. In simple and compound myopic astigmatism also it is not un- common to get exactly the same test under the influence as before, yet a great many of these very cases cannot tolerate the correction at first. Then spasm is suspected and mydriatics used. Finally we arrive at practically the same glass we found at first, and the patient is able to wear it with the greatest comfort. The ophthalmometer is gradually sinking to the level of the proper sphere of its usefulness. Giving corneal measurements only, it does not embrace the changes produced by astigmatism residing in the lens. As is well known, lenticular astigmatism may just neutralize the corneal astigmatism, or it may augment it, or even reverse its char- acter entirely. It can hardly be considered as being more useful than a check upon subjective methods, or, perhaps better, an aid. After all, how much need has a competent man of anything besides the ordinary subjective methods and the ophthalmoscope? The use of other appliances are invariably followed by the sub- jective tests also, and decision is given to the results of the latter. In refractory children who are determined not to wear glasses, and in people who are too illiterate to read letters or figures, these auxiliary methods are sometimes of great assistance. From the scanty mention made of muscular insufficiencies, I infer the doctor relies upon the careful and minute correction of the refrac- tive error to relieve eye-strain and its chain of allied disorders rather than exercise of the weakened muscles or correction by prisms or tenotomies. Those enthusiasts who are being called upon to advance some of the muscles they set back several years ago, are learning to place the operation where it properly belongs. While it has proven a boon to a large number of sufferers it has produced a quota of its own. Moderation is becoming the order of the day. D. A. MacLachlan, M.D. : There is much to commend in Dr. Stewart’s admirable paper, and I cannot do better, perhaps, than to enlarge somewhat upon thoughts which he has not discussed at THE REFRACTION OF THE EYE. 393 length. We all differ, however, in our methods of thought and ac- tion, and we often get mutual good in comparing ideas and methods. Very frequently our differences are not due solely to native peculi- arities, but to early instruction, surrounding circumstances and op- portunities, the kind of patients we have to treat, etc. I am not in the habit of relying upon the ophthalmoscope in de- termining refractive errors. In fact, I seldom rely upon any one method ; and even after verifying one test by another, and another, and accurately measuring the. refraction, it has been my experience that a large amount of judgment must be exercised in prescribing lenses. We find, as we do in prescribing remedies, that each person is an individual having native and acquired peculiarities which must be taken into account in our endeavor to relieve his complaint. We all believe in the necessity of mydriatics to determine refrac- tion accurately, and we are all indebted to Dr. Stewart for giving us the results of his careful and thorough investigation as to the relative value of the various drugs in use. My own preference is for hotna- tropine, chiefly because accommodation is so soon recovered after its use. For years I have used a preparation comprised of homatro- pine (the alkaloid) and cocaine, of each 10 grains and castor oil 1 ounce. It acts much more profoundly than the aqueous preparation of the hydrobromate, which is insoluble in castor oil. The oil is not as pleasant to use as water, but the very sticking to the lids, which is the unpleasant feature, causes it to be retained longer in the con- junctival sac, and thus renders the drug-effects more profound. I have rarely found the use of any other mydriatic necessary. When relaxation is desired for a length of time, I have used atropine or hyoscyamine from the start. One drop of the homatropine prepa- ration usually produces complete relaxation in from twenty to thirty minutes, which lasts about twelve hours. The eyes should be kept closed until the examination begins, to avoid the slight corneal film arising from the cocaine. A four-grain solution of eserine, which I use in oil also, restores accommodation in a few hours. As my patients are largely students, who must use their eyes again within a few hours at most, I am obliged to use something very transient in its effects. The mydriatic being so unobjectionable I use it in almost every case, and almost always associate examination of the fundus at the same time, so as to learn the exact condition for record and possible future reference. Retinoscopy is a favorite method with me also, especially in ex- amining children, or unintelligent patients, and in bad cases of astig- matism; I find it a great saving of time in many instances, and the greatest possible help when other methods can hardly be used at all. The question of eye-strain is of such peculiar interest that I can- not refrain from saying a word upon the subject. That it is of the highest importance no one doubts. So much has been said concern- 394 world’s homoeopathic congress. ing it that specialists are frequently accused of making a “fad” of it. While I recognize that it is a very great factor in producing numerous and varied disorders, I must be classed, I think, among the conservatives. Doubtless, over-use of the eyes, more than any one thing, makes it necessary for patients to put on glasses. General enervating influ- ences, however, in most cases, make ordinary use of the eyes over- use. The student who reads long and late, at the same time deprives himself of necessary exercise and fresh air, and in the majority of persons there can be but one result, viz., loss of vigor and that physi- cal well-being which we call “ tone.” Now, he becomes “bilious,” and ordinary use of the eyes becomes over-use, while his study must be kept up, and so he goes from bad to worse. Glasses, like crutches to the lame man, will tide him over until he can resume his hygienic habits and thus regain lost strength, after which his glasses may pos- sibly be discarded. A somewhat extended experience in general practice making me acquainted with the many localized conditions which induce systemic derangements has made me less hasty in ascribing headache, dys- pepsia, etc., to eye-strain. A goodly number of nervous disorders are undoubtedly due solely to refractive errors, but by far the larger proportion are due to lowering of general tone and vigor in the first place. When this has occurred, an accommodative or muscular effort that had formerly been made with ease now becomes difficult and painful. How often do we see patients who have for thirty or forty years had the most perfect health with never a suspicion that there was anything abnormal about their eyes, following an illness, find themselves unable to read or use the eyes without serious trouble, which nothing but glasses would relieve. Perfect recovery from the spell of sickness may have taken place in every part but the eyes. There the natural defect which previously required no conscious effort to compensate for, now must be corrected. My own case is a fair example of this. I require a lens of -f- .25 D. S. E. -f- .25 cy. ax. 90, for each eye for reading only. Up to 30 years of age I had subjected my eyes to the hardest kind of use without ever experiencing the slightest difficulty, although I had, more than once, suffered from severe illness — in one instance, from malaria lasting two or three years. During one winter, I became greatly reduced in strength by overwork, while at the same time my eyes were unduly exposed to sun and snow. From that time I have suffered more or less constantly from eye-strain. Several leading American and Euro- pean oculists have prescribed for me both simple and compound lenses, including prisms, but nothing gives me more than partial re- lief. When I am in the best possible physical condition I have the least difficulty, and vice versa. It would seem to me very far-fetched, indeed, to attribute my ocu- THE REFRACTION OF THE EYE. 395 lar disability to refractive error. It was not a factor at all, until my general vigor was impaired, and is now proportionatply lessened or increased by improvement or loss in my physical condition. I sometimes think that weakness of the ocular muscles has more to do in producing eye-strain than do errors of refraction. And yet, how often we find a refractive error deranging the ocular muscles. I recall the case of a vigorous man of about 25 years, a farmer, who had very bad convergent strabismus. He was perfectly healthy, and suffered no inconvenience except constant and somewhat annoying diplopia. He brought his child to me for operation. 1 noticed his own crossed eyes, and examination showed a manifest hypermetro- pia of about 1 H. in both eyes. Relaxation revealed a total of about 4 D. Thinking it would be an interesting experiment to try the effect of the correcting lenses upon the strabismus, I fitted him with glasses, with the result of completely straightening the eyes. In this case, the refractive error caused spasm of both the ciliary and internal rectus muscles, and was, moreover, the sole cause of the trouble. Such striking instances, however, are comparatively rare. In the vast majority of cases, the cause of the ocular difficulty is a mixed one, depending, first, upon a predisposing cause, such as ill health or reduced vigor; and second, upon an exciting cause, such as a refractive error, or a lack of balance, or co-ordination of the ocular muscle. In my own experience, eye-strain is rarely the cause of such remote troubles as dyspepsia, etc.; my own observation would lead me to think that the effects of eye-strain are limited to disor- ders of the head, with a few secondary reflex disturbances of more distant parts. It is true, that putting strong glasses over normal eyes will in- duce prompt nervous disturbances; but, it also is true, that eyes which have been accustomed to abnormal refraction from birth ex- perience a surprising degree of comfort and good vision. So recon- ciled do they become to the effort required to compensate for their ocular defect, that, frequently, they will not tolerate correcting- glasses — it has become “a second nature.” I most heartily endorse Hr. Stewart’s suggestion that all chil- dren’s eyes should be examined. If there is a sufficient error to require correction, it can scarcely be done too early. Squint, am- blyopia, exanopsia, and other conditions dependent directly or indi- rectly upon abnormal refraction may be averted. The ultimate form, mind, and disposition of such a child may be greatly improved also, by proper glasses. The paramount importance of this subject makes it more desira- ble that we, as specialists, should be fully conversant with