Review, April 1, 1874.

on them the performance of certain sacrifices, he has by some been accused of credulity, yet the first of these practices was merely part of the careful examination he instituted into all the phenomena of each individual case of disease-a part, moreover, to the importance of which attention has recently been drawn by Dr. Maudsley; while the second simply showed his pious care in the discharge of what, in common with some of the most enlightened men of his own and long subsequent times, he regarded as his religious duties.

He taught that the differences between various diseases depend on their cause and seat. He classed maladies as acute, which he again sub-divides into very acute, or those terminating within fourteen days, and the less acute, which may last sixty days; and chronic, or those which exceed that term. Here he again dwells upon the harmony and relation he conceived to exist between the "microcosm and the "macrocosm," asserting that acute diseases are those of youth, spring or summer, warm climates, bile and blood (all of which he regarded as analogues), and that chronic diseases were those of age, pituita, black bile, and winter. He further classifies diseases as epidemic, endemic, sporadic, hereditary, benign, malignant, mortal, dangerous, simple. He recognises four stages in every disease, the onset, the aggravation, the height, or acme, at which the crisis occurs, and the decline. A favourable crisis, according to him, depends on the "coction" of the humours, with evacuation of all superfluities; this evacuation he regarded as the indication, and to some extent the gauge, of the "coction," and unless it was profuse he always feared the malady would recur. He acknowledged, however, that a favourable issue sometimes succeeded very scanty evacuations; a fact which his sanguinary and drastic successors generally overlooked, until Hahnemann again drew attention to it. He compared the development of the "coction" to the ripening of fruit, and as this only takes place at fixed seasons, so the former he thought could only occur on certain days, viz.: in acute diseases, the 4th, 7th, 11th, 14th, 20th, 21st, 40th, and 60th, every fourth day being a critical day in diseases not exceeding 20 days, and every seventh in those not excceding 40 days; and in chronic diseases crises occurred every 4th, 7th, 11th, 14th, 17th, 20th, 27th, 34th, 60th, 100th, 120thevery twentieth being a critical day when the disease

Review, April 1, 1874.

exceeds 40 days in duration. An immense number of observations must have been made to satisfy even himself of the truth of such doctrines as these; so that, although we may doubt the accuracy of his conclusions, we cannot question the extent of his research. He elsewhere speaks of certain congenital or infantile diseases terminating when the sufferer attains the age of 14 years, and many persons now-a-days are of opinion that not a few maladies disappear on the arrival of puberty. It was perhaps a Pythogarean prejudice which led him to assert that all deaths from disease, and likewise all complete recoveries, took place on an uneven day, month, or year of the malady. Hippocrates gave a greater proof of acuteness by describing the curious phenomenon of "metastasis."

But it is in his symptomatology that the acuteness of his discrimination, and depth and width of his research, are most conspicuous. Curiously enough, he does not dilate much upon the pulse; but he examined the tongue; eyes; countenance (the "facies Hippocratica" is well known); position or decubitus; action (as " picking straws," which he first pointed out as an indication of approaching death); habits, whether changed or not, as loquacity, taciturnity, &c.; nature of delirium and dreams, if present; respiration, whether quick or slow, easy or oppressed; whether expiration is prolonged, or inspiration prolonged; sleep or wakefulness; urine, its colour, smell, sediments, &c.; fæces, their colour, smell, acrid character, &c.; flatus; vomited matters; expectorated matters and saliva; sweat, nature, amount and extent, whether general or partial; mucus of the nose; cerumen of the ear; tears; and purulent discharges when present. To give any just illustration of the minuteness of his examination of every one of these objects would require an essay solely devoted to the purpose; here I can only remark, in conclusion, that his observations thereon are always striking and usually just; and that, not content with setting down the sum of symptoms therefrom deduced, he further proceeded carefully to compare those of each individual organ or function with those of every other in every case of disease. When we add to this consideration the fact that Hippocrates describes more than 250 diseases known even to later times by the names he himself employs, besides numerous others now differently designated or wholly extinct, we shall not hesitate to endorse the testimony of Galen, that

"Hippocrates was the most careful and exact of all physicians," and shall feel little surprised at the marvellous accuracy of his prognosis.

(To be continued.)

ON HÆMORRHAGE.

By J. HARMAR SMITH, Esq.

(Continued from page 159.)

Hæmaturia (continued).

There is an interesting case of hæmaturia reported by the late Professor Henderson, in the British Journal of Homeopathy, Vol. XIV. p. 15. The disease was of several months' duration, but was cured in three weeks by turpentine 1x and 1.

