a due consideration of the concomitant symptoms and circumstances, we convert a temporary evil into a permanent one, even if we relieve the symptoms and delight the patient.

Again, ordering glasses for constant use when no inconvenience is experienced in distant vision, merely because the total error of refraction discovered would seem to call for it, is in my opinion an abuse of spectacles. The discovery of refractive errors by the use of test lenses, or by retinoscopy, or by the ophthalmoscope, is a beautiful exhibition of special skill, but after that to arrive at a knowledge of the immediate cause of the asthenopia, and to be able to decide upon the proper course of treatment, and to be able not to prescribe glasses-this requires a far greater skill-therein lies the true art of specialism founded upon the science of general medicine. Philadelphia, Pa., U.S.A.

CONCOMITANT SYMPTOMS.

BY M. W. VAN DENBURG, A.M., M.D.

IT has not been my good fortune to meet for many a day with so pleasing an item as one in Dr. Cooper's paper on the lobelias in the December number of the Homeopathic Review. I refer to his quotation of Dr. Malan's report concerning Hahnemann while in Paris; how he sent his pupil back to get the concomitant symptoms (p. 722).

One of the most unfortunate things among many others in the Hahnemannian arrangement of symptoms, is the loss-the utter destruction-of this invaluable characteristic of drug action. To the present generation it seems unaccountable that one who valued concomitants so highly as did Hahnemann, should have so completely annihilated them in his pathogenetic record. This may have come about from several causes.

From his habit of writing each symptom separately, in a sentence by itself (Organon, sect. 85 et seq., also 139), and the consequent necessity of casting the whole pathogenesy in a tabulated statement, upon some general plan.

Had the concomitant symptoms been more carefully expressed in writing his first statements, they would

surely have found a clearer expression in the arrangement that followed.

It is impossible for us to make up the great loss sustained in the unrecorded experience of so careful and accurate observer as was Hahnemann, in regard to concomitance in disease symptoms. Many of these are found in chronic diseases; but many more must have been left without a history save in the education of his immediate pupils.

Equally great, and of more practical value, is the loss of these concomitant symptoms in the Materia Medica. Hahnemann's wide experience in drug proving, the enthusiasm of his followers at the dawn of the new school, made every phase of drug-proving a success. Concomitance could not have been overlooked, but its value was disregarded. There are hints of it scattered through every part of the Materia Medica Pura, but they are mere hints. So much is it observed by the method of arrangement, that whoever wishes to obtain a clue to a clear understanding of this relationship, may consider himself fortunate if he be able to find it after the most patient study, and careful research.

It is also probable that the omission arose from the peculiar views Hahnemann held as to drug-powers, views not equally shared by all his followers. Organon, sects. 116-118, shows that he regarded every symptom evinced by every prover as a legitimate part of the drug effects, as a part of the properties of that drug; no matter if the symptom was manifested by only one out of many provers, or appeared only once in a given prover, still it was a property of that drug. Section 281 would lead us to expect that this rare symptom would prove just as effectual in a case of sickness, as any other symptom in the pathogenesis. "In view of the infallible proofs of experience," many an intelligent practitioner must demur to this statement.

It is a fact that every drug proving is based upon two factors; the individuality of the prover, and the individuality of the drug. If the drug remains a constant quantity, the individual provers' idiosyncrasies at least do not. Those symptoms can best be trusted which arise most frequently in all provers. For these show a strong probability of equality in the individual factors.

Now concomitant symptoms form as legitimate a part of the pathogenesis of a drug, as they do of a natural disease. If we are to prescribe for the "totality of the symptoms" of a disease, it must be by a "totality of the symptoms" of a drug.

Hahnemann speaks of constructing a drug-sickness from the recorded symptoms, like those of the natural sickness of the patient. (Organon, sect. 152).

It would be an error just as culpable, and no less a check to certain success, to omit concomitant symptoms in the drug as in the natural sickness. To take into account concomitant symptoms is as much a part of the "totality" in either case as to take account of any other leading phase.

The great and pressing need, among many very important ones, for a complete reconstruction of our Materia Medica is the restoration, in an available form, of the concomitant symptoms in drug pathogenesy. The “daybooks" are too bulky, too expensive, too rare.

The cyclopædias are, like the unabridged dictionaries, a terror to the student. Too often they lie unused from their very cumbersomeness.

If the "small book" had concomitant symptoms plainly set forth for each drug treated, it would have one merit at least, that of being a truthful drug sketch, even though in outline only. It would be a "skeleton of a totality," that would be worth remembering, and always available.

