our part, we have found that Digitalis in the second and third decimal trituration, in doses of five centigrams two or three times a day, or a simple decoction of from fifty centigrams to two grams of the plant in one hundred and twenty grams of water, is sufficient to regulate the contractions of the heart and to increase the intra-vascular pressure. Thanks to this remedy, and to its auxiliary, Caffein, we have often brought back to life patients whose situation seemed desperate.

Arsenic is the medicine for the beginning of the cardiac cachexia. The heart beats weakly, the pulse begins to show irregularities, the nights are oppressive and full of anguish, oedema of the feet appears and disappears. The principal indication for the choice of this mineral is the fear that fatty degeneration has commenced to attack the heart. Arsenic, by its profound influence on nutrition, is capable of holding in check, for a long time, passive dilatation of the heart, and of maintaining the equilibrium of the circulation. Dose, from four to six drops a day, of any dilution between the first and sixth.

Not less important than Arsenic, in the treatment of secondary dilatation of the heart, is Phosphorus, but it corresponds to a more advanced stage of the disease. The asystolism is more pronounced, bronchial catarrh has become more or less permanent, hemorrhages and passive pulmonary congestions take place, dyspnoea compels the patient to pass the night in an armchair. It is this condition of stasis in the lungs which ought to determine the choice of this remedy. Moreover, it does not seem possible to treat, with any chance of success, steatosis of the heart, without the aid of Phosphorus. We have no need to recall to mind in this connection with what rapidity this substance, introduced into the organism in a poisonous dose, transforms the muscular fibres, especially those of the heart, into fatty matter. We have also found this metalloid of great value in degeneration of the heart, whenever the pulse became irregular and intermittent, and vertigo more or less permanent. This agent is not less precious in aortic regurgitation and stenosis of the aorta of atheromatous origin. The pulse is small, intermittent, difficult to find at the wrist; vertigo and syncope indicate cerebral anæmia. For a dose I am accustomed to give one drop of the third dilution, three or four times a day, when I desire

simply to re-establish the regularity of the circulation; but when vertigo predominates, and there is a threatening of syncope, I give one drop of the first dilution every two hours.

In the last place, I have a few words to say on the preparations of lime. They have no direct affinity for the heart, but on account of their well-known influence on nutrition, the phosphate and muriate of lime ought to be and are very efficacious means of quieting palpitating hearts in young people who are growing rapidly. We cannot obtain any important results while one of these salts does not enter into our plan of treatment. It would be useless to give them iron in any of its forms, for the case is not one of simple anæmia, but rather an impoverishment of all the reparative elements, caused either by a defective assimilation or by an excessive expenditure. Now it is just this malnutrition which Calcarea corrects. Let us hasten to say, that we do not attribute this salutary influence to any chemical action, but to its vital action on cellular nutrition. This can be proved by the doses we find most successful, which vary from one to six drops a day, of any dilution from the first to the thirtieth. In the affection which we are now considering, Calcarea phosphorica will generally have the preference over the other preparation, though we should choose the muriate whenever there is a tendency to gastro-intestinal catarrh.

Gentlemen, in bringing this essay to a close, I desire to beg your indulgence for anything in it which may be incomplete or imperfect. As a mitigating circumstance, I will ask you not to lose sight of the particular object of my work, which is to enable physicians who are not conversant with our doctrines to verify them, and this in such a way as to leave no doubt in the mind of the most sceptical experimenter. With this intention, I have limited the number of heart remedies to those which are most important. To speak of the virtues of Agaricus, Belladonna, Carbo vegetabilis, China, Ferrum, Kalmia latifolia, Lachesis, Naja, Spigelia, Veratrum album, Veratrum viride, and others, would have led us far away from the end which I had in view, and would have been an obstacle to precision and clearness. This, at any rate, is what I have aimed at. It is for you, gentlemen, to decide if I have succeeded. [Applause.]

THE EXPERIENCES OF A SUCCESSFUL PRACTITIONER.

I.

Without

THERE are some physicians who believe that the Code of Ethics was made solely for the benefit of the older members of the profession who have secured a position. I used to think so when I was younger. Now, I believe that the next thing to looking after your own interests and seeing that you have a fair show in the race for professional success is to stand up for medical ethics through thick and thin. shocking any personal modesty, I may say that I have followed out this principle with good result. There is such a thing as being charitable to your brother, and if you can only show that charity to advantage before a third person, you are quite sure to benefit yourself, especially if the third person is in need of medical advice. But all the while you must keep a single eye to the glory of the Code, and recollect that he who plays with fire must have a long reach. As I said before, I never lose any opportunity of speaking well of a professional brother when I am accidentally called to see his case. To this, in fact, I owe most of my success in practice; for not only will his patients force themselves upon me, but he will call me in consultation to others. As there are not a few who would like to know how this is done, I may perhaps flatter myself that a little detail of personal experience may not be uninteresting. By way of premising, let me say that I am particular to cultivate younger men and help them along in practice as well as I can. To illustrate this particular point, I will refer to an instance or two that occurred in the earlier practice of Pine Ridge, which showed the benefits of my magnanimous spirit.

