disposition to generate tubercle still remains, and in nearly every instance the patient will eventually fall a victim to the disease.— These cavities become the seat of a more or less abundant tuberculous suppuration, this is of course absent till the tubercle has made its way into the bronchius. We shall here only allude to the existence of a trachael, pleural or costal fistula, the history of these does not belong to our present subject. alterations without any external symptoms, in-chius, and is rejected by expectoration it conforming us of the gravity of the lesions which stitutes a vomica. It is just possible that one had taken place in its substance. of these caverns may heal, but even if they It is equally difficult to ascertain the pre-do, other tubercles remain, or if not, the presence of tubercles in the cerebellum, in most cases indeed their existence is not even suspected. M. Lugol has met with several instances in which tubercles as large as a walnut or a horse chesnut, have been found in the cerebellum, in subjects who presented during life no indication of encephalic disease. One of the cases he relates in illustration of this fact, is interesting in a physiological point of view. A young girl, though 17 years old, presented no indications of puberty, the breasts and genitals were completely rudimentary. The head was always thrown backward, and it was only by an effort of the will that it could be brought forward. M. Lugol has seen tubercles in the tuber annulare, (pons varolii, l, fig. 4) without any symptoms. On examining the lungs of a patient who has died with tubercles, we are often tempted to ask ourselves, why did not this patient, in whom so large a portion of the lungs is destroyed, and what remains is so compressed and condensed that it is no longer capable of receiving air, die of asphyxia? It is evident that they cannot be said to breathe by the lungs, for a long period before they die; now in such cases, which of the organs takes the place of the pulmonary tissue? M. Lugol had no facts which authorize him to attempt an answer to this difficult question. The Presence of tubercles in the lungs may coincide with an otherwise healthy state of the the lungs may not be healthy even in the adorgans; indeed M. Lugol questions whether Tubercles in the Lungs. In the lungs, tubercles are so commonly met with, that M. Lugol believes it to be a rule having very few exceptions, that they always co-exist in that organ with other scrofulous disease, if the patient have attained to the age of puberty. They may appear very early in life, and obstinate cough in children sometimes depends on their presence. The period of life at which they are most commonly developed is the few years after puberty. At this period From all that has been said, it results that we too often observe in scrofulous patients pulmonary tubercle is in fact but tuberculous the terrible array of symptoms which charac-scrofula. This is the position which the disterize phthisis. Puberty then is the time at which tubercles in the lungs most commonly appear, and this is a rule so general, that in the only three cases in which M. Lugol recollects having assured himself of the absence of tubercles vanced stage. ease ought to occupy, and pathologists would never, in all probability have attributed phthisis to inflammation if they had studied it as what it is, a manifestation of scrofula. Nor would thousands have been hurried from the lungs of scrofulous patients of adult into their graves, as they have been every age, the organic signs by which puberty is year with rail-road speed, if phthisis or concommonly manifested were entirely absent. sumption, had not been treated as inflammaScrofulous patients, however, occasionally advance in years, without any manifestations tions, by bleeding, antimonials, cathartics,, of tubercles in the lungs, and it happens blisters, &c. &c. Hundreds of these, would sometimes, though rarely, that at that period have been saved every year, by nature alone, the symptoms of scrofula gradually diminish, and finally disappear entirely-but the predisposition still exists and the malady may return sooner or later. Sometimes the invasion of tubercles in the lungs is sudden, and their generation progresses with frightful rapidity. This form of phthisis is rapidly fatal. This may be assimilated to what occurs in the cervical region. from the change of seasons, who are now mouldering in their graves, the victims of the scientific quackery of the schools. Tubercles in the Liver, Kidneys, Ovaria, and Testes-The liver is often found to have undergone the fatty degeneration in scrofulous patients, but it is not often the seat of tuberTubercles in the lungs follow precisely the cles. They are rare in the biliary ducts, same course as elsewhere. At first disseminated though M. Lugol has seen one the size of a in the tissue of the lung, they gradually con- large walnut in the cystic duct. They are verge as they increase in size, and uniting, more common in the spleen than in the liver, form tuberculous masses. These when they and when