Surgery and its adaptation into homopathic practice

Preface

The author of this volume has a satisfactory reason for its publication at the present time, in the desire so urgently and generally expressed for a surgical work in connection with Homoeopathy. A perusal of its contents will satisfy the reader that the materials have been collected from a tolerably wide field of research. That much important matter has been overlooked is unhesitatingly admitted ; the chief labor, however, has been accomplished, and should the work be favorably received, in a future edition more practical matter will be embodied, omissions supplied, and its defects as a whole remedied.

The descriptions by Homoeopathic practitioners of some of the unusual varieties of disease, are deficient in that accuracy and precision of detail, which are essential to certainty of practice. These imperfections may be attributed often to the obscure nature of the disorders themselves ; in many instances to their complicated conditions arising from the fact of not having been submitted to Homoeopathic treatment in the earlier periods of their existence ; to their comparative infrequency of occurrence, as well as the limited means yet discovered for their removal.

From the volume there is purposely excluded many surgical details, together with a large amount of mat-

IV PREFACE.

ter connected with surgery, but not with its practice ; the chief object of the publication having been the collection and arrangement of those materials which are considered as constituting the medical treatment of surgical diseases. Little as may have been, and much as remains yet to be accomplished, an impartial scrutiny cannot fail to discover, that Homoeopathy has already contributed considerably to alleviate and cure a vast amount of disease previously beyond the reach of medical treatment. If so much progress has been made in so short a period of time, it may be confidently expected that future physiological provings will substitute medicinal for surgical instruments, by which many diseases now so formidable and fearful will be successfully combated.

Time, however, and the united efforts of numbers of properly educated practitioners, will be necessary before there can be accumulated that amount of rigid and intelligent experiment, close description and truthful testimony, all confirmed by practical experience, by which for several of the specific and malignant forms of disease a reliable or certain treatment will be ascertained.

Tt would be foreign to the occasion as well as derogatory, to notice in a work devoted to a branch of medicine so essentially exalted ■ in its nature as surgery, the very illogical objections so often repeated against everything connected with Homoeopathy. Its absurdity and impotency in the estimation of some are proven even in the fact, that Homoeopathic practitioners have recourse to mechanical means for the treatment of accidents, or the removal of mutilated or

PREFACE. v

diseased parts ; in other words, because medicines have not physical power to supply the place of cutting instruments, bandages, fracture boxes and pulleys, it is unworthy the attention of an intelligent mind. As this objection, however, applies equally to alloeopathy, the two conflicting doctrines are thereby placed in the same position, and there the Homoeopathic physician may be quite satisfied in allowing them to remain.

An outward abuse, however, of Homoeopathy, with a clandestine use of several of its medicines, and often in minute doses — for example of arnica, ipecacuanha, aconite, pulsatilla, bryonia, belladonna and others, certainly does not comport with that moral dignity, which should be one of the attributes of the physician; nor is it in accordance with those rules of ethics by which the medical profession profess to be governed. A posterity, however, and that not very remote, will render the tribute to whom it justly belongs.

In a few instances only, throughout the work, have the strength and frequency of repetition of dose been mentioned; to have done so frequently would have increased unnecessarily the bulk of the volume ; .the presumption being entertained, that such knowledge is already possessed by those who venture upon surgical practice. Full instructions as to the mode of preparation of the medicines, the potency usually employed, and the circumstances regulating repetition, are contained in the Homoeopathic Pharmacopoeia and numerous practical works. As a general rule it may be observed that most success will be obtained from dynamizations not lower than the third, and in a large proportion of cases, especially in those of a chronic or

VI PREFACE.

sub-acute character, as likewise in those of a specific nature, the twelfth, eighteenth and thirtieth dilutions will be found to be possessed of most curative action, and that more certain and positive effect will be obtained from their exhibition at long rather than at short intervals.

