Aversion to the smell of food, which causes nausea and loathing.

Arsenic. In the later period of the stage of effusion, which has failed to yield to other remedies. There is great dyspnoea, with but little pain; much prostration, the patient being weak and cachectic; cyanosis; restless anxiety.

Hepar sulph.-Persistent plastic pleurisy. Great sensitiveness to the open air; moist skin; the patient easily perspires.

Rhus tox.-Acute attack coming on after exposure to cold and damp; after a wetting while heated and perspiring. Muscular pains in various parts; pains in the extremities; disposition to change the position of the parts, which is followed by relief.

Sulphur. Plastic exudation, slow to disappear. Also, in cases of serous effusion, coming on insidiously, and lingering. Great need of fresh air; feet and head hot; hands and feet burn; palpitation; atonic dyspepsia. Kali carb. Dry pleurisy

phthisis.

pleurisy complicating complicating

Pleurisy complicating

Phosphorus.-Pleuro-pneumonia.

original mention detailed the histories of eleven cases. After a time Addison's name was given to the disease presenting the group of symptoms first described by him. According to Rolleston (Allbutt's "System of Medicine "), Trousseau was the first thus to honor Addison. Since Addison's time the disease that bears his name has been studied carefully by others-notably, by Greenhow, who presented his paper covering a study of nearly two hundred cases in the Croonian lectures for 1875.

The cause of Addison's disease is not exactly known. Addison believed that any disease that interfered with the function of the suprarenals would cause the symptoms described by him. Others have thought that the symptoms were produced through disturbance of the sympathetic nervous system.

In all of Addison's cases disease of the suprarenals existed. Since then other cases have presented all the clinical symptoms of Addison's disease, but change in the suprarenals has not been discovered at the necropsy. Again, extensive destruction of the suprarenal capsules has been found after death in cases where no clinical evidence of Addison's disease had existed dur

ADDISON'S DISEASE.*

By WALTER SANDS MILLS, M. D., New York City, Physician to the Metropolitan Hospital, Blackwell's Island; Physician to the Out-patient Department, Hahnemann Hospital; Physician to the Out-patient Department, Harlem Homeopathic Hospital.

Up to 1855 no such disease entity as Addison disease was known. Under date of May 21, 1855, Dr. Thomas Addison of London published an original communication entitled, "On the Constitutional and Local Effects of Disease of the Suprarenal Capsules." In this paper Addison said that he had observed at various times a number of cases that were anæmic, but that gave a history of none of the ordinary causes of anæmia; these cases became extremely weak, but did not lose flesh; they also presented a peculiar pigmentation of the skin.

At first, for want of a better name, Addison called these cases cases of idiopathic anæmia, Necropsies made on a number of them gave but one common lesion, namely, disease of the suprarenal capsules. After a few such observations, when he observed the peculiar group of symptoms, Addison was enabled to diagnosticate disease of the suprarenal capsules. The *Southern Hom. Med. Assn., 1900.

Addison's disease is a rare affection. During my five years' connection with the Metropolitan Hospital I have seen but one case. I have seen none in private practice. For ten years previous to 1900 the records of the Metropolitan (formerly the Ward's Island Homeopathic Hospital) show but one case.

The most sriking symptom connected with Addison's disease is the pigmentation of the skin. This may vary all the way from slight exaggeration of the normal pigment on exposed surfaces of the body to a deep discoloration of the whole surface. My case was of the latter class. The patient entered the hospital May 1, 1900, and died September 13. During his entire stay I was in charge of the ward in which he lay, and saw him several times each week. Some slight bronzing of the skin appeared on the face and hands, but it was deeper on the body, arms, and legs than on the exposed parts of the person. It was general, but darker on the back and legs than on the front of the body and

thighs. The whole surface was so discolored that the man had the appearance of a mulatto. The exact shade was a brown about the color of light piece of black walnut. When the patient entered the hospital he was also suffering from pediculosis coporis. The irritation had caused much scratching. Many of these scratches were so deep that scabs were formed. After the scabs fell off white scars were left that formed striking contrasts to the general pigmentation. These scars changed but little, if

any, in color. This agrees with other observers that scar tissue is not discolored in Addison's disease. Cases of general pigmentation, however, are rare. Usually the pigmentation occurs mostly on the face and hands, the exposed parts of the body.