Fort Edward, N.Y.,

December 11, 1888.

REVIEWS.

Headache and its Materia Medica. By B. F. UNDERWOOD, M.D. New York: A. L. Chatterton & Co.

1889.

ANY book which will assist a medical man in finding a medicine capable of curing some forms of headache must be welcome. In the one before us, the author has collected together, within a comparatively small compass, the prominent headache symptoms of some of our best proved medicines, and has done so in a readable and, moreover, workable manner.

After briefly classifying headaches on the basis of their fundamental causes, he proceeds to present a study of the symptomatology of the more important medicines provocative

of headache. Having done so, a summary is given of the medicines producing pains resembling those present in the several classes of headache he has described. He then carries his analysis further and gives a very fair repertory of the pains, concomitant symptoms, and the conditions under which the several medicines he has dwelt upon excite pain.

It is a useful book, and one likely to be of much service to the practitioner anxious to cure a difficult and obstinate case of, oftentimes, one of the most puzzling disorders commonly met with.

Visiting List and Prescription Record. Otis Clapp. We fully commented on this useful physician's companion last year. There is little to add to and nothing to alter in our remarks then made. The book may be briefly described as a visiting list, case book, cash book, and day book in one portable volume. It measures 4 in. by 6 in. by in., and is bound in a substantial calf cover with flap. It would be better if the paper were a little thinner, and would present a more pleasing appearance if the conspicuous monogram, &c., in large gilt letters were omitted.

The Homeopathic Physician's Visiting List and Pocket Repertory. By R. FAULKNER, M.D. Boericke & Tafel, New York. In addition to the advantage of an ordinary visiting list, this book contains a concise index or repertory to the Materia Medica. From time to time useful suggestions cannot fail to be obtained from this source, although it does not claim to be complete. Being bound in with the visiting list as a pocket book, it can be consulted without attracting attention, and thus without bringing upon the careful and industrious physician the reproach of ignorance, which many patients unacquainted with the homoeopathic method are sometimes in haste to throw upon him.

The book is handsomely bound in morocco, and is very neat in appearance. Our own pockets are not sufficiently capacious to carry about a book of this size (8 in. by 41 in. by in.), but probably those who once use it will always use it.

Calendar for 1889.

FLETCHER AND Co., Gas Engineers,
Warrington.

THIS calendar is got up after the fashion of a tailor's bundle of patterns. One of the leaves is to be torn off daily, whereupon the correct date and an advertisement of some of Fletcher's

manufactures greet one's vision. The calendar is unattractive, and has little to recommend it. This is, however, very far from being true of the gas apparatus advertised. Mr. Fletcher has made a long series of careful scientific experiments to ascertain the exact proportions of air and coal gas required to yield the highest degree of heat. We have some practical experience with gas apparatus, and of Fletcher's amongst the rest. We know of none so simple and so economical of gas for the same yield of warmth as these. For cooking and general heating purposes, whether for large or small apartments, and for almost every kind of laboratory work, they are probably the most efficient in the market. All material used is of the best, and where elegance of design is required it will not be found lacking. We should like Mr. Fletcher himself to know that his appliances run risk of being brought into discredit by incompetent workmen recommended by his firm in London for fixing.

MEETINGS.

REPORT OF THE HAHNEMANN HOSPITAL, PARIS. GENERAL meeting held April 27th, 1888; Dr. Chancerel, President, in the chair. The report embraces a period of twenty-one months, from April, 1886, to December, 1887. The general meeting was not held at the usual time in 1887, on account of the death of Madame Thérese Léon Simon, the first lady patroness of the hospital, and always a devoted supporter of the institution.

The most interesting feature in connection with this particular report is that it formally announces the fact that the Hahnemann Hospital at Paris (founded 1870) has been recognised by the State as an "institution of public utility." The official decree is printed with the report, and is dated August 9th, 1886. By this date, therefore, it is no news to those directly interested in the hospital. To us, however, it is a piece of very gratifying information.

During the period embraced by the report, 183 in-patients were under treatment, of whom 103 were suffering from acute diseases. In the out-patient department, 2,412 new patients were admitted, 26,415 consultations given.

Friends and patients of the hospital will mourn the loss of Dr. Masson d'Ardres, whose place at the hospital is taken by Dr. Charroppin.

The financial condition of the hospital is satisfactory, although latterly there has been a diminution of receipts from the paying beds.