to most other medicines; and that it really has the power of arresting a continued fever, preventing, perhaps, the access of a typhoid condition.

My success has been so uniform with the low dilutions, that I have not tried the higher.-Am. Hom. Obs., Aug., 1866.

Hyperemia Hepatis. By Dr. SCHLEICHER, of Pesth.*

Simple hyperæmia of the liver, with accompanying polycholia, is a very common form of disease in Lower Hungary. In this disease the liver swells perceptibly, and its increase in volume is easily ascertained by percussion; as a rule it is not painful, but often very tender to pressure, owing probably to simultaneous hyperemia of the peritoneal covering. There is at the same time an increased secretion of bile, evidenced by (1) intense colour of the skin, (2) bilious vomiting, (3) bilious diarrhoea, (4) in many cases demonstrable distension of the gall-bladder. The stomach and bowels may at the same time be more or less affected with catarrh; in many cases, however, they are not at all involved. There is often no febrile state, but generally there is slight fever; and it is remarkable that this often assumes an intermittent type, so that it is often not easy to determine whether we have to do with an ague or with symptomatic fever.

and

It has often happened to me that such patients have been ineffectually treated with quinine allopathically, and for that reason have applied to me. Large doses of quinine administered in such cases aggravate the disease. There is often but one febrile attack, the disease terminates with bilious vomiting or diarrhoea. More frequently the disease runs a slow course. The cause of the disease is generally to be found in malaria, and it occurs very frequently during an epidemic of ague. I have often observed it as a consequence of eating a large quantity of fat food; sometimes also it is produced by mental emotions, especially anger. I should say it is oftener met with in women than in men. The homoeopathic therapeutics of hepatic diseases are not very far advanced; the characteristic distinctions of the remedies that act on the liver are not very distinctly marked in our provings: hence much of the treatment of hepatic diseases requires the light of clinical observation. In addition to Mercurius, Nux, China, and Bryonia,

* Hirschel's Zeitschrift, August 15th, 1866.

I have frequently employed with advantage the Carduus marianus in the disease alluded to.

The following case is an example of the remedial power of this remedy :

Mrs. N―, æt. 41, came under my care in July of last year, and her state was as follows:-She was thin, with black eyes and dark complexion, of marked choleric temperament; her hand dry, the palms only occasionally moist; complexion and conjunctiva rather yellowish; nothing wrong in the respiratory organs or heart; the liver extends two fingers' breadth below the ribs, and its left lobe particularly enlarged, the surface flat, somewhat tender when pressed; stomach distended with flatulence, but no tumour either in the stomach or bowels; tongue clean; appetite not bad, but some discomfort during digestion; frequent sickness, even when the stomach is empty, though never amounting to actual vomiting; constant bitter taste; stools very irregular, often constipation for days together, then suddenly slight griping and diarrhoeic evacuations of marked bilious character; she complains of weight and pressure in right hypochondrium; ill humour and irritability; pulse small, contracted, and rather quick; every evening, about eight, rigor comes on, lasts half an hour, and is followed by heat, with headache and thirst. This febrile state lasts till towards morning; during it, however, the patient sleeps uninterruptedly, though restlessly. During the day she is out of bed, and performs her household duties, but feels ill and weak. This condition had lasted four weeks, and had been fruitlessly treated with quinine and purgatives. In former years the patient had often suffered from ague; she is fond of fat food, and is very easily vexed. Similar symptoms she had often experienced, and two years ago she had had recourse to Carlsbad, which had apparently benefited her, but could not prevent a recurrence of the disease.

The whole morbid picture pointed to a liver affection; but it was a moot point whether the fever present was symptomatic, or whether it was an ague which caused the hepatic affection. The circumstance that there was no complete apyrexia, and that quinine had not acted even palliatively, seemed to show that it was a primary hepatic affection: moreover, there was no epidemic of ague during the previous summer. The question now to be considered was, what kind of liver disease it was? As lungs and heart were normal, it could not be venous stasis; catarrhal icterus was not to be thought of, as the signs of gastric catarrh were

absent, and the bile passed off freely, as proved by the bilious diarrhoea; true parenchymatous hepatitis it was not, from the absence of etiological cause, pain and corresponding fever. There was evidently no new organic growth, as proved by the smooth surface of the liver; hence I diagnosed hyperæmia of the liver with polycholia. The slight icterus is accounted for in such cases, that in consequence of the increased sanguineous congestion and the permanent irritation of the hepatic cells, more bile is secreted than can pass away; hence there is a partial absorption of bile. The digestive disturbances are explained by the sympathy of stomach and bowels, and the presence of an excess of bile in them. Finally, the periodical fever is the expression of the reflex of the persistent irritation of the liver in the nervous system. It must be taken for granted that the hyperæmia in this case resulted in a moderately hypertrophied liver, caused by repeated hyperemias and aguish attacks; hence the prognosis was not very favorable for perfect recovery.

