CASES ILLUSTRATIVE OF THE PATHOGENESY OF CASE 1.-Dysphagia, &c., February 22nd, 1860. Mrs. W-, Sheffield, æt. about 30; bilio-nervous temperament; strumous diathesis. Is about seven months pregnant, the second time. About two years ago when in the same stage of pregnancy, had an attack of spasm of the muscles of the extremities, especially of the hands and calves of legs, which was cured by Nux Vomica. I was now summoned in great haste several miles into the country to visit her, and found her labouring under a similar affection in an aggravated form, not only the muscles of the extremities being in a state of spasm, but there being also considerable difficulty in swallowing. I remained some time with the patient, during which there was some relief to the symptoms under the alternate use of Belladonna and Nux Vomica. 23rd. Reported better. 24th. No return of spasm, but suffers from diarrhoea. Arsenicum. March 1st.-Received an urgent message informing me that the symptoms had returned with increased severity. I could not go immediately, but sent some Globules of Belladonna (1) and visited her in about two hours, when I was informed she had been worse for the last two days. Before beginning to take the Belladonna two hours previous to my visit there was complete dysphagia, the saliva running from the mouth, and if liquids were given they passed from the pharynx into the posterior nares, and were discharged from the nostrils instead of entering the oesophagus. There was immediate improvement on beginning to take the Belladonna, and she can now swallow tolerably well. The tonsils and soft palate are much congested. There are also painful contractions of the muscles of the calves of the legs, and contrac tion of the flexors of the fore arm and fingers. Continue the Belladonna in alternation with Nux Vomica (2). 2nd. Symptoms above described much relieved, but replaced by diarrhoea-still some injection of the fauces. Omit Belladonna and Nux Vomica, and take Mercurius (2) every four hours. 9th.-Had continued free from the spasms until yesterday, but great loss of power was left in the muscles of the calves, and she could not stand without help. Much worse since; has had a sleepless night; dysphagia returned; fauces injected, but no swelling of tonsils; muscles of calves of legs painfully contracted; diarrhoea less. Repeat the Belladonna and Nux Vomica. 11th. The difficulty of deglutition and cramp were relieved by the medicines in a few hours; the inflammation of mucous membrane of fauces now much lessened, and no soreness felt. Omit the medicines. 10 p.m.-Was hastily summoned and found that the dysphagia and other symptoms had returned in a more acute form than ever; remained with her for several hours. Belladonna as in previous attacks afforded relief to the dysphagia, and the spasms of the extremities afterwards yielded to Nux Vomica, although the loss of muscular power continues. 12th.-No return of spasmodic symptoms, but diarrhœa has supervened. I continued to attend this patient until April 1st, during which period the attacks recurred every two or three days, generally in the night after the first sleep, and were followed by diarrhoea; the spasmodic attacks recurring on its cessation. The dysphagia was nearly always relieved by Belladonna, and the contractions of the muscles of the fore arm and calves of the legs by Nux Vomica, although the latter remained weak. The attacks, however, became more difficult to subdue, as the full term of gestation approached, and the husband's relatives not being homoeopathists the case was transferred into the hands of an allopathic practitioner, under whose treatment my former patient died shortly after delivery. This case presents several points of interest. I have never either met with a case of precisely similar symptoms during pregnancy, nor do I remember to have read of a precisely similar one. A similar, although much slighter attack having happened during the first pregnancy, and at the same period, would point to this condition as either a predisponent or exciting cause of the symptoms, especially when the absence of any symptoms of the kind during the interval between the pregnancies (a period of nearly two years), would seem to prove that there was no organic disease. Some would pooh-pooh the case, as one of hysteria, which amongst old-school practitioners is a common excuse for not treating a case at all. I had, however, attended Mrs. W-, for years prior to her marriage, during which she had had no symptoms of this complaint, which marriage is known rather to cure than to cause. Admitting, however, for the sake of argument, that the symptoms were due to hysteria, yet the relief afforded by the medicine in a complaint so intractable under ordinary treatment would prove only the more signally the power of the remedy. The symptoms were no doubt due to morbid reflex action excited by the presence of the fœtus