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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 homoeopaths, 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 diarrhoea, 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 kidney shaped 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 diarrhoea, 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.

These places measured about one and a half by three and a half inches, as demonstrated by the patient's sensations, for they were entirely unaccompanied by any apparent organic change in the integument. For over a month the patient was treated for this pruritus, without avail, by internal medication and external applications, and it was always noticed that when the pruritus was somewhat better the diarrhea was always worse, and vice versa. As she had for two years been under the best of treatment for this trouble before coming under my observation, and as the patient was very anxious to have something radical attempted, an operation was suggested, to which she eagerly consented. This was undertaken on the supposition that the disease was purely a neurosis, since the three common causes irritating discharge, skin diseases, and parasites could be excluded; also because the demarcation between the normal and hyperesthetic skin was so distinct.

On September 5, 1891, the patient was prepared for operation. The pruritic areas were first outlined by pencil, the parts having previously been shaved and treated antiseptically, and then the anesthetic was given. She was in a much weakened and exhausted condition, and took ether badly. Elliptical incisions were made on the left side, around the hyperæsthetic skin, and the included integument dissected off, and the wound brought together by deep catgut sutures, reënforced by two or three deeper silk ones. On the completion of one side the patient. was found to be acting so badly under the anaesthetic that operation on the other was postponed until another time. Recovery was uneventful; the wound healed perfectly without suppuration. She has never had any pruritus in the side operated on since September 5th, now more than eight months; and, what was quite unexpected, for three month she had none whatever on the right side either, so that that side has received no operation. Recently she has had slight itching at times on the right side. What was not unexpected, her diarrhoea practically ceased with her recovery from pruritus.

She writes (May 8, 1892) that she now considers herself a well woman.

THE sanctity of the jury-room appears to be so well guarded that even in case of sudden sickness, a physician may not enter except after due process of law. In the Foss will case, tried recently in Boston, the jury were deliberating, when, late in the evening, one of them was suddenly attacked with what proved to be a stroke of apoplexy. The officer in charge notified the deputy sheriff, who, not having authority to let any one into the jury-room, drove across the city and informed the sheriff, but even this official was not high enough to act, and another expedition started in search of the judge. As the latter happend to be at home, the requisite order was obtained to summon a doctor. - Boston Medical and Surgical Journal.

EPOCHS IN MEDICINE.

BY JAMES C. WOOD, A. M., M. D., ANN ARBOR, MICH.

[Being the Annual Presidential Address delivered before the Michigan Homeopathic Medical Society, May 17, 1892.]

If I were asked to name the discoveries or advances which, in my opinion, marked the four greatest epochs in the history of medicine I should, without hesitation, select the following: the discovery of the circulation of the blood, by Wm. Harvey; the discovery of vaccination, by Edward Jenner; the discovery of ether and chloroform; and the promulgation of the law similia similibus curantur, by Samuel Hahnemann. These several epochs have, I believe, more than all others, left their impress upon the development of medical science; but each has been important in its own particular way. Thus, Harvey's discovery marked a new era in the study of physiology and anatomy; Jenner's pulled the sting from that plague of plagues — smallpox; ether and chloroform robbed the operating ampitheater of its former terrors, and the application of the law similia similibus curantur, judged even by those who are not its advocates, demonstrated the utter uselessness, and indeed the actual harmfulness of the practice then in vogue, if it did not, as you and I believe, give to the world the best and most universally applicable law of cure yet enunciated.

William Harvey, the discoverer of the circulation of the blood, was born in Folkestone, on April 1, 1578. His father, a prosperous Kentish yeoman, sent him through the Canterbury grammar school. At nineteen he took his B.A. degree from Caius College, Cambridge, and at twenty-four he was made a doctor of medicine by the University of Padua, where he had for instructors the renowned anatomists, Fabricius and Casserius. On his return to England, in 1602, he settled in London, and in 1609 he applied for the reversion of the post of physician to St. Bartholomew's Hospital. His application was signed by Dr. Atkins, the president of the college, and by James I. The occupant, Dr. Wilkinson, died the same year, and Harvey succeeded to the post. As a practitioner he became very popular, and had among his clientèle Francis Bacon and the Earl of Arundel. In 1628 he published his "Exercitatio Anatomica de Motu Cordis et Sanguinis."

I will briefly review the state of knowledge appertaining to the circulation of the blood previous to the publication of the foregoing work. According to the theory of Aristotle the blood in man and the higher animals is elaborated from the food in the liver. Passing from the liver to the heart, it is carried by the veins throughout the body. His Alexandrian successors,

Erasistratus and Herophilus, modified his theory, and taught that the veins carry blood from the heart to the members, and that the arteries carry a subtle kind of air or spirits. Galen discovered that the arteries contained blood as well as "vital spirit," and are not merely "air-pipes," as their name implies. With this exception, the theory promulgated by Aristotle remained the same from the Christian era down to the sixteenth century. For nearly one hundred years before the birth of Harvey it was well known that the blood is not stagnant in the body; but until Harvey enunciated his doctrine the conception of a continuous stream returning to its source had not been thought of. It was believed that the blood moved irregularly, as regards both direction and speed, as air circulates in a house, or a crowd moves in the streets of a city. The functions of the heart as a motor were not comprehended. It was supposed that the septum of the heart, being pervious, permitted the blood to pass directly from the right to the left side; that one kind of blood flowed from the liver to the right ventricle of the heart, thence to the lungs and general system by the veins, and that another kind flowed from the left ventricle to the lungs and general system by the arteries. The supposed function of the heart was to commingle blood and spirits, after sucking in these fluids, during diastole. Sylvius, a sixteenth-century anatomist, described the valves of the veins. Vesalius demonstrated the complete closure of the septum between the two ventricles. Servetus believed that the spiritus naturalis, as he termed the blood, is transformed in the lungs into spiritus vitalis, and he, therefore, was the true predecessor of Harvey in physiology. Yet the significance of the valves was unsuspected, and the idea of a complete pulmonary circulation was not fully comprehended. Harvey believed that "wise men must learn anatomy, not from the decrees of philosophers, but from the fabric of nature herself." He accordingly began his investigations into the movements of the heart and blood by examining them, as they actually go on in living animals. By experimenting on dogs, cats, pigs, serpents, frogs, etc., he most clearly demonstrated the anatomy of the heart, the veins, and the arteries. But he strove unavailingly to discover the channels by which the blood passes from the arteries to the veins. His conclusions may be summed up as follows:

I. The dynamical starting point of the blood is the heart, and not the liver. 2. The action of the right and left sides of the heart, auricles, ventricles, and valves is the same, the mechanism of both being for reception and propulsion of liquid, and not of air, since the blood on the right side, though mixed with air, is still blood. 3. The blood sent through the arteries to the

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