CASE NO. 2. A young man nineteen years of age presented himself at the clinic with a scar about an inch long over the left eyelid, drawing the lid away from the eye, exposing the globe, and causing a severe deformity.

History. He had indulged in too much beer with a companion, and finally they quarrelled, his friend throwing a beertumbler at his head, taking off a piece of skin about an eighth of an inch wide. A physician, having been called, stitched the edges of the wound together, with the above result.

Treatment. The patient was put under the influence of chloroform, the scar excised, and a model of the wound taken; a piece of skin the shape of the model, only a little larger, was then taken from the patient's arm, and placed over the exposed surface of the wound over the eye; the edges of the wound having been undermined, the edges of the flap were pushed underneath them, so that the flap-edges were completely covered for about a sixteenth of an inch all around. An incision was made in the centre of the flap for drainage, iodoform and a firm bandage applied, and the patient put to bed. On examining the wound on the fifth day, the flap was found adherent; the edges of the wound had retracted, and appeared shrivelled, yet not exposing the flap-edges. In about three weeks, the wound had healed, with complete removal of deformity, and only a slight scar around the flap. Not a suture had been used in this operation.

In speaking to his class about this case, the professor said that the frequent failure of plastic operations was due to stitching the flap-edges to the wound-edges, which caused them to become necrotic, and thus cause the death of the flap. If the skin surrounding the wound was undermined, and the edges of the flap pushed underneath, they would have a healthy, firm, and the best antiseptic covering that could be procured. Another point of great importance in plastic operations was the perforation of the flap so that it would lie close to the surface of the wound, to which it should be held by a firm bandage. It should not be examined before at least five to seven days.

DOCTRINES OF THE ORGANON. — PRIMARY AND AFTER EFFECTS.

BY LEWIS BARNES, M.D., DELAWARE, O.

We are told in Sect. 63, that "every drug

produces a

certain change in the state of health of the body," and that "this is called primary effect;" that there is a re-action of the vital

1 Reprinted from the Medical Advance, July, 1887.

force which "endeavors to oppose this effect, . . . and it is called after-effect or counter-effect;" and that (§ 64) “during the primary effect . . . our vital force seems to be only receptive or passive," "compelled, as it were, to receive the impression made upon it by the drug," but that afterwards "it seems to rally," "and the result may be twofold," first, "the exact counterpart of the primary effect;" second, "where nature affords no exact opposite condition," the vital force appears "to put forth its superior strength" to extinguish the effect of the drug, and to establish "the normal state of health, which is the after-effect, or curative effect."

- ―

The "twofold" action referred to, called counter-effect and after-effect, amount to the same thing, for in § 65 they are no less than four times employed thus together.

Hence our drugs are to be so given that the so-called primary effects must correspond with the symptoms of disease. They are, indeed, the chief if not the only forces of the drugs, those that come afterwards in an opposite or counter form being the opposing powers of the vital force. The point here is, that cure results, not really from the drug, but from vital action excited by it; this is opposite the disease, because it is against the drug, which acts like or with the disease. But medicines given in seeming opposition to disease are really in opposition to the vital force, which is acting or re-acting against the disease. This . action of the drug, therefore, may serve to check disease in a measure, that is, to palliate it; but in so doing it weakens and impairs the vital force, which is the only really curative agency. And thus permanent mischief is likely to result.

Such is the clearly expressed doctrine of the Organon. It is not my present purpose either to approve or deny its truth, but simply to show what the Hahnemannian teaching is, and, as far as his authority is concerned, to settle the vexed question as to whether cures are wrought by the primary or secondary effects of drugs. The point is clearly in favor of the primary as the essential agency. It is important to have this fixed in the mind. If any one is in doubt about it, he should examine the sections above quoted, and see; for a serious matter hangs upon it.

The matter is this: Our provings appear to be made up of an indiscriminate mixture of primary and secondary effects,-drugeffects, and counter-effects of the vital forces; those that are like and those that are unlike. Here lies before me now, while writing this, a published account of a proving, in one of our very best magazines. A drug, no matter what, or what potency, was taken - three, six, and nine doses — on three successive days. Would the primary and secondary mix during that time? Let us waive that, for we have ten pages of symptoms recorded day

by day for seventy-four days, all given as medicinal effects of the drug recorded as guides for its use! What a mixture of primary and secondary, allopathic and homoeopathic, even supposing them all to be drug effects! How much of our materia medica has been composed in a similar way? Perhaps you will say that it is reliable and proper, for all that, and will appeal to cures in favor of your statement. I have nothing at present to say in reply, except that it violates the clear teaching of the Organon.

I am aware that it is said (§ 112) that after-effects "are rarely if ever perceived after moderate doses administered to healthy persons, for the purpose of experiment; and they are altogether absent after minute doses." This looks, at first sight, as if all effects might be chargeable to the drug as primary. But it may be answered, that the implied reason why they do not appear is, because they are too weak to be "perceived." We may conclude, therefore, that, if counter-effects do appear, it is evidence that they belong to the vital force, and not to the drug; and have no proper place in the drug record.

We are told further (§115), that some drugs produce effects which appear to be counterparts of other symptoms, but which "are not to be regarded as actual after-effects or counter-effects of the vital force, because they merely indicate an alternation or fluctuation of the various stages of the primary effect."

