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not an ordinary case of incipient phthisis; he could have walked twelve miles with pleasure, he told me. He was very fond of rowing, and being out a whole day with a friend about a month after having left off treatment, got a fresh attack of spitting of blood, again without Cough. I did not see any of the expectoration, but he told me that his nose bled at the same time. This was evidently from the exertion, but he had no pain in his chest, and no cough; there was a distinct shade of dulness in the right apex (the left being the first affected). I gave him Arnica, and after keeping quiet for a fortnight he was allowed to walk as usual. Soon after this the state of the drinking water was discovered. He looked pale and rather emaciated until the poisoned water was stopped, but after that improved so rapidly that, in about six weeks, one would scarcely have known him to be the same young man. I examined his chest then, and there was still feeble respiration in the left apex, but otherwise no appearance of phthisis.

I have related these two cases, as they seem to me to be purely pathogenetic in nature, and singular in the gradual production, in both cases, of an organic lesion, such as was capable of being detected by the ordinary means of physical diagnosis. I ought to add that phthisis exists in the family on the father's side, but remotely. There are two other sons—one, the eldest, had consolidation of one apex about ten years ago, while at a military college, but is now robust and well; another brother, younger than my patient with haemoptysis, is an officer in the army and in good health. The family tendency seems to be only sufficient to have determined the action of the lead chieOy to the lungs.

Remarks.—I am not aware that Lachesis has ever before been used as a remedy for incipient lead paralysis. I have found it to be most effectual in the cases in which I have tried it. I first used it about twelve years ago, in the case of a dispensary patient, a painter, who came to me with "wrist-drop," which had existed for a few days, and he had been obliged to give up work in consequence of it; it was my first case. I gave him Lachesis 6, from my general recollection of the fatal effects of snake-poison, viz. that death in snake-bite takes place from asphyxia, caused by paralysis of the muscles of respiration. It was an experiment, but it proved to be a crucial one; the man returned in a week so much improved that I was quite astonished, expecting after my experience of the tediousness of this complaint in hospital patients under the best ordinary treatment, that it would be weeks before he would be able to work again; he returned to work in the following week, and did not come to me again, which I have no doubt he would have done if he had had occasion to do so.

In the case of commencing lead paralysis which I have now related (Case 4) the improvement was equally rapid. The same might be said of the relief afforded to the asthmatic suffering of Case 3. These different facts, taken together, seem to point to Lachesis as a valuable medicine in some of the conditions produced by lead poisoning, i. e., paralysis and asthmatic suffering, with palpitation of the heart. The lead jaundice was also distinctly benefited by it, and would have been still more so, I have no doubt, had the patient not been taking the solution of lead at the same time. None of our books mention lead paralysis, except Hempel in his Lectures on the Homoeopathic Materia Medica; he says there, under Oleander, that Hahnemann recommends it in lead palsy. This is not definitely stated in the French translation (1834) which I have by me, though it might be implied from the following statement, "dans certaines paralysies sans douleurs . . . . le laurier rose est si-non un moyen propre a procurer la guerison complete, du moins un remede intercurrent indispensable ;" this is certainly not very encouraging! If I should have another case of lead paralysis, and Lachesis (or Crotalus) failed me, I should be inclined to try Apis, an allied remedy and a natural analogue of the serpent poisons. I say this on the strength of the record of a fatal case of bee-sting related by Dr. Strong, of Ross, in the September number of the Monthly Horn. Review for this year (1873*). A woman was stung on the 23rd of May; on the 28th she said to a friend, who called to see her, " I have lost the use of my hands " she complained also of her feet, that she had lost the use of them. On the 30th was seen by another neighbour, dying: "her nails had turned purple, her eyes and mouth were open, and she was labouring very hard for breath [i. e., death from asphyxia, as in fatal cases of snakebite. J. W. v. T.l; she died in about half an hour. After her death I looked into her mouth and found the back part of her throat very much swollen. I think she was suffocated. I do not think she could swallow. A surgeon by order of the coroner examined her body, and found traces of several stings on the back of her neck. The veins of the neck and throat were very much swollen and discoloured. This is much more definite than anything given by C. Hering, valuable as his treatise on Apia is. The only pathogenetic symptom in the direction of paralysis which I can find is S. 877, "Eingenommenheit des linken Armes." It was developed in himself, on taking the poison of one bee, in fifteen minutes; he does not say how long it continued, but from the way in which it is recorded in the proving it was evidently only a vague and passing sensation.

