don't say "lengthy" when you mean "long," or longer or shorter than long. Yes, the dictionaries give it, and so they do many other words, that the better usage of the day has relegated to the philological lumber room. Thanks, we don't smoke. In conclusion: Discharge your proof-reader. -Let's see. How many of the homoeopathic journals have obeyed the Dillon resolution, to profess allegiance to the homœopathic school of medication, and the support of homoeopathy per se? The way was opened by the Medical Era with an emasculated rendition, followed by the Southern Journal (we believe), with a full avowal. How many more were there? -Aconite is a homoeopath's lance, phosphorus his liver stirrer ; podophyllum his mercury; lachesis his gargle in quinsy; sepia his uterine supporter; belladonna his dilator for "oral" (à la Pratt); hydrastis his purgative; cantharis his diuretic; rhus-tox. his pneumatic bandage.-W. W. FRENCH, M.D., in Lo. Jour. Homœopathy. -You have all in your practice met the old woman who approaches a "laying-out" or a "lying-in " with the same morbid delight, and who in the latter class of cases beguiles the tedious hours of parturition with circumstantial accounts of all the cases of difficult and disastrous labor which have occurred within her wide experience and observation, duly embellished by her vivid imagination. Possessed of unbounded confidence in her own skill and knowledge in all matters tocological, the suggestions of the medical attendant she superciliously ignores, and his most explicit directions she willfully disobeys. Both advice and medicine, unless closely watched, she does not hesitate to administer, and it is impossible to tell which is the more baneful of the two. In short, she is the lineal descendant of the ancient witches, and chiefly renowed, like her more celebrated ancestors, for her pernicious activity in raising the Devil.-C. W. BUTLER, M.D. —If I had a similar case [intussusception] to-day, I should : Second. Not try any insufflation or external manipulations, unless I was sure the intussusception was only of twenty-four to thirty-six hours standing (the firm adhesions in this case indicated that it dated, at least, four to five days back), but make abdominal section at once. Third. Open the abdomen at the upper end of the affected part of the intestines, i. e., the part distant from the anus. Fourth. I should be inclined to give some opiate to secure relief from pain and rest to the body and intestines, and should not be apt. to put so great restrictions as to the diet or position.-DR. SANDBERG. -Dr. C. W. Butler, of Montclair, N. J., reports a Case of Transverse Presentation to the I. H. A. Bureau of Obstetrics, of great interest because of the action of pulsatilla in restoring the normal presentation. He says: "An examination revealed a transverse position (right iliac, dorso-abdominal), the side presenting at the mouth of the womb, with a point about corresponding with the angle of the scapula, over the center of the orifice. The os being now widely dilated, podalic version. was determined upon, but, upon attempting to introduce the hand, so irritable was the os and so violent its contractions, that after repeated attempts I desisted, deeming such manipulation even dangerous without anesthesia. Accordingly, I determined to go at once to my office for the anaesthetic. Although this necessitated an absence of more than an hour, I did not apprehend serious results from the delay because of the excellent general condition of the patient. At a quarter to eight A.M. I dropped a dose of pulsat.mm (Tafel) upon her tongue and departed. "At nine o'clock on my return I found the head and shoulders of the child already born, the nates and legs being still within the vagina.” This is the case. But Dr. Butler, in order to give the scoffers something to think about, lucidly reasons upon the phenomenon, brings to his aid known laws of anatomy and physiology, and challenges the medical unbelievers to a contradiction of his position, medically and anatomically. The case is reported in the July number of the Homaopathic Physician, and is deserving the study of the scientific homœopath, as well as Hahnemannian. -Every obstetrician must have observed that there is a great difference in the condition of the blood in different patients. It will stick to the fingers and the walls of the uterus like pitch. Woe to the attendant who thinks to overcome the trouble by injections into the cavity. Here is only one thing, mechanical removal, massage, and moist heat. If these three factors were called into action properly, we would not have one-third of all the fibro-myomas and intra-uterine, so-called placental polypi.