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ordered him to be sent to the country as soon as convenient to his parents. I have seen him often since, and a stronger or more intelligent boy it would be difficult to find.
The next case occurred in a girl aet. 11. The history of this case was that the child had fallen against a table, and two or three days afterwards complained of pain in the head. The parents did not consider this of any consequence; but the child continued to get worse and inclined to lie down, and was very restless. About ten days from this period of receiving the blow the parents asked me to see the child. On seeing her I carefully examined for any depression, but none was to be detected. She showed all the signs described in the last case, the deafness being also well marked. From the history and the signs present I diagnosed a case of meningitis, with incipent effusion. Warned by my previous experience, I determined to strike at the disease at once, and prescribed Iod. 1 and Verat. viride P, every two hours in alternation, the hair to be cut, and hot cloths applied to the head; the diet to consist of milk and water. This treatment was pursued for nine days, at the end of which period she was quite sensible. I then prescribed Sulph. 0 for ten days, following it up with China lx, and at the end of a month she was quite convalescent and robust.
I would now make a few observations on the treatment and what appears to me to be the guiding points in diagnosis. In the first place be sure the lodium you obtain is pure and of the strength you order. The first which I ordered was as clear as water, and its medicinal properties were equal to the 200th dilution so eloquently recommended by a London practitioner. What I obtained personally was of a bright red colour, and its action was most decided; and as life or death often hangs on the purity of the drug, it behoves us to be very careful to obtain the exact strength we consider to be necessary. In the second place the diet should consist of milk and water, as any stimulating diet, such as beef tea, will precipitate the dormant effusion. In the third place, hot cloths to the head are of infinite advantage, soothing the patient and procuring that needful sleep which enables nature to restore the diseased organ to its former vigour. In the fourth place, it is highly necessary to have an intelligent nurse always with the patient, as he may turn over on his face and become asphyxiated.
The guiding points in diagnosis appear to me to be the following :—viz., 1st. The history of a blow or a fall; no depression on examination, all the pain complained of situated in the head. In the second place, the gradual development of the symptoms. In the third place, when effusion has taken or is about to take place, the development of deafness gradually increasing. In the fourth place, you often find the patient lying on the back or side; turn him round and you will invariably find him resume his old position, a look of irritation rapidly passing over his features. It now naturally occurs to us, with what may this disease be confounded? It may be wrongly diagnosed for concussion or compression. How are we to distinguish these?
In concussion and compression the mental operations are suspended. In meningitis they are not exercised; temper is irritable. Pupils in concussion are not fixed; in compression fixed; in meningitis generally contracted. Respiration in concussion feeble, silent; in compression slow, stertorous snoring; in meningitis unaffected. The alimentary canal in concussion, no swallowing, involuntary movements of the bowels ; in compression, no swallowing, constipation; in meningitis the alimentary canal is unaffected.
Having thus briefly alluded to the leading distinctions of these diseases I would pass on to the consideration of my next subject, conjunctivitis, glancing also at ulceration of the cornea; and, as before, I would illustrate these subjects by some cases which I have lately treated.
Conjunctivitis is one of those diseases which the practitioner is continually called on to treat, especially in children. Tou may see the patient at first when there is simple inflammation of the conjunctiva, or at a later stage where muco-purulent discharge exists. In the first stage you may speedily cure the disease by a course of Bell., while in the second stage you must resort to a different mode of treatment.
A child aged five was brought to me with what the mother termed sore eyes. On examination I found the conjunctiva deeply congested and inflamed, and the child very sensitive of light. The mother informed me that the child's eyes were glued together in the morning. I prescribed Bell. 2 every three hours, to be continued four days, and a plain bread poultice on the eyes at night. On seeing the child at the end of this time the congestion had disappeared, but a nasty muco-purulent discharge existed. I now ordered Merc, cor., 3, every two hours, and saw the child again in four days. There was no decided improvement, and I now ordered a lotion of Tannin grs. x, Aquct Jiii; the lotion to be used three times a day. Merc. cor. 3 to be continued. On seeing the patient four days after it was much better, and in sixteen days quite cured.