At no time were we able to find pigmentation of the mucous membranes. This is contrary to the ordinary run of cases. Greenhow was of the opinion that it was not an essential symptom, but was due to local irritation. Anæmia

was shown by the light hue of the mucous membranes of the mouth and glans penis.

It

Asthenia is always a marked symptom. was well defined in my case. When he entered the patient was able to get about the ward, but was quite weak. Two of my confrères on the Medical Board, Dr. H. M. Dearborn and Dr. Arthur L. Root, saw the patient at different times during May, and agreed with my diagnosis. I, thereupon, endeavored to get him before the Academy of Pathological Science. The patient left the hospital at my request for the purpose of attending the meeting late in May, but never got there. The exertion was too much for him; he collapsed on the way, and was removal to another hospital, where he remained for a week before he was able to get back to the Metropolitan. Shortly after his return his strength failed so much that he was obliged to take to his bed. Asthenia was practically the cause of his death.

Associated with the general weakness is usually found a weakened heart. This was so in my case. The hearts sounds were very feeble, so much so that it was difficult to tell whether or no they were normal. After death the heart was found to be soft and flabby, but all the valves were perfect. The pulse rate was about one hundred throughout.

The temperature of Addison's disease is usually subnormal. In my case it was normal during May and June. In July and August it averaged from one hundred to one hundred and three, with daily variations of one to two degrees. For the last two weeks of life it dropped to normal again, and sometimes as low as ninety-eight.

At all times there was more or less gastric disturbance. The appetite was fair. Constipation was marked toward the end. There was much gas and much distress from it. symptoms are quite characteristic.

These

My reading reveals very little information regarding complications in this disease. In my case there were several. One was chronic nephritis of interstitial character. This was diagnosed during life and verified after death. This complication was also described in a case reported in Neurolog. Centrabl., 8, 1900 (North

American Journal of Homeopathy, August, 1900), in a woman aged twenty-nine.

Pulmonary tuberculosis is mentioned as sometimes associated with Addison's disease. Indeed, tuberculous change in the suprarenals was once considered the pathological lesion of the disease, and it was supposed to be associated with tuberculosis elsewhere in the body. Pulmonary tuberculosis was found in the case referred to above, but none in mine.

My case exhibited changes in the serous membranes throughout the body. These were discovered only at the autopsy. The pleura was adherent on both sides. The left lung weighed twenty-three ounces, about normal. The right weighed sixty-four ounces. The lung was oedematous, the pleura was thickened, and there was much bloody serum in the pleural cavity. The peritoneum seemed to be inflamed also.

The lower extremities and the genitals were enormously distended with fluid when the patient entered the hospital. The abdomen was also enlarged. Careful and repeated examination showed absence of fluid in the abdominal cavity, but the presence of gas. The liver seemed to be enlarged. This I now believe to have been caused by the cedematous lung and the pleuritic fluid. The liver was found to be perfectly normal at the post-mortem. oedema of the abdominal skin, the genitals, and the lower extremities was mostly due to the weakened heart. All of it promptly disappeared when the patient went to bed.

The

The diagnosis of Addison's disease must be made by exclusion. The prominent symptoms, pigmentation and asthenia, may either one occur in numerous other conditions. All are familiar with the asthenia of wasting diseases. In all of them we have other symptoms to guide us, so that there is comparatively little danger of mistaking the symptom for the asthenia of Addison's disease.

There are various forms of pigmentation that need to be differentiated. In most of them there is no asthenia. In some abdominal diseases pigmentation exists. In most of them, however, the pigmentation is confined to the face. Liver disease may also produce pigmentation of the skin. One point of differentiation lies in the age of the patient. Liver disease is apt to develop later in life. Addison's disease is rare after forty. The average age, according to Rolleston (Allbutt's System), is thirty-one. The liver was eliminated in my case, as it was found to be normal. The patient was thirtyeight.