One morning in driving through the village, I noticed the bright new sign of Dr. White. I smiled an inward satisfaction, and resolved to be his friend. At once concluding that I had more business than I needed, and that there was plenty of room for the new man, I resolved to call on him and welcome him to the town. This was done, and, to my surprise, he stated that he had not been led to expect such courtesy. The evening passed pleasantly, and, notwithstanding we were interrupted by my servant with fifteen calls for me, to which I must attend before retiring, the festivities were kept up until a late hour. As I left him I just happened to think of my patients, when he pitied me and charitably wished himself in my place. His young and innocent smile appealed to my heart, and soon after, when dropping to sleep on my couch, and thinking of his surprise at my fifteen extra patients, I resolved to be his friend. As he was working principally

for a reputation, I commenced my good deeds by recommending to him such chronic cases as I did not want, and who could not pay. I introduced the first patient by note, and received a gracious and appreciative reply, which hangs, duly framed, in my office. But this is by the

way.

I dropped in every now and then to see him, amd he being always in, I seldom lost the opportunity for a quiet and confidential talk. He was well prepared to practise, having studied two full years and attended in that time four courses of lectures, received two prize medals and a certificate for a month's attendance on a post-graduate course. My soul warmed at the opportunities I should have of recommending him accordingly to some of the good-paying patients I should send him. It may be well to state here that, at the outset of my acquaintance with him, I made him a present of a copy of the Code and secured his membership to our county society, thus insuring his professional standing. Need I say that, with all these advantages, the young man succeeded? He did. Is it a wonder that I should be gratified? Hardly. And could I be blamed for giving him help when he did succeed? But I proceed with my illustrations, and as details of cases are sometimes more instructive than generalities, I make no apology for introducing one or two here.

One summer afternoon I was driving past Smith's and was asked by Mrs. Smith to look at her son Harry. Notwithstanding I was in a great hurry, and had to visit thirty patients before supper, I consented to see the patient. I at once told the mother that the child was very sick; that it had evidently been left too long without proper treatment, and chided her for neglecting to send for me before. When she informed me that Dr. White was attending the case, I at once became mortified at my indiscretion, and, for a time, could not see my way clear to vindicate my brother's good name and uphold professional honor. Of course, I at once backed down, and openly confessed that I did not know that Dr. White was in attendance; that he was a good fellow, a friend of mine; that I was sorry I had said anything against him; that he was probably right, at least, I hoped so; that it was against our Code of Ethics to criticise each other's treatment, to destroy the confidence of our patients, or in any way strive to replace each other. The child vomited at this time, and I arose to retire, declining to have anything to do with the case until Dr. White should be sent for. The appeals of the mother brought me back, and I held the child's head. At the same time I whispered words of kindness in his ear. I informed the mother if it were my case I should have the child seen to at once, and urged her to send for Dr. White. I found a

I

good opportunity to say to her that Dr. White, although a very young man, with but little experience, was remarkably apt; that although he was brought up as a carpenter, he had learned the science of medicine in two years, and that such enterprising men should be encouraged. Politely declining to have anything more to do with the case, I gracefully retired, promising to stop myself and send Dr. White around. did so, telling him what good service I had done him, and how necessary it was in all our relations to prevent ill-feeling and jealousy by sticking to the Code and acting squarely with each other. I heard no more of the case until that evening, when I was summoned to meet Dr. White in consultation. I informed the father who summoned me that I was very much pressed for time, but that I would, nevertheless, do all I could to help my friend White.

Having arrived at the house, Dr. White examined the patient first, but quickly yielded to me. Anticipating that the case would be a difficult one for diagnosis, I had brought all my instruments of precision with me. Unfortunately Dr. White had none of these, but I believed it to be my duty to give the patient every chance. I examined the eye with the ophthalmoscope, and demonstrated to Dr. White and the father of the child the commencement of a choked disk. Dr. White had never seen such a thing before, and he was honest enough to say so before the family. The ear speculum showed a slight opacity of the tympanum, due to thickening around the malleus and slight oedema over the site of the tensor tympani muscle. The laryngoscope disclosed patches behind the uvula and a slight paralysis of the right vocal cord. The cephalic temperature was slightly increased (o of a degree) over the right or affected eye. A slight aortic murmur and a crepitant râle at the base of the lung proved the value of a stethoscopic examination. The liver was normal, but, on account of the relaxation of the umbilical ligament, hung a little low. Thermometer in the rectum marked 101° F. Urine collected to be afterward examined. Tested on the spot by a urinometer, much to the satisfaction of the father, who was pleased with the delicate action of the instrument.

The rectum being examined, some ascares vermiculares were found indicating a faulty nutrition of that point. The worms were slightly asphyxiated. Unfortunately, Dr. White had not examined this part of the body, a fact for which he was quietly blamed by the mother, who said from the first she "thought it was worms." I politely informed her that the doctor had done everything that was really required, and that my examinations were necessary only for the sake of clearing up any doubtful points. In fact, it was only called for on the ground that experience had taught me that it was best to be on the safe side. The