The patient's diet was limited to soups and roast fowl and veal; bodily and mental rest was enjoined; and I prescribed Carduus marianus 3, five drops four times a day. Under this treatment the malady was completely removed in the course of a week; but, as was to be anticipated, there still remained a slight enlargement of the liver, ascertainable by percussion, for which the patient took for four weeks Sulphur without perceptible effect.

Carditis. By Dr. H. GOULLON.*

Jenny J―, æt. 11, had suffered from inflammation of the heart, and when convalescent had a relapse in consequence of taking a chill upon an overloaded stomach. On the 20th of December she lay in bed, had passed a restless night, and now complains of great dyspnoea; the movements of the alæ nasi during respiration and the flushed face give the appearance of pneumonic affection, which is strengthened by the distinct bronchial respiration on both sides of the spine. Against pneumonia, however, spoke the sparkling eyes of the excessively excitable patient, the absence of cough and sputa; and finally, a careful examination of the heart showed that the seat of the disease was to be found in this organ. The pulse was over 120. The presence of strangers greatly increased the frequency of the pulse. The heart's sounds

*Allg. hom. Ztg., July 16th, 1866.

were loud; on applying the hand, the impulse of the heart was found to be of unusual force, but distinct sounds of endo- or pericarditis were not audible; there was somewhat extended dulness of the cardiac region towards the right. The prognosis did not appear favorable. The anxiety and excitement of the patient, already weakened by the first attack, pointed to rapid exudation. She got Aconite every hour, and at night a dose of Calc. carb. The report on the following day was so far satisfactory, that there was no increase, but rather a slight diminution of symptoms. Calc. was continued; but in consequence of the occurrence of drawing pains in the lower limbs, Bryonia was substituted for the Aconite.

On the 22nd December I again saw the patient. She was on the whole better; still, the quickness of pulse, the excitement and the periodically recurring palpitation of the heart, were not removed. For this kind of palpitation I gave Sepia with advantage; in a few days, in spite of the severe weather, the child could be moved to another house some miles distant. I may remark that after the Acon. and Calc. a beneficial perspiration broke out, which however, was not followed by any critical miliary eruption. The effects of Sepia in lowering the action of the heart are well known; and this remedy may almost be regarded as the homœopathic digitalis, were it not that Sepia is especially indicated in morbid increase of the heart's beats in cases of debility, e.g., from loss of blood, the puerperal state, &c. Increased rapidity of the heart's action arising from recent inflammations (pneumonia, &c.) is not removed by Sepia.

Treatment of Measles. By Dr. H. GOULLON.*

For the last nine months we have had in Weimar and neighbourhood an epidemic of measles, generally speaking of a benign character. Still, about four weeks ago a good many cases had a fatal termination. No case of death occurred under my treatment. The remedies employed were almost exclusively homœopathic. To this I ascribe the good results: for though I have said the genius epidemicus was benign, still there occurred, as I shall presently describe, some cases where complications or unusual intensity of certain symptoms from the first did not admit of a positive favorable prognosis. In some cases the premonitory stage was

*Allg. hom. Ztg., August 6th, 1866.

very violent, was distinguished by continual sleeplessness and delirium-cerebral irritation. In the greater number of the worst cases there was an obstinate cough, which did not correspond to the Aconite symptoms, but demanded at one time Hyos., at others Drosera, Spongia, or Hepar. The last-named remedies, together with Belladonna, were of use in a family of three children suffering from measles, for a long time masked by a regular croupy cough. When the exanthema did at last occur in these cases, it was very intense, and resembled in its confluent character scarlatina; while the violent conjunctivitis, and also the bran-like desquamation, prevented the idea of scarlatina. Moreover, difficulty of swallowing frequently ushered in the measles. The children

of the same family did not always take the disease simultaneously or in rapid succession; on the contrary, one half of them would often be in the desquamation stage, or beyond it, before the others took ill. I observed no vomiting or convulsions, as so often happens in scarlatina. Tenesmus of the bladder, with constant but ineffectual efforts to pass water, during the premonitory stage was rapidly removed by Pulsatilla. Calcarea carb. 12 was of great service in the case of a boy affected with serious cerebral symptoms. His parents had already given him up, as they had previously lost three children at the same age. The fever had lasted several days very severely; the exanthem did not come out; then occurred unconsciousness, snoring respiration, and sopor. This had succeeded to` an opposite state of excitement and delirium. Here (after a dose of Stramon. for the irritation of the nervous system) Calc. carb. acted in a marked manner; under its use the eruption came out plentifully.

Another case which seemed to be of most malignant character, that of a girl seven years old, terminated satisfactorily by the administration solely of Aconite. The very next day a great change was observable. In the morning a large worm (Asc. lumbric.) was vomited. Whether the violence of the fever had incited this previously peaceful inhabitant to rebellion, or the rebellion of the worm was the cause of the violence of the fever, I am unable to determine. With A. Vogel, I am disposed to think the former was the case. In such cases much harm is often done by the anthelmintic remedies of the old school. In one family, the boy took measles, and the girl soon afterwards chicken-pox. I met with no case of an adult taking the disease; the youngest child that took it was nine months old. In a brother and sister of the