Pigmentation may occur during pregnancy. It usually disappears after confinement in such

cases.

Tinea versicolor may readily be distinguished by its course.

Pigmentary spots are also left after numerous eruptions. It may also be associated with or follow prurigo, as in a case treated by me during August, 1900. The patient was a young woman from Illinois, who came to New York to place herself under my care. The pigmented spots were confined to the lower abdomen and to the thighs. There is little danger in confusing such cases with Addison's disease.

In hospital practice, occasional patients will appear suffering from what Greenhow designated as "Vagabond's Disease." A deep general pigmentation exists, due to the irritation of pediculosis and to accumulated filth. The only question of doubt as to my case was that it might be vagabond's disease. Everything else was eliminated. I eventually eliminated that, as constant care and cleanliness for over four months in the hospital did nothing toward eliminating the discoloration.

Continued use of arsenic will sometimes produce pigmentation of the skin.

Scleroderma of the skin presents pigmentation, but there are other characteristic changes in its structure that serve to differentiate it from Addison's disease.

The prognosis of Addison's disease is bad. Whether it could or could not be cured, if an early diagnosis was made, is a question. The onset is probably slow and insidious. Cases are rarely diagnosed until all symptoms are well advanced. It does not often run more than two years after a diagnosis has been made. Occasional cases have been reported cured.

Treatment consists in making the patient as comfortable as possible, and in trying to build him up with proper food.

In these days of organ-therapy extract of suprarenal capsules is advocated as a curative. measure. The equivalent of fifteen grains of the dried gland are given three times a day (Rolleston). So far the results have been uncertain; in fact, disappointing. I did not use it in my

THE MANAGEMENT OF THE PUERPERAL
STATE.*

By JENNIE BRUSH, M. D., Daytona, Fla.

If called four weeks before the time of confinement, begin treatment by an examination, to ascertain whether the patient is in a normal condition, as sometimes there is an accumulation of water in the system, indicated by shortness of breath, swelling of the lower limbs and abdominal tension, which gives the patient a great deal of discomfort; relieved by apiseum 3d, dissolved in glass of water and administered in teaspoonful doses every hour.

After the patient is in a normal condition, commence giving cimicifuga 6th, night and morning, as much powder as will lie on the point of a penknife. Seeing my patient once a week and learning whether she is in a normal condition, when the pains begin to come on dissolve an ordinary powder of pulsatilla 3d in glass of water; administer one tablespoonful every half hour.

Should the pains become unbearable, unsatisfactory, and discourage the patient, give passiflora tincture, 6 drops in half glass of water,, tablespoonful every half hour in alternation with the pulsatilla. As soon as the pains become expulsive, encourage the patient to try to help herself, which will expedite matters wonderfully; but I find it a pretty hard thing to convince a primipara that she can do this.

As soon as delivered, see that there is no pressure on the throat from the cord. Lay the child so that it cannot annoy the mother by its motions, and when the pulsation in the cord has nearly ceased, wipe the baby's eyes and mouth with a soft cloth wrung from water containing boracic acid or some other mild antiseptic; then adjust the funis clamps on the cord-first one. three inches from the navel-sever the cord between the clamps, wrap the baby in a soft blanket, and lay it aside; then give attention to the mother by removing the placenta, which is done by slight traction on the cord.

As soon as the placenta is removed, let patient rest while you wash the baby to see that all is right. Apply some wood-wool to the navel, ing too hard on the abdomen. Apply the band covering the clamp well to prevent it from pressand hand the little angel over to the nurse.

If the patient is nervous or hysterical, a few doses of asafetida 10th, given in water, will control the symptoms and bring comfort to the patient. Should there be symptoms of extreme weakness, a few doses of ammonium carb. will bring relief. As soon as she is in a normal con*Southern Hom. Med. Assn., 1900.

dition, remove the upper pad and apply the napkin to the vulva; make the room perfectly dark and quiet; then prepare 6 drops of arnica tincture in half glass of water, and the same quantity of tincture of viburnum opulis in another glass; give one tablespoonful every hour in alternation with the arnica; it will control hemorrhage, remove the soreness, and prevent after-pains.

