such division as into copious, congestive, and passive hæmorrhages would be sufficient." Under the first head bleeding from a ruptured vessel, as well as vicarious hæmorrhage, would be included. Under the second all these cases of turgid or streaked sputa or even of small quantities of pure blood would be included provided the source was pulmonary and that it arose from a congested state of lung. If this was of a phthisical character the case would assume a much graver action than if it simply arose from an inflammatory state of lung that might pass away and leave no evil behind. In passive hæmorrhage there would be but small trace of active congestion, but the prognosis would depend on whether tubercular disease were present or not. In copious hæmorrhage Ledum and Ipecacuanha would be found most valuable remedies. Ledum, especially in rapidly repeated doses, he believed to be one of our best remedies. China would be given as the hæmorrhage abated. Other remedies would be called for, especially if it was vicarious. In congestive hæmorrhage such remedies as Aconite, Bryonia, Phosphorus, Sepia, Arnica, Pulsatilla, Hamamelis, and China, but there was a medicine not generally used that he derived much benefit from, that was Nux moschata. Where a feeling of weight or oppression was complained of, with or without hæmorrhage, he generally selected this medicine. It would be found suitable also for passive hæmorrhage, but in these cases he considered Arnica, Pulsatilla, and Hamamelis, especially the last, as the chief remedies. was, however, much more than hæmorrhage to be considered; its character, the character of the sputa generally, and the time and character of the cough and other symptoms, should be considered in each case separately. The importance of studying the character of the sputa was shown if we noticed the plum-coloured sputa of congestion from aneurism and compare it with other forms. A correct diagnosis thus became of the greatest use in each case.

There

ON SOME POINTS IN THE THERAPEUTICS OF APOMORPHIA AND CHLORAL.

By D. DYCE BROWN, M.A., M.D.

(Read before the British Homœopathic Society.)

THE truth of any scientific law or system is generally demonstrated by an experimentum crucis, and when this is possible, it cannot fail greatly to strengthen the convictions of those who believe in the law or system, and to impress those who are inclined to be sceptical. In such a science VOL. XXXII, NO. CXXIX.-JULY, 1874.

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as therapeutics, where absolute proof is so difficult to be brought home to the minds of the sceptics of the old school, it adds immensely to our strength in argument when we can bring forward an experimentum crucis. Such has always seemed to me to be our power in accordance with the homœopathic law of predicating exactly the therapeutic sphere of a medicine before it is even tried in a single case. We have but to discover by experiment or by accidental cases of poisoning what are the physiological effects produced by any given substance, and we can at once say, and say with confidence in the result, in what cases of disease we shall find it useful. The subjects of my paper afford, I think, an excellent illustration of this point. They have nothing in common therapeutically, but I have grouped Apomorphia and Chloral together, as they are both recently discovered drugs, and I think that I am the first who has made use of these drugs homoeopathically.

To begin with Apomorphia. When I first read the account of Apomorphia a long time ago it was simply stated that it was found to produce sickness and vomiting in exceedingly small doses, and that it was proposed to use it as an emetic in cases where such was required. It then struck me that, if such was the case, it ought to be a valuable medicine in sickness and vomiting. This was all the information I had. But we have now, thanks to the careful experiments of Dr. Galley Blackley, a much more full account of its physiological action. Dr. Blackley's interesting paper is published in the British Journal of Homœopathy for July, 1873. I shall take the liberty of giving a sketch of its action as given by Dr. Blackley, and perhaps the best way is to quote Dr. Blackley's experiment on himself. He says, "On May 25th, 1869, at 9 p.m., my general health being good and the pulse and temperature normal, in the presence of my friend Dr. Wright I injected ten minims of a 10 per cent, solution of Apomorphine under the skin of the left arm, the pulse and temperature at the moment of injection being 72° and 98° respectively. During the first two minutes no effects were produced. After about ten minutes the pulse began to rise slightly

and the respirations became slightly accelerated. At the end of four minutes I felt a sudden qualmishness, which was almost immediately followed by nausea and profuse vomiting. This continued for several minutes, and was followed, as soon as the contents of the stomach had been evacuated, by severe retching. On taking a draught of water with a little brandy in it this was immediately rejected, and on drinking cold water this too returned at once. No bile, however, came up in the vomited matters. At the end of seven or eight minutes from the commencement of the experiment I began to feel very faint and was compelled to lie down, and almost immediately on doing so I fainted entirely, and remained in a state of syncope for about five minutes. On awaking from this I felt giddy and chilly, and was obliged to take a little brandy and water. This was retained, and as I began to feel slightly drowsy I remained lying down for the space of about an hour, during which time I perspired profusely. On rising I

I still felt slight giddiness, but no inclination to vomit. went to bed and slept soundly all night, awaking about 8 a.m. in my usual health, slightly pale, but very hungry.'