It will be observed during the perusal of this work, that portions of it, and more particularly those that relate to the mechanical treatment of injuries and surgical diseases, have been selected from standard authorities. The chapter on "the Means and Instruments for arresting Hemorrhage" is taken from " the Practical Surgery" of Mr. Fergusson ;* that upon Amputation from the modern work of Mr. Druitt ;f and with the necessary substitution and addition of Homoeopathic treatment, those upon Fractures and Dislocations from Dr. Hastings' "Practice of Surgery. "J The various other authors who have been consulted, and the medical periodicals that have contributed to the formation of the present publication, are mentioned in the foot notes throughout the volume.

Philadelphia, July 11, 1855.

* Pp. 34—37. f Druitt's Modern Surgery, pp. 534—546. t Pp. 164-238.

Contents

CHAPTER I.-— Inflammation ; Symptoms of, Analogy between Fever and Inflammation, Treatment of, Resolution, Local Treatment, Poultice in, 1

CHAPTER II.— Suppuration; Pus Globule, Properties of Pus, Medicines for Suppuration, 19

CHAPTER III.— Ulceration and Sloughing; Fallacy of Hunterian Theory, Granulation, Cicatrization, • 24

CHAPTER IV.— Gangrene, Mortification ; Phlyctense in Mortification, Sphacelus, Crepitation in Sphacelus, Line of Demarcation, Line of Separation, Dry and Traumatic Gangrene, 29

CHAPTER V. — Varieties of Inflammation. 1. Erysipelas. 2. Furunculus. 3. Anthrax. 4. Pernio. 5. Burns and Scalds, 38

CHAPTER VI.— Wounds. 1. Incised. 2. Punctured. 3. Contused. 4. Lacerated. 5. Poisoned — Hydrophobia. 6. Gun-shot Wounds. 7. Tetanus, 56

CHAPTER VII. — Means and Instruments for Suppressing Hemorrhage, 120

CHAPTER VIII.— Ligation of Arteries. 1. Topography of Neck. 2. Ligation of the Radial Artery. 3. Of Ulnar. 4. Of the Brachial. 5. Of the Subclavian. 6. Common Carotid. 7. Lingual. 8. Facial. 9. Anterior Tibial. 10. Posterior Tibial. 11. Femoral. 12. Iliacs, 137

CHAPTER IX.— Abscess. 1. Of Antrum. 2. Of Mammae. 3. Hepatic. 4. Lumbar. 5. Paronychia, 146

CHAPTER X.— Ulcers. 1. Simple Ulcer. 2. Irritable. 3. Indolent. 4. Index to Treatment of Ulcers, 174

CHAPTER XI.— Venereal Disease. 1. History of Syphilis. 2. Gonorrhoea. 3. Syphilis. 4. Primary Syphilis. 5. Bubo. 6. Constitutional Syphilis, . . 190

CHAPTER XII.— Cancer. 1. Of Face. 2. Of Mammas. 3. Uterus. 4. Fungus Haematodes. 5. Chimney Sweepers' Cancer, 226

CHAPTER XIII.— Scrofula ; Scrofulous Diathesis, Scrofulous Ulcers, 273

CHAPTER XIV.— Splints and Bandages, 279

CHAPTER XV.— Fractures. 1. Definition and Mode of Union. 2. Fracture of the Cranium. 3. Of the Nose. 4. Lower Jaw. 5. Scapula. 6. Clavicle. 7. Sternum. 8. Ribs. 9. Spine. 10. Pelvis, 288

CHAPTER XVI.— Fracture of Upper Extremities. 1. Fracture of Fingers.

2. Fore-arm. 3. Humerus, 310

CHAPTER XVII.— Fracture of Lower Extremities. 1. Of Foot. 2. Leg.

3. Patella, 321

CHAPTER XVIII.— Compound Fractures. 1. Pseudo Arthrosis. 2. Cracked

Bones, 334

CHAPTER XIX.— Dislocations. 1. Of Jaw. 2. Of Clavicle, 341

CHAPTER XX.— Dislocation of Upper Extremities. 1. Fingers. 2. Forearm. 3. Humerus, 352

CHAPTER XXI.— Dislocation of Lower Extremities. 1. Pelvis. 2. Toes. 3. Knee-joint. 4. Leg, 363

Vlll CONTENTS.

