the cachectic state is a certain sign that the suitable remedy has been chosen; and its use should not be discontinued, even if there should be a more frequent recurrence of the paroxysms : the cure is certain if the medicine be not changed." At the same time they argue that a remedy to be truly applicable to intermittent fever must correspond both to the nervous phenomena of the paroxysm and to the disorder of the vegetative life manifested in the apyrexia. If it merely influence the former, it can suit mild and recent cases only if the latter be its sole sphere, it cannot be a true antipyretic. The greatest fever medicines accordingly are those which, like arsenic, occupy the whole ground in the second rank stand such purely nervous remedies as ignatia, and such purely vegetative ones as pulsatilla.

There needs no argument to demonstrate the soundness, upon homœopathic principles, of these canons for the treatment of intermittent fever. But before I go on to their application to practice, you will naturally be desirous of knowing what has been the success of such treatment, both positively, and as compared with the ordinary method of administering quinine in substantial doses to every patient suffering from the malady.

Now, as regards chronic intermittents-cases that have been lingering on for months and years, the paroxysms suppressed for a time by bark, but relapsing again and again till it ceases to influence them any more-the testimony in favour of homœopathic medication (and that of the most Hahnemannian kind as regards individualisation and attenuation) is general and strong. You have only to look through any of our journals published in America, where the disease abounds, to satisfy yourself on this point. Nor does the treatment seem less successful when, as sometimes occurs, an epidemic of ague breaks out in a place ordinarily free from it. Here general experience seems to have confirmed Hahnemann's dictum on the point, "that each epidemic is of a peculiar, uniform character, and that when once this character is found from the totality of symptoms common to all, it guides to the discovery of the homoeopathic specific remedy suitable to all the cases, which is almost universally serviceable in those patients who enjoyed tolerable health before the occurrence of the epidemic.'

The experience of Drs. Wurmb and Caspar may fairly be cited here, as their cases were mostly of the chronic class. An account of their results which I am compelled to call very unfair has been given by Dr. Rogers, in his tractate entitled "The Present State of Therapeutics." He states that "these physicians considered they made rapid cures when not more than seven paroxysms occurred after the commencement of the treatment." He then mentions that one of their patients had

26 paroxysms, a second 25, and a third 21 before the disease was cured. Finally, he quotes them as saying that homœopathists have every reason to congratulate themselves on their treatment of intermittent fever, and that "it is evident, from these figures, that we may most satisfactorily enter the lists with our rivals "—leaving it to be supposed that the figures are those which he has just summarised. Whereas their actual results on this point, as given by themselves,* in answer to the question whether homoeopathists are able to effect a rapid cure of intermittents, are that in 77 cases treated by them, after the administration of the homoeopathic remedy there appeared no paroxysm in II cases, one only in 12, two in 9, and three in 8. Thus in 40 cases out of 77 the citó of the cure admitted of no question. Of the remainder, 15 had from 5 to 7 attacks, and the rest from 8 to 26. Of these last Drs. Wurmb and Caspar remark that they would not have shown so high a figure had the right remedy been chosen from the first; for after the last and curative selection had been made, no paroxysm occurred in 19 cases, one only in 16, two in 14, and three in 13-rapid success being thus obtained in 62 out of 77 cases. Remembering, then, that the aim of these physicians was not so much to stop the paroxysms as to cure the whole disease, and that all these 77 patients did leave the hospital well, and remained so, I think they were justified in saying that their results prove the sufficiency of homoeopathy in ague-at any rate of such homoeopathy as they practised, and in such agues as came under their

care.

Another writer on intermittent fever who has expressed and substantiated his confidence in the results of homoeopathic treatment, is Dr. I. S. P. Lord. An account of his work on the subject is given in the thirtieth volume of the British Journal of Homeopathy; and I think you will be induced by the review to procure and read the book itself.

As regards the treatment of recent agues occurring in malarious districts, I do not find the same expression of general confidence. Dr. Bayes, indeed, in an account of his experience of the disease as it occurs in the fen lands about Cambridge,† expressed himself well satisfied with the results he obtained. But he does not tell us how many of the seventy-five cases he tabulated were recent ones treated by him ab initio ; nor does he mention the time required for their cure. His best result is, I think, that he can say, "I have not had a single acute case become chronic in my hands, a result" (as he truly adds) "frequently following the suppression of ague by large See B. J. H., xii., 391.

† Annals, i., 441.

doses of quinine." When, however, we turn to the statements of those who practise in the thick of malaria in the United States and in India, we find that the ordinary treatment by symptomatic resemblance and minute dosage gives little satisfaction. The general experience of the American practitioners is fairly given by Dr. Vincent in the second volume of the United States Medical Investigator.

"Intermittent fever," he writes, "to me has proved an exceptional disease. I have seldom been able to cure a recent case of ague with high attenuations, nor (I might add) with any other attenuation. Even the best selected remedies fail me in a majority of cases. My own experience in ague is the experience of nineteen out of every twenty physicians of our school; and so thoroughly is this matter understood, that it has become proverbial in malarious districts that 'homœopathic physicians cannot cure ague.' Many persons, ardent homœopathists, will resort to quinine or an allopath if they or their families take intermittent fever, rather than take the chances of a run of the disease for several days and probably have to resort to it at the end."

To the same effect writes Dr. Sircar : †

"The fact is, practitioners flushed with their unexpected success in chronic cases with infinitesimals alone, and absolutely without quinine, were deluded into the belief that they could dispense with quinine altogether, at least in its massive doses; but when the hour of their trial came, when people began to confide them with cases from the beginning, they began to be disappointed, though unfortunately they could not see their mistake. In spite of greater diligence in the search after the appropriate remedy, in spite of renewed endeavours to hunt after symptoms of the patient and symptoms in the Materia Medica, the real remedy seemed always to elude the search and mock the struggle, till the cases were made over to the allopaths, who, with a few doses of quinine, effected the cure."

