the book before us is peculiarly and avowedly imperfect and untrustworthy; for the author himself says, in the preface, "The distinction of symptoms as the result of provings on the healthy (pathogenetic) or as the result of clinical observations on the sick (curative), or as belonging to both these classes, has not been retained in this work." So that true drug-symptoms and mere speculations are here put on a par ! This we think a radical imperfection, and one which detracts greatly from the value of the book; for how can symptoms only alleged to have been cured by a drug ever be accepted on an equality with those really produced by it? The author says of his book, "It contains the characteristic and most prominent special symptoms of the best proved and most used of our medicines." This it may do; but it does more, for it contains symptoms that hitherto have not been known to be produced by these drugs, and these mixed up along with the true and pure symptoms without any mark of distinction to know one from the other! A student, there

fore, who begins the study of the Materia Medica with this text-book will learn what he will afterwards have to unlearn : he will learn, for instance, amongst the symptoms of Calcarea carbonica-enlargement of the head, with open fontanelles; tumours and suppurating boils on the head; ulcers and specks on the cornea; oozing of blood from the eyes; fistula lachrymalis; discharge of pus from the ears; polypus of the ear, nose, bladder, and uterus; prolapsus ani; prolapsus uteri; bloody urine; ulceration of the larynx, of the lungs, of the skin, and of the bones; curvature of the dorsal vertebræ; epileptic attacks at night; St. Vitus's dance, &c. &c. all of which he will have to learn afterwards were not symptoms produced by the drug at all, but only those said to have been removed or under certain conditions removable by Calcarea.

Still, notwithstanding these unfavorable remarks we have felt ourselves compelled to make, the book is a valuable addition to the better part of our literature, and of its class perhaps one of the best yet issued.

657

CLINICAL RECORD.

Perforating Ulcer of the Stomach. By Dr. WATZKE.*

I.—Mr. H—, nearly 60 years old, by profession a painter on porcelain, of very pronounced choleric temperament, came to me for advice as a last resort. He had hitherto been treated by a colleague, Dr. R-, who at that time-seventeen or eighteen years ago-sometimes dabbled in homœopathy. He had previously had repeated hæmatemesis, to the amount of two or three pounds of blood at a time. Before that he had been long without any appetite, tormented with all kinds of dyspeptic sufferings, jaundiced, emaciated and debilitated; he complained of constant violent burning pain in the scrobiculus cordis, frequent eructation of wind, retching; the gastric region was extremely sensitive, and could not suffer the least pressure; beyond milk, clear soup and water, he could take nothing in the way of nourishment. The emaciation and debility had increased from week to week; the countenance was sunken; the skin flabby, of a waxy yellow colour, hot, dry; the bowels were constipated, stools blackishbrown and mixed with blood-clots. Unusual exertion, much sitting, insufficient food of bad quality, frequent and violent mental excitement, may have been the chief exciting causes of the malady.

I confess that the symptoms actually present, and especially the extraordinary emaciation and the appearance of the patient, who offered the appearance of the cancerous dyscrasia, at first led me to form a wrong diagnosis, for which my excuse must be that I had not an opportunity of observing the commencement and course of the disorder, and the appearance of the ejected blood. I gave a hopeless prognosis, but this was not justified by the further course of the disease. The chief remedies employed were

Arsenicum and Nux vomica. Under the use of these remedies the patient recovered some of his appetite in the course of six to eight weeks, increased in strength, the skin lost its jaundiced flabby appearance, he enjoyed refreshing sleep for hours together. He gradually recovered his health completely, and was able to partake of food which he had been unable to touch even in his former comparatively healthy years. Can there be any doubt that the source of the hæmatemesis was a round ulcer of the stomach which had now cicatrized ?

* Allg. hom. Ztg., April 30th, 1866. VOL. XXIV, NO. XCVIII.-OCTOBER, 1866.

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Six or seven years later, this patient, whose circumstances grew gradually worse and worse, and whose life was passed in care and anxiety, had a slight relapse, and though he recovered from this under the above remedies in a few weeks, his health was never perfectly restored. Dyspeptic sufferings, want of appetite, diarrhoea, are the affections from which he frequently suffers. He has now (1863) attained the age of seventy-eight years.

II. The following case will show the difficulty sometimes attending the diagnosis of the round ulcer of the stomach, and how even the most skilful physician is unable to pronounce with certainty respecting it.

