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vations must be made as to whether vicarious hæmoptysis, or direct phthisis and tuberculosis can originate from suppressed hæmorrhoidal bleeding.

(d.) The suppression of the lochia and the sudden suppression of the milk secretion are still more problematical causes of phthisis. Exact observations on these points are still wanting and wanted.

(e.) The suppression of long-continued eruptions of the skin was regarded by old authors as one of the most important causes of phthisis, and in this respect is discussed at length by Portal.* The modern incredulity as to suppressed skin eruptions leading to phthisis finds no slight support in the fact that "itch" was formerly included amongst the exanthems which induce metastasis. We know now that itch and many other exanthems are purely local and parasitic diseases, and therefore the metastasis of such diseases we rightly consider as "ein nonsens." Nevertheless, there is a considerable number of skin affections which were once confounded with itch, and which undoubtedly owe their existence to dyscrasia and not to parasites.

(f.) The healing of fistula-in-ano.-On this point my own experience accords with that of the ancients, and I remember two cases particularly in which phthisis appeared in previously healthy persons shortly after recovery from fistula. (Notes too long for translation, G. M.)

In both cases, it seems to me that the relation of phthisis to the cure of fistula can scarcely be a matter of doubt. Both patients had already reached an age when phthisis is not a very common disease, at least a phthisis running so rapid a course as in the first case. Besides, both had been previously quite well in their respiratory organs. In the first case the furuncular eruption at the beginning of the attack may not be destitute of significance in making the correctness of the causative relation still more probable. The second case is one of the most interesting and gratifying in my practice on account of its complete cure when all the symptoms of pulmonary and *Observations sur la Nature et le Traitement de la Phthisie Pulmonaire, tome I, p. 317.

laryngeal phthisis were present. I ascribe the result partly to local treatment, but chiefly to an issue in the arm that I had made in view of the cause which produced the disease. It is also interesting from its showing the alternation of phthisis with gout, a form of the disease which used to be designated "phthisis arthritica." I have likewise seen several other cases of fistula-in-ano preceding phthisis, but I am not in possession of positive facts respecting their development and termination. I have also frequently observed anal fistula in developed phthisis, but I do not remember that it exercised an essential influence on the progress of the lung disease.

Modern surgeons frequently deny that the operation for fistula is a cause of phthisis. We may conclude from this that phthisis follows the operation in a certain number of cases only, but by no means in all. Even the kind of operation, whether by cutting, or galvano-caustic, &c., may not be without some influence on the result, since resorption of detritus from the surface of the fistula may be facilitated by the one operation and rendered difficult by the other. Besides, operators often quickly lose sight of their patients and learn nothing of their subsequent internal maladies.

(g.) The suppression of chronic perspirations, especially affecting the feet, was formerly regarded as one of the antecedents of phthisis. Portal Portal reports a case in which phthisis appeared and ended fatally after the violent arrest of chronic, offensive, and copious sweating in the axilla by means of alum applied locally. Swelling of the arms preceded the phthisis.

I must once more lay stress on the declaration that I do not give my unqualified adhesion to the foregoing views of the older authors: but it seems to me that their experience deserves, and even urgently demands, an impartial examination. We have therefore henceforth to collect new and exact observations with regard to ætiology. The principal point will be to determine in individual cases

* Brushing the larynx with nitrate of silver and inhaling the spray of an alum solution.-G. M.

whether phthisis appearing after the above-mentioned diseases depends on simple cheesy pneumonia or on miliary tuberculosis.