the sub- ject, and that we should treat it in a simple, scientific way. I mean by that, that we should be careful not to attribute to eye-strain more of the ills of humanity than properly belong to it. We often blame 396 world’s HOMCEOPATHTO CONGRESS. the general practitioner because he seems to attach little, if any, importance to eye-strain as a factor in disease, but I sometimes think he is driven to assume this indifference to it by the extrava- gant claims of some specialists, who would have us believe that nearly all disease is due to refractive errors and allied disturbances in the eyes. Myron H. Chamberlain, M.D., Council Bluffs, la. : I think I understand the doctor to say that refractive powers should be cor- rected in troublesome cases, especially up to one-quarter dioptre. Perhaps it was difficult for me to hear him, but I know a great many cases where I have found that refractive troubles of only one- quartre dioptre, especially astigmatic, have given a great deal of trouble, and a correction of this has been very satisfactory to the patient. I would like to know the attitude of the profession on that point because I have so many of that kind of eases, and have got such relief from them (especially from those who are in the habit of complaining of eye-strain) by correcting one-quarter dioptre of astigmatism. Harold Wilson, M.D. : I think I understand Dr. Stewart to imply that he would prescribe glasses for children at as early an age as they could wear them, and which may be, perhaps, anywhere from two and a half years up. Now I wish to enter my protest against prescribing glasses for children when it is not necessary. It is very well known that the refraction of the eye undergoes a modification from childhood to adult life. The normal condition of the child’s eye is hypermetro- pic. Now why should we prescribe glasses for hypermetrophy in children simply because we have found that such a state of refrac- tion exists, when we know that hypermetrophy may become obliter- ated by the natural process of growth ? If we put our glasses on, we destroy the natural growth of the eye. If there are not sufficient reasons for doing so, I, for one, enter my protest against burdening children. This same feature applies also to adults; for in a great many cases it is often possible to avoid the use of glasses altogether by proper treatment of the patient himself or of the eyes themselves. There is one method of examining the eye to which I do not think Dr. Stewart referred (though I think I did not correctly hear all of his paper), and that is the shadow test for determining the refraction. In my experience, and in my judgment, we have in the shadow test one of the most accurate, most rapid and most satisfactory methods of making the examination. To any members of this section who have not enjoyed this method I most heartily recommend it. It is very accurate in the determination of small degrees of astigmatism where we are perhaps more anxious to obtain accuracy. Dr. Linnell: There were two points in Dr. Stewart’s paper which I do not clearly understand. I would like to ask the doctor THE REFRACTION OF THE EYE. 397 the question, in the first place, as to the strength of the Hyoscya- mine solution ; and whether he uses the same Hyoscyamine or a solution. I understand the doctor to say that he uses the Hyos- cyamine solution alone. E. Elmer Keeler, M.D., of Syracuse: It is with more than pleasing attention that I have listened to the paper of Dr, Stewart and the discussion thus far, and I am sure that the members will agree with me when I say it is a question of vital importance to our patients, and if there be a drug that we may use with universal sat- isfaction, I, for one, will be very glad to use it in place of Atropine. But in the remarks that have been so far made they show that gen- erally where the results would be satisfactory, it is claimed it is made from these other mydriatics, and if so, it leaves us in a faulty position. I have given all the various mydriatics a thorough trial in my practice, and must say that I have discarded them for the old stand-by. That point I would like to have some one emphasize emphatically — if it can be made a universal and successful drug — any one of these mydriatics. Wm. R. King, M.D : I have very few remarks to make. In the first place, the subject of the correction of the low degrees, as spoken of by Dr. Chamberlain, to my mind, is the most important, or, at least, we get our best results in reflex neurosis, as a result of refractive errors. That has been my experience. In cases where we have a more or less high degree of refractive error, whether it be hyperopia or astigmatism, there are describable symptoms ascrib- able to the eye. This neurosis is ascribable to more distinct, and often overlooked, degrees of astigmatism as low as one-quarter diop- tre. The correction of low degrees has often relieved symptoms that have entirely baffled remedies and hygienic treatment of other physi- cians and those who are not examining and looking to the eye for causes; and I think, for that reason, they give us, perhaps, the most unsatisfactory results in the correction of those low degrees. With reference to mydriatics, I may say that I never, or almost never, use them. I am satisfied with my results without mydri- atics, and my patients seem to be satisfied with them, and, conse- quently, I very rarely use them unless I have a case of very severe ciliary spasm to deal with. I find the necessity for mydriatics be- coming less frequent wherever I have been. The only mydriatic that I have used to any great extent has been* the old reliable Atro- pia. The Hydrobromate of bromium I have used several times. I cannot say that it has been of more advantage from the fact that its effect sooner passes away. We get, of course, absolute correction with mydriatics of the absolute amount of error, but it is not always the correction that is of most practical value to the patient. Dr. Stewart, in closing the discussion, said: There are two things in the paper I did not do. In the first place I did not try to 398 world’s homoeopathic congress. cover all the ground, and for two reasons. In the first place I was not capable of doing it, and if I could have done it, it would not have left any room for discussion. In regard to the gentleman that speaks of one-quarter dioptre of refraction, let me say that you should examine for errors of refraction and correct up to one-quarter of a dioptre. One question I put very particularly was the value of the twenty- five dioptre cylinder in the refractive work. In regard to children in the prescribing of glasses, to which Dr. Wilson re- ferred, the statement was not to put on the glasses, but it was to ex- amine the eyes, and then, if necessary, use your glasses. The word “ necessary ” covers a good deal of ground. Of course, that should be left to the judgment of the physician, and it depends upon a great deal. To have gone into the question in detail, that would have been to diverge, so I underlined the word “ necessary.” I avoided the subject of muscular insufficiencies for a very good reason. In the first place, it is in the hands of a gentleman that is just as capa- ble of handling it as anybody I know in the American Institute in this section. It has been brought up, and I want to say that I have frequently found cases where there were no errors of refraction, and in which I did find muscular insufficiences, and of course I did not ignore the use of the prism. Regarding retinoscopy, I regard it very highly, and I drew some close remarks regarding that and the ophthalmometer; but in my endeavor to get some other points in the paper I avoided that point ; but it is in the paper, and the Transactions will perhaps show my standing upon that question. Regarding the question of Hyoscyamine and its strength, 1 to 100 has been the strength I have been using, and it has been the pure white crystals. OPHTHALMIC SURGERY. 399 OPHTHALMIC SURGERY. By Elmer J. Bi^sell, M.D., Kochester, N. Y. Medical history records no more rapid and marvellous advance- ment than has characterized ophthalmology in the past quarter of a century. During this brief period, spanned even by the profes- sional career of some who listen to me to-day, there has gradually developed a science which excels in its perfection and exactness that of any other department of medicine. From a dark and un- explored chamber the eye has been transformed into a ball of light, revealing not only what is within its narrow bounds, but, like a mirror, much that lies outside it. So vast and important has become the consideration of abnormalities affecting the visual apparatus, and so wonderful, yet still imperfect, our facilities for detecting and overcoming these, that when I was asked to present to this Congress a paper upon ophthalmic surgery and to cover as much of the field as possible, although less than one-tenth of the oculist’s work is strictly surgical, I thought that volumes could not do it justice. I shall therefore endeavor to bring before you not only that which is newest, but that which is most practical. There are endless unique operations for rare and complicated cases, but they must of necessity be passed by, and only those surgical procedures be presented which will most frequently tax our thought and skill. By thus limiting the scope of this paper, I hope to elicit a more general and definite discussion. Aside from a better understanding of the anatomy and physiology of the eye and an improved technique in many operations, three elements — perfected instruments, local anaesthesia by cocaine, and absolute cleanliness secured either by simple irrigation or antiseptic agents — contribute largely toward accomplishing better surgical results than formerly. Great improvement has been made in the character and quality of our instruments. I think we are under obligation to the manu- 400 world’s homoeopathic congress. facturers for furnishing us such delicate instruments, perfect in ad- justment and yet easily rendered aseptic. A wonderful boon came to ophthalmic surgery in the introduc- tion of cocaine. By it we not only are enabled to secure anaesthesia limited to the parts to be operated upon, but other quite as desirable and important effects. I refer particularly to its power to contract the bloodvessels, so that less haemorrhage obscures our work during such operations as tenotomy or advancement for strabismus ; and to its action in producing hypotony, a certain degree of which is a great factor in the extraction of cataract. I think more attention should be given to this latter point, because by a careless and unscientific use of cocaine an unnecessary element of danger is artificially in- duced in operations involving the opening of the eyeball. My rule has been to apply a 2 per cent, solution three or