CHAPTER XXII. — Subluxations and Sprains. 1. Rupture of Muscles and

Tendons, 376

CHAPTER XXIII.— Diseases of the Periosteum and Bones. 1. Periostitis.

2. Caries. 3. Necrosis. 4. Exostosis. 5. Spina Ventosa. 6. Osteo Sarcoma. 7. Mollities Ossium and Rachitis. 8. Fragilitas Ossium, 379

CHAPTER XXIV. — Diseases of the Joints. 1. Synovitis. 2. Morbus Coxarius.

3. Fungus Articulorum. 4. Anchylosis. 5. Ecphyma Cartilagineum. 6. Diseases of the Bursae. 7. Deformity of Joints. 8. Talipes, 414

CHAPTER XXV.— Diseases of the Blood Vessels. 1. Diseases of Arteries, Degeneration of Tissue, Calcareous Deposit. 2. Aneurism. 3. Diseases of the Veins, Phlebitis, Consecutive Abscess, Varix, 435

CHAPTER XXVI. — Injuries and Diseases of the Head. 1. Wounds of the Scalp. 2. Concussion of the Brain. 3. Compression of the Brain, 445

CHAPTER XXVII.— Diseases of the Eye. 1. Ophthalmitis and Catarrhal Ophthalmia, 2. Ophthalmia Purulent. 3. Gonorrhoea!. 4. Syphilitic. 5. Rheumatic. 6. Arthritic. 7. Erysipelatous. 8. Variolous. 9. Scrofulous. 10. Iritis — Iritic Ophthalmia. 11. Psorophthalmia, 12. Hydrophthalmia. 13. Pterygium. 14 Diseases of the Cornea. 15. Hypopion. 16. Staphyloma. 17. Cataract. 18. Glaucoma. 19. Amaurosis. 20. Fistula Lachrymalis. 21. Tumors of the Eyelids. 22. Strabismus. 23. Ectropium. 24. Entropium. 25. Hordeolum. 26. Ptosis, 452

CHAPTER XXVIII.— Injuries and Diseases of the Ear. 1. Otitis. 2. Otorrhea. 3. Otalgia. 4. Deafness. 5. Congenital Occlusion of the Meatus, and other Affections. 6. Perforation of the Membrana Tympani 522

CHAPTER XXIX.— Diseases of the Nose. 1. Ozocna. 2. Polypus Nasi,... 531

CHAPTER XXX.— Diseases of the Mouth. 1. Hare-Lip. 2. Malformation of the Fraenum Linguae. 3. Ranula. 4. Cynanche Tonsillaris, 534

CHAPTER XXXI.— Diseases of the Neck, 1. Stricture of the OEsophagus. 2. Foreign Bodies in the Oesophagus. 2. Extraneous Bodies in the Larynx and Trachea. 4. Bronchocele, 542

CHAPTER XXXII.— Injuries and Diseases of the Thorax. 1. Hydrothorax— Emphysema — Empyema. 2. Injuries of the Chest, 547

CHAPTER XXXIII.— Injuries and Diseases of the Abdomen. 1. Wounds of the Abdominal Viscera. 2. Tumors of the Abdomen. 3. Ascites, 552

CHAPTER XXXIV.— Hernia. 1. Varieties of Hernia. Operations for Hernia, 558

CHAPTER XXXV.— Diseases of the Rectum. 1. Prolapsus Ani. 2. Hemorrhoids. 3. Fistula in Ano. 4. Tumors of the Rectum — Stricture of the Rectum — Fissure in the Anus — Pruritus Ani, 578

CHAPTER XXXVI.— Diseases of the Testicle and Penis. 1. Hydrocele. 2. Haematocele. 3. Sarcocele. 4. Varicocele. 5. Phymosis. 6. Parapbymosis. 7. Cancer of the Penis. 8. Castration, 588

CHAPTER XXXVII.— Diseases of the Urethra and Bladder. 1. Stricture of the Urethra. 2. Fistula in Perineo. 3. Retention of Urine. 4. Urinary Calculi. 5. Lithotomy. 6. Lithotripsy, 605

CHAPTER XXXVIII.— Question of Amputation. 1. Compound Fractures. 2. Contused and Lacerated Wounds. 3. Gangrene and Mortification. 4. Diseases of Joints. 5. Exostosis and Necrosis, 619

CHAPTER XXXIX.— Amputation. 1. Amputation of Lower Extremities. 2. Amputation of Upper Extremities, 627

SURGERY,

AND ITS ADAPTATION TO

HOMOEOPATHIC PRACTICE.

