to be taken at 9 P.M., or about twelve hours before the next paroxysm, and arseniate of quinine, 2 grains of the Ix trit. every three hours.

Aug. 8th. Paroxysm about the same in character, came on at same hour. Treatment was continued.

Aug. 9th. Pain very slight:

Aug. 10th. No return of the trouble. I prescribed arseniate of quinine Ix trit., four powders daily, and advised a vacation to the mountains or sea.

About Aug. 20th, he went to the seashore, but having a return of the pain two days afterward he returned to his home. At the solicitation of kind neighbors, an old-school physician was now called, under whose treatment he continued about four weeks constantly growing worse. And then some other kind neighbors told him of a "second-sight doctor," in an adjoining town, who could "see right through him," though ten miles distant, could tell him just what was the matter, and send medicine for one month's treatment, all for the small sum of ten dollars, payable in advance. The money was sent, and the prompt reply by mail contained the startling information that an "examination" had been made, revealing "the fact that the fluids of the body were very much deranged."

This was very lucid. A package of medicine was forwarded by express, supposed to last a month and set the "fluids" right. It was also stated that an "examination" would be made at the end of each week, and results reported.

He was then having a During the chill there The fever lasted

But before the end of the second week the patient became so much worse that he decided to ignore his neighbors, have his own way, and return to his first love. Accordingly I was called in again, Sept. 26, and found the worst case of malaria it has ever been my lot to treat. I think it was somewhat unique, too, as to the frequency of the paroxysms. He had had four distinct chills during the preceding twenty-four hours, each lasting about an hour, and followed by fever and sweat. My first visit was on Friday at 8 A.M. hard shake which lasted over an hour. was intense nausea with vomiting of mucus. about two hours, and the perspiration was profuse for an hour. The patient was very anæmic with marked cachectic look. abdomen was bloated, the spleen very much enlarged, the free border being distinctly felt about half way from the margin of the ribs to the umbilicus and nearly as low as the crest of the ilium. Bowels were constipated and urine scanty and high colored. Arsenic 3x was prescribed with three grains of quinine to be given after each paroxysm.

The

My second visit was at 9 P.M., and I learned that he had had

a paroxysm beginning at 2 P.M. and was then having another, which began soon after 8 P.M.

During the next day, Saturday, the paroxysms came a little earlier and the cold stage lasted longer-over two hours in some of the paroxysms. He also felt cold during the sweating stage. The quinine was increased to four grains after each paroxysm and aranea diadema substituted for ars.

Saturday at midnight he began to shake and continued to shake, without any intermission, till Sunday noon, twelve hours. At 6 P.M. he began to shake again and said to me, "Doctor, I shall shake all night again unless you stop it."

I felt that it would be wrong to allow him to shake all night again, if I could possibly prevent. I felt but little confidence in my ability to do so, but proceeded to administer morphine grain and atrophine grain hypodermically. The effect was most gratifying. In less than ten minutes he ceased to shake. In half an hour he fell asleep and had a good night's rest, the first for several weeks.

I had not expected more than temporary relief from the hypodermic injection, but to my surprise the patient had no chill from the time it was given till the following Saturday. Arseniate of quinine and citrate of iron and quinine were given during the week.

Saturday the patient complained of coldness. Sunday he had a slight chill and much nausea. I gave ipecac Ix and quinine, ten grains of the latter, to be taken early Monday morning, if he was not having a chill.

Monday came and with it two very severe chills. Again I gave morphine grain, hyopdermically, and again it stopped the chill and there was no return for nearly a week, arsenicum being the principal remedy given. But he seemed doomed not to pass a Sunday without a chill, and it came on early Sunday morning. I determined to give more quinine than I had done before, and he took twenty-four grains that day, with no buzzing in the ears. The next day it was increased to thirty-six grains, and the next to forty-eight grains, still with no symptoms of physiological effect. I had given it in two-grain pills, gelatine coated. The stools had been watched by the attendant, but I presume not very carefully, for the next morning after the twenty-four were given, most of them were found to have passed from the bowels undissolved. No wonder that ears did not hum and chills did not cease. I then gave tablet triturates grain of arseniate of quinine, twenty-four each day. About this time a communication was received from the "second-sight doctor," stating that an "examination" had been made, and that the case was progressing satisfactorily, and the "fluids of

the body were in better condition." This was very encouraging, but as the "doctor" with his "second sight," could not see his patient shake, nor see that he had been under a physician's care for more than two weeks, we did not attach much value to the information. He also suggested in his letter that it would. be best to take another month's treatment, for which the charge would be the same as before, (ten dollars).

The arseniate of quinine was continued about two weeks during which time the patient improved so as to get out of doors Occasionally. Since then he has had arsenic 3x, or citrate of iron and quinine 2x, as remedies.

He now gets out every day and is regaining his strength. The spleen has decreased in size, and color is coming back to

the cheek.

Three facts impress themselves upon me in connection with

this case.

Ist.

In intermittent fever, the paroxysms may recur as often as every six hours, though I am unable to find any mention of a greater number than two in a day, the double quotidian type.

2nd.