four times during eight minutes in cases where there was a strong probability that an iridectomy would be unnecessary, care being taken that the lids are kept closed during cocainization so as to prevent dryness of the cornea. This strength I have found to pfoduce sufficient ansesthesia and a degree of hypotony which favors the delivery of the lens in cataract extraction, and at the same time aids in preventing prolapse of the iris. In fact, it is this action on the part of cocaine which has done much to make simple extraction possible in so many cases. With a 2 per cent, solution I also believe that a smoother incision can be made, and the healing process goes on more rapidly and per- fectly because the epithelium of the cornea is less affected than when stronger solutions are applied. On the other hand, if there are in- dications that an iridectomy will be necessary, or if there is a slightly increased tension, I employ a 4 per cent, solution and prolong its action to ten minutes. In operation upon the lids or external ocular muscles I use this same strength. By thus individualizing, we can make cocaine serve a double purpose. The third factor in the general consideration of ophthalmic sur- gery is antisepsis. The great fact to keep before us is, that the end to be attained is absolute cleanliness , and I have no hesitation in saying that if this can be secured and maintained without the use of chemical germicidal agents, it is much the superior method, but I do not believe this possible under all circumstances. If the truth could be known I doubt not that many major operations are suc- cessfully performed when only ordinary, I may say partial cleanli- OPHTHALMIC SURGERY. 401 ness has been accomplished and not the theoretical, scientific, absolute cleanliness which we talk so much about. Possibly there is a practical surgical cleanliness which is not synonymous with absolute surgical cleanliness. However, as long as we cannot tell what point less than perfect cleanliness is safe and practical, we must diligently strive after the ideal. The fact to be emphasizied is that in our enthusiasm to secure a state of perfect antisepsis, we avoid employ- ing methods or agents irritating to the eye, which indirectly may do more harm than good. Very careful discrimination is necessary. The efficiency of an antiseptic agent is not simply its power to destroy micro-organisms, but to accomplish it quickly. Many of the drugs which possess truly antiseptic properties are irritating to the eye when used in sufficient quantity to be effective, and the question resolves itself into this, whether the dangers are greater in trying to secure cleanliness by simple irrigation and possibly failure to ac- complish the high ideal, or by using active germicidal agents which probably prove thoroughly effective, but in many cases cause some irritation which may mar the result of the operation. This cannot be satisfactorily answered without going somewhat into detail and bringing before us a few recent experiments. The list of anti- septic drugs which are being used in eye surgery is quite long — Car- bolic acid, Peroxide of hydrogen, Pyoktannin, Chlorine water, Boro- glyceride, Boracic acid, the Biniodide and Bichloride of mercury.. Some of these are too irritating, others act too slowly, and Boracic acid has been shown to possess no germicidal properties, although it is employed as much as any one drug named. I use it very fre- quently myself as a means to increase the specific gravity of liquids used about the eye. If it serves no other purpose than raising the specific gravity and thus preventing osmosis, it accomplishes great good. The most effective and at the same time the safest germicide is the Bichloride of mercury. In strengths varying from one to five thousand to one to fifteen thousand, it quickly destroys micro- organisms, but when the anterior chamber is opened, there is a pos- sibility of its inducing striped keratitis, resulting in permanent opacity of the cornea. The experiments of Carl Mellinger go to prove the following facts; First . — That a solution of corrosive sublimate, 1 to 5000, and even 1 to 15,000, if present in the anterior chamber for any con- siderable length of time, will cause permanent opacity of the cornea. 26 402 world’s homceopathic congress. Second . — That cocaine alone produces no corneal opacity, but that its presence within the anterior chamber increases the effect of the sublimate solution by making the endothelium more perme- able. Its use, also, by lowering the tension, favors the retaining of these solutions within the eyeball. Third . — That a 3 per cent, solution of boracic acid or a one-half per cent, solution of sodium chloride can be injected into the ante- rior chamber without any unpleasant results. My plan of preparing my instruments and patients for all major operations is as follows : All instruments are placed in boiling wa- ter, to which one-third alcohol is added. They are allowed to remain a few minute, then dried and transferred to an Arnold’s sterilizer, in which also I place all solutions to be used about the eye either during or after the operation. The various solutions of cocaine, atropine, eserine, boracic acid, etc., are in bottles corked with absorbent cotton, and these, with the instruments, are subjected to sterilization for one hour. The instruments are then placed in antiseptic absorbent cotton, and the bottles containing the liquids are not uncorked until necessity requires it. I could never under- stand the reasonableness of a surgeon being so very particular about his instruments, and at the same time (as I have seen done) employ solutions of cocaine or atropine made up simply with dis- tilled water, and placed in bottles probably not chemically clean. Such -solutions I do not believe are sterile, and therefore safe to use. 4n the preparation of my patient, I have the parts about the eye washed with soap and water, and in the cleansing of the lid-margins and conjunctival folds I make the following discrimination : if there are any unhealthy secretions, such as occur in blepharitis, conjunc- tivitis, or dacryocystitis, I employ the bichloride of mercury, 1 to 5000. Special attention should be given to the cleansing of the cilia and lachrymal sac. I have never found it necessary to adopt the plan of closing the punata by the cautery, or to employ Pag- enstecher’s method of slitting the canaliculus, and packing with iodoform cotton. On the other hand, if there are no unhealthy secretions, I see no necessity of using a germicide, which is irritating to some eyes, but trust entirely to thorough irrigation with a 2 per cent, sterile boracic acid solution, before, during, and after the operation. I employ the boracic acid, not because I believe it possesses any special germicidal OPHTHALMIC SURGERY. 403 properties, but (as I have stated before) to increase the specific gravity of the liquid. I hold this to be an important point, if solutions are to be injected into the anterior chamber. The above plan of antiseptic surgery has given me highly satisfactory results. Suppu- ration has been a thing almost unknown, and has never been of a serious character. Passing now in brief review some of the more recent operations which indicate progress in ophthalmic surgery, I note, first, as one of the most important, the mangle' or crushing operation for trach- oma. Dr. David Webster says it is one of the greatest discoveries of modern ophthalmology. It is certain, however, that by the judicious employment of this procedure, the poor victims of trachoma are saved months and even years of suffering and annoyance. Dr. Holtz was the first, I believe, to attract the attention of the profes- sion to this plan of treatment; but as he advised the use of the thumb-nails to express the granules, it was not generally employed until others devised instruments which rendered it possible to do more thorough and skilled work. The various instruments which are being used accomplish the same result by slightly different methods. Dr. Noyes’s angular forceps are simply a squeezing instru- ment, so constructed as to facilitate the operation well up in the retro-tarsal folds. Dr. Knapp’s roller forceps express the trachom- atous substance by a sort of mangle process. Sometimes, in chronic inflammatory cases, before using his forceps, he scarifies the infil- trated parts with the sillonneur of Johnson. Dr. George Lindsay Johnson, the originator of the sillonneur just referred to, scarifies the everted lids, and then destroys the granules with an electrolyzer. This plan is superior to the old cautery treatment. Other instru- ments have been made, but they do not differ essentially from those mentioned. In all of the above methods, general anaesthesia is usually necessary in order to thoroughly do the operation. The variety or stage of the disease modifies the character of the opera- tion, and affects, to a considerable extent, the ultimate result. The most highly satisfactory cures are obtained in follicular trachoma. There is one point still unsettled : that is, whether or no better re- sults are secured, when these operations are finished, by rubbing the lids with a corrosive sublimate solution. I have employed both methods, and think I have gained quicker results by cleansing (but not rubbing) the lids with the bichloride. In this connection let me 404 world’s homoeopathic congress. state that I have had very favorable results with “ grattage ” alone, using a small, stiff brush and the bichloride, 1 to 1000, as advised by Darier, Von Hippel, and others. One of the unpleasant complications of trachoma is blepharo- spasm. I have relieved two cases of this condition by stretching the orbicularis with lid-retractors. This operation was first brought to my notice through an article by Dr. Allport. The lids are held widely open for five minutes, and the operation repeated on another day if necessary. If one subject more than another has occupied the thought of ophthalmologists during the past few years, it has been that regard- ing the normal and abnormal conditions of the external ocular muscles. Dr. Harold Wilson will bring before you this subject, so that there is only one point which is pertinent to this paper. Is surgical interference necessary in heterophoria ? The vast majority of oculists now answer this in the affirmative for some cases ; still there are those yet who have not got their eyes or ideas straight regarding it. I care not for your theories ; experience has demon- strated beyond the shadow of a doubt that tenotomy, either complete or partial, is the only means which will permanently cure many cases. Neither do I think it wise to spend much time discussing whether a complete or graduated tenotomy is the better sur- gery. I start in with a partial tenotomy ; I often end the opera- tion by making it complete. The fact is, when I accomplish exactly what I want, I do not quarrel with the method. I hardly see how I could get along without both operations. In some cases of eso- phoria and exophoria, a graduated tenotomy has proven entirely inadequate; while in slight degrees of heterophoria, especially hy- perphoria, it has given just the- result I desired. In a few cases where, twenty-four hours after the operation, the eye had returned to the same relative position as before the tenotomy, I have per- manently improved their condition from one-half to one degree by carefully passing the S-tevens hook intothe wound and simply re-open- ing it. No hemorrhage occurs, and the healing process is only tem- porarily interfered with. Two years ago, Dr. Winslow stated that tenotomies changed the corneal curvature. Since that time I have tested, with Javal’s ophthalmometer, a great many cornee after the operation, and only in one case have I been able to verify his experience. Dr. Swan M. Burnett has also been searching for OPHTHALMIC SURGERY. 