:

Mrs. Mary Gr―, æt. 28, of delicate make and very irritable temperament, always regular in her monthly illness, the mother of two strong healthy boys, had for years complained much of dyspeptic sufferings. Many articles of diet, as rich and heavy puddings and vegetables, she could not bear to take; the things that suited her best were weak coffee with milk, and beef; but soon after the lightest food that usually agreed with her, she had often stomach-ache, distension and tenderness of the pit of the stomach, great eructation of wind, retching and colicky bellyache mental excitement, even when of an agreeable character, was usually followed by repeated watery diarrhoea. Her spirits were usually low; absent, laconic. A violent attack of cardialgia which came on one day about 3 a.m., without apparent cause, and presented the most dangerous symptoms, caused great anxiety to her family. She groaned, and complained of the most horrible pains in the stomach; she was doubled up, threw herself about uninterruptedly in bed; she could not bear the slightest touch on the pit of the stomach; her forehead was covered with cold sweat; her throat seemed to be constricted; she made ineffectual attempts to vomit; the hands and feet were icy-cold; the tongue dry; the pulse extremely quick, small, almost imperceptible. Before my arrival the attack had lasted upwards of half an hour. She could not bear the warm, moist bran fomentations they wished to apply. I prescribed Colocynth 3, a dose every quarter of an hour, under which the patient became gradually more quiet, and the pain more endurable, so that after the lapse of an hour she fell asleep, and slept several hours. Similar but not so violent attacks occurred once or twice a month. Colocynth, Belladonna, Conium, Veratrum, Cuprum, Gratiola, and Arsenicum ameliorated and allayed the malady, but did not remove

it. As the malady still continued to recur after several months' treatment, in spite of every precaution and the observance of the most careful diet, and as moreover a doctor to whom the patient applied behind my back declared that she had not a stomach but a liver disease, and pledged his honour to cure her completely in three months, she naturally confided herself to his care; and as I had so grossly mistaken the disease, I was dismissed in no very complimentary manner. However, after three, and even six months (for so long did the patient submit to the pills and purgatives of this charlatan), the disease was not only not completely cured-on the contrary, it was worse than ever. I, who had been for many years the family medical attendant, was again consulted. As the doctor who had supplanted me had insisted so strongly on the disease being one of the liver, I persuaded the family to take the opinion of one of the most distinguished of our diagnostic specialists. As a journey I was forced to make prevented my personal attendance at the consultation, I begged the professor to give me his view in writing. The following day I received the written opinion of the renowned diagnoser, the first line of which began with these words: "Morbum hujus ægræ non nosco." A residence during the summer in a hilly district, and a mild water-cure limited to cold compresses to the stomach and the shower-bath, acted favorably on the patient: her appetite increased (she bore butcher's meat particularly well); her appearance improved, she grew stronger; during the whole summer she had had but one slight attack of her spasms in the stomach. On her return from the country in autumn, the stomach affection seemed to be quite gone. She was pregnant; the pathological had given place to a physiological process: it however recurred, though in a different form, as soon as the latter had ceased. Scarcely four weeks after her confinement, the patient began to cough. She was rapidly carried off by galloping consumption. Post-mortem examination showed tubercular infiltration of both lungs; in the fundus of the stomach there were about ten radiating cicatrices; the liver was quite normal. Was the round ulcer of the stomach in this case caused by the commencing pulmonary tuberculosis? or, on the contrary, the tuberculosis by the ulcer of the stomach? Dr. Jaksch considers the dyspeptic symptoms which not infrequently precede pulmonary tuberculosis as symptoms of the commencement of the latter. Or might not the tubercular dyscrasia rather be the consequence of the dyspepsia and the abnormal blood-formation caused thereby?

The Magnet in Scrofulous Photophobia.

By Dr. C. MÜLLER, of Brüx.*

We all know how tiresome this photophobia is for the practitioner, when for weeks, and even months, he is unable on account of it to examine the eye in order to ascertain its condition. This is particularly the case with young children. Persuasion is of no use, force is equally unavailing; they turn the eyeball upwards with all their might; and even if we succeed in separating the eyelids for an instant, they plunge their heads downwards to escape the light, and we can see nothing of the cornea, and are unable to ascertain whether there is a phlyctena or ulceration, or no. The photophobia is sometimes extreme, with scarcely any inflammatory symptoms. Nor is it only children who are subject to this scrofulous photophobia; I have seen the best marked forms of this affection in adults, twice in men above fifty. In both the photophobia was as great as it is seen in children; one of them buried his head among the bedclothes just as children do, and protested incessantly that he would rather die at once than suffer any longer this spasm in the eyes and dread of light.

In June of last year, my friend Dr. Haus, of Töplitz, sent to me a youth, æt. 17, who had been affected with scrofula from his childhood, because at school they were unable to cure him of his ophthalmia and photophobia, and because his relatives resided in Brüx. He had had all sorts of internal and external remedies. I treated him from the 9th of June to the 30th of September, when he went to Prague to pursue his studies. When he came to me, he wore a green shade over his eyes, which I ordered him to lay aside, or at least to change for a sky-blue one; for I do not approve of green shades in such cases, because the colour of the medium through which we see (the air) is not green, but blue; because blue is a simple and primary colour, while green is not, but is composed of blue and yellow; because red is the complementary colour of green, and is the very worst colour for the eyes. I got him, therefore, to lay aside his shade; but I was unable to examine the eyes well on account of the excessive photophobia. I found, however, the albuginea very bloodshot. The windows in his room were covered all day with red curtains. All sorts of medicines

* Hirschel's Zeitschrift, August 1st, 1866.