Review, Mar. 1, 1889.

was !" So that, neither in his defects nor in his merits could the unhappy successor hope to rival the defunct practitioner to whose practice he had incautiously succeeded. The story is amusingly told, and is not without a moral, which every-day experience frequently points.-British Medical Journal, December 8th, 1888.

BOENNINGHAUSEN'S TREATMENT OF CROUP. OUR contemporary, The Homœopathic Physician (January, 1889), brings before its readers once more Boenninghausen's celebrated treatment of croup. The article is one by Dr. P. P. Wells, first published some 28 years ago, and recently revised and added to. The routine plan consists, as is well known, in the administration of the following powders (five in all, if required) :-1 of aconite, 2 and 4 of hepar., 3 and 5 of spongia, all in high dilution. It is represented as having proved curative in 300 cases without a failure, of which 290 were membranous croup. The powders were given at intervals of half an hour until relief ensued. "This is certainly a remarkable success-very remarkable, in comparison with the results of any other known treatment." It is recommended by the author on the ground of its simplicity, its safety, its promptness, and the completeness of the cure obtainedcomplete cure within two hours.

The following case is reported by Dr. Carrol Dunham :The patient, æt. 18 months, had been ill 12 hours (taking aconite 12) before he was seen by Dr. Dunham. On entering the house, the hoarse ringing respiration was heard, although the patient was on the second story. He was found sitting up in his crib, with an expression of great anguish, breathing at the rate of 35 per minute, and with great labour. There was but little cough, occasionally an effort which resulted in a hoarse dry bark, but which was immediately suppressed, because it interfered with respiration. The hands were frequently applied convulsively to the larynx, but as a general thing the child was quiet, looking with pitiful appealing eyes to the bystanders, as if for aid. The skin was dry, except at the forehead; pulse hard, not full, 130. He has vomited once, bringing up a small piece of tough membrane. "Here was a case of membranous croup of great severity, which had been in full blast at least twelve hours before I was called to it, in which the purple-tinged face and the exhausted aspect of the child showed that the powers of life had already begun to fail under the imperfect decarbonisation of the blood. Dr. Dunham hesitated to trust to Boenninghausen's method in such a severe case, and

tried bromine 1 in water every 15 minutes. At the end of two hours the patient was weaker and the respirations more rapid-40 per minute. Hepar s. trit. 2 was then given for 2 hours, in alternation with the bromine. No improvement had ye taken place, and the disease appeared to be steadily advancing to a fatal termination. It had already advanced to a stage at which Trousseau, at the Enfans Malades, refuses to perform tracheotomy. At 5 p.m. Dr. Dunham determined to give a powder of aconite 200, followed at half-hour intervals by one of hepar 200 and spongia 200 alternately. At 7 o'clock the child was greatly relieved, respirations 30 per minute, less laboured, softer, cough more frequent and looser; a second series of powders were given at intervals of an hour. The child slept at 11 o'clock and at intervals during the night, and no more medicine was given. The child recovered rapidly without any sequelæ, and on the fifth day was as well as usual. This was unquestionably the most severe case of croup that I have ever seen recover.'

Interesting as this long series of cases of severe illness is, most of our readers to-day would hesitate to regard the malady as true or membranous croup in any large proportion of the cases. The writer draws attention to the fact that in his experience the disease (croup) commonly "returns on the second and third nights with more or less severity." This of course at once suggests "spurious," "false," or spasmodic croup." In membranous croup the morning remissions are only ill-marked as would be expected-often they are entirely absent; they are, on the other hand, a characteristic feature of spurious croup. Writers in the early part of the present century, and towards the close of the last, were acquainted with the distinction between these two affections, yet it is also true that some disputed there being two kinds of croup, and accounts including both varieties were frequently published without any distinction being made. Such has doubtless been the case with this series, and what would be otherwise incredible becomes easily understandable on the supposition that a large proportion of the cases referred to were "false," while a minority were probably cases of membranous croup. This supposition clothes the article with an appearance of genuineness which it wants on any other. This view detracts but little from the merit of the treatment, if any cases of true croup were so rapidly and completely subdued by it.

We cannot forbear remarking upon the foot-note appended to the article by the editors of the Homeopathic Physician. Accepting the whole series (or 290 out of 300) as true croup they yet complain of the method of treatment, objecting to the

predeterminate alternation and the stereotyped plan. One would have supposed that a method which saved 100 per cent. of cases of a disease usually having a mortality of from 50 to 80 per cent., would have been a sufficient justification of it, at least in that particular disease, even though it might not establish a universal principle.

The article we have commented upon furnishes a striking instance of the pressing need for fresh investigation of disease in the light of knowledge acquired during the last half or quarter of a century.

THE STUDY OF THE MATERIA MEDICA.

