chromic acid was already causing some superficial sloughing when the case accidently fell into my hands.

A new crop of warts was fast coming on in the place of those last removed by the action of the acid. Passing sounds readily reduced the stricture, and I turned to the Homœopathic Materia Medica to find a remedy to cure the warts.

After a careful and thoughtful study of the whole case, I gave him Thuja 30 in infrequent doses. Within three days a marked improvement was manifest, and in in three weeks he was perfectly and entirely well, not a trace of the warts remaining. I have no apologies to offer for using this remedy in the thirtieth dilution; the critic who sneers at its action in this case and expresses a doubt as to its efficacy, simply knows too little about the case to argue it with me.

That patient is grateful beyond expression, and says there is no trace of doubt in his mind that Thuja has cured him.

Since writing the above my former associate, Charles M. Koier, M. D., has told me of a peculiar case recently coming under his care. An infant ten months old was brought in by its parents, who protested that there was absolutely no veneral history in their families. The child's perinæum was, however, covered with about sixty wellformed figwarts. Dr. Koier made a very rigid examination of each parent and failed to find any taint of venereal disease in either. He concluded, therefore, that the child contracted the disease, from which the warts had sprung, by being kissed. It is altogether likely, indeed, that some ardent but diseased admirer of the little one had given this child something through the medium of a kindly meant, but none the less dangerous, kiss.

I merely make mention of this case to show how careful we all must ever be not to do any innocent person an in-. justice. If that child contracted a venereal disease by the method suspected by Dr. Koier, it would be cruel to lay its sufferings at the door of its parents, who, so far as human ability can judge, are entirely innocent.

HEADACHE: VERATRUM ALBUM.

F. E. WATTS, M. D., Port Allegheny, Pa.

Mrs. C. Has been subject to a severe nervous headache for years. Any over-exertion, as riding or working during the hot days, would bring on these headaches. Frequently commencing in back of head the pain would go. over the head and settle in, sometimes one eye, sometimes the other. Silicea, Spigelia and several other remedies given with no relief. One day noticed the brow contracted and eye-lids nearly closed on account of intensity of the pain. This had been a continuous symptom from the beginning, and Veratrum album relieved the headache at

once.

UREMIA.*

DR P. JOUSSET.

We will at this time take up a subject, which, though very difficult, is nevertheless essentially clinical-Uræmia. It is an affection frequently met with, grave and insidious and which may kill the patient in a few hours; it is therefore very important to be able to give this affection an early recognition. In the beginning of puerperal or scarlatinal eclampsia or in a patient who is coming down with scarlatina it is easily recognized; but there are many obscure cases which now and then will deceive the physician.

For example: You are called in the night to a patient taken with suffocation. You are told he has had one or two similar attacks on previous nights. You think it an asthmatic attack-the patient furthermore having all its appearances a false security which is terminated by a fatal denouement.

Another time it is a patient who is in a comatose state with or without convulsions. You will wonder if it be an apoplectic attack, a cerebral hæmorrhage or an epilepsy.

* Translated from L'Art Medical by H. P. Holmes. M. D., Sycamore, Ill.

Or, again, it is a patient who has delirium or hallucinations. Patients presenting this form have been sent to the asylums; they were all simply cases of nephritic uræmia. You see in such cases the importance of the diagnosis.

Uræmia is not a disease, but a symptom of a disease. It is an affection caused by the insufficiency of the urinary secretion. The blood becomes urinous. I will not say that it contains carbonate of ammonia or any other product, leaving that for the time with the many theories advanced. The organism is freed by the kidneys of many excrementitous products; if, then, this elimination is hindered or becomes impossible either by a renal lesion or on account of any obstruction to the excretion of the urine it results in a special morbid condition-a veritable poisoning designated by the name of uræmia. That absence of the elimination of the excrementitious products, whether it results from an alteration of the kidney which, as an organ, has lost its secreting properties on account of Bright's disease, cancer, hydatids or suppurative nephritis; or whether it results from an obstacle to the elimination on account of a calculus lodged in the ureters or bladder; or by compression exercised upon these organs by a tumor, the effects produced are the same.