-RoSA H. ENGERT, M.D. -Dr. F. H. Lutze, Cheshire, N. Y., says: "While making a trip to Europe in 1882 I cured the following cases of sea-sickness": I.-A little girl aged twelve, nux. v. 30: nausea and vomiting early in morning of bile, sour mucus, slime, and the characteristic constipation of nux v. II.—The father of above little girl, vomiting all day, worse mornings; accumulation of water in the mouth before vomiting and with the nausea; had always vomited on riding in car or carriage, especially if he rode backward. Petr. 30 cured. III.-A lady, aged thirty-five, nausea and vomiting after eating, and from smell of food, with heat rising from stomach to throat (I thought she suffered from uterine derangements by her appearance); also sinking and gnawing in pit of stomach. Sep. 30 cured. IV. Another lady about same age as above, I cured with three onegrain doses of borax 30 in one day, after having been sick ever since leaving the harbor of Bremen (about six days). Her symptoms were: "Every time the ship goes downward, my stomach and everything inside of me comes up; vomit almost constantly." Dyspepsia produced by the abuse of bark is not rare. Its symptoms are heaviness, slow digestion with eructations and rumination; the sensation of fullness disappears sometimes while eating, and is often relieved by a little food; in other cases the appetite remains good in spite of the dyspepsia; gastric flatulence; diarrhoea, especially right after a meal; somnolence, lassitude of limbs; disinclination to move about, downheartedness, hypochondriasis. It suits gouty patients. China sixth dilution acts well, though sometimes one has to go lower.— Medical Counselor. China 8m has done us excellent service under similar symptoms: our guiding symptom was, "I am so full, Doctor, if I could only gulp up the wind, I know I could be better." SOME ENLARGEMENT OF THE LIVER.* By JNO. C. MORGAN, M.D., Philadelphia. OME time ago, whilst reading the disease-history of an esteemed colleague, and his own discovery, while abroad, of the fact that "his liver was enlarged," and noting that other fact, that antecedent to this he had suffered from a chronic suppuration; so striking was this sequence, that I could not but marvel when I thought how little physicians generally lay such things to heart. Hence this paper, which I trust may help to remind them of their import. The clinical forms of hepatic enlargement are neither few nor simple, but many and complex, with the widest differences in their pathological nature and tendencies. One common feature, however, is the proneness of all forms to involve the general abdominal circulation, and even that of other organs, as the head and the lower extremities, either through reflex sympathy, as in vertigo, or by direct mechanical obstruction, as in hæmorrhoids and dropsy; but these effects are far from being uniform in degree with all. That which is most grave and important relates to the portal vein, and to its sources in the abdominal viscera. Its secondary sub-division * Read before the Homœopathic Medical Society of the State of Pennsylvania, Sept. 18, 1889. in the substance of the liver implicates all these organs in whatever happens to this one. In particular, excepting in cases of the so-called nutmeg liver," the spleen almost always takes on secondarily an engorged condition, in which the stomach and its functions, as well as its own blood and lymph-making offices, are involved; tending to both anæmia and cachexia, and proving an occasion of confusion between the separate forms of liver diseases which may alike lead to these results. Enlargements may be generalized by saying that all of them are the result of morbid activities, and that they are the antecedent to a contractive, or atrophic, degeneration, with gradual abolition of activity; but in some forms the patient commonly dies before this point is fairly reached; in other forms, not until it is fully declared; for instance, the amyloid change. With this introduction, we may mention the most important individual enlargements; and, firstly: Active Congestion, or Acute Hyperæmia.