The foregoing examples of metastatic phthisis or tuberculosis are easily explained by my theory. In some cases we perhaps find cheesy lymph-glands, as where chronic skin eruptions have pre-existed, or some other kind of cheesy deposit, such as pus collected in an abscess. In others, vicarious hæmorrhage may be at the foundation of phthisis, as after suppressio mensium; whilst in anal fistula we may have to do with resorption from the wound. But there are also cases in which none of these explanations avail, and we are thrown back on the ancient doctrine that in certain circumstances the products of regressive metamorphosis are regularly eliminated by ulcers, eruptions, &c., and that when these vents are suddenly closed the products in question are retained in the body, and set up disease in the organs in which they are deposited. Such an hypothesis must appear to be almost incredible as long as suppuration and excretion are regarded as the local operations of tissues. But now that Cohnheim's researches bring us back to the old opinion that pus is separated from the blood, the supposition is by no means far-fetched that foreign and perhaps morbid products also may be separated from the blood along with pus through the channel of suppurating surfaces. This doctrine stamps the apparently local disease as a general one, and explains both the difficulty of curing it and the disadvantage of its sudden suppression.

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A REVIEW OF HAHNEMANN'S

INSTRUCTION FOR SURGEONS RESPECTING VENEREAL

DISEASES.'*

By W. B. A. Scorr, M.D. Edin.

NONE of the writings of Hahnemann appears to me better calculated to induce practitioners of the old school to give at least a hearing to the great master's doctrines than the treatise on venereal diseases by the discoverer of homœopathy. In the year when this work was first published (1789) Hahnemann had not as yet thrown down the gauntlet to the adherents of the old system (if, indeed, an incoherent mass of heterogeneous theories deserved the name of a system), nor had he reached the doctrine of infinitesimal doses which is still believed by many ignorant persons to be the essence of homoeopathy, and which, from its startling, and, at first sight, paradoxical character is, doubtless, apt to deter many inquirers from the very threshold of the investigation. We have here simply a learned, modest and ingenuous treatise on a too common disease, in which the author is shown to be at least on a level with the highest authorities of his own day in etiology, pathology, and diagnosis; while, in respect of treatment, he has anticipated nearly all the improvements which have since his time been gradually and in spite of much opposition introduced into the soi-disant "regular" practice. This being the case, it is surely worth while at least to pause and consider whether it may not be possible that the man who, in 1789, "with something of prophetic strain," preached amid the scorn of his contemporaries the doctrines universally received in 1873, may not in 1810 (the year of the publication of the Organon) have taught much which the future will confirm, and which it will one day be the acknowledged reproach of the present age to have condemned unheard. If a traveller should find on his * Leipzig, 1789. Translated by R. E. Dudgeon, M.D., in Hahnemann's Lesser Writings.

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arrival at each successive stage of his journey that it, as well as those preceding, has been accurately described by one who has previously traversed the same route, surely such a discovery would afford at least a prima facie ground for believing that his predecessor's descriptions of the stages which still lie before him are worthy, if not of blind and implicit confidence, at any rate of careful examination. And this appears to us to be no inapt parallel to the case of Hahnemann and his opponents of the present day. One by one most of our founder's doctrines have established and maintained their ground, some even during his own lifetime, but the greater part since his decease. Bloodletting, mercurial salivation, the monstrous treatment of gastric acidity by the antipathic administration of alkalis (compare Drs. Ringer and Buckheim), prescriptions compounded of as many ingredients as the famous dish in Aristophanes, the practice of suffocating a fever-patient in a hot and airless room, and denying him even the cup of cold water which he craves, "heroic" treatment generally, large doses, the

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reducing" system, together with many other absurdities against which Hahnemann entered his honest and courageous protest in a minority of one, are now, happily, things of the past; and the once celebrated treatises which extolled them have been deservedly relegated in vicum vendentem thus et odores. But while this is the case, the wise old physician who alone, or all but alone, protested against these modes of procedure more than three quarters of a century ago, in the midst of obloquy, derision, and neglect, has been studiously ignored by the very men who have obtruded on the world his discoveries as their own, and who may be said to hold their fame, wealth, and professorial chairs on the all but expressed condition of ignoring or vilifying the genius the results of whose labours they pirate. The professional forefathers of the "regular" school acquired for themselves an unenviable notoriety by abusing Harvey and Jenner, and some still living took part in the disgraceful persecution of Dr. Elliotson by the authorities of a college well known for the loudness and frequency of its professions of unlimited toleration; but, to do the "regulars" of the

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