I will now relate two cases of ulceration of the cornea. I may remark -that there are two varieties of this form, viz., ulceration of the proper substance of the cornea, and ulceration of the conjunctiva cornea, and you find these both require different treatment, because the treatment that applies to one is totally useless for the other.
A girl, ast. 19, asked my advice about a speck which was situated on the right eye. On examination I found a superficial ulcer of the cornea. She only complained of a feeling of something on the eye, and a certain amount of dryness. I prescribed Podophyllum 3, three times daily, and at the end of a fortnight she was quite cured, and nothing was visible on the eye. I believe that in ulceration of the conjunctiva corneae Podophyllum is specific.
A young man consulted me about something which was situated in his left eye. He had been under allopathic treatment for some time, but with no benefit. He complained of a sensation of sand lodged in the eye, and occasionally violent stitches. On examination I found an ulcer situated in the cornea proper. 1 prescribed Ars., 2 trit., every three hours for a week. On seeing him I found that the feeling of sand in the eye was gone and also the violent stitches, but no improvement otherwise. I now ordered Podoph. 3 every three hours, for a week, but with no benefit. I then ordered Merc. cor. 3 every three hours, and dusted in a little Calomel with a camel's-hair brush, and asked him to come and see me every third day. I continued this treatment for about seventeen days, when the ulcer had almost disappeared. I then prescribed Sulph. 0 morning and evening, and at the end of six weeks from the commencement of the treatment he was quite cured.
Cerebral Exhaustion or Break-down from Over-study.
In consequence of the mental hard work required in training for the professions or University honours, we frequently meet with a greater or less break-down of the cerebral faculties, so that the patient is unable to endure continued application to business of any kind, and in consequence becomes nervous and depressed. If this continues long he falls into desultory habits, becomes hypochondriac, and stands a fair chance of being thrown out in the race for life altogether. In these cases and in other nervous diseases I have observed, and find the same remark made by Brown-Sequard, that it is better not to go on long advising total rest and abstinence from business, with frequent change of air and scene &c, all of which are essential at first, but we must counsel the return to a moderate amount of steady responsible daily occupation. To this and the usual hygienic rules we must add steady perseverance in specific treatment with medicine chosen in accordance with the homoeopathic law. Often we do not get the opportunity of a full trial of steady perseverance in homoeopathic treatment, as these patients are changeable and full of whims ; so they go from one physician to another and give no plan a fair trial.
But sometimes we meet with sufficient success at the first to induce the patient to continue the treatment. The following is a case which may serve for encouragement both to ourselves and similar patients.
A young clergyman broke down in studying some years ago and was attacked with extreme restlessness, fits of drowsiness, headache, &c, so that he was obliged to give up all work for nearly four years. Then he improved so that he was able to undertake duty about a year ago, but has since gradually become affected with the following symptoms, so that he fears he must give up work again. On 6th of June, 1873, he complained of great excitability, and on the least surprise or mental emotion he is seized with tremor all over, and palpitation. He has frequent headaches characterised by a dull throbbing all over the head, worse at night, especially after being in company or a close room. Lobs of memory; bowels costive, and if two days confined he has dull headache and general oppression. The sleep is usually heavy and unrefreshing, but after the least excitement he often lies awake for hours with restless fatigued feeling and itching of the skin here and there. Buzzing in one ear. Fits of melancholy and causeless depression, and he fancies he has all sorts of diseases.
He was ordered two drops of the 1st dec. dilution of Sabadilla night and morning daily, and two grains of the 1st centes. trituration of Platina at noon every second day.
On the 3rd of July he stated that the bowels were opened naturally, the excitability and headache were less ; no buzzing in the ear and the causeless fear was relieved. Other symptoms the same.
Prescription: four drops of Anacardium 1 cent, night and morning daily; two grains of 1st dec. trituration of Santonine at noon every second day.
On 6th August he was better of all the symptoms and complained only that his memory and intellectual powers were still too easily upset by work. JEihusa cynapiurn \ drop of the pure tincture night and morning every second day.
On the 10th October he reported that he was perfectly well and had been so for the last few weeks.