they co-exist in these two organs, soften and are evacuated, leave behind them those in the spleen are most advanced. M. tuberculous caverns, which are cavities in the Lugol has never seen tubercle in the pansubstance of the lungs, the walls of which are creas. In the kidneys tubercle is common, it formed by pulmonary structure or by what invades both the cortical and the tubular porremains of the tuberculous matter. When a tions, and sometimes acquires the size of a tuberculous mass empties itself into the bron- walnut. There are seldom more than three 10 Anatomy of the Ganglionic Nerves. or four. M. Lugol has seen tubercle in the urelers. He has only once seen it in the ovaries, when it co-existed with tubercle of the folds of the mesentery, the cerebellum and the lungs. Tubercles in the testes are not uncommon. Tubercles in the Muscles, Bones, and Blood Vessels.-Tubercles may be generated in the muscular as in other tissues. M. Lugol has however only seen it in the psoas, in that case, the tubercle was in the midst of the muscle. There was no lesion of the bones in the neighborhood, the tuberculous matter had evidently been generated there. As to the doctrine which attributes tubercles to inflammation, it deserves a more detailed notice. Inflammation is a peculiar and complex state, having some symptoms which are in herent in its nature and essential, and others which vary according to its particular location. Now the products of inflammation differ in different organs and tissues. The liver does not suppurate as the lungs do, nor the serous as the mucous tissues. Tubercles on the contrary, are as we have said always identical, never varying, whatever organ they may attack. The generation of tubercles More than twelve years ago, M. Lugol sa- has been most studied in the lungs, let us extisfactorily demonstrated the existence of tu-amine it there in reference to inflammation bercles in the bones, developed in the osseous tissue and increasing as tubercle does elsewhere at the expense of the tissue in which it is developed. They have been found in the centre of bones surrounded by healthy osseous Tubercles are often developed around large blood vessels, but that dropsical effusions so common in scrofulous diseases, depended on the pressure of these tumors upon the vessels, M. Lugol has not been able to convince himself. He has never known one of these tuberculous tumors penetrate the coats of the vessel around which it was developed. structure. Tubercles in the Blood.-M. Lugol has found tubercles swimming in the blood of the iliac It was veins at the origin of the vena cava. impossible to admit that the tubercles had originated externally to the vessel. They were of an ovoid form, ten in number. Having now studied tubercle in the differ- fies its nature. M. Lugol, however, I may say with great deference to his opinion, is mistaken in the true character of tubercles. They are, as I have found them by numerous dissections, diseased lymphatic glands, and the new symp toms I have introduced to distinguish this disease, and which depend entirely on the motive power of the system, demonstrate this fact in the clearest manner. as its cause. Pneumonia is a common disease, so common that did there really exist any connexion between it as a cause, and the generation of tubercles as an effect, that connexion would assuredly be discovered. But this is not the case. Nay more, the labors of Bayle and other pathologists prove that pneumonia has no connexion whatever with the generation of tubercles. Bayle examined the bodies of numerous patients dying with pneumonia; he found the lungs hepaticised, carnified, but never tuberculous. Again, epidemic pneumonias are by no means uncommon, and where they have prevailed, a great mass of the population ought to be affected with tubercles, yet this has never been noted as a consequence of epidemic pneumonias by any of the authors who have left us descriptions of them. M. Lugol hesitates to allow pneumonia any influence even in augmenting the secretion of tubercle, his facts however, do not authorize him in pronouncing a positive opinion. He thinks that many pathologists have attributed pulmonary tubercle to inflammation, who never would have thought of adopting such an etiology, for any other form of tubercle, as tubercle in the liver, the spleen, the mesentery, &c.