trary that canal cleanses itself of such infective bacteria in from two to eight days at longest. It has also been found that in the culture tube it is difficult to obtain a growth of pathogenic germs when once the vaginal bacilli have been permitted to get a start; and also on agar plate cultures he found that a streak of vaginal bacilli will inhibit the growth of staphylococcus pyogenes aureus at the intersection of cross streaks of this micro-organism, whereas at some slight distance removed the latter grow abundantly. From this and other experiments it seems that the vaginal secretion has a certain destructive or inhibitory action upon pathogenic germs, especially as these mostly require an alkaline reaction for their development. When such are not actually destroyed there is at least brought about a condition of diminished virulence. When, however, the conditions of the normal vaginal secretion are altered, as, for example, by the profuse alkaline lochia. by the menstrual fluid, and by increased discharge from the racimose cervical glands whose secretion is alkaline, the normal inhibitory conditions in the vagina are diminished and infection occurs more easily. The same is true when a similar state of affairs is brought about by disturbed circulation, especially venous, as induced, for example, by tumors, displacements of the uterus, foreign bodies in the cervical canal-like polypi, and foreign bodies in the vagina as pessaries, for instance. The protective qualities existing in the vagina are also disturbed, probably in the same manner, by frequently repeated irritations as in excesses in venere or self-abuse. The inflammatory reactions thus induced are notoriously almost self-limiting, if only the cause be withheld for a short time.

Now in recounting these several means of changing the vaginal secretion and thereby permitting or actually causing infection, we have not mentioned gonorrheal infection; but this subject is so extensive, especially with reference to the question of latent gonorrhea, that it cannot at present be further touched upon than to say that the diplococci of this disease are remarkably persistent in any mucous tract once infected by them, that they are demonstrable in various places in the genital tract, as, for instance, in the endometrium, in the cervical glands, in the urethral and vulvo-vaginal glands, even when an active gonorrhea is no longer present; and in fact they have been found, probably in diminished virulence, within the vagina of prostitutes, who show otherwise normal vaginal secretion. It has been observed clinically that these pathogenic bacteria, in a condition of latent virulence, may be aroused by irritative conditions of various sorts, traumatism, and various other circumstances diminishing the normal resistence of the tissues, and

thereby re-establish their original picture of recent infection.

It must be apparent from the statement of these facts that the conclusion which I desire to draw is that in many cases of pruritus there is an altered bacterial condition in the genital tract and in the vagina especially, in consequence of which a condition of infection really obtains, as we understand that term, although this infection may be so slight as regards virulence of activity, that there exists no pronounced inflammatory reaction, but only sufficient to change the secretions enough to induce pruritus vulvæ. This change in the secretions is probably not alone dependent upon the mere presence of foreign bacteria but is also augmented by different ptomains, in addition to certain as yet obscure chemical alterations of the secretions induced by them.

The fact that the vagina is a portion of a living body, whose bacterial flora is evidently subject to fixed laws should not be lost sight of in our treatment. It is possible in the use of the vaginal douche and other antiseptic means to overstep the mark, and by inordinate repetition to so interfere with the normal reparative processes above suggested, that the genitals in spite of persistent antiseptic treatment and other therapeutic means, will be found to continue in a sad condition of inflammatory irritation. I have seen a number of cases wherein frequently repeated antiseptic vaginal douches have failed to relieve the infected condition for which they were prescribed, and the cases recovered from treatment only after tapering off in the use of the douche, thereby permitting the vaginal secretion to re-establish its normal condition.

A case of pruritus vulvæ in a married lady recently presented such an exquisite verification of some of the opinions expressed in this article, based upon bacterial observations some of which have been referred to above, that it shall be briefly related. The patient, pregnant in the fifth month for the third time after eleven years' interval since the last gestation, consulted me for unendurable itching of the pudendum. The skin of the labia was thickened, and somewhat edematous, and abraded from scratching. There was some laceration of the cervix and of the perineum. The vagina and cervix presented the venous congestion usual at her period of pregnancy, and were red and irritated. The vaginal discharge was not at all profuse but was rather scanty, milky, and somewhat thinner than is seen in absolutely normal cases. The urine was profuse and frequently discharged. It contained no albumin nor sugar. The treatment consisted in applying a mild antiseptic wash to the cervix and vaginal walls, a bland ointment to the vulva and occasional permanganate of potash vaginal douches. She responded

nicely to treatment but soon had a relapse, from which she recovered after using the same treatment. In another three weeks the troublesome condition returned after a long walk, during which she was compelled to retain the urine for a long time. Being somewhat discouraged on account of the relapses occurring in the case, I examined the internal parts with care, and now discovered two polypi, about a half inch long, hanging within the os uteri, which had escaped discovery at previous examinations, or else only at this time presented to view within the cervix. They were at once removed by torsion. The same treatment above mentioned was administered at this one visit to the office, and within a few days the patient was well.

