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and not in the suitability and correct choice of the doses; on the other hand, as long as we do not occupy ourselves with the cognisance and differential diagnosis of the diseases and only cultivate that of the remedies, so long are we not justified in announcing our therapeutic system as a rational one, intelligible and accessible to all educated physicians. Homoeopathy groans under dogma as well as under conservatism; she sighs under the pressure of one-sidedness, and gasps under the shackles of restriction; nor will she ever, in such " form" as this, be able to lay claim to universal esteem and recognition.
Conservatism is, as Dr. Gerstel described it, the deathknell of homoeopathy! The old will die off one by one, and the young will turn away with aversion from our method, glorious and blessed as it is. The young are otherwise led and otherwise schooled than by conservatism. We must work and live amongst the principles of modern medicine as a whole, and turn them to account for our doctrine. That is what I understand by "Progress;" for I am incessantly pressing it on my homoeopathic colleagues that it is only by progress that our method of cure will ever grow in vitality, and thus be in a condition to maintain itself for the coming generation, to overspread the wide world, and dispense blessings to its utmost limits.
ON CERTAIN PATHOLOGICAL POINTS OF
By Edward T. Blake, M.D., of Reigate.
(Read before the British Homoeopathic Society.)
I. Sublingual Ulceration in Hooping-cough.
Mr. President And Gentlemen,—It is my purpose first to consider a peculiar pathological condition coexistent with a very ordinary disease always endemic in some part of this country, which has, strange to say, escaped the observation of physicians till within a comparatively recent period. I allude to ulceration beneath the tongue occurring in the course of hooping-cough.
You are aware that MacCall has pointed out the existence of the sublingual sore of pertussis. The observation was made during the winter of 1869-70, when MacCall found ulceration present in 111 out of 252 children attacked with hooping-cough, i.e., in more than 44 per cent. The affection varied in degree from a mere abrasion to a deep fissure with a grey or yellowish surface, and often bleeding during or after a paroxysm. In 105 of the 111 it was situated in front of the fraenura; in 4 out of the other 6 its varying position was accompanied by some abnormal disposition of certain teeth.
He considered it to be due to the rubbing of the tongue against the latter in the act of coughing. He looks upon it as a valuable diagnostic sign in cases where the cough is not heard by the physician.*
Unfortunately for the probability of the explanation afforded by Dr. MacCall, children rarely cough with their tongues extruded, and it is quite an anatomical impossibility to bring the fraenum into contact with the teeth. Dr. MacCall was mistaken when he hailed his observation as a discovery, for as early as the year 1844 the association of these phenomena was observed and discussed by Amelung, Bruch, Braun, Leirsch, Schmidt, Zitterland, and others. Then come Gamborini's observations, and many other writers on this subject followed in his wake; chief amongst them may be named Messrs, Charles and Bouchut.* I have said that MacCall thinks the ulceration useful in differentiating this disease; in my own experience the sublingual ulcer is of too uncertain occurrence °to be a diagnostic sign of much value. In the two towns Reigate and Redhill I had last year 6 cases of this tedious disorder, 1 only had the ulcer; it was as large as a pea; it had a yellow base and was seated in the centre of the fraenum.
* Glasgow Medical Journal, 1871, iii, 172.
During the present winter 18 cases have up to this date fallen to my share; of these again 3 only have exhibited ulceration of the fraenum, 2 others had ulceration of lips and tongue. I should much like to hear the results of your own observations on this point. Apart from its pathological interest, to the physician who employs the symptomatic clue to thread the intricate labyrinth of Therapeia, when present, this sign will lead him to a greater accuracy in the selection of his remedy. He will think of such medicaments as Agaricus, Bovista, Carb. veg. Causticum, Graphites, Kali carb., Lycopodium, Natrum Carbonicum, Nitric acid, Nux moschata, Phosphorus, Bichromate of Potash, and Iodine, including its potassic and mercurial compounds.f These have been observed to produce sublingual symptoms in addition to a cough more or less spasmodic and continued in character.