While morphine is a remedy much abused, I believe that if carefully and properly used it is a remedy that we cannot afford to wholly discard, if we have any regard for the comfort. as well as the recovery of our patients. I do not think that it would ever cure a case of intermittent fever, but in this case it certainly gave the patient immediate relief, and suppressed the paroxysms long enough for other remedies to act.

3d. Gelatine-coated pills are most uncertain things in some cases at least. I used pills from the same lot in another case with good results. I suppose the trouble in this case must have been in the "fluids of the body," as pointed out by the doctor blessed with "second sight."

the base of the tongue in its relation TO MANY THROAT TROUBLES.

BY JOSEPH CHASE, JR., M.D., EAST WEYMOUTH, MASS.

[Read before the Massachusetts Homeopathic Medical Society.]

In presenting this paper I wish to call your attention, briefly, to the results of a few observations made during the last year and a half. My attention was first attracted to the subject, while attending Dr. Hooper's clinic at the City Hospital.

A woman presented herself, stating she had swallowed at piece of an onion, and since then she felt as though it had lodged in the throat, and that she could neither get it up nor

down. She was in a state of nervous excitement lest she should choke to death in consequence.

Examination revealed nothing but an enlargement of the glands at the base of the tongue, so that they touched and overhung the edge of the epiglottis, having probably existed there in this state for some time, and her attention had been especially called to it by the irritation caused by the onion and the nervous fears arising therefrom.

By touching the parts with a cotton-covered probe the spot was located by the patient, and was the seat of the greatest hypertrophy. The treatment advised was the removal of the growths. I never learned whether the patient submitted to it or not; but was assured by Dr. Hooper, that it would be attended by entire relief, as had been many other similar cases. The symptoms were such as cover a large number of cases which come to the general practitioner. The patient has either swallowed something and it has lodged, or else something is growing, or at any rate there is a feeling as of a lump in the throat, sometimes more apparent in the morning when the patient will "hawk," and "spit," and "gag," in his vain endeavors to dislodge it. For this condition, kali bichrom., or some other more appropriate remedy is prescribed, and the patient is assured that the cause is due to a nervous habit and he should avoid the hawking, as it only irritates and insures the continuance of the trouble.

This treatment may relieve, in a great measure, many similar cases while others it will not. We know the base of the tongue is studded with giands just anterior to the epiglottis and laterally they become continuous with a chain of glands, which extend up the sides of the pharynx including the faucial tonsils, meeting again at the vault of the naso-pharynx and there forming the tonsil of Luschka; this circle of glands is known as the circle of Waldeyer. They become hypertrophied in some individuals locally, according to age. In childhood, the tonsil of Luschka, forming the annoying adenoid growths with the ensuing troubles, and the enlarged faucial tonsils with concomitant abscesses and follicular inflammation. These undergo more or less of atrophy after the age of puberty, and when they have done all the harm possible, interfering with the general development of the child in its growing years, and ofttimes greatly impairing, if not totally destroying the hearing. In later years the glands in the lower segment of the circle are affected, causing the symptoms above mentioned.

It seems, however, that those are not all the symptoms which enlargements of the glands at the base of the tongue are responsible for. Many obstinate coughs owe their perpetuation to the

same cause. For the tickling, itching, and smarting in the throat-pit, with cough and raising of frothy, glairy or purulent sputa, we prescribe acon. bell., bry., phos., etc., and later, hepar, kali bichr., merc., and such remedies, which we have relied on, and with good reason, to produce a cure; still in many cases the length of time required is objectionable; and again only temporary relief is obtained, as in the cases of large hypertrophies, that at best only remain in quiesence ready again to be the source of trouble on the earliest occasion. As these glands become hypertrophied and their functions become destroyed thereby it is the proper thing to remove them at once. Still it is not always that a hypertrophic condition exists as the cause of many of the symptoms spoken of, more especially those of a more acute nature. In such cases there seems to be a congestion about the base of the tongue and also the epiglottis itself, with dryness and other symptoms of inflammation without extending to the larynx itself, though to which ofttimes the symptoms have wrongly been referred.

It is here, however, that homoeopathy has shown to advantage, for by the definite symptoms in each case it gives the particular remedy, without the knowledge of the exact locality; yet this knowledge is of advantage in enabling us to apply remedies directly to the affected parts as an aid to a more speedy cure. This is done by wiping the parts with a laryngeal probe around which is firmly twisted a piece of absorbent cotton wet with a 4% solution of cocaine or nitrate of silver, (ten grains to an ounce). This last has been used with great advantage. in the more chronic cases, when there is not sufficient hypertrophic tissue to warrant its removal, or when for other causes it would be deemed inadvisable. The trituration of guiac and solution of corrosive merc. have also been used with beneficial results.

There were three cases, which came under my observation, where a considerable hemorrhage occurred, and which seemed to come from the base of the tongue, one of which was quite alarming and the attending physician called it a pulmonary hemorrhage, and the patient was doomed to an early grave. He, however, recovered and is now in robust health. He had later attacks of the same symptoms which precede the hemorrhage and by making the application of cocaine, and later of nit. of silver sol. he was immediately relieved of them.

In these cases the base of the tongue and surrounding parts were covered by a network of blood vessels, many of which were enlarged and somewhat varicosed.

I cannot positively say that the hemorrhage came from this locality; but still the indications strongly pointed in that direc