Sections of one of the polypi show it to present the usual appearances of such growths; that is, a loose fibro-connective tissue, con

taining many vessels and vascular sinuses and a few uterine glands. The external surface is bare of epithelium in some places, and in others there is a covering of cylindrical epithelium.

Microscopic examinations of the vaginal secretions made at the time of greatest intensity of her ailment, show almost a pure culture of cocci. There were no gonococci present.

The patient has not been able to determine the cause of her ailment. The last relapse was ascribed to a long walk and compulsory retained urine. It is certain that the case was not gonorrhea, neither was the puerperium influenced by the infection, for the latter was afebrile. On the other hand, it appears probable that the constant irritation induced by the cervical polypi so changed the normal resistence of the tissues as to permit the growth of micro-organisms which gained access to the vagina in the usual ways. The same simple treatment applied with transient effect was promptly curative when the irritation occasioned by the foreign bodies was removed.

It is unnecessary to recount in detail other cases which have responded to treatment. In some cases this has consisted in curettement when suspected to be occasioned by endometritis. When the cervical glands were inflamed applications of one of the silver salts, usually the nitrate, were made to its canal and to the portio vaginalis. The vagina was cleansed by applications of boric acid solution or some other mild antiseptic solution, or calendula or formalin solution. Externally a bland ointment was used, containing aristol or nosophen or markasol. In some cases an ointment containing cocaine was soothing and gave the case a start by palliating the itching. A vaginal douche once daily, gradually diminishing in frequency, was prescribed, containing either borax, bichloride of mercury, or potassium permanganate; or actuated solely by physiological reasons, a douche acidulated with acetic or lactic acid.

IT

OUR MATERIA MEDICA.*

BY J. HERBERT MOORE, M. D.

Brookline, Mass.

T has been stated by an eminent physician with whose life-work every homeopathic physician is, and every other physician should be, familiar, that "The first and sole duty of the physician is to restore health to the sick." Paraphrased to mean it is the paramount duty of the physician to restore health to the sick, is to state a truth to which every practitioner into whose hands the sick are committed should subscribe.

In these days of concentration of medical attention and effort upon disease action, both in the study of its essential nature and causative factors as well as in the beneficient measures of preventive medicine, this admonition to bear in mind the ultimate aim of the physician toward the patient already sick is apt and timely. Thor* Read before the American Institute of Homeopathy.

ough conversance with all that pertains to the intricate problems of disease, as well as to its effect upon the human economy, is to be desired and striven for by him who desires to become a scientific physician; but of what use is this learned person to the already unfortunately and seriously sick, if he carries to them in the other hand no curative measures.

Some such question as this, with a realization of its significance on account of his experience with the harmful therapeutics of his time, was the controlling factor that led this physician, who considered of first importance the cure of his patient, to be ever on the alert for a better therapeutics than that offered at his time. This attitude at length enabled his mind to be receptive to the first glimmer of light, flickering out of the like resemblance of that malarial disease to its curative specific, which through his efforts was ultimately to illumine the prevailing chaotic therapeutic measures with the noon-day brightness of the homeopathic principle of therapeutics.

Second in importance to his discovery of this principle, and an outcome of it from necessity inasmuch as the skilled artisan, to accomplish his best work, must have tools of which he knows, is the method Hahnemann promulgated of ascertaining the true and sure action of drugs by testing or, as we call it, proving them upon the healthy human organism; such action constituting the materia medica of homeopathy.

It is a healthy sign of the times in the progress of our school that we hear, in this practical and scientific age, dissatisfaction concerning our materia medica. But let us understand one another and at the outset emphasize the fact that it is not with the principle of proving drugs upon the healthy human organism with which we are dissatisfied, for all are alike agreed that this is the key opening the door into the realm of curative drug action. Rather is it a dissatisfaction with results growing out of imperfect methods in carrying out our provings. We must discriminate between an intelligent dissatisfaction emanating from those qualified to emphasize the shortcomings of our materia medica with which all should be in sympathy; and an unintelligent grumbling and fault-finding concerning materia medica as a whole, among many who have shown no inclination to become students of this subject and to try to grasp it as best they might, resulting in a condemnation of materia medica on their part to the degree that they prefer to consign this subject to that biblical region where, to be sure, it might be thoroughly purified but, in the process, might be totally destroyed.

With this unreasonable dissatisfaction we should have no sympathy but merely ask if materia medica is as faulty as these malcon