will tell us what they do in the affection as seen there; and whether they can do better than old-school practitioners with their large doses of ipecacuanha powder.*

Three special varieties of acute dysentery must be noted here, as requiring their own remedies. In the scorbutic form there is general assent as to the virtues of rhus (though arnica must not be forgotten), and in the malignant or typhoid form to those of arsenic. When the symptoms intermit and return periodically, you must treat the case as if it were one of ague, i.e., with cedron or quinine unless the symptoms point definitely to any other medicine.

And now a word about chronic dysentery, which not unfrequently comes before us for treatment, especially in returned Anglo-Indians. A capital case is reported in the first volume of the Annals of the British Homoeopathic Society, as treated at the London Homœopathic Hospital by Dr. Hamilton. Mercurius corrosivus, followed up by nux vomica and ultimately phosphoric acid, were the curative medicines,-all in medium dilutions. Cod-liver oil was also given,-the emaciation being great; and milk only allowed for food. I would add sulphur and nitric acid to the list of remedies. Of the former Jahr writes:-"If in spite of all treatment various single symptoms remain, such as tenesmus, slimy discharges with or without pain; or if blood reappears in the discharges from time to time, there is no better remedy than sulphur, which should be resorted to in every case if the disease, after the first violent outbreak is subdued, threatens to run a protracted course." As regards nitric acid, we have Rokitansky's statement that "the dysenteric process offers the greatest analogy to the corrosion of the mucous membrane produced by a caustic acid"; and in the present instance we have evidence that the action is not local only. Stillé mentions a case (you may read it in the Cyclopædia of Drug Pathogenesy) fatal on the eighth day after the ingestion of a teaspoonful of strong nitric acid, in which the usual lesions were found in the mouth, fauces, œsophagus, and stomach, but the small intestine was sound. The colon, nevertheless, was "intensely and deeply ulcerated."

I have discussed this medication in my Pharmacodynamics, and am unable to claim it for homoeopathy, or to deny its efficacy. The question between it and our own remedies must be a comparative one.

LECTURE XXXVI.

DISEASES OF THE DIGESTIVE ORGANS.

The Intestines (continued).

From diarrhoea and its congeners I pass to the opposite condition of the bowels, and shall begin the present lecture by discussing constipation and some of its offshoots.

The way in which we behave towards constipation, and in regard to the action of the bowels generally, affords one of the most obvious points of difference between the new school and the old. Purgation by various means constitutes at least one half of the ordinary practice of physic; and "aperient medicines" form the staple alike of the apothecary's stock in trade and of the family medicine chest. Conceive, then, the revolution which ensues when homoeopathy is adopted, whether by physician or patient. With fear and trembling at first the treatment of cases is conducted without the customary "unloading of the bowels." But as time goes on we come to see that our patients do all the better without having an artificial diarrhoea added to their other troubles. We find that daily defæcation is by no means an essential of health; that the bowels are a part of the whole organism; that their inaction, if obviously morbid and injurious, is a disease requiring specific treatment, and not an obstruction to be overcome by temporary expedients. Instead of "clearing out the alimentary canal" with drugs which act like brooms and shovels, we become convinced that Nature is her own scavenger. Remove the morbid condition which hampers the intestinal action, and the bowels will act of themselves. See how it is in acute febrile disorders. The constipation which obtains here is of the same nature as the anorexia on the one hand, and the scanty secretion of urine on the other. You would not dream of whipping up the appetite by bitters, or stimulating the kidneys by diuretics. You know that both the gastric and the renal inaction depend upon the fever, and will depart with it. You have only to apply the same principle to the bowels. If you will just leave them alone, and apply yourself to the fever, they will give you no trouble. Three, ten, fourteen days may pass before they act, but no inconvenience will result; and at last they will be opened as naturally as

though they had been so the day before. As it is with fevers, so is it with other diseases, both acute and chronic. The constipation is but one element in the whole morbid condition. It should be taken into account, often into special account. It may guide us to medicines like sulphur, nux vomica and lycopodium in preference to calcarea, pulsatilla and carbo. But it would be unscientific to go out of our way to treat it independently,-still more to do so with purgatives. In chronic disease accompanied with constipation the bowels will often begin to act regularly under a medicine having no special relation to the intestines, but which is influencing the whole organism for good.

I am not denying that constipation, both acute and chronic, may come before us as a substantive and primary intestinal disorder. Indeed it is my object at present to tell you how to treat it when so occurring. Without further preface, then, we will proceed to our subject.

Constipation in its acute form may be said to be present when the bowels become temporarily inactive in consequence of a sudden change from active to sedentary habits, as at the beginning of a sea-voyage, or of the confinement necessitated by a fracture or other accident; also sometimes from change of air, and (in women) from marriage. But this is no disease, generally rights itself, and hardly calls for specific medication. You may give your nux or opium if you like; or, if inconvenience is caused, you may let the patient use an enema, or take a seidlitz powder or a dose of castor oil. The temporary trouble is removed by temporary means; and then all will go on as before. But the true disease in which acute constipation occurs as a substantive malady is

Intestinal Obstruction, the ileus or passio iliaca of the old writers. I need not remind you how large an addition to our power of diagnosing this malady has been made by the researches of the late Dr. Brinton. Nor can we do better than follow his guidance in the management of these cases as regards the limitation of the ingesta and the maintenance of rest. We need not, but we are glad to, agree with his injunctions to refrain from purgative medicines. And the use of

enemata, of insufflation, of electro-magnetism, and of surgical procedures is common ground between us; the only difference being that the medicinal remedies we possess make us to a large extent independent of these aids.