It is the custom since Freirichs to describe uræmia as a slow uræmia and a rapid uræmia; I will not adopt that division. They have also considered it possible to localize some of the forms of uræmia in a special department of the nervous centers; the convulsive form is traced to anæmia of the middle lobe; the comatose form to cerebral anæmia, etc. We will return to that question.

Uræmia presents itself in five forms:

1st. Eclampsia or convulsive;

2nd. Comatose;

3rd. Delirious;

4th. Dyspnoetic;

5th. Gastro-intestinal.

Most authors describe only those forms and group the first the varieties under the name of cerebral. I prefer the first division on account of the strong characters which

those three forms present, and in describing them to you I will tell you to what lesion they may be ascribed.

All of these forms have common characters which we will take up in review. The poverty of the urine which is a common sign; for verifying this we take the specific gravity and this is ordinarily found light, frequently below 1010. The presence of albumen in the urine is regarded as a constant symptom, but that is not always true; there are cases where no albumen is found. The diminution of the quantity of urine is also a sign not always constant; also do not allow yourselves to be deceived by the absence of albumen or by polyuria; the patient may urinate abundantly, but the urine he passes is only water. Another character is the diminution of the toxical condition of the urine. You know the experiments made upon rabbits; when a certain quantity of normal urine is injected into the veins of an animal it produces uræmia, accidents which do not happen where the same quantity of urine is injected from a uræmic patient. This is a good experimental sign, but one cannot always employ this means in practice. Another character is the presence of urea or especially the carbonate of ammonia in the exhalations of the patient. In placing a small rod dipped in hydrochloric acid before the mouth of the patient, crystals of acetate of ammonia will be deposited. There is also a lowering of the temperature excepting in the form of eclampsia; the fingers have a death-like appearance and there is paralysis of the extremities. Usually the pupils are contracted, but not in all forms.

The eclampsia or convulsive form may be complete or incomplete. When complete it is a convulsive attack almost identical to an epileptic attack, with distortion of the features, frothing at the mouth, both tonic and clonic convulsions and a period of collapse; but there is not the initial cry. In the interval between the attacks there is at first a complete return of consciousness; an elevation of the temperature is observed; the pupils are contracted during the attack and dilated during the interval; then follows the coma with loss of reflex excitability, amblyopia, temporary blindness, etc.

My teacher, Jean-Paul Tessier, who has succumbed to uræmic attacks following diabetes, described his experiences to us on his death-bed: "I see you, I converse with you," said he, "all at once I see red, I lose consciousness and the convulsions commence," etc.

In the incomplete form there are convulsions, contractures, tetanic form (Jaccoud). The convulsive form is met with in catarrhal and parenchymatous nephritis, in the epithelial nephritis, (Lancereaux), in the nephritis called infectious, following variola and scarlatina, in the puerperal state, etc. In this form there is an elevation of the

temperature.

The comatose form should not be confounded with the periods of coma which follow the attacks of convulsions in the eclamptic form. The patient is apathetic, in a torpor, a somnolency from which one rouses him with difficulty and which borders upon coma; the patient replies in mutterings when spoken to. There is no paralysis and the physiognomy simulates ecstacy; the patients have a sort of solemn air. This form is sometimes accompanied by a mild, tranquil delirium; the pupils are contracted and we find a lowering of the temperature. I said there was no paralysis, but some cases, however, have been observed which presented localized paralysis, or monoplegias. The comatose form is ordinarily observed in advanced cases of parenchymatous nephritis.

The delirious form comprises two varieties, the pure delirious form with or without coma and the form of mental alienation. In the latter case the cerebral symptoms may simulate insanity in all its forms,-the insanity of Bright's disease. Dieulafoy observed a case of Bright's disease in which the patient during a fortnight, to a certain extent, was a prey to hallucinations with ideas of persecution and suicide. This delirium may last for several weeks or even months, but it is most frequently cured. This form is observed in interstitial nephritis.

The dyspnotic form presents three varieties. Sometimes it appears in the form of a nocturnal attack as an attack of asthma and entirely ceases by morning. The