405 this complication, but writes that he has been unable to discover it. In the January number of the Archives of Ophthalmology , Dr. Eu- gene Smith presents a new method of performing tenotomy. He raises the muscle well up from the sclerotic with peculiar ring- shaped forceps, and then passes a De Wecker stopkeratome through the conjunctiva and centre of tendon, close to its attachment. The only advantage over Dr. Stevens’s operation is that less haemor- rhage occurs. I have not performed the operation, but should fear that there would be some danger of passing the lance-shaped keratome into the sclera. A few rules have served to guide me in my surgical work for heterophoria : First . — Carefully, repeatedly, and by various methods, test the muscles before deciding upon an operation. Second . — Correct any existing ametropia and try other plans of treatment first. Third . — Be reasonably sure that the defect is symptom-pro- ducing. Fourth . — Be over-careful to do too little rather than too much. My experience has been that tenotomy for heterophoria, if skill- fully performed upon carefully selected cases, gives more uniformly definite results than any other operation in ophthalmic surgery. Closely allied to the surgical work for heterophoria are the operations for strabismus. Nothing markedly new has been pre- sented in this field. Dr. Wray has suggested the introduction of a central suture in advancement operations to take the strain off of the supra and infra-corneal sutures. Briefly, his method is as fol- lows : One end of the suture is secured to the stump of the tendon near the cornea; the other is passed well back so as to transfix from within out the muscle and conjunctiva. Over this end of the suture is passed a perforated shot, and the amount of traction regulated by means of it. It seems as though this would unnecessarily compli- cate the operation and annoy the patient. I am securing uniformly good results in advancement by using Dr. C. H. Beard’s single pul- ley suture. More perfectly than by any other operation which I have employed has this method advanced the muscle in the direct line of its axis. It has been a reproach upon opthalomology that so little has been accomplished in removing defects, either in the shape or transparency 406 WORLD S HOMOEOPATHIC CONGRESS. of the cornea. Transplantation of the cornea has almost inevitably proven a failure. Galvanism for slight leticoma is far from satis- factory. Dr. Knapp has lately introduced a new operation for kerato-conus, which I think is destined to be quite generally em- ployed in treating this deformity. By means of an oval-tipped electrode he cauterizes the apex of the kerato-conus. Considerable reaction follows, but all of his six cases reported were ultimately somewhat improved. The advantage of a cautery in ulcerations is being more and more appreciated. I use in my office the Edison current for this purpose, and find that some of the worst corneal ulcers heal as by magic after thorough cauterization. In fact, it is largely displacing Saemisch’s incision. I have several times per- forated the cornea, but no bad results have followed. There are a number of operations which are in an experimental stage yet and of doubtful expediency. Chief among them are op- tico-ciliary neurotomy, resection of the optic nerve and injection of the bichloride for deep structural changes, such as in choroiditis. The last, and still the most important, operation in ophthalmology which I shall consider, is senile cataract extraction. This I cannot hope to present in full, but only touch on certain points, which I trust will elicit discussion. At the present time no question bear- ing upon this subject is of greater importance than how to deal with immature cataracts. Statistics, such as presented by Dr. W. A. Brailey, show what a small per cent, of cataractous lenses are mature when first examined. In his practice he found only one in seven, excluding congenital, zonular and secondary. Of the immature cataracts, 45 per cent, remained unchanged ; 13 per cent, were slightly better; 19 per cent, slightly worse; and 23 per cent, de- cidedly worse, the interval of re-examination varying from three months to eight years. Dr. A. B. Norton has given us the results of one hundred cases of incipient cataract treated at his office with Homoeopathic remedies. Forty-two per cent, remained unchanged ; 13 per cent, were improved ; 26 per cent, were slightly worse; and 19 per cent, were decidedly worse. There is a striking similarity between the results presented by the two surgeons. This goes to show how hard it is to determine just what is nature and what is drug effect. Dr. liisley believes that vision can be improved or maintained in many cases by correcting errors in the refraction and giving attention to the general health. He emphatically states that OPHTHALMIC SURGERY. 407 increased visual power is not due to “the absorption of any opacities already formed in the lens, but to improved conditions of the vitreous, choroid or retina.” Admitting that there are cases helped by the Homoeopathic remedy and correcting of the refraction, still there is a large class of im- mature cataracts in which both of these means are out of the ques- tion. Sufficient vision remains to go about, but not to engage in the ordinary avocations of life. These are the patients which en- list our sympathy and tax our skill. Waiting for maturation of the cataract may mean broken-down health, or poverty, or both. What can be done? Two active courses can be pursued : First . — Remove the immature lens as it is. Second . — Artificially mature it and then remove it. For myself, I prefer the first plan as involving less risk. This can be accomplished by two methods, each with a variety of modi- fications. The one feature which distinctly distinguishes one from the other is whether or not injections are made into the anterior chamber. Dr. Tweedy does not use injections, but performs an iridectomy and makes a peripheral opening in the capsule with the Grafe knife. He claims that such a capsulotomy keeps the par- ticles of lens substance, which cannot be removed, from coming in contact with the iris. Some surgeons, however, remove a piece of the anterior capsule, and others make a point of doing a preliminary iridectomy. The method of making intra-ocular injections is rapidly gaining ground. McKeown, De Wecker, Panus, Knapp, Lippincott, and many others, are employing it to a considerable ex- tent. A variety of instruments has been devised for this purpose and a number of different solutions tried. McKeown has used sim- ply distilled water in 70 per cent, and Panus’s solution in 30 per cent, of his cases. De Wecker injects a weak solution of Eserine; Lippincott a one-half per cent, boracic acid solution, and Knapp a one-half per cent, of sodium chloride. The bichloride of mercury is not now used because of the discovered danger to the cornea. I have employed injections ten times. If the lens is very immature, as it was in six cases, I do an iridectomy ; otherwise not. I make a free laceration of the anterior capsule and inject a warm 1 per cent, sterile boracic acid solution. I have not had a single bad result. 20 In two cases V = ^q. A sharp attack of iritis followed in one case, 408 world’s homceopathic congress. but was controlled, and useful vision resulted. I employ a one-half ounce hypodermic syringe with a sterling silver tip, and never use the same tip on more than one case. A point made by Knapp is not to be overlooked ; that is, to introduce the nozz'e within the corneal section, so that the liquid will run from within out. This is disregarded by some, but it seems to me that there is an element of danger in washing septic matter into the wound. The second plan, that of artificially ripening the lens, has many followers : Foerster, McHardy, Noyes, and others. There are six different ways of accomplishing it : First . — Simple division of the anterior capsule. Second . — Division of anterior capsule and iridectomy. Third . — Division of anterior capsule and external massage. Fourth . — Simple paracentesis and external massage. Fifth . — Iridectomy and external massage (Fderster’s operation.) Sixth . — Iridectomy and internal massage. As the mere mention of these methods so clearly indicates the work to be done, a fuller description seems unnecessary. In operating upon mature or nearly mature cataracts, the first thing to be decided upon is, shall an iridectomy be performed ? The profession are still divided on this point. Simple extraction, how- ever, now has the lead, and certainly is the ideal operation. With a section well in the corneal tissue, prolapse of the iris — the chief danger — is not a common complication. In extractions, with an iridectomy, prolapse of the iris into the angles of the wound is nearly as frequent. Preliminary iridectomy still has its advocates, and it would be hard to furnish better visual results than they are able to present. No one method of operating will be adapted to all cases. We should never sacrifice the best visual results for the sake of cosmetic appearances. Simple extraction followed by secondary capsulotomy combines cosmetic effects with good, visual acuteness. There are, however, many cases of cataracts associated with myopia or slightly increased tension, in which iridectomy gives the better results. There is one feature of simple extraction which has been of inter- est to me. Formerly I always used Eserine, a one-half or one per cent, solution immediately after the delivery of the lens. I have of late largely discarded it. Prolapse of the iris rarely occurs, less iritis follows, and fewer adhesions between the iris and capsule re- OPHTHALMIC SURGERY. 