-Med. Gaz. The following are extracts from M. Lugol's fourth lecture on the formation of tubercles in internal organs: "The numerous checks and repeated deccptions to which physicians are daily exposed in the DIAGNOSIS and TREATMENT of tuberculous diseases, do they not prove that it is necessary some other which is less fallible? You all know to leave the beaten track of inquiry and pursue that auscultation and percussion are useless in the diagnosis of pulmonary tubercles.mencement of the mischief, they are superBoth alike insufficient to announce the comfluous at the very time that they become cles; for then these are discoverable by other capable of indicating the presence of tubermeans, and alas! are too far advanced in their development to warrant our hopes of arrality of cases. I will even go a step farther, resting their progress-at least in the geneand say that the unlimited confidence placed by the greater number of practitioners of the present day in auscultation and percussion, To the Royal Medical and Chirurgical Society. Jan. 25 has had the effect of too often inspiring a fatal security in many tuberculous diseases, which are thereby allowed to advance in their progress, until this is revealed by physical phenomena at a period when remedial measures have but little chance of effecting any good. But what are the means, you will say to me, that are to be substituted in the room of auscultation and percussion? I answer, gentlemen, induction. Examine by these boasted methods this patient, and tell me what results you obtain. Negative results you will reply. And yet I maintain that he is tuberculous; for his father, his mother, and his brothers, have all died of tuberculous disease; and he himself is affected with it in his chest at the present moment. Believe me, this plan is much less deceptive than the other one. I tell you, the inductive method cannot mislead you; for nature is invariable in its causes as in its effects; and the external signs of tuberculous scrofula must give you assurance that similar morbid productions exist in internal organs, especially in the lungs. M- Lugol is mistaken in regard to the certainty of this method; for nothing is more common than to find all the external signs of tuberculous disease, without tuberculization of the lungs, and this fact is disclosed by the absence of the magnetic symptoms, while their presence gives the first notice of the commencement of the disease in the lungs even before the cough commences. 1842. Dr. WILLIAMS, President, in the Chair, the following facts concerning Tubercles of the Brain in children, with a Tabular View of 30 cases of the af fection, was communicated by Dr. T. H BURGESS. brain is laid before the society by the author, An analysis of 30 cases of tubercle of the preparatory to a more extended communication on this subject, which he promises to afford. After noticing the importance of extended post-mortem researches, with a view to the pathology of the brain, so as to comprehend with some general remarks on his Tabular View. In his 30 cases, the ages he observes, lesions of the medulla oblongata, he concludes varied between 19 months and 12 years. With respect to sex, 14 were boys, 16 girls. during life; in two, only periodical head-ache: In four cases, no cerebral symptoms existed in two, deafness and purulent discharge from of intellect, were observable; the duration of In the remaining cases, head-ache, this chronic state varying from one month to vomiting, amaurosis, convulsions, weakening the ear. three years. toms, a few with symptoms of softening, the Nine died with acute hydrocephalic symprest of consumption, small-pox, &c. culous masses, varied considerably in different The number, volume, and site of the tubercases, the degree in which the pathology of tubercles A discussion took place, relating chiefly to in the brain was known in England; Dr. Adthe disease was so familiar to practitioners, dison, particlularly, stating that he believed brain it was almost confidently expected that that in many obscure chronic affections of the tubercles would be found either in the substance of the brain or in its membranes. "It is by viewing the question from this elevated point of view, by studying it in all its ensemble, that you will be best enabled to comprehend it in its details; and these cannot be understood by the special methods of These are all cases of children. The disexamination which have been so much re-ease in the brain is besides very common in commended of late years. adults, as we always have cases of it on The tuberculization of internal organs ex The existence of tubercles in the lungs is so frequent, that I must admit that they are present in all scrofulous persons. You know that all, or almost all patients, who have pulmonary tubercles. are, or have been at some in our Medical Colleges, who have often extime, affected with tubercles in the neck; the posed their ignorance by denying the exismajority have had during infancy this external sign of scrofula; while others have had it tence of tubercular disease of the brain, at a later period of life. I believe that pulmo-" except in extremely rare cases." nary tubercles frequently exist in early youth, but it is frequently about the age of puberty that they are apt to be developed. Puberty in truth seems to have a fatal specific influence in promoting their development; and in our wards at the present moment there is a case which seems to confirm this opinion. A scrofulous patient, who, although 22 years of age, exhibited none of the usual characters of marriageableness, has just died, and in him no tubercles were found in the lungs. hibits in its development the same phenomena hand, which yield to the influence of the as tubercles which are outwardly situated- magnetic remedies, as it does when affecting there is no pain and nothing of mechanical other organs. derangements. known of the pathology of tubercles in the Very little, however, is brain in this country. There are even professors of the theory and practice of physic ARTICLE IV. The Sequel of Homœopathy. PROFESSOR HAHNEMANN divested himself of the shackles which bound him to the old visionary theories and routine practice of the schools, and undertook to effect a most important object by the most extraordinary means. portion. 