I consider that every drop of blood lost unnecessarily leaves the patient that much weaker. After twenty-four hours wash the vagina and uterus with a weak solution of carbolic acid, by injection, which should be done every day for nine days, when the patient should be able to sit up and the doctor be discharged.

POLYPHARMACY AND ALTERNATION.

By J. C. WHITE, M. D., Port Chester, N. Y.

I was much interested in reading the article Homeopathic Therapeutics" by Sarada Prasad Roy, M. D., L. H. M. S., in your journal issue of September 1, 1900, which the author says is the "outcome of long experience and lifelong study." This article contains so much to commend that one hesitates to take the part of a critic, even of that part which does not accord with his own "lifelong tudy and experience.' It is so much easier to tear down than to build -we all want to build-and to build permanently. In order to do so we must build wisely. In order to build wisely we must know our art and material well-must have the cumulative knowledge of centuries-I have an affectionate. regard for all co-workers in this noble branch of the world's work. "On the Alternation of Medicines," the doctor says, "opinions differ. There are some of our colleagues who adopt this mode of treatment, while there are others who are quite disgusted by the suggestion of such a mode of therapeutics. They are of the opinion that every case of illness (simple or grave) should be treated with the single remedy which can cover all the symptoms of the said case."

But if we look on the practical side we see that we have to alternate in many cases, because there may be many cases in which the different organs; or even if the single organ is affected, it is affected in a different way. As, for example: A man got gonorrhea two or three days ago, and he is treated with an indicated remedy of that disease; in this state of things he got a new disease, bronchitis, in addition to the former. You cannot say that the bronchitis is the result of the gonorrhea; necessarily, you shall have to prescribe a second medicine to cope with the bronchitis.

Another example may be cited: A man who has been suffering from dysentery applies to you for relief, and you prescribe for him; by this time he has ophthalmia.

In this case also you cannot say that the ophthalmia is the consequence of dysentery. Therefore, you must have something to do for ophthalmia-you must prescribe a second medicine or leave it to nature.

The third and last illustration is this: Suppose a man had an attack of pneumonia in the right lung and it had attained its third stage and he is treated accordingly. In the meantime his left lung is affected with pneumonia, with its premonitory symptoms. Afterwards the first stage of the disease fully developed within a short time; what is to be done in this case? Will you content yourself with continuing the treatment which was going on for the right lung, without doing anything for the left, until it attains the third stage, or prescribe a second medicine for the left lung? Shade of Hahnemann!

The first part of the doctor's article is so practically homeopathic that it seemed impossible that the same pen could have written the above assertions.

He says, "opinions differ as to the alternation of medicines." Thank God they do differ from him! Hahnemann differs from him, and so do all who endeavor to follow carefully his footsteps. He says, "if we look on the practical side. we see that we have to alternate (!) because the organ or organs are affected in different ways."

Did it ever occur to the doctor, in reading the pathogenesis of drugs, that each and every drug affects an "organ or organs in a different way"; that one medicine may both produce and cure discharges from the urethra, and bronchitis, at the same time? We note in this first example that the patient was taking "an indicated remedy." Suppose we substitute the indicated remedy in accord with the added symptom bronchitis. This is what we would expect of a student of Hahnemann.

His second example is: A case of dysentery develops ophthalmia. "He must take a second medicine for the latter, while continuing an indicated remedy for dysentery"! Did it ever occur to the doctor that bell. cures both dysentery and opththalmia? I have cured dysentery with bell. promptly several times without the aid of other medicines, and have also used it to advantage in the first stage of gonorrhea.