CHAPTER I.

INFLAMMATION.

Perhaps there is no subject, to which the attention of those interested in the investigation of medical questions has been directed, that has caused such diversity of opinion ; and to account satisfactorily for which, more hypotheses have been advanced, than that of Inflammation.

However, after much laborious and patient investigation, and many protracted discussions, the majority of the profession of the present day, coincide in the opinion that Inflammation — properly so called, or when fully established — consists in an engorgement of the capillary vessels, dependent on their* diminished action, and the relaxed condition of their coats, together with more or less accelerated motion of the heart and arteries ; and that from such an abnormal condition arise the well known characteristic symptoms — pain, heat, swelling and redness. (Dolor, calor, tumor, rubor.)

In all organic textures, the transmission of the blood from the minute branches of the arteries to the minute veins is effected through a net-work of microscopic vessels (the capil-

* Dr. Fletcher's Elements of General Pathology, p. 161. Miller's Principles of Surgery, p. 108. 1 laries), in the meshes of which the proper substance of the tissue lies. The diameter of these vessels varies somewhat in the different textures of the body, the most common size, however, being about 3^ of an inch.* It must be obvious, therefore, that if the action of these radicles be diminished, by any cause whatsoever, that the blood will not pass with sufficient acceleration through them ; and that in a short period, the heart still continuing its action, they would become enlarged by the unusual accumulation of blood.

This engorgement, this agglomeration of blood disks in the capillary tubes, dependent on their diminished action and increased power of the heart and arteries, is Inflammation. The whole process may be clearly demonstrated by a common surgical example, frequently encountered in routine practice — the application of some corrosive substance to the skin. The period of incubation might be designated, as the time that elapses between the application of the irritant and the establishment of the inflammatory process.

In the first stage there is not only an increased flow of blood to the affected part, but the circulation is carried on with increased velocity, which may result from the contraction of the capillaries, which, as has been before stated, are the essential seat of the disease.

As the coats of these tubes appear to be analogous to the involuntary muscular tissue of the human body, this contraction has been termed by some physiologists " spasm," while the subsequent relaxation and distention that occurs when Inflammation is fairly established has been designated "paralysis." As this dilatation proceeds, those radicles, that in the normal condition were only capable of transmitting the liquor sanguinis, now, by their extension, admit of the introduction of the red globules ; and those that previously circulated but a single file of the colored corpuscles, are now filled with them in agglomerated masses, and the augmentation of such a condition necessarily tends more and more to retard the circulation.

* Kirkes an 1 Paget, Manual of Physiology, p. 105.

The capillaries being overburdened with blood, there is consequently more transudation than in a non-affected part, and this consists generally of serum, which may be found in the interstitial spaces or upon open surfaces. The natural function of the part is exalted, if the normal action be secretion, the product is in increased quantity ; nutrition is enhanced, and the surrounding tissues somewhat increased in bulk.

This stage is not wholly inconsistent with health, and has been termed by recent physiologists " vital turgescence;" indeed it may be reasonable to suppose, that at certain periods of existence such a condition, when caused by a vital stimulus, is necessary to certain organs, in order that they may perform their destined functions, and thus fulfilling the office assigned them by the Creator, complete in perfectness the wonderful mechanism of the human economy. The blush upon the maiden's cheek, and the increased vascular action that takes place during the secretion of milk in the mammae, are not diseases ; but it is probable that nature, when she has performed the duty incumbent upon her, checks the normal stimulus she has brought to her aid, and this being withdrawn, the part having accomplished its mission, returns to the quiescent condition from which it has been aroused.

