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far as I have observed, no mention is made of percussion signs or vocal phenomena, and the large class of râles, with their welldefined distinctions, is represented only by the indefinite rattling in the chest, wheezing, and perhaps one or two others, nothing else being specified as to the exact location, character, time, etc. The varieties of respiration are more numerous, but they are mostly such as must have been observed rather by inspection than by auscultation, such as anxious respiration, convulsive, contracted (whatever that may be), cramped, difficult, failing, frequent, intermittent, etc. Utterly useless to meet the demands of modern science from our point of view are those that imply some sound, such as croaking, moaning, noisy, sighing, snoring, sobbing, etc. Among the heart symptoms once in a while we find mention of a bellows murmur, but without distinction of valve, rhythm, or quality. To be sure, this is not so strange, if we remember that when the old provings were made, the science of auscultation and percussion was yet unheard of or in its infancy; and many of our modern homeopathists seem to think it almost sacrilegious to suggest that any improvement can be made on Hahnemann. Yet Hahnemann strongly insisted again and again that the entire organism of the patient should be examined in every possible way, and that the “ totality of symptoms" should be made the basis of treatment. We all agree that he was not a mere superficial observer, but a profound thinker and a strictly scientific man, not only willing but anxious to take advantage of the best known methods of investigating disease. Had he lived in our time, he would undoubtedly have been among the foremost to insist on the necessity of the practical physician's acquaintance with and use of the microscope, stethoscope, laryngoscope, ophthalmoscope, chemical reagents, and other valuable adjuncts in the detection of morbid states of the system. desire was, of course, to have presented, on the one hand, as perfect a picture of the disease as possible, from every point of view, and on the other hand, as perfect a picture of the pathogenesis of the drug as possible, from every point of view. In fact, so anxious was he to lose nothing that might have any bearing on the case, that he spent much time and labor in observing and recording symptoms of disease which many of us now would consider entirely unnecessary, and which to some, indeed, have
His great seemed even ridiculous. Nevertheless, it is now apparent that he showed remarkably keen foresight in basing his system of therapeutics on symptoms which are the same in all ages, rather than (like his contemporaries) on shifting theories of disease, the pathology of his time, which is now nearly obsolete.
There is not the least doubt that, had he lived in our times, under no consideration whatever would he have given his sanction to a proving of a drug which had not been conducted on the most scientific principles, and in which all the methods of modern.research had not been made available.
According to the homeopathic law, the drug picture must cover the disease picture as nearly as possible. Therefore, the more accurate becomes our knowledge of the nature and manifestations of disease, the more accurate should our knowledge of the effects of drugs on the healthy organism become. If it is necessary for us as scientific physicians to make use of the microscope, stethoscope, and clinical thermometer to diagnosticate disease, equally necessary is it for us as scientific physicians to make use of these same instruments for diagnosticating diseased conditions induced by drugs in the healthy system. Although we believe that the nearer we can approximate the two pathological states (as well as the two sets of symptoms), the nearer shall we come to the true similimum, yet the subject just now under consideration is not an argument for pathology as the basis of therapeutics, but a more perfect symptomatology. On this all can and ought to agree.
For convenience, the term “physical signs” is used technically to distinguish the phenomena of disease as revealed to us by the laws of acoustics (mostly) in the physical exploration of the chest from the “rational or vital” symptoms of disease; and yet in a broader sense, physical signs are just as much symptoms as this latter class, and certainly ought to take a prominent position in our symptomatology. They are very few of them pathognomonic, and have to be grouped, to make a diagnosis, like the common symptons, and in fact with them. Their importance no really educated physician at the present day can doubt. Their relation to the diseased condition with which they are associated is certainly much more intimate than that of a great crowd of symptoms which cumber our already too voluminous Materia
Medica, many of which are merely accidental, and really have nothing whatever to do with the disease or drug action. Physical signs also cannot be called into being by an exuberant imagination, like the symptoms obtained by some drug provers. They are equally available in young children, the deaf and dumb, idiots and animals. No matter how much pathology may change, no matter how many changes there may be in the theories of their production or their meaning, the sounds, when once carefully noted, will remain as immutable and as trustworthy as the plainest subjective symptoms, headache, chilliness, nausea, etc.
Of course, it would involve an enormous amount of work to re-prove any considerable number of drugs with special reference to physical signs. If this were the only object to be attained, it is probable that a postponement to a far distant day would result. But for a good while there have been many complaints about our Materia Medica in other respects and loud calls for its purification.