His third example amounts to the same as the above. The man has pneumonia in right lung, it attains to the third stage, and is treated accordingly (with an indicated remedy, I suppose), and the left lung commences the same process. Had he received the indicated rem

edy the disease would not have attained to the third stage in the right lung, and the left would not have become affected, unless perchance it was a case of acute tuberculosis.

a

I notice that physicians who habitually alternate and practice polypharmacy expect disease to pass through all its stages-just the same as the old-school physicians-sometimes they may do so with the most careful prescriber, because of inability to get thorough history and symptomatology. When otherwise we expect resolution to commence then and there with the administration of the indicated remedywhether it be dysentery, pneumonia, diphtheria, or typhoid. Two or more remedies may be required to cure a given case, but never two at the same time or in frequent alternation.

If there is anything in the monumental work of Hahnemann more emphasized-made more emphatic-than another, it is the unity, the individuality of the remedy (not remedies), in accord with the totality of symptoms or individuality of the case.

By this individuality we mean the pathology (when possible), location, sensations, and the conditions of aggravation and of amelioration of symptoms. These are what we call the expressed language of disease or of perverted functions; distressed nature calling for the individual remedy which has given like symptoms in its provings upon the healthy organism as a whole, as a unit. We cannot alternate or give compounds for diseased conditions until we have first proved the alternate and compound. Such prescribing is not homeopathic, according to the doctor's theory. His patient having dysentery, and while taking "an indicated remedy," developed "ophthalmia requiring another remedy"; would require a third had a gumboil manifested itself, a fourth for an eruption, a fifth for homesickness, and so on. Is this looking upon the practical side? Nothing is practical which does not coincide with the law of nature. "Similia similibus curantur" is the law upon which we stand, and we know that it is true. The very simplicity of the law is a stumbling-block to those who prescribe for the disease, per se.

The doctor says his remarks are the result or outcome of long experience and lifelong study. He cannot know what his experience would have been had he practiced medicine according to the law, as the master did. Hahnemann's success was phenomenal.

I have practiced medicine three-score and six years. The first eighteen years I was an active worker on the old-school methods; active in condemning homeopathy, in observing the most vulnerable points exposed by its representatives. According to my own observations and

experience, polypharmacy is the greatest hindrance to the progress of homeopathy.

Time and space will not allow me to state my reasons or the particular influences which led to my conversion to homeopathy. I commenced the study without the help or advice of any homeopathic physician, and continued it for years without informing even my friends of my efforts in this way. One reason was, I was ashamed to do so after having condemned it so loudly; another reason was that the social tie of a physician to the fraternity is very strong, and one hesitates to loose its grip before he can feel that he is assured of success in a new departure. I occasionally gave or tried to give a homeopathic prescription, always disguising the taste or color with alcohol or with burnt sugar. My first real and signal success was with a sick horse. A gentleman, whose sick mother I was attending, incidentally mentioned that one of his mares (one of a beautiful black pair) was sick; that she would urinate every five to ten minutes, straining and groaning so that he could hear her in the house, urine bloody; that she had been down all day, and he thought she would never get up again. I was then in a hurry, just going, but I called for a teacup one-half-full of water, and a spoon. In looking in my case I found my cantharis bottle empty-had contained a ten per cent. solution. However, it contained a little moisture, not enough to drop out. I added a teaspoonful of water, shook it up and poured it in the teacup, telling him to give a teaspoonful every ten minutes. The next day I inquired after this patient. He said he gave her one dose and she stopped groaning; gave the second dose, she got up and went to eating. Had been all right without more medicine! Shortly after this I met a case which to me proved a medical education. While passing through a small neighboring village, three miles from home, was asked to stop and see a sick child, four years old. The child had scarlet fever. This was about noon. The child had already been visited that morning by three physicians. one old-school man and two alternating homeopaths. Each of the three had made the statement that the child was past cure, was not possible to save him. No effort was made, some medicine left. The child was being held in his mother's arms, throwing himself constantly from one arm of the mother to the other, cervical and parotid glands swollen so that the head was pushed back to the limit of extension. A sanious excoriating discharge from the nose; moanings and expressions of suffering with each motion; asking for water every two minutes, taking just enough to wet the mouth. Having a few years before worked through a very extensive and severe epidemic of scarlet