As the inflammatory process progresses, the arterial trunks partake in the excitement, and in endeavoring to overcome the resistance, enlarge, pulsate, and throw an increased quantity of blood to the part ; the already distended capillaries become more enlarged, the little contractility they possess becomes weaker, and the blood disks within them more agglomerated ; exudation is increased in quantity and deviates from the healthy standard ; the tissues around become enlarged and softened, because the exuded plastic material is too great for the normal appropriation of the textures, and if still the unhealthy action continues, the attenuated walls of the capillaries, unable to withstand greater distention, give way, and extravasation results; the surrounding tissues become filled with liquor sanguinis, pus commences to be formed, and the destroyed tissue of the part is mingled with the contents of the vessels.

4 SYMPTOMS OF INFLAMMATION.

Such are the pathological changes that are manifested from the commencement to the completion of the inflammatory process ; and if these occur with rapidity, and decline in the same ratio, the inflammation may be termed acute; if, on the contrary, the action be sluggish, and weeks and months elapse before the climax is established, the decline be of long duration, and the termination imperfect, the disease becomes chronic in its character ; and it is such a condition that frequently baffles and disheartens the practitioner with unsatisfactory results, and unlooked-for complications.

The acute form may assume a chronic character, from improper treatment, the habits of the patient, the condition of the affected part, &c, &c, &c.

The most prominent symptoms that denote the presence of inflammation, are, as has been above stated, the pain, heat, swelling, and redness.

Pain is the most characteristic symptom of inflammation, and is caused by the compression of nervous filaments, from the encroachment of the swelling upon them, which acts as a mechanical force ; consequently, the pain increases as the tumefaction advances, particularly if the surrounding textures are firm and unyielding. The function also of the sentient nerves is perverted, and they become, themselves, one of the seats of inflammatory action. Moreover, at each throbbing impulse of the heart and arteries, the nervi vasorum of the distended and elongated vessels add something to the general amount of pain. But such causes, as well as their results, are liable to vary. The pain present in inflammation is not uniform. It is, as has been before mentioned, in a great measure influenced by the elasticity of the textures in which inflammation occurs. Thus, when a bone is affected with the disease, it is more painful than when the skin is attacked. The intensity of the inflammatory action, and the sensitiveness of the affected part, also, to a great extent, influence the amount of pain.

Heat, — " The symptoms and consequences of inflammation,,,

SYMPTOMS OF INFLAMMATION. O

writes Mr. Liston,* — "and amongst others, heat — are modified by the distance of the affected part from the centre of the circulation. All actions, healthy as well as morbid, proceed with more vigor in the superior extremities — the head, the neck, and the trunk — than in the more remote parts of the body; for in the former the blood is transmitted more speedily, if not in greater quantity, and is not so liable to be impeded in its return." This is evidently true, as ascertained by the thermometer. The normal temperature of the body, at the heart and upper parts of the trunk, varies from 98° to 100°, at the extremities about 92°,f but there is very little rise of the mercury from the heat of an inflamed part, and though the patient complains of extreme heat, burning and throbbings, the thermometer only indicates a rise of four or five degrees. £ This; however, can be readily accounted for. During the inflammatory process the nerves of sensation, partaking in the general abnormal action, become perverted, indeed, increased sensibility is one of the signs of inflammatory action; this accounts for the sensation of heat so frequently noticed and complained of by the patient ; and if we also remember that a very fruitful source of animal heat is referred to the changes that take place in the blood circulating in the capillaries ; and as these changes are carried on with great rapidity in inflammation, we can readily imagine that the heat of the part which is the seat of the abnormal action, may be somewhat elevated.

Heat must also be connected with other symptoms, to assist in the diagnosis of inflammation, for we all know, and are every day told of burnings in different portions of the body, when there is not the faintest trace of any inflammatory action.

Swelling. — This effect arises from several causes ; first, the effusion of coagulable lymph and serum; secondly, the increased quantity of blood in the vessels ; thirdly, the depo-

* Liston's Elements of Surgery.

f Cyclopedia of Practical Medicine, p. 738.