4. "By the extinction of the totality of the symptoms in the process of cure, the suffering of the vital power, that is the entire morbid moved." affection, inwardly and outwardly, is re His object was a revolution in the preserves it in harmonious order." That is, theory and practice of physic. This he it is magnetized, with the forces in equal proavowed; and he supported its necessity and 2. Without this vital dynamic power, the importance with great ability; but the means organism is dead." Or, it is unmagnetized. 3. "In disease, the vital power only is priby which he intended to effect it, like the marily disturbed, and expresses its sufferings general who contemplates storming an ene-(internal changes) by abnormal alterations in my's camp, he kept a profound secret. His the sensations and actions of the system." Or one of the forces predominates. enemies in the distance, as well as his most obsequious proselytes, were equally in the dark, and while the first were amused, the latter were astonished at the novelty and profundity of his pretended expedients to demolish " the old allœopathy castles in the air." He had too much good sense to think for a moment, of attacking these ærial fortresses with " gross inanimate matter," after he had seen in the clairvoyant or somnicient state, the astonishing effects of the "spiritual, self-moved, vital dynamic power, which moves our systems, and preserves them in harmonious order." Besides this knowledge of the moving power of the human system, that of the identity of the magnetic or spiritual forces of nature with the powers of medicine, was one of those discoveries which he considered too far in advance of the intelligence and candor of the age to be entrusted to the rude resistance of established prejudices; and, therefore, in imitation of the wise examples of antiquity, he cautiously veiled it, under the specious garb of the magical effects of infinitesimal doses of medicines, for the purpose of preserving its advantages through this, to a more enlightened and liberal period. 5. "The sufferings of the deranged vital power, and the morbid symptoms produced thereby, as an indivisible whole, are one and the same." 6. "It is only by means of the spiritual influence of the morbific agent, that our spiritual vital power, can be diseased, and in like manner, only by the spiritual (dynamic) operation of medicine that health can be re stored."-ORGANON OF MEDICINE, Xviii. The following extracts from his "Organon," will bear conclusive evidence of the fact, that he does not depend on the natural quantity of the spiritual or magnetic forces in their medicines to cure diseases. 1. "It is only by the use of the minutest homoeopathic doses, that the reaction of vital power shows itself, simply by restoring the equilibrium of health. p. xx. 2. "But the signs of amendment furnished by the mind and temper of the patient, are never visible (shortly after he has taken the ated to the proper degree-that is to say, as remedy,) but where the dose has been allenumuch as possible. A dose stronger than necessary (even of the most homoeopathic remedy) acts with too great violence, and plunges the moral and intellectual faculties into such disorder that it is impossible to discover quickly any amendment that takes place. p. 193. The following are the corollaries on which 3. "A judicious physician will confine he founds his theory, and practice; his other himself to an internal application of the recorollaries being chiefly intended to veil his cally as possible, and will leave the use of medy which he has selected as homœopathidiscovery in its application to practice, by ptisans, little bags filled with medicine herbs, the gratification of the marvellous propensi- fomentations of vegetable decoctions, washes, and frictions with different species of ointties of his readers; and while he depends en-ments, injections, &c., to those who practice tirely on the action of the magnetic or spiritual according to routine." p. 202. forces, which he condenses in his homœopathic doses, for the success of his system. Prelude. "To presume that disease (non chirugical) is a peculiar and distinct something, re. siding in man, is a conceit, which has rendered allopathy so pernicious." Corollaries. 