The attacks were usually brief and the suffering consequently mild.

From this time on the disease made more rapid progress. During the fall of '98 there was hardly a day but that patient did not experience some pains of the character mentioned in both arms, chest and right leg, attacks lasting from several days to a week, during which time she had to remain quiet. The joints were frequently hot and sore, but no swelling. During the intervals of these attacks, lasting from two to three weeks, she was able to be about. Considerable stiffness resulted from these attacks. About this time a cough. developed, which continued nearly during remaining period of disease, accompanied with profuse expectoration. Microscopical examinations revealed no tubercle bacilli, but tissues from bronchial tubes and large quantities of saliva. There were occasional attacks of fever. It might also be of interest to note that up to this time, menses appeared at regular intervals of three weeks, at the age of 52. During the spring of '99, when the warm weather approached, there was some improvement, so much so that she decided to take a western trip to see whether she might possibly derive some benefit. She remained in California eight weeks, returning in August in worse condition than when she left. Still not satisfied, she went to Vermont to visit some rela. tives, thinking that possibly it might do her some good. She remained about three weeks, returning in September in still worse condition.

The symptoms now began to look more alarming. At this time the menses suddenly stopped, and with the suppression of menses, there began an attack of arthritis, assuming a different form from any previous attack. Intense pain began on ulnar side of right wrist, extending through carpal articulations, involving especially the carpo, metacarpal articulation of thumb. Swelling immediately followed œdema, extending over entire back of hand and fingers, being most marked along course of pain. Immediately over the seat of

pain, the skin was red, while other parts were white, easily pitting upon pressure, shiny, moderately tense. Simultaneously with the swelling in hand, a similar condition began in torsal articulations of right foot; the principal swelling being towards the median line about midway between internal malleolus and torso, metatorsal articulation of great toe, oedema extending over entire dorsal surface of foot, and like hand the skin was red and shiny over seat of pain. Two weeks later, a similar condition commenced in ankle of left foot, swelling covering external malleolus and extending along outer side of foot. One week later, the elbow of left arm was similarly attacked, swelling extending over external condyle. The swelling at this point was most marked, as well as pain and stiffness. All four points of attack indicated infiltration. As the acute symptoms subsided, the conditions following were similar. very slowly receding, the skin became shrunken, thinned, depressed and scar-like. It was firmly adherent to the subjacent tissues, excepting at the points where pain began. The fingers of right hand were contracted and held in flexed position. There was very slight movement in the metacarpo phalangeal joints. The fingers looked thin, the skin was drawn, smooth and glossy, and could nowhere be picked up. The skin became so tightly drawn over these points, that the original points of attack appeared so prominently that patient would refer to them as "camel's humps." The most marked contraction was in the left elbow, the forearm being semiflexed and could not be extended. The movements at shoulder joint were limited.

The oedema

The arms could not be lifted to

level of shoulder. in the joints as in the skin. Patient was finally unable to feed herself; could only with difficulty, by using both hands, hold an object. It might be of interest to note that when these joint symptoms developed, the cough stopped, and expectoration was very slight. There was, however, a continuous temperature.

The stiffness did not seem to be so much

I would like to call particular attention to these four points of attack and results following. From the beginning of swelling in right hand to the time swelling in the left elbow commenced, covered a period of about four or five weeks, and although the elbow was the last to begin to swell, it was the first to break down, possibly owing to the fact that this elbow was the part upon which she was dependent for support in changing position in bed.

The discharge was of a yellowish green color. Microscopical examination revealed only ordinary pus germs. At first it seemed as though it must be a very deep-seated inflammatory condition, yet at the very height of the swelling the joints were fairly movable, and had no apparent effect upon aggravating pain. The reason for this was evident as soon as the pus was discharged. Instead of being deep-seated, it extended only to the muscular tissue. For a few days sloughing ensued until an opening about an inch in length and half an inch in width was formed.