VARIOUS plans for studying the Materia Medica have been proposed. They have, however, one and all proceeded on the assumption that every symptom recorded as the result of taking a given drug is, as a matter of fact, a drug-effect. This state of child-like confidence in the capacity of every prover to be an accurate as well as a conscientious observer, has received many a rude shake during the last twenty or thirty years. There are still some, indeed, who are quite satisfied with the knowledge that a symptom is inserted in a proving, and just as satisfied with its authenticity as was the Yorkshireman with his authority for a certain statement, who, when questioned as to his reason for believing so-and-so, said, "Oi seed it i' t'pappers." He believed in the universal accuracy of newspaper editors just as fully as some of our brethren do in that of provers. Since, however, our time has been less occupied than once it was with polemical discussions, the period of rigid criticism of our drug-provings has set in and may now be said to be in full swing.

The last and most striking illustration of this critical spirit comes to us, appropriately enough, from the University of Boston. Dr. Conrad Wesselhoft, the Professor of Pathology and Therapeutics, and Dr. Sutherland, the Lecturer on Anatomy, having been appointed a committee on Materia Medica by the Massachusetts Homœopathic Medical Society, have presented a report containing very valuable suggestions: for a thorough re-examination of the pathogeneses of drugs, and have accompanied that report by three excellent illustrations of their method of proceeding, while they promise further instalments of the same during the year. The report and illustrative charts appear in The New England Medical Gazette for December of last year and January of this.

The practical question asked, and to be answered before a series of provings is accepted as a thoroughly reliable repre

sentation of the pathogenesis of a drug, is this-How many of these separate provings produce similar symptoms in each prover? The greater the number of similar symptoms arising in several provers, the greater is the trustworthiness of those symptoms. They lay down this rule, "Certain causes acting under like conditions always produce the same effects; and, hence, conversely, if we are seeking for causes, the rule will be that widely varying effects are not to be attributed to the same cause." Commenting upon this they add, "A proving properly made that is a carefully conducted test under methods which avoid error by varying the experiment-will invariably exhibit the same result upon repetition; if with each experiment by different provers the result varies, it cannot be attributed to the drug taken."

This is the basis of the whole scheme. It is carried out on the following plan:

1. Read through the whole of a proving in The Cyclopædia of Drug Pathogenesy.

2. Copy, on narrow strips of paper less than three inches wide, the record of each prover there given.

3. In such a manner as to arrange the symptoms in order according to the parts of the body, head, throat, stomach, &c. This is for comparison.

4. Having done so, place the strips side by side so as to bring the parts to be compared in a line, and then pass judgment as to whether they agree in the different provings or not.

5. If we find that the head symptoms of provers A, B, C, D to agree, we should consider them valid, though E might vary slightly.

6. If they should all be different, vague and uncertain as to pathological meaning and expression, for instance, if those who record head symptoms all differ while others record no such symptoms, the whole should be excluded, i.e., designated as valueless, because uncertain.

Charts displaying the provings of cactus, hyoscyamus and odine, prepared in this way, were exhibited at the meeting of the Society when the committee presented their report.

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The results obtained by each prover were placed in separate columns, so that the different provings occupy parallel columns. In these columns the convenient order of the parts of the body from the head downwards has been adopted, so that reading from left to right you may see at a glance the result obtained by each prover. You will see at a glance whether each prover had a fair number of effects, or whether all the effects embodied in the Materia Medica were claimed

by one prover only, while eight or nine others got no effects; whether the efforts are pretty evenly distributed; and, above all, whether the effects coincide with the different provers or whether they are widely different in sense and meaning."

This chart is prepared by pasting on to a sheet of black paper or linen a series of columns, each devoted to a proving. The columns are divided into the usual anatomical regions of the Schema. The longest proving occupies the first column. Then the symptoms of each proving relating, we will say, to the stomach, are cut out of each, and pasted on to the black sheet so as to be in parallel with the stomach symptoms in the first column.

Here we have the advantage not only of a Schema, but of a critical Schema-one which enables us to appraise the value of an alleged symptom.

These charts are published with the Gazette for December and January. For various reasons it is impossible for us to re-print them here, but we do most earnestly advise everyone who desires to study the Materia Medica thoroughly to pro cure these two numbers of the Gazette-Otis Clapp & Co., of Boston, are the publishers-and to go to work in preparing drug records upon the plan there described and illustrated. Its simplicity, and the facility with which it may be carried out, will be much more easily grasped by seeing a specimen than by any mere account of it which we can give.

By such a plan of study, a better view of the real character of a pathogenesis can be obtained than by any other hitherto proposed. Still it has one drawback, and this we fear is inevitable-it entirely obliterates that suggestive class of symptoms described by Dr. Drysdale as the "contingent." The effects which are more or less constant are the "absolute;" those which occur in only very susceptible people are the contingent; and as susceptible people are comparatively rare, these very suggestive contingent symptoms are also rare -symptoms which often enable us to successfully prefer one of two medicines, whose absolute effects are closely alike, to the other. Nevertheless the plan of Professor Wesselhoft and Dr. Sutherland is one which better than any other enables us to obtain an accurate knowledge of the absolute effects of a drug. And it is with these that we ought all to be especially familiar. Will not someone prepare such a chart, with a commentary on its revelations, for the Congress in September? There is ample time for such a paper to be got ready. Anyone who will undertake such a useful piece of work-useful to himself as well as to others-should send timely notice of his intention to the General Secretary, 29, Seymour Street, Portman Square, W.