I quite agree with Dr. Sircar when he goes on (he was addressing our Congress of 1874) :-"Gentlemen, I verily tell you that it is bark and its alkaloid which have kept up the vitality of the old school, and it is our disloyalty to them which has stood seriously in the way of the progress of our own school, and which not unfrequently brings unmerited ridicule. and abuse upon our doctrines." I have already ‡ demonstrated

* The late Dr. Allison Clokey wrote to the same effect in 1897 (see J. B. H. S., v., 290). He gave grain doses; and Dr. Bliem, who writes from Texas to support him, quotes Osler as representing such dosage as sufficient to prevent the paroxysms (Ib., vi., 104).

†M. H. R., xviii., 522.

Manual of Pharmacodynamics, sub voce Cinchona.

the full homœopathicity of quinine to the aguish paroxysm, and argued that in all cases where the paroxysm is the disease we can follow no better treatment than its administration. Dr. Sircar concludes by saying,-"In our anxiety to be homœopaths we must not forget to be physicians; in our zeal to worship Hahnemann we must not cease to worship truth whereever found." But the curious thing is that the treatment of recent ague by bark alone in otherwise healthy persons residing in malarious districts is Hahnemann's own recommendation. "The intermittent fever endemic there," he writes in the Organon, "would, at the most, only attack such a person on his first arrival; but one or two very small doses of a highly potentised solution of cinchona bark would, conjointly with a well-regulated mode of living, speedily free him from the disease." If such result do not follow, the patient must be treated with "antipsoric" (i.e., constitutional) remedies; there is latent disease in him which is only taking an accidentally aguish form.

The practical conclusion from all that has been said is obvious. It was the power of bark over the intermittent paroxysm which led Hahnemann to homœopathy. He never abandoned its use in real marsh fevers (as he called them); nor, I maintain, should we. He came, indeed, after he had ceased to practise in malarious districts, to recommend its use in a highly potentised, that is, attenuated form. But if those who now encounter the disease in its habitat find such "potentisation" best attained by substantial, or even massive doses, they are acting in the spirit though not according to the letter of his instructions: they are following him in "the medicine of experience." I believe, therefore, that in all recent and uncomplicated agues you will find it your best practice to give quinine in the apyrexia; a single full dose at its commencement, as ordinarily practised, and as recommended by Jousset, or repeated smaller quantities during its continuance. In the few intermittents I have myself seen, I have adopted the latter plan; and have found two or three grains of the first decimal trituration, taken every three or four hours, act very satisfactorily. Bähr (who says that, "as a rule, bark cures every case of ague originating in malaria, and of recent origin") finds the first centesimal trituration sufficient; and Dr. Panelli, from his Italian experience, says the same thing.* You will also remember the still prevailing tendency of ague to recur on its appointed. days, and will anticipate its advent by an occasional dose of the remedy till a fortnight or so has elapsed. While thus preventing the recurrence of the paroxysms, you may relieve their sufferings and mitigate their severity by drawing upon the rich *See United States Med. Investigator, iv., 161.

treasury of homoeopathic remedies, and giving them during their continuance. Aconite, if there is great thirst, restlessness, and anxiety; belladonna, if in the hot stage the head aches badly; ipecacuanha, if vomiting be distressing; veratrum album, if the chill be excessive and simulate the choleraic collapse-all these have proved helpful according to their indications; and Dr. Sircar gives practical evidence of the value of many other remedies of the same kind. In the "congestive chills," which are the American form of the "pernicious fever" of the Roman and other districts, Dr. Morse, of Memphis, reports very satisfactory results from veratrum viride. In these pernicious fevers, I may say, even so strict a homœopathist as Dr. Chargé admitted that we must fall back upon quinine, and must not shrink from such quantities as may be required for the speedy arrest of the paroxysms.†

*

In

But it is confessed by the most ardent admirers of quinine that it does not always succeed in checking even recent agues. If, therefore, the paroxysms are not speedily arrested by its use (and it cures very quickly when it does so at all), you will do well at once to abandon it in favour of other remedies. chronic intermittents, moreover, and in malarious cachexia, quinine can never be recommended; though its native bark may sometimes find place in virtue of general similarity between its effects and the patient's condition. There is a general agreement between our therapeutists as to the medicines from which in such cases the choice should be made. Arsenicum, nux vomica, pulsatilla, veratrum album, ignatia and ipecacuanha are Wurmb and Caspar's primary list; Bähr gives arsenicum, nux, veratrum, ipecacuanha, natrum muriaticum and arnica: Jousset recommends, under various circumstances, ipecacuanha, capsicum, nux and arsenicum. If to these are added aranea,‡ cedron, the eupatoriums, phosphoric acid and sulphur,|| I think that I shall have mentioned every medicine on which, save in very exceptional cases, you are likely to have to rely for help. As regards their indications, it is needless that I should. repeat here what I have already said when speaking of each drug. The only one I have neglected in reference to this disease is pulsatilla. Both Wurmb and Caspar, and Dr. Lord,

* United States Med. Investigator, ii., 359.

† See his communication to the Transactions of the World's Convention of 1876.

See J. B. H. S., iii. 97, 200.

§ Ibid., v. 391; vi. 99; viii. 156.

I have spoken of sulphur in connexion only with chronic ague. Dr. Cooper, however, has now adduced evidence from India and Turkey of its power over recent fevers of this kind. (See M. H. R., xxxiii., 127, 643.) He uses pilules saturated with the tinctura fortissima.