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eradication, or at least permanent modification, of disease; and, provided the case is an uncomplicated one, may proceed directly to the heart of the matter, which is the selection of the correct remedy

How shall we do it? Just here, at the outset, is where we must exercise the greatest care, as our success or failure depends greatly on the manner in which we have "taken the case.” The rules for the examination of the patient, as carefully formulated by Dr. P. P. Wells in an elaborate essay written in 1888, should be familiar to every prescriber, and put into practice with every case. Then, with the requisite study of repertory and materia medica, we need have few failures, and will be sure to make many brilliant cures.

If possible, we should endeavor to visit the patient during an attack at least once, that we may the better judge of the objective symptoms about which patients often unintentionally deceive us. Then, too, they can better describe the character and location of the pains while experiencing them than at a time of comfort. We must note the various positions assumed, and ascertain the reason for those positions, the conditions and times of aggravation and amelioration and the concomitants; but above all we must search most carefully in our examination for any peculiar symptom or condition that shall aid us in individualizing this case among others. This is where the specific nature of homeopathy comes to the front; each remedy is the specific against its own peculiar conditions, and those only, and one distinguishing symptom, like the "aggravation from cold drinks of sabadilla, or the photophobia of belladonna, will prove of more aid in finding the correct remedy than a whole page of general symptoms, which are peculiar to nothing, and exhibited by more than half our sick and ailing patients. Now, having proceeded to elicit their symptoms from the patient in question, the next thing to do is to write them down on the spot as we take them, while they are fresh and vivid. It is impossible to properly study a case without this aid. The next step, providing the remedy is not already apparent, is the study of repertory and materia medica. With the intelligent use of the former it seems to me almost impossible to dispense, if we expect to make a correct prescription, and while it takes considerable time at the outset it is a saving in the end.

The repertory seemingly best adapted to this use is the “Therapeutic Pocket Book," of Boenninghausen, of which we now have a new edition by Dr. Allen. While incomplete in many ways, its arrangement is still such as to make it of great value in this form of case analysis.

My method of use is very similar to that detailed by Dr.

Holmes, in the January Advance, differing only in some minor points. First, I have a sheet on which are printed the names of nearly three hundred remedies, with a blank space following each. Then, after arranging the symptoms of the case in as concise a manner as possible, we may proceed to check the remedies on the printed blanks. For instance, we will suppose that our first symptom is headache at the vertex. Now in the Boenninghausen four styles of type are used, signyfying different degrees of importance, which, in checking, we may indicate as 1, 2, 3, 4; therefore, under "vertex” we check the most important remedies, placing a figure 3 or 4, as the case may be, opposite the name of that remedy on the blank. Then proceed to the next symptom in the same manner, usually the character of the pain at the vertex, if it is “bursting ;” we then look for that rubric in the repertory under the general head of “sensations," and place the value of every remedy found to be indicated in troubles at the vertex opposite what we have already placed in the blank space, and so on through the list of symptoms. At the end, by adding these values, our attention will be directed to a certain few of the remedies for study, and while the highest is not always found to be the similimum, the correct remedy will nearly always be found among the half dozen at the top of the list'; while, if by some mischance we do not get it the first time the analysis of the case is made, a moment's consultation will usually give us what we desire in the way of further knowledge.

A few cases briefly noted will, while exhibiting nothing of unusual prominence, serve to show the results that may always be expected under like circumstances.

Case 1. Woman, 49 years of age, slender, dark complexion, had suffered, more or less, for the major part of her life with periodical attacks of migraine. About a year previous to my attendance a friend (?) had introduced her to the wonderful action of the Pheno-Caffeine pill in such conditions. She consulted her family physician, a prominent member of the opposition school in town, about these pills, and he characterized them as a “happy combination,” advising her to use "anything that would relieve those terrible headaches. Of course she took them, and they relieved the condition for the time being; but the headaches recurred oftener and oftener till, at the time of my first visit, she was in a half prostrated condition, with not enough energy to perform her usual household duties, which were light; a grumbling headache most of the time with frequent severe attacks, which now the pills had failed to relieve. The symptoms were as follows:

Headache preceded by hunger and extreme sleepiness, aching of face, upper jaw, teeth and front part of head, of the eyes on

turning them ; the attacks usually begin in the night and last through the next day, often with delirium ; sensation of dryness at vertex; sensation that the scalp was drawn over head; sensation that the bones of head were grinding together; pains through root of nose, worse from noise, better from pressure; perspiration of head during attack; backache; thirstless; nausea from walking, relief from vomiting bile; great restlessness; cold feet. Concomitant symptoms were headache after eating fruit; craving for sweets, constipation, stool large and hard; frequent nose-bleed from both nostrils, blood bright red; can hear heartbeat like a hammer after eating. Silica was prescribed, and the improvement during the first week was gradual and marked, and has since continued. This was in November last, and there have been but one or two slight attacks since, which were readily controlled by a dose of the remedy.