409 main. When I employ Eserine now, I apply only a one-fourth per per cent, solution. This causes less irritation. I should be pleased to know the experience of the members present regarding their treatment of a prolapsed iris. Some claim to have been able by gentle manipulation to replace it within the anterior chamber : others absoise it at once ; and Dr. Knapp allows it to remain ten days or longer before absoising, unless it occurs during the first twenty-four hours after the extraction. Regarding the after-treatment and dressing little need be said here. Nearly every oculist seems to have a method peculiarly his own. The tendency is markedly toward more freedom for the patient and more simple dressings for the eye. Some have gone to the very extreme and practically abandoned the idea of any after- treatment. During the past few years a number of interesting modifications of cataract extraction have appeared, and in conclusion I will briefly bring to your attention some of them. Dr. F. Parke Lewis divides the posterior capsule immediately after the delivery of the lens. He claims that by so doing, secondary cataracts are less frequent. Dr. Carter adopts the same procedure, claiming that it prevents the development of glaucoma. Both Drs* Tyner and Brockman prefer a preliminary peripheral capsulotomy with a Bowman’s stop-needle. Dr. Brockman reports four thousand cases thus operated upon. Galezowski and others open the capsule with the knife after making the first corneal puncture. Suarez De Mendoza introduces a suture into the lips of the section; and J. S. Prout keeps the lids closed by means of a suture. These measures, however, have not received any general adoption. Finally, careful attention must be given to the division of secon- dary cataracts. A capsulotomy should be performed as soon as practicable. If delayed too long, the capsule becomes tough and hard to cut. In the prescribing of glasses, Javal’s ophthalmometer has been of great service to me. It, more perfectly than any other instrument, shows the changes in the corneal curvature. This facili- tates the work of finding the proper astigmatic glass which will give the highest visual result. Secondary capsulotomy, when necessary, and the prescribing of glasses, are the final steps in the operation for giving sight to a cata- ract patient. They are the finishing touches upon a piece of work 410 world’s homoeopathic congress. that has been skillfully and delicately wrought, and without which all that has preceded may be of no avail. Discussion. B. B. Vietz, M.D. : Cocaine. — Of course all appreciate its worth. The strength of the solution to use, and the dangers of the drug are points that interest us and about which any discussion can be raised. For the first two years after cocaine came into use, I used a four- grain solution only in all operations about the eye. Enucleation was painlessly performed in two cases, iridectomy many times, etc., and I am not yet entirely convinced but that the effect of a weak solution, everything considered, is as satisfactory as when a stronger one is used. If then, a four-grain solution produces anaesthesia so completely, surely a two per cent, solution is plenty strong enough for the oculist. Dangers of Cocaine were not mentioned by the essayist. But the note of alarm is frequently sounded in our journals, one surgeon dis- carding it entirely in throat work. The dangers, I think, are over- estimated, for I have never seen any toxic effects whatever, and have used a 10 per cent, solution in operations about the nose and throat. Antisepsis. — Dr. Bissell states that “ cleanliness secured and main- tained without the use of germicidal agents is the superior method.” I am fully in accord with this declaration. I take issue with the Doctor, however, upon the method he suggests for preparing our instruments. I do not believe it is necessary to take so much trouble and precaution. He puts them, he says, first into boiling water and alcohol ; then transfers them to a sterilizer, where for an hour they are sterilized together with all solutions to be used. I confess to being very unscientific when it comes to the matter of an- tisepsis. In eye surgery my practice has been to wash my hands, wipe the instruments with absorbent cotton, have the patient’s face washed and cheek, lid and brow wiped with cotton. The cocaine solution I make myself in small quantities using always hydrant water. In eight years’ private hospital and college clinic practice, I have yet to see suppuration in a single case or bad effects that could be traced, remotely even, to germinal influence. I do not wish to be under- stood as advocating carelessness. Reasonable precautions should be taken in every case ; but this striving after perfect antisepsis is, to my mind, a useless waste of time and energy. Careless handling, bruising of parts during operations, has much to do with causing suppuration. Surgical Interference in Ileterophoria. — It is the consensus of opinion, I think, that high degrees of heterophoria, especially exo- phoria, can be cured by complete tenotomy, also that many cases of OPHTHALMIC SURGERY. 411 low degree get relief by systematic exercising of the muscles with prism. What to do with the medium grades is as yet, with me, an unsolved problem. I have nothing satisfactory to offer on the sub- ject. Unfortunately, I have seen so many cases operated upon by others where the condition was actually made worse, or at best not benefited, that it has deterred me from experimenting to any extertt. Strabisnms Operations . — The advancement of a muscle. In my library there are works on the eye by thirteen different authors. In describing this operation, all say substantially the same thing, only that some recommend two sutures, some three or more. But all claim that a diverging eye can be brought into position and held there by passing the sutures through the flap of conjunctiva only, at the margin of the cornea. Utter failure was the record of my efforts to advance a muScle in bad cases of divergence, until I learned how to make the operation. But not a hint is given in these thir- teen books mentioned of the necessary proceedings to ensure success. And that is the method of Dr. Wray, mentioned in the paper. One end of the sutures must be secured to the stump of the tendon at its insertion into the sclerotic to relieve the strain upon the conjunctiva or the sutures will tear out. Ninety-five per cent, of the operations for advancement are made upon the internal rectus, and usually upon adults. The eye seems to have become almost fixed in this position, and considerable power must be exerted to bring it into place, much more in my experience than the thin delicate conjunctiva is capable of sustaining. Immature Cataracts — Artificial ripening of the lens. My expe- rience leads me to declare against the procedure, from the fact that I have been unable to accomplish anything of the kind. The growth or formation of a senile cataract is a physiological progres- sive sclerosis. That of soft cataract is a regressive metamorphosis, different processes entirely. It is true that you may puncture the anterior capsule, perform iridectomy or institute any of the proceed- ures mentioned in the paper and set up this regressive process, and any transparent portions of a lens in a very short time will be- come opaque. But this portion artificially ripened is no harder than before, no more easy to operate upon for removal. It is possible that this cortical, opaque, pasty mass might harden if left long enough, though I have waited a year and upon removal found no evidence of any hardening. I make no further attempt to artificially ripen a senile cataract. Dr. Vilas : In undertaking to discuss the paper of Dr. Bissell, I am embarrassed at the outset in that direction by a hearty con- currence in nearly all contained therein. Moreover, on so vast a subject, so well treated by the essayist, I can hope to shed no ad- ditional light, but perhaps may emphasize some of the points made. It seems to me that if I were asked to name the greatest aid to 412 world’s homoeopathic congress. the ophthalmologist supplied during the time I have practiced oph- thalmology, I should answer the present use of cocaine. It has altered the whole course of professional life of an oculist, while to those who are constantly in the surgical arena it has proved invalu- able. I shall not dwell on the reasons for this warm encomium, because its advantages have been well set forth by the essayist, in whose method of use I concur. It requires a little, experience to get its best effects, however, even with the method given. Were I not confined to its surgical aspect, much more concerning its use might be said. The attention which anti- and asepsis has attracted can only be for the best interests of the profession, and yet I am of the opinion that reputations have been made by many of the special procedures connected therewith, only to quickly pass away. In my judgment absolute cleanliness secured and maintained by the simplest methods, is the result to be sought after ; and I cannot but believe that too much and too careful irrigating and drenching of the eye, internally and externally, is on the whole not only unnecessary, but often harmful. Too much care to the sterilization of instruments, lotions, and all adjuvants to an operation, and to the cleanliness of the patient and operator, can hardly be given, however; and it is oftener that the result is affected by neglect of this precaution than from appar- ently injurious pathological surroundings. In my own practice I also prefer to combat the dangers which may arise from an immature lens in a cataract extraction, than to attempt to artificially ripen it; and yet, unless some excellent reason (one almost imperative) compels, I prefer to forego the operation rather than to tempt disaster by too boldly attacking a lens which seems not yet fully ready for successful delivery. With the exception of the conclusions as to the results of opera- tions for heterophoria, which I consider too optimistic, I agree in the main with the balance of the paper — all of which is a valuable contribution to our proceedings. Dr. Randall: I have seen a little in some of the journals in regard to Phenic Acid obviating the systemic affection. I would like to know if any one has had any experience with that agent ? # Harold Wilson, M.D., of Detroit: I wish to mention an op- eration for convergent strabismus, which, although perhaps not altogether novel, has not to my knowledge been brought particularly to the knowledge of the profession. It is an operation which I have derived from my father, and from what source he obtained it I do not know, but I have used it for some time. It consists, briefly, in making two incisions through the conjunctiva, one parallel to the lower border, and one parallel to the upper border of the rectus muscle. The conjunctiva or the sub-conjunctival tissue is then dissected up with scissors back under the caruncle, and as far later- OPHTHALMIC SURGERY. 