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CLINICAL RECORD.

Treatment of Ulceration, Meningitis, and Conjunctivitis.
By Theodoeb R. Bbotchie, M.B..C.M., of Liverpool.

I Pbopose in this paper to consider three subjects, viz. ulceration, meningitis, and conjunctivitis, and to illustrate these by a series of cases which have come under my observation in practice.

The great resources which homoeopathy affords us in the treatment of these diseases, and the brilliant results which follow the successful application of the indicated medicines, are one of the many triumphs which we may justly claim for the principles we profess, and allow us to bear with equanimity the illiberal attacks of our allopathic brethren. To the eyes of the uninitiated the speedy cure of some of the malignant forms of ulceration appear almost miraculous, and to the practitioner they afford encouragement to persevere in the treatment of what may seem beyond the power of human skill. The first subject to which I will allude is ulceration.

To meet some of the malignant forms of ulceration requires often on the part of the surgeon the nicest discrimination, and the exact differential diagnosis of the remedies, as many medicines may apparently apply, yet be quite unsuitable to the case which he has under treatment.

I think you will also find that in some cases you must resort to certain local applications to assist or bring about the healing process, although I am confident that as we master the exact application of our homoeopathic remedies, we will rarely have to resort to extraneous helps.

The question which naturally occurs is, What is ulceration, and how does it occur? It is a solution of continuity with loss of substance, and is brought about by congestion or inflammation in the part, accompanied by exudation of liquor sanguinis, hence nutrition is suspended, the part becoming weakened and softened, and the substances thrown out likewise producing pressure, molecular death takes place, ulceration ensuing. Ulceration is more common in the cellular and adipose tissue than in muscles, tendons, ligaments, nerves, or blood-vessels, and I would now very briefly allude to some principles which apply to all the varieties of ulceration we may be called on to treat.

Locally, we must endeavour to subdue inflammation, for until this is accomplished no reparative process can go on; again, position and rest of the part is of great benefit, in order that congestion or determination of blood may not take place.

Constitutionally, nourishing diet, especially food easily assimilated, and a certain amount of stimulant in some cases, is of essential benefit.

Having thus briefly alluded to general treatment, I will now proceed to consider one of the most malignant forms we may have to deal with, viz., the phagedenic form of ulceration; and I will show the nature and treatment of this ulcer by cases which have occurred in my own experience.

A girl aet. 12 came to me with an ulcer situated beneath the inferior maxilla of the left side. On examination the ulcer showed first as to the edges. They were ragged, of a dark livid red colour, some parts everted, some inverted; The granulations were dark, livid, red, irregular, elevated, depressed, and painful. Discharge was ichorish, scalding, and very acrid. There was also great irritability of system, and the child was very much emaciated. I prescribed Kali bich. 3, a dose every three hours; beef tea, sherry wine, and plenty of arrowroot, to be continued for five days. I also ordered Camph. 0, morning and evening, to quiet the nervous irritability of the system. On seeing her at the end of this period no improvement had taken place, but the child had better rest at night, owing probably to the Camphor. I next ordered Merc. cor. 3, every three hours, for five days.

At the end of this time she again came to say there was no improvement. The ulcer was apparently spreading, and I was afraid lest it would open into the carotid. As there might probably be a syphilitic congenital cause, although I could get no history of syphilis, I prescribed Nitric acid 1, one drop every three hours. At the end of a week there was a marked improvement, which /

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happily continued, till at the end of three weeks the ulcer com-f /

pletely healed up, and nothing was visible except a white scar. The second ease to which I will allude occurred in a child aged three. The_ulcer in this case was situated a little to the inner side of the left nipple, and the history, as far as I could gather it was that an abscess had formed some time back, and burst, discharging matter, but had not healed up. On examination I found it presented all the characters of a phagedenic ulcer, accompanied with great nervous irritability, thirst, and looseness of the bowels. I prescribed Ars. 3, a dose every three hours, beef tea, arrowrcflpt, and a dessert spoonful of brandy to be given during the day;

Camphor 0 morning and evening. On seeing the child four days* after the ulcer looked rather healthier, but there was a good dual of prostration, the looseness of bowels, however, being better. I ordered Lachesis 6 for five days. On seeing the patient there was decided improvement, though it still looked suspicious; Lachesis to be continued, and at the end of a fortnight from this time it was quite healed up.