-This is the usual attendant upon atmospheric shocks, either of heat or cold; and of malaria. The function of the organ is excited, its vaso-motor relations are irritable, its area of percussion dullness is increased, the nervous system and the digestion are involved. The tongue gradually becomes coated; the spleen soon enlarges, and its percussion dullness extends to or beyond the tip of the eleventh rib; the patient is, when not in a febrile flush, sallow and anæmic, and is said to be "bilious." The enlargement is not very conspicuous, and must be sought for by percussion, which will also exhibit some tenderness of the organ. The mucous lining of the biliary ducts may become catarrhal, and the conjunctiva yellowish; but this is a separate class of cases, and of them more anon. Just here we must drive a nail to bind this pathological state, hepatic, with splenic congestion, upon the doctrine of Intermittent Fever, and of its insidious and peculiar obstinacy. It may be freely asserted that in ninety per cent. at least of the cases, this obstinacy depends upon some unappreciated lesion or groups of lesions; and upon this particular group more constantly than upon any other, particularly in those. baffling confirmed cases (comparable only with hysteria in their multiform but irrelevant symptoms, and their disappointing therapeutics), which every homoeopath in a malarial country so well and sorrowfully knows. The secret of easy cure of these is to recognize objectively, by percussion, etc., the enlargement and inflammatory tendency of the liver and spleen, and the relation of the multiplicity of symptoms to the portal circulation. This pathological conception furnishes to us a strong lever of that bête noir of many a tyro and would-be homœopathic physician. When the liver and spleen become normal, and the tongue clean, there will be found in the patient very little to remind us of inter mittent fever, or to vex us by periodic exacerbation; usually, only a neurosis, as at the first, and amenable to gelsemium as then, or to ignatia in very sparing dosage, or to some other drug chosen by pure symptomatology, which before brought us only defeat, it may be. Still, in such cases, be it remembered that it is not so much symptomatology itself that has failed us, as it is our stupid misconceptions of it; and often, our senseless over-dosing, at that early period when lesions are slight, and hence do not well bear it. And, lastly, the neurosis which. may remain, as just stated, must be scientifically handled or we may still fail. Trusting that this digression may be pardoned for the good which may be in it, we pass to another clinical form of enlargement of the liver, acute, like the preceding, in many cases, and allied to it; yet, in not a few, chronic also, viz., the enlargement of catarrhal hepatitis; enlargement with jaundice. It may originate in aggravation of this acute congestion or hyperæmia, whereby the percussion dullness is much extended; or it may begin with catarrhal dyspepsia or gastro-duodenitis ; in which case, the inflammatory process simply extends itself to a very limited area, by the continuity of the duodenal mucous membrane, into the common bile duct, and beyond, whereby its calibre is narrowed, through the attendant mucous swelling; and the bile, coming upon this obstruction, and being denied an exit (whence occur clay-colored stools), and being forced back upon the gall-bladder, with painful distension, and also into the liver itself, this retained bile infiltrates the whole organ and swells it up insomuch that the hepatic veins absorb very much of it, carry it into the general circulation, and it is then secondarily deposited in all the bodily organs and tissues; being seen very markedly in the whites of the eyes, if nowhere else, but commonly also in the skin, and likewise coloring the urine-constituting jaundice. (Obstructive jaundice is also apparent when a tumor presses upon the outside of the duct.) This biliary reflux, per se, enlarges the liver, but there is nearly always an inflammatory hyperæmia present besides, with tenderness on percussion. In the chronic cases all sorts of causes may be operative; chronic duodenitis, cancer of the stomach, or of the pancreas; also, biliary calculi, repeated attacks of malarial diseases, drug-poisoning by mercury and quinine, and alcoholism. Let us consider for a moment a form of acute hepatitis which is not separate from the other two, but is rather an attendant on both, and particularly on "active congestion." It is called, in conformity with the German fashion, "parenchymatous hepatitis." By this it is meant that the functional cells of the acini of the liver undergo inflammatory enlargement, and thereupon divide and multiply (or proliferate). This state of things directly increases the size of the whole organ. There are, thus, four frequently co-operating causes in these forms of enlarge |