Another case reported in the same Journal, Vol. XIII. p. 484, shows the importance of discrimination in the choice of remedies. This case had been five years under so-called allopathic treatment, the principal medicine which had been given during this protracted period was turpentine. The patient, a Frenchman, then consulted a homœopathic physician, Dr. A. Dours, and was cured completely in a few months, the medicine which cured the hæmorrhage being cantharis 6, though other medicines were afterwards required to meet other symptoms. A third case of bloody urine also reported in the British Journal, Vol. XVIII. p. 223, was cured by arsenicum 3, no other medicine being given. In this case there were anasarca and tubular casts as well as hæmaturia. The cure was effected in a month. A fourth case of recent origin reported in the same Journal (Vol. XXVI. page 583) was cured by a single dose of ipecac.

An examination of these instances confirms the often repeated precept, as to the necessity of individualizing our cases, and of varying our remedies according to the special symptoms present.

I met with a case of malignant small-pox several years ago, which was complicated with purpura hæmorrhagica. There was bloody urine, uterine hæmorrhage, and profuse discharge of blood from the bowels. The hæmorrhage in this case was due to a morbid condition of the blood itself. It was in fact an extreme case of blood poisoning, as was evidenced by the fact that that fluid was extremely fetid when it passed from the body.

No. 4, Vol. 18.

15

Hæmaturia, as well as other forms of hæmorrhage, is occasionally present in bad cases of scurvy, as well as in certain uncomplicated cases of purpura hæmorrhagica. In these also it is the result of blood disease.

The expulsion of blood from the mouth in larger or smaller quantities, is differently characterized according as it proceeds from the air passages or the stomach. In the former case it is nosologically described as hæmoptysis, in the latter, as hæmatemesis. We meet occasionally with cases which cannot strictly be included under either of these heads. I was some time ago called in by a colleague to visit a patient in consultation with him, who had been vomiting blood for several days. My friend had been unable to satisfy himself as to the source of the hæmorrhage, although a cursory examination appeared to point to hæmatemesis, half a pint of dark coloured coagulated blood having been repeatedly vomited at once. On careful inspection of the mouth and throat I discovered that the fauces were deeply injected. There was also pharyngeal ulceration. I therefore, besides prescribing medicines suitable to this condition, directed the nitrate of silver to be freely applied to the throat.

These measures produced an immediate improvement in the symptoms, and in a few days the hæmorrhage had entirely ceased, nor was there any relapse. This case furnishes an illustration, in addition to the one which has been referred to under the head of epistaxis, of the difficulty which may occasionally arise in the diagnosis of the cause of the hæmorrhage, in certain cases of vomiting of blood, as well as of the bearing of accurate diagnosis upon

treatment.

I shall now make some remarks on hæmatemesis proper, or vomiting of blood, the hæmorrhage having taken place, whatever the primary cause, from the vessels of the stomach itself. This is a much more rare affection than hæmoptysis, and more rare also than hæmorrhage from the intestines. Its nature and cause vary considerably in different in

stances.

1st. It may arise from disease of the coats of the stomach itself, as in ulcer or cancer, and in certain forms of irritant poisoning.

Of course in hæmatemesis of this character, our treatment must be by medicines which act directly upon the gastric mucous membrane.

Hamamelis and ipecacuanha are highly spoken of by writers of our school in this form of hæmorrhage, although their action is very far from being restricted to the stomach. The primary action of turpentine is upon the mucous membrane of the stomach and intestines. Dr. Ringer rerecommends it in hæmorrhage arising from chronic gastric ulcer, to be given in frequently repeated doses of 5 to 10 drops (Op. cit. p. 272). He is very far, however, from being the first writer who has directed attention to its use in such cases. Pereira, for example, says, " turpentine appears to have a constringing effect on the capillaries of the mucous. membranes, for, under its use catarrhal affections of, and hæmorrhages from these parts are frequently checked and often are completely stopped." (Pereira's Materia Medica, p. 711.)

Sir Thos. Watson also refers to turpentine as a remedy in vomiting of blood, though his doses are larger than Dr. Ringer's. In my leech prescribing days I had frequent occasion to prove the power of turpentine as an astringent. I was frequently summoned to stay the effusion of blood which I had directed, and I found the most effectual styptic in such cases to be the oil of turpentine. Hence, the continuity of the mucous membrane with the skin, as well as its similarity in structure and function would lead us to expect, what experience teaches, as to the astringent action of turpentine upon this membrane. When the hemorrhage is of a passive nature, and the patient debilitated, its action as a stimulant is also beneficial.

2nd. Hæmatemesis may be caused by a diseased condition of the blood itself, as we have noticed under the head of hæmaturia. In these cases local remedies will be of small benefit, at least palliative only. The only medicines which are curative here must be directed to the state of the blood. In scurvy, for example, even though accompanied by hæmorrhage, we know how strikingly and how rapidly chemical remedies, such as lemon juice, cure the patient, provided that the case has not reached a hopeless. and irremediable condition.

3rdly. Hæmatemesis may be vicarious of sanguineous discharges from other parts of the body. The most frequent example of this is its occurrence in cases of suppressed menstruation. When this is the cause, the vomiting of blood is generally an affair of comparatively little moment, and will almost certainly cease when the men