* Monthly Homoeopathic Review, vol. xvii, p. 569.


(Continued from Vol. XXXI, p. 483.)

We have now to consider the proofs derived from Jetiology in support of my theory.

The causes of phthisis and of tuberculosis have hitherto been usually divided into the constitutional and the occasional. The former were always placed in the front rank, whilst the latter were kept in the back ground, sometimes more, sometimes less so, according to the views which were held respecting the disease. Those who regarded phthisis as an inflammatory affection could not but take cognizance of the immediate or exciting causes, such as taking cold, &c., whereas, on the other hand, those who looked upon tuberculosis as a new formation had to consider such influences as unimportant.

We now recognise only the essential causes, that is to say, those factors and affections which occasion the taking up of fine foreign particles into the blood. The constitutional causes coincide in part with the essential, but with this difference that, according to my views, it is not the constitution but the already existent constitutional disease which is the causal force; in other words, tuberculosis results not from the phthisical or the scrofulous habit, but from existent phthisis (cheesy pneumonia), or from scrofula (cheesy lymph glands). The constitutional abnormality is the first instigator to the primary disease (phthisis, scrofula, caseous inflammations of divers organs), and therefore stands in an indirect relation only to the secondary affection, •e. e. true tuberculosis.

The exciting causes are similarly circumstanced. Under this head come cold, excesses, residence in vitiated air, bad and deficient food, mental emotions, excessive exertion, &c. They cannot, according to my theory, directly excite tuberculosis, with the exception, perhaps, of living in foul air; but they can very easily develop the primary affection, and then tuberculosis arises afterwards. Cold, excess, over-exertion, and the like, set up catarrh and pneumonia, which leave behind cheesy products, and in this way generate tuberculosis subsequently. The same causes may likewise arrest meustruation, start an haemoptysis, &c., and thus lay the foundation of tuberculosis, or bad air, deficient nourishment, &c, bring on scrofula, from which tuberculosis originates later. Accordingly, the causae occasionales are, to my thinking, by no means unimportant; they are the excitors, not of tuberculosis itself but of the primary diseases that lead to its development.

Let us now review seriatim the different primary affec


tions wliich are followed more or less frequently by tuberculosis.

1. Pneumonia.—It will not be necessary to enlarge on this subject here, because in an earlier part of my work I fully discussed the important part which cheesy pneumonia plays in the production of tuberculosis, and also because it is a well-established fact that nothing is more common than the combination of both acute and chronic tuberculosis with cheesy pneumonical products. We know that cheesy pneumonia both alone and when associated with tuberculosis constitutes by far the most frequent form of pulmonary consumption. We also know that the pulmonary inflammation which paves the way for phthisis need not be a special kind from the first, but that even simple croupous or catarrhal pneumonia may run on to caseation, and thus lead to phthisis. I have pointed out in a former discussion that the constitutional cause of phthisis is not tuberculosis, but cheesy pneumonia solely; whilst the most common exciting causes, such as cold, excess, over-exertion, &c., likewise point to cheesy pneumonia, as has just been stated.

The historical sketch of the doctrines held respecting pulmouary consumption which forms the introductory portion of my work plainly teaches us that the inflammatory origin of this disease was admitted, without the least doubt being expressed about it, by the majority of writers from Hippocrates down to our own time. This doctrine was first shaken by Bayle and Laennec, but was again stoutly upheld by other authorities, including Broussais, Andral, Cruveilhier, Bernhardt, &c. The disbelief on this matter was based on the recognition of miliary tubercle as a specific formation, and on the fusion of cheesy deposits (infiltrated tubercle) with true tubercles. We who now regard miliary tubercle as a secondary non-specific growth, and oppose the fusion just referred to, give our support to the old dogma that most cases of phthisis, i. e., those beginning with cheesy pneumonia, have an inflammatory origin.

2. Scrofulosis.—This is one of the most common causes of tuberculosis, although rarer than cheesy pneu

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