$ Loc. cit.

O FEVER AND INFLAMMATION.

sition of new matter; fourthly, the interruption of absorption, particularly noticed by Soemmering.

The swelling is, for the most part, confined to the cellular texture, and is commonly the greatest where the inflammation commences; but this symptom, when viewed alone, cannot by any means indicate the disease, others must be conjoined with it. In the simplest form of cedema, is there inflammation present ?

The redness is evidently caused by the increased quantity of blood contained in the capillaries, and of the introduction of the red globules into those radicles, which previously would not permit their admission. The color of the blood, also, in inflammation assumes a deeper tint, but there are some instances in which the inflammatory process may have been present to a certain extent, and the parts be paler. # This, however, is not generally the case. The enlargement and engorgement of the capillaries, was made plainly distinguishable by Mr. Hunter: he says, "I froze the ear of a rabbit and thawed it again; this occasioned considerable inflammation, an increased heat and thickening of the part. This rabbit was killed when the ear was in the height of inflammation, and the head being injected the two ears were removed and dried. The uninflamed ear dried clear and transparent, the vessels were distinctly seen ramifying through its substance, but the inflamed ear dried thicker and more opaque, and its arteries were considerably larger.

It may not be uninteresting to insert here a few remarks concerning the analogy between fever and inflammation. The theory appears to be very plausible, and supported with well founded arguments ; however, the object of referring to the subject, is merely to give the student an insight into the matter, hoping that the inquiring mind, anxious for further elucidation, will be led to other investigations, that may prove conclusive, either for or against the theory. " It must be

* Liston's Elements of Surgery.

FEVER AND INFLAMMATION. /

abundantly obvious," writes the late John Fletcher,* "that it is the first stage of fever which is (as in inflammation) that of increased action, at least with regard to the extreme vessels of the surface of the body (the essential seat of the morbid change), and the second that of diminished action with respect to these vessels ; and this, whether the exciting cause be stimulant or sedative. It is true — the increased excitement of these vessels being always attended by a diminished excitement of the rest of the body, and the diminished excitement of these vessels by an increased excitement of the rest of the body — it is difficult to divest one's self of the notion, that the cold stage of fever is one of deficiency of action, and the hot stage of increase of it ; and it was this which gave occasion to Dr. Armstrong to call the three stages of continued fever (corresponding to the cold, the hot, and the sweating stage of an intermittent) by the names of the stage of oppression, that of excitement, and that of collapse — names which, it must be remembered, apply only to the state of the body in general, and not of the capillary vessels of the surface, which, during the stage of oppression, are in a state of preternatural excitement ; during that of excitement, in a state of corresponding collapse ; and during that of collapse, in a state df reaction. ' Whenever,' says Dr. W. Phillip, ' increased temperature, swelling and redness appear, the capillary vessels are debilitated, and preternaturally distended.' Now, in the hot stage, the whole surface is affected with increased temperature, redness, and swelling. The deduction is obvious, and the analogy of fever, in every respect, with inflammation, is too manifest to require further comment. In fact, inflammation and fever differ only in their seat and in their degree : the seat of inflammation being anywhere, and more or less circumscribed, and its degree commonly considerable ; whereas,- the seat of fever is in the whole surface of the body, and its degree commonly slight. It is here, however, meant, that the degree of inflammation, in any

* Elements of General Pathology, p. 176. — ed. J. J. Drysdale, M, D., and J. R. Russell, M. D. Edinburgh, 1842.

TREATMENT OF INFLAMMATION.

given number of capillary vessels, is commonly slight in fever, compared to that of inflammation, properly so called ; but the number of them much more than compensates for the slightness of the inflammation of each, and the constitutional affection is? of course, great in proportion."