For practical purposes, the important diagnosis is between cases of simple obstruction and cases of strangulation, the latter of course including intus-susception. That simple obstruction, without special tendency to inflammation, may

exist, is I think abundantly evident if we look over any collection of cases of this kind. It has its parallel in incarcerated hernia. If fæcal accumulation can be detected, the explanation is evident; and not less so the indications for treatment. Opium is the medicine called for, as sluggishness of the peristaltic action must have preceded the accumulation; and enemata, manipulation and electro-magnetism are available auxiliaries. Where no such mechanical obstacle exists, I take it that partial spasm or paralysis is at the bottom of these cases. I commend to you here the steady use of plumbum. It has hardly been given with the confidence it merits; but it has played an important part in the treatment of several cases of intestinal obstruction.* As to its perfect homoeopathicity I need say nothing.

When the symptoms of obstruction are attended with those of local inflammation, we have to fear intus-susception in the child, internal strangulation (more commonly) in the adult. In the former case, the Hippocratic inflation of the intestines with air seems the most reasonable mechanical remedy for the mechanical disturbance; while belladonna,† nux vomica and aconite may help to correct irregular and excessive peristalsis, and to obviate inflammation. A case of Dr. Morgan's, in which the two latter remedies proved curative, seems to have been an instance of this form of obstruction in the adult. If internal strangulation, as by bands, adhesions, &c., external to the intestine, be satisfactorily diagnosed, I can suggest no better medicines, but I could not hope much from their action. If I were myself the sufferer, I do not think I should hesitate to have my abdomen opened with a view to having the strangulation relieved. The chances of recovery from the operation would be materially enhanced by our possession of such remedies as aconite, arnica, belladonna and mercurius corrosivus to obviate its evil consequences.

There is pretty general agreement among our therapeutic writers as to the value of the remedies I have mentioned, especially as to nux vomica and belladonna.§ Jousset agrees with me about plumbum and opium; but Jahr says that he has never seen any great effect from these medicines, and Bähr denies the homoeopathicity of plumbum, because in obstruc

* See B. J. H., xvi., 76; xxxi., 376; M. H. R., ii., 66.

In the form of atropine, given in about milligramme doses, this medicine has triumphed single-handed over desperate cases (see J. B. H. S., viii., 251; X., 112).

See M. H. R., ix., 100.

§ I may refer also to a paper by Dr. Drysdale, in vol. xxxv. of the M. H. R. (p. 1), with the discussion which followed its reading.

tion of the bowels the abdomen is distended, whereas in lead poisoning it is hard and contracted. Such an objection hardly seems to me to carry weight.

It is obvious that if our medicines can give this help in intestinal obstruction, they should not be less serviceable in

"

Hernia.—I do not mean that they can cure a rupture of any standing; although such an accident in young children, having evident connexion with some constitutional fault, might not unfairly be expected to yield under treatment. Dr. Guernsey says that "the properly selected homoeopathic remedy is always sufficient to cure such cases. Dr. J. F. Baker even goes further. In some "Lessons from Forty Years' Practice" which he put forth in 1876, in the Hahnemannian Monthly, he speaks of having cured in all about twenty cases of hernia in the adult. Lycopodium is his chief medicine against inguinal hernia (epecially, he thinks, when occurring on the right side); nux vomica or cocculus for the umbilical form. I was thinking, however, of the accidents of hernia-its incarceration or strangulation. Here it is certain that we may do much with medicines to effect spontaneous reduction, or to turn a previous failure of the taxis into success. In incarceration, opium; in strangulation, aconite, belladonna and nur vomica have been used with frequent triumphs over the obstruction. Thus, our eminent surgical representative in Berlin, Dr. Mailänder, says :— "Since I have practised homoeopathy not a single case of strangulated inguinal hernia has come within my experience, in which spontaneous reduction was not effected within at most four hours when belladonna 2 and 3, and nux vomica 3-6, had been administered in frequent alternation." Dr. Baumann confirms from his own experience the value of these remedies, but considers that in plumbum we have yet another remedy which may obviate the necessity of resort to the knife. He gives two cases of strangulated femoral hernia in which the last medicine proved very effectual.

And now, of

Chronic Constipation.—I have alluded to the frequent occurence of this condition as one element of the complex morbid states which come before us in practice; and have said that in this case it must only be given its due weight among the other symptoms of the patient. If he improves as a whole under the treatment prescribed, his bowels also will act more easily. But it is hardly credible to old-school practitioners how many patients come to us whose sole or at least central and fundamental malady is constipation itself. The refusal of the bowels