Possibly some time Dr. Dake's (or some equally good) plan for a national college of provers on a strictly scientific basis will go into operation, and furnish results which will be more trustworthy than anything we have at present. Until that time, perhaps a little can be done by individual effort. Where it is not prudent to bring out the full drug effects on man, the lower animals must be brought into requisition. Of course, it is unnecessary to add that those who conduct the experiments must be thoroughly conversant, theoretically and practically, with auscultation and percussion, and it is very desirable that in all cases the same classification and nomenclature of the physical signs be selected and invariably adhered to, in order to secure uniform results.
TWO CASES OF RUPTURE OF THE CHOROID FROM
CONCUSSION OF THE EYEBALL.
H. C. ANGELL, M. D., BOSTON.
L. R., æt. fourteen, was brought to me on Aug. 23 last. One week before, he had been knocked over by a stone thrown by a boy fifty feet away from him. The stone struck him at the outer angle of the orbit of the right eye, making a wound in the skin, which was afterwards dressed by the family physician. At this time the boy says he could see tolerably well with this eye ; but after a day or two the sight began to fade, and when he presented himself to me there was barely a perception of light left; he could merely point out the direction of a gas-light in a darkened room at a few feet distance. His left eye was emmetropic and in normal condition in all respects. The right eye showed no extravasation of blood beneath the conjunctiva, but it was reddened, apparently from epi-scleral injection, over the entire front of the globe. The pupil was enlarged to its fullest extent, and the anterior chamber was black and apparently filled with blood. The eye and the supra-orbital region of that side of the head were quite painful, there was severe photophobia, and the boy, heretofore healthy, looked pale, weak, and nervous. He had no appetite, his tongue was tremulous and white-coated. I prescribed Nux Vom. internally, and fomentations of extract Bell. in hot water around the eye and a collyrium of Atropine whenever the ciliary neuralgia became severe. The Atropine was prescribed for its sedative effects, and with the hope that it might in some way facilitate the absorption of the blood within the globe ; although, contrary to the previously received opinion on the action of this agent, recent experiments, according to Von Wecker, appear to show that Atropine increases the intraocular pressure.
* See report on Carbo veg. to the Am. Inst. of Hom. by Prof. Conrad Wessel. hoeft in 1877.
The diagnosis and prognosis were of course very guarded. As no light could be thrown into the eye, the use of the ophthalmoscope was inpracticable. There might be in such a case as this, in addition to the paralysis of the sphincter, and the hemorrhage into the anterior chamber, the effects of the blow observable at the present moment, also other and more serious results, viz., suppurative inflammation of the cornea, bursting of the capsule of the lens, and traumatic cataract, rending or stretching of the zonula of Zinn, with dislocation of the lens, rupture of the choroid in the equatorial region or fundus of the globe, and injury of the retina, or the latter might possibly be injured by itself from concussion. There was certainly no rupture of the sclerotic coat, as the shape and firmness of the eyeball were preserved.
Aug. 28. — With oblique illumination I could see streaks of bright-red blood mixed with the dark; this appeared to be in the back portion of the anterior chamber, between the narrow edge of the pupil and lens. The patient could distinguish white paper (the blank leaves of a book) moved rapidly before the pupil very near the eye. After this the pain and discomfort about the head and eye gradually became better, and in the course of a month vanished entirely. The photophopia and the deep-seated congestion of the front of the eyeball did not wholly disappear for some six weeks. The perception of colors and large objects came still more slowly.
Sept. 21. — He could distinguish the largest letter of test type, No. 200, at nine feet distance. The ophthalmoscope simply showed dark blood and shreds of fibrin floating in the anterior chamber. A month later he could distinguish letters No. 100 of the test type, at ten feet, but it was not until Nov. 19 that the vitreous humor became sufficiently clear to enable me to use the ophthalmoscope to advantage. I then discovered the rent in the choroid. It was situated (as seen with the direct image) between the disk of the optic nerve and the macula. It was about a diameter and a half of the disk in length, and a half, or nearly a half, the diameter of the disk in breadth ; its form crescentic, its edges running parallel with the margin of the nerve disk, about one diameter distant from it, curving round the latter below, and not extending quite up to the level of the disk above, the margin of the rupture was very red and ragged in outline, and at the lower end of the wound strongly pigmented. The white sclerotic was plainly visible over its whole extent, and the retinal vessels passed across the gap apparently in normal condition.
The extent and nature of the injury having now been determined, it appeared still necessary to be very guarded in prognosis. Considerable extravasations of blood into the vitreous are absorbed very slowly and sometimes but very partially. There is, unfortunately, no known remedy than can be used to specially hasten such absorption. In the aqueous they are absorbed more quickly, and in this case the anterior chamber was now free and transparent.
Obviously, normal vision in this eye could never be regained. There must always be a blind spot corresponding to this wound