in utero. Morbidly excited reflex action will account for many of the ordinary complications of pregnancy, such as vomiting, heartburn, false pains, strangury, &c., &c. Owing to some idiosyncrasy in the constitution of my patient, the nervous system became morbidly excited by the presence of the fœtus after a certain period of gestation. Hence, the temporary paralysis of certain motor nerves and the abnormal excitement of others. The nerves on which the first or voluntary stage of deglutition depends, appeared temporarily to lose. their power-those supplying the flexors of the forearm were morbidly excited inducing spasmodic contraction, whilst the corresponding muscles of the lower extremity were at times morbidly contracted, and this was followed by loss of power. The relief to the dysphagia, by Belladonna, was generally rapid and striking. This is a result we should expect from the provings of Belladonna. I had not, however, noticed, until referring to the provings now, whilst writing, and since copying the report at p. 123, for March 1st, the exactness of the correspondence of the symptoms and pathogenesy in this respect, thus in the provings, we have "Impeded deglutition, or entire ability to swallow even liquids, which return by the nose." (Jahr's Symptomen-Codex.) Whilst my report on the above-mentioned date is, "if liquids were given they passed from the pharynx into the posterior nares, and were discharged from the nostrils instead of entering the œsophagus." On this occasion, when the symptoms were so exceedingly well-marked, the relief was remarkably striking and rapid, more so than at any other time. Not only in our own provings of Belladonna, but in the records of cases of poisoning by it and its alkaloid, we find dysphagia a prominent symptom. Thus, in several of the cases quoted by Dr. Hughes, in his very interesting paper in the twentieth Volume of this Journal, we find this symptom present. Thus in Case I (this is a case of poisoning by Atropine), we find it said-"There was, moreover, great difficulty in getting the child to swallow-cach attempt to do so producing paroxysms of suffocation, which appeared to threaten his existence-a great deal of what was put in the mouth was thus wasted." (British Journal of Homœopathy, Vol. XX, p. 72.) Again, in Case II, we find as follows:-"A constant but unsuccessful attempt at deglutition was observable, and at every renewal of the attempt the muscles of the thorax and pharynx would be thrown into violent spasmodic action." (Op. and Vol. cit., p. 77.) Again, in Case III (p. 82)-"The sensibility of the pharynx was so much impaired, and deglutition so imperfectly performed, that on introducing a warm infusion of coffee into the patient's mouth, the liquid collected about the larynx, and his features became alarmingly turgid in consequence of impeded respiration." And in Case X (p. 178)—"Her teeth being closed, we had great difficulty in getting any liquid into her mouth, nor was she capable of swallowing it when we did." And in Case XII (p. 182)—" Complained of dryness in the throat, and great difficulty in swallowing." In a case cited by Dr. Hamilton, Pereira, and others, from Orfila, in which 150 soldiers were poisoned by the berries of Belladonna, amongst the symptoms there is recorded "deglutition difficult, or even impossible." (Hamilton's Flora Homeopathica, Vol. I, p. 68.) The relief to the dysphagia in the case of my patient was not rendered less real and undoubted, by reason of the frequent recurrence of the symptoms. If the view expressed above as to its exciting cause be well founded, seeing that the fons et origo mali remains in operation, we should expect that the medicines whose pathogenesy is suited to the symptoms should be palliative rather than curative in their operation, and that delivery alone should produce complete relief. And the relief of symptoms, even though only temporary, always appears to me as notable a result of the action of dynamic remedies, in a case where they are due to a permanent and irremovable cause, as is their cure where there is nothing to inhibit it. In this case, however, I had not the opportunity of knowing the medical history of my patient subsequent to delivery, as the practitioner who attended her was one of many others with whom I had formerly been on friendly terms, but who had ostracized me because of my adhesion to Homœopathy. I purpose taking another opportunity of commenting on the Nux Vomica symptoms in this case. CASE II.-Convulsions, January 3rd, 1861, Wm. J—, Allen Street, Sheffield, infant, æt. 4 months. Found on my arrival that it had been in convulsions for more than an hour; exciting cause unknown. Present symptoms.-Rapid twitching of muscles of right side of face, the mouth being drawn to right side; violent twitching of right arm and leg; pupils dilated and insensible to light, the left being most dilated; loud rattling in the |