These contrary symptoms, moreover, appear only "in regard to certain minor features," and in characteristically important ones. And since they constitute a mere "fluctuation," they should appear in close connection with the characteristic primary effects. If they appear some hours afterwards, can they be called fluctuations? If some days after, are they not "aftereffects"? If new symptoms appear after days or weeks, whether contrary to those of the first days, weeks, etc., or not, should. they not be assigned to re-actions of the system instead of being counted as primary effects of the drug? This is upon the idea that they come in consequence of the drug. But who knows or can know that such is the case? After-effects are not necessarily counter or contrary. Most symptoms, the most important ones, indeed, have no opposites. Such are all the pains. Their opposites are mere absences, states of ease, which are not recorded among symptoms. Such are mental disturbances, the most important of all, since their opposites are normal states. But when the system is impaired or disordered by a drug, or any evil agent, its re-action may appear in many disordered states, depending perhaps upon its comparatively weaker or stronger points. Why count them as characteristics of the drug?

After-effects may be called responses of the system, and each

system may respond in its own way, each somewhat differently from every other, just as each man's mind may respond differently from other minds, to the same invading influence. Aftereffects, therefore, should not be assigned to the drug so much as to the peculiarities of the "prover," which may not appear in another person, or perhaps in the same person at another time. This is an important reason why the experiences of provers should not be recorded as parts of a materia medica, unless they have been repeatedly observed in different persons.

I am aware that these facts will be unpalatable to many of our enthusiastic friends, who do not wish to have their terribly redundant materia medica stirred up and shaken. Once, at a meeting of the American Institute, I was privately expostulated with by one of our noblest college professors, for comparing the ideas of members with pure facts. He said they did not like to be held to the strict rules of evidence. But the time is at hand when they must be. We shall never stand upon solid ground until our system is developed in this way.

CEPHALALGIA SATURNINA.

BY S. M. GRIFFIN, M.D., DANBURY, CONN.

[Read before the Connecticut Homeopathic Medical Society.]

PERHAPS no single symptom is so frequently, obtrusively, and persistently presented to the physician's notice, as headache; and the day that passes without at least one prescription for this omnipresent malady is a remarkable exception. There is a special headache for each hour of the twenty-four, and fre quently one that has all hours for its own. There is, doubtless, a distinct headache for each separate disease of every organ in the body, headaches that come on in a greater variety of conditions and in more ways than the water comes down at the cataract of Lodore.

But sometimes we, as one may say, meet a bushwhacker, a free lance, a headache apparently unconnected with any other symptom. It is just a headache; "only this, and nothing more." Go down the entire length of the patient's system, examine every organ, seek subtly to extort a quasi-admission from the victim regarding some other lesion: it is all in vain ; it is a headache with no characteristic and no identity.

Such an one obtruded itself on the writer's notice two years since. The patient was a lady in otherwise excellent health, quite past the climacteric, hale and hearty in appearance, a farmer's wife in well-to-do circumstances and healthy surroundings.

The headache was chiefly peculiar in that it had no peculiarities. It came on at very irregular intervals, and from no apparent cause, and lasted a few hours or as many days. In no other respect did the system suffer. I had been recently introduced in this family, a family of decidedly allopathic tendencies, and they evidently expected my remedies to cure that headache if they possessed any virtues whatever. With very little on which to hang a prescription, one's imagination must perforce be drawn upon; and nux was given upon the supposition that the patient, being a good liver, was overfed. Again belladonna was prescribed for real or fancied turgescence of the cerebral bloodvessels. Or sepia, when the derangement was thought to have followed the climacteric. Anon mercury was exhibited, chiefly because no other remedy was indicated. Again sulphur, since that remedy is to be poured in as shrapnel, when no target is visible for a ball. Still the disease was not even mitigated, either in frequency or severity.

After repeated attempts, two symptoms only were discovered, - the pain was most severe at the vertex, and was sometimes accompanied with vertigo. This reduced the possible number of remedies from forty to fourteen. After perhaps a year's occasional prescribing, when riding by the house, musing on the unalloyed bliss of a physician's life, a group of excited persons were seen in the yard beckoning me to approach. The lady had suddenly become very dizzy, and fallen heavily to the ground. It resembled a paralytic seizure, but no symptoms ensued that should have followed an attack of that kind. From this time the paroxysms increased in frequency and severity, especially the vertigo, which detained her in bed often for three days.

After a time, and led possibly by these symptoms, it occurred to me that the lady's hair retained its color in quite a remarkable degree, and questions were put on this subject.

With an embarrassment that would have been charming in a lass of fourteen, the punctiliously truthful old lady confessed that she had used a little-just a little of a hair-dressing that she knew to be harmless, as she had used it for a long time. By dint of persuasion the bottle was produced, and a sample obtained, which, when tested, was found to be strongly impregnated with lead. This discovery was convincing; the strictly "Vegetable Hair Renewer" was abandoned; and simultaneously with the appearing of a light streak where the hair was parted, the much-combated headache voluntarily retired from the field. No other symptoms of lead-poisoning could be found, save those stated in the above report.