413 ally as may be desired. The hook is then introduced under the muscle through one of these incisions, and the point brought out through the other. The muscle is then severed. If further correc- tion is desired, lateral incisions into the capsule may be made. The advantages of the operation are the slight disfigurement and no (or very little) retraction of the caruncle. F. Parke Lewis, M D. : Just a word about the use of stronger cocaine in lowering the vision of the eye in the extraction of cata- ract, in four-grain solution, continued for ten or fifteen minutes. I believe that a certain amount of elasticity is necessary in the lens, and if, after using your cocaine ten minutes or more, you find all the elasticity is gone, and you have to squeeze the lens out, you very seriously imperil the result of the operation. I thoroughly agree in limiting the time for the use of cocaine in extracting the cataract. I very often use the cocaine two to four minutes ; it is quite enough. During the last year I have several times made oper- ations, in one instance with very peculiar results. The patient, an old man with the lens so far matured as to make reading impossible, and locomotion difficult ; after having made an operation the patient was told to come back in three or four weeks and have the lens removed. Not doing so after two months, inquiry was made, and it was found the operation had cured the lens in such a degree as to make it possible for him to read. No operation was, of course, necessary ; he could easily get around, and could read large print. It was rather a unique instance, and worth putting on record. In regard to the immediate capsulotoray, which Dr. Bissell has re- ferred to: while I was not aware, at the time I first made it, that it had been made by others, I subsequently learned by conversa- tion with Dr. Knapp, that the same operation had been made, and had been discontinued. The completing of an operation at one time is to me an important matter. The patient may come fifty, one hundred, or two hundred miles to have an extraction made. If you can finish the operation at the time the patient is convalescing, it is a very important thing, and it does not necessitate any long oper- ation. Moreover, the division of the capsule is in some instances followed by a general inflammatory condition. It is by no means a simple operation, or one devoid of danger. If, therefore, you can complete your operation at the time corneal incision is made and the lens removed without adding to the danger of your oper- ation, you have added enormously to the value of your primary operation. Since the matter to which Dr. Bissell has referred, I have many times made this immediate capsulotomy, and have had no reason to regret it. I believe it to be an entirely safe operation. So long as we have the iris in proper position, we may open the pos- terior capsule allowing the vitreous to go into the anterior chamber with no serious results. When the support is taken off, then an 414 world’s homoeopathic congress. element of danger is introduced. There has sometimes been a little loss of vitreous, a loss not sufficient to imperil the operation, but to make me feel like going no further. A. B. Norton, M.D. : I would like to add a suggestion as to w hat to do with those medium cases of exophoria. I want to reiterate the benefit, the improvement of leaving off your convex glasses in those cases of exophoria. I find, over and over again, cases where they have been wearing glasses, and have been treating for it. Leave off convex glass, and the exophoria soon disappears. In other cases, where they are not wearing those glasses, I think they should put on prisms. Let them have a prism to wear. Treat the muscles, strengthen the internal recti up to 70 degrees power, and if that does not correct the power, let them wear prisms, and later, in the higher degrees. If necessary, I am willing to op- erate. The operation which Dr. Wilson spoke of, for squint, seems to me to be like that of sub-conjunctivitis in the text-books. In regard to one of the Doctor’s questions about tannin, I will say that I do frequently use it, one to two hundred or five hundred. I use it very frequently, drop it into the eye every hour or two hours, and believe the essential value of it is found very frequently. Dr. Bissell, in closing the discussion, said : The question has been asked me regarding the special preparation of cocaine. I have had no special connection with it, and have not seen it used in our work. 1 do not think it is superior to any other anaesthetic agents that we have, and it is unpleasant to use, in soiling the clothing and staining, although it may be used. I think in one or two cases it has acted unfavorably, seemingly aggravating the case, and was probably used too strong; but 1 immediately discarded it and took something else. Regarding the operation for strabismus spoken of by Dr. Wilson, I should have given him the credit for it if I had known that it was peculiar to him. The first operation that I ever saw of the kind was not done by Dr. Wilson, and the only modification I make is a suture I put in, which has certainly given me wonderful results. In that respect it differs from Dr. Wilson’s, if he is really the orig- inator of it. THE STUDY AND CORRECTION OF HETEROPHORIA. 415 THE STUDY AND CORRECTION OF HETERO- PHORIA. By Harold Wilson, M.D., Detroit, Mich. Heterophoria may be defined as that condition in which bi- nocular vision, being temporarily suspended, the visual lines of the two eyes do not intersect at the point of fixation. It is characterized by a change in the innervation of the ocular muscles when the bi- nocular fusion of images is prevented. Under normal conditions, binocular vision for a given point is maintained by the co-ordinate action of the entire group of these muscles, and in the ideal eye, at least within certain limits, the innervation of these muscles is not a necessary function of the binocular act. That is to say, the binocular fusion of images being suspended, the innervation remains unal- tered. It becomes a function of this act only in states of hetero- phoria. Heterophoria is due essentially to a condition of faulty innerva- tion, which depends upon one or more of the following factors: 1. The form and position of the eyeballs (orbits). 2. The place of insertion of the ocular muscles. 3. The essential and relative power of the ocular muscles (ampli- tude of convergence). 4. The ratio of the positive and negative portions of the relative accommodation, together with the ratio of the convergence and accom- modation for the point in question. Under the first head it is clear that, assuming certain ratios of ten- sion among the muscles of the eye as normal when fixing some point at a given distance from the eye, such as 1 m. for example, these ratios must vary with the length of the basal line of the eyes. For at this distance, with a basal line of 50 mm., the angle of convergence is 1.43°, while with a basal line of 75 mm. it is 2.15°. In high de- grees of myopia the alterations in the form of the eyeballs limit their mobility, and, consequently, modify the convergence tension of the muscles. 416 world’s homoeopathic congress. There is some variation in the place of insertion of the ocular mus- cles. Stilling has observed a wide variation in that of the superior oblique. We may assume as normal the following measurements, representing the distances of the insertion of the recti muscles from the cornea (Fuchs) : mm. Rectus internus, 5.5 “ externus, 6.9 “ inferior, 6.5 “ superior, 7.7 In an eye where the muscular balance is ordinarily good, one or more muscles may become weakened by fatigue or disease, necessitat- ing an increase in the amount of nervous stimulus to these muscles in order to preserve binocular vision. Under these circumstances, if binocular vision becomes abrogated, heterophoria is an easy and necessary consequence. Here we have true “ muscular insuffi- ciency.” From the essential connection of accommodation and convergence, it is evident that the ratio of the positive and negative portions of the relative accommodation for any given point has an important bearing upon the muscular balance for that point. Indeed, if no other factor were operative to affect the muscular equilibrium, itseems reasonable to assume that it could be calculated from a knowledge of the relative accommodation. However, as a matter of fact, other causes uniformly do exert an influence upon the position of the eyes, and moreover may be of such moment that their effects entirely nega- tive that of the relative accommodation. We see, then, that heterophoria may originate in a number of ways. From the variety of causes we may infer that there must be a corresponding variation in the treatment of this disorder. We shall revert to this further on. Methods of Examination . — In ascertaining the amount and char- acter of the heterophoria present in a given case, the essential de- termination to be made is the position of the non-fixing or deviating eye. The common and most exact methods of making this determi- nation are subjective. Of objective methods, the only one that is practical is the old test of alternately covering and uncovering one eye with a screen. This is too crude to be of much value. Subjec- tive methods depend upon the uniformity and congruity of retinal THE STUDY AND CORRECTION OF H ETEROPH O RI A . 