* Bouchut, Hull, de VAcad. de Paris, 1868-9, et Jour, fur Kinder Krankheiten, 1865-6, et Traite Prat, de Malad. des Nouveau-nts. Charles, Des Ulcerations de la Langue dans la Coqueluche; also in art. "Coqueluche," Nouv. Diet, de Med. et de Chirurg. I am indebted to my friend Dr. Cooper for the early literature of this disease.—E. T. B.
t As to the ordinary remedies of the disorder under consideration, it must have struck all my hearers forcibly how lamentably all come short in certain cases. 1 have seen decidedly better results in the spasmodic stage from Mephitis putorius, the fluid of the pole-cat (for which we are indebted to Neidhard), than from the time-honoured but uncertain Drosera. When spasmodic symptoms predominate, Trousseau's favourite remedy, Sulphate of Copper, is followed by good results.
Agaricus, which gives under tongue symptoms "small painful ulcer, by the side of the fraenum of the tongue on the ninth day. After 18 coryza symptoms we have as regards resemblance to the cough of pertussis: "frequently returning sensation of tickling in the larynx, which induces short and frequently repeated coughing."
Bovista. We find, under this rarely-used medicine, "red, little spot on the franum lingua., which is painful to the touch." There are cough symptoms; but they belong essentially to the pharynx and occur accordingly in the morning. *
Carbo vegetabilis has been employed as a remedy in the course of pertussis; we find "crampy pain in the left side of the root of tongue."
There are 28 coryza symptoms.
Of the 68 symptoms under "throat and respiratory organs," one is "with retching " and one with "vomiting and retching, aggravated in the evening."
Under Causticum we have "soreness upon and under tongue and in palate." After 16 "coryza symptoms" we find under larynx:—" Cough and retching with difficulty of breathing; frequent, dry, short, and hacking cough, rarely accompanied by a discharge of mucus; dry, hollow cough, five or six fits at a time, with a feeling of soreness in the interior of the larynx in a space like a band, every fit of cough causing a pain and almost arresting the breathing."
Graphites gives "burning vesicles on the lower surface of the tongue," and "whitish, painful ulcer on the lower surface of the tongue."
Plumbago was credited by Hahnemann with the power of producing no less than 30 symptoms of "catarrh " and "coryza,'' besides 5 different "coughs," none of which, however, resembles the classic cough of pertussis.
Kali carbonicum,* we have a much more promising remedy, one indeed that already holds a post in our programme of treatment of pertussis. Its proving gives "soreness of the franum lingua" [the soreness is produced apparently by a vesicle, for the characteristic buccal symptom is] "vesicle with burning pain."
* Becker, of Miihlhausen, gives a rather singular but, I fear, not very practical, indication for the employment of this remedy in pertussis, viz., pityriasis over upper extremities and scalp, with dry hair. C. Hering holds this drug in high esteem for certain forms of hooping-congh, especially when agg. from 3 to 5 a.m. is present. Bccnninghausen affirms that he administered it with complete success in an epidemic where an early symptom was "puffing of upper eyelid."
There are 18 "coryza" symptoms, and when I tell you that there are over half a hundred "cough" symptoms, you will pardon my not quoting them. Suffice it to say that one of those symptoms is " accompanied by nausea" and two are with " vomiting f* resembling so far the especial explosion of hooping-cough.
Lycopodium presents, in its proving, a slight resemblance to the phenomena of pertussis: "ulcer under the tongue, being very troublesome when talking or eating." There are 24 "coryza symptoms" [rather above the average!]; one only of all the "cough" symptoms presents reflex, gastric contractions, "titillation with cough with retching." (I do not know, I must frankly confess, what to make of a symptom like this :) "nightly cough affecting the stomach and the diaphragm (? how), mostly previous to the rising of the sun."
Natrum carbonicum has "pustule near the fraenum." Hahnemann records no less than 33 catarrhal symptoms under this remedy. They coincide with the earlier stages of hooping-cough.
Nitric acid, it is well known, causes ulceration of the oral cavity generally. There is quite the usual modicum of "coryza" symptoms, 25 in fact, and they are well pronounced. This drug undoubtedly enjoys, like most of its compounds with the mineral bases, a specific action on the larynx.
Of the 35 "cough" symptoms, one is connected with "vomiting " and one must be given in detail, "concussive cough, in the night, the breathing being frequently arrested,