1. "During health, the system is animated by a spiritual, self-moved, vital power, which make use of small globules of sugar, the size of mustard seed; one of these globules having imbibed the medicine, and being introduced into the vehicle, forms a dose containing about the three-hundredth part of a drop, for three hundred such globules will imbibe one drop of alcohol; by placing one of those on the tongue, and not drinking any thing after it, the dose is considerably diminished. But if the patient is very sensitive, and it is necessary to employ the smallest dose possible 4. "The best mode of administration is to and attain at the same time the most speedy results, it will be sufficient to smell once."p. 207. been twice shaken,) is, in its turn to be shaken twice, remembering to number the dilution of each vial upon the cork as the operation proceeds. The MANIPULATIONS(!) are to be confirst up to the thirtieth or decollionth developducted thus through all the vials, from the ment of power, which is the one in most general use." twenty-nine additional vials, each of equal capacity with the first, and each containing ninety-nine drops of spirits of wine; so that It would be easy to add a great many re-nished with one drop from the vial of dilution every successive vial, after the first, being furpetitions of the same declarations in different immediately preceding (which had just forms, but these must be abundantly sufficient to satisfy even the greatest skeptic; for it is impossible in the very nature of things, that such minute doses of medicine should produce such effects, or any effect whatever, and this fact was well known to Hahnemann. He indeed says so in the above extracts, in the strongest language he could use, without expressing it in so many words, and thereby expose the object he wished to veil. Let us now see if we can ascertain by what means it was he communicated to his homoeopathic medicines a power which, it is conceded, sometimes, at least, produces the magical effects he describes, and which are claimed for it by homeopathists; and for this purpose it will only be necessary to select and place before the reader a few extracts from the same work above quoted. "All other medicinal substances, excepting sulphur, which, of later years, has been employed only in the highly diluted tincture (X), such, for example, as the metals, either pure, or oxydized, or in the form of sulphurets, and other minerals, petroleum, phosphorus, the parts or juices of plants, obtainable only in their dry or inspisated state, animal substances, neutral salts, &c.,-one and all were, in the first place, exalted in energy by attenuation in the form of a powder, by means of lionth degree. Of this one grain was then three hours trituration in a mortar, to the mildissolved and brought through twenty-seven vials, by a process similar to that employed thirtieth development of power.” p. 200. in the case of the vegetable juices, up to the Hahnemann, it will now be seen, imparts "The homeopathic healing art developes for its purpose the IMMATERIAL (DYNAMIC] power to, or magnetizes his medicines, as VIRTUES OF MEDICINAL SUBSTANCES, and to a magnetists magnetize their patients; or, by degree previously unheard of, by means of a a regular order of manipulations, which inpeculiar and HITHERTO UNTRIED PROCESS. By this process it is that they become penetrat-crease the power or potency of the medicines, ing, operative, and remedial, even those that, directly as the number of their dilutions; the in a natural or crude state, betrayed not the minimum increase being that of 1 to 100. least medicinal power upon the human system."-p. 199. It is difficult to conceive the minuteness of This, it will be conceded, is a very modest these doses in the thirtieth or decollionth deannouncement for such an important discove-gree" in the most common use" without the ry as that of magnetizing even inert sub-greatest exertion of the imagination, even stances, so as to give them a high and impor- when expressed in figures, thus: tant remedial power; and from my know 1,000,000,000,000,000,000,000,000,000, ledge of the subject, I cannot avoid entertain- | 000,000,000,000,000,000,000,000,000,000,-ing a strong suspicion, that Hahnemann 000. obtained his knowledge of this art, as well as that of the magnetism of the human system from some distinguished clairvoyant. But let us hear how he performs these operations. We find nothing more that is peculiar in Hahnemann's art of manipulation in the manufacture of his medicine, except that which is seen in the following paragraph. "When I make use of the word intimately, "If two drops of a mixture of equal parts of cinal liquid with ninety-nine drops of alcohol I mean to say that by shaking a drop of medialcohol and the recent juice of any medicinal once-that is to say, by taking the vial in the plant be diluted with ninety-eight drops of hand which contains the whole, and imparting alcohol in a vial capable of containing one to it a rapid motion, by a single powerful stroke hundred and thirty drops, and the whole twice of the arm descending. I shall then obtain shaken together, the medicine becomes exalt- an exact mixture of them; but that two, three, ed in energy to the first development of power, * or, as it may be denominated the first potence. We see clairvoyants in the somniscient state, magThe process is to be continued through netize water by the passes descending. |