The symptoms as above stated — pain, heat, swelling, and redness — are those that are most frequently manifested in inflammation, and are in themselves, generally, sufficient to the allopathic practitioner, not only to designate the disease, but also to suggest the system* of treatment that must be employed ; but, to the homoeopathic physician, though the pain, heat, swelling, and redness proclaim the pathological action that is being established, they are of but little utility with regard to the treatment. The medicines exhibited according to the law of simile are not to be prescribed for the name inflammation, but for the character and kind of the symptoms that present themselves in such an unhealthy condition ; the study becomes more arduous, the investigation more thorough, and the examination more minute ; the character of the pain must be ascertained, whether it be boring, sticking, tearing, lancinating, &c. ; the conditions that aggravate or relieve the sufferings must be investigated ; the time of occurrence, and the causes that produced the disease, must be understood; the temperament, age, sex, and habits of the patient must be noticed, and the supervening constitutional symptoms also receive their due share of attention, before the appropriate medicines may be selected and administered.

There are many instances, however, when some of the local

* Concerning the theories of inflammation adopted by allopathic writers and the fallacy of their treatment, we may refer the reader to a number of articles, entitled " Phenomena and Theory of Inflammation connected with Homoeopathic Statistics," written by Dr. Ozanne, and which appeared in the Homoeopathic Times (London), during the year 1852; and also to a paper, " On the usual Antiphlogostic Treatment of the Old School," by Dr. J. W. Arnold, of Heidelberg. The latter essay was reprinted in this country, in the Quarterly Homoeopathic Journal. Boston, 1849, pp. 24-35, manifestations of inflammation cannot be appreciated, but the constitutional symptoms— quick, full pulse, dry, furred tongue, high-colored urine, thirst, &c. — may, perhaps, lead to the detectection of the disease; "but," says Mr. Fergusson,* "some of these, even, are not entirely to be depended on, seeing that they may be present without the existence of inflammation ; whilst,, again, that disease may be in full vigor, and yet the symptoms may be such, that the most experienced may be deceived" Again, he says, referring to the same subject, "exceptions to these observations must be familiar to every one who has seen even a little practice."

Here, then, in the treatment of this disease, the homoeopathic practitioner has a most decided advantage, and one that may be instrumental in rescuing his patient from the grave.

Let us suppose that one of the "most experienced" physicians of the old school be summoned to attend a case, where " the disease may be in full vigor," and the presenting symptoms not such as would indicate to his mind, the high state of inflammatory action that is taking place in the system. What would be the course pursued ? Either to treat the name of some other affection, that the symptoms may somewhat resemble, and which may be entirely at variance with the true state of the disease ; or, perhaps, to prescribe for the invalid some " neutral mixture," without the most remote idea of the dangerous condition of the patient, who, under such treatment, in a short period may terminate his sufferings in death. But, on the other hand, the Homoeopathic physician — although to his mind the pathological condition of the part may be equally obscure — has the light of a law of nature, universal, and coextensive with disease, to guide him in the selection of his remedy.

That there must be some presenting symptoms is obvious, for, says Hahnemann, " There is no curable malady, nor any invisible morbid change in the interior of man, which admits of cure, that is not made known by symptoms, or morbid

* Practical Surgery, p. 70.

indications, to the physician of accurate observation. " Therefore, if the medicine be selected and administered in strict accordance to the law similia similibus, those symptoms will be removed, at least if the disease be curable ; and if removed, the affection, with its internal change, whether structural or functional, will have disappeared also. Hahnemann again says, " The cure which is effected by the annihilation of the symptoms of a disease, removes at the same time the internal change upon which the disease is founded, that is to say, destroys it in its totality. It is accordingly clear that the physician has nothing more to do than to destroy the totality of the symptoms, in order to effect a simultaneous removal of the internal change, that is to say, annihilate the disease itself." He says further, " It is not possible to conceive or prove by any experience after the cure of the whole of the symptoms of a disease, together with all its perceptible changes, that there remains, or possibly can remain, any other than a healthy state, or that the morbid alteration which had taken place in the interior of the economy has not been annihilated."

But let it not here be understood, that a knowledge of pathology is of no practical avail to the student of Homoeopathy ; on the contrary, by understanding the pathological changes that occur in any organ of the body, a class of medicines is suggested to the mind of the practitioner, and from this genus, the remedy must be selected, in accordance to the presenting symptoms.