The ulcer did not increase in size, neither did it show any tendency towards healing. There was very little discharge after the first evacuation. The other points of attack pursued a similar course. The slowly accumulated pus was evacuated; sloughing ensued for a few days, then remained stationary; discharge very slight. The opening at these places had no particular effect upon movement of joints, only to say as time passed on, the skin became more contracted and stiffness more aggravated.

The skin of face had a drawn look, particularly about mouth, the angles of which were drawn down. The eyes could be opened and closed fairly well. There was very great restriction of movement of lips and of muscles of face. The gums were shrunken so that teeth became loose.

The skin of right foot was greatly involved. (Just over the instep of right foot, at same place where pain began, was a red patch, circular in outline, about the size of silver half dollar, which had been there about four years. There

were no

accompanying symptoms). The toes looked thin,

skin very hard and drawn. The movements, especially in ankle, was very much restricted. There did not appear to be any special thickening of the joints themselves, but the skin over them was glossy and hide-bound.

Insomnia was the most marked nervous symptom. The examination of abdominal viscera was negative. The heart was in good condition. The urine had a specific gravity of and neither sugar nor albumen was found in it. Patient never complained of headache; never had nausea and vomiting, bowels were regular.

1024,

TREATMENT.

Treatment was unsatisfactory. At no time was any permanent improvement manifested, although nearly everything possible was done in regard to hygienic conditions. Change of climate, out-door exercise, massage and electricity were employed. Most careful attention to diet was observed. Tonics such as maltine and Cod Liver Oil were tried. Many remedies were also used, and often they afforded great relief improvement. Marasmus continued, and ended

but no

fatally Jan. 29, 1900.

SOME REMINISCENCES OF THE STUDY OF MATERIA

MEDICA.

BY N. R. PERKINS M.D., BOSTON, MASS.

[Read before Boston Hom. Med. Society, Oct. 9, 1900.]

The first prescription I ever made was in my student days, and it was for a stye. The remedy was pulsatilla. My next effort in the healing art was graphites, for a moist erruption behind the ears, in a teething baby. Both of these cases were soon well with no return of the troubles. My preceptor was a thorough homoeopathist, with him materia medical was the back bone of homoeopathy. A man of firm convic

tions and a fine sense of discrimination, who prescribed his remedies after careful study, and the results he obtained I have seldom seen equaled. From him I got my first impressions of materia medica. I refer to Dr. J. H. Jones, of Bradford, Vt. In the old Hahnemann of Philadelphia I had the opportunity of listening to the lectures of Dr. Hering. A few indications as given by him may not be amiss, but may bring to mind things we had forgotten, and those who had never heard Dr. Hering may get a new stimulus to study materia medica on purely homœopathic lines. In his lecture on coffea he gave the symptoms of severe toothache relieved by holding ice cold water in the mouth, while in manganium, anything cold makes the toothache worse. one sided headache as from a nail being driven into the head, he said, was characteristic. Colic with feeling as if the stomach would burst, cannot bear the clothes tight. Colic relieved from having the clothes tight, nit. acid.

A

In his lecture on cuprum he said it had the greatest amount of nausea of any of the metals. Vomiting relieved by drinking cold water, vomiting whenever he moves or drinks, veratrum. With cuprum, complaints begin on the left side and go to the right (similar to lachesis). Cuprum with him was one of the principal remedies in cholera.

Under the cough symptoms of kali bichromicum, he mentioned the stringy, tough mucus that sticks to the tongue and lips and has to be wiped off. Cases of tuberculoses with this system as a guide to the selection of the remedy have been cured by kali bichromicum, at least the bacteriological examination of the sputum before and after has so demonstrated. Dr. Hering said that one of the best remedies when labor was slow, on account of ineffectual pains, is natrum muriaticum. The symptoms of fever blisters on the lips in intermittant fever as being an indication for natrum muriaticum he underscored as being good. This symptom has been verified by many of us. For the cracking of the skin under and between the toes, and inflammation under the toe nails, the nails grow too thick, he gave sabadilla.