417 projection. The first instrument of precision for making the neces- sary measurements was Stevens’s phorometer. With this instrument, supposing the patient to be of ordinary intelligence, it is possible to measure deviations of the eyes in any plane with much accuracy. The substitution of a “ stopped” convex lens of short focus for the vertical and horizontal prisms employed in the phorometer, added to the rapidity with which a diagnosis as to the character of the devia- tion could be made. The “ rod test ” of Maddox marked another gain in the rapidity of the examination, and made it possible to measure the deviation of the non-fixing eye by means of scales drawn upon the wall of the examining-room. Burnett’s use of a strong convex cylinder was based upon the same principle. Another gain in convenience and precision was the introduction of the rotating prisms of Stevens, by which the separate displacing prisms were done away with. I have added another instrument to this number, a rough model of which I have the pleasure of exhibiting to this section. It consists essentially of a frame, holding upon its right side a cell containing two 6° prisms, with their bases in contact; or a Maddox, rod, suitably mounted ; and on the left a “ prism mobile ” of two 5>° prisms, which, by suitable mechanism, may be rotated in the same or in opposite directions, and the amount of rotation measured upon a- graduated circle so placed as to be easily seen by the observer. Be- hind the openings of this frame or slide are clips for holding various accessories, such as abducting or adducting prisms, a red glass* etc. With the double prism in proper position, and the “ prism mobile” at 0°, set to give horizontal displacements, the patient looks at the point of light through both openings and sees three images- of it. The middle image is seen by the left eye, and by turning the milled head of the “ prism mobile” it may be displaced horizontally either to the right or left, from 0° to 10°. If, therefore, this image is not in a straight line with the other two, it may be quickly brought into this position, and the exophoria or esophoria read off at once upon the graduated circle at the patient’s left. To measure deviations in any other plane, the double prism is rotated into that plane, the “ prism mobile” brought to zero, the small milled head in the face of the instrument pushed well up, and, the pinion of the recording disk being pulled out, the two prisms are rotated by means of this milled head in the same direction to the desired angle, when these adjustments, being reversed, the measurements are made in the same 27 418 world’s homceopathic congress. manner as at first. A little familiarity with the instrument will enable the observer to make these adjustments very rapidly. The Maddox rod may be substituted for the double prism if desired. To measure heterophoria greater than 10°, a supplementary prism may be inserted in the proper position in one of the rear clips, and its value added to the readings of the instrument. To measure abduction and adduction, or in fact, muscular power in any direction, the double prism or rod is removed from the right- hand cell, and the “prism mobile” having been set in the desired position, the muscular powers can be easily found by rotation of the milled head at the left. In these determinations also, supplementary prisms may be inserted into the clips if necessary. It will be seen that a considerable variety of measurements may be made by this instrument with rapidity and accuracy. Almost any object of fixation may be used, and at any distance from the eyes. The value of the double prism is, that it is easier to deter- mine whether three points are in the same straight line than whether (as in Stevens’s phorometer) two points are in an exactly horizontal or vertical line, as the case may be. I believe that the credit of suggesting this use of the double prism is due to Savage, although the first model of this instrument was made long before his sugges- tion came under my observation. So far as accuracy is concerned, there is a substantial agreement in the results obtained by the use of the Stevens phorometer, the rod test, and the little instrument above described. Bissell has made a series of comparisons of the rod and prism tests. In fifty-two cases of heterophoria, the findings of the rod test were greater than those of the prism test in twenty-six, the differences ranging from 0.25 to 4 prism dioptries, from which he concludes that the rod test is the more accurate. I do not believe that this accords with the experience of observers generally. For the determination of “ insufficiencies of the oblique muscles,” Savage employs the double prism before one eye, and a horizontal stripe at a distance of eleven inches, as a test object. If there is an insufficiency present, the middle line will run obliquely between the other two, the direction of the obliquity being dependent upon the particular muscle at fault. Heterophoria may be measured in degrees of refracting angle, or of minimum deviation ; in prism dioptries, in metre-angles, or in THE STUDY AND CORRECTION OF HETEROPHORIA. 419 centigrades. The most common method is to use the refracting angle of the necessary prism. There is at present, no agreement among oculists as to the most desirable of the various reforms that have been suggested. Symptoms . — In attempting to enumerate the symptoms of hetero- phoria, we enter at once upon debatable ground. A wide difference of opinion prevails among physicians as to the symptoms which heterophoria is capable of setting up. On the one hand is a class of enthusiasts who claim for this disorder the power of exciting nu- merous, remote and profound alterations in the functions of the ner- vous system, extending its effects to include chorea, epilepsy and insanity. In support of this claim, clinical experience in these affections is set forth, showing that they have sometimes been re- lieved by proper treatment directed to the heterophoria alone. On the other hand there are those who deny these claims in toto and presumably upon scientific grounds. It is difficult to deny the evi- dence of one’s own experience, or that of other competent observers, but it is not always easy to interpret clinical facts. So far as con- cerns the cure of remote disturbances of the nervous system, such as epilepsy, for example, by the performance of graduated tenotomy, it must be borne in mind that in idiopathic epilepsy at least, patients have often recovered as an apparent result of a variety of surgical operations, such as trepanation without discoverable lesion of the brain or meninges; circumcision for phimosis ; the excision of scar- tissue ; the removal of bullets, and many other diverse procedures. It is of the greatest importance to observe the fact that there is often a curative influence in a purely indifferent surgical operation. Thus we have recorded cases where, independent of the direct and proper results of the operation, abdominal tumors of considerable size have disappeared after a simple incision of the abdominal walls, and hip- disease has been cured, it is said, by removal of the fore-skin. Even without the hypothetical effects of trauma upon the nutrition, func- tional and organic diseases have not infrequently, I think, been cured simply by some radical change in the patient’s emotional state. My attention has just been called to a case of cataract reported as cured by “ Christian Science.” From the accumulated evidence now at hand, I believe that hardly more can be affirmed than that these remote neuroses may in rare instances be among the symptoms of heterophoria, but that their claim to such a place has not yet been established beyond cavil. 420 world’s homoeopathic congress. Seguin has recently given a provisional statement of the symptoms of certain forms of eye-strain. According to this writer, paresis (insufficiency) of the third cerebral nerves and attached muscles (in which condition we may get exophoria or hyperphoria or both) is marked by certain rather definite symptoms, of which he regards occipito-cervical pain and distress as the most characteristic. ‘‘The pain,” he says, “ diurnal, as a rule, and often not appearing until the patient has used his eyes in dressing, eating or reading, is usually greatest between the occipital bone and the second vertebra, though it often extends from the upper part of the occiput to the fourth or even sixth vertebra. It is sometimes more a ‘distress’ than a true pain, and is often accompanied by sensations of stiffness and tight- ness (‘ as if a hand grasped the neck ’). There is never, strictly speaking, neuralgia of the occipital nerves, or objective rigidity, as in beginning caries. Tenderness is rarely found, though in women spinal hypersesthesia (so-called spinal irritation) often coincides. Fre- quently there is a sensation of weight or downward pressure on the back part of the head, with (usually) intermittent numbness (a ‘dead’ or ‘ wooden ’ feeling) and formication. In some cases the fulness or tightness (cincture or cap feeling) extends to the whole head. Appa- rent loss of power of attention and concentration (volition) is much complained of, even to a degree simulating mental failure. Reading, writing, sewing, piano practice, conversation, even eating, are pain- ful or unbearable; in other words, the symptoms are increased by any act requiring convergence and accommodation. The prolonged duration of these symptoms, or, rather, of the strain, may lead to neurasthenia, insomnia and a curious mixture of hysteria and hypo- chondria, so that the diagnosis becomes more obscure. Headache is not rare, but in such cases there are also faults in refraction or other factors. Simple asthenopia, sense of fatigue, or pain in the eyes, orbits, brow or temples, is only occasional, and seldom a prominent symptom. Uusually the patient pretends to have strong eyes.” Payne has recorded a somewhat similar classification, referring the occipital headaches to exophoria and hyperphoria. He adds the additional symptom that these patients show marked inability to use their eyes at night, while their ordinary use in the daytime is com- paratively easy. Frontal pain or headache is referred to excessive strain of convergence or accommodation, as in hyperopia and astig- matism. The symptoms of esophoria are less clearly marked. Seguin THE STUDY AND CORRECTION OF HETEROPIIORIA. 421 notes, as associated with paresis of the “ sixth cerebral nerves/’ that a sense of confusion, or dizziness, not a true vertigo, is one of the most prominent symptoms. The use of the eyes for distant objects, walking in the streets, contact and business with other persons, at- tendance at church or in the theatre, sight-seeing, shopping and sim- ilar occupations may be productive of great distress to the patient, who feels better when quiet and alone. “ Various and peculiar sen- sations are felt in the head, such as a sense of fulness, ‘ as if the head would burst ;’ a downward pressure on the head, diffused or localized, ‘ as if a stone or sharp stick ’ pressed on it; a sense of constriction, general or cincture-like; pain in various areas of the scalp; occasional feelings of numbness (a ‘dead ’ or ‘wooden’ feel- ing), or of formication or worm-like crawling, also variously dis- tributed; a quasi-tinnitus, or noise in the head (not in the ears) is not rare.” (Seguin.) The symptoms of esophoria are not so characteristic as those of exophoria and hyperphoria, and will be seen to overlap them. Insomnia and general nervous debility are said to be not uncom- mon results of continued eye-strain. In the eyeball itself there are reasons to believe that various forms of local inflammatory affections, such as conjunctival hypersemia, blepharitis, ulcers, etc. (Stevens), may sometimes be indirectly dependent upon eye-strain. Stevens has called attention to certain facial expressions characteristic of the various forms of heterophoria. In esophoria, for example, the brows are compressed, with the inner end curving down toward the nose; lines upon the forehead low. In exophoria the brows are raised or arched; lines upon the forehead high. In hyperphoria the features are more irregular, and one eyebrow is compressed or drawn down, to correspond with the hyperphoria. Treatment. — Here, again, we enter upon a subject where widely different opinions are held. In approaching the question of treat- ment we must not fail to bear in mind the various causes which may lie back of the heterophoria. I am convinced that an intelligent appreciation of the causation in a given case, where possible, will often lead to a more just treatment than could be given by any man- ner of routine. It is true that it is often impossible to ascertain the cause in a given case of heterophoria with any exactness, but even a reasonable inference is highly desirable. Thus, in a case of exopho- ria due to paresis of the internal recti from general debility or over- 422 world’s homoeopathic congress. work, it would be manifestly improper to resort to tenotomy for its correction, while if it were due to the anatomical changes in the eye- ball incident to a high-grade myopia, the surgical procedure might be eminently proper. The treatment of heterophoria should begin with the determination of the following points: 1. The amount and character of the heterophoria: a, for infinity; b , for reading distance: i.e ., metre. 