Case 2. Woman of about 50, tall, spare, dark complexion, subject for many years to frequent headaches of great severity, obliging her to relinquish her household duties and remain in bed for a day or so at a time. The symtoms were as follows:

Drawing pain in nape and occiput, she must take down her hair; dizziness; nausea on rising in the morning; pain, better when quiet and in a dark room, worse from light and noise cannot bear it; thirstless; better from binding head, from cold water application, when sitting up, after sunset; grating sensation in nape; feet and hands cold; rush of blood to the head ; headache preceded by craving for food ; pillow seems as hard as a rock, cannot lie on it ; profuse flowing of dark blood every two weeks. Although much resembling a belladonna case, this woman's remedy was found to be arnica, which speedily brought relief; one new symptom, however, developing meanwhile — waking every morning with a cold spot in forehead. After searching through the materia medica it was found that this symptom was given under no remedy except arnica ; hence it was again administered, this time in a higher potency, and the symptom disappeared. For the past two years this woman has had very few headaches, and none that have not been speedily controlled by one or two doses of the same remedy taken early.

Case 3. Is of a young women, about 22 or 23 years of age, who, for six or seven years, had suffered from severe periodical headaches at intervals, of varying frequency, lasting several days at a time, and unfitting her for any occupation. During these long attacks the headache was present, in some degree, constantly, but was greatly aggravated from about 4 P. M. through the early part of the night, so that she could not go to bed or lie down. The pain was much worse at the vertex and nape; stiffness of nape; dullness of senses; better out of doors. Lycopo

dium cured the case readily, and there has been no return during the past year.

Case 4. Woman, aged 40, single, dark complexion, subject to periodical headaches from childhood, at intervals from once a week to once a month; could distinctly remember having them at five years of age.

Headache preceded by hunger; headache usually beginning in afternoon and reaching the climax of severity about 8 or 9 P. M., continuing until she can get sleep; headache often caused by shopping or getting overtired ; headache in forehead and vertex; also aching in temples, back of eyes, and at root of nose; eyelids heavy; eyeballs feel too large for the sockets ; vertigo; head and ears so cold that she must put on a woolen hood at night when she has a headache ; worse from riding on cars, from eating - particularly from pork or sauces; from the hot sun, from stooping, from thunder storms, from acids ; better from lying down, from sleep, accompanied by cold hands; by gas in stomach ; nausea, but no vomiting ; lame back; worse from storms, and on first moving; better from continued motion. Calcarea carb. proved the similimum in this case, and accomplished most excellent work. The case was treated more than three years ago, and in a letter received recently the woman says in regard to her headaches that “It was a gradual improvement. I did not have them as often or as hard; in fact I have had very little headace since that time, except during an attack of la grippe last winter.”

A CASE OF PRURITUS - OPERATION - RECOVERY.

BY J. F. BOTHFELD, C.B., M.D., WESTBORO INSANE HOSPITAL.

[Read before the Worcester County Homeopathic Medical Society.] The following case of pruritus vulvæ is reported simply because of the unusual method taken for its relief, and because of the unexpectedly good result following the operation. An interesting correlation is demonstrated as existing between a chronic diarrhoea and the pruritus — the cure of the latter removing all symptoms of the former. In the literature at my disposal no record of such an operative precedure has been found.

The patient, Miss E. D., of Concord, N. H., age 42, first came under my observation on March 11, 1891. She came to be relieved of a chronic diarrhoea of one and a half years' duration. She had previously been under the care of four other physicians, at different times, two of whom were homeopaths, and for short spaces of time only had she received relief from her very troublesome complaint. She had apparently received the best

treatment, both as to dietetics and remedies, yet with only temporary benefit. She now appeared anæmic, and much debilitated by her frequent evacuations. The case presented many interesting features from a therapeutic point of view; but it will be unnecessary, for the purposes of this paper, to enter exhaustively into these now. Suffice it to say that sulph. 30x was finally determined upon as the remedy, and everything was done in the way of hygiene that suggested itself.

The patient reported steady improvement for a while, both as to frequency and consistency of discharges ; and the first early morning evacuation was three and a half hours later than formerly.

On May 5th the remedy was changed to aloes 3x, for various reasons. This was continued, with the occasional substitution of sulph., for a period of three months, during which the patient said she had times of feeling almost well, only to be again discouraged by an aggravation of her diarrhea, brought on by some slight indiscretion, or by having been without medicine for two or three days. She, on several occasions, assigned this last as being a sure cause of her feeling worse ; so it is reasonable to suppose that the remedies had some influence on her disease.

Up to this time the patient had strenuously opposed a physical examination ; but in July she was told that unless she submitted to one her case would be dropped, and she then reluctantly consented. She now, for the first time, told of a most agonizing and persistent itching about the vulva.

The physical examination was negative as relating to the rectum and bowels - nothing abnormal was observed in the genito-urinary system ; but two extremely hyperæsthetic kidneyshaped areas were distinctly outlined just external to the labia majora, one on either side. Only on considerable urging would the patient speak about this pruritus. She finally said that it had been of years duration, antedating the diarrhea, and that she had formerly been under treatment by two physicians of her own sex, by one of them for a period of eighteen months, but never with any alleviation. She described her suffering, especially at night, as something intense. The least touch caused the most unbearable itching, and cold water burnt like fire, followed by great pruritus. Her mother said that her condition was most deplorable ; that it was difficult to exaggerate her misery; that she was bereft of sleep by night, and tormented constantly by day, so that she was despondent and depressed, and that she feared she would develop into a case of insanity.

As before stated, the areas of itching could be clearly outlined. There was a kidney-shaped surface of skin, with concavity inwards, just external to the labia majora, on each side.

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