Another form of ulceration which is often met with is the indolent ulcer. This ulcer, as you know, generally occurs about the middle period of life, and is of a very -obstinate character, being healed with the greatest difficulty. A rather interesting [ case came under my treatment in a man aet. 49, who consulted me j. about an ulcer situated at the anterior internal aspect of the tibia. j He had suffered for some years from this ulcer, and had tried various doctors and various remedies, such as Holloway's ointment, Ac., but without success. He said he believed he had Bpent £200; having taken Blue pills and Sarsaparilla ad infinitum, and he wished me to try and heal this very expensive ulcer. On examination I found"the edges deep, hard, and excavated, the granulations pallid, and the discharge thin and sanious. The first point to be attended to was to clean the sore, and afterwards stimulate the granulations. I ordered him to poultice the ulcer for forty-eight hours with a poultice made of oatmeal and buttermilk, which is about the, best drawing poultice you can get. As there was no doubt some disease of the bone existed, I ordered him Silic. 5, every three hours, and after the poultice was removed to use simple water dressings for a week, also to take a pint of stout during the day. At the end of this period I saw him again and found the sore much healthier looking, but still not so clean as I

desired. I ordered the poultice to be continued for a day or two; Silio. to be continued. On seeing him again in a week it looked much better, and I ordered Kali hick. gr. 1, Aqua Jvi, to be applied to the ulcer, at the same time I encircled it with plaster to keep up some pressure and diminish the size. Week after still improving; continue treatment. On seeing him at the end of this period he complained of a certain boring pain in the part. I resolved now to try Aur. 6, and Carbolic acid lotion for a fortnight. When I again saw him the ulcer was almost healed; but as one or two of the granulations were rather pallid, I touched them with Sulphate of Copper, and prescribed Sulph. 0 for ten days. On seeing him again the ulcer was quite healed, and he felt in remarkably good health. I told him to keep the leg firmly bandaged from the foot upward; and the last time I saw him he had no signs of a return of his old enemy.

The only other form of ulceration to which it will be necessary to allude is the inflamed ulcer; and I will illustrate its nature and treatment by a case which lately occurred to me.

A young man got scalded in the neck, and got some liniment applied to the part, which eased the pain, but a nasty sore resulted. On examination the part was red, inflamed, and swollen, with a thick offensive discharge streaked with blood, and great pain; in fact, showing all the signs of an inflamed ulcer. I ordered Aeon. lx, one drop every three hours, and a lotion of rectified spirits and water to be applied externally. On seeing him three days after, the inflammation had greatly subsided, but the thick discharge still continued, accompanied with a burning feeling. He was ordered Ars. 1, gtt. x, Aquce §iv, a dessert-spoonful every three hours, and at the end of ten days he was quite cured.

Before passing on to consider the next subject, I would remark that I am cenfident the true curative sphere of the treatment of all malignant ulcers lies in the acid group of medicines.

The next subject to which I will refer is meningitis, and I will show its nature and treatment by two very successful cases which occurred in practice during the past year.

The first case occurred in a boy aet. 13. The history of the case was that the boy received a blow on the right temple, the result of a fall against the edge of a fender. He complained a few days after of pain in his head, and appeared to be restless. He was then seen by an allopath, who ordered some mixture, but with no good result.-' His mother then consulted a more eminent allopath, who ordered a blister at the back of his neck. - The only effect resulting from this treatment was the formation of a large sore which did no good, and the boy continued to get worse. The mother then at the end of the tenth day asked me to see the boy. I found him sitting in an armchair lookmg pale, but occasionally a hot flush passed over his face, skin hot and dry, pulse wiry and jerky, tongue whitish, and inclined to be sick. On asking him where he had pain he put his hand to his head, complaining of pain nowhere else, but seemed to be irritable and disinclined to answer questions. I carefully examined the head, but could detect no depression. Taking the history into consideration, and the different symptoms, I diagnosed meningitis. I ordered the boy to be put to bed, and his diet to consist of milk and water, as being the most unstimulating. I prescribed Arnica lx, and Aeon. 1, every three hours. On seeing him the next day no improvement had taken place. Continued the same treatment for five days, but with no success. I then ordered Bell. lx, for four days, but with no benefit. The boy continued to get worse, and began to get rather deaf, and could with great difficulty be roused. On the eighth day I ordered Hry. lx, and continued this till the twelfth day, with a dose of Arnica every day when I saw him. He continued to get worse, and on the thirteenth day was almost insensible, quite deaf, and sleepless. Prom these signs I was convinced effusion had taken place above the arachnoid membrane, and being desirous of sharing the responsibility with some one, I determined on having a consultation.- I requested a medical friend on whose sound judgment and skill I could place every reliance to see the case with me. We both agreed as to the nature of the case, and determined on prescribing Iod. 1, and Verat. viride lx, every two hours in alternation, the hair to be cut, and hot cloths applied to the head. On seeing him next day he had slept rather better. This line of treatment was continued till the twenty-seventh day, when he was quite sensible, but rather weak. During that critical period I always when seeing him gave a dose of Arnica, but under the Iod. and Verat. vir. treatment the effusion completely disappeared. I then gave him Sulph. 6 for ten days, afterwards following it up by China lx, and at the end of six weeks he was quite convalescent, and able to move about. I then ceased my attendance, having

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