2. The mobility of the eyeballs in various directions. 3. The refraction. 4. The muscular power; a, adduction; b, abduction; c, sursum- duction ; d, amplitude of convergence. 5. The relative accommodation; a, for infinity; b, for reading distance. The practical value of these determinations is evident. That of the relative accommodation will be necessary or at least useful, in certain cases only. The amplitude of convergence may be deter- mined by means of Landolt’s ophthal mo-dynamometer, for its posi- tive, and abducting prisms for its negative portion. The informa- tion which it supplies is largely contained in the determinations of the adduction and abduction. Thus if the negative convergence — abduction — in a given case is markedly defective, tenotomy of the internal recti muscles for exophoria would be inadmissible. Hyperphoria . — Stevens states that the treatment for hyperphoria is tenotomy. This statement is in accord with my own experience. In some cases, where there is an error of refraction requiring the constant use of glasses, a correcting prism may be incorporated with them, and give satisfactory relief. Or with emmetropic eyes, the prism may be mounted in spectacle frames and worn constantly. It is questionable what internal remedies can do for the relief of hyperphoria. The late Geo. S. Norton, M.D., in 1889, called attention to the provings of Senega and Onosmodium, and their usefulness in affections of the ocular muscles, and reported a number of cases in which these drugs had been used with apparent benefit. The value of Senega in hyperphoria has been made the subject of a recent com- munication by Linnell, but as I have elsewhere endeavored to show,* the usefulness of the remedy in this disorder is by no means proven * Jour . 0., 0. and L ., April, 1893. THE STUDY AND CORRECTION OF HETEROPHORIA. 423 by the cases related. Indeed, the provings of Senega do not show any special adaptability of the drug to hyperphoria, so far as we understand the symptoms of this affection. Nevertheless, it might have an empirical or clinical value, but the evidence even here is defective. Norton says that the symptoms calling for Senega, are “dull, tired, aching, pressing pains in the eyes, or throughout the whole head, with smarting and burning in the eyes, always worse after using them and often accompanied by catarrhal symptoms of the conjunctiva.” Onosmodium has many symptoms of heterophoria in its proving, e.g., occipital headache; a dull aching pain extending down the back of the neck, or over one side of the head, generally the left ; vertigo, with strained or stiff sensation in the eyes, aggravated by use of the eyes for near work. Gelsemium has a transient vertical diplopia, and may be of value in those cases of hyperphoria accom- panied with the paretic or other characteristic symptoms of the remedy. Stramonium shows a marked vertical diplopia in its prov- ings. The importance of this symptom in the proving of a drug, is simply that it indicates that the drug has a direct influence upon these muscles which are concerned in the production of hyperphoria. We do not find diplopia (unless it be transitory) in heterophoria. But as a drug-symptom, diplopia is an indication that the remedy has an action along the line in which we seek for curative effects, and suggests that it may possess valuable therapeutic properties in the treatment of affections of the upward and downward-turning muscles of the eyes. So far as the applicability of these or other drugs to the cure of hyperphoria, is concerned, the evidence in their favor, is at the best, obscured by the fact that in almost all of the cases reported, other treatment than the medicinal was given the patient, so that the action of the remedy is not clearly shown. Norton, himself, limits all attempts at a cure by remedies to hyper- phoria of less than 2°. In higher degrees, an immediate tenotomy was advised. Systematic exercise of the affected muscles by means of prisms, has been used and recommended as a cure for hyperphoria, and the clinical evidence in our hands is favorable to its usefulness. In hy- perphoria of 1° and perhaps 2°, if persisted in, it may effect a cure, but in higher degrees it does not seem to be of much value. In a case where there is a manifest hyperphoria of say 1°, circum- 424 world’s homoeopathic congress. stances often suggest that there is an additional amount that is latent, and a correcting prism is prescribed, to be worn constantly, for the purpose of revealing this latent defect. Under these circum- stances, in many instances, the daily examination will show an apparent increase in the hyperphoria, until we may have developed in the course of a week, beginning with 1°, as much as 5° or more. This final amount is then accepted as the total of the real hyperpho- ria present, and made the basis of an operative correction. Now while it may happen that latent hyperphoria can be made manifest in this way in some instances, we must not lose sight of the fact that under the constant influence of a prism, the normal equilibrium of the eyes will often be temporarily changed so as to generate a species of false heterophoria. Thus it is possible to produce at will exo- phoria or esophoria in the same eyes, by wearing prisms with the base in or out, as the case may be, and either right or left hyper- phoria, as we please, in a similar manner. The heterophoria thus produced is of variable duration, but always temporary. It may not be possible always to distinguish between the factitious and the real defect. The increased relief of concomitant symptoms, by the corrected increase in the manifest heterophoria, if it occurs, or the greater permanency of the disordered equilibrium, might serve as distinguishing marks, but if we accept as the true state of muscular equilibrium, that shown while the eyes are under the influence of prisms constantly worn, we are treading upon dangerous ground, and if it is taken as the guide to the extent of the operation, we are apt to afflict our patients with an over-correction. With regard to the details of the operation itself, I have little to say, except that in tenotomy of the rectus superior, care must be taken to make the incision high enough, so that the tendon of the muscle will lie in the wound. Rather than to fail in this respect, the operator should measure the necessary eight mm. from the cor- neal margin with exactness. In my experience, complete section of the tendon is often required for the correction of even low degrees of hyperphoria. The lid retractor, held by an assistant is much more comfortable for the patient than the spring speculum. At the end of the operation, the correction should be as nearly perfect as pos- sible. If an over-correction is made, an appropriate advancement is easily done. Exophoria and Esophoria . — As in the treatment of hyperphoria, THE STUDY AND CORRECTION OF HETEROPHORIA. 425 we have here a variety of methods to choose from ; surgical, gym- nastic, hygienic and medicinal. As indicated above, we are to be guided by the causes lying back of the particular troubles in ques- tion, so far as we are able to discover them. There is associated with most cases of disturbed muscular equilibrium a defective ratio ,of abduction and adduction, as well as positive deficiencies in muscular power. Thus in a typical case of exophoria, we may find that the adduction is abnormally low, or the abduction excessively high. In the exceptional and irregular cases this does not obtain. We may have exophoria with an adduction of 40° or 50.° Or there may be exophoria in remote vision and esophoria for the near point ; or the reverse may be true. Out of two hundred and twenty-nine cases of exophoria, Norton found ten with esophoria in accommodation; in one hundred and fifty-eight cases of esophoria there were sixty- eight with exophoria in accommodation. These atypical cases are credited to the disturbing influence of hyperphoria, and the recom- mendation is made to correct this before undertaking the correction of the lateral disturbances. In some cases clinical experience seems to justify this assumption. Upon theoretical grounds however, there would not seem to be any satisfactory explanation of what we may call “crossed heterophoria,” in a faulty innervation of the supe- rior or inferior recti muscles. It is true that there is a slightly in- creased tension of these muscles in the act of convergence, but this seems hardly enough to account for the abnormal conditions so fre- quently met with. As I have elsewhere suggested, a more rational and satisfactory explanation of “ crossed heterophoria ” may be found in the relations between accommodation and convergence. If we have a case of slight esophoria in remote vision, for example, it is easy to conceive that in convergence for the near point, exophoria might result from an enfeebled power of accommodation, by which the added stimulus of the accommodative act was not adequate to maintain the necessary convergence. This is easily shown in an experimental way, by observing the effect of convex and concave glasses upon the position of equilibrium of the eyes in fixation for the near point. If we have orthophoria, or a low degree of eso- phoria for distance, we can obtain exophoria at the near point, by decreasing the amount of accommodation in use for that point by means of convex glasses. Exophoria may be transformed into esophoria or into orthophoria in a like manner, by means of concave 426 world’s homoeopathic congress. glasses. These experiments show very clearly the ease with which