Its action upon animals seems to be somewhat different from that in man, as in them a larger dose was required to produce the physiological effects. In summing up the effects produced by a physiological dose, Dr. Blackley gives those of digestion as follows:-" Qualmishness, nausea, vomiting, retching, convulsive movements of the stomach, præcordial pain, salivation, and diarrhoea (in cats)." I refrain from quoting the other symptoms produced, as, in man, the stomach symptoms are the prominent ones, and they are the only ones to which I wish to draw attention to-night. From the experiment above quoted, in which Dr. Blackley next morning, after a good night's sleep, awoke in his usual health and feeling hungry, and also from an experiment he made on a young carman, where after a dose sufficient to cause vomiting given at 8 p.m., the man walked home about 9, and ate a hearty supper on reaching his house, I infer that Apomorphia, though causing severe vomiting, does not cause, as other emetics do, any profound

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or marked interference with digestion, or even pain in the stomach. This coincides with what I find to be the sphere of its action on the stomach. The cases where I have used it with success are chiefly those where sickness or vomiting constitute the disease under which the patient is labouring. We frequently come across such cases. The tongue is clean, the bowels are regular, there are no headaches, the patient has a desire more or less for food, and has no pain after eating, but a feeling of nausea comes on at intervals, especially after taking food, which may or may not be vomited. In other cases, where there is marked dyspepsia, and where Nux or Pulsatilla is indicated, I find Apomorphia very valuable given at the time of the onset of the sick feeling, and repeated every ten minutes or quarter of an hour till it is relieved. This is over and above the administration of the other medicine suited to the dyspepsia which is given at regular intervals through the day. other cases still, when the vomiting is sympathetic, as in the case of a neuralgic headache, or a gall-stone, or a cerebral affection, or a uterine complaint, Apomorphia is equally useful. I observe that, in the discussion on Dr. Blackley's paper, Dr. Cooper is reported to have stated that he had seen immediate cessation of vomiting in a distressing case where a tumour pressed on the brain. The action of Apomorphia in sickness and vomiting seems to me very much to resemble that of Ipecacuanha, and it is indicated in similar cases. A very important point to be observed is that Apomorphia is a specific emetic and does not cause vomiting by any local irritant action. This is clearly shown by its producing emesis when injected hypodermically. As to the dose required to produce vomiting, when I first read the accounts of its effects as quoted from a German periodical, it was stated that a very much more minute quantity was sufficient than that stated by Drs. Blackley and Gee. Dr. Blackley in the experiment quoted injected subcutaneously ten minims of a ten per cent. solution, or in other words a whole grain, and in the case of the carman one twentieth of a grain was injected, while Dr. Blackley states that Dr. Gee found it necessary to give one and a half

grains by the mouth to cause vomiting in a man. I have unfortunately lost the reference to the periodical in which I read the account of the experiments, but there it was stated that one five hundredth of a grain was sufficient to produce emesis. In corroboration of this point I observe in the British Medical Journal of February 21st, 1874, a report of a paper by Dr. Walter G. Smith, read before the Medical Society of the College of Physicians of Ireland, on "Recent Therapeutical Remedies," in which he states that the dose hypodermically as an emetic is from 046 to 196 of a grain.

My first information regulated my choice of the therapeutic dose, which was the 3rd centesimal dilution. I have never used any other dilution, and the results I have obtained have been so gratifying that I do not see the necessity of using a lower potency. I got some of the pure drug from Macfarlan of Edinburgh, and had the 3rd cent. dilution prepared in Aberdeen in the form of tincture.

Dr. Blackley advises the trituration to be used, as he says the tincture does not keep. This is certainly a mistake, at least when diluted to the 3rd cent. ; as it has always in my hands answered admirably, which could not have been the case if the diluted tincture decomposed.

I now proceed to give some cases where Apomorphia has been used with success in the various forms of disease I have named. The cases are chiefly from my dispensary note-book as kept by the students.

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CASE 1. Mrs. E, æt. 50, May 17th, 1872. plains of sickness which she has had for last two days. Has a constant feeling of nausea, and disinclination to eat. No headache. Bowels regular. Tongue slightly whitish. R Apomorphia. This patient afterwards returned with another complaint, having been quite cured of the sickness.

CASE 2.-J. M. J—, æt. fifteen months, June 14th, 1872. Has been vomiting for last three days. Tongue whitish; bowels slightly loose; stools whitish; R Apomorphia 3, drop dose.

17th.-Vomiting much better, only vomited once